The health secretary, Patricia Hewitt, was today heckled as she defended the government's NHS reforms at the Unison health conference in Gateshead.
The response to Ms Hewitt's speech ranged from near silence to derisive laughter as the health secretary sought to both acknowledge the contribution of NHS staff and defend the measures being taken to reign in deficits.
The health secretary's efforts failed to appease many of Unison's members, who are angry at the pressures facing existing NHS staff, with posts remaining unfilled.
Ms Hewitt - described as "brave" by Unison's president, Christine Wilde, over her decision to attend the conference in the current climate - said she understood members' concerns over the government's health reforms.
"I know of the concerns, the anxiety even the anger that some of you feel. I want to hear about that directly from you," she told delegates.
Admitting the NHS and its workers were facing a "challenging time", Ms Hewitt said that "tough decisions" would have to be made about the future.
Ms Hewitt said she made no apology for repeating her controversial claim, first made yesterday, that the NHS had just achieved its "best ever year".
The claim caused an outcry over the weekend in light of mounting job losses being imposed by trusts in financial deficit.
"It is vital that, when we are debating the future of the NHS, we recognise the realities of how far we've come - as well as how much more we still have to do. That is why I make no apology for saying that from patients' point of view - the NHS - thanks to the effort of all of its staff - has just had its best ever year for patients. The facts speak for themselves," she said, as she contrasted the NHS inherited after 18 years of Tory government with the service offered now.
Ms Hewitt maintained that most of the NHS was not in deficit, adding that current problems over spending were "manageable".
Just 7% of NHS organisations were responsible for 50% of the deficit, she said.
The NHS had to become more efficient, she said, adding that many of the redundancies being announced involved agency staff rather than NHS employees.
"These aren't redundancies," she said. "Even though they are included in the headlines. It's common sense. Most places will tackle their deficits and make themselves more efficient with few or no redundancies. But we will have to face up to some difficult decisions. And in some hospitals, there are staff facing redundancies."
But Ms Hewitt admitted some redundancies could be squarely blamed on flawed management strategies.
She cited North Staffordshire hospitals in Stoke, where 1,000 workers faced the possibility of redundancies. "The real problem is that the hospital has not been organised in the most efficient and effective way," she said. Staff employed just last year now faced an uncertain future. This is grossly unfair, she conceded. Staff had been let down by the previous board, who had now resigned, she said.
"Thank goodness it happens very rarely - but when it does, and when staff are left facing redundancies in a situation like that, I think they deserve an apology."
But despite her best efforts, Ms Hewitt sat down to just a smattering of applause by disgruntled members.
The health secretary was then barracked during a 30-minute question and answer session over government claims that the job cuts were not impacting on patient care, its commitment to private sector input in the NHS, and funding cuts to training previously promised to the entire NHS workforce.
Martin Booth, from the eastern region, said jobs being axed or outsourced in his region as the area sought to tackle a soaring deficit.
NHS turnaround teams - the troubleshooters parachuted into NHS trusts facing the brunt of deficits - had been unable to identify savings, he told the health secretary. Instead, services such as mental health services for young people and the elderly were suffering because cuts brought about by a lack of necessary funding, he said.
"So I am sorry, but the deficits are having an impact," he said.
"When it is clear that there are not any savings to be made and more resources are required ... why can't those resources be put in?"
Ms Hewitt dismissed the suggestion that even more resources were needed. "Of course there are savings to be made," she said.
All healthcare systems across the world were struggling with the challenges of longer lifespans, greater consumer expectations, and the pace of technological and scientific change, she said.
Ms Hewitt was also criticised over the government drive to encourage more private sector involvement in the NHS. She was challenged by a delegate to confirm that in-house NHS service delivery would remain, rather than be completely outsourced to the private sector.
"Of course the NHS will go on employing people and providing services, quite rightly," she said.
Unison's head of health, Karen Jennings, later said she believed the minister had been "shocked" by many of the issues raised by delegates during the questions to the minister.
"She felt the rawness of the way people are experiencing problems at the moment and was taken aback by some of the issues that were raised."
"These staff are of course feeling shocked and anxious."
