NHS budget for Wiltshire gets significant boost, but a great debate must decide what treatments are affordable
Wiltshire Clinical Commissioning Group (CCG) is working hard to get its finances back on track and may soon be able to announce it will make the £5.5 million end-of-year surplus required by the Department of Health.
In many areas across England the demand for NHS services keeps on rising - especially in emergency (or A&E) departments. "We need", CCG Finance Director Simon Truelove told the board meeting (January 27), "to hold onto the fact that Wiltshire is bucking some of those trends."
While work is still underway on the Financial Recovery Plan, the CCG is showing successes in reducing hospital admissions and emergency department attendances.
Chief Officer, Deborah Fielding, reinforced the message: "We've managed to continue to progress our 'out of hospital' strategy - despite our financial problems."
Simon Truelove had some very good news about the CCG's funding allocation for next year. Following the Chancellor's Spending Review statement, Wiltshire will get £21 million more next year than had been expected - or an increase of 2.76 per cent more than the minimum 2016-2017 growth for all CCGs of 3.05 per cent.
This extra increase arises partly because the funding formula has been changed to recognise the extra health service pressures in a rural county with a higher than average number of older people.
This funding will allow a reduction in the QIPP savings for the next year - reducing them from a target of £28 million to £11.9 million. It's pronounced 'quip' and is anything but funny. It stands for 'Quality, Innovation, Productivity and Prevention' and provides a programme of ways for the NHS to make essential savings.
Much of the increase of funds over the current year's money for the CCG - a total of £31.4 million - is already spoken for in increased pension and national Insurance costs, an increase in money passed to the Better Care Fund which is co-managed with Wiltshire Council, the government's Parity of Esteem policy to upgrade mental health services, and so on.
However, the NHS as a whole still has to find £30 billion in savings. Over the following three years (2017-2020) the increases in the CCG's budget will be about a third less than for 2016-2017. Until election year 2020-2021 when the increase gets back to bumper levels.
And coming down the line for the CCG is the full take-over of primary care commissioning (GPs etc.) and the commissioning of the very expensive specialist care services (currently handled by NHS England.)
In the words of Wiltshire Healthwatch's Chris Graves: "The amount of money is better, but not enough. We have to decide what treatments do we want to support - how will the public react?"
There were calls for a debate with the public as to what the NHS could afford - something Simon Truelove has been advocating for some months. Dr Mark Smithies, who sits on the CCG board as its Secondary Care Doctor, asked: "Are we about improving health across Wiltshire, or are we about providing a month of life gained to one individual?"
One way, it was argued, to explain these dilemmas more clearly to the public might be to get better measurement of the benefits treatments provide to patients' wellbeing and quality of life.
This will need to be a much wider and calmer debate than that which usually greets decisions by NICE on which drugs give value for their cost. Thumbs-up-and-thumbs-down headline reactions cannot be allowed to influence the outcome of the debate.