HSJ analysis reveals that Foundation trusts increased the sums they spent buying healthcare from non-NHS bodies by almost 25 per cent, plus the rest of the day’s news andcomment.

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5.30pm Here’s the Health Foundation’s response to the chancellor’s autumn statement announcement:

Anita Charlesworth, chief economist at independent health care charity the Health Foundation, commented: “Halfway through this financial year, the net deficit across England’s hospital sector is more than £700 million and 80 per cent of acute hospitals are running at a loss.

“Pressures on our hospitals are not just financial - they are struggling to meet key targets for A&E, cancer and surgery. This is the stark backdrop to George Osborne’s announcement of extra cash for the NHS.

“Today’s Autumn Statement confirms that the NHS is the big pre-election public spending winner. What is now clear is the extent to which the announcement, made first at the weekend, is more than what was already planned.

“The government is adding £1.25bn to the Department of Health’s budget for next year. Health spending in 2015-16 is now planned to be £116bn in cash terms, that is £3.3bn more that the budget this year. It amounts to a 1.5 per cent increase in real terms.

“£1bn of this extra money comes from the Treasury Reserves, while the remaining £0.25bn is from the Foreign Exchange Fines (FOREX). This is a welcome increase to avoid a full blown funding crisis.

“Despite this additional funding, the NHS is far from out of the woods. The current government plans spending cuts of more than £30bn by 2018 to meet its targets to eliminate the deficit. In May 2015, the incoming government will need to reconcile this with the NHS funding requirement of at least £8bn at the end of the decade.

5.17pm Jeremy Hunt and Andy Burnham are having something of a spat on twitter, here’s a taste:

5.03pm Professor Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “Extra money for the NHS is of course very welcome and we look forward to more detail on how the transformation fund and development of primary care will work in practice.

“However, the statement was clearly a missed opportunity to address the issue of fair pay for NHS staff.

“More years of pay restraint would place further strain on the very people who have continued to deliver excellent services under enormous pressure.

“It is simply unsustainable to continue driving down wages in real terms for NHS staff and with the clear link between morale and quality of services, potentially damaging for patients.”

4.55pm Also responding to the chancellor’s autumn statement, Professor Sir Simon Wessely, President of the Royal College of Psychiatrists said: “We welcome the Government’s decision to invest an extra £2bn in the NHS.”

“Given the long-standing disparity between funding for mental health and physical health, we urge the Government to ensure that a significant proportion of this additional investment goes to mental health services.
“The additional money for general practice and community services- where 90% of people with mental health are diagnosed and treated- should ensure that people can access mental health treatment at the earliest possible stage.
“We are also pleased that the Government has acknowledged the mounting evidence for early intervention for eating disorders.

“We hope this funding will enable more immediate access to the expert care that can prevent eating disorders becoming severe and disabling, and support joined up paediatric and mental health services, outpatient and inpatient care, and services that allow continuity of care through to recovery.
“We are pleased to see the Government’s commitment to funding new early intervention pilots for 0-2 year olds. There is currently a gross inequality in the provision of perinatal mental health services and so we hope that improvements in this area will form a key part of the Government’s new approach.”

4.55pm Rob Whiteman, chief executive of the Chartered Institute of Public Finance and Accountancy, has responded to the chancellor’s Autumn Statement 2014 delivered today.

Speaking after the statement, he responded to concerns over the future of the public finances and public service delivery, the additional pressure facing local authorities, especially around business rates and long-term funding for the NHS.

Speaking on the public finances and the pressures now faced by public services after the Chancellors Autumn Statement, Rob Whiteman, said: “The staggering pressure now upon public services, with continued budget reductions to come well beyond the end of this Parliament, means they face increasing challenges to maintain delivery for taxpayers.

“When you add in the impact of the ring-fencing of some budgets, such as the NHS and the protection of pensioners, the significance of the cuts still to come for other areas of public spending could damage their ability to deliver.

“However, today’s statement contained little recognition of this and no explanation from the Government about how public services will continue under such long-term pressures.

“CIPFA has long argued that we need to move beyond the short-term nature of funding in this country and avoid measures aimed only at the next political cycle. As we stated in our recent Manifesto, we urgently need to start to address our long-term challenges and work to fix the public finances for the next decade, not just the next election.”

On the changes to business rates announced today Rob Whiteman said: “As Whitehall now only takes half the money raised by business rates, with the rest going to local government to fund services, it is concerning that the Chancellor could be dipping into someone else pocket to pay for his business rates tax cuts.

“Local authorities are working hard to continue to deliver for local people, so to potentially lose over £380m next year could have a significant impact upon their ability to serve the needs of those they are supposed to.

“And while the review into business rates is welcome, even if it looks likely to be much delayed, it is important that it carefully considers the impact of changes upon funding local government. We would hope that its remit will include a review of the scope for greater local control over both income and the level of the business rates.”

On increases in NHS funding announced at the Autumn Statement Rob Whiteman said: “While additional funds announced for the NHS by the Chancellor are welcome and necessary to relieve current pressures, a continual sticking plaster approach to NHS funding isn’t sustainable in the long-term.

“Instead, CIPFA would call for a whole system approach to the NHS with significant investment now in public health to lessen long-term acute spending pressures and to better manage future increases in demand.

“And we need a commitment from politicians that they will make no further structural changes to the way the NHS operate until we have a grip on its finances.

“Fundamentally we also urgently need an open and honest debate between the public and the political parties about what the NHS will need to survive of the next 10 to 20 years, we must accept that parts of the system may require alternative funding models such as payments or self-insurance if they are to continue.”

4.30pm Foundation trusts increased the sums they spent buying healthcare from non-NHS bodies by almost 25 per cent last year, HSJ analysis reveals.

Figures from the annual accounts of all 147 foundation trusts show they bought £412.1m of healthcare services from non-NHS organisations – an increase of £81m on the £330.9m recorded in 2012-13.

HSJ analysis shows the 20 trusts that spent the most on non-NHS services account for more than half of the total spend, and mental health trusts were disproportionately high spenders, relative to their size.

4.26pm For those of you just logging on - here’s our main story on the chancellor’s autumn statement announcement:

George Osborne this afternoon confirmed plans to increase NHS spending by around £2bn in 2015-16, funded largely on the assumption that other government departments will continue to underspend their budgets.

The chancellor’s autumn statement, published today, said the government would provide “£2bn of additional funding for the frontline NHS in England in 2015-16”, in support of the vision set out in the NHS Five Year Forward View.

The money is comprised of:

  • a £250m investment in improving out of hospital services, funded from fines paid by banks for exchange rate manipulation;
  • £700m of centrally held Department of Health and NHS England budgets that will be reallocated to NHS commissioners; and
  • a £1bn increase in the baseline NHS budget.

Full story here.

4.20pm Doctors’ leaders have said that extra funding announced in the Autumn Statement for the NHS is a step in the right direction, but urged politicians not to use the NHS as a political football in the run up to next year’s general election and to ensure it is not subject to another unwanted top-down reorganisation. 

Following the Chancellor’s announcement of an extra £2bn annually for the NHS and an investment of £1.2bn in GP services, BMA council chair Dr Mark Porter warned that, while additional funding is desperately needed, the NHS has suffered years of underinvestment and that turning things around will take time.

He warned that the NHS continues to face a number of challenges including a recruitment and retention crisis in areas such as emergency care and general practice. He also highlighted the importance of investing in GP surgeries to ensure they are fit for purpose and equipped to deal with rising patient numbers and more services being moved into the community.

A BMA survey of 4,000 GP practices earlier this year found that just over half of practices had seen no investment or refurbishment in the past ten years, four out of ten felt their current facilities were not adequate to deliver services to patients and almost seven out of ten felt their facilities are too small to deliver extra or additional services to patients.

Commenting following the Autumn Statement BMA council chair, Dr Mark Porter, said: “While this extra funding is desperately needed, the situation will not be turned around overnight.

“The NHS is going through its tightest funding period in half a century – rising demand and years of underinvestment have left services dangerously overstretched, compromising patient care. The NHS also faces other challenges including staff shortages, especially in emergency care and general practice.

“A quarter of hospitals are in the red and many GP facilities have been starved of investment for decades, leaving them struggling to cope with record numbers of patients coming through the surgery door. With more services moving into the community it’s vital that additional funding for general practice is invested in premises, so they can be made fit for purpose.

“Crucially, the NHS must not be used as a political football before the general election, or subjected to another unwanted top-down reorganisation afterwards. We need a long-term plan to deal with rising demand rather than short-term promises designed more for winning votes than truly saving the health service. Without this, the future of an NHS which remains true to its founding principles - open to all and free at the point of delivery - will be under threat.”

4.11pm Responding to the chancellor’s autumn statement, in which he announced the continuation of public sector pay restraint into the next parliament, Dr Peter Carter, chief executive & general secretary of the Royal College of Nursing said: “The UK’s nursing staff are working flat-out to keep the health service going under extraordinary pressure.

“They work long hours caring for the vulnerable, and have endured five years without cost of living increases.

“The prospect of this continuing for year upon year is an insult to hard working nursing staff and raises serious concerns about the UK’s ability to employ the staff it needs in the long term to meet the level of demand the NHS faces.

“The NHS has wasted billions on a chaotic reorganisation and on redundancy payments for senior managers who were then re-employed at great expense.  

“Without paying nurses a fair wage for the work they do, the Government is devaluing their work. Any prospect of creating an NHS that trains and recruits staff sensibly for the long term is badly damaged by this, and we will see hospitals recruiting expensively from overseas for years to come.”

3.31pm Cormac Tobin, managing director of Celesio UK comments on the role of community pharmacy, following George Osborne autumn statement speech:

George Osborne’s autumn budget review today confirms a £2bn boost to NHS funding that we’ve heard murmurs about for a little while. The chancellor branded it a “down payment” for the NHS Five Year Forward View.

Critics will undoubtedly pick apart the spending, claiming that it’s not enough to avert a crisis in a service that is already overworked and underfunded.

Yes, the figure may seem like a drop in the ocean considering the predicted NHS funding gap of £30bn, however I believe that the commitment of £2bn today is the start of making the five year forward view a reality, and given the general election in May 2015, the funding window is limited.

Yesterday, secretary of state Jeremy Hunt outlined that we are at a turning point for the NHS, and that the extra money was not just about putting more funds into the existing system.  It’s encouraging that not all of the £2bn is earmarked for more of the same, but will help to lay the groundwork for the future.

Mr Hunt also talks of four pillars from government which will support the delivery of the forward view; a strong economy with sustainable growth in NHS funding; changing models of provision with integrated care delivered closer to home; harnessing innovation and a culture of safe compassionate care where patients come first.

So how does the money committed today translate into action and the delivery of the strategy? Whilst a large chunk of this money will be needed to sustain existing frontline services, some will help to establish new provider models in primary care, for example multispecialty community teams.

Community pharmacy has a significant role to play in this new order, a sentiment echoed by the Secretary of State yesterday. New care models don’t have to mean massive transformations to care provision though: we are already doing great work in supporting patients in communities, wrapping services around people with long term conditions and addressing the prevention agenda. Our pharmacy teams can offer blood pressure and diabetes screening; asthma and pain management and so many more services that can save patients a trip to their GP or A&E department – while saving other frontline NHS services time and money.

Also today, a new manifesto for community pharmacy was launched in Parliament co-written by Pharmacy Voice, PSNC and IPF. This demonstrates the community pharmacy sector’s ambition to bring more people into pharmacies and make a mark on reducing the strain on the NHS, such as the estimated £1.1bn spent annually treating common ailments like coughs and sore throats.

We look forward to working with our NHS colleagues and government in the delivery of the Five Year Forward View and securing a prominent role for pharmacy in how services are transformed and delivered for the next five years and beyond.

3.12pm King’s Fund chief executive Chris Ham tweets from the think tank’s annual conference:

2.51pm Commenting on George Osborne’s announcement for an extra £2bn for the NHS in 2015, Graeme Currie, professor of public management at Warwick Business School said: “The extra budget provided is, in part, a response to the winter demand pressures every year, and for which the NHS seems to be unable to capacity-plan for.

“The winter demand hits hospitals, specifically A&E departments. Admittedly it is difficult for the NHS to have the sort of flexible labour force that private sector companies can develop, like zero-hours contracts, but surely something can be done to mediate winter pressures.

“Another pressure, and one which is less seasonal, is the changing population demographic, with people living longer and suffering from multiple disorders and so bringing additional cost. However, again this might be predicted and responded to.

“Indeed, the ‘Nicholson Challenge’, on departure of the previous NHS CEO, was a call to transform healthcare delivery to save billions of pounds. So we might ask, how, instead, the NHS is asking for additional budget?  

“While it is hospitals asking for additional budget, it is not necessarily hospitals that are the problem. The problem is one that lies at the system level. The Nicholson Challenge was one that required transformation of healthcare delivery, and indeed in rhetorical terms at least, CEOs of healthcare providers and commissioners promised such transformation to make significant savings.

“Yet such transformation relies upon care delivered outside hospitals, in primary care settings. It requires greater emphasis upon public health and prevention, self-management of long-term conditions and use of digital technology. So why hasn’t this happened?

“Policy-makers continually tinker with health and social care structures, with public health in a state of flux. 

“Meanwhile, primary care hasn’t developed sufficient capability and resilience to reduce undesirable A&E attendance - witness the Health Secretary’s recent use of A&E because of this. Having suggested this, there are pockets of transformation that realise the savings required through reconfiguration of services away from hospitals.

“Perhaps, ultimately what the NHS needs is to learn from these examples of best practice, so variation in quality and costs is reduced across local healthcare economies.”

2.50pm John Appleby, chief economist at the King’s Fund, tweets that only £295m of extra UK NHS money is recurring to 2018/19; all other spend is one off for 2015/16.

2.45pm The Association of the British Pharmaceutical Industry welcomes chancellor’s decision to increase rate of research & development tax credits

Commenting on the chancellor’s autumn statement, ABPI Chief Executive Stephen Whitehead said: “I welcome the Chancellor’s decision to increase the rate of Research & Development (R&D) tax credits for both smaller and larger firms which will have a beneficial impact on business investment in the UK.

“The pharmaceutical industry is a key contributor to the UK economy and a leading manufacturing sector. Our industry employs 73,000 people directly in the UK and invests £11.5m per day on R&D. We are concerned however that proposed changes to the Patent Box outlined in a written ministerial statement yesterday may affect incentives for investment in R&D.

“I am also pleased to note that the Chancellor has allocated increased funds to the NHS at what is a challenging time. The ABPI is acutely aware of the funding issues facing the NHS and the pharmaceutical industry has done its part by underwriting the medicines bill within agreed boundaries under the Pharmaceutical Pricing Regulation Scheme.

This is a platform for patients across the UK to get access to the latest innovative medicines. The ABPI is committed to working with all stakeholders to ensure that we can foster the best possible environment in the UK incorporating a holistic industrial strategy so that the pharmaceutical industry can continue to flourish.”

2.37pm Royal College of Nursing head of policy Howard Catton, tweets:

2.35pm In response to the Autumn Statement, chief executive of Independent Age, Janet Morrison, said: “We warmly welcome the new announcements regarding extra money for the NHS.

“However without a greater investment in social care, which has suffered huge cuts over the last four years, much of the benefit of the extra money will be lost as elderly patients are stuck in hospitals waiting for care home places or social care support in their homes.

“The arguments between councils and the NHS over spending the Better Care Fund demonstrate that there is still a huge distance to go before health and social care are recognised as one system, requiring joined-up solutions.

“With the implementation of the Care Act only months away, the government must step up to ensure that there is enough funding available for councils to carry out the new law effectively. The Autumn Statement has missed the chance to respond to the huge pressure already on councils.”

“We’re pleased to hear that the £2,000 annual National Insurance contributions Employment Allowance is being extended to older and disabled people who employ care workers, meaning they should experience a welcome reduction in their costs for care.”

“Since the social care sector is one of the biggest employers of apprentices, it’s good news that the National Insurance contributions on earnings up to the upper earnings limit for apprentices aged under 25 will be abolished.”

2.28pm HSJ’s Crispin Dowler tweets:

2.27pm HSJ correspondent Shaun Lintern tweets:

2.26pm Pay restraint for public sector staff including NHS workers will continue into the next parliament, chancellor George Osborne told MPs today.

Delivering his autumn statement in the Commons, Mr Osborne revealed the coalition government’s restraint on public sector pay was expected to have delivered £12bn by the end of the current Parliament.

Under the approach, NHS staff had their pay frozen for two years from 2011, then received a 1 per cent rise for 2013-14. For 2014-15 the government decided there would be a 1 per cent rise only for those not eligible for an incremental pay increase, despite a recommendation by the independent NHS pay review bodies of 1 per cent across the board.

1.43pm While welcoming the ‘belated’ extra funding to the NHS, Ed Balls has asked the chancellor to clarify whether the £2bn per year promise is to be above flat real terms spending.

1.32pm In response to today’s Autumn Statement announcing extra funding for the NHS in 2015/16, Chris Hopson, chief executive, NHS Providers, said: “Given that the current financial year is difficult enough for providers, George Osborne’s announcement of an extra £2 billion for the NHS in England in 2015/16 is particularly welcome.

“For some time we have argued that without extra funding in 2015/16 the quality of patient care could be compromised and the entire provider sector placed at risk of financial failure. Today’s signal from the Government will help to support the providers of acute, ambulance, community and mental health services to maintain the world class standards they deliver.

It is essential that this funding reaches the providers of frontline patient services as efficiently as possible to deliver benefits for patients and the tax payer. We will work with the TDA, NHS England and Monitor to ensure the funding allocation process is streamlined and appropriately respects local decision-making and autonomy in prioritising where investment should be made.”

“To make resources go further, we called in our Programme for the next Parliament for multiyear funding and planning frameworks for the NHS. We are pleased that this approach has the support of the Government and will give providers greater confidence in planning the best possible service for patients in the future.

“We’re also pleased with the Deputy Prime Minister’s pledge to invest an extra £150m to help children with eating disorders.

This is much needed investment in prevention and support for providers of community and mental health services who are facing rising levels of demand for all types of mental health needs. It is a further sign of the importance of fairly allocating funding across all parts of the provider sector.

“NHS providers are projected to end the 2014/15 financial year at least £533m in deficit, with the deficit in 2015/16 potentially reaching £1.1bn. It is important to recognise that this extra £2 billion is not a magic wand and that providers of frontline services need both sufficient investment to maintain existing services and sufficient funding to transform how services are delivered in future.

Our members are already harnessing new technology, delivering care closer to patients in the community and redesigning services across whole health economies. Funding support is needed to continue these efforts if we are to realise the ambitions of the NHS Five Year Forward View.

1.28pm Shadow chancellor Ed Balls has begun his response to George Osborne’s statement.

1.20pm The British Property Federation has welcomed the announcement of £1bn to be invested over four years in GP services.

The BPF last month urged the Secretary of State to prioritise delivery of a new generation of modern, fit-for-purpose primary care facilities, arguing this could not only improve patient care but also produce considerable efficiency savings for the NHS and wider economic benefits for the country as a whole.

Liz Peace, chief executive of the British Property Federation, said: “There is now consensus between patients groups and medical professionals that increasing the capability and capacity of out-of-hospital care is vital in order to sustain our NHS to be free at the point of need.

“Private sector investment can help this transformation. However, we do need to see further movement of resources from the secondary care system into primary and community care to enable NHS England to have the capability to increase the amount that it spends on new GP facilities.”

1.15pm Osborne has announced a VAT refund for hospices and support for Air Ambulance and search and rescue teams.

1.11pm HSJ reporter Shaun Lintern tweets:

1.10pm The chancellor has still made no commitment on the full extent of teh government’s extra funds set out in the Five Year Forward View. He has described the £1.5bn of ‘new’ NHS funding as a ‘downpayment’ on the funding needed to make the changes set out in the NHS’ document.

1.06pm Osborne says there’s going to be £10bn underspend across government departments this year

1.05pm Mr Osborne has said that £1.3bn of further savings will come from public sector pension reforms.

12.56pm Chancellor announces gov extending £2,000 employment allowance to include carers.

12.44pm Keeping our eyes peeled for new discussion of health in the chancellor’s autumn statement speech.

12.21pm The GMB union has just released the following statement:

GMB members took part in the strike action in the NHS across England & Northern Ireland on 13th October and 24th November to demand that the Secretary of State for Health stop burying his head in Whitehall and meet with GMB and all health unions to resolve the dispute.

The four-hour stoppages were followed by action short of a strike for the rest of both weeks with an overtime ban in the ambulance service and other NHS employees working to their contracted hours.

GMB conducted an official ballot of 22,000 members in the NHS in England and Northern Ireland. There was overwhelming support for industrial action against the government and employers’ pay policies.

The pay offer for NHS staff in England is an unconsolidated 1% pay award in 2014, restricted to staff not eligible for incremental progression and the same approach in 2015. This goes against the recommendation of the independent NHS Pay Review Body for a 1% consolidated pay rise for all staff.

This is the text of the joint statement: “Since 2010, NHS staff have had a 15% cost of living cut to the value of their pay; some have lost significantly more through cuts to other elements of pay.

The independent NHS Pay Review Body and the Doctors and Dentists Review Body were asked by government to recommend no more than 1% pay award. The NHS PRB went on to recommend just as government requested:  1% consolidated (i.e. pensionable and integrated into all future awards).

The Secretary of State for Health replied by saying that he would only pay staff on the top of their pay spine 1% as a cash payment on their basic pay, and then to be removed at the end of the year. This means pay rates in England will be frozen to 2013 rates.

In addition the NHS PRB and the DDRB have been stood down from making a recommendation for 2015/6.

The Governments in Wales and Scotland have agreed their pay awards with the Agenda for Change trade unions, including paying the Living Wage. The Government in England is refusing to enter into negotiations with health unions.

NHS workers have therefore been forced into a position of taking industrial action. The NHS staff are today, demanding talks following 2 days of strike action, action short of strike and working to rule across the country.

With a further £2bn promised by the Chancellor for the NHS for front line staff & services, trade unions representing over 1 million NHS workers are calling on the government to use some of this money to resolve the ongoing pay dispute. It is in patients’ interest to have staff who feel motivated and fairly rewarded rather than being pushed into taking industrial action because the government won’t negotiate with unions.

Without this the NHS faces more disruption into the new year and beyond.”

12.18pm Almost one tenth of foundation trusts’ entire £92.4m spend on severance packages last year was paid by a single provider, HSJ analysis reveals.

Full story here.

10.50am Writing in his regular HSJ column, The Guardian’s politics writer Michael White casts a wry eye over the last weeks negotiations over the extra cash pledges by the chancellor to the NHS last weekend.

He writes: Deft Mr Stevens (after his three negotiating trips to Number 11 in a single week) obliged George Osborne’s efforts with a warm welcome like a well rehearsed partner on Strictly Come Dancing.

10.37am The Guardian also reports that people are risking their lives because they nearly always do not recognise warning signs of cancer as potential symptoms of the disease, new research shows.

Although more than half of the 1,724 people in the study suffered bleeding, an unexplained cough or other common signs of cancer, just 2% of them realised they could have Britain’s biggest killer, the paper writes.

10.30am Broad coverage is given this morning to guidance released from the National Institute for Health and Care Excellence which encourages women with low-risk pregnancies to have non-hospital births.

The Guardian writes that this could see almost half of mothers-to-be planning to deliver their baby away from traditional labour wards.

NICE also advised midwives not to clamp and cut a baby’s umbilical cord until at least a minute after birth in the absence of complications, and generally within five minutes.

10.28am For those of you who missed it, HSJ yesterday revealed that at least half of the additional £80m investment pledged to mental health providers to help them deliver new access targets will come from existing budgets.

In a reverse of last year’s decision to cut mental health trust budgets by more than acute trusts NHS England and Monitor have imposed a 0.35 per cent uplift to the national tariff for mental health.

This will result in an estimated £40m less having to be saved through efficiencies by mental health trusts.

However, providers will have to use this money to meet new access targets to ensure 50 per cent of people experiencing a first episode of psychosis receive a National Institute for Health and Care Excellence approved package of care within two weeks of referral.

10.27am On the day of the Autumn statement the National Association of Primary Care welcomes the announcement of approximately £2bn allocated to the NHS, with Jeremy Hunt confirming that £1bn will be invested in ‘community and primary care facilities’.

NAPC recognises that primary care is at the heart of every community, putting it in the unique position to empower patients to lead healthier lives. The Five Year Forward View (FYFV) strongly supports preventative care for future generations, and for the future of the NHS.

NAPC is already at the forefront of defining and testing new models of working through its Practice Innovation Network (PIN) and the newly formed National Association of Provider Organisations (NAPO). The PIN continues to empower practices and community providers, through working with others, to improve the health and wellbeing of local people. The support for the Network continues to grow through its membership as it facilitates opportunities for practices and federations of practices to engage with their community on a practical level.

Dr Nav Chana, NAPC Chairman said: “I welcome the additional funding for the NHS, with investment targeted to primary care. This will support the development of new models of primary and community care as set out in the FYFV. New models of care focused on improving outcomes that matter to people can go a long way to providing the solutions we need for a sustainable NHS.”

Dr Nikki Kanani, NAPC Honorary Secretary said: “Primary and community care is under considerable pressure, and the additional funding is a much needed investment. We hope that this is the first step towards creating a stable NHS that can embrace innovation.

“However there is a need for demonstrable solutions which can support the implementation of the ambitions within the Autumn Statement and the FYFV, and create the culture changed needed to really change the way we care for our patients, and our 7 Point Plan delivers this.”

NAPC Seven Point Plan;

1.     Defining the value of healthcare around outcomes that matter to patients including health and wellbeing.

2.     Supporting new models of primary care provision through collaborative networks for the purpose of improving population health outcomes.

3.     Aligning incentives and contractual models that support improvements in local population health outcomes, leading to accountable care approaches.

4.     Developing a workforce that is responsive to the needs of a population, not fixating on any particular group.

5.     Supporting real time innovation across collaborative networks, to demonstrate new models of provision and promote integration of care around patients and populations.

6.     Purposeful (not just positional) leaders representing the breadth of primary care.

7.     Influencing policy to support the ambitions above.

10.21am HSJ reported yesterday that Jeremy Hunt has indicated that £1.5bn of additional funding to be allocated to the NHS in 2015-16 will be contingent on hospitals providing plans to become more “efficient and sustainable” and to deliver “a commitment to a paperless NHS by 2018”.

Chancellor George Osborne announced additional funding totalling around £2bn for the next financial year for the NHS yesterday, in the run-up to today’s autumn statement.

The health secretary set out how the funds would be used to the Commons yesterday, saying they would help implementation of the NHS Five Year Forward View.

He said: “£1.5bn will go on additional frontline activity but to access this funding we’ll be asking hospitals to provide assured plans showing how they will be more efficient and sustainable in the year ahead and deliver their commitment to a paperless NHS by 2018.”

10.15am Local, general hospitals will survive in some form in the future, but should operate as part of a network providing emergency and elective surgical care, president of the Federation of Surgical Speciality Associations John MacFie said today.

Following a meeting of surgical leaders, the consensus is that there are too many hospitals in the UK and Ireland attempting to provide emergency and a wide range of elective care.

The profession agreed that it should lead a reappraisal of the function of general hospitals to ensure high quality patient care into the future.

Speaking on behalf of the FSSA and as chair of the Surgical Forum of Great Britain and Ireland, John MacFie said: “Not every hospital that existed in 1948 can provide everything in 2014.

The result of trying to achieve this is an escalating problem of too many general hospitals attempting, and failing, to provide safe emergency and elective surgical care.

This growing problem must be tackled urgently. The only way forward is to reappraise the function of all hospitals to achieve optimum patient care. But, there is no place for vested interest groups to campaign to keep unsafe and unviable small hospitals open.”

The joint statement from surgical leaders, The Future of District General Hospitals, puts forward a series of solutions that include:

  • Redefinition of the function of general hospitals
  • A political solution that allows hospitals to form networks and work together
  • Better integration of health and social care
  • Blurring of the interface between primary and secondary care.

“We want to achieve consistent high quality emergency hospital care with access to specialist interventions for all. This aspiration will continue to drive the reorganisation of our hospital service to ensure we can provide the very best in patient care,” John MacFie concluded.

10.10am In response to the HFMA’s NHS Financial Temperature Check, finance directors’ views on the financial challenges facing the NHS,

Siva Anandaciva, head of analysis at NHS Providers, said: “Today’s report is a timely reminder of the strain providers of NHS acute, ambulance, community and mental health services are under.

“Even organisations with strong financial track records are now experiencing financial distress with some providers handing in their first deficit plan for 15 years. This reflects the increasing system-wide pressures on frontline services.

“The fact that 74% of trust finance directors are forecasting a worse financial position in 2014-15 compared to the previous year reflects the scale of the financial deterioration.

“NHS providers are investing in more clinical staff to maintain the quality of services and meet rising demand, but without changes to the payment and funding system to support this investment the financial pressures on the frontline will continue to escalate. Marginal rates for specialised services, the stagnated flow of non-recurrent funding, and an aggressive tariff efficiency factor will only increase rather than alleviate this financial distress.

“It is also concerning that just 11% of provider and 30% of CCG strategic plans have been agreed by all parties within the health economy. Greater alignment of strategic and operational planning is needed if we are to maintain and transform health and care services. It is encouraging that in areas such as Birmingham, Leeds and Somerset providers are playing an increasing role in bringing together different parts of the system to drive forward change.

“This system-wide collaboration can and must be replicated elsewhere as we seek to realise the ambitions of the NHS Five Year Forward View.

“It is reassuring that quality remains paramount with 94% of finance directors not expecting quality of services to deteriorate in 2014/15, but many of our members tell us they are being forced to compromise financial viability as a result. At the end of the day, this is an unacceptable balance to strike as all of us involved in NHS care want long term, sustainable care for all patients and service users.”

10.08am The Healthcare Financial Management Association this morning releases its regular NHS financial temperature check, a survey of finance managers across the NHS.

The report outlines the views of finance directors of 40% (191) of NHS organisations across England on the financial challenges facing the NHS.

While these findings come shortly after the recent announcement that an extra £1.95bn will be provided to the NHS in 2015/16, they give a clear snapshot of a current landscape of severe financial hardship. For example the NHS foundation trust sector has reported a deficit of £254m against a planned deficit of £59m; and the NHS trust sector reported a deficit of £376m against a planned deficit of £317m at the half way point of the 2014/15 financial year. 

At this point 55% of foundation trusts and 27% of NHS trusts were reporting a deficit.

Finance directors reported that the main causes of the decline are unforeseen increases in pay costs, combined with lower than expected savings from cost improvement plans. 82%of trust finance directors say the pressure on pay costs is chiefly due to increasing agency staff costs, while clinical commissioning group (CCG) chief finance officers’ (CFOs’) main cost pressures are continuing healthcare costs (72%) and emergency care costs (70%).

With no clear direction on where any new funding will be spent, HFMA’s members outline how they are planning to mitigate the increasing cost pressures, with 75% of CCG CFOs planning to invest in community services, while 87% of trust finance directors are looking to make urgent agency staff cost savings.

Another warning flag is that NHS finance professionals have serious concerns about the lack of clear system leadership across their local health economies. This is borne out by figures that show a lack of clarity about the main system leader in their health economy – 27% of area team finance directors identified the area team as main system leader, while 32% of CCG CFOs stated they were the main leader, and 30% of trust finance directors believe the trust is the system leader. 10% of trusts didn’t identify any specific leader at all.

Additionally, while there are doubts about the implementation of the Better Care Fund bringing benefits in year one, 62% of trust finance directors and 86% of CCG CFOs think it will help improve their organisation’s services for patients and service users in three years.

However, overall only 2% of provider trust finance directors and 34% of CCG CFOs are confident that the benefits set out in its plans will be achieved at all.

However despite being pessimistic about the overall financial position of the NHS, 94% of finance directors do not expect the quality of services to deteriorate in the coming financial year. When asked about the areas most vulnerable as a result of the financial pressures, two out of three finance directors in trusts and commissioners identified access to services and waiting times.

Paul Briddock, director of policy at the HFMA, said: “While we welcome the recent announcement of additional funding for 2015/16, there is no quick fix. It is clear that there has been a rapid deterioration in the financial position of the NHS during this financial year and financial pressure is being felt across the whole NHS system, but particularly in acute trusts.

“There must be an open and honest debate about how this money should be spent, and the importance of not only maintaining existing service and quality, but ensuring fundamental transformation of the service.

“The future success of the NHS depends on fast and effective clinically led transformation of services and clear, aligned system leadership.”

The HFMA is calling for action to be taken in a number of key areas over the coming months to ensure that NHS organisations remain clinically, financially and operationally sustainable:

  • Urgent action to improve national workforce planning and training
  • Faster progress on large transformation schemes
  • Addressing and ensuring strong system leadership across the whole NHS

7.00am Welcome to HSJ Live. We start the day with the announcement that Simon Stevens is to give the first HSJ annual lecture.

The NHS England chief executive will reveal his latest thinking on the future of the service at the event in London next week.

The lecture will be filmed and broadcast on hsj.co.uk, with the full text published on the site soon after.