Some contracts for 2015-16 remain unsigned two weeks after the deadline as some trusts only received their offers on the day they were meant to be signed, HSJ has been told, plus the rest of today’s news and comment

  • Conservatives pledge to fund forward view in election manifesto
  • Trusts received contract offers on deadline day
  • Policy delays risk ‘preventable deaths’, doctors warn NHS England
  • ‘No improvement over safe staffing’, nurse survey suggests

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5.00pm There has been a lot of debate in our comments section about HSJ’s exclusive interview with Andy Burnham, in which the shadow health secretary said the NHS Five Year Forward View left “many big questions unanswered” and Labour would not be setting the health service “on the right path” by adopting it without making “other fundamental changes”.

There was some support for Mr Burnham’s remarks. One commentor said: “Good - let’s have a bit of debate - I’ve become thoroughly sick of the unquestioning acceptance of everything in the 5 Year forward view… Based on his absurd suggestion that there’s £22bn of efficiency savings just waiting to be delivered I’m reserving my judgement for a while yet.”

Others were critical of this stance.”Sad to see party politics getting in the way as usual. Support for the 5 year forward view, across party lines, gave the NHS a fighting chance. If we continue to play politics with the management of the health service then I hold no hope for the next 5 years,” said another commentor.

4.18pm The Conservative Party has firmly backed the NHS Five Year Forward View in its election manifesto. It includes an explicit commitment to spend at least an extra £8bn a year on the NHS, over and above inflation, by 2020.

The manifesto document also includes a series of commitments to increase access to services and set up a “truly seven day NHS”, prompting concerns over how these would be paid for.

4.06pm Respondng to the Conservative manifesto, Nuffield Trust chief executive Nigel Edwards said: “The Conservative party’s pledge to increase funding for the NHS by a minimum of £8bn is a welcome recognition that the health service needs significant extra money simply to stand still.

“The funding pledge is also a vote of confidence in the NHS’s own five-year plan to transform healthcare services for the future.  But even with this additional money, the NHS will have to find unprecedented levels of efficiency savings within five years just to break even.

“In this context it is difficult to see how all of the improvements set out in the manifesto would be affordable, however welcome they may be. For instance, the party is absolutely right to aspire to seven-day access to NHS hospital and GP services by 2020. But providing a seven-day NHS service in hospitals will either mean big changes to the way services are run across the country or significantly more money.

“Without further funding, 7-day hospital services will probably require centralisation, involving the downgrade and closures of local services such as emergency surgery or maternity units.

“What’s more, 7-day GP working and an enhanced focus on prevention will mean spreading the already extremely strained primary care workforce even further. It is hard to see how these changes could happen without extra funds that go beyond £8bn minimum set out in the manifesto.

“It would be useful to have had clarity on which of the these proposals were immediate priority improvements and which are contingent on an as yet unrealised long-term economic plan.

“It is good to see the Conservative party demonstrate their commitment to improve access to mental health services, which, as we have previously documented, are deteriorating.

“However, while pooled health and social care budgets might help end fragmentation between services, such an approach will not mitigate the huge financial strain social care is under, which looks set to worsen under Conservative spending plans.”

3.03pm Responding to the publication of the Conservative Party’s manifesto, King’s Fund chief executive Chris Ham said: “Following on from Labour’s wide-ranging vision for reforming the NHS, the Conservative Party’s election prescription offers a mixture of incremental change and practical initiatives to improve services for patients.

“The commitment to find the £8bn a year called for in the NHS Five Year Forward View is welcome, though questions should continue to be asked about how it will be funded. Even with this extra funding, the NHS will still need to deliver herculean productivity improvements – this is the minimum requirement if the NHS is to continue to meet patient needs and maintain standards of care.

“With social care services under huge pressure, it is essential that increased spending on the NHS does not come at the expense of further cuts to social care budgets. While commitments to pool budgets and integrate services locally are welcome, the manifesto is silent about the unprecedented challenges facing social care.

“The arguments in favour of extending seven day services have been well made by health service leaders as well as politicians. Significant challenges will need to be overcome to ensure sufficient hospital consultants and other staff are available at weekends, and it will cost money. A seven day NHS is the right ambition but delivering it by 2020 will be a tall order.”

2.22pm Almost two thirds of nursing staff who have experienced a ‘red flag’ event while working on an acute adult inpatient ward have failed to see nurse numbers immediately increased to deal with the situation, according to a major survey of NHS staffing levels.

National nurse safe staffing guidelines introduced last summer for England state that when a “red flag” event occurs – such as when less than two registered nurses are present on a ward, or there is a 30 minute delay for providing pain relief – the person in charge should consider allocating additional nurses immediately.

The snapshot survey of 5,100 staff carried out by Unison in February, found 62 per cent of respondents who had experienced one of these events since the summer had not seen extra nurses brought onto the ward.

2.07pm Twenty senior doctors and experts have written an open letter to the NHS England board warning of ‘a high risk of preventable death’ for some patients due to delays in drawing up an access policy for a licensed drug.

The consultants urge NHS England to act now over what they say is a “matter of extreme urgency” to ensure patients in critical need receive the drug everolimus.

The drug has been shown to improve outcomes for children and adults with tuberous sclerosis complex, which causes growths in organs such as the brain and kidneys. The authors say that, without the drug, patients could suffer avoidable harm and death.

The letter, addressed to 17 NHS England board members, is signed by doctors and experts working across the NHS including specialists at Alder Hey Children’s Hospital and consultants in paediatrics, neurology and kidney disease. It is also signed by senior geneticists, scientists and clinical leaders.

1.55pm Responding to the Conservative manifesto, launched today, and in particular to its pledge to give at least an additional £8bn by 2020 over and above inflation to fund and support the NHS’ Five Year Forward View, and to extend services to seven days a week, Health Foundation policy director Richard Taunt said said: “Based on Health Foundation analysis and research, the additional £8bn by 2020-21 is the absolute minimum the NHS will need to cope with growing pressures over the next five years and we welcome a commitment by any party to provide that amount. 

“However, three areas need clarity - where will the money come from? How will they pay for service improvements? How will they support the NHS to improve productivity?

“We urge political parties making any funding commitment to explain exactly where they will find the money. In particular we would welcome clarity on whether this money will come from cuts in other department budgets, which could ultimately have an impact on the NHS.

“A promise to extend services to seven days a week would require resources in addition to the £8bn needed just to maintain the range and quality of care the NHS currently provides. Parties pledging to extend services would have to explain where extra funding to make these service improvements would come from.

“It is also worth bearing in mind that NHS hospitals have only improved productivity at an average rate of 0.4% a year over this parliament, with productivity having gone backwards over the last two years. This is substantially below the 2-3% set out in the NHS Five year forward view as being required, along with the £8bn additional resource, to close the NHS funding gap.”

1.45pm EXCLUSIVE: Some contracts for 2015-16 remain unsigned two weeks after the deadline as some trusts only received their offers on the day they were meant to be signed, HSJ has been told.

In the latest delay to tariff negotiations, trusts received contract offers on 31 March, the same day NHS England had stipulated that contracts must be signed.

According to NHS England’s timetable, which had already been revised after providers responsible for three-quarters of all NHS services rejected the national tariff offer, contracts should have been signed by 31 March.

However, several senior leaders at acute trusts have told HSJ that contracts had still not been signed yet and in some cases this would take several more weeks.

12.45pm Here are a few key points from the Green Party general election manifestoL

The party would increase the overal NHS budget by £12bn a year, and would increase alcohol and tobacco taxes to help fund these annual increases.

The manifesto also commits to providing free social care for older people, in line with the Barker report, at the initial cost of £8bn a year, but rising to £9bn a year at the end of the next parliament. It also commits to providing free social care at the end of life.

The Green Party would would repeal the 2012 Health and Social Care Act, according to the manifesto, and introduce an NHS Restatement Bill, abolishing competition and the purchaser-provider split and restrict the role of commercial companies.

The Greens would also end commercial confidentiality and “carry out an investigation into the opaque system of patronage and lobbying that has characterised the privatisation of the NHS”.

The party would also stop further private finance initiative contracts and seek ways to buy out existing PFI contracts “where that would represent good value for money”, setting aside £5bn over the next parliament for that purpose.

12.26pm The Green Party also launched its 2015 general election manifesto today.

You can read the full document here.

The party’s health policies are outlined on pages 31-35 of the document.

12.08pm You can now read the full Conservative general election manifesto.

12.03pm David Cameron: “Britain is on the right track…We’ve got exciting things laid out in this manifesto. Don’t let Labour take us back to square one.”

11.56am HSJ’s David Williams tweets:

11.53am Sky political editor Faisal Islam asks why the Conservatives have committed to an additional £8bn for the NHS, despite David Cameron previously saying that unfunded promises would the greatest risk to the health service.

“All our commitments are fully funded as part of our fiscal plan,” David Cameron responds.

He says Labour has no fiscal plan for the country. “They haven’t even reached the foothills. They haven’t even left the basecamp. They haven’t even left Gatwick,” he continues.

11.47am HSJ senior correspondent has compiled the NHS promises made in the in the Conservative manifesto:

11.44am The Prime Minister is now taking questions from the floor.

11.43am David Cameron closes his speech saying: “Let us not go back to square one, let us finish what we’ve begun.”

11.40am The Conservative manifesto also pledges to “restore and extend our public services”.

11.37am HSJ correspondent David Williams has made a few more observations on the Conservative manifesto document:

11.34am David Cameron: “There’s £8bn a year more for the NHS so it’s there for your family seven days a week.”

11.31am David Cameron: “Let us see this plan through… We’ll be back in the black, but only if the Conservatives are in government.”

11.30am David Cameron: “Just as this parliament, we’ll take action on the deficit, properly fund the NHS and cut taxes for working people.”

11.26am HSJ’s David Williams also tweets:

11.25am HSJ correspondent David Williams has made this observation about the Conservative manifesto:

11.23am David Cameron: “This is a greater country and we can be greater still, so let’s not waste the past five years… Let us finish what we’ve done.”

11.21am Mr Cameron describes the Conservatives as the “real party of working people in our country today”.

11.18am David Cameron has now begun his speech at the Conservative Party manifesto launch.

11.13am Mr Obsorne now introduces home secretary Theresa May to discuss national security.

11.12am George Osborne: “We stand before you with a track record of proving sanity to our public finances.”

11.11am Chancellor George Osborne is currently speaking at the launch the Conservative Party manifesto.

“We commit to finish the job that we have started” to “entrench the hard won economic stability of this country,” he says.

“Others want to risk everything that Britain has achieved, with neverending borrowing”, and a “return to economic chaos,” the chancellor adds.

11.04am The Conservative Party is due to unveil its manifesto in Swindon shortly.

Follow HSJ Live for full coverage of Prime Minister David Cameron’s speech launching the document.

10.59am The Times reports that doctors have called for an end to underfunding for dementia research before increased levels of the disease prompt a health and social care crisis.

A study carried out by the University of Oxford found that stroke research was also underfunded in comparison with cancer and heart disease.

They calculated that for every £10 of health and social care costs attributable to each condition, £1.08 in research funding was spent on cancer, 65p on coronary heart disease, 19p on stroke and only 8p on dementia.

10.55am The Guardian reports that prospective patients could be asked to present a passport to prove they are a UK resident before hospital treatment.

Guidance from the Department of Health tells NHS trusts that “where there is uncertainty” about patients’ entitlement to free care they must ask to see credentials including passports, driving licences, bills and bank statements.

Treatment at A&E departments and GPs’ surgeries will remain free for all, the department said, and no one should be denied treatment if it is deemed to be “immediately necessary or urgent”, but patients will face questions from staff, where possible, before being admitted as an inpatient or being given an outpatient appointment.

10.42am The Daily Telegraph reports that Labour is “risking patient safety” by failing to pledge an extra £8bn to the NHS, the King’s Fund has warned.

Chris Ham, the King’s Fund’s chief executive, said there was a “significant gap at the heart of [Labour’s] plans” and highlighted the pledge was the “minimum” required to “meet patient needs and maintain standards of care”.

10.20am There has been no improvement in safe staffing levels have seen no improvement over the past year,  according to a survey of more than 5,000 nursing staff by the health union UNISON today.

Almost of those surveyed half who responded (49 per cent) thought that staffing levels had got worse since May 2010.

Nearly two-thirds (65 per cent) reported that patients missed out on care due to understaffing, while around half (49 per cent) reported not having enough time with each patient.

Some of the main findings of the survey include:

  • 88 per cent support national mandatory minimum nurse-to-patient ratios
  • 45 per cent felt there were not adequate staff numbers to deliver safe and dignified care
  • 70 per cent were unable to take all or some of their breaks that day
  • 49 per cent said staffing levels had got worse since May 2010
  • 65 per cent reported care was left undone due to understaffing
  • 49 per cent reported not having an adequate amount of time with each patient
  • 42 per cent were caring for eight or more patients
  • 55 per cent working on night shift were caring for eight or more patients
  • 46 per cent said they wanted the next government to prioritise ensuring safe staffing levels
  • 37 per cent worked over their contracted hours
  • 75 per cent worked up to an hour of additional time, but only 8 per cent were paid for working overtime

One staff member surveyed said: “I could not offer adequate food or fluids due to workload. I did not have time to explain what was happening to the patient. I had no time to explain their diagnosis or treatment.”

Another said: “I was unable to give pain relief immediately as it is a controlled drug and two nurses are rarely available to check drugs for long periods of time.”

“If just one patient had a crisis of any kind, the other patients would have gone without care,” another respondent said.

UNISON head of health Christina McAnea said: “UNISON has carried out this survey for the past four years and it is deeply worrying that little has changed.

“Staff are still not able to see all their patients – despite working through their breaks and doing lots of unpaid overtime.

“Demands on the NHS are at an all-time high, but despite the government’s promise, the NHS is operating in a financial straightjacket.

“With not enough money to fund adequate staffing levels, nurses and midwives are running themselves into the ground as they struggle to keep the health service going.

“With the NHS possibly the most significant issue as the election approaches, voters should think carefully about what another five years of a Conservative-led government might mean.

“It is clear that nurses and midwives have no confidence in the existing guidance on safe staffing levels. It is failing both patients and staff because it doesn’t meet either of their needs.

“That is why we desperately need nationally set mandatory minimum nurse-to-patient ratios based on patient needs.

“Nurses and midwives should not have to ration their time and make the difficult choice as to which patients receive care and which ones miss out.

“It is unfair to put staff in this position and it jeopardises patient safety.”

10.10am From putting patient safety first to keeping evidence, from gathering support to doing the right thing — an expert advises on things to do to avoid medical errors.

9.58am In his exclusive interview with HSJ and its sister title Local Government Chronicle yesterday, Andy Burham also revealed that a Labour government would view health and social care as a single budget and would support NHS money being spent on care services.

The shadow health secretary also pledged the party would protect funding for social care “as best we can”. He said Labour’s commitment to provide up to £2.5bn extra money every year for the NHS should be considered as extra money for health and social care.

However, he acknowledged that while Labour had a “clear plan” for NHS spending if it formed a government after the election, there would not be a spending settlement for social care until the comprehensive spending review planned for the summer.

9.49am Mr Burnham’s exclusive interview came as the Labour Party launched its 2015 general election manifesto yesterday.

Labour also launched its “health manifesto” over the weekend, accused the Conservatives of making “unfunded commitments” after ministers pledged to invest significant extra funding into the NHS.  

9.45am In case you missed it, Andy Burnham yesterday said the NHS Five Year Forward View left “many big questions unanswered” and Labour would not be setting the health service “on the right path” by adopting it without making “other fundamental changes”.

In an exclusive interview with HSJ and its sister title Local Government Chronicle, the shadow health secretary said the forward view’s assumptions were based in part on current government policies, which a Labour administration would change.

His comments came after the Nuffield Trust raised concerns about the absence in Labour’s health manifesto of any reference to the forward view, which documented the shared view of national NHS bodies on the care reforms and funding the service will need in the next parliament.

7.00am Good morning and welcome to HSJ Live.

The Conservatives are launching their manifesto today. Stick around for full coverage of their health policies here on HSJ Live.