Our coverage of the NHS England chief’s first appearance before the Commons health committee, plus the rest of the day’s news and comment
6.28pm Readers of HSJ’s tablet app will be able to read reaction to Simon Stevens’ appearance in front of the Commons health committee from key health sector figures this evening. Here’s a taster:
Dr Stephen Kell, co-chair of NHS Clinical Commissioners leadership group said Mr Stevens showed “a real commitment to clinical commissioning and I was really pleased to hear that. There is a definite move to increase the local nature of commissioning, the local solutions and look beyond the one size fits all, which we know hasn’t worked in the past”.
David Hare, chief executive of the NHS Partners Network said: “Simon showed a deft handling of a tricky set of questions. What you saw there was a pragmatist saying ‘you should do what works’.”
5.53pm Simon Stevens has been reviewing the split between NHS England and clinical commissioning group budgets in his first few weeks in his post.
The new NHS England chief executive said he thought CCGs will thrive when they are given responsibility for primary care services. He would outline how the split between local NHS commissioning would “evolve” on Thursday, MPs heard.
5.50pm NHS England chief executive Simon Stevens has told MPs he does not share his predecessor’s concerns that competition law is standing in the way of health service reform.
Sir David Nicholson repeatedly raised concerns in the run-up to his retirement last month about the impact of competition law and regulation since the introduction of the Health Act 2012, and indicated legislation needed to be changed.
During his first major public appearance, before the Commons health committee this afternoon, Mr Stevens was asked whether it was correct that he was more “sympathetic” to the role of competition than his predecessor, something which has been asserted publicly by Monitor chief executive David Bennett.
4.55pm The new chief executive of NHS England has told Parliament it is widely believed that NHS funding will be increased in real terms between now and 2021 if the UK economy continues to grow.
At his first appearance in front of the Commons health committee today, Simon Stevens emphasised the link between NHS funding and wider economic performance.
4.50pm The merger or closure of small hospitals might not be the best way forward for the “fairly centralised” English NHS, Simon Stevens, chief executive of NHS England has told the Commons health committee.
In his first appearance at the committee Mr Stevens said that while some cases for centralisation were “unarguable”- such as stroke services- he did not think such an approach was always necessary.
4.49pm The committe session has come to an end. Stories and comment from senior health sector figures to follow.
4.45pm Where is the independent scrutiny for whistleblowers, asks Rosie Cooper rhetorically.
4.37pm Everyone in need of NHS continuing care will be entitled to personal care resources, Stevens says.
4.35pm He adds:We have got to systematise thinking like a patient and acting like a taxpayer.
4.33pm Stevens: We have got to set a tone within the NHS that says it is encouraged to reveal poor practice. We have got to set a new culture of openness across the NHS.
4.32pm James Illman tweets:
Stevens’ comments on care.data suggest longer delay could be on cards #StevensHC
— James Illman (@Jamesillman) April 29, 2014
4.24pm Asked about the Care.data delay period by Barbara Keeley MP, Stevens says: I don’t think there should be an artificial timescale, an artificial start date for extraction of GP data extraction as part of Care.data. We need to listen carefully to people’s views on this.
4.21pm Stevens: It’s important that patients and GPs are doing the choosing, not the hospitals themselves. We need to continue to ensure that the tariff-based payment reflects the health needs in the round of the patient being treated.
4.18pm HSJ Comment Editor Andy Cowper tweets:
Interesting ambiguity from Simon #StevensHC on competition & tendering in practice, & on the signals from blocked Bournemouth-Poole merger.
— Andy Cowper (@HPIAndyCowper) April 29, 2014
4.17pm Members of the committee are prodding Stevens to hammer down his views on competition and choice. He seems to trying to put forward the idea that his views are driven more by pragmatism than any ideology.
4.13pm In order to be able to get more modern out of hospital care, we are going to need to make sure GPs get the resources they need - I’m open to suggestions as to how that is done. We may need to give GPs more flexibilities to shape care.
4.10pm “We are not ranking clinicians by price” - confirms Stevens, after repeated questions from Valerie Vaz MP.
4.08pm: James Illman:
Competition is not the only answer to solving NHS probs says Stevens #StevensHC
— James Illman (@Jamesillman) April 29, 2014
4.04pm Discussion over procurement practices and CCGs - Valrie Vaz - asks Stevens if he fears that increased competition will increase legal bills for commissioners.
4.04pm “I am an avid reader of the Health Service Journal,” says Simon Stevens
4.00pm: Stevens: We are in the final stages of this year’s contracting round between commissioners and hospitals and I don’t think the Health and Social Care Act has made a great difference to these arrangements.
3.58pm: The conversation now moves on to competition…
3.58pm This is a matter for GPs, and local commissioners, replies Stevens. Some complementary remedies work better than others, he adds.
3.55pm David Tredinnick asks a question about homeopathic remedies - The NHS is missing a huge trick in terms of costs, he says.
3.55pm Stevens: There has been some suggestion the Better Care Fund would only be effective if it produced a 15 per cent reduction in hospital admission - it should not be thought of this way.
3.50pm: Stephen Dorrell asks Stevens about the ‘overnight’ financial issues caused by the introduction of the Better Care Fund (£1.9bn)
Stephens describes three ways the money will be spent:
- One element if money reinvested into NHS care and won’t leave the NHS
- A share of the money that will be spent in social care - this will produce an offset of people going to hospital who could have been treated in their own homes.
- Money being used outside the health service
What’s the relative size of these three funding buckets? This is work partly being done by council Health and Wellbeing boards, says Stevens.
James Illman takes the temperature of the room:
Stevens doing pretty well at not creating too many rods for his own back so far… #StevensHC
— James Illman (@Jamesillman) April 29, 2014
HSJ Reporter David Williams writes:
1/2 Highly significant from #StevensHC- asked whether the NHS can survive on flat real terms funding until 2021, Stevens says…
— David Williams (@dwilliamsHSJ) April 29, 2014
2/2 …most commentators think that if the economy is healthy, the UK will be spending more per head of population on health by 2021.
— David Williams (@dwilliamsHSJ) April 29, 2014
3.42pm Funding decision locally, for the most part, will be a matter for CCGs, he adds.
3.42pm In aggregate, there is no more funding in the health service. If you are going to do more of something, you will have to do less of something else, says Mr Stevens. He gives little details over any funding flows may need to change to help bolster mental health.
3.40pm Simon Stevens: There are some specific things that NHS has embarked on which it needs to get right in this area. Support for people with anxiety and depression (IAPT) is of course very important.
3.36pm Mental Health services are taking a greater hit as a result of the tariff deflator, says Sarah Wollaston MP - How will you deal with this, Mr Stevens?
3.31pm Simon Stevens: The £30 billion makes sense as a calculation, if you take assumptions that feed into it.
- -NHS spending remains flat in real terms until March 2021
- -That demand continues to grow at past rates
3.30pm Andrew Percy: Will the Nicholson challenge remain at 4 per cent?
3.29pm Stevens says he will work with CCGs, local government bodies and partners to work out what the NHS can do to put itself on a financial sustainable footing. He says he hopes to report back in the autumn.
3.25pm Asked about NHS England’s funding situation over the next two years, Simon Stevens says there is no doubt that times are tough. There is recognition that the NHS has been in some ways fortunate to be shielded from the impact of the financial situation, unlike their colleagues in local government.
He says in the past 2-3 years, efforts have resulted in ensuring the quality of services - much sacrifice from front line staff.
3.25pm Talk turns to money…
3.22pm HSJ Reporter James Illman, in the room, tweets:
Wollaston asks if there should be ‘personal lists’ for all patients not just old people? No silvet bullet says stevens #StevensHC
— James Illman (@Jamesillman) April 29, 2014
One user writes:
— HealthServiceJournal (@HSJnews) April 29, 2014
3.19pm An increasing number of people in rural areas feel like their healthcare system is being taken with them, with no replacement, says Andrew George, Conservative MP for Brigg and Goole.
3.17pm Stevens: Currently the NHS is planning for the next 5 years - hopefully this will be complete by the end of June - We will not find a single answer around the effects of reconfiguration e.g. in rural areas. In the past the NHS has been guilty of implementing a ‘cookie-cutter’ model of care provision.
3.12pm Charlotte Leslie: Do you have any concerns that we have one of the lowest ratios of beds per person?
Stevens: We need to carefully assess the needs of people locally. When you look at lengths of stay data - we are by no means an outlier.
3.10pm Charlotte Leslie MP asks how reconfiguration can be done better in future.
Stevens reply: Medical advances will drive changes - the NHS has been quite effective in reshaping itself in this sense.
I think a number of things currently done in hospitals will in future be done in community settings or at home. There are instances when there are beenfits to specialisation.
3.06pm Stevens: We want CCGs to take sensible action to support carers in a sensible way - formal strategies, in my experience, simply generates paper.
3.00pm Stevens: At the moment we have an artificially segmented set of support for those in need of the most care. They are not joined up at all for those requiring high intensity support.
2.55pm ‘Health and Wellbeing boards to have significant power in respect to the Better Care Fund’ - Stevens.
2.54pm Stevens: I think it is a laudable goal to bring health and social care support together, but I also think that the evidence shows that if you try and do this without properly focusing effort on the people this is aimed at, you may not have much of an impact. The Better Care fund has to deal with this reality if it is to be successful.
2.52pm Simon Stevens appears to be taking a strong line on moving more quickly to give CCGs more responsibility for primary care in their area.
He indicated CCGs will do better “when they can have responsibility for primary care services in their area”. Also mentioning specialised commissioning in their area, he said bringing budgets together would help give CCGs “that population focus” they require – as opposed to only for parts of the care for their population.
2.51pm When frail older people are admitted to hospital often they find themselves being moved to a care home on discharge and not to their own home. About 90,000 people a year find themselves in this position. Sometimes, the absence of alternatives is driving this, Stevens says - in response to a question from Rosie Cooper MP.
2.49pm Will CCGs be able to go towards three yearly annual planning? asks Sarah Wollaston. Parliament needs to decide this, replies Stevens.
2.47pm Stevens: At a time when the NHS budget is only just growing in real terms and when the specialist commissioning budget is growing at a higher rate - this is a circle that needs to be squared.
2.46pm Original split of responsibility between CCGs and NHS England for commissioning was hard to get right in terms of cost - Stevens
2.42pm “The way the specialist commissioning budget was conceived was an “over extension” of what specialist care means.”
“Across the health service, we have got to get better at listening,” says Stevens.
2.40pm: Valerie Vaz asks: How is the Health and Social Care Act working?
Stevens on CCGs: Talking to a number of GPs around the country, I have found that generally they are more supportive of CCGs than their predecessors, the Primary Care Groups - this surprised me.
2.38pm: [The committee] is not as bad as people say we are, says Valerie Vaz MP
2.36pm: Stevens: We know there is a lot that has got to change over the next five years in the NHS. We are going to have this conversation with social care, primary care, patients, taxpayers etc.
2.34pm: Dorrell says that Stevens’ own definition of his role goes beyond the commissioning function of NHS England. Stevens says he will work closely with Monitor, the Trust Development Authority, and the Care Quality Commission. There is a shared role to play.
2.31pm: Committee chair Stephen Dorrell MP welcomes Simon Stevens and asks him about any remaining financial interests in UnitedHealth. Stevens replies he has none whatsoever.
2.20pm: Meanwhile, we will also be tracking proceedings on here, so stay tuned!
2.15pm: To watch Simon Stevens’ evidence to the Commons Health Select Committee as it happens, along with our twitter coverage, click here.
1.00pm: Mid Staffordshire NHS Trust has released a statement following today’s sentence regarding the death of Mrs Gillian Astbury, who was not given regular doses of insulin because the team responsible for her care had not properly read her medical notes.
Jeff Crawshaw, Deputy Chief Executive of Mid Staffordshire NHS Foundation Trust said: “On behalf of the Trust, I want to again express our deepest and most sincere apologies to Mrs Astbury’s family for the unacceptable care she received at Stafford Hospital in 2007.
“Today marks the final stage in what has been a thorough and long running investigation into the failings which led to her tragic death.
“From the very beginning, we have acknowledged the failings in Mrs Astbury’s care, and we have never shied away from our responsibility for what happened to her.
“It has been recognised by all sides in this distressing case that our trust is a very different and much better organisation now than it was when this tragedy occurred.”
12.45pm: The new NHS England chief executive has initiated a quick-fire review of the organisation’s national structure and systems, amid staff concern about its “hierarchical” approach, HSJ can reveal.
Simon Stevens has asked commissioning development director Rosamond Roughton and Karen Wheeler to lead the review.
Ms Wheeler was recruited this month from the Department of Health to become the organisation’s director of transformation and corporate operations. He has asked them to report at the end of this month.
11.40am: Ahead of Simon Stevens’ first appearance before the Commons Health Select Committee this afternoon, click here to read an analysis of his career - first published when the former health adviser to Tony Blair was announced as Sir David Nicholson’s replacement last October.
11.35am: To read a round-up of what HSJ readers said about how the health service can move terminally ill people out of hospital and treat them in the setting of their choice, click here
On 12 April, HSJ, in association with Marie Curie Cancer Care, ran their final twitter chat disscussing how to keep terminally ill people out of hospital. The chat featured Michael Cooke, Marie Curie’s head of analytics, and Phil McCarvill, Marie Curie’s head of policy for England.
11.14am: NHS England is failing to collect “consistent, complete and accurate” waiting times figures from trusts, according to an influential committee of MPs. The Public Accounts Committee said the key performance measure was subject to missing and incorrect data. Read more here.
10.54am: The age of many NHS properties makes achieving energy efficiency an uphill task. However, retrofitting energy conservation measures can bring down emissions and costs, says David Rees, head of local government services at the PA Consulting Group.
Rees cites the example of University Hospital of South Manchester Foundation Trust. Their £3.3 million expenditure on energy efficiency has achieved reductions of more than 35 per cent in gas and electricity use over the past five years, amounting to a £390,000 decrease this year on fuel bills alone.
10.42am: Devon Partnership Trust has been ordered by regulators to ensure that patients requiring acute care are treated closer to their homes.
A report published last week by the Care Quality Commission states that the mental health trust must put systems in place, including “effective bed management” and clearer patient care plans, to ensure that nursing time is not taken up by searching for a bed.
10.30am: The British Medical Association has released a statement commenting on the publication today of a Public Accounts Committee report on the reliability of NHS waiting times figures.
Dr Mark Porter, chair of BMA Council, said: “Waiting for an operation or treatment can be a worrying and stressful time for patients, so it’s vitally important that information on waiting times is accurate and reliable. It is also essential so that GPs can provide patients with the right information on waiting times, as this can affect where they decide to seek treatment.
“Ministers need to ensure data collection is consistent and reliable. However a rise in the number of private providers and the fragmentation of services, resulting from the government’s top down reorganisation, has made this harder, not easier to achieve.
“What matters most is that doctors are able to treat every patient based on their clinical need and ministers must work with clinicians to improve the whole patient journey - from the care they receive from their GP, to a referral to a specialist. By involving those who deliver the service, and listening to their concerns, it is more likely that targets will be realistic, achievable and most importantly, meaningful for patients.”
10.24am: The Daily Mail reports on mistakes in hospital waiting list times undermining public confidence in the data, according to Commons public accounts committee.
Committee chair Margaret Hodge said: “If patients cannot be confident of accurate comparable data on the performance of hospitals they cannot exercise choice.
“Both GPs and their patients need reliable and comparable information about the waiting time performance of individual trusts so that they can make an informed choice about where to be treated.’ The committee’s report published today says the National Audit Office found records of waiting times riddled with errors.”
The Mail also reports that US drug company Pfizer is preparing a £60billion bid for the London-based AstraZeneca, which would make it the biggest foreign takeover of a British company to date.
AstraZeneca, which produces drugs to deal with diabetes, high cholesterol and cancer, affecting millions of patients. It rejected two offers from the maker of Viagra earlier this year, on the ground that they “very significantly undervalued AstraZeneca and its prospects”.
In a comment piece, The Mail’s city editor Alex Brummer argues: “If ever there was a moment to be fearful for Britain’s future as an advanced science-based manufacturing economy it is now.”
He adds: “The American bid for AstraZeneca is not only the biggest attempted foreign takeover in UK history, but is a direct assault on high-quality and skilled British jobs.”
More from The Mail, Mid Staffordshire NHS Trust has been fined £200,000 for the “avoidable” death of a diabetic patient in 2007, who was not given regular doses of insulin because the team responsible for her care had not properly read her medical notes.
A trainee surgeon has been struck off the medical register after he was found to have taken over 100 photographs of female patients during intimate examinations, The Mail reports
10.12am: The Guardian also covers this morning’s story on cancer survival rates. Its health editor Sarah Boseley writes that dramatic improvements in cancer survival mean that half of those diagnosed today can expect to live for at least 10 years – according to research from Cancer Research UK.
The paper notes, however, that survival rates in the UK still lag behind those of comparable western European countries.
10.00am: On its front page, The Timesreports on scientists developing a blood test that can predict the risk of cancer in older men.
The basis of the test is the discovery that men with a common defect in their white blood cells are nearly four times as likely to die from cancer as men without the defect.
Also in The Times, a quarter of recorded hospital waiting times checked in a random sample were incorrect, the Commons public accounts committee has said.
More from the paper - half of people with cancer will now survive in the long term, according to figures from Cancer Research UK.
The charity said the figures mark a “tipping point” in the fight against the disease, meaning it is no longer necessarily death sentence and is becoming a chronic condition that people can live with for decades.
Finally, a US study has found that children and young people given high doses of antidepressants are twice as likely to commit suicide as those given standard doses, the paper reports.
9.58am: Kicking off our review of the morning’s health sector stories in the press, The Daily Telegraph writes on its front page that half of patients who are diagnosed with cancer today will be “cured”, according to the authors of ‘landmark’ new research.
The paper’s health editor reports that experts hailed the findings as a “tipping point”, and said that dramatic improvements in diagnosis and treatment meant cancer could soon be classed as a chronic condition rather than a “death sentence”.
Elsewhere in the paper, patients’ groups have raised fears that hospitals will be forced to cut services before it is safe to do so. The groups have said that lives could be put at risk by NHS plans to slash the number of people admitted to hospital as an emergency.
Health officials have ordered hospitals to scale back admissions to levels not seen for a decade, as almost £2bn is diverted from their budgets to fund community and social services.
Another story, due to receive widespread coverage this morning: Some hospital trusts are deliberately skewing waiting list times to help meet targets in acts of “blatant fraud”, MPs have said. The Commons’ Public Accounts Committee warned that public confidence in waiting times is being “undermined” by hospitals which record false figures.
Finally, the paper’s medical editor writes that cases of a superbug that can break down antibiotics have risen exponentially in the past five years, government experts have warned.
Only one drug, from the 1950s, remains effective against infections carrying New Delhi metallo, and the bug will soon become resistant to that as well, researchers have said.
8.31am: Simon Stevens, who started work as NHS England chief executive on 1 April, will today make a much anticipated first major public appearance, in a hearing at the Commons health committee at 2.30pm.
The HSJ Live blog will cover the session as it happens, there will also be debate and coverage on Twitter at #stevenshc, and full news coverage and reaction at www.hsj.co.uk
Mr Stevens’ arrival has been celebrated by many NHS leaders and commentators, but he is likely to face some direct questioning from MPs.
One topic set to be addressed is competition and choice in the NHS. David Bennett, the Monitor chief executive, told HSJ three weeks ago that Mr Stevens was “more sympathetic to the role that competition and choice can play” in the NHS than had been his predecessor, Sir David Nicholson, who raised concerns about the operation of competition law and rules.
The new chief executive - who joined from US health insurance firm UnitedHealth and was previously health adviser to Tony Blair - will also be prepared to be questioned on:
- The future of small hospitals in the NHS, for which he appeared to give hope in his first speech in the new role, taking an apparently different tack to the trend of acute service centralisation.
- The future of NHS funding
- Whistleblowing and culture in the NHS
- NHS England’s specialised services budget overspend and the financial health of the NHS
- The state of NHS England and how he will make it operate better
7.00am Good morning and welcome to HSJ Live. Simon Stevens is due to appear at the Commons health committee at 2.30pm. Stick around for full buildup and coverage throughout the day of the NHS England chief executive’s appearance at the hearing.