Funding-gap worries are eating into support for government ambitions

Published: 16/05/2002, Volume II2, No. 5805 Page 19

Primary care trust deficits: two views from different ends of the telescope. Over breakfast, a well-connected government source tells HSJ that he is becoming just a little frustrated with the grass-roots whingeing in the NHS. Had not he and his colleagues just negotiated the best funding settlement in a generation? Had they not also created a three-year framework in which these funds can be applied with long - rather than short - term goals in mind? Deficits are nothing new in the NHS; is it too much to ask that PCTs just get on with the job and stop complaining about change?

Cut to a presentation at last week's primary care conference in Birmingham and a room of bemused public health managers. A bewildering list of responsibilities and priorities flash up in front of their eyes and the same thought runs through each of their minds, 'Where do I got the money and staff from?'

The speaker, former television doctor and now Southwark public health lead Dr Alan Maryon Davis, admits that major mismatches are being produced in an effort to balance budgets. 'It is not looking good, ' he says with masterful understatement. And it is not just public health, of course. Naturally, 'soft' targets are also suffering (see news, pages 6-7).

Managers do not dislike change, as our government friend suggests - they know that it will always be part of their working lives. What they dislike is poorly implemented change: it offends them both as NHS employees and professional managers. Huge swathes of the government's proposed reforms are sensible, well thought-out and the result of extensive consultation with the grass roots - and some of them are not.

When NHS Alliance chair Dr Michael Dixon speaks, ministers usually listen. They should do so this time when he points out that PCTs are having to pay off deficits at 'an uncomfortably fast rate'. Making the lives of those at the sharp end a little more 'comfortable' by finding some way to close funding gaps this year - even, God forbid, creating a little slack in the system - will help not hinder the delivery of targets.

Most managers are grateful to the government - honest - for its commitment to the NHS, but their gratitude will not stop them highlighting where reform and reality part company.