But the Prime Minister refused last night to apportion blame in cases where trusts have run up multi-million pound deficits.  

Hospital  trusts across the region – including Shrewsbury & Telford and Worcestershire Acute – are planning cuts in staff and services to try to get their books back into balance.

The Shrewsbury and Telford Hospital Trust is currently carrying debts of more than £31 million and is cutting nearly 300 posts at the Royal Shrewsbury Hospital and Princess Royal Hospital in Telford.

Speaking after an hour-long meeting at 10 Downing Street with West Midlands Strategic Health Authority chief executive Cynthia Bower and 11 other regional health chiefs, Mr Blair insisted that deficits covered up in the past by a national financing system could no longer be tolerated.

“People are now being asked to make the changes necessary to have a system which is sustainable in the long term,” he told the Shropshire Star.

The Prime Minister conceded that “difficult decisions” were being forced on some trusts.

“It’s absolutely true that where there are deficits it concentrates the minds of people about what’s wrong in their area. It focuses minds on changes that need to happen.

“These difficult decisions are being replicated in every walk of life, but the test is ‘do you get a better service?’

“Are we saying that the NHS – uniquely of any other organisation – has to remain exactly as it is, and if you change it, you are destroying the service?

“That cannot be right, and it does not happen in any other walk of life.”

Mr Blair said health trusts had to live within the resources allocated to them, but he added: “The idea that this is a service where we are cutting back the resources is absolutely absurd.”

Mrs Bower said there were no “magic solutions” by throwing money at the problem, but trusts with deficits could learn from those providing an excellent service within budget.