Simon Stevens delivers speech on seven day services and how efficiency challenge will be met, plus the rest of today’s news and comment
5.25pm NHS Confederation is the latest group to give its view on the government’s seven day services drive.
Rob Webster, chief executive of the NHS Confederation, said: “A move towards seven-day services for the NHS will provide a better, safer and more responsive experience for patients and could lead to a more efficient use of NHS resources. To achieve this, a wider culture change across the NHS is needed, in addition to resolving the financial, workforce and service design challenges.”
On funding Rob Webster said: “The commitment to find the extra funding, confirmed by the Prime Minister is very welcome. Even with this funding our members will need to find £22 billion of efficiency savings. We need clarity on the phasing of growth in funding for health and care if our members are to unlock these savings and we need reassurance that social care will be properly funded. We made this clear in a letter sent to the Prime Minister and signed by more than 50 senior health leaders.
“We all need to be honest with the public about the very real and immediate pressures facing health and social care and to manage them together.”
5.20pm Two trusts in the South West have announced plans to become an integrated provider.
A joint statement from Bill Shields, chief executive at Royal Cornwall Hospitals Trust and Phil Confue, chief executive at Cornwall Partnership Foundation Trust: “Today, we can announce that our two organisations have agreed to work together to explore whether we can become one integrated NHS provider.
“We both believe that integrating services will lead to higher quality, seamless care for patients and more effective use of public money.
“We are listening to people in Cornwall and the Isles of Scilly who want to see more joined up care, easier access to services and less bureaucracy in the NHS.
“It is still early days in our discussions and clearly we will want to consult further with clinical teams, partner organisations and the wider community to ensure we get this right for patients.
“Our trust boards will report and discuss the progress in June 2015.”
3.15pm On seven day services Paul Briddock, director of policy at the Healthcare Financial Management Association, said: “Our members and those working in healthcare welcome any practical steps to increase access and enhance the quality of the service we provide to patients. The Government’s pledges today are a step in the right direction. However, these plans will cost additional money in an already stretched system, therefore any extra funds committed should be coupled with guidance on how best to implement these fundamental changes to the way the NHS works at the moment.
“Proposals such as seven-day services will therefore need careful financial planning. However, despite having cost implications, the benefits of increased access to primary care provision should also lead to less unnecessary and expensive hospital admissions in the long run.
“One immediate practical challenge is a shortage in the number of GPs available to deliver these changes and the need to increase both the intake of doctors coming in the system and training through the GP ranks.”
2.50pm The Academy of Medical Royal Colleges has said it has led the way in promoting seven day services.
“The Academy and Colleges have led the way in promoting the need for seven day services. We said when our report ‘Seven Day Consultant Present Care’ was published in 2012 that it was not acceptable that patient outcomes should depend on when they are admitted to hospital and this variation is insupportable.
“The Academy developed three patient-centred standards to deliver consistent inpatient care irrespective of the day of the week. These standards reflect the importance of daily consultant review, and the consequent actions, to ensure progression of the patient’s care pathway.
“The Academy is clear that the priority for seven day hospital services must be in respect of urgent and acute care where there are real variations in outcomes rather than all elective care
“The Academy’s report stated that it was unlikely that the standards proposed in its report could be universally achieved within existing local resourcing arrangements and NHS tariff levels. Whilst full adoption of the standards may deliver some savings over time, it is not anticipated that they will be self-funding. Other interventions such as changes in working patterns and service reconfiguration onto fewer sites will be needed.”
Care UK, one of the country’s biggest independent providers of NHS care, works with approximately 1,000 people with learning disabilities.
The deal, signed for an undisclosed amount, forms part of a company strategy to concentrate on the provision primary and secondary NHS health services.
2.15pm Chris Hopson, chief executive of NHS Providers, has some questions about the government’s commitment to introduce seven day services across the NHS.
He said: “NHS Providers and the foundation trusts and trusts we represent support the government’s commitment to introduce seven day services across the NHS. As the prime minister has said today, the case to move to seven day services on grounds of patient outcomes, safety and quality of care is irrefutable.
“We also welcome the government’s recognition that delivery of universal and consistent seven day services is a complex task whose implementation will take considerable planning, change and investment. NHS Providers has been working over the last eighteen months, as a member of the seven day services forum, to work out how foundation trusts and trusts can meet this implementation challenge. We and our members stand ready to complete this work at the NHS frontline.
“Six early questions we want to work with others to answer, are:
- What does the NHS mean, in detail, by seven day services? We need to be clear which services will benefit from seven day provision so that we can properly manage patient expectations about what service improvements they can expect and when.
- How does this important new priority sit alongside other priorities for providers such as the need to realise £22 billion of efficiencies; move to new care models; and the output of the forthcoming new cancer and mental health taskforce strategies?
- What workforce changes are required for successful implementation and how can these be delivered?
- What is the anticipated full cost of this move, how will it be funded and how will it relate to both other funding pressures and the welcome extra £8 billion of NHS funding by 2020 pledged today by the Prime Minister?
- Effective seven day service delivery requires complimentary services across the entire health and social care sector - how will these be delivered?
- Implementation will be challenging for parts of the NHS, for example in rural trusts or in community services, what extra support will be available to help those organisations?”
Mr Wright will join the trust from Warrington and Halton Hospitals Foundation Trust, where he is currently deputy chief executive and chief operating officer.
He will take over from Peter Herring, who will retire at the end of July after nearly three years leading the Shropshire trust.
1.20pm Unison has said the seven day services plan will only work if the government avoids taking money from the extra pay staff get for working anti-social hours.
Head of Health Christina McAnea said: “The NHS should be able to provide the same quality of care no matter what day of the week a patient is admitted to hospital.
“We welcome Jeremy Hunt’s recognition that a seven-day NHS will cost money, and look forward to talking to him about how the proposals can be introduced.
“But for the government’s plans to work, ministers must find new money, not take it from the small amount of extra pay that nurses and other NHS staff get from working at night, weekends and bank holidays.
“The public is right to expect that the NHS should be well-run and safely staffed every day of the week, but they won’t want to see that happen at the expense of dedicated health professionals.”
1.15pm Nuffield Trust chief executive, Nigel Edwards, said that while the seven day services vision should be welcomed the government “should be under no illusions about the impact a seven-day NHS will have”, including requiring a “critical mass” of specialist staff.
He said: “The Prime Minister is right to aspire to seven-day access for patients to hospital and GP services – this will help to improve the consistency of care people receive at all times of the week. We have known for some years that there is a higher risk of mortality in our hospitals at weekends – this needs to be dealt with. Moving to a seven-day service will also help improve the flow of patients though hospital and the problems that result from the surge of demand on Mondays. Whether the Government will provide the funding available to achieve this aspiration is a key question though – the extra £8bn it has pledged by the end of 2020/21 will be enough to keep existing services running but little else.
“But the government should be under no illusions about the impact a seven-day NHS will have. It will mean significant changes to the way services are run across the country, and it will also require recruiting a critical mass of specialist staff. Making seven-day working a reality may also mean closures or mergers of local services, such as emergency surgery or maternity units. So, this will not only cost additional money beyond the £8bn but it will also require political bravery.
“Getting the right workforce in place will be a critical challenge as the main driver will be the need to recruit highly paid medical staff, as well as support staff. General practice in particular is very stretched and it takes time to recruit in extra capacity. In addition, the NHS currently pays a premium for weekend working so negotiations over terms and conditions for staff will need to be handled carefully.
“One of the key questions is what effect this will have on patient behaviour and whether this will merely create additional demands on local services that wouldn’t otherwise have happened – a problem of ‘supply-induced demand’ – or whether it will help smooth demand over seven days rather than traditional peak periods, such as Monday mornings where GP surgeries can be up to 40 per cent busier than on the average working day.
“In all of this the Government needs to be clear about the problem it is trying to solve by moving to a seven-day NHS, and crucially how the measures it is suggesting will achieve this in the resources available, as it is not immediately clear from the detail we have seen so far.”
1.10pm On the the seven day services plan Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said:
“There is a strong clinical case for seven-day services, particularly in rehabilitation where uninterrupted treatment is shown to improve recovery.
“But stretching five days of resources over seven won’t work for patients and is unfair on staff.
“As our new briefing shows, seven-day services need two things to be successful: funding and staff engagement in the process.
“We welcome Mr Cameron’s commitment to fulfil his campaign pledge of £8bn extra for the NHS, but it’s important to note that this sum is just to help the service stand still.
“Further funds will be needed as well as an emphasis on prevention to bring down costs in the longer-term.
“It is also critical for employers to approach these changes in a genuinely collaborate way with staff and their trade unions and professional bodies to ensure patients receive quality services that are both sustainable for the NHS and fair to those delivering them.”
1.05pm Clare Marx, president of the Royal College of Surgeons, has said seven day care must be consultant-led.
She said: “Mortality is higher for patients admitted to hospital at the weekend, so the government’s commitment to making seven-day care one of its early priorities is very welcome.
“Seven-day hospital care must be consultant-led to ensure timely intervention and better outcomes for acutely unwell patients. We must also ensure there is seven day access to key services and facilities in hospitals, like pharmacy, radiology, and physiotherapy, and support available in the community for the next steps in a patient’s treatment.
“This move will require significant change in the NHS. To aid NHS planning, the government or NHS England should commission and publish in-depth financial modelling of the anticipated cost of seven-day services and skill shortages.”
He said in a forenight’s time he will be spelling out how the £22bn efficiency challenge will be met.
Victorino Chua was convicted of killing Tracey Arden and Derek Weaver at Stepping Hill Hospital by injecting insulin into saline bags and ampoules.
He said there would be “at least an extra £8bn a year by 2020”.
11.00am The Independent reports that nurses will take industrial action if the government tries to cut pay to deliver its election promise of a “truly seven-day NHS”, the leader of the Royal College of Nursing has warned.
Peter Carter said that any “attacks on unsocial hours or weekend working payments” would be a “red line” for nurses.
10.55am The Department of Health has admitted it made a last minute reversal of its decision to stop providing “Project Diamond” funding for specialist hospitals in 2014-15, boosting the finances of up to 19 trusts.
The U-turn came at the end of the last financial year, with an election imminent and some of England’s most prestigious hospitals warning the funding cut would cause steep deterioration in their finances.
It followed a protracted battle over Project Diamond – as it is known by its London based recipients – which had been raging since the DH’s decision to stop providing the funding at the end of 2013-14.
10.50am HSJ correspondent Shaun Lintern has tweeted on the seven day services speech:
10.45am In response to the David Cameron’s speech on seven day service chair of the Royal College of GPs, Maureen Baker, said there was a “severe shortage” of GPs and it is “difficult to see how this will work without major investment in general practice and a major boost to the GP workforce”.
She said: “Waiting times for a GP appointment are now a matter of national concern and hardworking family doctors are going all out to ensure that patients can get access to a GP when they need one.
“But we have a severe shortage of GPs and it is difficult to see how this will work without major investment in general practice and a major boost to the GP workforce.
“Many practices are already offering extended opening hours but for the majority, seven day opening remains an aspiration and telling patients that they can walk into their local surgery in the evening or at weekends risks raising expectations that general practice cannot live up to with current resources.
“GPs are now seeing 370 million patients - 70m more than even five years ago.
“We manage 90 per cent of patient contacts in the NHS, but as patient demand has rocketed and our workloads have become more complex, the share of the NHS budget for general practice has fallen to an all-time low of just over 8 per cent in England.
“We welcome the new Government’s commitment to delivering the Five Year Forward View and hope that it will honour its promise of 5,000 additional GPs as a matter of urgency.
“Access to GP services is extremely important but prioritising weekend and evening access must not come at the expense of access and services during normal hours so that patients end up worse off.
“Practices must be able to tailor their services to the needs of their local populations.”
10.40am The Royal College of Nursing has said the NHS needs “sufficient resources” to provide enough staff to deliver seven day services.
A spokesman said: “The Royal College of Nursing supports moves to ensure that any patient care is if the same standard at 9am on a Sunday morning as 9am on a Tuesday morning. To make this a reality, the health service needs sufficient resources to be able to provide enough staff when they are needed. This includes all nursing, diagnostic, imaging, medical and support services. We look forward to working with the government to identify what is needed and ensure that the NHS is safely staffed 24 hours a day, seven days a week.”
10.00am Secretary of state Jeremy Hunt was on the Today programme this morning, giving more detail on the government’s vision for seven day services across the NHS. He also said the £8bn pledged would be a “minimum”.
He was asked where 5,000 extra full-time GPs would come from and replied that the government had increased numbers by five per cent but more were needed.
He added: “For many GPs, they feel it is like being in a hamster wheel. They can’t give the high quality care they want to give. They can’t keep tabs on the most vulnerable people.”
He said the government would have to change the way a GP works and new terms and conditions were needed as well as a new skill mix. He added: “We have to look at what is putting people off becoming GPs”.
He said in other countries there are more assistants for GPs and nurses could be used to do some routine tasks such as a blood test. GPs should also do less admin tasks.
9.50am David Cameron will deliver his first major speech since the election on his vision for a seven day NHS.
He will say: “There is nothing that embodies the spirit of one nation coming together – nothing that working people depend on more – than the NHS. Our commitment is to free healthcare for everyone - wherever you are and whenever you need it.
“That means getting the best care and making that care available for everyone – free – wherever they are and whenever they need it.
“So I believe that together – by sticking to the plan – we can become the first country in the world to deliver a truly 7-day NHS.
“And we must do so to protect and preserve the values of the NHS that are so central to our national identity.
“To keep our people healthy, to look after them when they fall ill, to care for the elderly with dignity and to ensure that free healthcare is always there whenever people need it most.
“By sticking to the plan we can and will achieve this together.
“A 7-day NHS, safe in our hands – for every generation to come.”
8.20am Jeremy Hunt has said increasing weekend working will include reviewing GP contracts, reviewing what is preventing people wanting to become GPs, and increasing the role in primary care of non-GPs such as physician assistants, nurses and admin staff.
7.41am Prime minister David Cameron is today due to use his first major speech of the new government to reemphasise its commitment to move towards “seven day” health services. He will also reiterate its plans to increase NHS spending through the Parliament.
The BBC reports that Mr Cameron will say staff will not need to work longer, but will have to work more flexible hours. The speech may be a reflection of the important the government is putting on renegotiating staff contracts to make it easier to deliver more out of hours working and to increase clinical productivity.
7.00am Good morning and welcome to HSJ. In case you missed it, here’s our Executive Summary, presenting you with the most important stories from Friday.