Simon Stevens, Sir Bruce Keogh and Jane Cummings face MPs, plus the rest of today’s news and comment
Simon Stevens at the health committee: what you need to know
- NHS England chief says the “single most important thing” this year is to reduce agency spend
- Department of Health figures show cost of running the NHS has fallen by £7bn since 2010
- First wave of urgent and emergency care vanguards to be announced this week
- Keogh: new research shows “weekend effect” on mortality rates
5.10pm How heroic efficiency savings will be made, being assertive, and underwear sales: have a read of the key points from Simon Stevens, Sir Bruce Keogh and Jane Cummings’ answers to Commons health committee questions today.
4.35pm Monitor’s annual report and accounts for 2014-15 confirmed that the foundation trust sector ended the year in deficit for the first time, with over half of all FTs losing money and a record one-fifth in breach of their licence.
The regulator’s chief executive David Bennett said the strategic plans originally submitted by FTs for 2015-16 and beyond were “unaffordable” and would have resulted in a worse financial performance for the sector than last year.
In his review of the year, Mr Bennett said: “Experience has taught us that struggling trusts cannot resolve their difficulties alone: they need a concerted, long-term response from the various providers, commissioners and users of services who make up their local health economy,” he wrote.
“Individual trusts, however, each need a reliable plan for the future and many are falling short on this. A review of trusts’ five-year strategic plans showed that only 30 per cent would secure a sustainable future.”
Other issues highlighted in the report include:
- Although 10 FTs were found in breach of their licence during 2014-15, eight demonstrated sufficient progress for Monitor to end regulatory action;
- Three FTs exited the special measures regime (two by delivering improvements in quality, one through merger with a neighbouring FT);
- Six new FTs were authorised, including the first three community FTs and the first FT providing high security psychiatric services – taking the total to 151, or two-thirds of all NHS providers;
- There was a significant decline in FT earnings, and the overall earnings margin of 3.8 per cent was below the five per cent threshold used to assess the long-term financial sustainability of FTs;
- The deterioration in financial performance was driven in part by “excessive use of agency staff” in response to demand, and exacerbated by a failure to achieve the cost savings planned.
Monitor confirmed that only 30 per cent of FTs submitted plans setting out a sustainable future in the medium term.
The annual report said: “70 per cent of plans suggested their trusts’ sustainability was at risk to varying degrees. Without fundamental change – for example, integrating and redesigning patient services – the sector is likely to face increasing financial distress.”
Mr Bennett said: “Our priority has been to help local commissioners and providers redesign the way they deliver healthcare for longer-term sustainability while continuing to maintain their operational performance. All this has to be done by the sector in the face of increasing demand and constrained funding.”
4.30pm The Department of Health underspent its revenue budget by just £1.2m in 2014-15 – a fraction of its £110bn budget – the department’s accounts reveal.
This is despite the DH’s position against its expenditure limit being propped up by a £250m increase to the revenue budget from the Treasury, plus £640m being transferred from the capital budget.
These transfers, revealed by HSJ in February, were prompted by the huge revenue pressures on the NHS provider sector.
Appearing at the Commons health committee today, Sir Bruce said he had been asked to revisit research on mortality rates for patients at weekends by the organisation’s chief executive, Simon Stevens, who also answered questions from the committee today.
Sir Bruce said his work was due to be published soon but told MPs it would support previous research showing there was higher mortality at weekends.
Burton Hospitals Foundation Trust believes the 10 year deal with the consortium, formed by companies EC Harris and Community Solutions Partnership Services, could also release millions of pounds for substantial hospital refurbishment.
The trust plans to use the partnership to raise capital on private markets in exchange for assets being transferred to the partnership. The trust will retain a 50 per cent stake in the assets, providing it with an ongoing revenue return.
This upfront investment by the consortium will be used to upgrade the trust’s emergency department, neonatal unit and outpatients department.
1.30pm NHS England will draw down a further £579m of historic surpluses to help the commissioning system break-even this year, new board papers reveal.
It is the second year the NHS commissioning system has relied on a large drawdown to stay in the black, raising concerns that similar reserves might not be available to cushion the sector in future years.
1.22pm The health committee hearing has now ended.
1.21pm Sir Bruce Keogh says that in September there will be a summit of all regulators to see how progress can be made on speaking out.
1.16pm Stevens: “This is about changing the expectations of leaders and organisations… [about] when an issue arises, what is the reflex response… We need accountability but we also need an improvement culture”.
1.13pm Labour MP Liz McInnes asks about the duty for candour now applying to all medical professions.
1.11pm Sir Bruce Keogh: “There is an increased recognition that mental health and physical health go together.”
1.10pm Sir Bruce Keogh: the younger age group in particular are now more relaxed about talking about mental health.
10.09pm Stevens: “I detect hugely encouraging signs [on mental health], even over the last 24-36 months.”
10.08pm Stevens: we are clear that the mental health taskforce has got to be co-designed with users of those services, experts by experience.
1.07pm Stevens: NHS England this year asked every CCG to increase its spending on mental health services at least in line with its overall growth.
1.05pm The discussion at the health committee hearing has now moved to mental health.
Stevens notes that £30m has been put in this year to pump-prime liaison psychiatry.
He also points out that use of the police cells for mentality health crises has reduced by 57 per cent from 2011-12.
1.03pm Andy Cowper also tweets about a joke made by Simon Stevens, which he said was in reference to Sir Stuart Rose’s former role as the chief executive of Marks and Spencers:
Simon Stevens: complexity of NHS management greater than that of selling underwear, alluding to wubbish #Woseweview. Jokes remark should 1/2
— Andy Cowper (@HPIAndyCowper) July 21, 2015
2/2 be struck from the record.
— Andy Cowper (@HPIAndyCowper) July 21, 2015
12.51pm HSJ comment editor Andy Cowper tweets:
On creating new types of cross-working clinical jobs, slow progress due to professional infrastructures, Simon Stevens tells HSC
— Andy Cowper (@HPIAndyCowper) July 21, 2015
12.47pm Conservative MP Maggie Throup asks Stevens how confident he is that the new models of care can be delivered.
12.45pm Labour’s Emily Thornberry is now quizzing Simon Stevens on ambulance services. She points out that if ambulances waiting over an hour to discharge, then patients don’t get access to one and could die at home.
12.40pm Stevens: Coming out last winter, the joint working between the NHS and local authories is continung to improve.
12.39pm Stevens says there is a trade-off between the how much you can pay the people employ and the number of people you employ.
12.38pm Stevens: “In the fullness of time, ultimately the NHS needs to pay [staff] the growing rate relative to the private sector, in order to recruit and retain the staff we need.”
12.37pm Stevens is asked by Labour MP Liz McInnes on the government’s announcements of a public sector pay restraint, announced in the Summer Budget.
“That is a question for the Department of Health, rather than NHS England,” he answers.
12.35pm The health committee hearing has now resumed.
12.26pm The health committee is now taking a short break.
12.22pm The proposition from NHS Employers is that no consultants should work more than 13 weekends a year, nevertheless where there are mortality concerns there does need to a change to working patterns.
12.20pm Stevens says the aim is not to provide all services seven days a week, but to “to forensically focus quite tightly” on those aspects of the health service where there is the greatest impact on weekend mortality.
12.15pm Face-to-face appointments don’t need to be the only model of seeing patients in primary care, Stevens argues, pointing to greater use of technology.
He says we need to look at other ways of treating patients for general practice to continue to be sustainable.
12.12pm Stevens on seven day services: “In an ideal world the health service would recognise that people have busy lives and can’t always take half a day off midweek to go an appointment.”
12.10am Discussing his work on weekend mortality, Sir Bruce Keogh tells the committee of his finding that the day of admission affects mortality.
He says this is an issues affects both elective and non-elective patients. Junior doctors are under pressure and under supported at weekends, he continues.
Sir Bruce also says new research that is due to be published, supports his findings.The sickness of patients at weekends has been taken into account in this research, and services should be available to care for them, he adds.
12.01am Sir Bruce Keogh references a HSJ survey of chief executives, who were asked whether they thought their hospitals were as safe during the weekend as during weekdays.
“You can guess what the answer was,” he says.
HSJ’s survey, carried out in January 2013, found that chief executives have significant doubts their hospitals are as safe at weekends as they are in the week.
The survey asked chief executives to rate their confidence in weekend cover at their trust from one to 10 (one being the lowest). The national average score was only 5.9.
11.58am The hearing has now moved onto seven day services.
Simons discusses the “legitimate reasons” the government has sought to bring seven days in NHS, pointing to the weekend effect on mortality rates and outcomes.
11.54am Stevens: NHS 111 is “not bad” but “it can be better”.
He gives some examples on how it could improve: It could be joined up with out of hours services. Information about patients could be shared with paramedics, an callerscould have this infroamtion reasily to hand. NHS 111 also have the abilty to book patients with a slot with their out of service or GP surgery the next morning.
11.50am Sir Bruce Keogh: In relatively short order, we’re going to see more mobile monitoring… moving towards more self-help.
11.47am Stevens: We need to move to a health service that is more anticipatory.
11.46am The government has published a short statement on the costs and benefits of the Health Act 2012 reforms.
It says costs were lower than planned and savings were greater. It says: “This means the government has successfully achieved its aim to reduce NHS bureaucracy costs by a third.”
HSJ senior bureau chief Dave West tweets:
Gov statement on ‘cost/benefit’ of Lansley reforms: http://t.co/tFPVvv5cQJAs most know the damage caused was disruption & opportunity cost
— Dave West (@Davewwest) July 21, 2015
11.43am Stevens is questioned on the government’s target for 5,000 more GPs by 2020.
“5,000 is going to be tough under the circumstances,” he says. He adds that we need to increase the attractiveness of general practice as a profession, but notes regional differences. London has no difficulty recruiting GPs, whereas regions such as the East Midlands struggle.
There “fairly concerted efforted” between NHS England, the RCGP and the BMA’s GP committee to get more trainees into general practice, he continues. “We are at a pivot where we’ve got to do something different… while keeping all that is great about general practice.”
11.41am Cummings: “We absolutely will be delivering on recommendation 23 [on safe staffing] from the Francis Inquiry”
11.40am Cummings says she has discussed safe staffing with Sir Robert Francis, and is happy with way forward as announced by health secretary Jeremy Hunt last week.
11.38am Cummings: Work by patient safety director Mike Durkin will have a strong focus on patient safety, and will besigned off by NICE and Sir Robert Francis.
11.36am Cummings: “We have always said that NICE would continue to support the work… they were always going to be engaged as we move forward.”
11.35am Jane Cummings: what has been increasingly clear is that looking at one profession has not been helpful, and we need to look at it in the round.
11.34am The SNP’s Phillippa Whitford now asks about NICE safe staffing guidelines, which HSJ has reported on widely.
11.33am Stevens: We need to substantially reduce the amount of spending on management consultancies, and a £50,000 limit for new contracts.
11.32am Earlier in the hearing, Jane Cummings said there would be an extra supply of 23,000 nursing staff by 2020.
She now clarifies that there is a “a very good supply of people in the UK who want to become nurses or midwives”, pointing out that there are more people applying to posts than there are posts available.
11.29am Labour MP Rachel Maskells asks Jane Cummings to clarify who she meant by those who could see the rise in agency staffing coming.
Some provider directors of nursing had expressed they were likely to need more nursing staff, Cummings responds.
“It’s very easy with the benefit of hindsight to say we should have known that,” she says.
11.26am Shaun Lintern also tweets on high numbers of agency staffing:
.@JaneMCummings accepts the pressures on nurses and the higher pay & flexibility of agency work may be a factor.
— Shaun Lintern (@ShaunLintern) July 21, 2015
11.25am HSJ correspondent Shaun Lintern tweets:
Stevens recognises the lack of investment and upstream availability of services in #mentalhealth has knock on costs later for services
— Shaun Lintern (@ShaunLintern) July 21, 2015
11.23am Asked on how we got to the situation of “exponential” growth in agency staff, Jane Cummings said some people did see this coming.
11.18am Stevens asked by Sarah Wollaston about whether the government’s £200m cuts to non-NHS public health funding will affect frontline services.
“It’s too early to say… But going forward that would not be a smart approach across the rest of the porfolio,” he responds.
11.16am Stevens: public health is “central” to achieving aims in the NHS Five Year Forward View.
The funding benefits from prevention will be felt in the back end of the five years, “but nevertheless it is clearly the right thing to do”
11.14am Sir Bruce Keogh: the national obesity statregy needs to span a number of different departments. It needs to start with education, and also relates to issues surrounding transport and exercise.
11.11am Stevens: on the things that the mental health taskforce is to look at is there a way, with local authorities, with helping people get back to work.
11.07am Stevens is now being quizzed on local authority-run public health services.
He says, owing to their democratic accountability, they have the ability to do some things that the NHS, with its national accountability, cannot.
11.04am Stevens is asked about whether public health is the poorer cousin of the NHS.
“I hope not, and it certainly needs not to be over the next five years,” he responds.
“That means a more assertive posture on tobacco, alcohol and sugar”
10.57am Asked about health and social care integration, Stevens says this will be different across the country. Some will “be full budget blending”, some will be with individuals through personal budgets, some will be with providers. However, this will rely on “mutual aid between the health service and social care”.
On whether full health and social care budget ingration is the solutions, he says: “Just combining two leaky budgets does not provide a watertight funding solution”.
“There are risks at a time of substancial funding pressures on both sides of the equation,” he adds.
10.45am Stevens is asked if there is a danger that on a local level contracts are inflexible and prevent creativity.
10.38am Stevens: “we’ve had a lively internal debate” between setting a national expectation for the vanguard sites, and letting them set their own metrics.
10.36am Stevens says vanguard sites are expected to do two things. First, bring about demonstrative change in their local area. Second, they must “produce generalisable insights that other parts of the health service can then beg, borrow and steal”.
10.34am Stevens is asked if all 29 vanguard sites are moving at a pace he is happy with.
“Yes… I do think it’s reasonable to allow them to tool up”, he says. He adds the discussion so far has been “high energy, but not pie in the sky”.
10.31am Stevens we are going to announce this week the first set of urgent and emergency care vanguards.
10.30am Stevens is asked if there are plans to extend the success regime to other parts of the country.
“In time yes, but first of all we need to demonstrate some success in our current three,” he responds.
10.29am Stevens: DevoManc will not be the universal model for England.
10.25am Sir Bruce Keogh: “We have to be very careful that we don’t undermine smaller hospitals”
10.21am Stevens says the summer budget announcement for public service pay restraint would increase the amount of effiency savings by this means, but this would still be “far and away the minority”.
10.15am Stevens: “We are not fixated on the idea there needs to be a single approach, we are responsive to the kinds of changes that people want to apply locally”.
When asked about section 75 regulations, he says people are finding flexible ways bring about integrated working.
10.12am Stevens says Department of Healht figures, expected to be published today, will say that costs of running the NHS have fallen by about £7bn since 2010.
“I suspect we are probably now the leanest when it comes to the management costs of any country”.
10.10am Cummings: Health Education England have increased the number of training positions for all staff, particualarly nursing staff.
But it’s not just about bringing more in, but making sure the existing staff and treated well and want to stay.
10.09am Chief nursing officer Jane Cummings: “We have to move the number of people working in agencies into permanent staff”.
10.07am Stevens admits that “we are now facing the consequences” of relative underinvestment in primary care over the past ten years.
10.05am Stevens says the “single most important thing” this year is to reduce agency spend. “It is critical we get that right.”
10.04am Labour MP Emily Thornberry says all of the clinicians she has spoken do not think the £22bn efficiency savings is achievable, and some think Simon Stevens is also aware that it is not achieveable.
She expresses her disappointment that he has not given more details about these effie
Stevens explains that a quarter of efficiency says would come from “prevention and demand moderation - “a combination of the things that are going to come from prevention and alternatives to hospital admissions”
Another quarter will come from reducing the prices that are charged to the NHS, while the third chunk (about 50 per cent) are the “voluminous” producivity oportunities for the provider sector
10.00am Stevens says there will be a “catch up period”, but over time we’ve got to focus on doing things better, which he describes as “frontiership”.
On whether additional funding would need to be frontloaded, Stevens says this would be decision for the Chancellor, but there “would clearly need to be investment” to ensure major changes can be brought about.
9.54am Asked on how these efficiency savings will me made, Stevens says “There are lots of zones where we are now mobilising folks to go at this hard”.
Stevens says half of efficiency savings comes from increasing productivity in the health service.
“We are not using our collective purchasing power effectively.”
“There is too much of ‘go it’ alone” culture among organisations”, he adds.
“Often for understanding reasonsable reasons”, he said “foolish decisions” had been made to cut staff that would save money in the long term, giving the example of mental health. There is also
9.51am Wollaston asks about the consequence for patients if the NHS fails to make £22bn efficiency savings.
Stevens: “The health service in 2020 will be bgger, better funded and providing better reatments, but over and abov that we need to create extra headroom”
When pressed further, he sauys “there will be missed opportunities for the things we want to”, giving the examples of mental health services and expanded primary care.
Wollaston clarifies whether this means it will result in not being able to make improvements to services, rather than cutting services
“It’s some combination of those two,” Stevens adds.
9.47am Stevens: “Since last October at least four things have changed.” He elaborates:
First, We are now in year one of the NHS Five Year Forward View. Second, the atumn statement. Third, budget annoucnements “changed some of the assumptions” about how much money the NHS had. He also said “we have had new cost pressures building up”, particularly in hospitals.
9.44am Dr Wollaston asks about funding, and how realistic the £22bn efficiency savings are.
“How accurate do you think those assumptions are?,” she asks
9.43am Committee chair Sarah Wollaston asks Simon Stevens what problems are keeping him awake at night
Stevens says three spring to mind immediately. First, keeping current services running while “how to manage for today while transforming for tomorrow”. Second, getting the balance right between local energy and national accountability. Third, “juxtaposing our focus on the national health servce” with looking at the other determinants of health.
9.41am The health committee hearing has just begun.
This is the first meeting of the new health committee following the general election. Former GP and Conservative MP Sarah Wollaston remains chair, but the majority of the committee’s membership has changed.
7.00am Good morning. Today NHS England chief executive Simons Stevens and chief nursing officer Jane Cummings will appear in front of the Commons health committee today.
It is Mr Stevens’ first time in front of the MPs since the general election in May. Mr Stevens and Ms Cummings are expected to be questioned on safe staffing levels following criticism of NHS England asking NICE to suspend its work on guidance and Jeremy Hunt’s intervention in the row last week.
The session is due to start at 9.30am. Follow HSJ Live and @HSJnews for updates.