Finance directors have a reputation for wanting to achieve. No-one likes to report bad news. FDs of bluechips know analysts will trawl through their trading statements and annual accounts with a fine tooth comb. Any hint of potential weakness is likely to spell a drop in share price.

But spare a thought for their counterparts in the NHS, under the pressure of tough statutory targets. These include avoiding incurring a deficit, no matter how poor their funding, while delivering 3% efficiency gains for 2008/09.

What's happened?

The 12-month jail sentence of Mid Essex Hospital Services NHS Trust's financial director Philip Neal, for falsifying accounts to reveal a surplus rather than deficit, has brought the issue into sharp relief.

His board decided the best way to get rid of a predicted £5m debt was to sell some land. Neal was responsible for the sales, but he submitted inflated valuations for the land. The valuations meant that for the financial year 2005/06 the trust reported a £1m surplus when in fact it was £10m in deficit.

While no-one would condone falsifying accounting, his sentence, given there were no obvious victims and the fraud was for limited financial gain (he got a small bonus of £2,500 for making the figures work), seemed a tad on the severe side.

Former FDs of trusts have expressed frustration with the Department of Health's financial targets and some of the unrealistic expectations of trust board members.

The problem is the pressure to perform is intense, with the prospect of NHS trusts that have still failed to gain foundation status being snapped up by their more successful counterparts.

Trust chief executives have been leaning on FDs to get results - year-end accounts in surplus - no matter how poor the level of commissions the trust has managed to negotiate from the primary healthcare trusts.

What's going to happen?

The pressure on FDs is likely to become heavier when the full effects of the Corporate Manslaughter and Homicide Act, which came into force this week [6 April], kick in.

If patients die as a result of under-resourced services then the police can swoop in to investigate trust board members, including the FD.

Investigators will look into what they could have done to prevent a potential situation where patients' safety was compromised.

Cost-cutting to deliver efficiency gains and surplus accounts will need to be balanced against ensuring patients' lives are not put in danger by hospital cutbacks.

Who'd work in the public sector?