NHS overspending: can service cuts be prevented?

We knew the NHS was under intense pressure - we now know what the latest impact is on the budgets of some of the largest health boards in Wales.

For those who follow developments more closely, we knew there were particular problems in four out of the seven Welsh boards.

The largest, Betsi Cadwaladr University Health Board which covers north Wales, is already under the direct control of the Welsh Government.

Cardiff and Vale, ABMU in Swansea and Bridgend, and Hywel Dda in the west are also facing an elevated level of monitoring because of concerns about a number of areas, including budgets.

Behind the scenes, it was known that balancing the books in these three health boards over a three-year cycle was not going to be possible.

No bail-out

One of the main reasons is that it has proved impossible for any of them to hit the level of savings they have to make every year.

The 'no bail-out' message from the Welsh Government is a reflection of the frustration felt at the highest level over consistency.

The feeling is if three can manage it then why is it not possible for the other four.

The backdrop is also the attempt to prevent Welsh Government budgets being overwhelmed by the scale of health spending that many say will be required in future.

The big question is whether there is sufficient low-hanging fruit to prevent services being cut in order to balance the books.

ABMU, and others, are focusing on a recruitment campaign to cut down on the cost of using agency staff.

Destroy

It is also trying to cut down on waste. Last year it says it had to destroy medication worth an eye-catching £4m after it ended up being stockpiled in the homes of people on repeat prescriptions.

No one will argue with these but they are unlikely to have an immediate impact.

The way the health boards respond to emergency surgery is also locked in. so the suspicion is the impact will be felt most heavily on waiting times for planned surgery.

The Health Secretary Vaughan Gething was circumspect on Good Morning Wales on Radio Wales earlier when he said he was "pretty certain" that would not happen.

Later on he clearly felt more confident when he told BBC Wales he did not feel it would make any difference.

The tone taken by the Welsh Government is interesting in how it breaks from the past when explicit criticism of health boards appeared off limits.

It will be fascinating to see whether this approach continues if the finances deteriorate even further.