THE authority which decides crucial changes to NHS services in Buckinghamshire has been rated the worst in England for the quality of its management.

Buckinghamshire NHS Primary Care Trust was the only such authority out of 152 to get the bottom one out of four score by auditors.

These were for three categories: managing finance, governing the business and managing resources.

And the county’s hospital authority was rated “among the worst in England” for spending by the Audit Commission, the watchdog for public bodies’ spending in England.

It dropped from three out of four to one for 2008/09, making it one of nine which got bottom “inadequate” marks. There are 126 such trusts in England.

Nationally, trusts were “performing well”, the commission said in its assessment of the 12 months to March 31 this year.

It comes after auditors said the county’s mental health authority is among the worst in the country (see link, bottom of story).

Andy McKeon, its managing director of health, said: ‘The finances at Buckinghamshire’s PCT and NHS trust are clearly worrying and a great challenge is ahead for them, especially in such financially uncertain times and with an expected budgetary squeeze on the horizon.”

Andrew Walker, chairman of the Buckinghamshire Local Involvement Network, an official local watchdog, said he “is seriously concerned at the ongoing issues with the financial position of both trusts”.

The PCT decides how NHS cash is spent in the county and, along with its predecessor authority, was the driving force behind controversial changes to A&E and women’s and children’s services at Wycombe Hospital.

It was the only PCT in England to go into the red, £7.5m, last year against an overall spend of £622m. Bosses say Government cash support is low as Bucks is seen as “healthy”.

Yesterday its chief executive Ed Macalister-Smith said: “This report reflects the organisation as it was 12-18 months ago.

“It is disappointing but not surprising and we already have improvement plans underway.” He said mergers – several bodies formed the PCT in 2006 – and “a lot of staff changes” had caused problems. Auditors had recognised progress, he said.

He said: “Over the past year, we have been taking on people with the skills and ability to lead the organisation out of trouble.

“With one of the lowest funding allocations in the country, it won’t happen overnight but we are now on the path to recovery.”

The hospital trust got three out of four for financial management, internal controls and value for money but a one overall as it ended the year £2.75m in deficit. It manages Wycombe, Amersham and Stoke Mandeville hospitals.

It was planning to end in the clear but was told “at the last minute” that it had to include profits from a land sale in this year’s and not last year’s accounts, leaving it in the red.

In a statement the trust said it was “very disappointed” by the overall score and that it has a “good history of strong financial management”

But it said: “This deficit arose due to challenges within the health economy – during the last quarter of the financial year, our main commissioner Bucks PCT, was unable to pay us for work undertaken by the trust.”

The trust is in further financial trouble this year because of problems at the PCT (see link, below).