• Real terms cuts expected to payment by results tariff

  • Tough road ahead for aspirant foundations

  • Query over future of capital investment

  • Staff costs may fall in real terms

Acute trusts fear the payment by results tariff will increase by just 1.5 per cent in cash terms from 2010-11. Even if inflation comes down, trusts will need to make millions of pounds in efficiency cuts to avoid falling into deficit.

Central Manchester and Manchester Children's University Hospitals trust finance director Adrian Roberts said a drop in tariff prices could hit trusts aiming for foundation status, particularly small district general hospitals.

Last month the Department of Health published figures to show it assumed up to six acute trusts would fail a year, requiring their services to be reconfigured.

The DH expects to save£265m a year when the failure regime is implemented - about 1.5 times the income of an average trust.

There are concerns about whether planned capital investment schemes reliant on private finance will go ahead. But NHS Confederation policy director Nigel Edwards warned speculation could "create a run on the health service" itself.

But staff costs could come down. NHS Employers this week recommended that doctors' and dentists' pay should increase by just 2 per cent in 2009. And anecdotal reports suggest recession fears are leading to an increase in applicants for public sector jobs.

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