Labour leader sets out his plans for the NHS, plus the rest of today’s news and comment

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7.08pm HSJ’s report on Mr Miliband’s speech is now live. Read it here.

6.55pm HSJ Editor Alastair McLellan tweets: Big Q over@ed_miliband promise of £100m for GPs is if scrapping health bill comp regs wld really save that much money. Many doubt it

6.49pm Dr Charles Alessi, chairman of the National Association of Primary Care, has also responded to Labour’s announcement.

He said: “Access to primary care services is at the heart of the relationship between people and their carers, and the NAPC welcomes anything which makes this easier.  We also welcome the prospect of increasing investment in primary care.  The whole of the out of hospital sector really needs investment if it is to play its part in managing the financial challenges that face us all.”

6.43pm Back to the speech in Manchester. Ed Miliband said:

“Labour will have the right priorities: - Co-operation not privatisation - Patients before profit That’s what makes the NHS what it is.”

6.38pm NHS Confederation chief executive Rob Webster said the organisation supported the use of competition where approriate and the role of Monitor.

“Our members tell us that the best prescription for primary care is not just additional money but also more collaborative working between primary care, hospitals and community services, and other partners like social care.

“The NHS Confederation supports the use of competition wherever it benefits patients and the taxpayer, as NHS Clinical Commissioners (NHSCC) called for in their manifesto launched last week. Like NHSCC, we believe that “the rules are not your enemy” and should be applied appropriately.

“We support Monitor’s role as a specialist sector regulator which offers some protection against the generic, inappropriate application of existing EU and UK competition law to the NHS. Labour’s proposals would not abolish competition in the NHS and it is important there is a regulator to ensure that it operates in the interest of the patient.

“We also believe that commissioners need the appropriate expertise to make effective decisions about meeting the needs of their populations. Any changes to commissioning capability - whether in CCGs or CSUs - should be tested against the impact on their ability to do so. The last thing the NHS needs is more forced reorganisation.”

6.34pm Nuffield Trust chief executive Nigel Edwards welcomed increased access to primary care but warned the proposals hinted “towards another NHS reorganisation.

He said: “We need fundamental change to primary care that enables GPs and their teams to assume 24/7 responsibility for coordinating people’s care, supported by a network of other professionals like pharmacists, hospital specialists, and social workers.

“Such a change won’t come about by tweaking regulations and tinkering with targets. Instead politicians should allow local innovation within a clear set of aims for general practice. These aims should include: listening more to patients, protecting the interests of vulnerable people living in care homes and taking responsibility for healthier communities overall.

“By focusing on top-down changes, these proposals hint towards  another NHS reorganisation. Locally driven solutions are the best way to achieve effective change to primary care.”

6.32pm Responding to the announcement, Dr Maureen Baker, chair of the Royal College of GPs, said: “There is a growing crisis in waiting times to see a GP across the country, and it is clear that this will become a key issue at the next election.

“GPs want to provide better access for their patients, but are being prevented from cutting waiting times because of the funding black hole in general practice. Ed Miliband’s announcement that more money should be channelled into general practice is therefore extremely welcome.”

She claimed some GPs were seeing up to 60 patients a day and feared missing things due to their workload.

6.29pm Mr Miliband highlights research which he says shows that a 5 per cent increase in patients seeing their preferred GP could reduce emergency admissions by as many as 159,000 a year – saving the NHS £375 million.

6.26pm The press release highlights HSJ’s recent CCG barometer which found widespread concern about the cost and impact of competition.

6.24pm HSJ has now recieved a press release from the Labour Party setting out more details on the policy. It says the extra £100m will be found by:

•       Scrapping the Government’s rules which have led to spending of at least £78 million on unnecessary administration and legal fees because NHS services are now under threat from EU competition law.

•       Cutting back the new bureaucracy created by this Government which has seen the costs of three sets of quangos – Monitor, the Trust Development Authority and Commissioning Support Units – spiral with their current spending just on consultants now totalling over £3 million a month.


6.22pm Labour are planning an election broadcast showing Mr Miliband working in Watford Hospital, the BBC’s political editor Nick Robinson reports.

6.20pm The BBC reports Labour is planning to reintroduce the 48 hour appointment target that the Coalition government scrapped in 2010. Mr Miliband says the policy has been carefully thought through.

6.17pm The Labour Party has tweeted that under a Labour government patients will get a GP appointment within 24 hours.

6.11pm He says these are hard times for the NHS and adds:

Ed: David Cameron has proved the oldest truth in British politics: you can’t trust the Tories with our NHS.— Ed Miliband (@Ed_Miliband) May 12, 2014 

6.09pm Ed Miliband’s speech has started.

Ed: I recently spent two nights with staff & patients at Watford’s NHS hospital. Every patient I met had such belief & pride in our NHS.— Ed Miliband (@Ed_Miliband) May 12, 2014  

6.06pm The BBC is reporting Labour will promise same day GP appointments for the most urgent problems.

Mr Miliband said the £100m funding for the pledge would come from savings made elsewhere in the NHS.

This would include cutting bureaucracy, he added, vowing to create three million more GP appointments a year.

6pm Apparently the speech is due to be featured on the BBC 6’o clock news but it didn’t appear in the headlines. Mr Miliband has tweeted to say an aide will tweet his speech.

5.55pm Ed Miliband is making his speech at Sport City in Salford. Quite a crowd awaiting him according to photos on Twitter.

4.30pm Ed Miliband is due to give a speech at 6pm tonight where he outlines Labour’s vision for health.

In preparation, he has been tweeting:

“On David Cameron’s watch we’ve had a chaotic & expensive reorganisation of the NHS that no one wanted & which he promised wouldn’t happen.”

“In the last 12 months almost a million people waited more than four hours to be seen at Accident and Emergency.”

4.10pm NHS England has responded to a story in The Observer yesterday which reported that the NHS is quietly dropping the Choose and Book system for booking outpatient appointments to be replaced with an e-referrals system.

Beverley Bryant, director of strategic systems and technology for NHS England said the contract on Choose and Book is coming to an end.

She said: “A new NHS e-Referral Service will supersede it later this year. This will build on the success of Choose and Book and lessons learnt to provide a more efficient service that better meets the needs of the NHS and our patients.

“This is part of NHS England’s commitment to making all referrals electronic and the NHS paperless by 2018.

“What we have been very clear on is the need to understand what referring clinicians and receiving organisations want from the new system. Managing a mixed economy of paper and electronic referrals is onerous for hospitals and the lack of total slot availability makes it difficult for referring GPs to move away from paper.

“We want a system that is quick, easy and beneficial for healthcare professionals to use and ultimately improves patient experience by providing flexibility and choice around the services we offer wherever the patient is.

“When Choose and Book was designed back in 2003 agile, open technologies were not readily available.  A major objective of the new NHS E-Referrals system will be to introduce functionality for patients as well as clinicians to facilitate Choice and to make the whole booking experience more user friendly”

3.45pm The HFMA, CIPFA and the Association of Directors of Adult Social Services have joined forces to support health and social care organisations to meet the integration agenda.

There are three areas the organisations will work together on:

  • Joint networking – bringing health and social care finance practitioners together to develop shared understanding of challenges and share best practice
  • Education – raise awareness across the sectors of how funding flows and how services are delivered
  • Research – identify areas where academic research could help to understand the impact of integration on the quality and costs of service provision.

The groups argue that there needs to be an understanding that NHS bodies and councils locally work in different political contexts. Health and wellbeing boards have a crucial role in driving forward the integration agenda, they said.

3.40pm Occupational therapists at Greenwich council have voted unanimously for strike action on 21 May in protest against an alleged “bullying culture”.

The therapists, members of Unite, will strike for 24 hours.

The therapists voted by 100 per cent for strike action over alleged bullying, harassment and the suspension of a work colleague accused of being too friendly with staff.

Unite regional officer Onay Kasab said:”I am extremely proud of the Unite members who have voted to stand up against ‘a bullying culture’. We have given the employer every opportunity to deal with the bullying – but it has failed to tackle this issue.”

2.50pm Monitor has just published the consultation responses to its new transaction guidance. This includes proposals for new arrangements to support trusts going through a merger or acquisition and risk assessment of transactions.

1.00pm Our story on nurse staffing levels guidance issued by NICE is attracting some interesting reader comments. You can join the discussion by registering on the HSJ site.

“a) about time too, b) why wasn’t this done as part of the NHS Plan in 2000? Imagine all the harm that could have been prevented. Also all the wasted hours by clinicians and managers arguing for safe levels of staffing. A ratio of 1:8 is probably a too low for nursing only, but if it is to be complemented by some recommendations for numbers of Health Care Assistants especially on wards with large numbers of dependent patients, then we would be getting somewhere. And how about implementing the Cavendish review while we’re at it?”

“A review every 6 months is OK if boards are receiving regular more frequent reports on actual nursing levels with particular reference to significant deviations from guidelines. It’s the right thing to do but it cannot help Trusts in marginal or poor financial state.”

12.22pm Help us find the most inspirational women in healthcare. This July we will be celebrating inspirational women in leadership and top executive roles, but also those making a difference on the front line of the NHS and within middle and senior management positions. You can vote using the form on this page.

This condition was spelled out in a letter circulated to CCGs and NHS England area teams last week, from the organisation’s chief operating officer Dame Barbara Hakin and its commissioning development director Ros Roughton.

The letter follows an announcement by NHS England’s chief Simon Stevens this monththat he would soon invite CCGs to apply for responsibility to co-commission primary care services.

Under its Health for North East London proposals, the accident and emergency department at King George Hospital was to be closed and the A&E at Queen’s Hospital expanded.

However, its recently appointed chief executive Matthew Hopkins, revealed at this month’s board meeting that it the trust was not now working towards a deadline for the reshaping of services.

11.16am In The Daily Telegraph, doctors who illegally pre-signed abortion forms could escape criminal action because of an “utterly preposterous” loophole, an MP has claimed.

In the past the Crown Prosecution Service decided not to prosecute two doctors because it said pre-signing was not necessarily proof the doctors had not signed “in good faith” as they might still have discussed the case later on.

David Burrowes MP said: “The improbable notion that doctors who pre-signed forms were scuttling around hospitals making sure that their illicit certifications were backed up by retrospective good-faith opinions is utterly preposterous”.

11.07am In our Resource Centre we look at how ‘social’ innovations such as group appointments and networks can benefit pregnant women and midwives and save money. Katharine Langford and Ana Esquerdo share lessons from a London project that can be applied to the wider NHS.

Figures released to the HSJ by the Department of Health reveal that Monitor could see a 19 per cent increase in its “core budget” from £48m in 2013-14 to £57.3m in 2014-15.

While the budget has been agreed it is still subject to a “formal sign off of [Monitor’s] business plans”, a DH spokeswoman said.

10.29am A South Shields man who failed 1,000 times to get a job as an NHS doctor using false details has been jailed for 15 months following a fraud investigation by NHS Protect.

Bai Bai Ahmed Kabia, 46, of Hathersage Gardens, South Shields, Tyne & Wear, was found guilty of 12 counts of Fraud by False Representation after making a series of applications to numerous NHS Trusts to work as a doctor. He was sentenced to 15 months’ imprisonment for each offence, to run concurrently. Dr Kabia admitted to making over 1,000 job applications, none of which were successful.

NHS Protect’s investigation proved that between November 2011 and February 2013, Dr Kabia had submitted 245 unsuccessful job applications to numerous NHS trusts to work as a doctor. A sample of these applications was studied by NHS Protect investigators, and they all contained misrepresentations regarding his previous educational qualifications, professional memberships and employment history. Kabia claimed to be registered as a doctor with the General Medical Council, to have been awarded an MSc from University College London and to be a member of the Royal College of Physicians - none of these assertions were true. Kabia was then arrested in a joint operation with Northumbria Police.

Kabia, who is stateless, had studied as a doctor in Russia and moved to the UK in 1994. He trained as a podiatrist and worked for some time on a self-employed basis. In 2013, Plymouth Hospitals NHS Trust contacted NHS Protect after interviewing Kabia for a job. NHS Protect issued an alert to trusts across England and Wales, requesting any information on job applications received from Dr Kabia.

Dave Horsley, Anti-Fraud Specialist, NHS Protect, said today “Dr Kabia submitted job applications to the NHS that he knew to be false, trying to deceive his potential employers. Had he been successful, Dr Kabia‘s appointment would have given him direct access to treat patients. It is pleasing that Dr Kabia was unsuccessful in his applications and that NHS employment procedures were found to be robust and effective. The custodial sentence reflects the seriousness of these offences and will serve as a powerful deterrent to others”. At sentencing, the Judge commented, “This type of offence is made more serious because it erodes the confidence of the public in the NHS. Dr Kabia showed breathtaking arrogance.”

10.13am International Nurses’ Day is a chance to reflect on the changing face of the profession, says chief nursing officer Jane Cummings.

She said: “Nursing has changed dramatically in the 150 years since Florence Nightingale founded the first nursing school in London – undoubtedly for the better.

“While compassionate care is still the guiding principle, advances in science and technology and changing health needs have seen nursing roles change dramatically.

“We now have specialist acute and community nurses, mental health and learning disability nurses and nurse consultants to name a few. Most nurses now either have a degree or are studying for one. They can specialise in a wide variety of roles including areas of practice such as promoting health and well-being, supporting patients manage their own conditions, prescribing medication, providing psychological therapies, treating minor injuries or illnesses or providing chemotherapy.

“This is testament to how nursing has evolved and advanced over the years. This will continue to evolve. Changing demographics mean that more nurses will start their careers in community, primary care or public health roles; they will work in voluntary or the independent sector and in integrated teams with social care, educators and others.

“The public debate around staffing levels quite rightly continues. This is a priority in the nursing and care strategy ‘Compassion in Practice’ and more recently, at the end of last year, I published guidance on nurse staffing with the National Quality Board. With the Department of Health, we have also commissioned NICE to look at the evidence available about adult hospital wards and make recommendations on determining nurse staffing. These recommendations will be published for consultation imminently.”

Over the next five years, researchers will look at groups of people at risk of depression and use a series of tests to discover if specific patients correspond to certain disorders.

Experts say that rather than being one disease, clinical depression is a collection of different disorders with one common symptom - low mood.

9.58am The Daily Mail reports that pensioners who require long-term care could end up paying double the cap on costs because there are hidden charges, a report by the Institute and Faculty of Actuaries claims.

The government has pledged that no one will have to pay their care costs if they spend more than £72,000 but costs that are not included in the cap include the cost of accommodation if living in a care home.

9.52am The Guardian reports on its front page that the number of Afghanistan war veterans seeking help for mental health problems surged in 2013 and is likely to peak again this year as the British military ends its 13-year conflict in the country, according to new figures published today.

The charity Combat Stress saw a 57 percent increase in the number of ex-military personnel needing treatment, which had a record 358 Afghanistan-related referrals last year, compared with 228 in 2012.

The National Institute for Health and Care Excellence has issued draft recommendations on nursing workforce levels in adult inpatient wards in acute hospitals. It is the first of a series of guidelines on safe staffing in different healthcare settings that NICE was asked to produce by health secretary Jeremy Hunt as part of the government’s response to the Francis report.

The draft guideline highlights that if each registered nurse is caring for more than eight patients during the day time on a regular basis, there is an increased risk of harm. However, it stopped short of saying trusts should never go below this.

8.07am: The Labour party Leader Ed Miliband is due to give a speech in Manchester today at about 6pm on the NHS. The party has trailed it stating he “will set out how the NHS will be better off with Labour”.

A statement says: “He will highlight how, after four years of David Cameron, it’s getting harder to see your GP, while nurses have been cut and waiting lists are growing - and how Labour will fight for the NHS to deliver the reforms which put patients first, not private profit.” HSJ Live will cover the issue as we get further details.

7.56am: Clinical commissioning groups were sent a letter on Friday by NHS England inviting them to apply to co commission primary care, following the announcement of the plan by Simon Stevens last month. The letter, from chief operating officer Dame Barbara Hakin and commissioning development director Ros Roughton, is attached, and here is a summary:

“The letter says that CCGs taking on responsibility for primary care will have to do so “within existing CCG running costs as far as possible”.

“The letter has been obtained by HSJ (see attached). It includes some further indication of how NHS England envisages co-commissioning taking shape, and the likely limitations to it.
“It states: “CCGs will be expected to ensure that their proposals take advantage of synergies with existing areas of CCG activity and enable functions to be discharged within existing CCG running costs as far as possible.
“Expressions of interest will need to indicate where proposals would rely upon area team staff working under the supervision of CCGs.” The wording suggests transfer of staff and running cost funds to CCGs will be very limited.

The letter asks CCGs to specify the form and timing they propose for co commissioning.
“It says there are a “spectrum of potential forms”, starting with simply “greater CCG involvement in influencing commissioning decisions made by NHS England area teams”.
“Another option is “joint commissioning arrangements, whereby CCGs and area teams make decisions together, potentially supported by pooled funding arrangements”.
“A further step towards CCG responsibility would be “delegated commissioning arrangements, whereby CCGs carry out defined functions on behalf of NHS England”, and in which case NHS England’s area teams would “hold CCGs to account for how effectively they carry out these functions”.