The head of the NHS Executive has admitted that managers are facing 'fatigue overload' in trying to implement the latest health service reforms.

NHS chief executive Sir Alan Langlands told a conference in London this week that the pace of the reforms 'is sometimes a bit daunting for a lot of people - including me'.

He said the announcement of more cash for the NHS from the Budget and health secretary Frank Dobson's statement on clinical governance this week (see above and right) were examples of the speed at which 'policy was emerging'.

But he attempted to reassure managers that 'the shower of guidelines' was easing off.

'The next few years are really about delivering services, not new policies,' he said.

'But that is not to say that we won't witness the occasional political flourish.'

Sir Alan admitted that there were some 'dangers and risks' in the programme ahead, including 'fatigue overload' or what he dubbed 'initiative-itis'. There were tensions in partnership working and a danger of overloading clinicians with the demands of clinical governance.

Sir Alan accepted that initiatives were being 'centrally driven' with money earmarked for specific projects.

'I make no apology for that,' he said, while also acknowledging that a balance had to be struck between a 'central hierarchy and local working'.

But Sir Alan drew attention to 'solid achievements', including falling waiting lists, increased elective surgery, balancing the books and 'the early benefits of partnership working'.