Shadow health secretary gives further detail on whole person care approach, plus the rest of the day’s news and comment

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Such legislation would empower boards to become commissioning bodies, the care minister said, speaking in his capacity as a senior member of the Liberal Democrat Party.

“The role of the health and wellbeing board could evolve into the united commissioning body for health and care in an area [and be] responsible for an entirely pooled budget,” he added.

Asked whether that would involve changing the law, Mr Lamb said: “You would require legislative change, but that’s not an insurmountable problem.”

5.20pm The Royal College of General Practitioners have “grave concerns” about Andy Burnham’s proposals to create hospital-led integrated care organisations.

Chair Dr Maureen Baker said: “The College has grave concerns about Andy Burnham’s proposals to create hospital-led integrated care organisations.

“His plans could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it.

“Only yesterday he criticised the expensive and time-consuming top-down reorganisation of the NHS as a result of the Health and Social Care Act. Yet his proposals would be just as disruptive, causing even more upheaval for patients and distracting doctors and managers away from what really matters – delivering excellent patient care.

“GPs want to work as part of wider clinical teams to ensure that the NHS can provide a single service to each patient, instead of the fragmented approach that too often is experienced by patients today. But it makes no sense for hospitals – organisations that provide acute, intermittent and specialist care – to lead on the delivery of person-centred, continuous and co-ordinated care.

“UK general practice is the envy of the world. GPs are consistently rated the most trusted healthcare professionals in the NHS so we are obviously doing something right.

“There are things we could do better and general practice – like all other parts of the NHS – needs to modernise. But it is critical that any changes must not sabotage the unique relationship we have with our patients and the way that we tailor services to our local populations.

“The College is positive about integrated care. We are positive about working with colleagues right across the NHS. But the model that Andy Burnham is proposing simply will not work.”

5.15pm The College of Emergency Medicine has today launched a strategy to improve the wellbeing of clinicians in emergency departments.

The President of the College of Emergency Medicine, Dr Clifford Mann said: “The challenge we are facing is to stop the ‘brain drain’ of doctors and consultants from our A&Es. They are leaving to work abroad because of the pressures on the system.

Achieving a better work life balance and offering sustainable careers is an essential part of tackling this issue. That is why we are launching Creating successful, satisfying and sustainable careers in emergency medicine for NHS employers to sue to help retain those skilled physicians whose training each nation of the UK has invested in.”

4.30pm National Voices has raised concerns about Labour’s vision for care coordination appearing to be hospital-led.

Director of policy, Don Redding, said: “We welcome much of Andy Burnham’s speech including the emphasis on care coordination and care that works around the individual and family. We do have some concerns that, under Labour’s vision, it appears that this will be hospital-led and NHS dominated. Health and wellbeing are produced by many local actors and we also need national government to enable local leaders to collaborate on reshaping services, including patient and community leaders.

“While we were pleased about the focus on health and social care working together, the current emphasis is strongly on the NHS. It’s important that the long movement towards personalised care led by the social care system is nurtured and developed. And we need to hear more about the vital role of the contributions from the voluntary sector, of neighbourhood support, personal budgets, peer support, social prescribing, and many other non-NHS inputs that are vital to make a reality of person centred care.

“We strongly welcome the pledge of free care to help people at the end of life to be cared for and die at home, if that is their choice. Our members working in palliative care have made a strong evidence based case for this and it would be great to see the other main parties match it.

“The Labour party, as well as the other parties, now has an important opportunity now to work with the voluntary sector to improve their policies and get them right.”  

4.08pm The Foundation Trust Network has welcomed Labour’s focus on accountable care organisations as a move in the right direction.

Chief executive Chris Hopson said: “The FTN welcomes the continued emphasis by the Labour Party on integrating services around the patient, including consideration of accountable care organisations. However it is crucial that all forms of NHS provider including those in the acute, mental health, community and ambulance sectors all play a core role in the development of an accountable care organisation model as in some economies it may be non acute providers who are better placed to lead. This should be alongside collaboration with primary and social care.

“While the additional investment from the Time to Care Fund is key, and welcome, we know that the devil will be in the detail and we look forward to further information about how this will translate into funding for improved quality of care in practice. Central to achieving the integration of health and social care to improve outcomes, will be maintaining sufficient investment in health services alongside a fairer funding settlement in social care.

“At this turning point in the NHS’ history, we need to avoid wholesale structural reform again at all cost. Instead we need to focus at pace on moving to the new models of care patients desperately need. It is time to move beyond the rhetoric, support the NHS at a time of rapidly growing difficulty and create a truly 21st century service.”

3.40pm Sir John Oldham, respected clinical leader who authored Labour’s integration policy commissioned by Ed Miliband, has just tweeted:

“Better to let folk decide locally how best to reinforce community and home care services rather than mandate x000 GPs nurses midwives etc”

3.35pm Bringing in social care is easy to say, but much harder to deliver, according to NHS Confederation’s chief executive Rob Webster in his response to Burnham’s speech.

He said: “Andy Burnham’s speech was consistent with some of the asks set out in the 2015 Challenge. In particular, his pledge to pursue joined-up service delivery around individual patients and local communities is something that everyone in the NHS would support. The physical, mental and social care needs of people need to be met through coordinated care. The emphasis on building capacity in the community to better support patients and therefore the hospital system is also welcome.

“Integrating services and ‘bringing in social care’ is easy to say, however, and much more difficult to deliver. There are significant financial and structural consequences that need to be managed. We look forward to further discussion on these with the Labour health team on how they would achieve this.

“What is clear is that a messy structural reorganisation of the administration of healthcare will get in the way of changes to healthcare delivery, and must be avoided at all costs. I am also keen to understand his plans for how trusts become accountable care organisations. This too should benefit patients and not be based on a top-down structural solution.

“What is paramount, and what the NHS needs to focus on, is that the health care and social care services people receive are well co-ordinated, no matter which organisation they are commissioned or provided by. There is room in the National Health Service for more than one way to do things, as long as the standards are high and the focus is on compassionate care for patients.”

3.30pm NHS Clinical Commissioners has responded to Burnham’s speech.

Co-chairs Amanda Doyle and Steve Kell said: “It is right to put the patients at the centre of the NHS and look at caring for the whole person. It is right also that we examine long term potential solutions to integrate NHS and social care services to ensure they are sustainable and responsive to the needs of the local population.

“GPs, at the heart of their communities, are best placed to determine local services as we increasingly focus on out of hospital services.  As clinical commissioners, Clinical Commissioning Groups are already working in partnership to deliver the best possible care for their patients and local populations. CCGs are embracing the opportunity to work with providers, local authorities, patients and carers, the voluntary and third sectors, to address many of the issues around integration and fragmentation to deliver clinically led solutions for their local populations and patients.

“The imperative now is to make those existing local partnerships work. In the run up to the election NHSCC looks forward to discussing further with the Labour health team to ensure there is no top down reorganisation of the system to give CCGs the time and space in a stable environment to be able to do their jobs for the benefits of the public and patients.”

In an exclusive interview, Paul Watson told HSJ co-commissioning was likely to involve services being commissioned “in partnership” with CCGs rather than NHS England transferring budgets to the local bodies.

He said a small proportion of the specialised services budget would be better “just commissioned by CCGs”, but that highly specialised services would need to be commissioned “once at a national level”.

12.45pm Two announcements from Burnham’s speech relate to rights for family carers and social care for the terminally ill. The details include:

  • Give carers of those with the greatest needs a single point of contact for the care of their loved ones
  • A new duty on the NHS to identify carers, and a new right for carers to ask for an annual health check
  • Protected funding for carer’s breaks, prescribed by GPs, to ensure more carers get the support they deserve
  • Help with hospital car parking for carers, by ending their exclusion from parking concessions
  • Abolish the bedroom tax, which hits 60,000 carers and penalises them for the extra facilities they need
  • Patients would be given the right to die at home, where clinically possible. Those on an end-of-life register would be offered free care at home, starting with those with substantial social care needs.

12.30pm A speech by 91-year-old Harry Leslie Smith at the Labour conference this morning, where he reflected on his experience of society pre-NHS, has proven to be very popular with the audience.

Here is a link to the full speech.

12.08pm Jeremy Hunt has responded to Burnham’s speech through a couple of tweets:

“Less than 5 minutes after criticising the Health and Social Care Act, Burnham promises a reorganisation of the NHS…”

“Andy Burnham talked about NHS privatisation that isn’t happening, and failed to mention Mid Staffs, which did.”

12.06pm Here is an interesting part of Burnham’s speech that has just been published:

“…we will look at how we can ensure private health providers contribute their fair share towards the cost of training.

“But, with the best will in the world, the NHS won’t be able to do it all.

“That is why I can announce today a big change in the way the NHS supports carers so they can keep going. No longer invisible but at the very centre of this new service.

“So today we announce new support for carers: protected funding for carer’s breaks; the right to ask for an annual health check; help with hospital car parking for carers; and we will go further.”

12.04pm And that’s it. Burnham’s speech is over. We will be collecting responses from the sector throughout the day.

12.03pm This coming election is “a battle for the soul of the NHS”.

12.02pm Will look at how private providers can contribute to costs of care.

12.01pm Focus on care at home, goal is to keep people at home. A care plan that is personal to the patient and their family.

This will need a new generation of NHS staff, with GPs at the centre. Mental health nurses and therapies will be at the heart of the team - “making parity a reality”.

12.00pm Integrating social care is “the key” to helping the NHS.

11.59am Bringing social care in and “lifting it up”, making caring “no longer a dead-end job”. Give NHS stability so it can make radical change.

Integrated care organisations should be created - avoid cutting care in peoples’ homes and spend thousands on hospital care - “we can’t afford it, it will break the NHS”.

11.58am Hospitals will be asked to collaborate and make the NHS the preferred provider.

11.57am Burnham repeats his pledge to repeal the health and social care act.

11.56am Calls for social care not to be focused on profits. “The market is not the answer to 21st century health and care”.

11.55am Burnham wants an end to the “scandal” of care for the elderly. Wants to end “slapdash” 15 minute visits for the elderly and the low wages for these staff.

11.52am “The time has come to complete Nye Bevan’s vision and bring social care into the NHS”.

“One service and one team - an NHS for the whole person.”

11.52am Burnham says he wants to speak to parents of children with disabilities, carers’ arranging for parents care - “Labour is with you”.

11.51am “Winter crisis for A&E is now a spring, summer and autumn crisis”.

11.50am Plan for NHS under current government is to “run it down and break it up”.

11.45am Burnham says that a big moment has arrived - a rescue plan is needed for a “shattered service”, a “vision for a 21st century NHS with time to care”.

NHS will be at the centre of the Labour election camapign and “they have the money to back it up too”.

11.40am Andy Burnham will be speaking in a few minutes.

11.20am The latest patient safety incidents data has been published, and reveals a 12.8 per cent increase in reported incidents compared to the same six month period last year.

In the six months from October 2013 to March 2014, 778,460 incidents in England were reported to the system.

Of those reported, 69.1 per cent were reported as causing no harm. 24.8 per cent were reported as causing low harm, meaning the patient required only increased observation or minor treatment as a result of the incident.

The proportion of incidents resulting in severe harm or death was less than 1 per cent of all incidents reported, with the percentage resulting in death at0.24 per cent, down from 0.26 per cent reported for the same period in the previous year.

11.12am Will Hazell tweets: “Bennett: hard to counter commentators in national media who blame competition for preventing service change ‘even if wrong’”

11.10am Will Hazell tweets from the Monitor board meeting: “12 further FTs could end up in breach of licence in addition to 28 currently in breach”

11.08am In the meantime, HSJ reporter Will Hazell is live tweeting from Monitor’s board meeting. Follow @whazell for updates.

11.00am Burnham’s speech has now been put back to 11.30am.

10.50am Burnham’s speech appears to have been pushed back. We will let you know once we have a revised time.

10.40am Andy Burnham is due to speak in five minutes.

10.32am James Illman tweets: “So - is@andyburnhammp going to come up with any answers how to deal with estimated NHS £30bn by 2020?”

10.25am The Times reports that patients suffering a cardiac arrest should not be taken to hospital but treated by ambulance crews at the scene, according to a senior doctor.

If they cannot be revived, then their death “should be accepted and made as dignified as possible” said Jonathan Benger, professor of emergency care at the University of the West of England and a hospital consultant in Bristol.

10.20am Unison has given more details about the strike on 13 October.

68 per cent voted yes for industrial action and 88 per cent to action short of strike action in a ballot which closed on 18 September.

Unison general secretary Dave Prentis said: “NHS members don’t take action often or lightly. For many of our members this will be the first time they walk out as the last action over pay was 32 years ago. The NHS runs on the goodwill of its workers, but this Government has shown utter contempt for them.

“We are working with NHS employers to minimise the impact on patients. But it’s not too late for Jeremy Hunt to act to avoid this and we repeat our offer to the government to negotiate with us despite him refusing to meet with health unions about pay.” 

10.15am According to the Labour Party website Andy Burnham will now be speaking at 10.45am. Stay tuned.

10.10am @jamesillman: “3. How will acute trusts transform into integrated care orgs without a reorganisation, as he has repeatedly promised?


Things we need 2 know from @andyburnhammp this AM at #Lab14 : 1. what is meant by integrated care org? Means diff things to diff ppi CONT

— James Illman (@Jamesillman) September 24, 2014

9.58am James Illman has been tweeting some questions that might be answered in Burnham’s speech this morning.

2. Is £2.5bn boost real terms or cash? Pretty sure real terms, otherwise it’s basically wiped out by inflation but good to confirm #Lab14

— James Illman (@Jamesillman) September 24, 2014

9.55am The Guardian also reports that the NHS is to be hit by strike action over pay for the first time in 32 years amid staff anger at being denied a one per cent salary rise by Jeremy Hunt.

Staff will stage a four-hour walkout between 7am and 11am on Monday 13 October. They will also take other industrial action short of a strike such as not working unpaid overtime and taking rest breaks.

9.55am HSJ reporter James Illman is at the Labour conference and has been tweeting his observations. Follow @jamesillman for updates.

9.50am The Guardian reports that Ed Miliband played what he hopes will be his trump card in the election by promising 20,000 more nurses and 8,000 more GPs in a £2.5bn-a-year move to make the state of the NHS the central issue for voters.

The paper adds that Miliband won few plaudits for his delivery, but delighted party activitsts with the announcement of an annual Time to Care Fund which would tackle delays in GP appointments and rescue A&E departments.

Addressing a fringe session held by the King’s Fund today, the shadow health secretary revealed he would announce tomorrow that “every hospital” would grow into an integrated care organisation.

He added: “I want the hospital organisation to  grow into an integrated care organisation because the ‘year of care’ idea would put more stability under their financial planning. Their outlook would be firmer.

9.30am We will be providing live coverage of Andy Burnham’s speech at the Labour conference this morning, which is due to kick off at 10.30.

9.00am A successor to the HSJ Efficiency Awards, these awards recognise excellent use of resources and seek out examples of demonstrable improvement in outcomes, both within back office functions and clinical initiatives.

Click here to see the winners

Not only does UK healthcare face unprecedented financial pressures, but there has never been a greater focus on care quality, outcomes and patient experience.