An uncertain year ahead for the NHS: Brexit & staffing - funding & patient safetyThe NHS has lived with a funding crisis since 2010. Now the Prime Minister is promising a long term funding settlement - and has even said there will be cash available after Brexit that could go to the NHS.
That will definitely not be the £350million a week promised pre-referendum by Boris the Bus. However, Boris Johnson's recent tweet “Fantastic news about NHS funding...Stand by for Brexit dividend!!" brought a bath load of cold water from on high.
Mrs May's promised 'long term settlement' for the NHS may in the end prove to be long on years and short on cash.
Readers of The Sunday Times might have noted last weekend's headline: 'May orders £4bn Brexit boost to save ailing NHS.' But as one seasoned, non-political commentator wrote next day: "A more appropriate headline might have been: 'May apologises to the ailing NHS for screwing it up'."
Briefly, how did we get where we are? When the Coalition government announced NHS funding in April 2011, our MP welcomed the extra £19 million the NHS in Wiltshire would 'enjoy'.
Under questioning Conservative Central Office admitted this figure amounted to 'a marginal increase'. So marginal it would not even cover inflation, let alone the higher NHS inflation and the soaring demands of the ageing population.
And so it has gone on with annual increases of between 0.9 and one per cent - and now and again emergency top-ups when doom-laden headlines got too much for the politicians. A story of cumulative underfunding and little or no capital spending.
Now the NHS providers (mainly hospital chiefs) are saying that during 2018-2019 patient safety will continue to be compromised and A&E waits and treatment waiting lists will grow longer.
They are short of beds - between 10,000 and 15,000 more are needed. And, with recruitment hit by Brexit departures and uncertainties and the removal of training bursaries for nurses, they are very short of staff - of 36,000 nurses & 9,600 doctors.
So how does the funding Wiltshire's NHS stack up for the coming financial year - the year of the NHS' seventieth birthday?
The background is that last autumn the Chancellor found an extra £1.6 billion for the NHS. But £1 billion of that is making up for money already spent - that is it will help pay off deficits at some Clinical Commissioning Groups (CCG) and many hospitals.
It does mean that from the remaining £600million plus £500million NHS England had been saving to fund 'winter pressures', Wiltshire CCG receives an extra £5million. But it will get no more annual 'winter pressure' top-ups from the government - so the CCG has ring-fenced a £2.8 million as their own fund for winter pressures.
And they plan to have a £9.2million pot of savings to carry forward for when things get even stickier.
The CCG's Chief Financial Officer, Steve Perkins, told the Board last week that they could manage and still find the 'surplus' they are required to keep back. However, it will need a programme to find savings of £15.8 million.
This will mainly be salami slicing marginal sums from a large range of services. But prescriptions are targeted for a £3.3 million saving. And there is the risk that that continuing rise in unplanned or emergency care will mean hospitals will not be able to meet their targets for planned care (like hip and knee ops) - with downside financial implications for them and for the CCG.
And the hospitals that serve Wiltshire will continue to be overcrowded, continue to miss A&E waiting time targets and continue to find depleted social service blocking beds.
The CCG's funding for the joint Wiltshire Council-CCG Better Care Fund (BCF) projects will continue to be higher than required by the Department for Health.
A year ago Parliament's Public Accounts Committee criticised the BCF nationally as 'little more than [a] ruse to paper over funding pressures.' The BCF in Wiltshire has not delivered all that was promised and this puts a question mark over the planned moves toward the integration of Wiltshire Council's social care and the CCG.
Apparently, such developments were discussed during the CCG Board's private session last week. We shall watch to see what emerges.
The CCG's Board also heard that our Sustainability Transformation Partnership (STP - known as BSW for Bath & North-east Somerset, Swindon and Wiltshire) is in deficit. When someone suggested that 'there's not much more we can take out', Steve Perkins was quick to say: "Not so much 'taking out' - as what we can do differently."
The first reaction of the BSW STP was to appoint a 'finance lead' to support the work of identifying 'areas for recovery'. This appointment will help push up the numbers of senior NHS managers - which now exceeds the figure for 2010. One of the main drivers of the Lansley restructuring was to reduce management numbers.
During 2018-2019 (the year that starts on April 6), the NHS in England - as in Wiltshire - will continue to be challenged. Promises by Jeremy Hunt of a 'new NHS hospital every year in £3.5billion splurge' (The Times), of new medical schools training more doctors and of more midwives, will not do anything for the NHS this coming year.
Before we get too starry eyed about such promises of more staff, we should remember that the 2010 promise of an extra 4,200 health visitors for England by September 2015 was never achieved.