Senior managers are more worried about balancing their finances and making cost savings than grappling with the government’s latest round of NHS reforms, an NHS Confederation survey has found.

The survey was carried out in January by the Picker Institute and asked 279 senior healthcare managers to list the three most important issues for their work in the coming year.

Sixty two per cent said that making efficiency savings and sorting out their finances would be one of their top three concerns, with 31% putting it at the head of their list.

By contrast, only 32% said that understanding the government’s white paper reforms, the transition to the new system and reconfiguration would among their top three issues. Thirteen per cent said this group of topics were most important to them.

Nigel Edwards, acting chief executive of the NHS Confederation, said: “We are already picking up worrying signals from a number of hospitals and primary care trusts about significant money pressures emerging, and this is before the very challenging rigours of next year’s tight financial settlement.

“Policy makers have got to be alive to this if they are serious about protecting frontline services. In general terms, the NHS budget has had protection, but that doesn’t mean individual organisations won’t come under pressure.”

The survey also found that although maintaining, protecting and improving the quality of services in the NHS is high on the agenda for NHS managers, it does not have the same importance as financial issues.

Forty six per cent of those surveyed indicated that this group of issues would be in their top three, but only 19% said that it would be the most important.

Similarly, 46% said that understanding and supporting GP commissioning would be one of their top three priorities, but only 13% classed it as the most important issue facing them today.

Edwards added: “These results should set the alarm bells ringing. They show that while the Westminster village is focusing on NHS reform, finance is the issue keeping NHS chairs and chief executives awake at night.

"Our members are focusing on this issue because they know that good patient care depends upon financial stability – the two are inextricably linked."

The Confederation has warned that 2011 looks to be a tough year, with the NHS budget being flat and the service needing to find £20 billion worth of efficiency savings over the next four years.

Edwards said: “Trusts are currently working on the biggest ever efficiency savings, the biggest ever management reductions and the biggest ever reform programme, all at the same time. It’s a mammoth agenda and the dangers of distraction are obvious.

“We have got to do everything possible to eke out genuine efficiencies rather than simply shrinking services.”