A QUICK glance at the Nuffield Trust's report into the funding pressures facing the NHS in Wales to 2025/26 might be enough to trigger shivers at the thought of what type of service we will have left by then.

The report, commissioned by the Welsh Government, looks at the huge financial challenges facing the NHS until the mid-2020s, and the reasons for rising pressures on the service.

Packed with figures, it is tough read for those of us for whom the labyrinthine world of finance is not a strong point, but its message is clear: Given even the best case scenario, massive savings will have to be made during the next decade to keep the NHS in Wales within budget.

In a way this is of course, nothing new, particularly to those within Wales' individual health boards who have over the last four or five years had to oversee savings programmes totalling tens of millions of pounds.

Since Aneurin Bevan University Health Board came into being five years ago this autumn, it has presided over annual savings programmes that overall comfortably top £150 million. And the latest estimate of the cumulative savings required between now and the end of 2015/16 is around the £80m mark.

The Nuffield Trust report's headline estimate is that there will be a funding gap of £2.5bn for the NHS in Wales by 2025/26, at 2013/14 prices.

That is based on a series of assumptions including maintenance of the current rate of efficiency savings until 2015/16 and that funding is held flat for the decade thereafter.

Other assumptions about the possible funding available for the NHS in Wales over that 10 years produce estimates of a funding gap of between £1.1bn and £3.6bn.

Sticking with the £2.5bn estimate, and trying to put it into some sort of context, that is equivalent to the total budget for the NHS in Gwent during the next two-and-a-bit years.

And while the task of bridging that gap would be spread out across Wales and across a 10-year period, it is still an eye-watering amount of money.

The mantra throughout the NHS in Wales in recent times has been that the service must change to meet the challenges of an ageing population, rising demand and a tougher financial reality.

Changing the way health services are provided however, is a complex and sensitive process, wherever in the UK that change might be proposed.

For more than two years, health bosses and clinicians in South Wales have been planning changes to four key services - emergency care, neonatal services, obstetrics and paediatrics - to try to meet the challenge of improving staff training and practical experience, and the safety and quality of patient care.

But it means fewer hospitals in the region will provide a complete range of the aforementioned services, and the consultation on the proposals, known as the South Wales Programme, has been a long process, not least because the need to take into account the tens of thousands of consultation responses.

Part of the South Wales Programme includes plans for a Specialist and Critical Care Centre for Gwent, which itself is the centrepiece of a service modernisation programme called Clinical Futures that has its origins back in 2003 and which will not see the centre completed until 2019.

In tandem with all this are ongoing efforts to try to minimise hospital admissions, and provide more care in or closer to people's homes, a challenge when as a general population we are living longer but the burden of chronic illness is subsequently getting heavier.

The Nuffield Trust report states that the population of Wales will rise by five per cent between 2012-25, but while the under-65s population will increase by one per cent, the over-65s will rise by 26 per cent.

In the nine years to 2010/11, the number of people admitted to hospital with a chronic condition rose from 105,000 to 142,000.

One of the report's most striking projections is that of the increase in NHS spending need of individual health boards, from 2010/11 to 2025/26 based on a continuation of average staff pay rises, increases in chronic condition admissions according to long term trends, no acute sector efficiency savings, and a halt in the fall of unit costs for prescriptions.

With these assumptions in mind, the spending need would increase by between 53-67 per cent, with Aneurin Bevan University Health Board requiring a 56 per cent increase.

Against an existing annual budget of just over £1bn, that would mean some £500m more for Gwent, but the reality is that this will not happen and budget settlements for the early part of this 15-year period show that big annual savings, of £20m and more, are having to be made.

The big question is how many more efficiency savings can be made in a service that, across the UK, has in another report this week been deemed one of the most cost efficient in the developed world?