Published: 10/01/2001, Volume 112, No. 5787 Page 7

Managers fear that another major reorganisation of the NHS in Scotland is on the cards, only months after unified boards were introduced. They believe that the future of Scotland's 28 trusts is in jeopardy, leading to increasing centralisation which they claim will stifle innovation.

Legislative change will be required to abolish trusts - which have already had their power significantly eroded in the new system - meaning that abolition is unlikely to happen until after the Scottish elections in 2004. But the move could form a significant plank of Labour's election manifesto.

The Scottish Executive has confirmed that it has commissioned what it calls an 'important piece of work' to examine management and decision-making within NHS Scotland. A spokesperson said it had not been decided who would be carrying out the work.

The project's remit includes making recommendations on the 'optimum number and configuration of NHS organisations appropriate for the size and geography of Scotland'.

Scottish secretary of the Institute of Healthcare Management Donald McNeill said managers were confused by mixed messages.

'On the one hand you have the first minister, Jack McConnell, saying the priority is delivering on the promises which have already been made, rather than further restructuring. But then you get the health minister, Malcolm Chisholm, setting up this group to examine the management of the NHS in Scotland.

'I've no doubt that the longterm aim is to get rid of trusts and this will lead to greater centralisation, which will stifle innovation.'

The 15 unified boards were introduced on 1 October 2001. At present, trust chairs and chief executives have places on the board but trust chief executives remain accountable officers under existing legislation. But many trusts, especially acute trusts, face increasing financial difficulty, which led to record levels of deficit last year.

There has also been strong criticism of individual trusts. For example, the Beatson oncology unit was removed from the control of North Glasgow trust at the end of last year and put in the hands of the unified board after consultants resigned citing lack of resources and management difficulties.

But the Scottish Executive denied that specific changes - including the abolition of trusts - were on the agenda. A spokesperson said: 'In the health plan, we stated that we would have a review of NHS management to see how we could make it more streamlined and accountable. That is what we will be carrying out.'

Forth Valley Acute Hospitals trust chair Ian Mullen said more change was unsettling for the NHS: 'Getting rid of trusts, which have brought local accountability and put decision-making closer to the patient, is not necessarily the way to go. You could instead find ways of introducing leverage and incentives to the current system.'