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Jeremy Hunt orders NHS England bosses to stick to waiting time limits Jeremy Hunt orders NHS England bosses to stick to waiting time limits
(35 minutes later)
Jeremy Hunt has ordered NHS England to stick to waiting time limits, putting him at loggerheads with its leaders who said hours earlier that insufficient funding from last week’s budget made this impossible.Jeremy Hunt has ordered NHS England to stick to waiting time limits, putting him at loggerheads with its leaders who said hours earlier that insufficient funding from last week’s budget made this impossible.
NHS England told ministers on Thursday it would have to tear up guarantees on waiting times and deny patients new drugs next year because of the lack of money. NHS England told ministers on Thursday it would have to tear up guarantees on waiting times and deny patients new drugs next year because of the lack of money. But the health secretary rejected the proposals and signalled the start of months of difficult negotiations over what care the NHS can and cannot afford to provide in 2018-19.
In an escalation of its public dispute with ministers over what the NHS can afford to do, it also said it would ignore recommendations to improve patient care made by the National Institute for Health and Care Excellence (Nice). “I would say very simply that the government is absolutely committed to NHS constitutional standards, that is why we found a significant increase for the NHS in the budget. Our absolute determination is to move back to hitting those standards,” Hunt told an audience of NHS chiefs hours after the plans emerged.
The twin threats, made at an unprecedented public board meeting, put Hunt in danger of having to explain to the House of Commons why the NHS is reducing the amount of care it offers. They could also lead to months of rows between NHS leaders and ministers as they discuss what services the health service can no longer afford. In an unprecedented move reflecting a widening gulf with the government, NHS England used its board meeting to warn that it had to make “difficult choices” next year that would involve limiting what it could provide for patients.
But hours later Hunt rejected the plans and made clear that ministers expected hospitals to keep meeting the waiting time targets. The health secretary told an audience of NHS chiefs at the King’s Fund: “I would say very simply that the government is absolutely committed to NHS constitutional standards, that is why we found a significant increase for the NHS in the budget. It blamed the chancellor, Philip Hammond, for creating what the Patients Association said was an “extraordinary” situation by giving it only £1.6bn extra funding for 2018-19 in his budget last week – less than half of the £4bn the NHS boss, Simon Stevens, had called for.
“Our absolute determination is to move back to hitting those standards, which we’re not hitting all of at the moment – we recognise that.” In a paper given to its board, NHS England said: “NHS constitution waiting times standards, in the round, will not be fully funded and met next year.” Hammond made clear last week that the £1.6bn was to be used to improve waiting times, which have been increasingly breached since 2014.
He added: “Part of that is a funding issue. Part of that also is a capacity issue. I think we will have constructive, sensible discussions with NHS England to find a way forward to meet our objective, which is to get back to meeting those standards.” NHS England also said it may refuse to act on new guidance from the National Institute for Health and Clinical Excellence (Nice) if it believed it did not have the money or staff to implement them. That could lead to England’s 209 NHS clinical commissioning groups refusing to pay for new drugs that Nice has deemed value for money for the NHS or declining to change practice as a result of guidelines that Nice issues to promote better care.
Patient groups reacted with horror to the situation, which emerged at NHS England’s first monthly board meeting since the chancellor, Philip Hammond, gave it £1.6bn extra funding in the budget – less than half the £4bn it had demanded. NHS England dismissed the idea that the service could be expected to provide ever more care at a time when its annual budget increases of 1% to 2% were far smaller than rises in patient demand, running at up to 7% a year.
The chief executive of the Patients Association, Rachel Power, said: “It made clear how patients will lose out as a result of political decisions about the funding of health and social care. There will be longer waits for elective surgery, and therefore more pain and worse outcomes for many.” In its board paper on what it could afford to do next year, it promised “more scrutiny of unfunded new expectations that are loaded on to the NHS. For example, 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.”
She praised NHS England for having “faced up to the consequences of the underfunding of the NHS by the government”. Patient groups and medical organisations reacted with alarm to NHS England’s twin threats. Rachel Power, the chief executive of the Patients Association, praised it for facing up to what she said were the consequences of government underfunding of the NHS.
“NHS England has also said it is unable to implement best practice as advised by Nice on a routine basis – an extraordinary state of affairs. We have now reached a point where the NHS constitution will be routinely breached and NHS services are being withdrawn,” Power said. She said: “It made clear how patients will lose out as a result of political decisions about the funding of health and social care. There will be longer waits for elective surgery, and therefore more pain and worse outcomes for many. NHS England has also said it is unable to implement best practice as advised by Nice on a routine basis – an extraordinary state of affairs. We have now reached a point where the NHS constitution will be routinely breached and NHS services are being withdrawn.”
On Thursday NHS England repeatedly told ministers there needed to be “realism” about how much the NHS could do from now on and that “some difficult judgments about priorities” would have to be made. Decisions will be hammered out in potentially tense discussions over the next few months about what the government’s annual mandate to the NHS – setting out what ministers regard as the NHS’s key tasks in 2018-19 – should involve. Dr Chaand Nagpaul, the chair of the British Medical Association, said it was “deeply worrying that the body with responsibility for running the NHS is warning of the service’s inability to meet national standards of care. Unfortunately, it is patients who are unfairly suffering the consequences of a clearly underfunded service. Doctors … can’t continuously plug gaps by penny pinching and poaching from elsewhere in an overstretched service.”
NHS England disclosed its thinking in a briefing paper to its board billed as setting out “the results and implications of the 2018-19 budget, and next steps”. NHS England urged ministers to bring “realism” about what it sees as the NHS’s shrinking role as a result of its funding settlement to discussions that will take place between now and the spring over the service’s mandate for 2018-19 – its annual set of instructions from government. “Some difficult judgments about priorities” were unavoidable, Stevens and other chiefs stressed.
In a section about the need to “be realistic about what can be expected from the remaining available funds”, it said: “It would be unfair to set unattainable goals which staff would then be criticised for not meeting. In part this therefore means more scrutiny of unfunded new expectations that are loaded on to the NHS. The Royal College of Surgeons agreed with NHS England’s analysis that the extra £1.6bn Hammond gave the NHS last week was insufficient. It said the huge advance in patients’ rights represented by maximum waiting times could be lost if they were no longer important.
“For example, 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.” Its president, Prof Derek Alderson, said: “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.”
Guidelines issued by Nice, which decides what treatments represent value for money for the NHS, are meant to be binding on the 209 NHS clinical commissioning groups (CCGs) that hold NHS budgets locally. However, many CCGs ignore some of them, for example on providing IVF treatment. Stevens backtracked on the possible scrapping of plans to improve cancer and mental health care as part of the cost-cutting drive, which he had mooted earlier in the month. Both areas, and also primary care – especially GP services – would now be key priorities in 2018-19, he said.
On waiting time targets, which have existed in the NHS for more than a decade, the briefing added: “Even without increased volume [demand for care], and even assuming this year’s unprecedented elective demand management success continues, our current forecast is that – without offsetting reductions in other areas of care – NHS constitution waiting times standards, in the round, will not be fully funded and met next year.” NHS England in effect accused Hammond of being ready to break a key pledge in this year’s Conservative general election manifesto, which promised to increase health spending per head of population every year until 2022. While the extra money in the budget meant that per capita funding would rise by 0.9% next year, it would then fall by 0.4% in 2019-20, it claimed.
Labour immediately raised doubts about whether it would be legal for the NHS not to enforce key waiting time targets, given that they are enshrined in the NHS constitution. Philip Hunt, its health spokesman in the House of Lords and an ex-hospital trust boss, said it would be illegal.
Jonathan Ashworth, the shadow health secretary, said: “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.”
The NHS England chief executive, Simon Stevens, backtracked on the possible scrapping of plans to improve cancer and mental health care as part of its cost-cutting drive, which he had first floated earlier this month. Both areas, and also primary care – especially GP services – would not be key priorities in 2018-19, he said.
But NHS England in effect accused Hammond of breaking a key pledge in this year’s Conservative general election manifesto, which promised to increase health spending per head of population every year until 2022. While the extra money in the budget meant that per capita funding would rise by 0.9% next year, it would fall by 0.4% in 2019-20, it claimed.
Chris Hopson, chief executive of NHS Providers, which represents hospital trusts, praised the “realism” of NHS England’s “excellent, sensible, helpful board paper on what happens next post-budget”.
The Royal College of Surgeons said forcing patients to wait to undergo surgery would cost the NHS more in the end. “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,” said Prof Derek Alderson, its president.
“Rationing and delaying surgical treatment are false economies. For example, current CCG 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.”
NHS England also ratified plans to stop prescribing a range of “low-value treatments”, including fish oil, herbal remedies and homeopathic treatments, as part of a plan to save up to £190m from its £9.2bn bill for prescribed medications.
Meanwhile, the board lifted the threat of closure that had been hanging over two hospital units that operate on children’s hearts.
Glenfield hospital in Leicester has been given more time to meet clinical standards on performing complex congenital heart surgery. And NHS England is backing ambitious plans by the Royal Brompton hospital in London to relocate its unit which provides that care, as part of a wholesale move from its current premises to a planned £800m new-build facility at St Thomas’s hospital in central London, which it will share with specialists from other hospitals.