Summary
Thanks for following the blog today and all your comments. Here is a summary of the day’s events.
- Jeremy Hunt has said NHS England (NHSE) must still strive to meet the waiting time targets in its constitution after its leaders said they could not be met, placing him at loggerheads with health service bosses.
- Earlier, NHSE bosses said waiting times standards would be neither fully funded nor met next year, at a meeting to discuss their response to the budget settlement. Chief executive Simon Stevens had asked for £4bn for the health service in 2018/19 but was granted only £1.6bn.
- Labour, Lib Dems and health experts claimed the move, which they said was a consequence of government underfunding, would lead to long waits for routine operations like hip and knee replacements.
- NHSE also warned that guidelines from the health regulator, the National Institute for Health and Care Excellence, on new drugs and treatments may not be implemented in future unless “they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up”.
-
The decision to protect planned investment in mental health care was welcomed by the Royal College of Psychiatrists (RCPsych) and Mind. However, the RCPsych said a longer-term spending commitment was needed. NHSE chief executive Simon Stevens said as well as mental health services, planned investment in primary care and cancer services would also be protected.
-
Three heart surgery units have be saved from closure, after NHSE made a U-turn on their future. Units at the Royal Brompton in London, in Leicester and Newcastle had been earmarked for closure as part of plans to consolidate services offering specialist surgery and care for congenital heart disease patients. The decision to keep them open comes after years of campaigning. One, in Manchester, will still close and be consolidated with services offered in Liverpool.
- The board recommended that low value treatments, including fish oil, herbal remedies and homeopathy no longer be provided on the NHS. It said it would save the health service hundreds of millions of pounds a year and also free up millions of GP appointments currently taken up with prescribing such medicines.
And with that rejection of what the NHS bosses said that morning, the conference ends not on a note of harmony between health service leaders and politicians, as King’s Fund chief executive Chris Ham earlier said was needed, but with Jeremy Hunt and the NHS board at loggerheads.
Hunt insists targets must be met
A Press Association reporter has asked Hunt about the NHS England board meeting earlier and the fact that health service leaders said that waiting time targets would have to be abandoned next year (which Labour suggested the NHS had been pushed into through insufficient funding but might not be legal under its constitution).
In response the health secretary, reaffirmed his commitment to the constitution and the established targets.
Updated
Earlier, NHS England was highlighting its productivity increases of 1.7% a year, much better than the wider economy, warning that there was only so much more - if any more at all staff could do.
Hunt is pointing out where he things the NHS can do better:
@Jeremy_Hunt :Things the NHS needs to do better; 1. spread best practice; 2. workforce planning and skill mix (draft workforce plan before end 2017 for consultation); 3. marry tech and safety #KFAnnual2017
— Eden&Partners (@EdenPolitics) November 30, 2017
He moves on to safety:
People more often mention workforce constraints rather than financial ones, says Hunt #KFAnnual2017 #NHS Goes on to talk about Mid Staffs scandal
— Guardian Healthcare (@GdnHealthcare) November 30, 2017
Last year we removed ovaries from three patients by mistake, says Hunt #KFAnnual2017 #NHS
— Guardian Healthcare (@GdnHealthcare) November 30, 2017
We need to be better at spreading best practice, adds Hunt #KFAnnual2017 #NHS
— Guardian Healthcare (@GdnHealthcare) November 30, 2017
He suggests that money is not the most important thing holding the NHS back but staffing levels, although many would argue the two are inextricably linked:
People more often mention workforce constraints rather than financial ones, says Hunt #KFAnnual2017 #NHS Goes on to talk about Mid Staffs scandal
— Guardian Healthcare (@GdnHealthcare) November 30, 2017
Hunt is defending the performance of the NHS (and by definition the government) in the face of increasing demand:
.@Jeremy_Hunt “Most of the key safety indicators have gone in the right direction despite the pressures of the past five to seven years” #KFAnnual2017
— The King's Fund (@TheKingsFund) November 30, 2017
The health secretary is about to begin.
Jeremy Hunt on stage now after cycling to #KFAnnual2017 #NHS
— Guardian Healthcare (@GdnHealthcare) November 30, 2017
Chris Ham, chief Executive of the King’s Fund, where Jeremy Hunt will shortly be speaking, said in response to events earlier today, imploring NHS leaders and politicians to work together:
Today’s NHS England Board meeting is welcome recognition that we need to begin a discussion with the public about what the NHS can be expected to provide with the funds it has been given.
The NHS must play its part by continuing to seek and deliver improvements in efficiency but these will not be sufficient to bridge the funding gap. Politicians and NHS leaders need to find common cause in engaging with the public and avoid adopting adversarial positions which will undermine public confidence in their stewardship of the NHS.
We’re about 20 minutes away from the health secretary’s speech. While we wait, doctors’ union, the British Medical Association (BMA), has added its voice to those expressing concern at the impact of underfunding.
Dr Chaand Nagpaul, BMA council chair, said: “It is deeply worrying that the body with responsibility for running the NHS is warning of the service’s inability to meet national standards of care. Unfortunately, it is patients who are unfairly suffering the consequences of a clearly underfunded service. Waiting time targets for hospital care haven’t been met for years and patients face growing delays to see their GP as general practice struggles to cope with demand.
“Doctors always want to deliver the best possible care for our patients, but we can’t continuously plug gaps by penny pinching and poaching from elsewhere in an overstretched service. Ministers must listen to the warnings of doctors, and to the NHS’ own leaders, and take urgent steps to put the NHS on a sustainable footing.”
Updated
I’m going to put the blog on hold now until 4.50pm when Jeremy Hunt is giving a speech at the King’s Fund annual conference, in which he will have the chance to respond to what NHS England leaders said this morning.
In the meantime, you can read the news story by my colleague, Denis Campbell, on today’s developments so far:
Unite, which has 100,000 members in the NHS has complained bitterly about the impact of government funding on its members.
The union’s head of health, Sarah Carpenter, said:
We should not have to be juggling, as the world’s sixth largest economy, between lengthening waiting lists or whether to direct resources to A&E departments.
Staff morale is on the ropes as they are asked to do more with fewer resources – and there is only so much extra that you can ask dedicated professionals to do. ‘Recruitment and retention’ is now a major problem for NHS trusts.
The pay austerity that NHS staff have endured since 2010 needs to be addressed and, as yet, it is not clear how this will play out. The next stage after the budget announcement is for the NHS unions to explore what this actually means and what such a deal could look like.
Philip Hammond’s budget has not solved the cash crisis facing the NHS – the same set of stark challenges still remain and they need to be tackled urgently.
The Royal College of Surgeons, in this case jointly with the Society for Cardiothoracic Surgery, has also responded to the reconfiguration of congenital heart disease services in England, announced at this morning’s meeting, bemoaning how long it took to happen.
Services at the Royal Brompton in London, and in Leicester and Newcastle, which have been under threat for some time won a reprieve but a heart surgery unit in Manchester will close.
In a joint statement, the college and society said:
These changes should have happened decades ago. The endless delays to a decision being made on this reconfiguration has caused great uncertainty to all of the hospitals involved, their staff and the children they care for.
Currently, some smaller teams are very stretched in their ability to provide a comprehensive 24/7 service and to develop sustainably. It is fundamentally important that specialist surgical centres are large enough and treat patients regularly enough to develop full expertise to treat all conditions. It is vital that centres have adequate resources to support patients with increasingly complex needs, especially access to paediatric intensive care beds.”
It’s vital centres are properly staffed to provide on-call rotas and teams have the time to create a supportive environment where new techniques are shared and future specialists can learn.
Reacting to this morning’s meeting and the admission that waiting time targets cannot be funded or met, the Royal College of Surgeons (RCS) has said that delaying treatment is a false economy
RCS president Prof Derek Alderson said:
While last week’s Budget increase for NHS funding was welcome, NHS England’s analysis is clear that it is still insufficient to help meet the current needs of patients within existing targets. It is disappointing that the progress the whole NHS has made over the last decade on planned waiting times, such as for heart and brain surgery, now risks being lost.
We accept that difficult decisions will need to be made but we believe more of the money released by the government should be targeted at waiting times in the NHS before they deteriorate further.
Rationing and delaying surgical treatment are false economies. For example, current commissioning group policies designed to delay surgical access for obese patients and smokers only defers treatment and potentially adds costs through increased use of painkillers, physiotherapy, and welfare support for out-of-work patients. The RCS does not accept that such policies either save money or help patients.
We are prepared to continue working with the NHS to determine where genuine savings can be made where the evidence proves intervention does not benefit patient care. Such options have not yet been exhausted.
Summary
The public part of the meeting has concluded so here’s a summary of what happened and what is still to happen (namely Jeremy Hunt’s response):
- Waiting times standards will not be fully funded and met next year, NHS England (NHSE) has said, at a meeting to discuss its response to the budget settlement. Chief executive Simon Stevens had asked for £4bn for the health service in 2018/19 but was granted only £1.6bn.
- Labour, Lib Dems and health experts said this was a consequence of underfunding by the Conservative government and would lead to long waits for routine operations like hip and knee replacements.
- NHSE also warned that guidelines from the health regulator, the National Institute for Health and Care Excellence, may not be implemented in future unless “they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up”.
-
The decision to protect planned investment in mental health care was welcomed by the Royal College of Psychiatrists (RCPsych) and Mind. However, the RCPsych said a longer-term spending commitment was needed. NHSE chief executive Simon Stevens said as well as mental health services, planned investment in primary care and cancer services would also be protected.
- The health secretary, Jeremy Hunt, will have a chance to respond to NHSE’s plans for next year when he gives a speech at the King’s Fund health charity this afternoon.
-
Three heart surgery units have be saved from closure, after NHSE made a U-turn on their future. Units at the Royal Brompton in London, in Leicester and Newcastle had been earmarked for closure as part of plans to consolidate services offering specialist surgery and care for congenital heart disease patients. The decision to keep them open comes after years of campaigning. One, in Manchester, will still close and be consolidated with services offered in Liverpool.
- The board recommended that low value treatments, including fish oil, herbal remedies and homeopathy no longer be provided on the NHS. It said it would save the health service hundreds of millions of pounds a year and also free up millions of GP appointments currently taken up with prescribing such medicines.
Updated
Nice guidelines 'may not be implemented'
Another significant passage in the paper about planning for next year is the suggestion that guidelines from the health regulator, the National Institute for Health and Care Excellence, may be ignored. The relevant passage says:
New advisory Nice guidelines can only expect to be implemented locally across the NHS if in future they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up.
NHS England has released more details of the decision taken today to end routine prescription of certain medicines.
It says by ending the provision of “low value treatments, including fish oil, herbal remedies and homeopathy” on the NHS, hundreds of millions of pounds will be saved each year. It will also also free up millions of GP appointments that are currently taken up with prescribing these medicines, it says.
The treatments the board agreed should no longer be routinely prescribed are (together with the reason for doing so):
- Homeopathy – no clear or robust evidence to support its use
- Herbal treatments – no clear or robust evidence to support its use
- Omega-3 Fatty Acid Compounds (fish oil) – essential fatty acids which can be obtained through diet, low clinical effectiveness
- Co-proxamol – pain killer which has had its marketing authorisation withdrawn due to safety concerns
- Rubefacients (excluding topical NSAIDS) – warming muscle rub products, limited evidence
- Lutein and Antioxidants – used to treat the eye condition age related macular degeneration, low clinical effectiveness
- Glucosamine and Chondroitin – used for joint pain, low clinical effectiveness
Proposals were also presented to stop the routine prescribing of products that:
- Can be purchased over the counter, and sometimes at a lower cost than that which would be incurred by the NHS – paracetamol is an average of four times as expensive when provided on prescription by the NHS, compared to when it is purchased in pharmacies or supermarkets. It can costs around £34 for 32 on prescription including dispensing and GP consultation fees.
- Treat a condition that is considered to be self-limiting, so does not need treatment as it will heal/be cured of its own accord, such as a common cold.
- Treat a condition which could be managed by self-care, i.e. that the person does not need to seek medical care or could visit a pharmacist.
Pointing the finger of blame at the Conservatives, the shadow health secretary, Jonathan Ashworth MP, says effectively abandoning waiting time targets may be illegal. He said:
“NHS England’s unprecedented confirmation that NHS constitution waiting times standards ‘will not be fully funded and met next year’ is the direct result of Philip Hammond’s failure to give the NHS the funding it needed in the recent Budget.
“Today NHS bosses have effectively conceded that the 18 week target for treatment can’t be met given continued underfunding of the NHS.
“This will mean more and more patients waiting longer and longer in pain, discomfort and distress for elective operations. This is the real debilitating impact on patients’ quality of life as a result of Tory austerity.
“What’s more, there are serious questions about the legality of effectively abandoning a standard of care enshrined in the NHS constitution. As a matter of urgency Jeremy Hunt must now tell us whether he intends to amend the law and the NHS Constitution through legislation and publicly accept his government’s funding squeeze is jeopardising legally guaranteed standards of patient care.”
Readers have been in touch to tell us about their experiences and the concerns they have for the future given the funding gap and their views on the tough decisions which have to be made.
A 29-year-old nurse working in Cornwall said she doesn’t think everyone realises quite how bad the situation is.
No-one in the NHS wants to ration care when it means putting our patients at risk, but some services are so stretched now that people are already at risk. In the last few weeks I have had genuine fears for the lives of some of my patients in hospital.
It is a terrible decision and one I am glad I don’t have to make, but without more funding it’s just not possible to keep going like this. It comes down to would we rather have half a hospital working safely, or a whole hospital working dangerously? It’s very scary.
One GP in south-east London said the cuts over the last couple of years have affected the way they care for their patients:
I once referred a patient for an urgent appointment and it was made for six months time. Some people can wait a whole year. The situation looks dire.
A 50-year-old emergency physician said in their department there are often ill people in corridors and ambulances “queuing up like a serpent’s tail”.
One of my colleagues collapsed yesterday from exhaustion and refused to go home as she wanted to carry on working!
I worry that unsafe practices will become routine, that we will somehow get ‘used to’ working under such circumstances, and that the morale will break down completely.
Updated
There has been a more positive response to the decision to protect planned investment on mental health services (and cancer and primary care services).
Prof Wendy Burn, President of the Royal College of Psychiatrists, said:
Mental health patients and staff across the country can breathe a sigh of relief today. NHS England chief executive Simon Stevens said vital plans to improve mental health services will be kept on track for at least the next financial year. But the promise is to spend an extra £1 billion on frontline mental health services and treat one million more people by 2021 – so we need a commitment to take us beyond 2019.
The next step is to make sure that money gets to patients on the front line. We’re very worried that local healthcare commissioners are being allowed to divert cash intended for mental health services to pay for debts elsewhere. Commissioners must be held properly to account for the decisions that they make.
And Paul Farmer, chief executive of Mind, independent chair of the NHS Mental Health Taskforce and chair of the advisory and oversight board for the delivery of the Five Year Forward View for Mental Health, said:
We are pleased that the NHS has restated its commitments around mental health. The delivery of the Five Year Forward View for Mental Health is essential to bringing mental health services up to a basic standard, to start building the support we have lacked for many, many decades.
We know that the NHS has to make difficult decisions at the moment – it is the right choice to invest in mental health because the sooner people who are struggling get the help they need, the more likely it is that they will avoid needing more intensive and expensive support further down the line.
The Nuffield Trust has also raised concerns about the extent to which waiting lists will grow next year.
Prof John Appleby, the thinktank’s chief economist, said:
It is clear from today’s board meeting that the big question emerging from last week’s budget is how far waiting lists for routine operations like hip and knee replacements are allowed to grow in order to preserve and improve other services like A&E and cancer care.
With the NHS under severe financial pressure – and, as NHS England acknowledges, already spending money it doesn’t have to keep the show on the road – today’s meeting puts down a clear marker that something will have to give. As we and the other health think tanks have warned, the budget settlement fills around just half of the funding gap for next year.
Photograph: Robert Stainforth / Alamy/Alamy
Waiting time standards 'won't be met'
Lots of responses are coming in to the plans for 2018/19. The Lib Dems have homed in on page four of the board paper, which says:
NHS constitution waiting times standards, in the round, will not be fully funded and met next year.
Additionally, on page four, it says:
Factoring in England’s growing and ageing patient population, age-weighted NHS revenue growth per person becomes 0.9% in 2018/19 and -0.4% in 2019/20.
The Lib Dems’ former health minister, Norman Lamb, said:
This is the inevitable consequence of the government’s continued underfunding of our NHS.
Patients will suffer longer waiting times for routine operations, while progress towards improving mental health care risks being reversed.
The public very clearly wants to see more investment in the NHS as a national priority.
The Liberal Democrats have set out a clear plan to raise £6bn for the NHS and care by putting a penny on income tax.
We need to be honest with the British people that securing the best possible standards of care will mean all chipping in a little more.
Heart surgery units saved
The board have voted that, subject to certain conditions, heart surgery units at the Royal Brompton, London, and in Leicester and Newcastle will not close as was previously mooted.
A unit at Manchester University NHS Foundation Trust will stop offering specialist surgery and care for congenital heart disease patients but the services previously offered there will be consolidated in Liverpool instead.
Keogh has now excused himself from the discussion because he when he leaves the board at the end of this year he is to be chairman of Birmingham women’s and children’s NHS Foundation Trust.
Four trusts have been identified as not meeting acceptable standards for level 1 services, i.e. providing specialist surgery and care for congenital heart disease patients, the board hears:
- Manchester University NHS Foundation Trust (formerly Central Manchester NHS Foundation Trust)
- University Hospitals Of Leicester NHS Trust
- Royal Brompton & Harefield NHS Foundation Trust
- Newcastle upon Tyne Hospitals NHS Foundation Trust.
All of these level one centres had previously earmarked for closure but the new recommendation is that only Manchester, which only has one surgeon, should do so, with services, in that case, consolidated in Liverpool.
Leicester was said to have presented a “a convincing plan for meeting the co-location standards”, Royal Brompton & Harefield was said to have presented an ambitious plan to collaborate with Guy’s and St Thomas’ and services at Newcastle will also be kept open until at least 2021.
This is the reaction from Leicester West MP, Liz Kendall:
Fantastic news!!! @NHSEngland decides to keep children’s heart surgery at Glenfield. Huge thanks to all the staff, patients & families, campaigners & MPs who’ve supported our campaign. We couldn’t have done it without you!
— Liz Kendall (@leicesterliz) November 30, 2017
They are onto agenda item six now: “Congenital Heart Disease Services for Adults and Children: Future Commissioning Arrangements.”
Medical director Bruce Keogh is giving some context, namely the deaths in the 1990s of babies at the Bristol Royal Infirmary, whose heart surgeons were not as skilled as others elsewhere.
Referring to the 2001 Kennedy review into the tragedy, he says one of the recommendations was to rationalise services to safeguard standards.
He says:
We are reaching crunch time, this has been going on since 2001, we need a decision... The uncertainty that has surrounded the past 17 years has been highly counterproductive for people working in this speciality.
This is what the shadow health secretary thinks of the discussion on planning for next year (Jeremy Hunt is giving a speech at the King’s Fund health charity this afternoon):
NHS bosses just effectively conceded 18 week target won’t be met because of Tory underfunding. But this breaches the legal duty in NHS constitution. At Kings Fund later Jeremy Hunt must tell us if he now intends to legislate to amend NHS constitution
— Jonathan Ashworth (@JonAshworth) November 30, 2017
Sir Malcolm Grant CBE, @NHSEngland Chairman, continuing discussions around budget related planning matters. The #NHSEnglandBoard meeting can be viewed live via: https://t.co/fFWiXjLYsP pic.twitter.com/4cEFSEjeh9
— NHS England (@NHSEngland) November 30, 2017
Medical director Bruce Keogh makes clear that the guidance on “items which should not be routinely prescribed in primary care” is just that, i.e. it is not a ban but about “judicious” prescribing.
A consultation between July and October received more than 5,000 responses online and more than 200 through the post.
Keogh says the guidance, previewed earlier this year, remains largely unchanged.
He says there was no evidence to support the prescribing of homeopathic remedies on the NHS.
They have identified 26 conditions where over the counter medicine is sufficient, says Keogh.
Non-exec director Lord Victor Adebowale CBE asks “how we will monitor for unintended consequences?”
Keogh says they will consider that.
The recommendations are passed.
Treatments to b cut off routine prescriptions list in full attached: inc. homeopathy, herbal treatments, fish oils, co-proxamol #NHSBoardMeeting pic.twitter.com/PeI8BIRO82
— James Illman (@Jamesillman) November 30, 2017
Updated
Dame Moira Gibb, another non-executive director, says the public must understand that not everything can be done, staff can’t be continually pushed to do more and more.
Her view is echoed by NHS England chair Prof Sir Malcolm Grant, who says:
We should not set out blindly imagining that our staff can do everything.
He says chief executive Simon Stevens needs to carry out a “rigorous process” reflecting the discussion.
We have to find an accommodation of all of these conflicts ...to ensure that when we enter the financial year 2018/19, we are confident of our ability to deliver.
That is the end of that agenda item and there was not the detail that many anticipated after the post-budget warnings. There was detail of the services to be prioritised but no flesh on the bones about those that will be cut.
Next up is “Items which should not be routinely prescribed in primary care”, which should reach concrete conclusions.
Non-exec director Lord Victor Adebowale CBE refers to the amount allocated in the budget as a “tough settlement” and seeks extra reassurance from chief executive Simon Stevens that mental health will be protected, as he suggested it should be, given that historically it has been underfunded.
Another non-exec director Prof John Burn says it’s “enlightened self-interest” to put money into mental health and primary care.
Simon Stevens, @NHSEngland Chief Executive, at today's #NHSEnglandBoard meeting, discussing budget related planning matters. The meeting can be viewed live via: https://t.co/fFWiXjLYsP pic.twitter.com/L17xnCguu7
— NHS England (@NHSEngland) November 30, 2017
We’d like to hear from NHS staff about how you have been affected by cuts. How has funding helped in the past and what will the proposed changes mean?
You can share your views and experiences with our journalists by filling in our encrypted form here. Your responses are secure as the form is encrypted and only the Guardian has access to your contributions. We will do our best to keep you anonymous.
Your stories will help our journalists have a more complete picture of these events and we will use some of them in our reporting.
Stevens is asked about how the public and patients will be involved in discussions.
He says patient groups have already been engaged when coming up with priorities over the next two years. Healthwatch is also being engaged.
There will be public consultation by NHS England as well as a formal public consultation ultimately by the Department of Health, he adds.
Matthew Swindells, national director – operations and information, says:
There are going to be some really difficult decisions that we need to make.
Chief executive Simon Stevens said the recommendation is to uphold the planned investment in mental health, cancer care and primary care next year.
He says the working principle is to be as “stretching but realistic” about what can be achieved in other areas so that frontline staff already under pressure are not overwhelmed.
We have until March 31st to get this combination of judgements right.
Paul Baumann, NHS England’s chief financial officer, says the assessment is the budget settlement won’t enable the health service to deliver all the expectations place upon it while still living within its means.
Heres a page from #NHSEnglandBoard paper on 2018/19 planning - word 'realistic' appears a lot . 'NHS won't b able to deliver (what is expected) within the Budget settlement, NHSE finance chief confirms pic.twitter.com/Om169DLKvV
— James Illman (@Jamesillman) November 30, 2017
Before chief executive Simon Stevens begins on agenda item four, the big issue of “planning for 2018/19 in light of budget”, chair Prof Sir Malcolm Grant says the duty of NHS England leaders is stewardship, “to use scarce resources to obtain best benefits for patients”. He adds:
We are not a political entity, we are not politically aligned.
Grant says there will always be “difficult choices”. He highlights the “extraordinary productivity of the NHS”. He says there is a rolling productivity increase per year of 1.7%, which he says is well above the economy as a whole.
This is significant because the NHS is continually being put under pressure to make productivity increases to save money.
They discuss preparedness for winter.
Chief executive Simon Steven says there is “an enormous mobilisation going on across the NHS” for winter. He says NHS England was fortunate to receive an extra £350m for winter in the budget.
Addressing the public, he says there is still time to get your flu jab and says uptake is higher than last year.
Bruce Keogh, NHS England medical director, says “with a following wind” he hopes everything will go “okay” but cautions that events are unpredictable.
The meeting is just starting now. You can watch the livestream at this link.
NHS England chair Prof Sir Malcolm Grant is explaining the format of the meeting, including that there will be a section held in private later.
He says 1,000 papers have come into the board for the meeting.
The shadow health secretary, Jonathan Ashworth, has tweeted about the meeting this morning with foreboding:
Tory health cuts & underfunding of NHS continues, the per capita promise broken, waiting lists at 4 million & 18 week target abandoned. Will we today learn of further rationing and dropping of patient standards ?https://t.co/wZgXi4Oosf
— Jonathan Ashworth (@JonAshworth) November 30, 2017
National Voices, an umbrella group of more than 100 health and social care charities, has already warned the NHS against making decisions it feels lie outside its remit.
In an open letter to Simon Stevens, published on Friday, the coalition’s chief executive, Jeremy Taylor, wrote:
On the one hand, we recognise that NHS England and local commissioners will have to make some very difficult budgeting decisions. On the other hand, NHS England and local commissioners arguably have no mandate to make significant reductions to the NHS offer. This is properly a matter for ministers and Parliament. No political party proposed such reductions in their general election manifesto and nobody voted for such.
Ahead of the meeting, NHS Confederation, which represents organisations across the healthcare system, has published results of a poll of its members, which shows the level of pessimism among them.
It received 107 responses from health leaders to the question: “How much of a difference will today’s Budget make to your organisation’s ability to give good care?”
Just 3% answered “big improvement”, half (50%) said “small improvement” and 47% responded “no improvement”.
NHS Confederation chief executive Niall Dickson said:
The fact that nearly every senior leader in the NHS felt that the budget will make little or no difference says it all. We gathered together the largest coalition of doctors, patients, carers, voluntary groups as well as our NHS organisations and social care partners to plead with the chancellor to take a bold step – no such step was taken.
History tells us that the NHS needs around 4% a year above inflation just to keep up with demographic and technological demand. Today we are facing major challenges in both of these areas.
The government is now planning around 1.4% on the NHS in England, with a promise to meet any additional cost pressures caused by lifting the pay cap for nursing and other support staff.
“Health ministers and NHS England officials also did their best to make the case to the Treasury but with limited success. The lack of adequate funding for both health and social care remains one of the great social issues of this time – and patients and those who rely on social care are suffering every day as a result.
We cannot go on staggering from year to year. We need a grown up and honest debate about the long-term funding needs of both the NHS and social care.
Here is some background on some of the key figures likely to be prominent at the meeting.
NHS England chief executive Simon Stevens. An expert at putting his wishes for the health service with diplomatic subtlety, Stevens, who has been in the job for three-and-a-half-years, has radically changed course. His public warnings this year of the danger of underfunding, including if his request for £4bn extra in 2018-19 was not met, have put him on a collision course with Jeremy Hunt and Theresa May after years of treading on eggshells.
My colleague, Denis Campbell, wrote:
He has upped the ante by giving May a choice: fund the NHS properly – as independent bodies such as the Office for Budget Responsibility, Institute for Fiscal Studies and the National Audit Office would define it – or risk it visibly deteriorating as plans to improve cancer and mental health care (a subject close to May’s heart) are halted, more patients are forced to wait longer for operations in hospital, and GPs, hospitals and community services end up “retrenching and retreating”.
NHS England chair Prof Sir Malcolm Grant. While it was Stevens who made the demand for £4bn and warned of the consequences if it was not fulfilled, it was Grant who subsequently said that it would lead to “difficult debate about what it is possible to deliver for patients with the money available”. This has led Health Service Journal’s bureau chief Dave West to suggest (£) it is “a sign, that, with the mud already flying in Mr Stevens’ direction, more of the noise will be made by Sir Malcolm in the run up to his term on the board ending next autumn”.
NHS England medical director Bruce Keogh. After announcing that he will stand down at the end of this year, after 10 years in the role, Keogh may feel he has little to lose from speaking out. After the budget, he tweeted:
Personal view...Budget plugs some, but def not all, of NHS funding gap. Will force a debate about what the public can and can’t expect from the NHS. Worrying that longer waits seem likely/unavoidable.#NHS
— Bruce Keogh (@DrBruceKeogh) November 22, 2017
Agenda
The meeting, which is being held at NHS England’s HQ in Elephant Castle, south London, is scheduled to begin at 10.45am.
The most interesting agenda items are:
4. Planning for 2018/19 in light of the Budget
This is where we can expect to hear the debate about increased rationing and longer waiting times for treatment
5. Items which should not be routinely prescribed in primary care: findings of consultation and next steps.
There was a preview of this earlier this year when the NHSE chief executive, Simon Stevens, detailed plans to stop giving patients travel vaccinations, gluten-free foods and some drugs that can be bought over the counter. He said GPs would be told to not prescribe medications such as those for upset stomachs, travel sickness and haemorrhoids in the drive to eliminate waste.
6. Congenital Heart Disease Services for Adults and Children: Future Commissioning Arrangements
This relates to NHS England’s controversial plans to close heart surgery units. Those previoulsy earmarke for closure are children’s units at the Royal Brompton in London and Glenfield hospital in Leicester, and a unit at Central Manchester - which has just one surgeon for congenital heart defects - which treats adults and children. There has been a long running debate over which should close and the Royal Brompton and Glenfield have defied the plans, campaigning fiercely to stay open
A critical meeting of NHS leaders is taking place today at which they will decide their response to the £1.6bn granted to the health service in England for 2018-19 in last week’s budget - less than half the £4bn minimum chief executive Simon Stevens said was needed.
On 8 November, Stevens warned that without the requested extra funding, cancer and mental health care could deteriorate and the waiting list for hospital operations could hit 5 million.
After the budget, NHS England released a statement by its chair, Sir Malcolm Grant, indicating that the settlement given to the health service meant that this board meeting would take on added significance, suggesting it would spell out what the what the NHS can no longer do - or afford to do - in the light of the £2.4bn funding gap.
Grant said:
The extra money the chancellor has found for the NHS is welcome and will go some way towards filling the widely accepted funding gap. However, we can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available. The NHS England board will need to lead this discussion when we meet on November.
We will be providing live updates from the crucial meeting.
