How much will patients notice as Wiltshire's NHS commissioners start their financial recovery plan?
News from the Treasury about the 'extra' money for the NHS might have cheered members of the Wiltshire Clinical Commissioning Group (CCG) over their breakfasts - before they left home for their board meeting (November 23.)
Their optimism was probably quite short lived as it became clear this money would still lead to the smallest increase in NHS funding over the five years of the Parliament since the 1950s. At least the NHS had won the argument over 'front-loading' part of the promised money.
The vital question is whether this level of funding will lead to future changes and reductions in services and treatment that will be noticed by patients across England. As the money is accompanied by the demands of a huge, multi-billion savings target, the answer is almost certainly 'yes'.
This year, the same question is being asked about the CCG's funding problems. As Marlborough News Online has reported, the CCG has found itself on NHS England's 'naughty step' and had to prepare a Financial Recovery Plan to get their finances back on track.
They should have ended the current year with a 'surplus' of £5.5 million - which would have been returned to them the following year. Instead they are forecasting a £4.8 million shortfall - leaving a 'surplus' of £700,000.
The Financial Recovery Plan (FRP) has fifteen schemes which if a hundred per cent successful would save £3,144,229 - and more realistically may save £2,815,479.
The schemes divide into two categories: measures that will not be noticed by patients and schemes that probably will hit at least some patients. The first category are what might be called housekeeping economies.
The most obvious one seeks to maximise rebates offered by drug companies for using identified drugs. This has a target saving of £200,000 and is already getting results.
As with many such economy drives, some of the schemes prompt one to ask why the measures were not in force already. The NHS budget is not designed as a way to boost drug company profits.
Another scheme which should lie firmly in this category is a review of repeat prescriptions in order to reduce 'prescription of unnecessary repeat medication' - or ending the cache of unused drugs in bathroom cupboards. This is to be done through training given to GP surgeries, community services, pharmacies and care homes.
This should bring savings starting this month of £500,000 at best, but maybe £400,000.
Two more of the fifteen schemes lie closer to patients' experience of the NHS. A major cause of the CCG's overspend is a rise in 'planned care' - which covers non-emergency operations like new hips and new knees.
This scheme - which targets Great Western Hospital and the private Circle hospital in Bath - is set to save a maximum of £500,000 and should reach a saving of £387,500. This will involve a reduction in the number of operations the CCG will pay for.
Another scheme involves a review of patients receiving continuing health care 'to cease any inappropriate payments agreed by the Joint Decision Meeting panel'. That aims to remove £107,000 of care.
Some of the schemes are wrapped up in NHS-ese. Explaining those to the public in terms they can understand will be almost as difficult as explaining the problem of the missed 'surplus' itself.
One of the CCG's Lay Members told the meeting that their planning was good, but their delivery was 'not quite so good'. There has been a staff reorganisation to give more weight to delivery - that reorganisation will be now tested. Next year brings another and more critical test.
Deborah Fielding, the CCG's Accountable Officer, reminded the board that the FRP was not the end of the road - the savings hill gets much steeper for 2016-2017, maybe as steep as £28 million: "Don't fall into a trap where we think it's all over."
On the slightly brighter side, Wiltshire CCG is not in as bad a financial situation as some other CCGs. Mid Essex CCG needs to make savings of £15.7 million this year and is consulting on stopping funding hearing aids for those with mild hearing loss, prescriptions for gluten-free foods, vasectomies and female sterilisation.
And all that is before the fine print of the Chancellor's spending review has been properly investigated.
NOTE: this article has had a paragraph removed which mistakenly gave a misleading impression of the CCG's plans for 2016-2017.