Hospital bosses under financial pressure are left feeling they have to "cook the books" in order to satisfy regulators' cost cutting demands, a whistleblower has told MPs
Officials from Monitor and the NHS Trust Development Authority (TDA) are alleged to have told finance directors (FDs) there was "nothing in the bank" and individual positions would be at risk if hospitals breach their deficit plans this year.
The whistleblower said they had a "genuine fear" that patient safety and quality of care could be compromised as a result of trusts' "short term actions to reduce headcount".
Giving evidence to a Public Accounts Committee inquiry, the FD of a NHS Foundation Trust district hospital regulated by Monitor said they were "very concerned" over the pressures being placed on colleagues across the health service.
"My fear is that some FDs may be pressurised into taking the wrong judgements and making inaccurate claims to keep the regulator at bay," they said.
The whistleblower referred to a case where a valuation was fraudulently amended by an NHS accountant in order to attain a £1 million surplus. When discovered the FD was prosecuted in 2008, convicted and jailed for the alteration that masked a deficit of £10 million.
They commented: "I fear for FDs, being put under similar pressure to 'cook the books'."
The whistleblower listed a number comments allegedly made by Monitor and NHS TDA officials during a meeting last month that left him "shocked and very disappointed".
The unnamed officials are alleged to have told FDs gathered at the meeting: "There is nothing in the bank - [we] have to create our own credibility" and there was "massive HMT [Treasury] and No 10 influence".
In reference to the budget target one official was quoted as saying: "If we're bust this year - it's all off. They will come after individuals ... Don't stuff the balance sheet - will be fatal."
The whistleblower gave evidence to MPs on condition that their identity was kept secret.
Monitor and the NHS TDA said it had asked hospitals to review accounting estimates to ensure they were a "true reflection of the issues the NHS is facing".
However the regulator said patient safety remained a priority and managers still had the power to increase spending to meet demands.
A spokesman said: "The scale of the financial challenge is clear, so we have asked providers to submit challenging, but realistic plans for next year. These plans will be rigorously assessed and agreed by trust boards before final submission.
"Where we have asked providers to make operational changes to reduce costs we have always been clear that this must not come at the expense of patient safety. For example, providers can override the agency controls where safety is an issue.
"We have also asked finance directors to review accounting estimates to ensure that they are accurate and provide a true reflection of the financial issues the NHS is facing."
According to reports the hospital sector is expecting to breach its £1.8 billion target for its controlled deficit this year, with some estimating a £400 million overspend.
The latest figures for the third quarter of last year are expected to be published later this month.