Politicians should recognise the NHS needs to ‘get more out of’ and reduce the cost of its staff, the NHS Confederation chief executive has said, plus the rest of today’s news and comment

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5.15pm Somerset Clinical Commissioning Group is considering whether to release itself from contracts with a number of local providers in a bid to reduce financial pressures.

CCG leaders have discussed the proposals as part of a plan to move to an outcome based model for commissioning care across the county.

A paper presented to the group’s board meeting last month states: “The CCG is of the opinion that a radical and ambitious strategy is required to ensure high quality, joined up and sustainable person centred care is provided across Somerset.

2.15pm Rob Webster said workforce was one of four issues political leaders across all major parties were failing to recognise during the election campaign.

His comments follow former NHS chief executive Sir David Nicholson today predicting the NHS would need to take “emergency action”, such as vacancy freezes, in the near future to address funding shortfalls.

Mr Webster said political parties were not being realistic about the severity of the NHS’s financial problems, and in particular had not addressed rapidly falling spending on social care.

He also criticised “arbitrary targets for increasing specific sorts of staff” in manifestos. He questioned whether they were either “affordable” or “desirable”, and instead said the focus should be on “team based working”.

11.45am The Healthcare Financial Management Association has issued a response to Sir David Nicholson’s comments on the state of NHS finances

Paul Briddock, director of policy at the Healthcare Financial Management Association, said: “Whichever party, or combination of these, is elected will have its work cut out when it comes to the NHS. The ‘substantial financial problem’ Sir David Nicholson speaks of isn’t new news – it’s something managers, and indeed everyone in the health service, has been working hard to tackle for some time.

“HFMA research shows nearly two in five of NHS organisations are reporting a rapid deterioration in finances – over a third of commissioners and three quarters of trust finance directors predicted they would end the 2014-15 financial year in a worse financial position than 2013-14.

“The comments about how hard it is to implement change and find efficiency savings in the NHS are spot on – but this would be the case for any huge organisation, even one that doesn’t literally deal with life and death on a daily basis. This too isn’t something unfamiliar to NHS managers and finance teams. Over the last 18 months they have been managing a vast transformation and set of reforms, which are only now beginning to be bedded in, with budgets that are getting smaller in real terms.

“But the NHS must embrace change if it’s to be fit for the future. We need radically different models of care and integration. It’s true that as part of their manifestos, the main parties are talking about providing extra services, whether that’s the Conservatives and seven-day-services or the Lib Dems and increasing access to IAPT. However we need to take a medium to long-term view with pledges like these, which aim to provide savings in terms of reducing unnecessary and expensive hospital admissions further down the line.

“Rather than talk about blame and shifting responsibility, everyone responsible for planning and delivering NHS services must work in a unified way – this means politicians, civil servants, clinical staff and healthcare finance professionals working together to design and implement the service transformation needed. The NHS has always needed to be, and will increasingly need to be, agile, flexible and responsive to the needs of the public – this won’t change regardless of who takes office in May and it’s something we’re ready to take on.”

11.16am Commenting on the publication of the party political manifestos, which include new commitments, ‘arbitrary’ targets on increases for some staff groups and ‘scant’ mention of social care funding, Rob Webster, chief executive of the NHS Confederation, said: “The NHS is facing some of the biggest service and financial challenges in its history. If we are to tackle them, local leaders will need to be given the backing to work with their local communities to transform care. 

“Manifesto commitments will need to be backed by concrete action from the next government – rhetoric can never be a substitute for reality when it comes to patient care.

“I am pleased with the impact the 2015 Challenge Prescription for the Election, which the NHS Confederation and 22 other leading health and care organisations produced, has had. Many of the parties’ proposals back reductions in preventable illness. There has been an increased focus on achieving parity of esteem between mental and physical health from the parties. 

“There are welcome improvements and commitments signalled by the parties. There are also still a number of issues which are not addressed and which must be priorities for whoever forms the next government.”


“How much money we put into the NHS is a political choice. That choice has consequences in terms of service offer and efficiency. Where parties have committed to extra funding this is very welcome – we know the cost to other spending departments.

“What is clear is that the gap between demand and resources by 2020 will be at least £30bn – more if you add social care. That can be closed by two means – income and efficiency. With the extra funding set out in the Five Year Forward View, the NHS will need to find unprecedented levels of efficiency savings of at least £22bn. If parties put less in, then we will need to be even more efficient or cut services. 

“If we are to succeed, the political parties must be straight with the public about the huge scale of the savings and increases in productivity required over the next parliament. It means we will need to fundamentally change the way we provide care for millions of patients which itself will require funds for “double running” services and investment in estates, IT and innovation.”


“We need to move away from arbitrary targets in manifestos for increasing specific sorts of staff. Instead the next government must help facilitate sustainable long term workforce planning, which meets the needs of local areas. Any promise to increase staff will need to be backed by an appropriate increase in funding for the health service.”

Social care

“Plans for social care funding need to be clearer. When social care is cut, often the NHS feels the pain. According to estimates from Age UK, nearly 382,000 fewer people receive fully funded social care today compared to in 2005/6. The charity also estimates there are 900,000 older people between 65 and 89 who have unmet needs for social care. Many will see health issues arise as a consequence, adding to the pressure on NHS services and budgets. The next government will need to urgently find a sustainable funding settlement for social care. 


“If we are to tackle the big challenges, the NHS needs stability. Whoever starts on the task of implementing their manifesto in government must be mindful of the disastrous impact any centrally driven reorganisation will have on local efforts to improve care. We would urge any incoming government to commit to the principles set out in both the Five Year Forward View and by the 2015 Challenge partnership.”

10.14am Milton Keynes Hospital Foundation Trust has been given university hospital status as part of plans to create the country’s first private medical school.

The trust will take on its first cohort of undergraduate medics, in partnership with the independently funded Buckingham University, in 2017 and has announced plans to build a £6m academic centre onsite.

Trust chief executive Joe Harrison said he wants Milton Keynes to become “a world class centre for healthcare, teaching and research”.

10.13am The latest from the HSJ news team: The Care Quality Commission has rated Mid Essex Hospital Services Trust as ‘requires improvement’ following an inspection that found unregistered staff were providing nursing care.

The regulator was so concerned by the findings it took immediate action against the trust by imposing an urgent condition on its registration.

Mid Essex, which runs Broomfield Hospital and Braintree Community Hospital, was rated requires improvement for whether its services were safe, effective and well led, “good” for whether services were caring but ‘inadequate’ for their responsiveness.

10.03am. HSJ bureau chief and early riser Dave West tweeted some of the higlights from the exchange between Sir David and the BBC’s John Humphrys. Here are some choice cuts:

9.58am You can hear Sir David’s full interview on BBC Radio 4’s today programme this morning here. Among other things Sir David told Today that the NHS in England was accruing large deficits which would become clear later this year.

6.55am Former NHS chief executive Sir David Nicholson, who left the post in April last year, has spoken out about the severity of its current financial situation.

He said in interviews with the BBC that there was a “substantial financial problem” which would become “crystal clear” later this year, and that politicians were not acknowledging the type of thing that would need to happen to address it.

According to the BBC Sir David will say the service faces “managed decline”, and will also state that the Lansley NHS reorganisation during the last Parliament was a distraction from the need to improve services and efficiency.

He said the service would need “emergency action” to address funding shortfalls, such as vacancy freezes, in the coming year.

Sir David told the BBC: “I have not heard in most of the conversations politicians are having at the moment about what they’re going to do about that financial hole.

“They want to talk about extra services and extra investment when actually there is a problem there to face.”

He said the NHS would have to take “emergency action” such as vacancy freezes.

He said: “It will also mean the politicians having to suspend some of their ambitions about the new things they want to do while some of the money that’s being promised to the NHS is spent dealing with that particular operational problem.”

His comments come as annual accounts for 2014-15 and financial plans for 2015-16 are being finalised. Health secretary Jeremy Hunt told HSJ yesterday the Department of Health would balance overall in 2014-15, and claimed the funding it had already planned for 2015-16 would be sufficient.

Sir David’s interview was due to feature on the Radio 4 Today programme at 7.10am and 8.10am.

6.45am NHS England chief executive Simon Stevens considers the NHS Five Year Forward View a “compass rather than a route map” on how to transform the NHS, writes Michael Younger, head of healthcare at Penna.

Yet to follow the compass and develop a reformed, efficient and streamlined NHS requires leaders with new skills, and ways of thinking and working, he argues.