Patricia Hewitt was given the silent treatment by health workers after delivering a speech in which she defended her assertion that the NHS was enjoying its "best ever year".

The Health Secretary, whose claims at the weekend came were intended to counter daily reports of redundancies and debt across the health service, was greeted by stony silence as she took to the stage in front of 1,000 delegates at Unison's conference in Gateshead.

At the end of a 50-minute address - in which she told her "friends and colleagues" of the need to accelerate the Agenda for Change programme - the Health Secretary received only a smattering of applause.

Ms Hewitt maintained that most of the NHS was not in debt. She said that 7 per cent of NHS trusts were responsible for 50 per cent of the deficit. She said that cutbacks on the use of agency staff were common sense and defended the use of the private sector.

The speech was punctuated by heckling, derision and hisses. Some members of the audience laughed out loud as the Health Secretary said that she valued the contribution made by rank-and-file NHS workers and sympathised with their anxieties.

Karen Jennings, Unison’s head of health, said that the minister had been shocked by the issues raised by delegates during a subsequent question and answer session.

"She felt the rawness of the way people are experiencing problems at the moment and was taken aback by some of the issues that were raised," she said.

Earlier today, Dave Prentis, the union's general secretary, said that he would not hesitate to back workers who took industrial action to obstruct further job cuts or modernisation.

Some 300 miles away In Downing Street, Tony Blair was also given a rough ride by journalists when his monthly news conference was dominated by questions over the unfolding crisis.

The Prime Minister said that there were inevitable difficulties and challenges ahead. He said that the predicted £623 million overspend, bed closures and 7,000 job losses in recent days - all despite record investment - were the birth pains of a modernised NHS.

"The purpose is to create a different type of NHS, reformed and modernised for today's world."

One reporter asked the Prime Minister: "I noticed you didn't use the phrase 'the NHS's best ever year'. Would you like to do so?" Mr Blair replied: "The facts speak for themselves."

Both the Prime Minister and Health Secretary pointed to the improvements seen within the health service since Labour took power in 1997.

They both spoke of the record investment in staff, buildings and treatment and trumpeted falls in waiting times for cancer, cardiac and casualty treatment. Both said that the NHS was a prize worth fighting for.

Ms Hewitt said she made no apology for repeating her controversial claim, which caused David Cameron, the Conservative leader, to wonder aloud "what planet she is on".

The dispute continued in Parliament where Tory MPs demanded a formal statement from the Health Secretary. John Redwood (Wokingham) accused Ms Hewitt of going "out and about" in the media to avoid questions from the House.

Andrew Lansley, the Shadow health secretary, said: "For Patricia Hewitt to tell the NHS to ’modernise or die’ is intolerable arrogance.

"This statement is from a Secretary of State who has presented incoherent, inconsistent and incompetent reforms and is now telling the NHS to get on with it or risk destruction. Conservatives want to make it work."

Sylvia Denton, president of the Royal College of Nursing, had earlier said that the minister’s view was without credibility. "If this is the best ever year I would not like to see the worst. It is as simple as that," Mrs Denton said. She added that the cuts had left nurses "not just demoralised, but really angry".

Mr Cameron, recently returned from the icy wastes of Svalbard in Norway, said that the reason for the NHS's woes were mismanagement, not reform.

"This is really important because the Prime Minister is saying ‘it’s the reform that’s causing problems but, you know, it’s hurting but it will be working’. That’s wrong. We haven’t had proper reform in the NHS. What we’ve had is mismanagement and bungling from the centre."

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