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A 'tough' financial climate for the NHS in Wiltshire - winter pressures, a case of flu and shrinking money

From one day to another, nationally the finances of the NHS go from 'tight' to 'awful' to 'desperate'.  The latest financial turmoil came as Wiltshire Clinical Commissioning Group was outlining to its board the detailed planning that has gone into their preparations for winter.

The board also heard that the first case in Wiltshire this winter of a patient with a Type A flu is being treated at one of the three acute hospitals that serve the county. And there are signs of a rise in norovirus cases - known as the 'winter vomiting bug'.

Nationally the financial issues got past 'desperate' on Thursday (November 30) with NHS England warning that waiting time targets would have to be abandoned next year and perhaps more services rationed.

On the finical front things were somewhat calmer in Wiltshire.  Having made some economies during the year, Wiltshire CCG is on course, its board meeting was told on Tuesday (November 28), to deliver its required one per cent of budget as a 'surplus' - which is carried forward.

This achievement should be set against a forecast that came out a day later that England's CCGs as a whole are 'likely' to be in deficit for the current financial year by £500 million.  

Our CCG reckons that Wiltshire's NHS services are currently underfunded by about £16 million - and that, perhaps coincidentally, is their target for savings during 2018-2019.   The word for the Group's finances is 'tough' - but getting 'tougher still' next year.

The extra money - £2.8 billion over three years - provided in Philip Hammond's recent Budget is divided into a bit aimed at this year's winter pressures and another £1.6 billion next year and the remainder for 2019-2020.

Despite a pledge in this year’s Conservative general election manifesto to increase health spending per head of population every year until 2022 - it will not now be happening.  The extra money in the budget means, it is claimed, that per capita funding would rise by 0.9% next year, but would fall by 0.4% in 2019-20.

This year's extra money announced in the Budget turns out to be £335 million - not the £350 million that was emblazoned across the Vote Leave bus and referenced in the Chancellor's speech. That £350 million was, of course, 'promised' or 'suggested' as £350 million a day for the NHS rather than a one year sum equalling one-three-hundredth-and-sixty-fifth of the Vote Leave figure.

The CCG do not yet know what their share of the £335 million will be, but if it is divided up on the basis of population, Wiltshire will get just under £3 million.  When it was suggested the Group would have to think quickly how best to spend it, executives in the board meeting smiled and said they were already bidding for it.

Non-executive director Peter Lucas threw a bit of a curve-ball question to the CCG's director of finance, Steve Perkins - asking:  " What should we be worrying about?  What keeps you awake at night? "  Apart from his four-year-old child, he thought long and hard:  "How do we get true change and sustain our ability to provide the right services and maintain standards."  

Transformation of the way services are delivered was needed, he emphasised, to 'reduce the system cost'.

The extra money in the Budget was not the £4 billion NHS England wanted for next year.  But the 'tough' finances and their consequences cannot have come as a surprise to the government.  They are the result of seven years of 1.1 per cent increases in the NHS budget.

Before 2010 and Coalition Government, the NHS budget was increased by about four per cent a year - and that is currently happening elsewhere in Europe.  This level of increase is necessary to keep ahead of inflation and to keep up with the health needs of ageing populations, more complex conditions and more costly treatments.

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