Patricia Hewitt, the Health Secretary, today named and shamed 18 NHS trusts facing financial crisis as the Government battled to bring health service deficits under control.

The Department of Health said that teams of financial specialists would be sent into 18 organisations facing the greatest financial risks, as the NHS in England braced itself for an overall deficit running into hundreds of millions of pounds.

Ms Hewitt said that it was a "difficult and anxious time" for staff working in trusts forecasting a deficit, but the Government was determined to get tough in order to balance the NHS books.

Publishing a "rulebook" for the NHS for 2006/07, the Health Secretary said that financial good health would be among the priorities for all NHS organisations.

But she insisted that they were not putting money before medicine and were not blaming managers for the problems seen in many trusts.

"People feel if you talk about money in the NHS you are somehow betraying the patients," Ms Hewitt said.

"But we all know that when you are responsible for an organisation, if you are wasting money or overspending you can’t do the things that really matter."

A report by the DoH finance director, Richard Douglas, today showed that 62 NHS organisations forecasting a "significant" overspend had received an external assessment of their financial position.

As a result of this assessment, 18 organisations are to get immediate "turnaround support" to help them tackle their financial problems.

Ms Hewitt said there was a focus on tackling deficits at this point so the NHS could move back into the black during the next financial year.

"For the next financial year we actually want to move the NHS towards a surplus and we want every part of the NHS to start thinking about how it can build reserves.

"Every organisation ought to be operating on the basis of small reserves," she said.

Last year Ms Hewitt revealed that at six months the NHS was forecasting a total deficit of £620 million, although others have claimed it could rise as high as £1 billion by the end of March.

But today she refused to say what the total projected deficit now stood at, saying the situation was being closely monitored.

The Audit Commission today also published a report into concerns about the financial position of another NHS organisation - Maidstone and Tunbridge Wells NHS Trust.

The "public interest report" by PricewaterhouseCoopers concluded it was unlikely the trust would be able to recover its cumulative deficit of almost £17 million by the end of March without significant extra support.

The report said the trust’s board recognised it could not deliver these savings in 2005/06 without critically impacting on their ability to deliver care to patients.

It added that the trust had a statutory duty to break even over an extended five-year period and was therefore required to clear its cumulative deficit by March 31.

But the trust was unable to do this, the report said. Ms Hewitt said the reasons for deficits were complex and varied between each area.

She said in some cases affluent areas in the South East, such as Maidstone and Tunbridge Wells, were running up deficits which were not reflected in more deprived regions.

Ms Hewitt suggested this was because better off areas had more GPs who therefore made more referrals to hospitals, pushing up costs.

The cost in poorer areas tended to be focussed in more emergency care due to health problems not being dealt with earlier.

Ms Hewitt pointed out that the rulebook, or "operating framework" for 2006/07, published today, included many priorities other than managing finances.

It provides the rules and guidance within which senior clinical, financial and general managers will lead the development of local health services.

The rulebook says there should be a focus on reducing deaths from heart disease and stroke, supporting patients with long-term conditions and a move towards a maximum 18-week wait from GP referral to hospital treatment.

It also says the Government’s reforms will continue to be embedded, including the Payment by Results funding system being extended and patient choice increased.

Ms Hewitt pointed out that the vast majority of NHS organisations were managing their finances successfully, but a minority were failing to manage within their resources, despite significant increases in funding.

"The organisations that will receive intensive turnaround support account for just 3 per cent of all NHS organisations but 26 per cent of the total gross projected overspend.

"Improving financial management does not mean compromising services for patients.

"Any action that the NHS takes to reduce deficits should not lower the quality of care provided to patients."

The 18 NHS organisations which will receive immediate "turnaround support" are:

• Barnet and Chase Farm Hospitals NHS Trust (2005/06 deficit forecast at six months - £8 million)
• Brighton and Sussex University Hospitals NHS Trust (£14 million)
• Cheshire West Primary Care Trust (£15 million)
• George Eliot Hospital NHS Trust (£5 million
• Hammersmith Hospitals NHS Trust (£37 million)
• Hillingdon PCT (£26 million)
• Kennet and North Wiltshire PCT (£6 million)
• Mid Yorkshire Hospitals NHS Trust (£15 million)
• North Sheffield PCT (£4 million)
• Selby and York PCT (£10 million)
• Sheffield South West PCT (£4 million)
• Sheffield West PCT (£4 million)
• Shrewsbury and Telford Hospital NHS Trust (£10 million)
• South East Sheffield PCT (£4 million)
• Surrey and Sussex Healthcare NHS Trust (£41 million)
• The Royal West Sussex NHS Trust (£17 million)
• University Hospital of North Staffordshire NHS Trust (£18 million)
• West Wiltshire PCT (£8 million)

These trusts were not all necessarily the organisations with the highest deficits but those deemed to need the most help in turning around their financial difficulties.

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