The NHS has reached a ‘crunch point’, to coin a phrase used recently by prime minister Tony Blair as he desperately defended the government from accusations of financial mismanagement.

Yet health secretary Patricia Hewitt has tried to deflect attention away from the government by blaming poor financial controls at health trust level for the deficits and redundancies with which many trusts are now grappling. But were accountants in the health service to blame? Could they have done more to prevent the crisis?

Michael Sobanja, chief executive of primary care trusts body the NHS Alliance, blames a ‘culture of spend’ – a group of health managers ‘brought up’ at a time of huge investment weren’t able to cope when the cash flow dried up.

The situation wasn’t helped, he says, by the Department of Health failing to tackle overspends when they were first identified last year.

Professor John Appleby, chief economist of health think tank the King’s Fund, feels FDs have been unfairly blamed for the current problems.

He can cite two financial directors of health trusts in London sacked recently because of financial deficits.

Many trust FDs warned their chief executives and board masters that the financial strategies they had chosen were risky, he says, but decisions were taken based on the pressing need to meet targets.

The lack of financial skills among board members is where Nigel Edwards, policy director for the NHS Confederation, believes some of the blame lies.

This was the problem identified by some of the turnaround teams sent in last year to sort out the financial problems.

There were also systemic failures: ‘The financial control systems people traditionally had have not been working as well now because of the sheer scale of new initiatives thrown at organisations that hadn’t been well costed,’ Edwards admits.

Nor did some board members appreciate the effect of the new payment by results system being introduced in the NHS, where a hospital’s finance settlement is based on the number of patients it treats. Generous pay awards for consultants and GPs added to the problem.

Many observers predict that the outgoing NHS chief executive Nigel Crisp will be made a scapegoat for the current crisis, as he takes early retirement, and speculate the prime minister will grasp at the opportunity to be seen as the man who saved the health service.

Either way, FDs remain at the forefront of trying to untangle problems created by political pressure, and a lack of financial expertise among health trust board members.

It could be time for FDs to magic a financial rabbit out of the hat.