HSJ Live 15.04.2015: Hunt: Seven day NHS may be cheapest way to meet rising demand

5.10pm The Conservatives’ plan to extend weekend working would help the NHS meet rising demand for operations, rather than being an additional cost pressure, the health secretary has argued.

The Tory election manifesto, published yesterday, has promised a “truly seven day NHS”.

In an interview today, HSJ asked Jeremy Hunt about NHS England analysis from 2013 which said moving to seven day working would require service reconfiguration and involve additional cost.

5.05pm Health secretary Jeremy Hunt has told HSJ the better care fund should be ‘accelerated and extended’ to help the social care sector benefit from increased spending promised for the NHS.

In an interview today, Mr Hunt also stressed that his party’s promise of an extra £8bn for the NHS was not dependent on continued economic growth, and reiterated the Conservative Party’s insistence that the pledge was “fully funded”.

His comments came after yesterday’s publication of the Conservative manifesto, which included a commitment to real terms growth in NHS spending of at least £8bn by 2020, on top of the increase already committed for 2015-16. This is designed to close the funding gap identified by the NHS Five Year Forward View.

At its annual health conference in Liverpool, Unison, which has 300,000 NHS members in England, voted in favour of a motion to ballot for industrial action if any future government tried to reduce the £1.8bn spent on unsocial hours payments.

Both the coalition government and NHS Employers have proposed changing the way staff are paid for working outside normal hours to help make the delivery of a seven day NHS more affordable.

3.55pm The Liberal Democrats have criticised the role of competition in the health service, pledging to repeal parts of the Health Act 2012 and end the competition authority’s role in health.

The party’s general election manifesto, released this morning, says it is “committed” to repealing any parts of the Health Act 2012 that “make NHS services vulnerable to forced privatisation through international agreements on free markets in goods and services”.

The party says it would also work to end the role of the Competition and Markets Authority in health. The document adds: “The needs of patients, fairness and access always come ahead of competition, and that good local NHS services do not have to be put out to tender.”

2.55pm Nuffield Trust chief executive, Nigel Edwards, says the Lib Dems manifesto “sets an encouraging tone” for how the NHS could be treated in coalition negotiations.

He added: “We also strongly endorse the proposal that the Liberal Democrats will ensure that targets in the NHS are evidence-based and do not distort clinical priorities. We have raised concern about how the four-hour A&E target can distort behaviours inside hospitals in a way that is not in the interest of patients or staff.  

“But despite the funding increase, it is regrettable that the party’s own detailed funding plans suggest that the majority of this £8bn will not come on-stream until halfway through the parliament. Moreover, there remain big unanswered questions over how feasible it is to expect £8bn to pay for all the additional proposals in the manifesto.

“No mention is made of the significant efficiency savings of 2-3 per cent per year outlined in NHS England’s Five Year Forward View to fill the NHS funding gap by 2020. Indeed the Forward View’s proposals to transform the NHS are not explicitly discussed in the manifesto, which is disappointing. The NHS will already be straining for an unprecedented £22bn of efficiencies exactly when the Liberal Democrats wish to invest in mental health, end of life care and avoiding hospital admissions. Yet evidence that investment in these interventions saves money in the short-term is limited.

“The party’s extremely ambitious plan to pool all health and social care budgets by 2018 is concerning when we don’t know the outcome of Manchester’s experiment. While ending the fragmentation between these two services is the right aim, pooling these budgets across the country is fraught with difficulty and would make it hard to guarantee the £8bn the NHS needs as a minimum to break even.

“The manifesto contains no discussion of further funding for social care, which has already experienced deep cuts since 2010. So the party is right to call for a Fundamental Review of NHS and social care funding this year.”

2.50pm Monitor is probing the financial sustainability of Cambridgeshire and Peterborough Foundation Trust – just weeks after it took on an extra 1,400 staff as part of one of the NHS’s biggest, most complex service restructures.

The regulator said the trust was “meeting its current fiscal projections” but it “still faces longer term financial challenges”.

A statement by the watchdog said it “wants to be sure the trust is financially strong enough for patients to receive quality care in the future, particularly given the increased number of services it will be providing”.

2.10pm The Health Foundation’s chief executive, Jennifer Dixon, said she welcomes the Lib Dem commitment to increase mental health funding but would “welcome clarity” on the pledge to pool NHS and social care budgets by 2018.

She said: “The Five Year Forward View analysis - which the Health Foundation supports - is that health funding will need to increase by at least 1.5% a year in real terms in each of the five years of the next parliament to meet growing pressures on the service even if there is rapid progress on improving productivity. Any backloading of the funding – funding increases at a later stage – may cause real challenges in a service in which three quarters of acute hospitals are currently in deficit.”

“It is positive that there is a commitment to increase mental health funding and look at the very serious issues afflicting mental health services. However, more spending on mental health can only be effective if there is also focus on dramatically changing the way mental health care is delivered. Re-balancing total NHS spend in favour of mental health may be the right thing to do, but it could mean quality in other areas will suffer, and any party that makes this pledge will need to be clear on where the axe will fall.”

“We would welcome clarity on the pledge to pool the NHS and care services’ budgets by 2018, which appears to be a significant extension of the Better Care Fund. We echo the call in the Five Year Forward View for a proper evaluation of the results of the 2015/16 Better Care Fund before any national decision is made to expand it further.”

2.05pm The King’s Fund has responded to the Lib Dems manifesto. Chris Ham said the failure to mention social care in any of the main parties’ manifestos meant it had become “the ghost at the feast”.

Chief executive, Chris Ham, said: “The Liberal Democrats have set out a very clear and detailed prospectus for the NHS in their election manifesto.

“At the heart of this is a clear commitment to deliver integrated care, including a pledge to transfer responsibility for social care to the Department of Health and a target date of 2018 to pool NHS and social care budgets locally. This confirms that integrated care is now the destination for all the main parties, even if they have mapped out very different journeys to get there.

“The pledge to find the additional £8 billion a year called for in the NHS five year forward view is welcome. However, the detail behind the pledge indicates that most of this new funding will not be available until the latter half of the parliament, so it will not address the immediate financial pressures facing the NHS.

“Proposals to invest an additional £500 million a year in services close to people’s homes could help reduce pressures on hospitals by reducing delayed discharges. However, like the other two main parties, the Lib Dems do not address the significant and growing pressures facing social care services. Social care funding has become the ghost at the feast of this election campaign.

“The Liberal Democrats have led the way in pushing mental health up the agenda. While they are right to prioritise spending on mental health and community services, holding back most of the £8bn funding increase until 2017/18 will create an unsustainable squeeze on acute services in the meantime.”

12.46pm A proposal to replace two district general hospitals with a single facility was revealed after consultants hired to investigate the move were overheard discussing it in a conference call on a train.

The consultants from Deloitte were recorded discussing Epsom and St Helier University Hospitals Trust by a BBC reporter as the train approached Waterloo Station.

The plans for a single 800-bed hospital were not denied by the trust or local clinical commissioning groups, which commissioned the consultancy firm. This afternoon health secretary Jeremy Hunt said he did not support the move.

The regulator is on course to rate the seven trusts, covering constituents in 12 target seats, before polling day.

With the NHS one of voters’ top priorities, the ratings and inspection reports could influence the results of local campaigns and help decide who forms the next government.

Last month the regulator published a list of 18 providers, on which it expects to publish inspection reports before 7 May.

11.55am Here is the UKIP manifesto in full.

11.43am UKIP would put a GP in every A&E department.

11.42am UKIP has pledged to build a 500 bed military hospital with accommodation for 150 family and friends.

11.40am UKIP also pledges to “bring the NHS and social care” together. Deputy chairman Suzanne Evans says this will stop 1m lost bed days due to delayed discharges.

11.38am “We will ensure that GPs’ surgeries are open at least one evening per week, where there is demand for it.”

11.38am UKIP manifesto on PFIs:

“We will stop further use of PFI in the NHS and encourage local authorities to buy out their PFI contracts early where this is affordable.”

11.26am He says UKIP is fully committed to the founding principles of the NHS. More nurses, doctors and midwives. Would end hospital car parking charges.

11.25am Farage says UKIP would “revisit the Barnett formula” to give Wales and England a better deal.

11.25am Nigel Farage is now speaking. He says that all migrants to the UK will need their own health insurance.

11.20am In the Lib Dems manifesto it calls for the Department of Health to be in control of care policy and funding as well as health to join up the two areas.

HSJ was told this exclusively by Care Minister Norman Lamb last month. You can read our interview here.

11.20am UKIP will be launching their manifesto at 11.30am.

11.15am Monitor has opened an investigation into the financial sustainability of Cambridgeshire and Peterborough Foundation Trust.

The regulator said that although the trust has improved its care for the elderly and those with long-term conditions it faces “longer-term financial challenges”.

The regulator’s investigation will seek to understand the underlying financial risks and challenges the trust faces. It will also examine whether the trust’s leadership has a good understanding of these challenges and is developing effective ways of dealing with them.

11.10am The Lib Dems have also gone in big on joined-up care and would “permit” commissioners and providers to form a “single integrated health organisation”.

They say they would “encourage the development of joined-up health providers, which cover hospital and community services, including GPs, learning from international best practice. We will permit NHS commissioners and providers in a local area to form a single integrated health organisation where appropriate.”

11.05am YouGov has said that health has overtaken immigration for the first time since the coalition came into power in 2010. It is now the second most important concern for the public behind the economy.

11.00am The Lib Dems have said quite a bit on NHS funding in their manifesto.

Here’s one key section:

“To ensure the NHS is safeguarded for the long term we will commission a non-partisan Fundamental Review of NHS and social care funding this year. We will involve as many people as possible in this nationwide consultation.”

10.55am Half a billion of the £8bn pledged will go towards perventing hospital admissions and speeding up discharges.

10.50am Lib Dems would establish a £50m mental health research fund to “further our understanding of mental illness and develop more effective treatments.”

10.48am They would introduce “care navigators” to help people find their way around the healthcare system.

They would also “set stretching standards” to improve the physical health of people with mental health problems.

10.46am The Department of Health would have “full responsibility” for care policy and funding to join up health and care at a national level.

10.45am The Lib Dems will also “secure local agreement” on a “full pooling” of NHS and care service budgets with a target date of 2018.

10.45am They will also “work with Monitor to reform NHS funding systems, moving away from payments for activity to tariffs that encourage joined-up services and preventive care.”

10.42am The Lib Dems would repeal parts of the Health and Social Care Act “which make NHS services vulnerable to forced privatisation through international agreements on free markets in goods and services.

“We will end the role of the Competition and Markets Authority in health, making it clear that the needs of patients, fairness and access always come ahead of competition, and that good local NHS services do not have to be put out to tender.”

10.40am The Lib Dems would develop an NHS “student guarantee”, making it easier for students to get care and support while at university, particularly those with long-term health conditions or caring responsibilities.

10.38am Here is another section from the manifesto on benefits and the NHS:

“Improve links between Jobcentres and Work Programme providers and the local NHS to ensure all those in receipt of health-related benefits are getting the care and support to which they are entitled.”

10.36am Clegg says one in four of citizens suffer from mental health problems in their lives. But there has been “what amounts to systematic discrimination” against those people.

Lib Dems “will turn the page” on the treatment of these people. They have “started to lift the lid on the stigma”.

He cites waiting times standards for mental health and wants to introduce a £1.25bn fund for childrens and adolescent mental health services.

10.35am In the Lib Dems manifesto there is suggestion that the NHS will be encouraged to be “greener” in procurement processes.

“Grow the market for green products and services with steadily higher green criteria in public procurement policy, extending procurement requirements more widely through the public sector including to the NHS and Academy schools.”

10.31am Clegg’s first mention of the NHS - “quality healthcare for all” with £8bn funding for the NHS.

10.30am And here’s the manifesto in one document.

10.25am The Lib Dems manifesto is now up on their website. Here’s a link to it.

10.25am Nick Clegg says that neither Labour or Conservatives will win outright so what “really matters” is who works with them.

10.00am The Daily Mail reports that more than a third of GPs are considering retirement in the next five years, a survey by the British Medical Association shows.

Another one in ten is thinking about moving abroad to countries including Canada and Australia, where the pay is higher and workload less stressful.

A poll of 15,560 family doctors also found that one in six is considering going part-time and 7 per cent are contemplating quitting altogether.

9.50am The Liberal Democrats will launch their manifesto at 10am today. Follow us for live updates.

7.00am Good morning and welcome to HSJ Live.

To start the day, help us find the top clinical leaders in healthcare.

HSJ, working with Veredus, is celebrating those clinical leaders who are making a big impact on health service policy, and medical advancement to provide high quality, safe care for patients.

We will be honouring those working in healthcare who not only excel in their professional specialism, but whose impact extends beyond their professional sphere.

In particular, we are looking for those leaders who you believe are having the greatest influence on health policy, service transformation, clinical research and innovation.

To decide which nominees make the final list, the HSJ team and an expert panel of judges will consider:

• Policy: To what extent have they influenced healthcare policy nationally in the run-up to the election and are likely to do so over the next 12 months?
• Service transformation: To what extent have they influenced improvements in services as envisaged in the NHS Five Year Forward View or are likely to do so over the next 12 months?
• Innovation: To what extent have they used their clinical leadership drive innovative solutions in health and care?

Click here to make a nomination.

Nominations will close on Friday 1 May.