The NHS in crisis: GWH is weathering the winter storms - but they may be a permanent problem
On Thursday (March 2) I went to one of the NHS' "burning platforms" - as described in the morning's news bulletins by the regulator's chief inspector of hospitals. I went to the Great Western Hospitals NHS Foundation Trust - to their monthly board meeting.
No flames in sight. But quite a lot of red ink, some anger, too few beds, recruitment difficulties especially with nurses, nurses recruited but not passing language tests, one day of 'chaos', running out of monitors, lots of stress and tiredness - and lots and lots of sick and injured people treated and returned to good health.
And there's been a great deal of preparation for the arrival of Care Quality Commission inspectors on March 20.
The board learnt about January's pressures - especially those at the doors of their emergency department - or A&E. The number of attendances was very slightly down against December's figures. But that brought no respite for clinical staff.
Of the 6,858 people attending A&E in January, 3,254 had to be admitted as emergency cases. This was 2.3 per cent higher than December, but a whopping 10.9 per cent higher than in January 2016.
It was noted that many of those admitted were in the frail category and also had much more complex conditions or who are more acutely ill and so took longer to get fit and well enough to leave hospital: "This looks like a demographic phenomenon" - one they will need to live with as more people live longer.
By coincidence the King's Fund quarterly report issued that day said the current crisis at hospitals was not about winter pressures (fairly mild and no major outbreaks of flu or norovirus and a lot or preparation for winter) but about those patients with complex conditions.
At the other end of patients' journey through hospital, January's delayed transfers of care figures told a bleak story. The number of bed days lost to delays in getting Wiltshire patients home, to nursing homes or to other care beds was 360 days (for Swindon patients it was 450.)
The brighter news is that in total that was 281 days better than December - and figures for February will be better still. The bad news for the future is that it was 62 per cent up on January 2016.
One of the causes for these delays lies with care at home. One executive expressed concern at the lack of care at home in Wiltshire largely due to staff vacancies: "I can't see those jobs getting any more appealing twelve months from now."
There was some dismay - and some anger - that promised money coming through to GWH simply had not arrived. This was producing a cash flow problem.
There some sighs that the savings regime was continuing into next year - and the year after - getting harder every year to find savings that did not impact on patient safety.
Ten months in, this year's savings figure had been 92.6 per cent met. For 2017-2018 they had to find another £14million - and £11 or 12million for the year after. Taking about £50million out of the hospital's costs over four years.
One director warned: "We shall have to make fundamental changes to the services we provide." Another characterised the process: "It's plates on sticks."
There was also a warning that treating more patients at home was an expensive option and difficult to achieve in rural areas.
Much NHS good news seems to carry 'buts': GWH has achieved official approval to introduce a pioneering treatment for breast cancer - one of six hospitals in England to get the approval.
The treatment involves giving breast cancer patients a one-off dose of radiotherapy while they are still in the operating theatre. The necessary equipment was part paid for by a Brighter Futures appeal. It has been at hospital since 2015 and so far has only been used as part of a pilot project.
The 'but' comes now: will the Clinical Commissioning Groups for Wiltshire and Swindon agree to pay for the treatment?