HSJ’s daily digest of Wednesday’s essential stories

A warning for the Treasury

Health Education England chief executive Ian Cumming has warned the Treasury that any cuts to the arm’s length body’s budget would mean a direct impact on NHS frontline services.

Mr Cumming spoke out on Wednesday after senior health policy think tank figures said last week that the Treasury may try to redefine the NHS funding “ringfence” to only include NHS England’s £101bn budget.

There have been suggestions from leaders at the King’s Fund and Nuffield Trust that education and training budgets could be affected.

Mr Cumming told HSJ: “Absolutely the [HEE] budget should be ringfenced because the vast majority of what we do is direct frontline expenditure on the NHS.”

He then illustrated the kind of uncomfortable decisions NHS leaders would have to make after the comprehensive spending review on 25 November if the Treasury does redefine the ringfence: “Clearly out of a budget of just less than £5bn, if we are spending £3.5bn on junior doctors salaries, and that is not within the ringfence, there is only two things we can do. We can either pay less to the trusts for those junior doctors or we can have fewer of them.”

Two in, two out

Accident and emergency departments should be judged by two new standards, the president of the Royal College of Emergency Medicine has put out there.

Clifford Mann has called for A&Es to be performance managed, not only on whether or not they meet the four hour target, but also on how many minutes a patient waits beyond four hours and how many patients are discharged in comparison with those admitted.

This comes three months after Sir Bruce Keogh scrapped the admitted and non-admitted elective waiting time targets.

Dr Mann said these two new targets would allow commissioners and regulators to be “confident and sure” that an A&E department’s performance is being measured accurately.

He also revealed that the workforce shortage in emergency medicine is now so great that £3m is spent on locums every week. He said an average A&E costs £6.5m a year to run so a fortnight of locum spend is the equivalent of keeping an A&E open for a year.

The price of victory

The awards had a record breaking year for entries - 532 leading to 140 organisations being shortlisted. Twenty-one organisations have been judged to be leading the way in this increasingly important area for the NHS.

The tough competition for shortlisted places and trophies reflects the service’s increased focus on the financial challenge. It also reflects the success with which the best entrants are meeting it.

In November’s spending review, the government will make the most important financial announcement for the health service since the 2002 budget. Even if it settles on the most generous possible interpretation of its commitment to an extra £8bn for the NHS, the service is going to find itself struggling for cash. Our winners have lessons on saving money without compromising care for the whole NHS.