The NHS faces 'difficult decisions' in coming years as it adjusts to smaller - and possibly negative - funding growth, former health secretary Patricia Hewitt has warned.

Speaking at an "economics summit" arranged by the NHS Confederation, Ms Hewitt said PCTs had "very difficult decisions" to make. They needed to focus on "patient outcomes rather than the health of different provider organisations" to ensure the best use of resources, she said.

"There will be some places that will struggle, both in and outside London, because they are going into the next few years with underlying deficits," she warned.

Spending increases

Despite gloomy economic prospects for the next five years or more, Ms Hewitt said the NHS was better placed to deal with this than it had been before due to recent real terms spending increases. The financial surplus, growing understanding of the patient pathway and efforts to strengthen commissioners would also help, she said.

She praised the Department of Health for securing a two-year funding deal for the NHS, but warned that although the National Institute for Health and Clinical Excellence had been successful at "deep and small level engagement", this was not visible to the public as a whole.