Jeremy Hunt has laid out his vision for the NHS for the next 25 years in a wide ranging speech. Follow HSJ Live for comprehensive coverage, plus analysis and reaction

Jeremy Hunt’s ‘25 year vision’: what you need to know

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5.55pm You can catch up on HSJ’s full coverage of Jeremy Hunt’s vision for the NHS over the next 25 years, which he laid out in a wide ranging speech this morning:

5.53pm Leading health thinktanks have questioned where the money for seven day working will come from, following the health secretary’s ultimatum to doctors on the issue this morning.

Jeremy Hunt told delegates at the King’s Fund seven day working “may well” increase staffing spend and later told the House of Commons: “We think we can afford additional NHS staff, including new GPs, within the extra that the government is putting into the health service.”

The government has committed to increasing the annual NHS budget by £8bn by 2020, which is to cover the shortfall identified in the Five Year Forward View, which commits the NHS to making £22bn in efficiency savings over this period to close the £30bn funding gap predicted if services continue as they are in this period.

5.45pm Commenting on Jeremy Hunt’s speech this morning, Academy Medical Royal Colleges chair Dame Sue Bailey said: “Doctors up and down the country will, I am sure, applaud the vision and clarity of what has been set out today.

“What the Secretary of State said chimes with many of things that Medical Royal Colleges, as the voice of doctors on issues of quality and standards, have long been arguing for.

“But as always, it’s the gap between Whitehall’s vision and the reality on the wards, in surgeries and communities that’s the real issue. We know what we need to do to provide safer, smarter and more patient centred care.

“But we need the resources, the space and the capacity to make those changes. I know, however, Medical Royal Colleges are up for that challenge.”

5.37pm A new body to investigate clinical failure and incidents of patient harm in the NHS will ‘operate without fear or favour’, the government has said.

The new Independent Patient Safety Investigation Service will be led by national patient safety director Mike Durkin and hosted by the new regulator called NHS Improvement, which is being created by merging Monitor and the NHS Trust Development Authority.

The investigation body is being created following criticism of the NHS system in both the Morecambe Bay and Mid Staffordshire inquiries which found widespread failures to investigate and learn from clinical incidents.

Patient safety incidents are currently reported to the National Reporting and Learning System but the new service will build on this by selecting incidents to investigate and ensuring lessons from serious failures are learned and acted on across the NHS.

Current patient safety functions, such as the NRLS, which reside with NHS England will be transferred to NHS Improvement and will require legislation to amend the 2012 Health and Social Care Act.

5.31pm This morning Jeremy Hunt gave a major speech on NHS reform to the Kings Fund in central London.

You can now watch a 25 minute video, produced by the King’s Fund, includes key passages from the speech, in which Mr Hunt he outlines his plans to make NHS patients the most powerful in the world, affirms his commitment to transparency, declares war on the BMA, and explains a new approach to provider regulation.

5.24pm The Rose review is also critical of a number of changes brought about by Health Act 2012, such as the abolition of strategic health authorities.

5.23pm The health service should increase the size of its graduate scheme tenfold, the Rose review into NHS leadership has concluded.

The long awaited review of NHS management by former Marks & Spencer chief executive, Lord Rose, was published today as part of a wider package of reforms outlined by Jeremy Hunt, the health secretary.

5.11pm Earlier today the health secretary tweeted:

4.35pm Responding to the publication of the Review Body on Doctors’ and Dentists’ Remuneration erport into consultant and junior doctors’ contracts published today, BMA chair Mark Porter said: “It is positive that the DDRB has recognised the potential impact of these proposals on the working lives of doctors and that ‘one size will not fit all’, and we hope that the government does the same.

“However, the DDRB’s comments that it is unclear about how these changes could be made without further resource highlights how the health secretary’s ultimatum is nothing more than headline grabbing rhetoric.

“He has chosen to dodge the hard choices and announce something that makes a great speech but does little to put in place the resources the NHS really needs.

“Just adding an extra doctor to a ward will make no real difference if the support needed is not there.

On the BBC the health secretary admitted as much,yet he continues to make no mention of the extra nurses, diagnostic staff, porters, admin staff – the list goes on – that would be needed to deliver the same high level standard of care patients deserve seven days a week.

“We have been clear that we would be willing to work with the health secretary to better improve services.

“So today is nothing more than a cynical attack on doctors and an attempt to negotiate through press release rather than offering to sit down and discuss constructively with the very people who are delivering seven-day services for patients and who he expects to deliver these further changes.  

“If the health secretary really wants to put patient care first and foremost then he should work with those who spend each day doing just that as well as putting in place the proper funding for emergency care, rather than sniping from the sidelines and issuing artificial deadlines. Patients deserve no less.”

4.29pm We’ve got an update to our story earlier today that an American healthcare corporation is being brought in to support five trusts in improving quality and clinical engagement.

The health secretary this morning announced a five year, £12.5m programme to bring in Virginia Mason to five hospital trusts with a combined turnover of more than £2bn.

4.21pm There is a ‘compelling’ case for seven day services in the NHS and medical consultants should lose their contractual opt-out for weekend work, according to an independent pay review.

The Review Body on Doctors’ and Dentists’ Remuneration has supported health secretary Jeremy Hunt’s call today for individual consultants to work across a seven day service but also called for doctors to be offered contractual safeguards to prevent exploitation.

It said: “In our view, the current ‘opt-out’ clause in the consultant contract is not an appropriate provision in an NHS which aspires to continue to improve patient care with genuinely seven-day services.”

The report, published this morning, endorsed proposed changes by NHS Employers to consultant contracts as part of a broader package of contractual reform.

3.55pm NHS Providers chief executive Chris Hopson said Jeremy Hunt’s speech today “has, at its core, a new phase of transparency, learning and development aimed to improving the quality of patient care and we welcome that focus”.

“Part of driving this change and supporting a longer term vision for the NHS involves introducing seven day services. NHS trust leaders who employ consultants tell us that the consultant contract as currently configured, with its opt out for weekend non emergency work, is the biggest barrier to the delivery of seven day services.

“Beyond seven day services, the reform of doctors’ and wider NHS contracts are fundamental to promoting a flexible and affordable workforce. We therefore welcome the Secretary of State’s focus, urgency and ambition on this issue and stand ready to support the delivery of  these reforms as soon as possible.

“It is NHS providers who have the responsibility to deliver outstanding care 24 hours a day, 365 days a year. We welcome the Government’s recognition that those providers need the support of the NHS’ national leadership to deliver those responsibilities. We therefore welcome the Secretary of State’s emphasis on the importance of provider autonomy”.

Mr Hopson also welcomed the bringing together of regulators Monitor and the NHS Trust Development Authority under the new name NHS Improvement, saying it the move could “streamline regulatory and oversight processes and eliminate duplication of effort”.

“The Government’s recognition of and investment in improvement support is also welcome, however we need to look at the detail of how NHS Improvement will combine its regulatory and improvement roles.

“We welcome Ed Smith to his important new role – his leadership and that of the new NHS Improvement chief executive will be crucial in ensuring NHS providers are able to meet their current challenges”.

3.51pm Responding to Jeremy Hunt’s comments on weekend-working contracts for consultants, Labour’s London Assembly Health spokesperson Onkar Sahota said: “The health secretary’s threat of forcing through contracts for a seven day NHS will only intensify the problems faced by London’s health services.

“A confrontation of this kind with GPs and Consultants will lead to further low morale, early retirements, and more resignations.

“Clearly the goal of round the clock care is something that Londoners would welcome, but Jeremy Hunt simply won’t be able to deliver it unless he can recruit more doctors, boost retention, and reduce pressures on the health service.”

3.35pm NHS Confederation chief executive Rob Webster has said the Rose Review into NHS leadership, published today, “reflects some of the pressures our members are facing against a backdrop of unprecedented challenge”.

“We know we have great people at all levels in health and care showing effective leadership in tough circumstances and under intense scrutiny. We also know this is not the case everywhere.

“In healthcare we make difficult decisions every day and we must always be guided by our values, which should be consciously stated and shape our recruitment, selection and development processes.          

“The Five Year Forward View gives us real hope and an opportunity to deliver a new leadership approach between national organisations and the frontline NHS, built on a culture defined by our values and a focus on working in partnership to deliver the care patients need and want.

“We need to ensure that politicians, regulators and the media are helping to create the right environment within which great NHS leadership can flourish.”

3.29pm Commenting on the confirmation today that MPs are to receive a 10 per cent pay rise, Unison’s general secretary Dave Prentis said: “Pay austerity might be over for MPs, but it goes on and on for everyone else in the public sector.

“If pay restraint is at an end for politicians – who are public servants too – it should also be over for nurses, teaching assistants, hospital cleaners, council staff and other public sector workers.

“The government felt able to ignore the advice of the NHS pay review body, but not, it would seem, the equivalent body for MPs.

“Not content with holding pay down for public sector workers for another four years, the government is spitefully going ahead with new laws to make it almost impossible for public servants to go on strike and win pay rises in future.

“No wonder so many staff in our hospitals, schools and local councils are beginning to think they’d be better off working elsewhere.”

3.17pm Oh Chris, you’re making us blush…

3.10pm The Royal College of Paediatrics and Child Health has said it “[welcomes] the health secretary’s commitment to creating a ‘seven day’ National Health Service”.

Vice president Carol Ewing said: “As paediatricians, we support a 7-day NHS and in the majority of paediatric units up and down the country this is already happening. 

“Children can deteriorate quickly and it’s important that parents and carers know where they can go and be confident that their child is being seen by a suitable health professional – wherever they are and whatever the time.

She added that “in order to deliver safe, high quality care, paediatrics must be a 24 hours a day, seven days a week specialty and the most experienced doctors need to be present at the busiest times”.

2.45pm Jeremy Hunt reiterated his criticism of top-down target culture in his speech to the King’s Fund this morning.

The health secretary previously praised the benefits of peer review to improve standards, in place of top-down approach, in another speech to the King’s Fund in May.

In his May speech, Mr Hunt set out in more detail how peer review could be adopted by the NHS to encourage improvements.

He is keen to adopt metrics that make services comparable, giving the example of a metric that would allow a comparison between mental health services in Somerset and Gloucestershire.

2.22pm HSJ correspondent Will Hazell has noticed that Rose Review is very criticial of the changes brought about by the 2012 Health Act.

He tweets:

2.14pm Also commenting on today’s report from the independent Pay Review Body, Unison’s head of health Christina McAnea said: “Health workers will be relieved to learn that the report doesn’t see unsocial-hours payments as a barrier to delivering seven-day services – as Jeremy Hunt and the NHS employers have claimed in the past. 

“The real barrier to a truly seven-day NHS is a lack of staff to ensure safe services every day of the week. 

“Sadly, the reality is that the government would rather make up for the chronic underfunding of the NHS by cutting staff pay. 

“This report highlights the possible impact on patients of any reduction in unsocial-hours payments.

“If NHS workers were not paid more for working at night, and over weekends and public holidays, many would vote with their feet, and either leave the health service altogether or seek more lucrative agency work.

“The PRB report shows the effect that cuts to unsocial-hours payments would have on staff morale, and make recruitment and retention of key NHS staff more difficult. 

“The real barriers to a safe seven-day NHS are underfunding, understaffing and lack of employee involvement.”

2.03pm In response to the findings of the independent Pay Review Body, Unite’s head of health Barrie Brown said the union welcomes the fact it “has demonstrated its independence on this issue, despite ministerial pressure in recent times that has either undermined or ignored its findings”.

“The [Pay Review Body] has put the kibosh on the claims from the Department of Health and NHS Employers that payments for unsocial hours create a barrier for delivering seven-day-a-week services.

“The heart of the matter when it comes to delivering 24/7 services is the lack of staff caused, in major part, by the continual pressure on salaries that has seen pay eroded by 14 per cent in real terms for NHS staff since 2010.

“Healthcare professionals are walking away from the NHS they love because they can no longer afford to work for the health service or take the mounting work pressures, stoked up by continual ministerial interference.

“Jeremy Hunt’s disdain in addressing the serious staffing and pay issues facing the NHS will come back to haunt this government before the next general election.”

1.53pm It has been an extremely busy morning for health policy in the wake of Jeremy Hunt’s speech at the King’s Fund. Here is a round-up of the most important stories of the day so far:

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1.33pm Health secretary Jeremy Hunt today intervened in the debate over safe staffing levels in the NHS, announcing future guidelines will be independently reviewed by the National Institute for Health and Care Excellence.

In a marked change to current policy, Mr Hunt said work on safe staffing levels currently led by NHS England’s chief nursing officer Jane Cummings will now be taken forward by the new regulator, NHS Improvement, overseen by national patient safety director Mike Durkin.

Dr Durkin would work with Ms Cummings and NHS England.

Mr Hunt revealed NICE would be asked to independently assess the work, which will then also be reviewed separately by chief inspector of hospitals Sir Mike Richards and Sir Robert Francis QC.

1.30pm The independent NHS Pay Review Body has said there is a ‘compelling’ case for moving towards seven day working, in a report published this morning.

But, the body added, the introduction of seven day services will “inevitably” have to be traded off against affordability.

The report has been released to coincide with Jeremy Hunt’s major speech on NHS reform this morning, and represents a challenge to the British Medical Association. The BMA is at odds with the government over the issue.

The Pay Review Body advises the government on the pay of NHS staff – but it does not cover doctors and dentists, whose pay is subject to separate agreements with the government

1.23pm King’s Fund chief executive Chris Ham said there is “much to welcome” from the health secretary’s 25 vision for the NHS, “including the continued focus on safety and quality of care, the emphasis on transparency and the goal to make the NHS the world’s largest learning organisation”.

“This signals a significant move away from using external pressures such as competition and targets to drive change towards reforming the NHS from within by supporting leaders to improve quality of care.  

“Many of the themes in the speech will strike a chord with NHS staff but they will take time to deliver results. The test will be whether the emphasis on devolution and self-improvement can be maintained in the face of short term political imperatives - ministers invariably find it difficult to resist intervening, particularly when NHS performance declines.

“An even bigger challenge will be to implement this vision at a time when NHS organisations are having to respond to huge financial and service pressures.

“A seven day NHS is the right ambition but will be difficult to deliver. As the war of words with the BMA indicates, significant challenges will need to be to overcome to ensure sufficient staff are available at weekends.

“There is also the question about how it will be paid for. The £8bn increase in the NHS budget the government has pledged by 2020 is the bare minimum needed to maintain standards of care and will not cover the additional costs associated with it.”

1.19pm The Patients Association has said it welcomes the health secretary’s move to “phase out Monday to Friday culture” and criticised the attitude of the BMA towards the measures.

Chief executive Katherine Murphy said: “Patients should have easy access to 24 hour 7 days a week care. The NHS is a publicly tax funded service and should be built around the needs of patients.

“The Patients Association do not believe that it is not for the doctors’ unions to decide how a public funded service should be run.

“The NHS is not there for the benefit of professionals.  Patients can’t pick and choose when they need to use it and doctors can’t pick and choose when they want to work in it. 

“The public need to have confidence that when they are in need of care that it is easily accessible.  Why should we have less care at weekends than the rest of the week?

“Patients need access to appropriate services, diagnostic services, x-rays and scanners but also need access to most appropriate professionals.”

1.11pm Responding to the health secretary’s announcement on seven day working this morning, Royal College of Midwives chief executive and general secretary Peter Carter said: “The RCN and its members have always supported efforts to ensure that patients receive the same level of care on a Sunday morning as they would on a Tuesday morning.

“As the RCN has made clear, these plans will need proper resourcing and will require more staff in some areas.

“The independent pay review body has today published its report on seven day services.

“This report echoes the position of the RCN - there is currently no contractual barrier to seven day working, but it will require resources and the engagement and involvement of frontline staff and the organisations that represent them.  

“The biggest threat to safe seven day working is inadequate staffing levels, so it is vital that staff morale is not damaged to the extent that retention and recruitment are undermined.”

1.08pm Health Education England is to take over responsibility for the NHS Leadership Academy, the health secretary confirmed today.

Jeremy Hunt said he would accept the recommendation made in Lord Rose’s long awaited review of NHS leadership, which is published today, that the academy should shift to HEE.

In a speech setting out his 25 year vision for the service Mr Hunt said: “In line with [the review’s] recommendations, the national responsibility for nurturing and developing talented leadership in the NHS - including the NHS Leadership Academy - will be brought together and become the responsibility of HEE.”

HEE welcomed the decision, which it said would “be good for leadership development in the NHS and good for patients”.

1.04pm Patients will be told the Care Quality Commission rating and waiting times for their local hospitals when making appointments through a new electronic booking system to encourage ‘truly informed’ patient choice, the health secretary has said.

In a speech at the King’s Fund today, Jeremy Hunt said patients would for the “first time” be able to make a “truly informed choice about which local service is best for them”.

Mr Hunt said that from next year “GPs will be asked to tell patients not just which hospitals they can be referred to, but the relevant CQC rating and waiting time as well”.

However, HSJ understands GPs will not be asked to pass this information on to patients. Instead, it will be included in the new e-referrals system to replace Choose and Book.

1.02pm In response to Jeremy Hunt’s speech this morning, particularly on the movetowards seven day working, Roger Goss of Patient Concern said: “His plan should at least expose the British Medical Association as the most patient-unfriendly organisation in the country.

“Its attitude to 24/7 care gives its members and the medical profession a bad name. Apparently it doesn’t matter if patients die as a result of test results and diagnoses being delayed 24 or 48 hours at weekends.”

12.55pm In response to the health secretary announcements today on the new NHS Improvement body and the Patient Safety Investigation Service, Health Foundation director of improvement Will Warburton has said: “‘Improvement’ needs a strong voice in the system and the new body, NHS Improvement, will be well-positioned to influence nationally, helping providers address the challenges they are facing.

“However, inserting improvement into an organisation with a regulatory culture and function could be risky.

“Those leading in the front line are often too burdened by ever-increasing demands to have time to think about improving services as they go along.

“The balancing act will be to guard against the temptation, as finances tighten, to resort to command and control approaches and unrealistic demands for short-term transformation.

“Our experience of supporting improvement in the NHS over the past 10 years has shown that it needs local ownership, takes time, and works best when it taps into the creativity, discipline and professional motivation of doctors, nurses and other health care professionals. Positively engaging them will be crucial for success.

“The government will also have to ensure that the newPatient Safety Investigation Service has sufficient clout to influence all system players to act in a way that supports a strong safety culture.

“The new service must provide a truly independent investigation function to improve learning from failure, as well as encourage greater public engagement with safety and understanding of risk and harm.”

12.46pm NHS England’s safety function will be moved to the new combined provider regulation body NHS Improvement.

Jeremy Hunt announced the new name for the organisation, bringing together Monitor and the NHS Trust Development Authority this morning.

In a speech the health secretary Jeremy Hunt said this would also see Mike Durkin, NHS England’s director of safety, set up a new “Independent Patient Safety Investigation Service modelled on the Air Accident Investigation Branch”.

Mr Hunt said: “A ‘no blame’ learning culture in that industry has led to dramatic reductions in both fatalities and cost - and we now need to do the same in healthcare.”

12.41pm The Royal College of Emergency Medicine has said it welcomes today’s announcement that the government intends to negotiate a new contract for hospital doctors, which “[recognises] the intrinsic unfairness of current contracts for those doctors and specialties that already provide a seven day service, including evenings, nights and weekends”.

Present Clifford Mann said: “Full Recruitment and retention into emergency medicine with the consequent savings on locum costs will only occur when employment contracts offer an equitable work life balance for those who undertake to provide direct patient care irrespective of day of week or time if day.”

12.40pm The Commons debate has now ended.

12.38pm York Central MP Rachel Maskell questions how seven day working can be funded alongside £22bn efficiency savings.

Mr Hunt responds that part of those savings will come from having a consistently streamed service across the week.

12.36pm Back to the Commons debate, the health secretary says “we need to be able to discharge into the community over seven days”.

12.31pm In response to the health secretary’s speech this morning on the future of the NHS, Royal College of Surgeons president Clare Marx said: “There is much to welcome… which complements the NHS Five Year Forward View.

“We particularly support his commitment to establishing a clearer learning culture in the NHS and a strengthened focus on patient safety.

“On seven day care, it is widely recognised that the same quality of care is not currently available to patients across the week, particularly for emergency patients at weekends.

“Many doctors and most surgeons already commit to working over seven days and we support moves to help ensure this is standard practice in the NHS.

“However, we would like to see this apply to other key hospital services such as diagnostics, pharmacy, and radiology. This is an essential step for patient safety and should help to reduce variability in standards of care.”

2.28pm Labour MP Emily Thornberry has reiterated her criticism of the health secretary earlier this morning, over the tone that he has taken with the BMA, and has cited concerns by RCGP chair Maureen Baker that today’s announcement over seven day services will “sound alarm bells” among GPs.

She says there are “insufficient numbers to carry out seven day working”, and described Jeremy Hunt’s tone as “alarming”.

2.25pm Illford North MP West Streeting welcomes the partnership with Virginia Mason, but asks the health secretary to meeting him and other local MPs over particular concerns over the local health economy.

12.21pm Kingston Upon Hull MP Diana Johnson criticises the Fit and Proper Person Test for managers, in reference to former Hull and East Yorkshire Hospitals Trust chief executive Phil Morley, who moved into another chief executive role amid concerns about his behaviour.

12.20pm Hunt: “This is not a confrontation with doctors… This is a battle with the BMA.”

12.18pm Labour MP Karin Smyth asks the health secretary to ensure NHS managers get the support they need in implementing changes. She also warns his against getting into a confrontation with doctors.

12.17pm Barrow and Furness MR John Woodcock says he welcomes the Government’s response to the Kirkup report, and asks for the health secretary’s assurance that families will continue to be involved in the process of implementing its recommendations.

12.13pm In responding to a question from his former ministerial colleague Norman Lamb, the health secretary wished him luck in his bid to become Liberal Democrat leader.

12.12pm Dennis Skinner to Mr Hunt: “The doctors and the nurses don’t trust you. It’s time you got out.”

12.11pm Hunt: There needs to be better collaboration between senior cancer consultants and GPs.

12.10pm Hunt: We think we can afford additional NHS staff, including new GPs, within the extra £10bn that the Government is putting into the health service.

12.09pm Hunt: Ambulance services should have the confidence that if they take patients to hospitals on a weekend, there will be a consultant available to treat them.

12.08pm Hunt: the progress to towards seven days applies just as much to mental health as other services.

12.06pm Former health minister Norman Lamb asks the health secretary to ensure that seven day working also applies in mental health and to patients being dischanged.

12.04pm Twickenham MP Tania Mathias, who is also a dcotor and BMA member, asks the health secretary to recongise the existing strong leadership with the NHS.

12.01pm Exeter MP Ben Bradshaw asks how Mr Hunt will pay for seven day services given that he has lost control of finances.

The health secretary responds that a lot of hospitals have gone into deficit to make important changes, and we need to find smart ways to redce hospital deficits.

He adds that hospitals have employed 8,000 new nurses to deal with short staffing, and if it is not sustainable then it is not quality care.

11.58am In response to Dr Whitford’s question, Mr Hunt says it is “not easy to make a rigid distinguish between elective and emergency care”. There are a lot of services that are currently only available Monday to Friday, which is contributing to patient deaths.

11.57am In response to Dr Wollaston’s question, the health secretary says there are some things where we need to spend money soon, such as additional capacity in primary care.

He also says local leadership matters at both CCG and trust level, which are both areas where we need to make much improvements.

11.56am Discussing seven day working, SNP health spokeswoman Philippa Whitford warns there is a blurring between the elective and the emergency system. She asks him to start talking about them in separate tracts.

11.54am Health committee chair Sarah Wollaston urges the health secretary to make sure that the extra money invested in the NHS is front-loaded.

11.53am He says there is a choice between “are you on the side of the patient or are you on the side of the union”.

11.52am Hunt: “We are not blaming unions, and we are not blaming unions because unions will always look for what we get.”

He blames Labour for changes to doctors’ contracts in 2003-04. The last Labour government changed the consultant contracts and many doctors did not like this, Mr Hunt argues.

11.51am The health secretary accuses Andy Burnham of scare-mongering in his claims that health minisyer David Prior is looking at a review in charging for NHS service. Mr Hunt says such claims are “not true”.

11.50am Burnham: “I don’t believe some of Secretary of State’s more political statements were appropriate…. nor will they build the consensus that we be required across this House to bring these changes… He will not achieve his goals by provoking conflict with doctors.”

11.47am Burnham: Can the Secretary of State look at the idea of opening an independent body for receiving whistleblowing concerns from NHS staff?

11.48am Burnham welcomes the health secretary’s acceptance in full of the recommendation of the Kirkup report.

11.47am Burnham also criticises the health secretary for giving very detail about how seven day working will be funded, given that existing resources are already strained - “this announcement today appears to be unfunded”.

11.45am Burnham sharply criticises the health secretary for “declaring war” on the BMA and for the “provocative headlines” he has briefed.

“I do not believe that talk of imposing deals at this stage is helpful”.

11.44am Burnham says he supports in seven day working principle, but is concerned about the manner in which the health secretary is trying to drive through reforms.

“Isn’t there a risk of implementing seven day services by simply spreading existing resources more thinly?,” Burnham asks.

11.43am Responding to Hunt’s statement shadow health secretary Andy Burnham said he agrees with much of what he has said, but will focus his remarks to seven day working.

11.42am Hunt thansk “everyone who has come forward in recent thanks to reshape the culture of the NHS”.

11.41am Hunt: When we first introduced transparency in the NHS for patients, some called it running down the health service. In fact, public satisfaction has gone up.

11.40am Hunt: Around 6,000 people lose their lives every year because we don’t have a weekend service in hospitals.

11.39am Hunt: the change to the consultants’ contract, removing the option for weekend opt-out for newly qualified doctors, will be implemented from April 2016.

11.38am Hunt: I am today publishing the observations on seven day working from the Doctors and Nurses Pay Review Body.

11.37am Hunt: Today I am accepting all 19 recommendations of the Rose Review in principle, including moving responsibility of NHS Improving Quality from NHS England to Health Education England.

11.35am: Hunt: “e will accept all recommendations from the Kirkup report, including bringing in the regulation of midwives in line with the regulation of other professions.

11.34am Hunt says the Government will today publish its response to Sir Rober Francis’ second report, to Bill Kirkup’s report into care failings at Morecambe Bay, and to the Rose Review.

11.33am Hunt: the failings at Mid Staffs were not isolated, local failures. The Government and NHS have been facing them together, “but because the changes we need are largely cultural, a long journey still lies ahead”.

11.32am Jeremy Hunt has now begun his oral state to the House of Commons.

11.31am The Nuffield Trust has said the Government is “right to want seven-day access for patients to hospital and GP services”, which “should also help improve the flow of patients though hospital and the problems that result from the surge of demand on Monday”.

Responding to Jeremy Hunt’s announcements on transparency and seven day working this morning, chief executive Nigel Edwards said: “The Government is right to want seven-day access for patients to hospital and GP services. We must find ways to tackle higher mortality rates at weekends. Moving to a seven-day service should also help improve the flow of patients though hospital and the problems that result from the surge of demand on Monday.

“The truth is there is more than one reason for the longstanding problem of patchy weekend services. These proposals assume that the biggest obstacle to seven day working is that consultants are unwilling to work at weekends.

“But while more hospital doctors working on Saturdays and Sundays could help in some areas, other staff - from those trained in scanning and imaging to lab technicians and pharmacists – are just as crucial. Without this, we risk having hospitals full of consultants, but without the scans or tests patients need for the doctors to take action.

“Perhaps the biggest barrier to seven day working is finding the money to pay for it. The £8bn pledged by the government for the NHS by 2020 is only just enough to keep up with population change. Estimates suggest that seven day working will cost significant amounts of money, but it is still unclear where this will come from at a time when the NHS needs to find huge and unprecedented efficiency savings.

“A genuine seven day service will also inevitably mean tough decisions about merging or closing much loved local wards.

“We’ve argued for some time that fixating on just a few targets risks warping behaviour, and looking at wider information will do much more to help the NHS improve. It’s good to see the Secretary of State acknowledge this. He should start by relaxing the one-dimensional emphasis on decisions being made within four hours in A&E.

“It’s just as important to manage and understand other vital measures that are often overlooked, like trolley waits and the number of people who have to come back to emergency wards within a week.”

11.19am Jeremy Hunt is due to give an oral statement to the House of Commons immanently on NHS reforms.

Follow HSJ Live and @HSJnews on Twitter for full updates.

11.17am The internet entrepreneur and cross-bench peer Martha Lane-Fox has been tasked with finding ways to help increase the use of digital innovations in the NHS.

Jeremy Hunt has used part of a wide ranging speech this morning to set out how the government would look to embrace the potential for technology to “shift power to patients”.

Baroness Lane-Fox of Soho, the co-founder of the online holiday retailer Lastminute.com and chair of a charity teaching digital skills, has been asked to develop proposals to be presented to the NHS National Information Board by the end of the year.

11.10am NHS Clinicial Commissioners has said it “wecome[s] the move towards greater transparency”, and argued that clinical commissioning groups need to have “the freedoms and flexibilities” to continue to “evolve into a system that is focused on patient wellbeing as well as illness”.

Responding to Jeremy Hunt’s speech today, co-chairs Steve Kell and Amanda Doyle said: “We welcome the move towards greater transparency and agree with the Secretary of State that patients and local people should have more information about those who are accountable for buying and delivering their local healthcare services.

“We are keen to make sure the metrics and performance targets are right and that CCGs must have the ability to influence what’s measured to ensure the focus remains on outcomes on population health.  Reducing national targets is a positive step by Jeremy Hunt which starts to eliminate perverse incentives which is good for patients and good for local NHS systems.

“Our members already work on population based commissioning models, working in partnership with their local health economy to develop the local solutions that fit the needs of their populations and patients.

“Clinical commissioning continues to evolve into a system that is focused on patient wellbeing as well as illness, and we now need to enable that to go further and faster by ensuring they have the freedoms and flexibilities to truly transform care.”

11.07am Giving his take on the health secretary’s wide-ranging speech this morning, HSJ editor Alastair McLellan has described it as “a little overblown” and “effectively a roundup of overdue policy announcements which needed to be made before the summer recess and some kite flying of new ideas”.

11.03am The professional codes for nurses and doctors are fit for purpose - but further work should be done to provide incentives to ensure all staff are more open, the NHS medical director has reported.

Sir Bruce Keogh was asked to review the codes by Jeremy Hunt after the inquiry into maternity services at University Hospitals of Morecambe Bay Foundation Trust.

In a letter to the health secretary, published this morning, Sir Bruce said: “I believe the codes, as far as they go, are fit for purpose; and the insertion of the professional duty of candour is a welcome sign that the professional bodies recognise the importance of the issues you have raised.

“However, there is more that could be done. Not least a message that true professionalism includes a presumption towards open, frank and considered behaviour. I would like to work with the professional regulators to see what further incentives we could agree to ensure all NHS staff – whether clinical or managerial – are more open.”

10.57am Shaun Lintern also tweets:

10.55am HSJ correspondent Shaun Lintern, who was a ‘press huddle’ with Jeremy Hunt following his speech to the King’s Fund, reports that health secretary has not given a clear answer as to whether NICE will be given a veto over its staff staffing work.

He tweets:

10.45am Earlier today the British Medical Association criticised Jeremy Hunt’s “wholesale attack” on doctors over seven day services, which the body accused of being a “blatant attempt by the government to distract from its refusal to invest properly in emergency care”.

Speaking ahead of the health secretary’s speech to the King’s Fund this morning, BMA chair Mark Porter: said: ““Doctors support more seven-day hospital services and have repeatedly called on the government to outline how they will fund and staff them. Despite whatever the health secretary may claim, his simplistic approach ignores the fact that this is a much broader issue than just doctors’ contracts.

Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that for two years the government has failed to outline vany concrete proposals for introducing more seven-day hospital services. The health secretary has questions to answer. How does he plan to pay for it? How will he ensure there isn’t a reduction in mid-week services or fewer doctors on wards Monday to Friday? Yet again there are no answers.

“More than 80 per cent of the public believe that doctors alone cannot deliver seven-day services without proper support, yet the health secretary makes no mention of the extra nurses, diagnostic staff, porters, admin staff – the list goes on – that would be needed to deliver the same high level standard of care patients deserve seven-days a week.

“Doctors believe patients should have access to the same quality of care, seven days a week. If the health secretary wants the same he should be working with us, not setting artificial deadlines and attacking the very people who are the leading advocates for patients, protecting and improving patient care in the face of unprecedented rising demand and funding deficits.

“This is a blatant attempt by the government to distract from its refusal to invest properly in emergency care. So, I say again to the health secretary, get real and show us what you mean.”

“Doctors support more seven-day hospital services and have repeatedly called on the government to outline how they will fund and staff them. Despite whatever the health secretary may claim, his simplistic approach ignores the fact that this is a much broader issue than just doctors’ contracts.

10.36am The Care Quality Commission has said “welcome[s]” Jeremy Hunt’s “vision for ademocratic and innovative NHS which empowers patients and staff alike”.

In response to the health secretary’s speech this morning, CQC’s chief executive David Behan said: “As highlighted by the Secretary of State today, CQC’s new inspection model - with its unwavering focus on ensuring that everyone receives the safe, compassionate, high quality care they deserve - is showing real results.

“We will continue to use our inspections to identify where improvement in the care people receive is needed, to highlight and share good practice when we find it, and to give people the information they need to make informed choices about their care.

He added: “The NHS Improvement agency will play a vital role – a single agency focussed on ensuring that all NHS Trusts have the support they need to implement the improvements that they and CQC identify as necessary.

” And the new Independent Patient Safety Investigation Service (IPSIS) will bring both additional opportunities to learn, and additional rigour, to the current system through its investigation of individual patient safety incidents – providing another route via which patients’ voices can be heard, and helping the NHS learn from its mistakes and make improvements based on that learning.

“We are also keen to support IPSIS in its work on safe staffing levels. We know that sufficient staffing can have an impact on the quality and safety of care – although it is important that this work goes beyond numbers alone. We look forward to contributing to the development of this methodology to make sure it translates meaningfully into better care for patients.

“The feedback we have received tells us that people find CQC’s judgements on health and social care services useful – so I am pleased that Secretary of State has further demonstrated his confidence in our judgments by highlighting the need for people to have access to this information when they are making choices about their care.

10.30am After HSJ exclusively revealed last week that many of the functions of Monitor and the NHS Trust Development Authority would brought together in a single ‘new body’, which would also take on new patient safety and improvement work, Jeremy Hunt today announced that the merged body will be called NHS Improvement.

The body will be chaired by Ed Smith and Lord Ara Darzi will become a non-executive director.

The move was announced by the health secretary in a speech at the King’s Fund in London this morning.

He said he expected a new chief executive to be appointed to the body in September. Mr Smith will lead the recruitment process.

10.20am Martha Lane-Fox has tweeted:

She was asked by the health secretary to develop proposals for the NHS National Information Board before the end of the year as to how there can be a bigger uptake of new digital innovations in health by those who will most benefit from them.

10.15am The health secretary is determined to make his mark. Only time will tell if his ideas, which he claims constitute a “reformation moment” for the service, will be justified, writes HSJ editor Alastair McLellan.

10.14am Jeremy Hunt has promised ‘more transparency in return for fewer targets’ in a major speech setting out his vision for the direction of the NHS over the next 25 years today.

In March, England will become the first country in the world to publish avoidable deaths by hospital trust.

The King’s Fund will publish ratings on the overall quality of care provided to different patient groups in every health economy.

In his speech in London Mr Hunt also said:

  • Monitor and the TDA will be renamed NHS Improvement, with an explicit mission supporting providers to become more efficient and provide higher quality car;
  • The new regulator will be chaired by Ed Smith, currently NHS England’s deputy chair;
  • Lord Darzi has been appointed a non-executive director for NHS Improvement; and
  • NHS England’s patient safety function, led by Dr Mike Durkin, will be moved to the new regulator.

10.11am NHS England chief executive Simon Stevens said he welcomed the combined provider regulator bringing together Monitor and the NHS Trust Development Authority, announced by the health secretary this morning, as “heralding an era of much greater alignment across the national bodies” as set out in the NHS Five Year Forward View.

He said: “The appointment of NHS England’s vice chair Ed Smith as the new chair of Monitor/TDA, alongside a globally respected clinician of Ara Darzi’s standing are both hugely welcome.

“This sets the stage for much greater alignment between the commissioning and system leadership work of NHS England and the new improvement and oversight function for NHS provider trusts.

“The Forward View argued the need for strategic coherence in the national leadership of the NHS, and today’s moves are another step towards that, with further steps to come.”

10.08am An American healthcare corporation is being brought in to support five trusts in improving quality.

The health secretary this morning announced a five year, £12.5m programme to bring in Virginia Mason to five hospital trusts with a combined turnover of more than £2bn.

The trusts are:

  • Shrewsbury and Telford Hospital Trust;
  • Surrey and Sussex Healthcare Trust;
  • Barking, Havering and Redbridge University Hospitals Trust;
  • Leeds Teaching Hospitals;
  • and University Hospitals Coventry and Warwickshire.

Virginia Mason are being paid £9m by the Department of Health, with a further £3.5m set aside to cover costs such as airfares and managing the project.

The programme will see visits from Virginia Mason staff and the training of some staff at each trust on the Seattle based company’s methods and principles.

10.03am The Royal College of GPs has expressed concern the implication of Jeremy Hunt’s call for seven day working on GPs who are “already being pushed to our limits in trying to provide a safe five-day service for our patients”.

In response to Mr Hunt’s speech this morning, RCGP chair Maureen Baker said: “Today’s focus might be on hospitals but the Secretary of State’s announcement will sound the alarm bells for hardworking GPs who fear we will be next in line - even though we are already being pushed to our limits in trying to provide a safe five-day service for our patients.

“There is already a severe shortage of GPs and it’s difficult to see how we can be stretched even further to provide routine seven day opening.

“Many GP practices are already running extended opening hours but forcing GPs to do this would present a massive risk to patient safety by creating exhausted and overworked GPs.

“We also fear that it could precipitate a mass exodus from the profession, and it is our patients who will bear the brunt.

“More than half of all out of hours services in the UK are run by or led by local GPs. We think that the emphasis should be on better resourcing for these services and on making patients and the public aware of the services available so that they can have better access to the skills of a GP 24/7 when they need them.

“Family doctors are already working harder than ever, carrying out more than a million patient consultations a day - around 360m consultations per year. This equates to 150,000 more consultations per day compared with five years ago - the equivalent of the entire population of Oxford seeing their GP every day.

“We simply cannot do any more and continue to provide a safe service for our patients with the current resources and workforce available to us.

“Mr Hunt has acknowledged that general practice has been historically under-funded. We now need the Government to deliver on its pre-election promise of 5,000 additional GPs in England as a kick-start towards delivering the safe care our patients need and deserve.”

10.02am Jeremy Hunt has now finished taking questions from the floor. He isdue to answer oral questions in the House of Commons later this morning.

10.01am Hunt: “the way we get through this very, very tough period is by having an exciting vision for the future”.

9.58am Hunt: “One of the reasons we had Mid Staffs because in those days the defition of being a good CEO was to meet your targets… and live within your budget”.

9.57am Hunt: I’m not going to second guess CCGs on a local level, but they don’t always have the information to make smart commissioning decisions.

9.55am Hunt: “My frustration is not with doctors. I have yet to meet a doctor who doesn’t support seven day services… but I can’t hide my frustation with the BMA”.

The health secretary notes how he has been in discussions with them since 2012, and points to the union walkingout of talks last year.

9.53am Hunt: “In terms of the costs of sveen day working, the proposals won’t reduce the pay bill… in fact the pay bill may go up”.

9.51am Hunt says he never wanted national mandatory minimum staffing levels. “We won’t be able to afford the staff we need if we simply say we’re going to solve this problem by recruiting more and more staff”. He adds that we “need to be more intelligent” when it comes to appropriate staff levels.

9.50am Labour MP and health committee member Emily Thornberry asks whether Hunt is being “a little bit too confrontational” with the BMA.

9.47am Hunt: “We need to make sure we have a flexible system for seven day working, making use of technology.”

9.46am Hunt on seven days working: “this isn’t about asking any doctors to work longer hours”.

9.45am Hunt: “there is a huge amount across government” for tackling obsesity and public health.

9.43am Hunt: “we have moved on from the idea that we can’t share data because of data protection rules… We have a duty to share data when it’s in a patient’s interest”.

9.42am Hunt on health and social care: “We are looking at them absolutely as one entity”.

9.39am Hunt is asked by a GP about whether seven day working in general practice could be achieved in a network or co-operation than by individual practices.

9.38am Stephen Dalton from the Mental Health Network asks the health secretary to comment on the concern about social care.

9.35am Jeremy Hunt’s speech to the King’s Fund has now ended, and he is now taking questions from the floor.

9.33am Hunt: “The transition to patient power will dominate healthcare for the next 25 years.”

9.32am Hunt: I have asked Martha Lane Fox to develop “practical proposals” for the NHS Information Board before the end of the how to new digital innovations in health can be taken up and who can benefit from them.

9.30am Hunt: Today I can announce that NHS England will come up with “concrete proposals” before the end of the year to make sure there is meaningful choice offered in maternity and end of life care and for those with long term conditions”.

9.29am Hunt: from next year all GPs will be asked to tell patients not just which hospitals they can be referred to, but the releavent CQC rating and waiting time.

9.27am Hunt: There will be six weeks to work with the BMA union negotiators before a September decision on the new contract. “But be in no doubt: if we can’t negotiate, we are ready to impose a new contract.”

9.26am Hunt hits out at the BMA’s criticism of seven day working: “I won’t allow the BMA to be a roadblock to reforms that will save lives”.

9.25am Hunt: “By the end of this parliament I expect the majority of doctors to be on 7-day contracts”.

9.24am BREAKING: Consultant contract to be reformed to remove opt-out for weekend working for newly qualified doctors.

9.23am Hunt: “This is my offer to the NHS today: more transparency in return for fewer targets”.

9.22am BREAKING: The long-awaited Rose report will be published today.

9.21am BREAKING: Five NHS trusts will be buddied with the Virginia Mason hospital in Seattle, deemed by Hunt as the the “safest hospital in the world”.

9.20am BREAKING: Mike Durkin’s patient safety function will move to NHS Improvement, and Dr Dukin will also set up an airline-style Independent Patient Safety Investigation Service modelled on the Air Accident Investigation Branch, which fosters a “no blame culture”.

9.19am BREAKING: Hunt announces new operating name for joint-led Monitor-TDA body will be NHS Improvement, chaired by Ed Smith and with Ara Dazi as a non-exec director. The chief executive is yet to be appointed.

9.18am Hunt: “We need to move towards Valancia-style population-level commissioning”, but “we can be officially neutral” about what solutions different parts of the country are trying out.

9.16am Hunt: every health secretary arrives in office committed to local decision making, but any epidemicor scandal means they “discover their inner Stalin”. But “independent, smart measures of performance area by area” means heath secretary can relax a little”.

9.15am Intelligent trnasparency also means “an intelligent conversation with the public about the role we all need to play to make ourselves a healthier nation”.

9.13am Hunt: NHS has been “famously descibed as a national relgion, but the problem with religions is that when you question the prevailing orthodoxy, you can end up facing the Spanish Inquisition”. However, intelligent transparency is becoming thr “reformation movement”.

9.12am Hunt: Intelligent transparency goes beyond hospital, for example to GP surgeries and domicillary care. Next year we will become the first country in the world to publish avoidable deaths by hospital trust.

9.11am Hunt: Nearly all 11 Keogh trusts have shown “dramatic signs of improvement”, many decribing a “dramatic change in culture”.

9.10am Hunt describes “intelligent transparency”, which has prompted “some fairly predicatable opposition”, with political opponents accusing his announcement of 11 Keogh hospitals as running down the NHS.

9.09am Hunt: Decades of building processes around system targets and objectives, often with best intentions, has demoralised staff.

9.08am “If we truly want to change from a patient-centric system, the NHS needs a profound change in its culture”.

9.07am Hunt: Government is willing to support the NHS Five Year Forward View financially, supported by a strong economy, “but alongside a plan, we need a vision.

9.05am Hunt: The Francis report “shocked me to the core” and Mid Staffs was a “total betrayal of what the NHS stood for”, which was emblematic of a targets-driven culture

9.04am Hunt: “Conservatives have been responsible for the NHS for more of its history than any other party.”

9.03am Hunt: “The NHS was most definitely on the ballot paper” during the last election.

9.01am Jeremy Hunt has just begun his speech to the King’s Fund, which he has said is “probably the most important speech that I have given as health secretary”.

8.43am HSJ correspondents Sophie Barnes and Shaun Lintern will be reporting live from Mr Hunt’s speech at the King’s Fund. Follow @sophieevebarnes on Twitter for live tweets.

8.41am Ahead of Mr Hunt’s speech this morning, NHS Employers chief executive Danny Mortimer said: “Today sets a clear direction for reform which is good news for patients and we now need to work together with our medical colleagues and their trade union, the BMA, to implement the changes the Secretary of State has indicated.”

8.29am Jeremy Hunt has just appeared on the Today programme. He repeated many of the themes he’s been making throughout the morning.

He said changing consultants’ contracts would bring back a “sense of vocation”, and be supported by medical directors up and down the country because of their struggle getting consultant cover on weekends.

He said the NHS had the opportunity to use the Mid Staffs scandal as a “turning point” to make the NHS the safest health system in the world. He also said he had yet to meet a doctor who would be happy for a family member to be admitted to hospital on a Friday or Saturday.

However he did say the NHS would need more consultants.

8.11am Following his major speech at the King’s Fund, Mr Hunt will also be making an oral statement in the Commons later in the morning, responding to a number of reports. Stick around for comprehensive coverage of both.

7.59am A good question from Richard Humphries of the King’s Fund. You’d think that if the health secretary is outlining a 25 year vision for the NHS he could not afford to leave out social care:

7.56am However, he said the government would not ask any doctor to work longer hours or unsafe hours.

7.53am He also said that access to urgent diagnostic tests and professional handovers were also key.

7.51am Jeremy Hunt is doing a tour of the broadcasters this morning. Appearing just now on BBC Breakfast, he said the lack of consultant cover over the weekend was one of the “critical things” contributing to avoidable death.

7.30am HSJ understands that the government will today finally publish the long awaited ‘Rose Review’, the review of NHS leadership carried out by former Marks & Spencer chief executive Lord Rose.

The BBC’s health editor, Hugh Pym, suggests something to look out for in the report:

7.21am Jeremy Hunt has made an appearance on Sky News. Here’s what the Conservative health team tweeted earlier:

7.17pm John Humphries made a slight slip up when he referred to the health secretary:

7.09am The government’s plans to reform consultants contracts is the lead story of Radio Four’s Today programme, this morning.

6.00am Good morning. Health secretary Jeremy Hunt will today lay out his “25 year vision” for the health service in a wide ranging speech at the King’s Fund.

Mr Hunt is due to start speaking at 9am, and the speech is expected to include a direct challenge to the BMA to co-operate with him on bringing about seven day working for consultants. The wide ranging speech may also herald significant changes to the regulatory landscape, and moves to give more power to patients.

He will give doctors an ultimatum over seven day working and make a direct challenge to the British Medical Association over seven day services.

Mr Hunt will say he will not allow the doctors’ union to be a “road block” to reform, and will impose a September deadline on negotiations.

Earlier this month HSJ revealed that the Department of Health and other national officials were working on plans to bring together many functions of Monitor and the NHS Trust Development Authority in a single “new body”, which would also take on new patient safety and improvement work. This is expected to feature in Mr Hunt’s speech.

HSJ will provide the most comprehensive coverage of the speech and what it means for the NHS. Check HSJ Live throughout the day for updates.

HSJ correspondents Sophie Barnes and Shaun Lintern will be tweeting from the event in London. You can also follow HSJ news team on Twitter for the latest developments.

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