THE time for excuses is past, the Health Secretary told the NHS yesterday.

Failure to tackle long-standing problems was no longer an option, Patricia Hewitt declared after a seminar at No 10 chaired by the Prime Minister.

The Government, rocked by the large deficits run up by some NHS trusts despite a doubling of NHS spending, is struggling to retain credibility.

Yesterday it organised a carefully staged event at which some of those responsible admitted errors and promised to do better.

No magic elixirs emerged. Sir Ian Carruthers, the acting chief executive, rehearsed money-saving strategies familiar to a generation of NHS managers — more day surgery, quicker discharges, better use of operating theatres, reducing admissions from accident and emergency departments and cutting agency costs — while Tony Blair nodded sagely.

The “narrative” remains that the bulk of the NHS is in balance and relatively few trusts are responsible for most of the deficits. But nobody explained why an NHS harried by targets and with managers lurking on every corridor had been unable to implement basic changes of the type outlined by Sir Ian.

Mr Blair concluded the seminar by saying that retreating from the reform plans was not an option. “We have to hold our nerve and be confident that the changes will deliver a better service,” he said. “We have a huge ambition: to end the process of waiting in the NHS. There is no way we are going to do it by the old way of working. If we back away, we are doing no favours to patients at all. It will be a challenging year, there’s no doubt about that at all. But turnaround can be done and has to be done.”

The seminar’s participants came from organisations that had been in trouble but had recovery plans in place. Tom Taylor, chief executive of Shrewsbury and Telford Trust, said: “No change is not an answer. We could not carry on losing £10-12 million in public expenditure every year.”

Duncan Newton, medical director of Bradford Teaching Hospitals NHS Foundation Trust, said that managers should talk to clinicians. “They know where the problems are,” he said. “They’ve known about it for years. If it were industry, these problems would have been sorted out years ago.”

Anthony Sumara, chief executive of North Staffs NHS Trust, said: “You don’t need to be a rocket scientist to see how to improve.” But he offered no explanation of why such changes had not been made before.

The Department of Health announced approval of two new Private Finance Initiative contracts, at University Hospitals Birmingham Foundation Trust and St Helens and Knowsley Hospitals, worth more than £1 billion. Ms Hewitt also announced a new structure of ten enlarged strategic health authorities, each covering a region in England. These bear a remarkable similarity to the regional offices of the NHS abolished in 2001.

Andrew Lansley, the Shadow Health Secretary, said that billions of pounds had been given to the NHS without increasing productivity.

“It is clear that the meeting was cobbled together at the last minute in an attempt by Downing Street to get a grip after the Department of Health lost control over NHS finances,” he said. “The NHS needs reform, which is what Blair and Brown promised years ago. But, even today, reforms are confused and inconsistent.”

Gill Morgan, chief executive of the NHS Confederation, said: “We hope that today’s announcement will signal the start of a proper debate about the challenges and opportunities that the service faces.”

Niall Dickson, the chief executive of the King’s Fund think-tank, said that reorganising the strategic authorities was the right policy at the wrong time. “This reorganisation, the latest in a very long line, has simply thrown the NHS into even greater turmoil.”

FULL CIRCLE

1974 Central management introduced

1991-95 Creation of NHS trusts and division into purchasers and providers

1995 Era of the Conservative internal market and GP fundholding. NHS run by central executive and nine regional offices

1997 Internal market abolished by Labour

2001 NHS Executive and regional offices closed; 28 strategic health authorities (SHA) created; 303 primary care trusts (PCTs)

2004 Patient choice reinvents competition between trusts

2006 28 SHAs merged into 10, more or less coterminous with the old regional offices; 303 PCTs merged into about 100 new ones, much the same number as the old health authorities; commissioning handed back to GPs

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