Will it be a happy seventieth birthday or a wake for Wiltshire's NHS in 2018?Please put it in your new diary: 5 July 2018 sees the seventieth birthday of the NHS. Will it be a happy celebration or more of a wake?
Like those many people in the nation's ageing population who are subject to increasingly complex conditions and often subject to pensions hit by inflation, so the ageing NHS will find the year ahead fraught with dangers from increasingly complex organisational changes and, of course, shortage of funding.
How will the NHS change in Wiltshire over its coming birthday year? Apart from the everyday problems of too few GPs, too few nurses, overcrowded A&E departments, too few hospital beds, late ambulances, rising waiting lists and so on, there will probably be two major changes in the way the county's health services are organised.
They come under the headings of 'integration' and 'Accountable Care Organisations'.
First, this article looks again at the increasing integration of health and social services - Wiltshire Council joining with the Wiltshire Clinical Commissioning Group (CCG). Secondly, a future article will look at moves towards arranging health services under a single contracted provider - an Accountable Care Organisation.
The legal and governance changes needed for integration are still underway - there has to be a workaround to comply with the responsibilities laid down in the Act of Parliament that set up the CCGs. But for several years the money from the NHS budget has been flowing towards services the Council is responsible for - many millions from Wiltshire's NHS budget have gone to the jointly run Better Care Plan.
And the money is still flowing. Just before Christmas, Wiltshire Council announced: "Carer Support Wiltshire has been awarded a new contract to support carers of all ages in Wiltshire."
"The contract has been awarded by Wiltshire Council, with funding support from the NSH Wiltshire Clinical Commissioning Group, and builds on the existing work Carer Support Wiltshire has been doing with them for a number of years to support adult carers."
"From 1 April 2018, assessment of carers aged under 18 will be led and coordinated by Wiltshire Council children’s services, with breaks and activities available through Carer Support Wiltshire where appropriate. Young people currently supported by Spurgeons Young Carers Wiltshire will be contacted in the new year with details of the new arrangements for support."
The announcement then included statements from two Wiltshire Councillors and the boss of Care Support Wiltshire - and one statement from the CCG, from its Chair Dr Richard Sandford-Hill: “The care and support provided by carers enables many people to remain in their own homes and helps prevent admissions to hospital and care homes."
"Carers are expert partners in care, but they are more likely to neglect their own health and well being, which can be detrimental to them and to the person they are caring for. Carer Support Wiltshire provides practical and emotional help for carers, and we’re delighted to continue working with them”.
The point that will need to be addressed as integration between Council and CCG deepens is this: where will such use of the NHS budget stop? How much of the CCG's budget will be left for primary care (notably local surgeries with their GPs and nurses), community health care (travelling nurses and specialist services especially for the elderly) and hospitals.
Just about anything the Council does can, at a stretch, be considered to have an impact on health. You could, for instance, say that unmaintained roads are a health hazard. Or lack of safe access to schools causes stress and anxiety in parents and children. Or lack of efficient consumer protection can lead to hospitalisation.
The government funds the main preventative services under the Public Health budget - money that goes directly to local authorities to administer. The government has cut this budget and services in Wiltshire have - it is said - been trimmed back.
You would not know this from Wiltshire Council's Annual Report on its public health services for 2016-17 - the year that ended in April 2017. This was published (slipped out?) on December 21 - with no explanation for the delay.
It is not the kind of annual report that would win plaudits at Companies House. There are no figures of income or spend. There are no figures of staff numbers. Thus there is no way to compare how the Council has spent the budget with the previous year's finances. Nor can we tell how many staff have gone as the budget was cut.
It is a PR stunt of a report with 25 pages that leave us with columns of text mainly outlining its - very worthwhile - schemes beside a column showing a bewildering blizzard of half digested and unannotated statistics. And giving no transparency at all on the way public money is being spent.
The report's introduction states: "This report by the Director of Public Health covers a range of topics associated with the health of the population of Wiltshire."
It does list the 'Top five health protection risks in Wiltshire: Influenza, flooding, loss of telecommunications, disruption to fuel supply and major reservoir dam failure/collapse'. Plenty of scope there to call on funds from the CCG's already stretched NHS budget to mitigate those risks to health.
Perhaps the answer is for the government to hand the Public Health funding and responsibility over to the CCGs. They at least have a duty to report fully on staffing levels and the way the money is spent.
If, on the other hand, integration of Council and CCG responsibilities continues apace, we can expect to see more and more money from the NHS budget going to support the Council's public health functions.
FOOTNOTE: Many people in Marlborough will interested to read what Wiltshire Council's Public Health annual report has to say about air pollution and its effects on health:
Local authorities have a duty to monitor air quality within their areas having regard to national air quality objectives and standards and report this information to the Department for Environment, Food and Rural Affairs (DEFRA) on an annual basis.
Air quality in Wiltshire is predominantly good with the majority of the county having clean, unpolluted air.
There are however a small number of locations where the combination of traffic, road layout and geography has resulted in exceedences of the annual average for nitrogen dioxide (NO2) and fine particulates (PM10).
Information relating to air quality monitoring in Wiltshire can be found on our dedicated air quality website: www.wiltshireairquality.org.uk
There is no mention at all of any steps being taken to reduce the harmful effects of those 'exceedences' - such as London Road in Marlborough - or help people avoid their effects. That is a serious health matter.
Live readings from the London Road monitor can be reached directly from the button on marlborough.news' front page.