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Has August - once the silly season for news - become the scary season for news about the NHS?

While the boards of many public bodies take this month off, the board of Great Western Hospitals Foundation Trust (GWH) met on Thursday (August 6.)  It had some good news to report as well as a progress on its battle against an eight figure deficit for the current year.

Its executives are also facing some new NHS organisational changes.  The forced marriage between Monitor (whose experts have been poring over GWH's books since October) and the Trust Development Authority.  What this will mean for a Foundation Trust hospital like GWH will remain unclear until a chief executive of the new organisation is named.

In addition, their postbag has been pretty full with letters from Whitehall and regulators calling for such things as 'proportionate application' of safe nursing levels: something staff at GWH spend their days - and many nights - doing anyway.

August was once the silly season for news.  Now it is clear that politicians use July to set a few booby traps, in the hope the grass will grow over them while people are holidaying.

Last month, in the House of Lords the Under Secretary of State for NHS Productivity, Lord Prior (a former Conservative MP), announced a government inquiry into whether the NHS should be paid for in future through 'user charges' and insurance, not through tax.

We should not be too worried about this - it may just be a sop to certain twitchy back-benchers. 

After all, in 2011 David Cameron went out of his way to reassure an audience of health workers:  "We will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system."

In case they didn't hear it the first time, Cameron repeated his pledge in a list of five guarantees: "In this country we have the most wonderful, precious institution and also precious idea that whenever you're ill … you can walk into a hospital or a surgery and get treated for free, no questions asked, no cash asked. It is the idea at the heart of the NHS, and it will stay. I will never put that at risk."

Of course, it was also said before the 2010 general election that there would be no more top-down NHS reorganisations.  At least one Conservative candidate in the south-west was saying then that commissioning decisions should be made by clinicians - they knew then all about Lansley's plans.  

Those plans were a booby trap setting the NHS back some £3billion in the reorganisation costs - let alone the on-going costs such as those further changes to regulators.

August has also been chosen as the time for a four-week consultation on the Chancellor's £200million cut to local authorities' public health budgets.  This has to be an 'in-year' cut - that is it will cut current spending plans.

It is thought it may become a straightforward 6.2 per cent cut on this budget line across all local authorities - a budget that had no growth from the 2014-2015 level.  The King's Fund is quite clear that this cut will have knock-on effects to the NHS.  The way the cuts will be implemented "sits uncomfortably with the government’s claim that these are ‘non-NHS’ cuts."

Back in the real world, GWH has recorded three months meeting the 4-hour target in their emergency department (ED.)  They hope they can sustain this despite the continued rise in numbers coming to their ED.

Earlier this month they suffered a day's blip with 'coachloads' arriving at ED.  They are trying to find out what caused this rush as some other hospitals in the region experienced a similar sudden rise in numbers.

It should be added that among other achievements, GWH hit all the required standards for cancer treatment times throughout 2014-2015 - and into the first months of this year.  And their hospital mortality rates are still among the best in the region.

The GWH Board heard more about the struggle to reduce the forecast deficit.  At the start of the year this stood at £18.7million, but after three months is at £16.4million.

The view on the deficit from the newly confirmed Finance Director, Karen Johnson, was: "Fourteen [million] and twelve seem do-able to me."  

Chief Executive, Nerissa Vaughan agreed: "£12million is achievable - £10million is where they [Monitor] would like us to be. Getting the deficit as low as possible gives us a good start for next year.  Winter is the risk.  I always worry about winter, but we've done more to prepare this year."

Pressures keeping spending high at GWH have come from increasing demand, the national shortage of qualified nurses, and the tariff under which GWH is paid by commissioners for treating patients.  

Staff pay - including agency costs largely spent on nurses - is down £644,000 in the first three months of the year.  The most expensive agency has not been used since the beginning of June.

In June another pressure appeared: the cost of drugs.   These costs are largely recouped from commissioners, but impact on GWH's tight cash flow.

In June the drugs bill was over planned costs by £563,600 (making an £822,000 'overspend' for the first three months of the year.)

This news came on the day that a national inquiry was announced into allegations that two drugs companies were charging "excessive and unfair" prices for an epilepsy drug used by 50,000 people in Britain.  

This drug used to cost the NHS about £2.3million a year - by 2013 the annual cost had soared to £50million.  Pfizer and Flynn Pharma will be investigated by the Competition and Marketing Authority to see if the NHS can be saved a few million pounds.  

We might not yet be paying at the till as we leave hospital, but when it comes to keeping NHS costs down, 'every little helps'.

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