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The Guardian - UK
The Guardian - UK
Politics
Andrew Sparrow

NHS England chief says May 'stretching it' to say NHS getting more extra money than it asked for - politics live

Simon Stevens, NHS England chief executive.
Simon Stevens, NHS England chief executive. Photograph: Parliament TV

Afternoon summary

  • Simon Stevens, the NHS England chief executive, has undermined Theresa May’s claim to be funding health properly by flatly contradicting her assertion that the service has been given all the money it wants. He made the point during an assertive appearance before the Commons public accounts committee during which he also disagreed openly with Chris Wormald, permanent secretary at the Department of Health. Wormald said spending on health in the UK was in line with the OECD average. Stevens said that that was misleading because the OECD figures included countries like Mexico, that the UK spent less than on health than comparable advanced nations, and that it spent 30% less on health per head than Germany. May has repeatedly said that the NHS was given more than Stevens requested when he set out his five-year plan. But Stevens denied this. He told the MPs:

Like probably every part of the public service we got less than we asked for in that process. So I think it would be stretching it to say the NHS has got more than it asked for ... There are clearly very substantial pressures, and I don’t think it helps anybody to try and pretend that there aren’t.

Stevens, a former Labour councillor and a health adviser to Tony Blair who was appointed to run NHS England by David Cameron, was not asked about a Times story claiming that No 10 aides think his unenthusiastic approach is contributing to problems in the NHS. (See 9.21am.) But his evidence, which also saw him demanding a more robust government response to the social care crisis, was interpreted as him fighting back. (See 4.35pm.)

  • Jeremy Hunt, the health secretary, has claimed that Labour’s proposals to scrap corporation tax cuts to release more money for health are “mortally dangerous” to the NHS. Speaking in a Commons debate on the NHS called by Labour he said:

This reveals, I’m afraid, a fundamental misunderstanding about how you fund the NHS. Corporation taxes are being cut so that we can boost jobs and strengthen the economy so that we can fund the NHS. The reason we’ve been able to protect and increase funding in the NHS in the last six years, when the party opposite was not willing to do so, is precisely because we’ve created two million jobs and we’ve given this country the fastest growing economy in the G7 - and that is even more important post-Brexit.

So to risk that growth, which is what their proposal will do, would not just risk funding for the NHS - it’d be dangerous for the economy and mortally dangerous for the NHS.

That’s all from me for today.

Thanks for the comments.

Updated

Q: What effect would a hard Brexit have on the NHS?

Wormald says Brexit would raise issues for the DoH. But the issue does not dominate the department’s thinking.

There would be an impact on workforce, and impact on drug regulation and an impact on the mutal recognition of health costs.

But the government is not giving a running commentary, he says.

Stevens says about a quarter of NHS doctors are foreign nationals. The NHS has a slight advantage, in terms of having a relatively low proportion of hospital doctors over 55. But the NHS will continue to need to hire foreign staff.

Mackey says this year the NHS will deliver efficiency savings at just over 3%. He says 4% has been set as a target. He says he would like these targets to be lower. He says people did not expect the NHS to be able to achieve the efficiencies it has managed this year. But it will not be possible to go on like this forever, he says.

The Times story this morning said Downing Street aides complain that Simon Stevens is not “enthusiastic”. (See 9.21am.) The Times’s Chris Smyth says Stevens has been using his evidence this afternoon to hit back quite pointedly.

And this is from Jonathan Ashworth, the shadow health secretary.

Just hours after the prime minister stands up at PMQs commending her government’s funding of the NHS, the NHS England chief tells MPs that it would be stretching it to say that the NHS has got more money than it asked for.

Theresa May is in total denial about the crisis the Tories have created in the NHS.

The warnings from professionals and patients have flooded in, but Theresa May has just buried her head in the sand. At prime minister’s questions today she again refused Labour’s calls for extra funding, claiming that she’s given the NHS the money it needs. But her argument has now been blown out of the water by two top NHS chiefs who have starkly laid out the truth: the NHS is facing financial crisis under the Tories.

Enough is enough. Theresa May needs to come out of her bunker, admit she’s got it wrong and guarantee the funding the NHS needs.

Number 10 should listen to the experts like Simon Stevens and not be briefing against him.

The two NHS “chiefs” Ashworth is referring to are Chris Hopson (see 3.04pm) and Simon Stevens (see 3.15pm and 4.40pm.)

Norman Lamb, the Lib Dem health spokesman, has put out this response to Simon Stevens’ comments about the NHS not getting all the money it wanted. He said:

These worrying comments reinforce the case for a fresh approach to NHS funding.

The government must stop trying to shoot the messenger and admit that current levels of underfunding are not sustainable.

We urgently need serious cross-party discussions on how to fund the NHS and social care in the long-term, or standards will fall and patients will suffer.

Partisan politics has failed, and no one party can provide a solution to this crisis.

My genuine hope is that the prime minister’s acceptance of my request to meet [see 12.28pm] might be the start of a more rational approach, which could provide the NHS and social care with the resources they need to provide high-quality care for future generations.

Stevens is now talking about STP’s (sustainability and transformation plans).

Video of Stevens saying the NHS got less than it asked for from the government

Here is a video clip of Simon Stevens saying the NHS got less than it asked for.

Simon Stevens has been going for almost an hour and a half now, and he still has not been asked about today’s Times splash. (See 9.21am.)

But the Times story may explain Stevens’ tone. This is from Alastair McLellan, editor of the Health Service Journal.

Stevens says there are four beds in care home for every acute hospital bed.

So what happens in care homes affects hospital.

He says the problems in the care sector need to be stabilised “pretty quickly”.

Then the government needs to push health and social care integration over the next few years.

And, after 2020, the government needs a proper review of the way health and social care is funded.

ITV’s political editor Robert Peston reckons there is something remarkable about the NHS chief executive openly contradicting the DoH permanent secretary.

Caroline Flint, the Labour MP and a former health minister, goes next.

Q: Labour built health centres to improve what services GPs can offer. Why are these not being used?

Stevens says GPs’ views have changed. In the past, when “polyclinics” were proposed, GPs would run a mile.

He says, although the NHS is efficient, there are still more efficiencies that can be achieved.

This is from Huffington Post’s Paul Waugh.

And this is from the Times’ Patrick Kidd.

Wormald says total health spending is around the average for the OECD.

Stevens says he does not like to disagree with Wormald. The OECD includes countries like Mexico. If we look at countries we normally compare ourselves to, we are spending less than the average. We are spending 30% less per head than Germany, he says.

He produced a newspaper cutting from the Daily Mail saying Britain spends less than Europe on doctors, beds and scanners. He implies that is a tribute to the NHS’s efficiency.

UPDATE:

And this is from Health Service Journal’s Dave West commenting on Waugh’s tweet.

Updated

Steven says he is going to refresh his five-year NHS plan. He says the update will be produced by the end of March.

Labour says NHS chief's evidence 'blows apart' May's NHS spending claims

Here is Jonathan Ashworth, the shadow health secretary, commenting on Simon Stevens’s evidence.

Stevens says life expectancy is rising five hour a day.

Q: Why are hospitals busier now than before?

Mackey says some of it is to do with social care. Some of it is consumer led. There has also been a spike recently in people admitted with respiratory problems. Some of these are people who would not have been alive a few years ago, so some of this is increasing life expectancy, he says.

Anne Marie Morris, a Conservative, says people who turn up to A&E get treated for free. But if they turn up to a GP, they have to pay for prescriptions. Is that encouraging people to go to A&E?

Stevens says he will write to the committee about this point.

Meg Hillier goes back to the four-hour waiting time issue. She quotes from what Jeremy Hunt said on Monday. He talked about it applying to urgent cases.

Stevens says the government has committed to maintaining the target.

But clinic operating patterns have changed.

And the places you can go to get urgent care are expanding.

He says people think the target is to be seen within four hours. But the target is for people to be treated within four hours, or admitted to hospital.

As a result, some people get admitted to hospital after three hours and 59 minutes so the target gets met.

That is something that should be looked at, he says.

Kwasi Kwarteng, a Conservative, goes next.

Q: What can the government do to help?

Stevens says some of the things that the NHS is doing it would be doing even if it were awash with cash. People are living longer. So health services need to be reconfigured.

He says demand for health services depends on how healthy people are. And that is determined by things outside the health service. For example, smoking is going down. But child obesity is going up. And there are things the government can do to address that.

Second, the government could look at the way funding terms relating to retirees are directed.

This is from the Times’ Chris Smyth.

Updated

Q: Will targets be relaxed?

Mackey says targets will not be relaxed.

Jim Mackey, the NHS Improvement chief executive, says it is hard to manage risk when departments are crowded. The NHS is trying to address this.

It will look at whether there should be new standards, for example saying some patients need to be seen in two hours.

Meg Hillier, the Labour MP who chairs the committee, says Jeremy Hunt said on Monday that the four-hour A&E target was being dropped.

Wormald says Hunt did not say that. He says Hunt was making the point that we need a conversation about how and A&E is used.

Q: So the target is not being dropped?

No, says Wormald. It is staying.

Q: But it is being breached?

Wormald says it is extremely important. It is the toughest target of its kind in the world.

  • Chris Wormald, permanent secretary at the DoH, says the A&E target is staying.

Stevens says, given what the NHS needs to do, especially to support GPs, there will have to be capital investment.

The NHS has got some of that.

But there are many more schemes it could be funding than it is funding.

There is “an unmet need” for capital investment, he says.

Stevens says the five-year plan envisaged expanding capital investment.

But it is being cut by about £1bn a year, he says.

Stevens says there are “very real pressures” in the here and now.

Over the next three years there will be very real pressures.

And by the end of the decade health spending per person will have gone down, he says.

Here is more from Simon Stevens’ opening remarks.

Updated

Simon Stevens is giving evidence with Chris Wormald, permanent secretary of the Department of Health (DoH), David Williams, director general finance and group operations at the DoH and Jim Mackey, chief executive at NHS Improvement.

Wormald says the NHS got all that it asked for.

But this is a challenging time, he says.

Q: How confident are you you will balance the budget?

Wormald says he aims and expects to hit the budget.

Stevens says it would be 'stretching it' to say NHS got more than it asked for

The Simon Stevens hearing is starting now.

Q: Is the NHS getting more money than it asks for?

Simon Stevens says the NHS will get an extra £10bn over six years.

But the forward view was for five years.

He says it would be “stretching it’ to say the NHS has got more than it asked for.

(Theresa May has said that the NHS asked for £8bn from government and that it has been given £10bn.)

The NHS is facing “substantial pressures”, he says.

The NHS was fortunate to get front-loaded increases, he says.

But he says there are “genuine choices” to be made.

Updated

And here is a chart from the NAO report showing the growing gap between NHS trusts spending and income.

Chart showing NHS trusts income and spending.
Chart showing NHS trusts income and spending. Photograph: NAO

Here is a summary of the National Audit Office report, Financial sustainability of the NHS, that this committee inquiry is based on.

And this is what Amyas Morse, head of the NAO, said when the report was published.

With more than two-thirds of trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups unable to keep their spending within budget, we repeat our view that financial problems are endemic and this is not sustainable. It is fair to say aggressive efficiency targets have helped to swell the ranks of trusts in deficit over the last few years. The Department, NHS England and NHS Improvement have put considerable effort and funding toward stabilising the system, but have a way to go to demonstrate that they have balanced resources and achieved stability as a result of this effort. Therefore, value for money from these collective actions has not yet been demonstrated.

NHS England chief executive Simon Stevens questioned by MPs

The Commons public accounts committee is holding a hearing as part of its inquiry into the financial stability of the NHS this afternoon, and Simon Stevens, chief executive of NHS England is due to give evidence after 3pm.

Here is a briefing from the committee about the inquiry.

And here is an extract.

The financial performance of NHS bodies worsened considerably in 2015–16 and this trend is not sustainable, according to the National Audit Office.

In 2015–16, NHS commissioners, NHS trusts and NHS foundation trusts reported a combined deficit of £1.85 billion, a greater than three-fold increase in the deficit position of £574 million reported in 2014–15. Provider trusts’ overall deficit grew by 185% to £2.45 billion, up from £859 million in 2014–15, against total income of £75.97 billion. In addition, two-thirds of NHS trusts (65%) and NHS foundation trusts (66%) reported deficits in 2015-16, up from 44% of NHS trusts and 51% of NHS foundation trusts in the previous financial year. The number of clinical commissioning groups reporting cumulative deficits was 32 in 2015–16, up from 19 in both 2014–15 and 2013–14.

Chris Hopson, chief executive of NHS Providers, is giving evidence to the committee at the moment. He told MPs that he does not think the NHS has got all the money it needs.

Updated

Mark Carney, the governor of the Bank of England, is currently giving evidence to the Commons Treasury committee. He has said that Brexi is no longer the most significant domestic risk to economic stability.

My colleague Nick Fletcher is covering it on the business live blog.

Lunchtime summary

  • May has said the crisis in Northern Ireland will not delay the triggering of article 50. (See 12.52pm.)
  • A hard Brexit could cause the “biggest disaster” in higher education for many years, academics have warned. As the Press Association reports, applications from across the European Union have already dropped by 14% at Cambridge University for undergraduate courses, MPs were told. Hostility towards immigrants, devaluation of the pound and uncertainty over research projects have also deterred postgraduates from heading to the UK, the education select committee was told. Quitting the EU provides opportunities to improve research funding and international collaboration but a so-called hard Brexit would be damaging for the sector, academics said. Alistair Fitt, vice-chancellor of Oxford Brookes University, said: “It would probably be the biggest disaster for the universities sector in many years.”
  • Theresa May has been urged to stop the Green Investment Bank being “killed off” by a sale to private firm Macquarie, amid fears the assets will be stripped and its environmental purpose abandoned. As Rowena Mason reports, MPs from across the parties raised concerns about the proposed sale in the House of Commons, after Caroline Lucas, co-leader of the Green party, called a debate arguing the whole process should be stopped. Nick Hurd, an energy minister, refused even to confirm that Macquarie is the preferred bidder, citing commercial sensitivity.But Lucas launched into an attack on the Australian investment bank, saying it had a “very, very worrying and dubious track record”. She said:

This preferred bidder, Macquarie, not only has a dismal and terrible environmental record, it also has an appalling track record of asset stripping. So why has the government given preferred bidder status to this company?

PMQs - Verdict from the Twitter commentariat

This is what political journalists and commentators are saying about PMQs on Twitter.

Most seem to think Jeremy Corbyn won.

From ITV’s Robert Peston

From Newsnight’s Emily Maitlis

From the Spectator’s James Forsyth

From the Financial Times’ Sebastian Payne

From the New Statesman’s Stephen Bush

From the Telegraph’s Christopher Hope

From the New Statesman’s George Eaton

From the Daily Mirror’s Jason Beattie

From the Guardian’s Anushka Asthana

From the BBC’s Norman Smith

From the BBC’s Laura Kuenssberg

From the Times’ Matt Chorley

From the Guardian’s Rafael Behr

From the Independent’s John Rentoul

From the BBC’s Vicki Young

From ITV’s Chris Ship

From the Times’ Patrick Kidd

From PoliticsHome’s Kevin Schofield

From Sky’s Robert Nisbet

From Sky’s Beth Rigby

PMQs - Verdict

PMQs - Verdict: One of the challenges of leadership is not just doing the right thing but being seen to do the right thing. Taking charge, getting on the front foot, seizing the initiative. Not just leading, but showing leadership. And that was Theresa May’s main problem today. She could respond to Jeremy Corbyn’s questions about the NHS with a measure of authority, but she did not sound like someone engaging with the scale of the problems afflicting the NHS or with much idea about what to do about them. Corbyn won comfortably.

Perhaps she thinks the whole thing is just routine winter difficulties whose seriousness has been exaggerated by a politically-motivated opposition, publicity-seeking charities and the sensationalist press (like that well-known leftist organ, the Sun). Even if May did take this view, she should have something more to say. But all the evidence points to the NHS and the care system facing a structural crisis, not just a seasonal one, and May came across as complacent.

This was exemplified by this answer, in response to a question from Corbyn about a particular NHS horror story. She replied:

I accept there have been a small number of incidents where unacceptable practices have taken place but what matters - we don’t want those things to happen - is how you then deal with them.

She may come to regret that phrase “small number of incidents”.

I have not done a count, but Corbyn now seems to have won most of the encounters he has had with May since the autumn of last year. They are not flashy, knock-out victories, but he is asking solid questions and exposing May’s weaknesses. Before Corbyn became party leader many people assumed that PMQs would be the one area where his deficiencies would be most exposed. But, surprisingly, PMQs is now becoming one of the arenas in which his leadership is at its most assured.

Updated

As usual, I missed the questions from Angus Robertson, the SNP’s leader at Westminster, because I was writing up the snap verdict. Here’s a catch-up.

Robertson asked about the crisis in Northern Ireland.

Will the prime minister tell us what the consequences will be if no agreement can be found?

May said the government was trying to strike a deal.

We are treating this with the utmost seriousness. The Northern Ireland secretary is urging all parties to work together to find a way further, I myself have also spoken to the Taoiseach about this issue so we are putting every effort into this. If within seven days we don’t have nomination for a deputy first minister the matter would go to an election.

Robertson then argued that, if Northern Ireland does not have an executive, May would not be able to fulfil her promise to consult it about Brexit. And he asked if May would be willing to postpone triggering article 50.

It stands to reason that she’ll be unable to properly consult, to fully discuss and find agreement on the complex issues in this time period. In these circumstances, will the prime minister postpone invoking article 50, or will she just plough on regardless?

May ruled out delaying article 50.

It’s about ensuring, as he says, we want to ensure we do hear the views from all parts of the UK, that’s why we have established the joint ministerial committee European committee to take the view and the JMC plenary.

First of all we want to try to ensure that within this period of seven days we can find a resolution to the political situation in Northern Ireland, but I’m also clear that in the discussions we have it will be possible - it is still the case that ministers are in place and executives are in place - that we are still able to take the views of the people of Northern Ireland.

I’ve taken the quotes from PoliticsHome.

My colleague Anushka Asthana, the Guardian’s joint political editor, will shortly be discussing PMQs in a video on the Guardian’s Facebook page where she will also be taking questions from readers/viewers.

Nicky Morgan, a Conservative, asks about a constituent battling cancer. Her tax credits have been stopped, she says. Can May get the Treasury to look at this?

May says she is sorry to hear about this. She says a Treasury minister will look at this case.

And that’s it. PMQs is over.

(That was quite short by John Bercow’s standards. It over-ran by less then 10 minutes.)

The DUP’s Gavin Robinson asks May that nothing can be or should be gained from threatening the peace process in Northern Ireland.

May says the progress made in Northern Ireland has been hard won. That is why it is important to get a return to the power-sharing institutions.

Labour’s John Woodcock says 24-hour access to A&E and maternity services risk being lost in Copeland (where there is a byelection). Expectant mums face a 40-mile journey on roads that could be blocked.

May says she understands the problems in Cumbria. A lasting plan is being developed for high quality services. She says final decisions about the unit at West Cumbria hospital have not yet been taken.

The SNP’s Alan Brown asks why Steve Webb has been given a knighthood given his role in the raising of the state pension age for women, which has led to waspi (women against state pension inequality) losing out.

May sidesteps the knighthood point, but defends the government’s record on pensions.

James Davies, a Conservative, asks if May will support a plan to invest in rail infrastructure in north Wales.

May says this plan sets out an ambitious programme. The department for transport will work on this.

The SNP’s Joanna Cherry says many banks are closing local branches, with adverse effects on the elderly. Convenience stores are taking up the strain. Will May meet her to discuss how banking can service the community?

May says there are many ways people can access bank services. But she will look at this, she says.

Edward Argar, a Conservative, says nothing can be more distressing for a parent than having a child murdered. He says two families are setting up a campaign for better treatment of victims’ families after an acquital.

May pays tribute to the campaigners. She says she is committed to ensure the voices of victims are heard. Amber Rudd, the home secretary, is taking this forward, she says.

The Lib Dem MP Norman Lamb says there genuine concerns about the NHS. That is why MPs from all parties are calling for an NHS and care convention. Would May meet with them to hear their case?

May says she would be happy to have that meeting.

Richard Fuller, a Conservative, asks about the Bedford community business school. Will May ensure her industrial strategy takes account of small business.

May says it will be looking to the economy of the future. Crucial to that is the growth generated by entrepreneurs.

PMQs - Snap verdict

PMQs - Snap verdict: Corbyn had the best of that exchange, May finished strongly, but her jibe about Labour making multiple pledges based on corporation tax savings could not really dispel the impression that she had little or nothing to say about a crisis that goes well beyond routine opposition shroud-waving. The NHS is traditionally a good subject for Labour but Corbyn was passionate and focused, he responded particularly well to May’s point about mental health and he sounded credible and convincing. May had her moments - her British Red Cross put-down will probably resonate with many - but generally she gave the impression of being a politician on the defensive, not someone taking charge.

Updated

Corbyn says no one wants mental health patients to go to A&E. But people are desperate. And social care is not being properly funded. So will the government do what Labour is demanding and bring forward social care spending. (See 10.47am.)

May says Corbyn asked about this before Christmas. He may find it strange that people say the same as they did a few weeks ago. Half of delayed discharges are in just a few areas. That shows that this is about best practice.

Corbyn says he will continue to do this because May has not addressed the budget. The government has cut the social care budget. May said she wanted a shared society. She has got that. More people sharing hospital corridors on trolleys, and more people sharing A&E departments. May is in denial. The NHS is in crisis. He says she should cancel corporation tax cuts.

May quotes from a Labour MP saying the opposition has to be more grown up. She says Labour has already spent the corporation tax cut revenue Corbyn mentioned already eight times. Yesterday Corbyn indicated that he was incompetent. If he was in charge, the economy would suffer, she says.

Corbyn says May seems to be in denial. She won’t listen to experts. So will she listen to Sian, who works in the NHS. He quotes from an account from Sian about a child not getting proper help.

May says there have been a small number of incidents where unacceptable things took place. The NHS must learn lessons from them. She says we should be grateful for NHS professionals. The Tuesday after Christmas was the busiest day ever in the NHS. And more people are being treated by A&E than ever before.

Corbyn says we all praise the NHS. But the government is planning to cut a third of beds. The BBC revealed last night there has been an 89% increase in people with mental health issues going to A&E. So shouldn’t mental health spending by ring-fenced.

May says in her speech on Monday she said there was more that could be done. But this is about appropriate care. When she was in Aldershot on Monday, she spoke to patients who said they did not want to go to A&E. In that areas A&E admissions have stabilised because of good practice.

Jeremy Corbyn wishes MPs and members of staff a happy new year. He pays tribute to a 22-year-old soldier who died in a non-combat incident in Iraq. And he sends condolences to the family of the seven-year-old killed in York.

He says the Red Cross has described the NHS as being in a humanitarian crisis. Does May agree with Jeremy Hunt about wanting to fiddle the A&E waiting time figures.

May also pays tribute to the solider who died in Iraq. He was a fine young man. And she expresses condolences to the family of the girl who died.

There are always pressures on the NHS in winter, she says. And we have added pressures because of the ageing population. We have all seen humanitarian crises, she says. To use that description was “irresponsible and overblown”.

Corbyn says 1.8m people had to wait longer than four hours in A&E departments last year. The Royal College of Medicine said problems were reaching a dangerous level. Other royal colleges said similar things. If May won’t listen to the Red Cross, who will she listen to?

May says more people are being treated every day. But it is not just a question of targets. It is a matter of making sure people are provided with appropriate care.

Mark Menzies, a Conservative, asks if May backs the construction of a new nuclear power station in the north east.

May says she does support new nuclear, especially as we move to a low carbon society. She welcomes the plan for a new nuclear power station in Cumbria.

Chris Law, the SNP MP, says it has been six months since the EU referendum. The Scottish government is the only administration to have published a Brexit plan. Has Theresa May read it?

May says she will set out more details of the government’s plans in a few weeks. The SNP wants to leave the UK, and therefore leave the EU, she says.

Here is the list of MPs down to ask a question.

PMQs

PMQs will start in about 10 minutes. It is the first PMQs of 2017.

This is from the BBC’s Laura Kuenssberg.

And this is from Huffington Post’s Paul Waugh.

Sarah Wollaston, the Conservative MP who chairs the Commons health committee, has used Twitter to defend Simon Stevens in the light of today’s Times story.

With Simon Stevens, the NHS England chief executive, giving evidence to the Commons public accounts committee later, it is worth flagging up what David Laws, the Lib Dem former education minister, said about the claim that the government is fully funding Stevens’s five-year plan for the NHS in his book, Coalition. This is from my colleague Denis Campbell’s story about Laws’ claim.

In his new book about the coalition, Laws claims that Stevens made clear to Downing Street his view that the NHS needed an extra £15bn or £16bn over that period in order to keep running smoothly while also transforming how it cares for patients.

However, Laws writes, in extracts serialised in the Mail on Sunday: “No 10’s reaction was: ‘You’ve got to be joking.’ Stevens was told there was no way the PM and chancellor would sign up to an ‘impossible and excessive’ commitment this size. He was told: ‘Get it down to a more deliverable sum.’”

The Five Year Forward View – Stevens’s blueprint to reshape the NHS and close the £30bn gap in its funding expected to have emerged by 2020-21 – was published in October 2014. Stevens indicated that the service could cope with an £8bn rise and would find £22bn of efficiency savings. Laws claims that was because Downing Street had made clear to him that any more than £8bn would be unacceptable to them.

It is an open secret at NHS England that its leadership – Stevens and other key figures, including the chairman, Prof Sir Malcolm Grant, and the medical director,Prof Sir Bruce Keogh – think the £8bn is far too little and that the £22bn savings target is unachievable.

Frank Field calls for 1% increase in national insurance payments to help fund NHS

The Labour MP Frank Field has put out a statement explaining why he is one of the 20 MPs from all the main parties who has signed a letter calling for an NHS and care convention. Here is an extract from the release.

Frank has this week been contacted by an A&E nurse who describes herself as ‘broken’. The nurse has reported to Frank that up to five ambulances at a time are queuing each night to offload their patients, as the A&E unit is full to capacity. In addition, nurses are themselves sustaining injuries due to the shortage of staff available to move beds and heavy equipment.

The nurse told Frank that, ‘I am desperate. I love nursing but dread going into work every day and night as every day is the same. I have actually cried this week before going in, worrying about what I’m going into.

‘I have been screamed at, had people yelling at me in my face wanting answers and solutions I can’t give as I’m only a nurse. I worry for my patients, I worry for their families, I worry for my colleagues.

‘The only saving grace in this is I’m part of one of the most committed team-spirited and fantastic [group of] people I have ever met. I’m proud to be part of this team but I’m not sure how long we can continue to work like this.’

Field is proposing an immediate 1p increase in national insurance contributions to help fund the NHS, as the first move towards a new National Health and Social Care Service, funded in full by a reformed national insurance system. He said:

The funding of the NHS is currently built upon extremely shaky foundations. The impact of this inadequate funding on patient care and staff morale is becoming increasingly clear. I therefore believe that the government should immediately begin weighing up options for an increase health and social care budgets, before taking steps to merge the two services into a combined, adequately funded National Health and Social Care Service.

By 1p Field means 1p per pound, obviously. The main national insurance rate for employees is 12%. Field’s plan would take it up to 13%. He would also increase the national insurance paid by employers by the same amount, taking it up from 13.8% (the main rate) to 14.8%.

Frank Field.
Frank Field. Photograph: Frank Baron for the Guardian

Guardian Health Network have published a good article written anonymously by an NHS trust chair. Here is the full piece.

And here is an extract.

I think describing the current situation as “a humanitarian crisis” is a bit over the top. The bigger question is that the demands of targets on individual trusts are probably – choosing my words carefully – leading to gaming. Equally we are all meant to have abandoned all elective surgery but there are strong suspicions that certain trusts are not following this; still doing certain surgery because they make so much money.

What we are seeing is a breakdown in the trust and cooperation between different parts of the NHS. So we have seen mental health almost withdrawing from the sustainability and transformation plan process. We have major acute hospitals trying to protect their pre-eminent position by being too important/big to work with others. We have clinical commissioning groups in denial about their total absence of any long-term future. We have NHS England shouting down the phone at hard-pressed managers. We have NHS Improvement texting chief executives on Saturday afternoons checking that they are on top of the situation and expecting them to be at work.

Not one of these actions is going to help a hard-pressed consultant with targets – or more critically the patient. Worse than that, the pressure from above is largely political because government ministers and MPs cannot accept the reality of the general slide to a service that doesn’t meet what the public expect.

Labour urges No 10 to stop blaming NHS chief Simon Stevens

Jonathan Ashworth, the shadow health secretary, was on Sky’s All Out Politics a few minutes ago talking about the NHS. Here are the key points.

  • Ashworth criticised Downing Street for reportedly blaming the NHS England chief executive Simon Stevens for conditions in the health service. Ashworth said:

I think it is really, really unfair blaming Simon Stevens, who’s a civil servant who runs the NHS. The buck stops with Theresa May and Jeremy Hunt. On Monday Jeremy Hunt appeared to be blaming the public for turning up at A&E. Today they appear to be blaming this poor guy Simon Stevens. No doubt tomorrow they will be blaming the weather. They’ve got to take responsibility.

  • Ashworth re-iterated Labour’s call for the NHS and social care to get more funding. This is the main demand in the Labour motion that MPs will vote on this afternoon. It says:

That this House supports NHS England’s four-hour standard, which sets out that a minimum of 95 per cent of all patients to A&E will be treated within four hours; notes the widespread public and medical professional support for this standard; further notes that £4.6bn has been cut from the social care budget since 2010 and that NHS funding will fall per head of population in 2018-19 and 2019-20; and calls on the government to bring forward extra funding now for social care to help hospitals cope this winter, and to pledge a new improved funding settlement for the NHS and social care in the March 2017 budget.

Asked how much extra money Labour wanted to spend on the NHS and social care, Ashworth said Labour wanted the £700m extra supposed to be allocated to social care in 2019 to be brought forward. On NHS spending generally, he did not put a figure on how much extra the NHS would get under Labour but he said it was wrong for the government to be cutting corporation tax and inheritance tax when it could be putting this money into health.

I’m not a clinician so I think people should listen to whatever the clinical advice is to them when they ring 111 ... I don’t think it is appropriate for me as a politician to advise people on medical matters.

Leave out from ‘House’ in line 1 to end and add ‘commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the government’s support for the Five Year Forward View, the NHS’s own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17m people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.’.

  • He said he would be challenging Jeremy Hunt to say what he would do to help hospitals cope if there is a severe cold weather snap.
Jonathan Ashworth.
Jonathan Ashworth. Photograph: Sky News

Updated

Here’s Tim Farron, the Lib Dem leader, commenting on the Times’ story.

It is blame the expert time again from the Conservatives. Simon Stevens has heroically kept the NHS afloat, despite its scandalous lack of funding.

The government is getting slaughtered by MPs of all parties for the NHS crisis it is presiding over, so to distract attention it blames the expert.

The public uses NHS hospitals and GP surgeries. It sees the reality. People know Theresa May is starving the NHS of the vital funds it needs. Theresa May should stand down the Number 10 spin doctors and start listening to the person who knows what is really wrong with the NHS.

This is what the government is saying in response to the calls for an NHS and care convention. A spokeswoman said:

We recognise the pressures of an ageing population which is why we recently announced almost £900m of additional funding for adult social care over the next two years.

This government has gone further to integrate health and social care than any other before it.

We have brought budgets together for the first time through the Better Care Fund and given the NHS an extra £10bn per year by 2020-21 to fund its own plan to build a more responsive, modern health system.

But as the prime minister has made clear, this is not solely about money.

That is why we are working to find a long-term, sustainable solution which helps local authorities learn from each other to raise standards across the whole system.

The claim that the government is putting an extra £10bn into the NHS is not accepted by Sarah Wollaston, the GP and Conservative MP who chairs the Commons health committee. She says £3.5bn of that is coming from cuts to other areas of health spending.

Norman Lamb, the Lib Dem former care minister, was on the Today programme this morning talking about the call backed by MPs from all the main parties for an NHS and care convention to find a long-term solution to the rising medical and care costs caused by having an ageing population.

He is urging people to back a petition supporting the idea.

No 10 plays down reports of rift with NHS England chief Simon Stevens

The NHS is likely to be the story of the day. With doctors warning that the NHS “will fail” this winter and patient care will suffer unless the government provides an emergency cash injection, Jeremy Corbyn may well decide to lead on the issue at PMQs. Labour is also staging its own debate on a motion calling for the NHS and social care to get more funding. And this afternoon Simon Stevens, the NHS England chief executive, is giving evidence to a committee of MPs. That would be newsworthy anyway but the hearing should have an extra edge because Stevens is the subject of a Times splash saying Number 10 have got it in for him. Here is the Times front page story (paywall).

And here is how it starts.

Theresa May’s senior aides have privately criticised the head of the NHS as Downing Street seeks to shift the blame for mounting chaos in hospitals.

Key members of the prime minister’s team accused Simon Stevens, chief executive of NHS England, of being insufficiently enthusiastic and responsive. They expressed their views in internal meetings, The Times was told.

No 10 was also understood to have been irritated by “political” interventions from Mr Stevens, including the suggestion that ministers should pay for social care by abandoning free bus passes and other pensioner perks.

Number 10 is playing down the report, but not directly denying it. A Downing Street source said:

We don’t recognise any of this.

I will reporting more on this as the story develops, as well as focusing on PMQs and the Stevens hearing in detail. But, as usual, I will be also covering breaking political news as it happens, as well as bringing you the best reaction, comment and analysis from the web. I plan to post a summary at lunchtime and another in the afternoon.

Here is the agenda for the day.

9.15am: University academics and vice chancellors give evidence to the Commons education committee about Brexit.

12pm: Theresa May faces Jeremy Corbyn at PMQs.

Around 12.40pm: MPs begin a debate on a Labour motion demanding extra funding for the NHS and social care.

2.15pm: Mark Carney, governor of the Bank of England, gives evidence to the Commons Treasury committee.

2.30pm: Simon Stevens, the NHS chief executive, gives evidence to the Commons public accounts committee about the financial sustainability of the NHS.

You can read all today’s Guardian politics stories here.

If you want to follow me or contact me on Twitter, I’m on @AndrewSparrow.

I try to monitor the comments BTL but normally I find it impossible to read them all. If you have a direct question, do include “Andrew” in it somewhere and I’m more likely to find it. I do try to answer direct questions, although sometimes I miss them or don’t have time. Alternatively you could post a question to me on Twitter.

Updated

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