ENSURING health chiefs in Worcestershire do not spend a penny more than their budget, while keeping politicians happy and meeting targets, is "a significant challenge", according to Dr Richard Whitmore, a health chief at the South Worcestershire Primary Care Trust.

He says, that despite the fact the Trust has been allocated a £240m chunk of the Government's £45bn annual NHS budget, the figure is a small drop in the ocean for what the trust has to achieve.

The SWPCT has to pay for all the healthcare of 270,000 people living in the region - excluding private patients - and its not an easy or cheap task, he says.

It has to battle with an increasing number of Government targets and sometimes it can prove impossible to keep everyone happy when deciding how the budget is allocated, says Dr Whitmore.

"In recent times, the Government of the day has taken a keen interest in the use of this money culminating now in the target culture.

"The majority of this money is given to Primary Care Trusts to buy healthcare and to ensure the Government's targets are met.

"This includes the district nurses dressing leg ulcers at home, doctors prescribing life- saving new drugs such as the statins, which lower cholesterol and the risk of heart attacks, and all the activities at the new Worcestershire Royal Hospital for South Worcestershire patients."

The trust was created by the Government from existing county health authorities and community trusts, around two years ago, as an attempt to involve health professionals in the management and delivery of healthcare.

The PCT formed a Professional Executive Committee, made up of five GPs - including Dr Whitmore, who is its chairman - a district nurse, health visitor, therapist, senior social services manager and executive directors.

The committee's main task is to deliver the best health care to the county's population.

"Within the PCT, changes in services to patients are discussed and agreed by the Professional Executive Committee," he said.

"This ensures that professionals who are involved in patient care are also involved in decisions affecting their care.

"A significant challenge for these people is to ensure that not a penny more than the budget is spent while keeping the politicians happy that the targets are met.

"At times this seems an impossibility, and at other times it is an impossibility, as was recognised by John Hutton, Minister of State for Health, in answer to Peter Luff, MP, when he commented on the expected deficit in Worcestershire Acute Hospitals NHS Trust for the next two years."

Dr Whitmore said all of the county's PCTs, hospital trusts and social services workers now need to work in collaboration to achieve a health service that provides best value for money.

"We will have to work co-operatively, which means that GPs, hospital doctors, nurses, social workers and managers will be spending more time in meetings so that agreed service changes are implemented," he added.

This could lead to changes and a modernisation of the county's health service.

"Examples of these range from changes in who can do what - nurses doing what doctors used to do, health care assistants doing what nurses used to do, and changes in where healthcare is given, " he said.

"The benefit of this is that staff can be encouraged to take on new and advanced roles if they wish and, on occasions, this results in costs being reduced allowing the budget to go further.

"Of course, there is also a vast amount of activity which is not linked to the headline targets.

"The 'bread and butter' of healthcare still goes on.

"The staff providing it require managerial support plus ongoing training and development throughout their careers.

"South Worcestershire PCT operates within one of the lowest administrative budgets in the NHS in an attempt to direct as much of its overall budget as possible to patients' services."

He said there was a host of reasons why the county's health trusts face debts.

The trust received less Government funding than expected, drug costs were on the increase, and new legislation had reduced junior doctors' working hours, causing difficulty in providing around-the-clock cover in some hospital departments, he said.

Other budget-busting problems included targets to reduce waiting times and lists, which meant an increase in operations that require more staff.

"Ensuring patients wait less time for investigation and treatment of cancer has put great pressure on a workforce which simply does not exist in sufficient numbers until new training programmes have produced more qualified staff," Dr Whitmore added.

"The PCT has to be aware of all these pressures and where changes are needed, they need to ensure that the public, patients, local councils and voluntary organisations are consulted in good time.

"The consultations have to be real and meaningful, despite the short time spans available."

He said the trust had set up patient groups, such as the Worcester Cancer Partnership Group, in order to listen to the concerns and suggestions raised by patients and carers who have experienced local services.

"This is just one example of our activity that indicates to the population of South Worcestershire that the staff of South Worcestershire PCT are determined to convert their money paid in tax into high quality healthcare," he concluded.

Do you haved a health story? Contact Emma Cullwick on 01905 742254 or email her at: ec@thisisworcester.co.uk