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| NHS England says waiting time targets will not be met - live updates | NHS England says waiting time targets will not be met - live updates |
| (35 minutes later) | |
| 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. | 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. | 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: | 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. | 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.” | 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. | 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 | 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: | 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. | 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. | 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. | 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. | 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. |
| 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): | 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. | 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. | 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”. | 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 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. | 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. | 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. | 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. |
| 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: | 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. | 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. | 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. | 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): | 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 | Homeopathy – no clear or robust evidence to support its use |
| Herbal treatments – 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 | 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 | 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 | 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 | 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 | Glucosamine and Chondroitin – used for joint pain, low clinical effectiveness |
| Proposals were also presented to stop the routine prescribing of products that: | 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. | 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 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. | 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: | 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. | “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. | “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. | “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.” | “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. | 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. | 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. | 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. | 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: | 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. | 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”. | 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! | 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. | 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. |
| There has been a more positive response to the decision to protect planned investment on mental health services (and cancer and primary care services). | 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: | 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. | 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. | 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: | 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 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. | 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. | 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: | 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. | 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. | 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. |
| 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: | 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. | NHS constitution waiting times standards, in the round, will not be fully funded and met next year. |
| Additionally, on page four, it says: | 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. | 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: | The Lib Dems’ former health minister, Norman Lamb, said: |
| This is the inevitable consequence of the government’s continued underfunding of our NHS. | 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. | 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 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. | 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. | 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. |
| 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. | 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. | 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. |