THE National Health Service seems to be in a complete mess in terms of strategic management. The organisation doesn't work in a joined-up way and its financing is higgledy-piggledy. In one sense, this is hardly surprising. A recent national survey showed 80 per cent of the nation wanted the NHS to provide the best available treatment whatever the cost. According to the Healthcare Commission, Hinchingbrooke is an "excellent" hospital. Yet its financial position has gone horrendously adrift. It had a deficit at the end of March 2005 of about \u00A34million. A year later that was forecast to be \u00A36.5million but, when the final bills came in, it became \u00A37.75million. Suddenly, three months later, it became a \u00A320million deficit for next March on income of \u00A372million, then a \u00A330million shortfall, then back to \u00A320million, now maybe \u00A333million - or \u00A324million if all goes well. What lies behind these extraordinary numbers? Hinchingbrooke's error - maybe na\u00EFve, but certainly understandable - was to believe what Whitehall had said. It planned and built a \u00A322million treatment centre in the expectation of sufficient patients to remunerate the \u00A3250,000-a-month payback cost. Effectively, though indirectly, the Government reneged on that deal. As a result, a chief executive who gave 150,000 Huntingdonshire patients a standard of hospital service they could not reasonably have dreamed of five years ago is about to leave. What's more, chief executives' resignations from NHS posts seldom come in isolation. Scapegoats tend to run in herds. Others may also come under pressure to resign over a financial crisis that is largely or completely not of their making. Only if they connived at or hid the known problem could they be at fault - and, even then, they may have been trying to protect Ministers or the NHS from understandable accusations of supreme incompetence. Douglas Pattisson, who described his six years at Hinchingbrooke as "very special", did not want to talk about his decision to resign. However, from recent conversations with The Hunts Post he had clearly been looking forward to presiding over major planned improvements to Hinchingbrooke's services to patients. The lack of patients in the treatment centre, which was operating at only 70 per cent capacity until the trust shifted other work there and closed no-longer needed beds in the main hospital, had been a serious worry, but it was being addressed. It is hard to see how much more he could have done to address a shortfall that was not really of Hinchingbrooke's making. Hospital trust chairman Sue Smith said she hoped a replacement for Mr Pattisson would be announced soon, but that may be a temporary appointment. In the meantime, his deputy Liz Pointing will take charge of the ship. Even though reorganisation of the PCTs has thrown a number of senior NHS managers into the potential melting pot, it is not thought that any of them is likely to succeed Mr Pattisson. Clearly, the trust's board has someone else in mind.