LACK of cash could make vital changes required by a scathing national report on high death rates difficult, a NHS finance boss says.

Bucks Healthcare NHS Trust stressed this week at its board meeting - and in front of a council scrutiny committee - that it is working hard to address the failings highlighted in The Keogh Review.

See more background on Keogh HERE.

The trust was one of 11 in the country placed under special measures.

Tom Travers, Director of Finance, who warned of a potential £5m deficit at the end of 2013, said this had not even taken account of many of the likely expenses linked to making improvements following Keogh.

He said: "Only a small amount of Keogh costs have been reflected in the forecast and so far. Clearly as this develops and the costs are firmed up we will need to update that in terms of forecasting.

"If we can't secure a level of funding then clearly the organisation is challenged in terms of finding additional cost release elsewhere to afford the levels of investment that may be required by Keogh."

Chief Executive Anne Eden said there would be costs associated with additional nurses, consultants, and boosting weekend staff levels. But she assured councillors at the Health and Social Care Select Committee meeting on Thursday that "we are really pushing on apace to deliver" improvements demanded by Keogh.

There is a renewed focus on mortality rates and staff are looking to root out 'suboptimal' care, she said.

The NHS chief said wants to rebuild staff morale and public confidence, acknowledging both have been severely dented by the report. She said: "Generally the care is perceived to be good but generally isn't good enough."

She said that is why they have called their own review 'every patient counts'.

She said: "Rest assured we won't just tick the box around the plan, it's very much a continuous journey."

Already additional doctors are working at weekends at Stoke Mandeville Hospital.

An external review looking at the numbers and the skill mix of staff is due to report back soon and there is also an internal probe examining in particular out of hours staffing levels.

Salford Royal Hospital NHS Foundation Trust has been called in to help the Bucks trust. It will mentor bosses and help it to make the required changed.

Ms Eden said: "What was encouraging was there were things they felt they could learn from us too, so we see it as a two way street."

She confirmed plans to gain foundation trust status - which would provide more independence and give patients more of a say - are on ice until the trust is out of special measures. She hopes it will get a "clean bill of health" before too long but said it will not be a case of "job done" by December, stressing that it will be an ongoing process.