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Last Updated: Wednesday, 14 June 2006, 04:58 GMT 05:58 UK
Managers call for 'more open' NHS
Image of an operation
The NHS deficit tops 500m
The NHS needs to become more open and honest about its problems if it is to avoid lurching from crisis to crisis, senior managers say.

NHS Confederation chief Gill Morgan will tell health managers secretiveness causes people to try to cover up problems, rather than tackling them.

A survey of 199 NHS bosses found 82% thought the cash crisis was made worse by a lack of transparency and trust.

Figures published last week showed the NHS was facing a 512m deficit.

Nearly one in three trusts failed to balance the books last year, causing the health service's debt to more than double in 12 months.

Finance directors have been under a lot of pressure because NHS financing has been put under the spotlight
John Appleby, of the King's Fund health think-tank

For months, the NHS was denying the problem was going to get worse, but from the start of this year hospitals have had to cut jobs, closed wards and delayed operations as the problems began to bite.

And in an interview with the Guardian newspaper on Wednesday, Sir Ian Carruthers, the NHS acting chief executive, admitted that big acute hospitals may have to close to eliminate the deficit.

Ms Morgan, in a speech to open the NHS Confederation's annual conference in Birmingham on Wednesday, will question whether the drastic measures could have been avoided if the NHS had been more open when the debts began to mount.

'Malign culture'

She will add that there is a strong feeling among managers that the heavy focus on targets has led to a "blame culture" which reports on failure rather than acknowledging problems early and preventing failures ever happening.

Ms Morgan will say: "This is a malign culture which will prevent us improving the service for patients as we become too concerned with what we present to other parts of the services.

"And the last year has been bruising and one of the side-effects has been a damage in morale and a loss of trust."

The NHS Confederation will also publish a survey of 199 chief executives which shows 82% believe the current problems have been compounded by a lack of trust and transparency across the health service.

John Appleby, chief economist at the King's Fund health think-tank, agreed a culture of secrecy had emerged.

"Finance directors have been under a lot of pressure because NHS financing has been put under the spotlight.

"Talking to them, they felt compelled to say the situation was rosier than it was."

He said this was caused by higher public expectations at a time when the NHS was getting more money than ever and also pressure from above by senior managers at strategic health authorities.

A Department of Health spokesperson said: "We agree that strong leadership is essential in the NHS to help foster a culture where problems are acknowledged early so that the right action can be taken to deal with them.

"We are already making changes towards greater transparency - for example, Patricia Hewitt has now committed to publishing financial information on a quarterly basis."

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