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| NHS leaders meet to discuss cutting services amid funding gap - live updates | NHS leaders meet to discuss cutting services amid funding gap - live updates |
| (35 minutes later) | |
| 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 | |
| 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. | 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. | 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: | 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”. | 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 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: | 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 | 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 |
| The meeting, which is being held at NHS England’s HQ in Elephant Castle, south London, is scheduled to begin at 10.45am. | 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: | The most interesting agenda items are: |
| 4. Planning for 2018/19 in light of the Budget | 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 | 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. | 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. | 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 | 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 | 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. | 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. | 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. | 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: | 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. | 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. | We will be providing live updates from the crucial meeting. |