The NHS provider sectors’ financial situation deteriorated steeply in the first months of this financial year, coverage of NHS England’s board meeting, and the rest of today’s news.
4.57pm The average income tax of GP contractors was £102,000 in 2012/13, a of 0.9 per cent fall from the previous year, according to figures released by the Health and Care Information Centre today.
GPs’ incomes have been gradually falling since their peak of £110,000 in 2005-06, the year after the introduction of new contracting arrangements.
Their average average gross earnings was £271,800, an increase of 1.4 per cent increase from 2011-12. However, their expenses rose by 2.9 per cent in this period, hitting £169,700.
In the report, The GP Earnings and Expenses report 2012/13, released today, the HSCIC also found in 2012-13:
- The average income before tax for GPs (contractor and salaried) in the UK was £92,900 for those GPs working in either a GMS or PMS practice compared to £94,200 in 2011/12, a decrease of 1.4 per cent.
- The average income before tax for salaried GPs in the UK was £56,400 compared to £56,800 in 2011/12, showing a slight decrease of 0.6 per cent.
- For both GMS and PMS GP contracts, the largest expenses category is ‘Employee’.
4.05pm NHS England has postponed plans to allow to GP practices to register new patients outside their boundary areas until the new year.
Under the 2014-15 GP contract, GP practices were to be allowed to register new patients from outside their traditional boundary areas without a duty to provide home visits for such patients, which they are currently stipulated to do.
The move would “increase flexibility in the system” and “increase the freedom that patients have to choose a GP practice that suits them,” NHS England said. For example, patients would have been able to register with a practice closer to their workplace rather than their home if they commute into work.
However, NHS England said it needed more time to ensure set up new services, working with local urgent care services and NHS 111, for circumstances in which these patients may need urgent close to home and are not able to attend their practice.
An NHS England spokesman said: “This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP.
“With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.
“This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in - a decision that has been taken in the best interests of GP practices and patients.”
3.48pm In response to Monitor’s report published today, which revealed that the foundation trust sector was in deficit for the first time, Mark Porter, Chair of British Medical Association’s council said: “This is extremely worrying and shows just how much pressure hospitals are under.
“Despite years of flat-lining investment in the face rising demand the NHS has coped well until now, in large part down to the hard work of front-line staff, but we’re at a critical point and the cracks are starting to show.
“Services are stretched to breaking point, targets are being missed during the summer months when the NHS is not subject to seasonal spikes demand and waiting lists are at a six year high.
“We cannot continue to meet rising demand on the health service with under-funding. Unless urgent action is taken to put the NHS on a sustainable financial footing it simply won’t be able to cope and patients will suffer.”
3.30pm Whether its bringing together whole systems of health and social care or rethinking care in a single department, integration must proceed by persuasion, not force. Ingrid Torjesen reports.
3.10pm A former chief executive of a private waste company, Colin Drummond has brought his experiences of staff empowerment to Taunton and Somerset Foundation Trust with great success, writes Jennifer Trueland.
2.53pm There is no easy way to sort out the future of NHS finances, but the longer we delay the worse the situation will get, writes Anita Charlesworth, chief economist at the Health Foundation, in a comment piece for HSJ.
HSJ, working with NHS Employers, the NHS Leadership Academy and the British Medical Association, is seeking to celebrate the outstanding contributions professionals from black and minority ethnic backgrounds make to healthcare – and nominations are now open.
This November we will be celebrating individuals working within healthcare who can be considered to be BME pioneers – people from BME backgrounds who, through exceptional leadership abilities or their day to day example, are inspiring others and helping to shape and deliver excellent care for all.
Nominees can be working across health and social care, and at all levels, and can be from a clinical or non-clinical background – we want to identify and celebrate people you are proud to work with and who inspire you. We are particularly looking for people who you believe meet two or more of the following criteria:
- Benefit: how has this individual’s work benefited patients? To what extent have his or her efforts helped enhance access to and/or the quality of care?
- Influence: to what extent has the individual been a game changer in his or her organisation, or more widely?
- Leadership: to what extent has this individual created a platform for others? Has he or she enabled greater numbers of BME staff to take up roles at all levels of the health sector?
- Inclusivity: to what extent is the individual having a long term impact on the debate around inclusivity within the health sector?
A panel of expert judges will decide on the final list, which will appear online and in print in HSJ during November.
The closing date for nominations is Friday 26 September.
2.37pm In Resource Centre today, there are many practical obstacles standing in the way of developing mutuals in the NHS but there have been some success stories and the government has clearly identified their transformative power, writes Mark Johnson, a partner in the public services team at Geldards LLP.
In this week’s issue Labour rejects Simon Stevens’ claim that NHS competition will require the commissioner-provider split to be “dismantled”. Plus:
- For the first time Monitor will help a foundation trust become a “full integrated care organisation”
- Four of the five fast-tracked better care fund plans are aiming low on emergency demand cuts
- A health information expert says “conflict of interest” undermines consultant level quality data
- Elective and accident and emergency performance stalls
- Kim Holt argues the slow response to the Rotherham child exploitation scandal exposes huge system failures
To find the latest issue, simply navigate to “This week’s issue” on the app, or tap on the cover image on the homepage.
1.43pm The Health Foundation has also responded to comments released by Monitor and the NHS Trust Development Authority, which reveal that two thirds of acute hospitals in England were in deficit during the summer, and NHS acute hospitals had a net deficit of half a billion.
Chief economist Anita Charlesworth said: “This is serious news for the NHS in England”.
She added: “These figures show how much stress the service is under, as it fails to meet many of the key standards on waiting times, ambulance response times and cancer care. The financial position is dire. The problem is not going away.
“As MPs meet for their party conferences over the coming weeks they need to recognise that the NHS faces fundamental, long-term challenges and that any new government must do more than tweaks to policy and small injections of cash. The NHS needs and deserves a commitment to transformation and a proper answer to the funding challenges in the short and medium-term.”
1.13pm Lewisham and Greenwich Trust is proposing to move stroke services out of one of its acute hospital sites to help cope with demand for emergency beds.
The trust hopes to make 28 beds available for emergency admissions by piloting a move of Queen Elizabeth Hospital’s acute stroke unit, in Greenwich, to neighbouring University Hospital Lewisham.
1.09pm Cambridge University Hospitals has clashed with commissioners over £1m withheld from the foundation trust for failing to meet a target that it believes it met.
Commissioners have withheld 2 per cent of their monthly contract payments to the trust since July – roughly £500,000 per month – for missing its target for the proportion of patients waiting less than four hours in accident and emergency.
1.05pm Commenting on Monitor’s report, shadow health secretary Andy Burnham said: “The NHS is heading rapidly in the wrong direction. It is not just standards of patient care that are getting worse but NHS finances too.
“David Cameron put the NHS in today’s fragile financial position when he decided to break his promise of ‘no top-down re-organisation’. It turned the NHS upside down and cost a staggering £3bn.
“David Cameron must take urgent action to stabilise the deteriorating situation - patients fear much worse will be in store next year. This is why he is losing public trust on the NHS.”
1.02pm Join an HSJ Twitter chat to the debate on the current state of the foundation trust sector on 22 September.
The health regulator Monitor today published its latest quarterly performance report, covering the first quarter of 2014-15.
The report’s author, Jason Dorsett, Monitor’s director of financial reporting and risk, will be taking part in an HSJ Twitter chat at 12pm on Monday 22 September to answer your questions about the report and the FT sector
Among the issues Mr Dorsett will be discussing are:
- how FTs are performing against key national healthcare targets, such as accident and emergency waiting times, cancer targets and ambulance response times;
- the sector’s financial position in what many people expect to be a crunch year for provider finances;
- what regulatory action Monitor has taken against FTs this quarter and why; and
- what action FTs should take to improve their financial and operational performance.
12.52pm The bosses of clinical commissioning groups and NHS providers have been told to raise their game to hit waiting time targets in a letter from NHS England, Monitor and the NHS Trust Development Authority.
It also reveals that national officials are now not expecting the flagship elective waiting time targets to be met until after the end of November. Earlier in the summer they had hoped they would be met in September.
Simon Stevens, David Bennett and David Flory, the chief executives of NHS England, Monitor and the NHS Trust Development Authority respectively, said “very high demand” in 2014-15 had made delivery “ever more challenging”.
However they said: “It is essential that you continue to focus on meeting the NHS constitution standards and take rapid action to improve performance where these standards are not being met.”
The letter was sent to NHS provider chief executives and CCG leaders today.
12.39pm Commenting on the latest quarterly reports on financial performance from Monitor and the NHS Trust Development Authority, Richard Murray, director of policy at the King’s Fund, said: “These figures are significantly worse than expected and provide yet more evidence that the NHS is heading towards a financial crisis.
“The only question now is whether the crunch comes during the current financial year, as now seems increasingly likely, or whether it can be deferred until next year.
“The position in the acute sector in particular has deteriorated sharply, with around two thirds of hospitals now either already in deficit or forecasting a deficit at the end of the financial year. The number of foundation trusts in deficit is unprecedented.
‘We do not yet have a read out on the position of commissioners but it is unlikely that they will be able to offset the rapidly worsening position among trusts and foundation trusts.
“Unless significant extra funding is found, patients will bear the cost as staff numbers are cut, waiting times rise and quality of care deteriorates. Emergency support is needed for otherwise sound organisations that are running up deficits as a result of the unprecedented pressures on their budgets.
“A new health and social care transformation fund should also be established to meet the cost of essential changes to services. This is a big ask in the current financial climate but the money to do this cannot be found from existing NHS budgets.”
12.36pm Monitor has appointed Fiona Wise as improvement director for University Hospitals of Morecambe Bay Foundation Trust.
The trust was placed in special measures in June.
Ms Wise is a former chief executive, with over 40 years’ experience in the health service. She will work in the trust in a part-time capacity.
Monitor’s regional director Adam Cayley said: “This extra support will help the trust to make the improvements that are needed to ensure better care for patients in Morecambe Bay.
“Fiona has a wealth of NHS experience, particularly in helping organisations to improve the way they provide services to patients. She will help the trust to build on the progress that it has already made.
“We will continue to look closely at the trust’s progress and will take further action if necessary.”
12.25pm Earlier today at NHS England’s board meeting, chief financial officer Paul Baumann discussed its finance paper.
He said risks run to £400m, and aiming for surplus of £400m makes it an “uncomfortable risk”. The biggest risk is to the specialised commissioning budget, he added.
There is also a risk that continuing healthcare provisions could be higher than the £250m put against it.
However, he said it is doing significantly better on QUIPP savings compared to last year.
12.16pm Responding to news that NHS providers have suffered “unprecedented” financial problems in the first few months of this year, Nuffield Trust chief executive Nigel Edwards said: “We know that NHS Trusts have been struggling financially for some time. But today’s revelation that 80 per cent of acute foundation trusts are now in deficit - and many have failed to meet the most visible waiting times targets - is very worrying indeed.
“The sector as a whole is in now deficit for the first time, yet foundation trusts are generally the higher-performing hospital trusts that we’d expect to meet their financial and access targets, even during a period of austerity.
“Back in July, we warned that the NHS could experience a funding crisis before the general election. We concluded that trusts’ increased reliance on temporary and agency staff, growing hospital admissions, and tight funding was combining to make the NHS poorly placed to deal with continued austerity, with efficiency savings harder and harder to come by.
“This seems borne out in today’s figures from Monitor, which show foundation trusts making smaller efficiency savings than planned and a worrying and unsustainable reliance on agency staff.
“Both FT and NHS trusts are findings themselves in between a rock and a hard place: a desire to increase staffing numbers in response to the Francis Inquiry at the same time as an unprecedented squeeze on NHS finances.
“While there is scope for greater efficiencies to be wrung from the system, this will not be enough. There are a lot of good ideas about how to change the way that care is provided and how services are run that could help meet the challenge. But these take time to deliver and need investment. At present there is little funding for major change unless trusts are already in financial distress, by which point it is often too late.”
12.10am In a statement, the Foundaton Trust Network said today’s first quarter provider finance figures from Monitor and the Trust Development Authority, showing the “first ever quarterly deficit” for the the foundation trust sector “confirm what our members have been telling us about the huge, unfunded investment they are making in quality and the unceasing demand for NHS services”.
The statement continues: “As Monitor says in its report, these unprecedented deficits are due to “demand pressures, [and] the need to maintain care quality”.
“NHS providers are telling us they have had their busiest period ever this summer with many seeing record numbers of patients, even more than in the traditional ‘winter pressure’ period. They are also telling us that the cost of quality improvements - increased staffing, more beds – on top of the inexorable demand rise means that the high levels of efficiency savings they are delivering are being wiped out.”
The FTN’s chief executive Chris Hopson said: “NHS providers are performing heroically in delivering high quality care across the country in the face of the highest demand for their services they have ever experienced.
“These first quarter figures show the cost of investing quality and dealing with increasing demand. They should come as no surprise as we and others, like the Kings Fund and The Health Foundation, have been predicting this for some time.
“They provide a dose of realism about the true costs of meeting rising demand and investing in greater quality. You get what you pay for. We now need to work with commissioners, regulators and policy makers to establish how we can sustainably finance the access and quality standards we all want to deliver.”
12.05pm More from NHS England’s board meeting:
Discussing the performance report, chief operating officer Barbara Hakin said pressure in the urgent care system is often a marker of when planned care is not working as well as it might.
Ambulance service waiting times are marginally below standards we would expect to see, she added.
She said NHS England has put a significant amount of funding into urgent care and have now received all the system resilience group plans.
Giving an update on his urgent and emergency care review, the body’s medical director Sir Bruce Keogh said 50 per cent people who for call an ambulance could be treated at home, and suggested more could be made of paramedics.
Chief exective Simon Stevens said there has been a 19 per cent increase in urgent cancer referrals in last year, “but we need a game plan”.
11.39am NHS providers have suffered “unprecedented” financial problems in the first few months of this year, new official figures suggest.
Monitor, which regulates foundation trusts, said they overall had the worst start to a financial year in their history – recording double the level of deficit they had planned in the first quarter. It said the scale of the underperformance against plan was “unprecedented”.
The sector reported a total net deficit of £167m for the first three months of 2015-16 against a planned deficit of £80m, according to papers for its board meeting next week.
The NHS Trust Development Authority, which oversees the 98 NHS providers which are not foundation trusts, also reported new figures today.
11.32am In response to Monitor’s report into the performance of the NHS foundation trust sector, Paul Briddock, the Healthcare Financial Management Association’s director of policy, said the figures “show a worrying decline in the financial position of foundation trusts”.
He continued: “The figures come as no surprise given what our members have been telling us. The cumulative effect of year on year real terms reductions in the NHS budget for FT providers of 4 per cent per annum, coupled with increasing demand for services and the cost of quality improvements being required means that the majority of FT providers are struggling to cope.
“The NHS is at a crossroads. The reality is that the given the scale of the £30bn required savings on the £110bn NHS budget (a real terms reduction of over 25 per cent), this cannot be done by targeting efficiency savings alone. We simply can’t afford to carry on providing all the services that we currently do in the same way. An honest and open debate is required with action on what the NHS can and cannot afford to provide, and the changes required in how services are provided.
“In the absence of this we are beginning to see organisations, particularly acute providers, starting to miss quality targets and show signs of financial distress.”
11.26am Discussing NHS England’s five year forward view at the body’s board meeting this morning, Malcolm Grant said it cannot be a top down dictated document. We need to make sure changes we advocate will get traction with those who deliver them, he continued.
Victor Adebowale earlier said the NHS needs to find new voices and invert the pyramid, so ideas for change are not all coming from the top, but also from frontline.
HSJ’s Sophie Barnes (@sophieevebarnes) will be tweeting regular updates from the meeting throughout the morning.
11.15am Relatives of a grandmother who died while waiting in a queue of ambulances outside a hospital have demanded an apology from health bosses.
Sonia Powell, was taken to Morriston Hospital’s Accident & Emergency Unit in Swansea, South Wales, on Wednesday afternoon, following a suspected heart attack.
Her family said the 73-year-old had been waiting “at least an hour” by the time she died.
Health officials, who say the wait was in fact around 40 minutes, have now launched an investigation.
11.10am Barbara Hakin, NHS England’s said clinical commissioning groups as new organisations had a great deal of work to do last year and the quality of two year plans was not robust enough.
She added some of the work this year will involve looking at those two year plans again.
11.03am Back to NHS England’s board meeting, Simon Stevens has said the body is not proposing to introduce new planning requirements for 2015/16.
It will focus more on planning activity levels and financial arrangements to deliver financial balance, and will focus on five year plans and encouraging local systems to continue making these happen, Mr Stevens said.
11.00am Almost one in three people with mental health problems do not know where to turn in the event of a crisis, new figures show.
The Care Quality Commission said it was “concerning” that 32 per cent of people who receive community mental health services have no idea where to turn if they are in trouble.
Meanwhile, one in five who did know where to seek help in the event of a crisis said they did not get the assistance they needed.
Following its survey of 13,500 people who frequently use these services in England, the health regulator said that community mental health care “must improve”.
10.59am Commenting on the launch of MyNHS website, NHS Confederaton director of policy Dr Johnny Marshall said:”Improving people’s access to the right information in a format they can make sense of – neither over-complicated, nor over-simplified – should enable them to make more informed decisions about accessing local health services.
“It is vital that the information made available tells the whole story in a way that genuinely increases people’s understanding and knowledge. This is how we will empower people to hold their local services to account. The engagement of both the NHS and public from the outset in developing this type of knowledge service will be essential in getting this right.
“At present it is not clear whether the data that will be underpinning MyNHS provides for such insight. Ultimately it will be on that basis that its success will be measured.
“What is just as important as having accurate and timely data is understanding it. By itself, data can sometimes be meaningless and confusing. So it is vital that not only do we present the right information but that we support patients to turn that in to an increased understanding with which they can make informed choices. Only then is knowledge really power.”
10.50am More from NHS England’s board meeting, Simon Stevens will be meeting with chief executives in November to look at performance and what can be learned for next year.
10.46am NHS England chief executive has the said that the body, along withMonitor and the NHS Trust Development Authority, are writing to chief executives s to describe a “simplified, more coherent” ask when funding is provided.
Mr Stevens said there need complete clarity about what hospitals say they can deliver and make sure they have money to do so.
Follow @sophieevebarnes on Twitter for further updates from NHS England’s board meeting.
10.40am An update from NHS England’s board meeting this morning:
Simon Stevens - making good progress in developing waiting times standards for mental health— Sophie Barnes (@sophieevebarnes) September 19, 2014
10.36am The Care Quality Commission has recommended that Queen Elizabeth Hospital King’s Lynn Foundation Trust remains in special measures.
Also today, the FT regulator Monitor announced it had appointed a “contingency planning team” to consider the trust’s long-term future.
10.33am Former NHS England chief executive David Nicholson has called for a hypothecated NHS tax to be established, in a piece written for The Guardian Healthcare Professionals Network.
After “assess[ing] the opportunities for efficiency and productivity gain likely to be delivered in the NHS”, he suggests “the government would take the final decision on the level of the hypothocated tax and the amount allocated to the NHS.”
10.19am A new website to enable patients and staff to compare hospitals across a broad range of metrics from accident and emergency waiting times to the quality of meals has gone live today.
HSJ previously reported that MyNHS website includes data on patient safety, efficiency, quality, public health, social care commissioning and hospital food standards. All the metrics included are already published but they are often hard to access or find, or presented in a format which is not user friendly.
Hospital metrics used on the site, hosted on the NHS Choices website, will include mortality ratios; infection and cleanliness ratings; agency staff spending; and whether or not fresh fruit is available.
The Department of Health said the new MyNHS website would “highlight the best performing areas and improve standards through competition and transparency”.
10.11am In response to Monitor’s report, Rob Webster, chief executive of the NHS Confederation, said in statement: “We have been warning for some time that NHS trusts will fall further into deficit as they try to balance rising demand for care against flat funding.
“These figures are more evidence of the incessant demand faced by our members this year and the impact on their finances as they strive to deliver safe care every hour of every day. Health and social care leaders are working tirelessly to ensure this remains the case.
“As well as dealing with the short term, it is clear that we need an urgent debate about how we deliver sustainable services in the medium term. The 2015 Challenge Manifesto sets out 15 asks for the system that will ensure our future secure. Today’s figures provide the backdrop for the debates that we will take into the party conferences as we consider issues like adequate, long term funding settlements and pump priming for change.”
10.10am Here are some other findings from Monitor’s report on the first-quarter performance of the foundation trust sector:
- The sector reported a deficit of £167m compared with a planned deficit of £80m
- 86 FTs reported a deficit of which 80 per cet were acute trusts
- The combined deficit of the 86 trusts was £227m, offset by 61 trusts making a surplus of £60m
- Trusts spent £391m on contract and agency staff, double the £189m they had planned
- Trusts made £223m worth of cost savings which is £58m less than planned;
- 2.7m patients received emergency care and 0.5m non-emergency inpatient treatment
- 18, 200 patients received cancer treatment, but the sector failed to treat 15 per cent of them within 62 days of referral by a GP
- The sector as a whole breached the target to treat 90 per cent of admitted patients within 18 weeks of referral;
- The sector as a whole failed the A&E waiting time target of seeing 95 per cent patients within four hours;
- 28 trusts (19 per cent of the sector) were subject to enforcement action by Monitor because of governance and performance concern
Commenting on the report, Monitor’s chief executive David Bennett said: “Trusts are striving to overcome the challenges they face while still meeting patients expectations for quality care. However, we believe trusts can make further progress by improving their planning, aggressively implementing best operational practices and working more effectively across local systems.
“In particular, getting a greater grip on their staffing costs, especially for agency staff, will help trusts increase their financial resilience. But many trusts also need strong support from their staff to identify and urgently deliver cost savings, with ideas for redesigning operations being implemented at maximum pace.”
10.02am HSJ reporter Sophie Barnes will be tweeting from NHS England’s board meeting today, due to start at 10.30am. For @sophieevebarneson Twitter for all updates.
9.52am: NHS England’s board meeting will begin shortly and is expected to include debate on the NHS’s major problems with waiting times performance.
9.46am: Monitor has published its report on the first-quarter performance of foundation trusts. It shows a steeply deteriorating financial position. The regulator said the severity of the problem in the Q1 2015-16 was “unprecedented”. Full coverage will follow.
7.00am Good morning and welcome to HSJ Live. We kick start the day with a comment piece from Mike Birtwistle on Ed Miliband’s health strategy in the run up to the 2015 general election.
Mike argues that while Labour’s dominance in the polls over NHS issues has declined, at his party’s conference next week the Labour leader has the opportunity to start convincing voters he should be trusted with the health service.