Published: 30/06/2005, Volume II5, No. 5962 Page 3

Should government intervene to tackle the historic debt of NHS trusts? This question is exercising some big brains at the Department of Health who realise that without assistance some trusts will not be able to achieve foundation status by 2008 or cope with service demands in a NHS not blessed with current investment levels. There is also a logical desire to create a 'level-playing field' before the widespread introduction of payment by results.

Many people, including foundation trust regulator Bill Moyes and Birmingham and the Black Country strategic health authority chief executive David Nicholson, think action is required (news, page 5). Mr Nicholson's comments are particularly telling, given that he is the man charged by the DoH with chairing the high-powered system reform leadership group which is developing the 'rules' to govern how the NHS will operate in an era of choice, payment by results and foundations.

The DoH has, until now, remained tightlipped. It knows that openly discussing plans to tackle historic debt would see all kinds of financial skeletons being produced from trust cupboards. It is also aware that any suggestion of a 'bail out' would encourage the kind of ill-disciplined financial behaviour, from clinicians as well as managers, which created some of the problems in the first place.

Government is not about to start rewarding poor financial stewardship with cash - nor should it. However, there are trusts struggling with long-term financial burdens which are both not their 'fault' and beyond the capability of even the most brilliant team of managers and clinicians to resolve.

Where that situation exists alongside a deep-seated and demonstrable commitment and capacity to drive service redesign in the direction of greater quality and efficiency, the DoH should act.

The analysis of primary care trust allocations (pages 18-19) reveals the government acting sensibly in the face of financial inequity. The 'sympathetic' approach the DoH is now saying it will take to some historic deficits is another chance to do the same.