Published: 05/09/2002, Volume II2, No. 5812 Page 4 5

A primary care trust slated in a damning internal report will struggle to improve its services because of a 'severe financial situation', according to its own chief executive.

Morecambe Bay PCT - the largest in the country and one of the few trusts which also provides secondary mental health services - is already cutting services while being forced to make savings of£7m.

The investigation into adult services completed in July said the concerns originally raised by whistleblowers at the trust had 'to a large degree been substantiated'.

The PCT investigation found individuals and teams were left 'to identify their own clinical standards'. Divisions between clinical teams, staff and managers had 'a detrimental effect on patient care' and there appeared to be 'no clear understanding' among staff of what was a serious incident.

A 'significant number' of staff were acting up to ward manager and team leader positions 'based on personal recommendation, without a formal assessment of competency'.

Doubt was also cast on the inclusion of secondary mental health services in the PCT. The trust board is urged to 'review' progress - 'or otherwise' - on commitments made to the health secretary when the services were brought in.

However, chief executive David Jordison told HSJ that 'a really difficult financial situation' would delay implementation of some of the review's 48 recommendations.

'The resources will dictate the speed, ' he said. 'Many recommendations involve training.

'A perennial difficulty in this trust is releasing staff for training because we have to [temporarily] replace them. We have never been able to do that.'

He added: 'We are doing things as urgently as we can.We can get on with 80 per cent of them. We can do training - and it'll either break the bank or [we will] do it slowly.'

The PCT is already making£7m in savings - including cuts in services - and has received£10m support from the Cumbria and Lancashire strategic health authority. 'So We have got a£17m problem, ' said Jordison.

A mental health committee has been set up and an action plan will go to the board at the end of the month.

A spokesperson for the SHA said that it would be looking 'very carefully' at the PCT's action plan to ensure it addressed the review recommendations.

'If it doesn't, serious questions will be asked.'

He added: 'If they are saying finance is a consideration That is something they need to identify in the action plan. There are always solutions to problems. It is incumbent on them to come up with solutions and make the case.'

One of the original whistleblowers' representatives, Royal College of Nursing regional officer Paul Gardner, said: 'I do not think we should let the pound rule the plan. If they're going to concentrate on the financial things, the commitment has to be questioned.'