Glasgow and rural Scotland face a major clawback of their share of health funding under plans approved yesterday by Health Secretary Nicola Sturgeon.
She gave the green light to a redistribution of nearly £7bn of her budget to bring spending into line with a new assessment of health needs.
It means that, over several years, Greater Glasgow and Clyde will lose 2% of its current budget for acute services, or £35.6m at today's costs.
Although that is the biggest cut in money terms, the reduction in share of spend is far greater for small, rural health boards. The troubled Western Isles board faces a reduction in its share of the acute and community health budget, which would mean 18% less than it has this year.
The minister promised yesterday that no board will face cuts as a result of the changes, as they will be gradually phased in but an indication of their significance is the calculation of how they would change this year's budget if they were applied now.
In Dumfries and Galloway, the reduction would be of 5%. In Borders 7%, and in Highland 4%. Lothian will be the big winner, largely due to its growing population and also because it is reckoned to have been underfunded for years.
Although it could take up to a decade, the effect on this year's budget would allocate £58m more to hospital and community services in greater Edinburgh, or a 6% boost.
Lothian benefits from more than half of the money being reallocated between the formula that began to shape budgets eight years ago and the new one adopted yesterday.
Out of £6.87bn distributed to health boards to pay for hospital and community services, £82m would be re-allocated by this new formula if it were applied this year, representing 1.2% of the budget.
Among other gainers would be Lanarkshire, up by £19.6m to £755m. NHS Forth Valley would also gain, up by £12.5m to £375m. Grampian would be up as well, with an estimated £14.7m on top of its current £625m acute services budget.
There are wide differences between the money some health boards receive and the amounts they should receive under the so-called Arbuthnott formula adopted in 2000. That is because the formula has been applied only slowly to ease the past transition, and that process is not complete.
NHS Greater Glasgow and Clyde, for instance, is reckoned to receive £44m more this year than it deserves under the existing formula. While the new formula would mean much less, it represents £8.5m more than Arbuthnott recommended.
The new formula is good news also for Lanarkshire, Grampian, Orkney, Lothian and Forth Valley.
The formula was drawn up by NHS Scotland Resource Allocation Committee and takes account of changing population, life expectancy, deprivation and remoteness of rural communities.
It applies to hospital and community health, plus GP prescribing, but not to primary care such as family doctors.
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