Published: 14/10/2004, Volume II4, No. 5927 Page 6 7

Primary care trust managers fear their attempts to carry out the government's action plan on tuberculosis may fail unless they are given extra funding.

Chief medical officer Professor Sir Liam Donaldson launched the plan Stopping Tuberculosis in England last week. Its 'recommended actions' suggest an increased role for digital x-ray vans, DNA fingerprinting to track TB spread in communities and case managers for every TB practice.

But PCT managers and TB experts argue that the lack of resources attached to the package means the action plan is no more than a 'wish list'.

Milton Keynes PCT chief executive Barbara Kennedy said her trust was already spending£24m above its budget this year before the action plan was introduced just to cover the 'basic things' it needed to do.

'If there are additional public health issues such as TB, the difficulty would be prioritising given that there is not sufficient money in our system to do all the things we wish to do.We believe TB to be very important, but at the moment it is not within the set things that we will be able to afford funding for.'

Ms Kennedy added: 'I am quite concerned that the expectations nationally exceed the resources locally to do all the things we are meant to be able to do.'

Salford PCT director of public health Julie Higgins, said she thought the aims of the plan were 'very positive'. But she said that she did not think the PCT would be able to allocate more money to tackle TB 'unless we have a crisis'.

Another PCT chief executive, who did not wish to be named, said: 'It is fine putting in mobile units, but the real issue is the hard work of following cases up because it goes on for ages and That is where the costs really begin to come in. Our money goes on things we have targets for - accident and emergency really is top of the list and frankly TB is not.'

They added: 'If you really want these things done properly you have to invest in them.You cannot just expect PCTs to keep finding the money.'

Sir Liam said New York had demonstrated that TB could be successfully tackled, with cases falling by 45 per cent from 19922002. The plan says the 'can-do philosophy' shown in the US had been key to turning the tide against the disease.

He said: 'The NHS has been given a lot more money and within that increased level there should be ample to address the needs of this plan.'

But Professor Peter Ormerod of the British Thoracic Society's joint TB committee said the plan was 'a wish list without the means to deliver it'. Some£20m was needed for TB services, including 40 specialist doctors supported by 100 specialist nurses, he added.

'They make a big point in the action plan of saying the US had made a big improvement...what they conveniently forget to say is that the US spent $2bn to do so, ' he added.

Dr John Moore-Gillon, president of the British Lung Foundation, said: 'It is good-practice guidance.

It is not really an action plan - it is not telling PCTs what they have to do. Inevitably PCTs are going to concentrate on areas where there are specific targets.'

On the move: TB vans

Mobile digital x-ray vans will target prisoners, the homeless and inner cities with a high prevalence of TB as the Department of Health looks back to the 1950s and 60s for inspiration for its action plan.

If a pilot scheme in north London is successful next year the vans - which cost more than£400,000 each and can handle up to 350 people a day - are expected to be rolled out across the country.

North central London TB network manager Lynn Altass said: 'It will go out all around London. It will primarily reach out to the prisons - because there is a lot of TB in prisons - the homeless, and also areas where there are high TB levels.'

The van would be used at community events, particularly for ethnic minority groups, and would be sent out over the Christmas period to be used by homeless people collecting their free meals.

The move comes after a week's trial last year of a similar van from the Netherlands which Ms Altass said was 'very positively received'.

'For people who are scared of institutions they could go into the van and were not in a hospital seeing people in white coats. It was very informal and people felt relaxed on it.'