HEALTH trust directors, faced with a bill for £12million improvements at Burnley General Hospital, fear that cash backing for the project may be withheld by the regional health authority.

And in the current climate of the screwdown on public spending - providing the ammunition for the pre-election tax giveaways - their concern is justified. Indeed, politics are already sending a chill financial blast through health care at Burnley as the trust is warned that government-imposed cash restrictions could axe £400,000 from the trust's capital spending programme next year.

And that's even before funding of the hospital's major Phase Four improvement project gets considered.

What happens, then, if those fears are realised?

Is the improvement to health care in Burnley to be put on ice or delayed along with scores of other vital public service schemes - just as we saw yesterday when Lancashire's schools and road improvement programme was cut to the bone by government cuts - so that votes may be bought?

Perhaps not.

For one way out of such a difficulty would be for the trust to use the independence given to it by the reforms of the health service and, instead of waiting for a thaw in government's politically-motivated spending freeze, raise money for Phase Four by borrowing in the money markets.

As yet, there is no indication that the trust will employ this tactic, but if proper priority is to be given to improving health care in Burnley - rather than that aim being the subject of political dogma - then the directors might well consider it.

That may demonstrate the new powers and independence that health trusts have.

But, of course, there is a flip-side. That of servicing the debt - the costs of which remove money from health care.

And given that levels of health care are being inevitably put under pressure by the cash cuts the trust is already facing and that it is already struggling to balance its books, a borrowing plunge into the money markets would be a painful way of keeping the hospital improvements programme on course.

But, really, though the availability of this avenue highlights the benefits of local control over health care that the trust system and its greater autonomy have created, it also shows something else if the directors are virtually forced to go down it.

That is the sorry old story of government under-funding of the NHS still haunting the system and of central funding itself still being a political football.

Converted for the new archive on 14 July 2000. Some images and formatting may have been lost in the conversion.