Simon Stevens, Paul Baumann and Bruce Keogh appear in front the health select committee, plus the rest of today’s news and comment

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5.55pm For the most part, Simon Stevens has received the reaction to the NHS Five Year Forward View he had hoped for.

In the long term it could have as great an impact as the NHS Plan, writes HSJ editor Alastair McLellan, in his latest leader column.

5.38pm The health committee meeting has now ended.

5.36pm Dr Wollaston asks whether the NHS five year forward view was developed free from political interferance. Stevens confirms it was.

Dr Wollaston also refers to the £55 incentive for GPs to diagnose dementia. She asks if that originated politically or from NHS England. Stevens confirms that it came from NHS England.

5.35pm Stevens notes that mental health is the only set of services in the NHS that has staked out what will do in the next five years, referring to the joint NHS England and DH earlier this month.

5.34pm Dr Wollaston asks who will be held to account if progress is not made on parity of esteem for mental health services.

Steven responds: “We will.”

5.32pm Barbara Keely mentions pancreatic cancer - and whether this is some good news available to patients and their families.

Sir Bruce Keogh says he doesn’t want to give an quick and easy answer to that, noting that it can be a diffficult diagnosis to that, but he is happy to go away and think about that further.

5.31pm Speaking on mental health, Steven says “we’re out of balance” with spending and “trying to make a concrete balance to change that” but introducing the same sorts of quality standards that have brought funding into physical health.

5.29pm Sir Bruce Keogh says there will be new types of hospital consultants emerging, such as the ‘generalist’ or the ‘hospitalist’.

5.26pm Speaking on the different care models proposed in the five year forward view, Stevens says things will be different in different parts of the country.

As one example, he suspects in Birmingham there will be two large groups of GPs taking on greater roles as MCPs (one of them being the Vitality Partnership), some GPs choosing to remain unaffilated, and one hospital, perhaps University College Hospitals, taking on some primary care services. He says there will be a few different models, but they will be geared towards integration. He caveats that he has not had conversations with these organisations, but that is his assumption.

He adds the distinctions between GPs and hospitals consultants is betting more blurred.

5.15pm Stevens says NHS England is assuming that the increases in demands to adult social care services in the past few years, and incremental funding pressures, will continue.

5.14pm Stevens says NHS England has not made an assessment on what the next parliament is going to do in terms of adult social care funding.

5.12pm Keeley said the voluntary approach to referring and identifying carers “isn’t going to work”. She asks if this should be compulsory.

Stevens says we need to recognise there are different local approaches that need to be taken into account.

5.11pm Stevens says carers “is a massive issue”. He points out that the forward view is a short document and there were lots of issues not included in it.

5.10pm Barbara Keeley says the five year forward view should have given greater recognition to carers.

She says she regards them as “expert partners in care” and it would be right to give them that due prominance.

She accuses there of being a “shirking or running away” of the duty to carers.

5.05pm David Tredinnick asks Stevens if he supports a single health and social care budget.

Stevens responds: “It depends”.

He says from the patient’s point of view, we need to increasingly try and dissolve those distinctions between health and social care.

But, he says we should not kid ourselves that just putting together budgets for two highly pressurised areas would work.

4.57pm Commitee chair Sarah Wollaston asks Simon Stevens what advice he is giving the government about what changes they need to make nationally to bring this about?

Stevens said “there is a combination of advice and advocacy coming to bear”.

Stevens confirms he will be advocating strongly for these areas. “We firmly believe that unless we change the conversation on these areas…. the NHS is going to crowd out the work that we could be doing by focusing on preventable illness”, he says.

Stevens said it would be good to look at the role at what mayors and local authorities could play in this.

4.53pm Stevens says “none of what you say is contested” but “ultimately people do get it…it’s right to support the health of people who work for us”.

Sir Bruce Keogh says there needs to be a “huge change in perception” about exercise.

4.52pm Labour MP Barbara Keeley says there are three prime barriers:

1. Activity and exercise has costs that some people cannot afford. It is expensive to join a gym. How is everyone going to afford this?

2. Activity levels are being hit by cutbacks in local governments e.g. parks and leisure centres.

3. People who take exercise, particularly if they’re overweight, older or not used to, will injure themselves. GPs may tell them to stop this acitvity and people across the NHS are still saying “rest is best” when it is not.

Keeley asks how the NHS is going to tackle these barriers?

4.48pm Stevens says one of the blind spots in this country is that because employers are not “on the hook” for employees’ healthcare, we have tended to neglect workplace health.

4.47pm David Tredinnick asks Stevens about the recommendation for financial incentives for companies for employees losing weight and for the NHS too.

He refers to Stevens’ own personal weight loss while working for UnitedHealth in the United States.

4.45pm Stevens says if we don’t get serious on obesisty as we have with smoking “then we know what the future looks like, the future looks like lots more diabetes”.

4.44pm Rosie Cooper refers to the “radical upgrade” in public health called for the in NHS five year forward view. She asks how confident NHS England is in it, given pressures in councils and public health spending.

Stevens says in some way there has been a lost decade e.g smoking rates, heavy pressures in many hospitals from binge drinking, supporting children from primary school onwards with obesity.

He says “the N in NHS does matter”, and NHS England will argue about areas that are outside its direct control.

4.41pm Sir Bruce Keogh says the aim is to built the urgent and emergency care review in public so when there is a change “it doesn’t feel like some sort of big bang, it feels like the normal thing to do”.

4.40pm Andrew Percy asks when there will be a complete remodelling or radical altering of the commissioning of emergency care.

4.39pm Stevens says closures and service changes will continue, as there always have been, but they now have to make clinical sense.

4.38pm Stevens says there are “some very difficult trade-offs” to be made with the affordability of services.

4.37pm Stevens refers to the Dalton review - “David will be referring fairly soon”, he says, estimating that it will be within the next eight weeks.

4.35pm Sir Bruce says: “There isn’t an easy and immediate answer to that”.

“What prevails in one community doesn’t necessary prevail in another,” he points out.

Stevens adds the relative reimbursement of smaller versus larger hospitals are currently “a bit out of whack” and NHS England is looking into that.

4.33pm Andrew Percy asks what will actually be happening in viable smaller hospitals in ten years’ time?

4.32pm Speaking about the urgent and emergency care review Sir Bruce Keogh says “what is specialist one year will be routine in five or ten years time”. He gives the example of handheld MRI scanners being available in the future.

4.29pm Stevens: “On the better care fund, we should have something for you later this week.”

4.28pm Stevens says there will be announcements “quite shortly” on the assurance process for the better care fund.

4.27pm Committee chair asks Stevens how much money NHS England would ask the government for “pump priming”.

Stevens said he will not hazard a figure until detailed work has been done around the country.

4.24pm The health commitee meeting has resumed.

4.15pm The health committee meeting has briefly paused as the division bell has rung in parliament.

4.13pm Leslie asks for resassurances that there won’t be further probelms with NHS Property Services.

Stevens says NHS Property Services was set up as a company by the Department of Health, not NHS England.

However, he said NHS England will be having a frank conversation with how some of their porfolio can be freed up to bring about necessary changes.

4.07pm Responding to a question on innvation by Charlotte Leslie, Sir Bruce says NHS England has an ambition to turn the health service into the “go to place” for new and exciting things.

He refers to the academic health science networks, which will be test beds for innovations, which can then be rolled out. He says it is early days yet, but there have been some encouraging signs.

4.00pm Sir Bruce Keogh says NHS England are entirely in favour of some alternative treatments - some being mentioned in the five year forward view - but they need to be supplimented with evidence about their efficiency.

Sir Bruce says NHS England is open to any kind of evidence and will look at it with an open mind.

3.55pm HSJ’s Nick Renaud-Komiya tweets from the committee hearing:

3.50pm Conservative MP David Tredinnick mentions the new care models outlines in the NHS five year forward view.

He asks whether these new models are intended to bring about efficiency gains.

Stevens says he does envisage there being efficiency gains.

Sir Bruce says the specific models go some way towards breaking down the barriers between primary and secondary care.

3.48pm Stevens says there are some particular circumstances where there needs to be more support available, listing IAPT as an example.

In some parts of the country there would need to be more providers brought it in addition to local mental health trusts which are “in a polite word, struggling”.

3.40pm Cooper asks about there being no reference to competition in the NHS five year forward view.

Stevens says competition is a tool, but it cannot be allowed to be the tail that wags the dog.

3.58pm Rosie Cooper asks if there is a case for revisiting the NHS’s complex leadership arrangements.

Stevens says you could do, but those different NHS bodies all carry out different roles.

Stevens points out that the NHS has one of the lowest administrative costs looking at health services globally.

3.35pm Stevens said we would lose something very important in saying that the price of an NHS fundedhealth service would be deny patients’ choice.

3.34pm A few more tweets from Nick Reanud-Komiya who is at the health committee hearing:

5.32pm Valarie Vaz asks when Stevens’ involvement stopped with UnitedHeath.

He clarifies that he has had no involvement with his former employer since he took up his NHS England post, and is not going to.

Asked on TITPP, Stevens says there is a fierce debate on whether it would be damage the NHS.

Pressed by Vaz on whether he would fight against against TITPP if this was the case, Stevens says yes - if that was the case. He also quotes a European Commission letter to Denis Healy saying that would not be a concern.

3.23pm Labour MP Valarie Vaz asks whether the NHS five year forward view is calling for the repeal of the Health and Social Care Act.

Stevens responds that it is a matter for parliament, and it is a highly political issue that NHS England does not have a position on.

3.22pm Dr Wollaston asks whether we are heading towards greater charging in the NHS.

Stevens any extensions of charhing would need to be explicitly established by parliament, and he sees no appetite for it.

Stevens adds that he will be very clear with CCGs who are proposing any charges that in contravention of rules.

3.20pm Dr Wollaston asks what powers NHS England has over decisions where NICE guidance is not met, for example with fertility services

Stevens says formally NHS England doesn’t have power on these decisions, but it has a responsibility to seek to ensure the NHS continues to provide a uniform, high quality service across the country.

3.19pm Committee chair asks what kind of grip NHS England will exert centrally to prevents gaps in access to services across the country.

Stevens says it is a concern but there is more unformity of care across the county now, for example following the creation of bodies such as NICE.

3.15pm Nick Renaud-Komiya tweets this from the health committee hearing:

3.11pm Conservative MP Charlotte Leslie asks whether the five years is sufficient and what about the medium to long term?

Stevens says there are some elements such as the human genome project won’t have a payoff in the next 2-3 years but could ultimately fundamentally change healthcare.

3.08pm Percy also ask whether it is time for political parties to have a cross-party approach to the NHS funding gap and whether there should be a royal commission.

Stevens responds that royal commissions have not be very successful in the past. He says the NHS has tried to give its opinion in the five year forward view and it respects the democratic process about whether its aims are put into practice.

3.03pm Conservative MP Andrew Percy poses a question on whether NHS England has assessed the value of the contribution of private providers in the NHS e.g. in contributing to efficiency savings.

3.00pm Stevens says NHS England’s intention to use the next 5-6 months to look at different part s of the country to see where they are and the cost of transition for where they need to get to.

Stevens adds there will need to be investment in infrastructure – and there are sources of funding for that. There are around £4bn of savings on foundation trust balance sheets, which are for the most part prevented from being invested in services such as in primary care.

He clarifies that it would be a “bad answer” to either dicate one solution for everyone or to simply leave it to localties to muddle through. He states the next 5-6 months will be about having a local-national conversation.

2.58pm Another tweet from HSJ’s Nick Renaud-Komiya:

2.55pm Commenting on a suggestion made by Rosie Cooper, Stevens argues that pay restraint is unlikely to be an indefinitely repeatable strategy as the rest of the economy picks up.

Over time, to recruit and retain nurses in hospitals they will need to be paid the going rate.

2.54pm HSJ’s Nick Renaud Komiya tweets:

2.51pm Labour MP Rosie Cooper asks the level of efficiency gained managed in the last 2-3 years - and how practical is it to achieve its efficiency aims?

2.48pm Stevens says the NHS will meet the revenue limit set for it by parliament this year.

2.47pm Stevens discusses the £30bn NHS funding gap predicted by his predeccessor David Nicholson.

Stevens says the gaps could be reduced by by improving demand for services.

He adds that the health service can, as a result of “substancial changes in the way care is provided” lead to efficiences by greater integration of services rather than by salami slicing.

He thinks that would still leave a £8bn gap - and to close that there would need to be 1.5 per cent real terms increases each year in each parliament. He admits that is a “big ask” but still “still substancially less” than it has been able to afford.

2.43pm Dr Wollaston asks for an overview of how far the whole sector is in deficit right now.

Paul Baumann says his undertsanding is the latest position is that 53 out of 147 FTs are expected to be in deficit

Baumann says at this point in the year about 15 per cent CCGs are expected to be in cumulative deficit.

Stevens clarifies that the NHS in the round is not expected to be in deficit and is expected to balance its books.

2.40pm Simon Stevens says it is a huge testament to people across health service that the quality of care has remained very strong and there have been some improvements in the last five years, despite pressures.

2.39pm Committee chair Sarah Wollaston asks what the current sitation is in the NHS funding gap.

2.36pm The hearing has now begun.

2.32pm The Commons health committee hearing on NHS spending is due to begin any moment now.

HSJ reporter Nick Renaud Komiya will be tweeting live from the hearing. Follow @NickRenKom Twitter for regular updates.

2.16pm A board game, created to inspire discussion about person centred care, allows players to walk in ‘other people’s shoes’ in a fun and non-confrontational way, writes Gill Phillips, its creator and one of HSJ’s Inspirational Women in 2014, in Resource Centre today.

2.04pm The publication of a consultation document for the 2015-16 national tariff payment system has been delayed by three weeks, officials have confirmed.

NHS England and the regulator Monitor, which is responsible for setting the parameters of the care payment system, have said that they want to take time to “look carefully” at feedback.

The document’s release had been planned for this week.

1.45pm A former associate director of Christie Foundation Trust who sued the provider for alleged bullying behaviour has had her case thrown out by the High Court in Liverpool.

Mr Justice Parker also dismissed as “nonsense” allegations by claimant Tracy Boylin that she had been “falsely imprisoned” in a meeting room for eight hours by human resources consultant Christine Pilgrem.

1.30pm This is a reminder that NHS England chief executive Simon Stevens, medical director Professor Sir Bruce Keogh and chief financial officer Paul Baumann will be speaking at the Commons health select committee in a hour’s time.

They will be questioned by MPs on public expenditure on health and social care.

Follow HSJ Live for full coverage from 2.30pm

HSJ reporter Nick Renaud-Komiya (@NickRenKom) will also be tweeting live from the committee meeting.

1.24pm Controversial proposals to transfer patients between hospital sites at a struggling North West trust have been revealed.

North Cumbria University Hospitals Trust has published a “clinical options appraisal” detailing its “early thinking” on how several of its services could be put on a sustainable footing.

Under the proposals, high risk medical patients could be transferred from the trust’s West Cumberland Hospital to Cumberland Infirmary in Carlisle.

1.21pm Healthcare leaders in Birmingham are already seeking to establish the new models of care provision proposed in last week’s NHS Five Year Forward View, HSJ can reveal.

11.54am Help us find healthcare’s latest rising stars.

Following a successful launch last year, HSJ in partnership with Celesio is again celebrating the up and comers who are making a real difference to healthcare.

We will name our latest collection of Rising Stars as the new year starts, and we are looking for your nominations.

Our aim is to celebrate the people whose work and decisions are already improving healthcare, and who are considered likely to be the NHS leaders of the future. A panel of expert judges will decide on the final 25.

You can make your nominations now. Please be sure to give the individual’s name, job title, organisation and a short description of why you think the person should be considered as an HSJ Rising Star.

The closing date for nominations is Monday 3 November.

Click here to see who was on the 2013 HSJ Rising Stars list

11.25am Thousands of patients are at risk of being left without a GP as the number of surgeries applying to “shrink” their catchment area doubles, The Telegraph reports.

The paper writes that “soaring” numbers of practices are asking to reduce their practice boundaries, closing their lists to new arrivals or forcing current patients to go elsewhere, according to that data.

Doctors said they were “completely overstretched” with too few of them to cope with rising demand from an ageing population.

11.10am The Daily Telegraph reports that NHS managers and top council officials will the stripped of their redundancy payments if they are subsequently rehired, the government will announce today.

Under the legislation, anyone earning more than £100,000 who takes a new job in the same part of the public sector within a year will have to repay all or part of their redundancy package.

The new legislation will apply to the NHS and local government, but not the armed forces, the BBC nor the Bank of England.

However, it will only apply to new contracts, meaning that most existing public sector workers will not be affected.

11.00am A woman who spent £25,000 of family savings on private cancer treatment that she is unable to get from the NHS in Wales has said her finances are running out, The Times reports (newspaper only).

10.49am Also in the The Times, tests to to screen men for prostate cancer may be doing more harm than good, as about 11-19 per cent of men who were told they had the disease may have been mistakenly disagnosed, a study has found.

10.43am The Times reports on a scheme by Mind in which hairdressers and pub landlords have been trained to recognise the signs of mental illness in customers. The charity says the model should become routine.

The scheme, being run by the Tameside, Oldham and Glossop branch of Mind, teaches professionals who frequently come into contact with the public to spot the early signs of mental illness and direct sufferers to where they can get help.

Teachers, waiters and library workers are among the groups of professionals that have been trained as part of the scheme.

10.30am Responding to the Mind report on mental health, Labour’s shadow minister for public health Luciana Berger, said: “Mental health should be treated no differently to physical health but these findings are further evidence that mental health is clearly at a disadvantage when it comes to allocating funds.

“The government is failing to honour its promise of treating mental health with the same importance and attention as physical health.

“David Cameron must urgently tackle the crisis in mental health services. Ministers must do more to ensure that services needed by people with mental illness are in place and patients get the help and support that they need.”

10.26am In today’s papers, The Guardian reports that less than 1.5 per cent of English local authorities public health budget is spent on preventing mental health problems, with some councils spending nothing, according to a by the mental health charity Mind.

Local authorities have allocated less than £40m to mental health in 2014-15 as opposed to £108m on obesity, £160m on smoking and £67m on sexual health, research by Mind has found.

Councils took over responsibility for preventing physical and mental health problems in their communities from primary care trusts in 2013 but some did no even know they were responsible for the latter, the charity has said.

10.07am A respected London teaching hospital has been told it ‘requires improvement’ by the Care Quality Commission.

The watchdog issued the directive today after its inspectors pinpointed problems in a range of services provided by Chelsea and Westminster Hospital Foundation Trust’s during an inspection in July.

9.55am The Health and Social Care Information Centrehas today publishe its annual quality and outcomes framework (QOF)report.
QOF data is primarily used for allocating reimbursements to GP practices for appropriate treatment of patients with specified conditions, including coronary heart disease and asthma.

You can view the full report here.

7.00am Good morning. Hospitals are criticised for not adopting clinical best practice but no one is taking responsibility for ensuring it happens or supporting them to improve, says David Oliver, professor of medicine for older people at City University London and a member of the HSJ Commission on Hospital Care for Frail Older People.