We do not know the true state of the finances of the different health services. We know they will all be different, and we know they will all need bailing out and subsequent rationing. The difference per capita by post-code or region in the bailout will be interesting. Emergencies will always trump other demands.. (The Mirror 2011 – Norman Tebbit: Don’t let David Cameron destroy our NHS)
Ben Borland in the Sunday Express reports 4th October 2015: NHS cash crisis: Patients to pay for hospital shortcomings – HOSPITAL patients could suffer this winter because of a looming cash crisis to pay for emergency beds and staff cover.
Health boards are already warning that Scottish Government targets on reducing bed blocking and emergency waiting times may not be achieved.
The annual surge in demand could be even more extreme this year as weather forecasters are predicting an unusually severe winter.
El Nino – the warming current in the Pacific Ocean – usually causes temperatures to plunge in Europe, such as in 2010 when Scotland suffered the worst winter in decades.
In July, Shona Robison wrote to all health boards to demand there be no repeat of the chaos caused by cancelled operations and overcrowded hospitals last winter.
The health secretary wants to see bed blocking reduced to the level of October 2013, when 1,062 healthy patients were stuck in hospital because they had nowhere to go.
In October 2014 the figure was “significantly” higher at 1,380, although by July this year it had been reduced to 1,124.
Ms Robison also said all health boards must do more to ensure that 95 per cent of casualty patients are seen within four hours.
Scotland’s 14 health boards are currently working on their winter plans, which have to be ready by the end of October.
However, NHS Grampian is already raising concerns about Scottish Government funding being axed this year.
A report by Director of Modernisation Graeme Smith warns: “Some aspects of surge response depend upon an increased spend on capacity such as emergency beds or agency staff.
“In winter 2014 these costs were met by non-recurring funding provided by SG however it is unlikely that a similar funding stream will be available for the coming winter.”
Mr Smith also warned that meeting the bed blocking and four-hour waiting time targets set by Ms Robison presented a “significant challenge”.
Ministers set aside £18.2 million to help ease the pressure on the NHS last winter, before Ms Robison was forced to give an extra £10million just days before Christmas.
However, after working throughout the year on measures to avoid another breakdown in hospital care the Scottish Government may not be inclined to bail out health boards so easily this year.NHS Lothian has set up a special “winter planning board” which is working on the “assumption” that there will be additional money for winter.
However, the health board is warning that the risk of missing both the bed blocking and four-hour waiting time targets remains “very high”.
More patients than ever are waiting for a care home place, especially in Edinburgh. There are proposals to increase bed numbers, although they will push the health board – which is already predicting a £26million overspend – even further over budget.
Professor Alex McMahon, Director of Strategic Planning, warned: “In the short term the inability to resolve the current position means that we have little additional capacity for ‘winter’ demand spikes.”
Theresa Fyffe, RCN Scotland Director, said: “Planning for increased demand on our NHS during the winter is essential. Patients, quite rightly, now expect it and it’s good that the Scottish Government and health boards are focused on this serious issue.
“But, with vacancy rates still increasing, as the most recent workforce statistics showed, health boards, which are already overstretched by increased demand on services all year round, face a huge task to be ready before the end of October.”
However, Ms Robison insisted a “record” £100million investment had been put in place to tackle bed blocking across Scotland, adding that winter funding levels would be “similar” to last year.
She said: “We know that the winter months are always more challenging for our health boards but we have robust plans in place and funding levels will be similar to last year. With more people now living with long term conditions and a growing number of older people with multiple conditions and complex needs and it is vital that we learn from the lessons of last winter.
“We’ve issued winter guidance to health boards almost two months earlier than last year, to ensure they build in optimum levels of resilience capacity in preparation for winter.”