Massive investment in the NHS is failing to trickle down to the front line, and much of the money is being spent on expensive agency staff and more managers rather than extra beds and better treatments, a survey by the Royal College of Nursing (RCN) shows.

Nurses are gathering for the RCN's annual conference in Harrogate, to discuss whether Labour's reforms of the health service are having an effect. An extra £5.9bn has been poured into the NHS in the past year in a bid to hit targets on access to GPs, reduce A&E waiting times and improve cancer care.

The NHS chief executive, Sir Nigel Crisp, has said the organisation is working so well that the next tranche of targets for 2005 may be hit early. But the survey of 1,000 nurses by MORI found many frontline staff had not seen the effects of the extra billions.

Less than a third of nurses believe the number of permanent staff has increased in the four years since the NHS plan for reform started. But 47 per cent said spending on agency staff had increased and 52 per cent believed more money had gone on employing managers.

Only half of those questioned said there had been increased investment in new equipment. Two-thirds claimed the number of specialist, critical care nurses had not increased and 64 per cent of mental health staff said promised increases in secure hospital beds had not materialised. Fifty per cent of nurses said patient experiences had improved since 2001, but one in three thought the state of the NHS would become worse.

Beverly Malone, the RCN general secretary, said: "Nurses are the champions of patients and they know more than anyone whether their care is improving. This is a hugely important survey which should directly feed in to any future investment planning."

Tim Yeo, the Tory health spokesman, addresses the conference today, with John Reid, the Secretary of State for Health, speaking on Tuesday. The Tories hope to convince nurses to back their proposals for "patient passports", where people would be given money for treatment they could use in the NHS or the private sector. Mr Reid aims to win over delegates with promises of greater powers for the profession.

Nurses have had massive improvements in pay and powers under Labour, but they are concerned that managers rely on agency and overseas staff to achieve tough targets on waiting times and bed delays.

A spokeswoman for the Department of Health said: "We continue to recruit record numbers of nurses: 67,500 since 1997. We [agree] the NHS still spends more on agency nurses than we would like to."

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