Lucrative NHS turnaround work has been picked up by the Big Four, as the health service’s financial crisis lurches deeper into the red.

With KPMG completing the last of 98 assessments of financially struggling NHS and primary care trusts, the Department of Health revealed that further work on the trusts would probably be split between the Big Four, with little sign of smaller firms picking up any support contracts.

The forecast £620m deficit for the end of January leapt to £790m, which has increased pressure on NHS chief executive Sir Nigel Crisp to step down. Sir Nigel had called for a £200m reduction in the overspend.

A DoH spokesman said immediate turnaround work had been undertaken on 18 of the trusts. Another 23 trusts have been highlighted in a recent report by DoH finance director Richard Douglas as requiring further support.

Tenon government and public services director Adrian Rutter said the trusts would want to be seen to bring in a firm viewed as a ‘big player’.

PKF, Smith & Williamson and Begbies Traynor confirmed they had not been approached to apply for turnaround support tenders.