Published: 04/04/2002, Volume II2, No. 5799 Page 4 5

Health secretary Alan Milburn has urged hospital trusts to 'open their books properly' so the new wave of primary care trusts can have a stronger and better informed commissioning role.

But the launch of one of the biggest structural changes in NHS history came with more of a whimper than a bang. The death of almost 100 health authorities was overshadowed by a rather more high-profile bereavement, while the birth of 28 strategic health authorities and 138 primary care trusts - bringing total PCT numbers to over 300, received scant media attention.

The Department of Health told HSJ no decision had been taken to scale down the launch - which was marked only by a press release on Monday and a handful ofmedia briefings late last week - in the wake of the Queen Mother's death. A spokesperson said media arrangements for the launch of the PCTs had remained unchanged, though naturally interest had been affected by the royal death.

In a press release, Mr Milburn stressed acute trusts must allow PCTs proper access to scrutinise.

'It will be very important that in every local community, hospitals open their books properly so that local PCTs can see they are getting good value for money from the care they commission.

'In certain places, there are good working relationships between the embryonic PCTs and the local hospitals. Elsewhere, that hasn't been the case.'

Mr Milburn backed away from forcing hospitals to hand over their accounts, arguing it would be against the spirit of the changes being made. But he said DoH officials will be talking to hospitals and PCTs to see how greater scrutiny could be introduced.

From this month, PCTs will control 50 per cent of the NHS budget, moving to 75 per cent by 2004.

The commissioning leverage of PCTs has been central to debate about government policy to shift power to the front line. In January, NHS Alliance chair Dr Michael Dixon warned that hospital trusts often gained the upper-hand in negotiations with PCTs because of their greater access to financial information.

The National Association for Primary Care welcomed Mr Milburn's words as 'a step in the right direction'. A spokesperson said: 'A lot of money is ploughed into secondary care and it has not always been clear how well that money is being spent.'

NHS Confederation chief executive Gill Morgan said: 'It is all very well making the information available - most of it is available already - but what PCTs need is help, a framework so they can get the information they need. It is about being able to ask good questions. That will be more important in making improvements to patient care.'

The NHS modernisation board will also be brought in to explore the idea of a 'contract' between the NHS and local communities.

'Under this, PCTs will set out where the money goes at a local level, put forward their specific proposals for spending in the future and detail what the money will deliver, 'Mr Milburn said.