Published: 08/12/2005 Volume 115 No. 5985 Page 3

The exact number vary depending on your definition. But however you work it out, it is clear that the problem of financial deficits is becoming concentrated. In other words, a smaller proportion of trusts are in an ever deeper hole (news, pages 5-8).

The 74 trusts which have relatively small debts will come under pressure to squeeze themselves under the break-even bar at year end. That will not be easy; it will not go unnoticed by local media and pressure groups, and proposed tightening of Healthcare Commission criteria alone will not help them achieve balance.

However, the more imposing barrier to overall breakeven for the NHS is, of course, the 52 trusts with deficits bigger than£5m. Surely no-one still believes that the problems at these organisations are due to incompetence among senior managers - even if that was true in the past.

The turnaround teams announced last week must concentrate on solving underlying structural problems rather than changing individuals. NHS chief executive Sir Nigel Crisp has said there will be no 'bail out' for heavy debtors.

That may certainly be the case for organisations in their present form. It remains to be seen whether a restructure that is heavy enough to, in effect, create a new entity will allow more flexibility.

A turnaround process that creates sustainable change should be welcomed.

That said, a tendering exercise that appears to have been carried out over the weekend may not be the best standard-bearer for good planning.

And could one suggest that Ian Dodge's urgent recall to the Department of Health to head system reform is evidence that the centre itself needs a dose of 'turnaround'?

A cheap shot, perhaps. But the decision to cut short his sojourn as health adviser to the prime minister (news, page 11) suggests that someone at or near the top of the government believes the DoH needs a greater measure of political coherence. He may not be the only new face in the near future.