Questions around chancellor’s claim that he can ‘conceive’ of country ‘affording’ £8bn, plus the rest of the day’s new and comment
3.55pm Our pedigree chums at the Department of Health have a can-do approach, but their mealy mouthed missives aren’t easy to digest. Read this week’s End Game here.
3.15pm Questions are being raised about Chancellor George Osborne’s potentially significant comments last night about future NHS funding. He appeared to suggest that the financial requirements set out in the NHS Five Year Forward View can be met if there were to be in the next Parliament a “similar increase in funding… as we have achieved in this Parliament”, as long as the forward view’s most optimistic assumptions of efficiency can be delivered.
He said the requirement outlined in the forward view was “funding on a scale that is possible to conceive our country affording”.
It is unclear what the chancellor means. NHS senior leaders yesterday said the forward view requirement was for a 1.5 per cent real terms growth each year. However, the average annual real terms funding growth between 2010-11 and 2013-14 was lower than 1.5 per cent, and current plans for this year and 2015-16 would also deliver real terms increases smaller than 1.5 per cent.
Furthermore, the largest real terms growth in this parliament (of 2.6 per cent) came in 2013-14, but this was in large part achievable because the Department of Health eliminated almost all the budget underspend it has carried for several years. Achieving real terms growth during this Parliament has also been aided in part by low inflation, some have suggested.
King’s Fund chief economist Professor John Appleby has pointed out that the real terms increase in NHS funding is expected to have been £4.8bn cumulatively over six years from 2010-11 to 2015-16 – short of the £8bn cumulative real terms increase which was called for by 2020-21 by NHS leaders yesterday.
So it is difficult to see how a “similar increase in funding” would meet the requirements of the forward view.
3.05pm The first half of 2014-15 has shown a continuing decline in acute trusts meeting the target for 95 per cent of accident and emergency patients to be seen within four hours and there’s little sign the trend will be reversed in the second half, says Robert Royce.
The independent healthcare consultant argues that the notion that the problem with accessing emergency treatment in NHS hospitals in a timely fashion is somehow a phenomenon of winter has lost what little credibility it might have had years ago.
2.23pm Patients of Mid Staffordshire NHS Foundation Trust will be treated by neighbouring NHS trusts following the formal transfer of services on 1 November 2014.
An order confirming the transfer and allowing for the future dissolution of the trust was laid in Parliament earlier today.
Services at County Hospital (formerly Stafford Hospital) and Cannock Chase Hospital will be provided by University Hospitals of North Midlands NHS Trust and The Royal Wolverhampton Hospital NHS Trust respectively. Both hospitals will remain open.
In order for any outstanding criminal cases to be dealt with, a shell legal entity will remain in place temporarily. As such, Tim Rideout, a former primary care trust chief executive, will be appointed as part-time administrator, to work as and when required.
The current trust special administrators (Alan Bloom, Alan Hudson and Hugo Mascie-Taylor) will support the receiving trusts for one week after the transfer of services in order ensure a smooth transition and hand over to Mr Rideout.
1.49pm Labour still intends to repeal the Health Act 2012 despite the shift in focus away from competition in the NHS Five Year Forward View, a shadow health minister has told HSJ.
The document - published yesterday by NHS England, Monitor and the other national NHS bodies - made no reference to competition or private providers. It is understood that competition is not an important focus of the senior national leaders’ vision for service development.
However, Labour peer and former health minister Lord Hunt today told HSJ there “absolutely” needed to be a legal change to change the effect of competition rules, regardless of the shift in policy emphasis.
1.27pm When faced with reconfiguration in the NHS, management must ensure that their staff feel confident enough about the changes to be emotionally committed. It is about cultural leadership, London North West Healthcare Trust chair Peter Worthington tells Jennifer Trueland.
1.00pm Emergency admissions to accident and emergency departments have hit their highest level since records began, the latest NHS England figures reveal.
Official figures of last week’s performance show that demand on emergency departments across the country has escalated, with 78,131 patients arriving at major A&Es requiring admission compared with 77,742 in May.
While emergency admissions have steadily risen over the past four years, the increase this year has steepened.
12.45pm A patient video, based on airline style safety advice, has been developed by the NHS in an attempt to cut avoidable complications such as blood clots, pressure ulcers and falls.
Based on the concept of safety advice given on an airplane before it takes off, patients will be shown a film and provided with an information card to help them look after themselves during their hospital stay.
12.38pm The Labour party have released the following statement:
Shocking figures today show the extent to which people are waiting for hours in A&E and thousands are languishing on trolleys for hours before being admitted to overcrowded wards, because people are becoming trapped in hospital once they have been treated - and the amount of money that it is costing taxpayers.
Liz Kendall MP, Labour’s shadow health minister, said the number of delayed discharges from hospital, which could be avoided if elderly people had the right care and support in the community or at home, has soared by 65 per cent since the 2010 General Election.
Over the last year, these delays have cost £260m. This could have paid for nearly 6,300 community nurses, or an entire year of home care visits for over 37,500 older people.
Liz Kendall MP said: “These appalling figures show the scale of the crisis in care that has developed under David Cameron.
“Increasing numbers of frail, elderly people are ending up going to A&E and getting stuck in hospital because they can’t get the care they need to help them stay living at home. This isn’t good for them, and costs the taxpayer far more.
“Delayed discharges cost £260m in the last year alone – money which could have paid for a year of home visits for 37,000 elderly people or nearly 6,300 nurses.
“Alongside today’s A&E figures, which show the four-hour waiting target has been missed for the 65th week in a row, the choice is now clear: the NHS going backwards under the Tories, or Labour’s plans to join up health and social care so we get the best care for patients and the best value for taxpayers’ money.”
11.56am The regulator Monitor has opened an investigation into Great Western Hospitals Foundation Trust as a result of the provider’s ongoing financial problems.
The Swindon-based trust, which last year saw revenues of £308.1m, has had to deal with cost increases due to the growth in the number of patients requiring emergency treatment.
While the trust has put plans in place to improve its financial position, the regulator has said it would like to understand whether more needs to be done to tackle the problem in the long term.
11.52am The care minister has described the evidence that health and social care integration will save money as still ‘embryonic’.
Norman Lamb’s comments came in response to NHS England casting doubt on the better care fund’s ability to reliably cut costs.
Speaking to HSJ as NHS England published its Five Year Forward View, Mr Lamb described changing the model of care to better support people with long term conditions as “the big challenge of our age”.
11.37am A major West Midlands trust could be forced to change its leadership unless it starts hitting waiting times targets, according to a condition placed on its licence by Monitor.
Under the condition, directors could be removed from Heart of England Foundation if it does not improve.
The action was taken because of the trust’s failure to reduce waiting times alongside “concerns regarding mortality rates”.
Heart of England has missed the four hour accident and emergency target for seven consecutive quarters and has been subject to enforcement action since December last year.
11.36am This week’s issue of HSJ magazine is now available to read on our tablet app. Click here to download our apps.
11.26am Emergency admissions to accident and emergency departments are at their highest level since records began, the latest NHS England figures reveal.
The figures for last week show that the demand on A&E departments across the country is escalating with 78,131 patients arriving at major A&Es requiring admission.
There were nearly 5,000 extra admissions than at the same point last year and the numbers jumped up by nearly 3,000 from 75,389 the week before.
This demand has meant A&Es have struggled to meet the target to see, treat, admit or discharge 95 per cent of patients within four hours, with only 89.6 per cent of patients visiting major A&Es seen within four hours.
Demand is also growing on departments that usually treat patients with more minor complaints, with the performance of all A&Es dropping to 93 per cent. The sector traditionally meets this target.
11.25am A London gynaecologist is facing so many negligence claims against his work that a special scheme has had to be agreed between lawyers and the NHS.
The now defunct trust that Rod Irvine worked for contacted 2,000 women who had been treated by the specialist gynaecologist to notify them that there may be concerns with their treatment, it has emerged
Specialist medical lawyers acting on behalf of victims of alleged negligence by Mr Irvine have agreed a special scheme with the NHS to ensure that patients’ cases are reviewed as quickly and efficiently as possible.
Mr Irvine was suspended from practice in November 2012 and it emerged last year that the South London Healthcare Trust, which has now been dissolved, contacted around 2,000 women who had operations or other procedures undertaken by Mr Irvine, notifying them that there may be concerns with their treatment.
Law firm Irwin Mitchell is representing around 20 people who allege they have suffered injuries as a result of treatment by consultant gynaecologist Rod Irvine. Irwin Mitchell has a specialist team which deals with group actions in medical negligence who have pioneered similar schemes with the NHS Litigation Authority (NHSLA) involving doctors around the country facing multiple claims such as Manjit Bhamra in Rotherham and Rob Jones in Cornwall.
Now the NHSLA which deals with medical negligence claims has set up a special scheme alongside expert lawyers at Irwin Mitchell to review claims relating to Mr Irvine as quickly and efficiently as possible but it will only be open for a limited period so patients affected are being asked to apply to the scheme as quickly as possible.
Esther Wilkinson, a specialist solicitor in the medical negligence group actions team at lawyers Irwin Mitchell, representing the patients said: “Our clients have suffered life-changing injuries and we are investigating allegations against Mr Rod Irvine including alleged delays in the diagnosis of cancer, a failure to follow clinical protocols, and various serious surgical errors including damage to organs and a failure to deal with obvious infections.
“We have been contacted by many women who thought they were alone in having concerns about the treatment provided by Mr Irvine. Many of them aren’t aware that other women have been affected and that concerns were first publicly raised about Mr Irvine’s clinical practice as far back as April 2012.”
11.19am NHS Employers has threatened to close the medical consultant contract to new doctors or those changing jobs following last week’s breakdown in pay negotiations with the British Medical Association.
The employer organisation also warned of “complete removal” of the Clinical Excellence Award regime after the BMA pulled out of talks ahead of a government deadline this month.
NHS Employers, which negotiates on behalf of NHS trusts and the government, said it was now “more likely” that ministers would ask the Doctors’ and Dentists’ Review Body to examine changes to contractual terms and conditions which relate to seven day services and junior doctors.
11.17am Staff at three high security psychiatric hospitals will strike on October 24 following a dispute with the government over health workers’ pay.
Members of the Prison Officers Association at Broadmoor in Berkshire, Rampton in Nottinghamshire and Ashworth on Merseyside will walk out for four hours from 7am.
It will be the first strike by psychiatric nurses at the three sites over pay, and follows a four to one vote in favour of action in a ballot.
11.06am 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 nominations now using the form below. 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.
11.02am Chancellor George Osborne has said that on continued funding levels the country can ‘afford’ the figures set out by NHS England Forward View document.
Speaking to Sky News Mr Osborne said: “I’m not setting out today the exact spending plans for coming years. But I would note this. If you achieved a similar increase in funding over the coming four or five years as we have achieved in this parliament, and you achieve the ambitious efficiency plans that Simon Stevens has identified, then you meet the conditions of this report…
“Simon Stevens sets the parameters for a grown up debate ahead of the general election. The English NHS is not in crisis today but there clearly are pressures. It is funding on a scale that is possible to conceive our country affording”.
10.49am Spectator editor Fraser Nelson writes in the Daily Telegraph today that NHS England chief executive Simon Stevens understands NHS problems, private sector solutions – and the politics of bringing the two together.
He argues that the Five Year Forward View, the NHS’s radical plan for changing care provision in a way to better suit patients, has created an odd consensus between Labour and the Tories as both were quite happy with yesterday’s plans.
Nelson writes: “No matter what either party says about the NHS at the next election, they now both have the same plan: to trust Simon Stevens, and hope that he’s right.”
Elsewhere the Telegraph carries a leader this morning that argues that further reform of the health service is not just desirable, but inevitable.
The paper states that in a time where the political debate around the NHS, especially on the Left, is defined in such a way as to suggest compassion is only measured by money, the NHS needs to be more imaginative.
10.36am In today’s Guardian Polly Toynbee dedicates her column to the Five Year Forward View. She says that Simon Stevens spoke “truth to power” yesterday by asking for more money for the NHS. She argues that while some people on the left feared Mr Stevens would be a privatising “stooge”, “the thrust of his five year plan heads off in an entirely new direction” to the competition enshrined in the Health and Social Care Act.
She says that with power devolved to Clinical Commissioning Groups, Mr Stevens “may have to lead by sheer force of personality and the rationality of his plan, to pull back together the fragmented NHS”.
She concludes: “There is no escape for any political party now: they must say how they will find the money.”
10.26am In The Times comment section Philip Collins writes that the Five Year Forward View has “sketched a revolution” but that change takes a long time in the NHS, and the concept of integration has been around since the NHS was born. He writes: “To suppose that this array of autonomous bodies, which together compose the leviathan we know as the NHS, can somehow, against all precedent, wish itself integrated is a truly fond hope”. But he says this goal is a necessity.
10.24am Almost 2,000 cancer patients are missing out on life-saving surgery every year and ageism could be to blame, figures from Cancer Research UK suggest.
The Times reports that the charity sys that 1,800 people a year with lung cancer are not receiving surgery despite being in the early – and operable – stage of the disease.
10.22am The Times (newspaper only) reports that the health secretary has insisted that the main political parties agree on the future of the NHS, as the Conservatives and Labour each inch towards promising more money.
Both health secretaries endorsed the radical vision for reforming the service laid out by Simon Stevens.
Mr Hunt said that politicians should stop “constantly pretending there are vast areas of disagreements”.
10.18am The Times reports that laziness contributes to as many deaths as smoking and threatens to bankrupt public services, health chiefs warned yesterday.
One in six deaths can be traced back to inactivity and the country is moving 20 per cent less than in the 1960s, Public Health England said in a report which insisted that “everybody needs to become more active, every day”.
10.10am The Guardian reports that health ministers from all three main Westminster parties yesterday refused to commit to an extra £8bn funding sought by the NHS Five Year Forward View.
The politicians embraced the report’s principles, arguing it endorsed their current political positions, but shief away from commiting to the extra cash above inflation over the next parliament.
9.35am The British Geriatrics Society welcomed the launch yesteray of NHS England’s Five-Year Forward View. This report offers a bold set of recommendations for meeting the changing needs of patients, in particular the complex needs of frail older people.
BGS research and guidance on the care of older patients supports the Forward View’s assertion that traditional divides between primary care, community services and hospitals are increasingly a barrier to integrated and patient-centred health services.
This is especially true for older patients living with multiple conditions including frailty and dementia, the 350,000 residents of care homes (whose needs the report explicitly prioritises), and the vulnerable “oldest old”.
NHS England’s recognition of the needs of frail older people is therefore extremely welcome: providing high-quality care to this specific group of patients will be crucial for building an effective system of health and social care for patients of all ages.
Commenting on the report Professor David Oliver, President of the British Geriatrics Society, said: “This report is a major step towards building an NHS which is fit for the future, and we welcome its recommendations. As the largest individual group of NHS service users, frail older people must be at the heart of any vision for improving and modernising healthcare provision. We also welcome a renewed focus on supporting the 5 million carers for older people.
The challenges facing the NHS in providing high-quality care to older patients are already substantial, and will continue to grow. The British Geriatric Society and its members will play a leading role in helping NHS England to face these challenges.
BGS members, including geriatricians, nurses and allied health professionals, are already engaged in experimentation and the development of care models at the interface between community and hospital, shaping new models of care which will better meet the needs of all of our population, including frail older people with complex needs.
Putting the recommendations of this report into practice will be complex and demanding, particularly in areas such as the development of shared electronic records, new models or primary care, or more support for carers.
The British Geriatrics Society and its members are excited to be part of that process, and to work closely with NHS England over the next five years and beyond.”
7.00am Good morning. There is evidence that the NHS is not learning from preventable errors. While there are some patient safety initiatives actively supporting a cultural change, unless we listen to the experiences of families in a timely way, we won’t learn, write James Titcombe and Murray Anderson-Wallace