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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 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!
They are onto agenda item six now: “Congenital Heart Disease Services for Adults and Children: Future Commissioning Arrangements.”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.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.Referring to the 2001 Kennedy review into the tragedy, he says one of the recommendations was to rationalise services to safeguard standards.
He says: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.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):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 constitutionNHS 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
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/4cEFSEjeh9Sir 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
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.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.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.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.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.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?”Non-exec director Lord Victor Adebowale CBE asks “how we will monitor for unintended consequences?”
Keogh says they will consider that.Keogh says they will consider that.
The recommendations are passed.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
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.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: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.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.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.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.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.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.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.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/L17xnCguu7Simon 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
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.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.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.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.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.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:Matthew Swindells, national director – operations and information, says:
There are going to be some really difficult decisions that we need to make.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.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.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.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
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
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
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.