How will winter's chill test the health of the Great Western Hospital's finances and staff?
Executives at Great Western Hospital have been working hard for several months with the Clinical Commissioning Groups the hospital serves to prepare for the winter pressures. But whether or not there is a serious flu outbreak, the hospital is already hard put to it to cope with the spring, summer and autumn pressures.
National statistics show that there are currently 36,000 nurse and midwife vacancies across the NHS. If they tell you it's all about to get better, remind them there are now 700 fewer nurses training in England in the first year after NHS training bursaries for nurses were scrapped.
With that as background, it is hardly surprising to find Great Western Hospital's board being told they have a current vacancy rate of 8.8 per cent of their total workforce. That equates to 461 whole time equivalent staff members.
If that is not to compromise safe treatment and care of patients, 397 'front line' staff among that 461 had to be replaced day in and day out during October - and some at night as well - many with costly agency staff.
In October GWH's agency staff bill (and that is not only for nursing staff) was £925,000 above the planned or budgeted level. If that rate of spending continues, GWH is looking at a total cost of agency staff for the year of £12,554,000.
And that raises another problem for the hospital executives. NHS Improvement (NHSI) which regulates foundation trust hospitals like GWH, has put a ceiling on the amount GWH should spend on agency staff this financial year. It is £8,685,000.
Hospital executives are in an impossible position. NHSI do not order policies on the training of staff, they cannot lift the pay cap or change the welcome for EU nurses - which all affect the number of nurses available - but they expect hospitals to be able to work within these contradictory imperatives: do not spend so much on agency staff - oh, and do not compromise patient safety.
GWH is not faring well against the targets for waiting time in A&E (four hour target 95 per cent - latest level at GWH 88.1 per cent), cancer care - treatment within 62 days (target 85 per cent - latest level at GWH 74.6 per cent) and planned operations and care (target 92 per cent - latest level at GWH 90 per cent.)
You can check these figures each month with the BBC's tracker.
As winter brings more people to A&E and probably many more people needing hospital beds two issues raise their heads - again: delayed transfers of care and the number of beds at GWH.
At GWH delayed transfers of care (DTOCs) - people ready to leave hospital but cannot do so because further care or beds is not ready or available for them - were up in October to a total of 1,148 days. They were 40 per cent up on the previous month and 43 per cent higher than the same month last year.
For patients from Swindon the increases were 34 per cent on the previous month and 27 per cent higher than October 2016.
For patients from Wiltshire the situation was more worrying: DTOCs were 44 per cent up on September and 66 per cent up on October 2016.
And October was the month that the government threatened to withhold funds from local authorities that had not done enough to boost care provision in order to reduce the number of DTOCs.
Anxiety has been expressed at the national level that this winter hospitals that are already running with bed occupancy well above the safe level of 85 per cent, will become critical.
When GWH was built (it opened in 2002) it was smaller than its predecessor the Princess Margaret Hospital. In the meantime, Swindon's population has increased dramatically.
In mid-2002 the population of the town was estimated to be 181,447. At the 2011 census it was 209,709. The 2017 estimate is 224,306. And by 2021 it is projected to be 239,993.
If you count the population of the area served by Swindon's Clinical Commissioning Board rather than of the Swindon Unitary Authority, the projected figure for 2021 is 245,382
Even with the ongoing moves to treat more people at home or nearer to their home, it is surely time NHS England and NHS Improvement acted to at increase GWH's capacity.