Commissioners have selected a consortium led by NHS providers as preferred bidder for a pioneering £800m contract to deliver older people’s services in Cambridgeshire, plus the rest of today’s news and comment

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4.30pm The Royal College of Nursing has criticised the NMC’s decision to increase registration fees to £120.

Peter Carter, the body’s chief executive and general secretary, said: “This is a big blow to nurses and midwives.

“It means yet more pressure on their personal finances at a time when they are still reeling from the Government’s unfair decision to deny them a cost of living pay rise.

“The NMC’s move to hike its fees is deeply damaging to nursing morale, which is why the RCN totally opposes this increase.”

He added: “We believe the NMC should pursue alternative funding options instead of expecting some of the lowest paid public sector workers to bear the brunt of its financial problems.

“The health service is already struggling to keep nursing staff in the profession. If the government wants to show support for a workforce that is feeling dejected and unvalued it should step in to help fund the NMC’s work and ensure this outrageous fee rise is avoided.”  

4.25pm GMB is the fourth trade union to vote in favour of strike action over the dispute over pay for NHS workers. It follows Unison, Unite and the Royal College of Midwives.

However, the Royal College of Nursing has said it will not ballot its members for strike action.

4.20pm Members of the GMB union in England and Northern Ireland have voted to support strike action over NHS pay.

GMB said 78 per cent of its balloted members voted in favour of strike action and 91 per cent voted in favour of action short of a strike. Turnout was 23 per cent.

It will now issue formal notices to NHS employers of strike action on 13 October and further action short of a strike the rest of that week.

Brian Strutton, the union’s national secretary for public services, said “GMB members have spoken loud and clear. They are prepared to take industrial action in the NHS to fight for fairness in pay.

“GMB is open to talks with government and employers but unless there is some meaningful change we will be calling on GMB members to hold a four hour strike between 7am to 11am on 13th October. This will be followed by an overtime ban in the ambulance service from 14-17 October and for the same period a ‘work your paid hours’ instruction for the rest of the NHS.

“We are sending formal notification of this action to all affected NHS employers so that they can work out essential cover requirements to ensure patient safety.

“Nobody in the NHS wants to go on strike, but the anger and frustration of the workforce with the cavalier treatment by government and employers towards them has spilled over into industrial unrest.

“GMB and the other trade unions on the staff side hope this programme of action will get some movement in this deadlock and we will plan further periods of action through the autumn and winter if it does not.

So it is imperative that Jeremy Hunt, the Secretary of State, meets the staff side unions as a matter of urgency.”

4.05pm The Spectator’s Isabel Hardman argues the prime minister’s section on the health service was the strongest part of his address to the Conservative Party conference:

“The best passage was undoubtedly his thundering judgement on Labour’s NHS campaign. He spoke, clearly choked a little by emotion, about his own experience of relying on the NHS ‘night after night with a child in your arms’. ‘How dare they suggest I would ever put that at risk for other people’s children?’ he shouted. ‘How dare they frighten those who are relying on the NHS right now?’

“It was sincere, and it was good. But it was also necessary because the only small sparks of passion that came from the Labour conference last week were on the NHS. It may be the only place that Ed Miliband’s party can go, but it’s still a pretty good place for them to go because voters care about it. So the Tories needed to neutralise that NHS attack. And speaking about it in personal, emotional terms makes it much more difficult for Labour to respond.”

3.57pm Responding to the prime minister’s speech, Rob Webster, chief executive of the NHS Confederation, said: “Mr Cameron has set out his commitment to invest in the NHS until 2020.

“This includes a welcome announcement on protecting NHS funding in real terms for 5 years.

“We recognise that this requires some early choices on investment elsewhere.

We will need to wait for the whole picture to emerge to get a sense of whether this will be a sufficient step towards sustaining the NHS in the future.

“We need to see, for example, how social care fits into what is a critical period for the service.”

3.54pm The Royal College of Nursing has also responded to the prime minister’s pledge to ringfence NHS spending.

Peter Carter, the body’s chief executive and general secretary, said: “The NHS is currently on a knife edge – staff are trying to deliver against a backdrop of tight finances, staff shortages and short term planning.

“Staff will feel some degree of relief that the NHS will have its budget protected under a future Conservative government.

“However this merely mirrors the financial situation during this parliament – and the reality on the ground has been of intense pressure, long waiting times, rising demand and undervalued and demoralised staff.

“NHS patients now need all parties to acknowledge the scale of the demands which will face health and social care over the coming years. With the twin challenges of an ageing population and public health emergencies, it is difficult to overstate how badly a real injection of funding will be needed.

“We are encouraged that the prime minister believes this is important enough to place it at the centre of his conference speech.

“As the NHS becomes the battleground at the next election, the RCN is determined to hold all the parties to their pledges and ensure that the rhetoric matches the experience of staff and patients.”                                   

3.30pm Responding to David Cameron’s announcement that the Conservatives would protect the NHS budget in the next parliament, Nuffield Trust chief executive Nigel Edwards said: “At a time of continuing austerity across the public sector, the prime minister’s pledge to protect NHS spending in the next parliament is of course welcome.

“But we should be under no illusions: a flat spending settlement for health looks and feels very similar to a spending cut.

“Up until 2010 health spending grew above inflation every year, due in large part to the ageing population, technological change and staffing costs. So the spending settlement over the past 5 years has subject the NHS to a historically unprecedented squeeze.

“These pressures aren’t going away any time soon. In fact, with efficiency savings harder and harder to realise, more and more hospital trusts going into the red, and hospital admissions still on the rise, the next few years look set to be some of the toughest the NHS has ever faced.

“What’s more, as austerity across the wider public sector bites, already very deep cuts to social care will put many frail elderly people and their carers under even greater strain. This will inevitably impact upon their health and wellbeing as well as on the wider system. This is despite the fact that around £1bn is being transferred from health budgets to social care.

“Protecting the NHS budget is important and necessary. But the bigger question facing the next government concerns how they will fund health and social care over the long-term.”

3.27pm The first successful takeover one foundation trust by another has received final approval, it has been announced.

Frimley Park Foundation Trust’s takeover of neighbouring Heatherwood and Wexham Park has been signed off by Monitor, with final formalities set to be completed before the end of the week.

3.13pm Also in The Times (newspaper only), prostate cancer patients face a lack of access to specialist NHS nurses and are often denied the best treatments, a report says.

According to the male cancer charity Orchid, men with prostate cancer receive less help with controlling pain and a lower standard of care than patients with other common cancers, such as breast cancer.

3.01pm The Times reports that many health charities campaigning for the use of specific drugs could be caught in a conflict of interests because they are receiving funding from the companies making them, according to a report by the BMJ.

The report names the Multiple Sclerosis Trust as an example because it received funding from Bayer. The charity says that the National Institute for Health and Care Excellence is denying patients “lifesaving” drugs such as Sativex, which is marketed by Bayer.

2.23pm Responding to the Conservative Party’s NHS announcement at its annual conference in Birmingham, King’s Fund chief exectuive Chris Ham said: “At last senior politicians are beginning to debate the very significant challenges facing the NHS.

“We now wait to hear from the Liberal Democrats next week and hope this signals the start of an open and honest debate about how to address these challenges in the run up to the election and beyond.

“However, as they stand, neither Labour nor the Conservatives have addressed the scale of the funding challenge facing the NHS. In the short term, more money is needed to support NHS organisations struggling as a result of the unprecedented pressures on their budgets and meet the costs of essential changes to services.

“While there is still scope to improve productivity, unless this funding is found, patients will bear the cost as staff numbers are cut, waiting times rise and quality of care deteriorates.

“In the long term, as the Barker Commission has set out, a new settlement is needed that puts health and social care on a sustainable footing. This means ending the historic divide between the two systems and facing up to hard choices about how to pay for this.

“The focus this week on general practice is very positive and we welcome the commitment to extend opening hours to more GP surgeries. What is needed now is a detailed debate about how primary care is organised. While the pressures they are under should not be under-estimated, GPs need to work differently to deliver a wider range of services to larger numbers of patients.”

1.50pm Councils in London have asked to be given greater involvement in the commissioning of primary care.

London Councils, which represents the capital’s 32 boroughs, has written to NHS England calling for local authorities to have a bigger role in several ways.

The letter, shared with HSJ, comes as NHS England examines bids from most clinical commissioning groups to “co-commission” general practice, which the national organisation is currently responsible for.

1.46pm Responding to David Cameron’s speech to the Conservative Party conference, shadow health secretary Andy Burnham said: “Labour has already pledged an extra £2.5bn over and above Tory plans to pay for 20,000 more nurses and 8,000 GPs - investment that David Cameron has failed to match.

“People will take David Cameron’s pre-election pledges on the NHS with a large pinch of salt. Last time, he promised ‘real-terms increases’ but then cut NHS spending in his very first year in office.

“He promised ‘no top-down reorganisation’ but then brought forward the biggest ever, throwing the NHS into chaos and siphoning £3bn out of front-line care to pay for it.

“He promised no privatisation but has proceeded to put NHS services up for sale without the permission of the public.

“He promised to protect the NHS but its getting harder to see your GP and waiting times are going up.

“Cameron’s promises on the NHS have been shown to be not worth the paper they are written on. You can’t trust the Tories with the NHS.”

1.40pm Unite has criticised the the NMC decision to increase registration fees to £120 as a “kick in the teeth” and accused the body of “riding roughshot” over nurses.

The union’s professional officer Jane Beach said: “Our members will feel that they have been kicked in the teeth by the NMC which pushed ahead regardless, riding roughshod over the strong opposition of its registrants. 

“Nurses, midwives and specialist community public health nurses have seen their pay eroded by up to 15 per cent in real terms since 2010 – and now the financial thumb screws have been turned again.

“This decision was made, despite the fact that the NMC has nearly £10m locked way in its reserves.

“And our members are still reeling from absorbing the last 32 per cent increase – from £76 to £100 - in the registration fee.”

Unite’s policy is that there should be a moratorium on any fee hike until at least March 2016 – and even then, any increase should be linked to the annual pay rise for NHS staff.

Unite also represents mental health, acute and school nurses, as well as a number of midwives.

1.29pm The Council of the Nursing and Midwifery Council today agreed to increase its annual registration fee for nurses and midwives from £100 to £120.

The change will take effect from March 2015.

NMC chief executive Mark Addison said: “Today we made the difficult decision to increase the annual registration fee for nurses and midwives to £120. 

“We have considered the responses to the consultation in detail and we have listened carefully to the issues raised.  We recognise the financial pressures that many nurses and midwives are facing at a time of widespread pay restraint, and the tough and demanding jobs they do.

“However, as council members and trustees of the NMC, our first duty is to ensure the protection of the public. We are committed to keeping the fee at the lowest level which allows us to fulfil that statutory duty, and we will continue to search for more efficient ways of working. 

“Currently, the only way for us to significantly to reduce our costs is to change the existing legislation, which requires us to take more cases to a hearing than is necessary.  We will continue to press vigorously for changes to our legal framework.”

1.25pm The Health Foundation has also welcomed responded to the governement’s pledge to ringfence the NHS budget.

Chief executive Jennifer Dixon said: “ In 2015-16 alone the NHS will have a hole in its finances to the sum of £2bn.

“Spending pressures are expected to increase by £30bn by the end of the decade but most estimates suggest that productivity savings will meet just a third of this. There is no quick fix.”

“Our More than money: closing the NHS quality gap report which was launched last week argues that we need an increase in ongoing funding for the NHS above and beyond inflation, alongside a new transformation fund to support changes in the way that care is delivered.

But we believe that money itself is not enough. What is needed is capability support for providers of health care working to deliver integrated care.

“Such support might include building skills in basic management, change management, improvement skills and analysis, all with the objective of improving quality and efficiency. 

“Further to this we appeal for candid dialogue between politicians and both the public and NHS about the challenges, and why significant change is needed now.” 

1.20pm The Foundation Trust Network said it “welcomes the Prime Minister’s pledge to preserve the NHS ring fence throughout the next parliament.

A statement issued this afternoon read: “Given the likely pressure on public expenditure this is a significant and important commitment”.

“However, the harsh and uncomfortable reality is that neither this nor the pledge made by Labour last week goes very far in closing the financial gap facing the NHS. Demand for NHS care is rising by 4 per cent a year - in the first three months of this financial year, for example, hospital emergency admissions were up by 4% and the most urgent ambulance journeys by 7 per cent.

“Under both pledges, the NHS’ income would lag a long way behind the demands being placed upon it and the service would have had 10 continuous years of its lowest ever income growth.

“The NHS has a lot of work to do by next May to work out how we close the gap over the life of the next Parliament. Our members are working hard to ensure that they can release every potential pound of efficiency saving.

However, as Monitor has highlighted, even if every efficiency gain and new model of care is delivered there would still be an overall gap of £7bn at national level. In parallel, our members are looking at how to transform services around the needs of patients in partnership with other local organisations.

“They are working to break down the barriers between different parts of the NHS, for example hospital and primary care. This work must continue and, as it does, we will need a national debate on the choice between more money for the NHS or a lower level of care.

“Avoiding this debate will lead to piecemeal failure. Patients and the public deserve better.

“In the meantime we face an urgent, major, problem. The NHS’ financial plans for 2015-16, which need to be finalised in the next 60 days, have a £2bn gap. We either have to fill this gap or provide less care.

“Given that 60 per cent of acute hospitals are now in deficit, the option of simply passing the problem to NHS providers, as the NHS has done over the last four years, carries the risk of tipping the entire sector into financial collapse.”

12.40pm The prime minister also attacked Labour’s ability to govern the NHS, evoking the Mid Staffordshire scandal.

He said: “It was the Labour Party who gave us the scandal of Mid Staffs,” and accused the party of saying “the old rubbish about the Conservatives and the NHS” and  “spreading complete and utter lies”.

12.35pm The prime minister only briefly discussed the health in his address to the Conservative Party conference.

He said: “We came in and we protected the NHS budget”.

Confirming that he would ringfence NHS spending, David Cameron said: “The next con government will protect the nhs budget and [invest] more”.

He said the Labour has never understood and would never understand that “you can only have a strong NHS is you have a strong economy”.

He cited the cancer drugs fund as one of the government’s successes, but said that was “only possible because we managed the budget”.

“More people are hearing those magic words - ‘all clear’,” he said.

“From the country that unravelled DNA, we are now unmapping it for every individual”.

12.31pm Cameron refers to his son Cameron, saying: “I’m someone how’s relied on the NHS and know how important it is”

Speaking about the opposition, he said: “How dare they suggest I would ever put that at risk for other people’s children?,” to a rousing applause.

12.27 Cameron has now begun speaking about the NHS.

11.58am David Cameron said: “English votes for English laws, the Conservatives will deliver it”. This would mean that English MPs alone would be able to vote legislation concerning the English health service.

11.48am After an introduction by chief whip Michael Gove, David Cameron has begun his address to the Conservative Party conference.  

11.37am Introducing David Cameron, chief whip Michael Gove said: “There are more doctors and nurses than ever before, who are working in an NHS that is better before”.

He also described the Conservatives as the “party of social justice”.

11.15am David Cameron is expected to announce his pledge to ringfence NHS funding in his address to the Conservative Party conference.

HSJ Live will be following the prime minister’s speech live from 11.30am today.

11.09am The Financial Times writes: “The prime minister’s final conference speech before the end of the election will attempt to set an optimistic tone, looking beyond spending cuts and holding out the prospect of tax cuts for working families.”

“The decision to extend protection of health spending until 2020 means George Osborne, the chancellor, has a shrinking number of targets for cuts as he attempts to reduce public spending by at least £25bn.

“But the prime minister believes the Tories must confront Labour’s claims that the health service would be endangered if he wins a second term.”

11.00am In a leader today, The Telegraph says: “If it comes down to a choice between providing better care for patients and avoiding inconvenience to their doctors, it is clear which side the government should be on.”

10.57am The Daily Telegraph reports that, in a direct challenge to Labour, the prime minister will say that his strong record on the economy means that he can afford to protect spending on the health service.

Mr Cameron will tell delegates at the Conservatives conference in Birmingham that the death of his son Ivan in 2009 made him “understand very personally” the importance of the NHS.

He will add that the Labour party “will never understand” that the country “can only have a strong NHS if you have a strong economy”.

10.53am There is plenty of coverage of the prime minister’s offer to “protect” NHS funding in today’s papers.

The Guardian reports that this is the first time the prime minister has pledged to ringfence the health service from spending cuts for the next parliament, but it will still leave the NHS under cost pressures due to increased demand for services.

10.45am The Parliamentary and Health Service Ombudsman is radically changing how it investigates complaints and provides customer service to ensure people have a voice when they have a complaint, writes Dame Julie Mellor in a comment piece for HSJ.

10.20am The Parliamentary Health Service Ombudsman has pledged to help seal the “regulatory gap” identified by the Care Quality Commission after abandoning its probe into an historic complaint.

The ombudsman, Dame Julie Mellor, spoke out following concerns at the collapse of an inquiry into the treatment of baby Elizabeth Dixon.

10.13am EXCLUSIVE: A new public services ombudsman should be established with powers to probe the decisions of clinical commissioning groups and councils, the Parliamentary Health Services Ombudsman has said.

Dame Julie Mellor made the appeal alongside Local Government Ombudsman Jane Martin in an exclusive double-headed interview with HSJ.

10.00am BREAKING: Commissioners have selected a consortium led by NHS providers as preferred bidder for a pioneering £800m contract to deliver older people’s services in Cambridgeshire.

Cambridgeshire and Peterborough Clinical Commissioning Group announced the “Uniting Care Partnership”, which comprises Cambridge University Hospitals Foundation Trust and Cambridgeshire and Peterborough Foundation Trust, was its preferred option to be the “lead provider” under the new contract which goes live in April 2015.

The NHS-led bid was awarded the much-vaunted role over two other bids, one by the “Care for Life” consortium, which comprised private provider Care UK, Lincolnshire Community Health Services Trust and Norfolk Community Health and Care Trust, and the other from private provider Virgin Care.

9.56am Sky News political editor Faisal Islam has also commented on the prime minister’s planned announcement to ringfence the NHS budget:


9.38am Meanwhile health policy consultant Mike Birtwistle tweets:

9.33am In response to David Cameron’s expected announcement on ringfencing the NHS budget, HSJ’s senior bureau chief Dave West tweets:

2.07am: The prime minister is today expected to confirm the Conservatives would again ring fence the NHS budget from below inflation spending growth.

David Cameron’s speech to the party’s conference in Birmingham today means a Tory government would maintain growth at at least the pace of inflation, delivering at least flat funding in real terms, but is not commiting to greater increases, according to several newspaper reports.

He was expected to say: “The next Conservative government will protect the NHS budget and continue to invest more.”

Mr Cameron was expected to emphasise the importance of the NHS to the party, and mention the role of the NHS before the death of his son Ivan.NHS leaders have widely expected real terms funding growth to continue under any government, but many experts have said greater increases will be needed for the service to remain in balance and maintain standards.

Mr Cameron’s comments will follow another Tory headline announcement on the NHS yesterday - commiting to improved GP weekend and evening access, while Labour leader Ed Miliband last week said a Labour government would spend an additional £2.5bn on the NHS in 2015-16.

Mr Cameron was also expected to reiterate the party’s assertion that maintaining NHS funding will rely on economic growth. He was expected to say: “We know this truth - something Labour will never understand and we will never forget - that you can only have a strong NHS if you have a strong economy.”

The offer does not answer the calls from many within the NHS for additional funding above real terms, particularly in 2015-16. There have been several calls for a “transition fund”.

The NHS Confederation has called for £2bn additional a year and the Foundation Trust Network said last week: “There is a widely acknowledged gap of between £1 and 2 billion in the current 2015/16 NHS plans. The ball is firmly in the Government’s court.”

2.06am Good morning and welcome to HSJ Live. We begin the day with the news that the Parliamentary Health Service Ombudsman has pledged to help seal the “regulatory gap” identified by the Care Quality Commission after abandoning its probe into an historic complaint.