HSJ Live 19.12.2014: NHS planning guidance live coverage

5.10pm Huge importance has been attributed to prevention in both the Five Year Forward View and in the planning guidance. Here’s what the man responsible for driving improvements in public health, Duncan Selbie, the boss of Public Health England, had to say about the guidance:

“The NHS Five Year Forward View makes clear that Government, the health service, employers everywhere and people themselves have to get serious about tackling obesity, alcohol and tobacco if we are to help the NHS further cope with demand going forward. We are wholly in support of this planning guidance which puts prevention at its heart along with new models of care and patient and public empowerment.”

4.58pm Some more comment on the planning guidance from the health service’s national leadership. Here’s what Monitor chief executive David Bennett said:

“The NHS needs to focus on delivering for today while also planning for tomorrow. Introducing the new models of care that we set out in the Five Year Forward View is fundamental for ensuring services are sustainable in the long-term. Over the next year Monitor and our national partners will put the NHS planning process under closer scrutiny to ensure providers and commissioners work together to deliver the services local patients need. Crucially, we will also build on our existing support arrangements to offer additional help to local health economies in significant difficulty, so that all the relevant local institutions in an area are able to address their current performance challenges together and create the conditions for future transformation.”

4.55pm As we move closer to the Christmas break, a festive question: how much did Monitor spend on its Christmas party?

Yesterday health minister Dan Poulter revealed that figure in response to a parliamentary question from Labour backbencher Steve Rotherham.

Monitor’s planned expenditure for Christmas parties this year totalled £4,695.50.

The regulator employs over 400 staff.

Dr Poulter’s response also revealed that the Health and Social Care Information Centre’s planned Christmas expenditure totalled £200 on decorations and trees.

4.45pm Here’s Health Foundation chief executiveJennifer Dixon’s comment on the planning guidance:

“The focus on accelerating change to improve quality of care and prevent ill health is welcome. The obvious question is how. The planning guidance makes useful suggestions, in particular to support new models of care and in areas that are struggling the most. But there now needs to be a coherent and evolving improvement strategy across the NHS. The ingredients of this include: scaling up quality improvement capability at the front line; a boost to operational excellence and managerial competence in providers; intelligent leadership willing to take calculated risks based on evidence; and a long-term policy environment which helps.  Not all of this is in place yet, but it should be firmly developed over the next 5 years to support the ambition of the NHS Five Year Forward View - co-created between the service and the national ‘system stewards’.

“The Planning Guidance suggests that while work will start in 2015/16 on building strong partnerships for future service transformation, the NHS will need to focus on achieving performance standards and will need to live within its financial means. This to-do list will be incredibly tough and the challenging financial situation facing the NHS next year should not be underestimated.”

4.14pm Here’s some more information about how the first providers will move to the new models of care outlined in the forward view.

Areas wanting to the be the first sites to develop the new models of care must express their interest by 2 February.

Some of the first sites will be agreed in February, and their programmes will be developed by the end of March. 

The process will be overseen by a New Models of Care Board, co-chaired by NHS England and Monitor.

There will be prototypes for four new models of care. There include multispecialty community providers (MCPs) and integrated primary and acute care (PACs) systems which were both set out in the forward view.

They will also be testing out models of enhanced health in care homes and “additional approaches to creating viable smaller hospitals”, such as specialist franchises and management chains, recommended in the Dalton Review.

4.01pm You can find the full planning guidance document here.

3.58pm The guidance reaffirms the move to a whole health economy approach to planning and regulation and says that in order to “progress the Forward View, the chief executives of the six national bodies will serve as a single leadership group, working with a broad coalition of partner bodies”. In addition to further the prevention agenda Public Health England will work with NHS England to help assure commissioners’ plans.

3.48pm The planning guidance makes some pretty important announcements on mental health.

The document, published by NHS England today, also makes clear CCGs must raise their mental health spending to at least the level of their individual allocations.

NHS England is demanding the rise to help fund the parity of esteem agenda and the move towards new access standards for mental health services from next April.

3.45pm Here’s what the organisations that authored the planning guidance have flagged up about it:

• sets outs seven approaches to a radical upgrade in prevention of illness, with England becoming the first country to implement a national evidence-based diabetes prevention programme
• explains how £480 million of the extra funding… will be used to support transformation in primary care, mental health and local health economies;
• makes clear the local NHS must work together to ensure patients receive the standards guaranteed by the NHS Constitution;
• underlines the NHS’s commitment to giving doctors, nurses, other staff and carers access to all the data, information and knowledge they need to deliver the best possible care;
• details how the NHS will accelerate innovation to become a world-leader in genomic medicine and testing and evaluating new ideas and techniques.

3.40pm For the first time ever the annual planning guidance has been and jointly produced by NHS England, Public Heath England, Monitor, the NHS Trust Development Authority, the Care Quality Commission and Health Education England (the same six organisations who authored the forward view).

That being the case, the leaders of those organisations have all commented on the guidance. Here’s what Simon Stevens, the chief executive of NHS England and the man who spearheaded the forward view, had to say:

“Today we are allocating extra cash for towns, cities and villages across England to help the local NHS meet the rising demands and changing needs of the patients we’re all here to serve. Frontline nurses, doctors and other staff are working incredibly hard – including over this holiday period - but with a growing population and an aging population it’s clear the health service can’t just keep running to catch up. Instead we need to begin to radically reshape the way we care for patients, which is why there is such widespread support and enthusiasm for the NHS Five Year Forward View.”

3.36pm HSJ’s main story on the planning guidance is now live:

Planning guidance for the NHS in 2015-16, published this afternoon, reveals NHS England wants to set up a cohort of health economies that can develop “prototypes” of new care models such as primary and acute care systems and multispeciality community providers.

The Forward View into Action says those sites chosen to be in the “vanguard” must already have a record of “tangible progress” to new ways of working over the past year and positive relationships between commissioners and providers.

The selected areas will receive investment from the transformation fund announced earlier this month as part of the chancellor’s autumn statement.

3.31pm The planning guidance is now out. Here are some extracts from NHS England’s press release:

“The leaders of the NHS in England today set out new steps to be taken during 2015/16 to deliver the NHS five-year forward view.

“Called The Forward View into action: planning for 2015/16, the planning guidance is backed by the recently-announced £1.98 billion of additional funding, with specific allocations each area of England.

“In allocating the £1.98 billion (which is on top of the cash the NHS was already expecting next year), NHS England is passing £1.5 billion to frontline health services including primary care, local clinical commissioning groups (CCG), and specialised services.

• every CCG will get real terms budget increase… More of the extra funding for local health services is being used to more rapidly increase NHS budgets where health needs are greatest, and for those parts of the country where the population is growing rapidly, and where services are under greatest pressure.
• spending on GP and primary care services will for the first time in a number of years grow in real terms at a higher rate than for other local health services, in recognition of the pressures in primary care.
• to begin tackling relative underinvestment in mental health services, every CCG will be expected to use its extra funding to increase funding for local mental health services in real terms next year by at least the level of the CCG’s overall funding growth. In addition a further £110 million of dedicated purchasing power is being injected to improve services for people with severe mental health problems, with anxiety and depression, and with eating disorders particularly children and adolescents.” 

2.44pm HSJ’s Life of Brian themed 2014 Christmas cover has gone down a storm today on Twitter, with lots of people suggesting other quotes we could have put in speech bubbles. Why not post your own captions under the line of our cover story?

2.32pm The 2015-16 CCG allocations and planning guidance is expected in the next couple of hours. As soon as they are available we’ll let you know, so stand by for news and in depth analysis.

1.40pm The Competition and Markets Authority has cleared the proposed merger of Chelsea and Westminster Foundation Trust and West Middlesex University Hospital Trust.

The competition watchdog analysed the merger on the basis of its impact on competition to attract patients for both inpatient and outpatient services by specialty, and to provide both elective and emergency services for commissioning bodies.

The CMA’s investigation looked at whether the merger was in the overall interest of patients and found that it will not lead to a material reduction in competition between hospitals in the area or loss of choice for patients, CCGs, or NHS England. It said there will remain a number of alternative providers in the areas affected. These vary by specialty of treatment but include Imperial College Healthcare Trust, London North West Healthcare Trust, Royal Free London Foundation Trust, Great Ormond Street Foundation Trust and Hillingdon Hospitals Foundation Trust.

The CMA does not believe that the merger will lead to a material reduction in the quality of services for patients (including clinical factors such as outcomes, infection rates and mortality rates, and non-clinical factors such as waiting times and patient experience) and will not materially reduce the hospitals’ incentives to innovate and improve their services.

CMA director of mergers group, Nelson Jung said: “The CMA has now considered a number of hospital mergers and has cleared the majority of them. We have also issued guidance explaining our role in reviewing NHS hospital mergers earlier this year. As a result, it is increasingly understood that patient choice and the quality of healthcare services are at the heart of our assessment. The smooth running of this case is also attributable to the parties engaging early with both Monitor and the CMA to ensure that mergers raising no material competition issues can be dealt with swiftly.”

1.32pm NHS Employers has responded to the announcement of new strikes early next year by health unions.

Danny Mortimer, chief executive of NHS Employers said: “NHS staff have received either an increment (worth around 3.4 per cent) or a one per cent pay award this year. Employers are of course disappointed that a number of trade unions will again seek to disrupt the delivery of care, impacting on patients and their families as well as their colleagues.

“This is one of the busiest periods for the NHS. We hope that trade union members will maintain their previous constructive approach, so that the most urgent patients continue to receive the care and treatment they need.

“Discussions continue with trade unions regarding pay, though agreement has, we acknowledge, been difficult to reach. Employers continue to be clear that they cannot afford further increases in pay at this time.

“A pay award for all staff on top of increments would have the equivalent of 14,000 newly qualified nurses, which could have put further pressure on the health service and staff as they strive to give safe, quality patient care.”

1.30pm NHS England has published updated guidance to help commissioners, GPs and providers support mental health patients exercising their legal rights to choose who provides their care and treatment.

In April 2014 the government established for people with mental health conditions the same legal right to choice of provider as has existed for several years in physical health, representing a major step towards realising parity between physical and mental health.

NHS England published interim guidance in May 2014 and consulted widely on this.

In response to the feedback received, the guidance has been updated. In addition a set of clinical scenarios to illustrate how mental health patients’ legal rights should work in practice have been published.

Care minister Norman Lamb MP said: “I am absolutely determined to achieve equality between mental and physical health care. That’s why, for the first time, we’re making sure anyone referred for mental health treatment has the right to choose who provides their care, as is the case with physical health.

“This guidance is an important step in helping health and care providers support people with mental health problems to make informed decisions about their care.”

12.55pm The Department of Health has responded to the news that NHS workers will strike in the new year.

A DH spokesman said: “This is disappointing. NHS staff are our greatest asset and we want to make the current pay system fairer - which is why we have put forward proposals that would guarantee all staff would get at least a 1 per cent pay rise this year and next, but these have been rejected by the unions.

“We have taken tough decisions to increase the NHS budget, but we can’t afford a consolidated pay rise in addition to increments without risking 10,000 frontline jobs.”

12.30pm A specialist cancer trust in Merseyside is pressing ahead with plans to build a new centre in Liverpool.

Clatterbridge Cancer Centre Foundation Trust claims its proposals have been met with “resounding approval” from people in the region, even though one of its current sites will lose services.

Under its plans, Clatterbridge will build a new hospital on the same site as the Royal Liverpool University Hospital and University of Liverpool.

12.23pm Here’s what Christina McAnea, Unison’s head of health, had to say about the strike action:

“We warned months ago that this dispute is here to stay unless the government and NHS employers are prepared to negotiate with us.

“Today is likely to be the busiest day in the NHS with ambulance and accident and emergency staff put under huge pressure to deal with the fallout from the many Christmas parties taking place across the country.

“We have decided not to take strike action over the Christmas period as services are already at breaking point at this time. Our members are demonstrating their concern for patient safety. I only wish the employers and government would do the same.

“Instead they are being completely irresponsible by refusing to have meaningful negotiations on how we resolve this dispute. And they are putting patients lives at risk.

“Our members’ pay has been frozen or held down for the past five years and there is no end in sight. On average, they have lost around 10 per cent in the value of their pay over the life of this parliament.

“We now have no option but to escalate and plan for longer strikes. The anger among health workers has reached levels where they are now ready to walk out for 24 hours. NHS staff have been singled out by this coalition government for the worst treatment across the public sector.

“Other groups will get their recommended pay increases – for MPs this is 11 per cent.

“In the NHS, many workers are facing serious financial hardship especially at this time of year. It is a national disgrace that 77,000 NHS staff still don’t receive the living wage and that many have to rely on food banks. The governments in Wales and Scotland have committed to paying this.

“All we are asking is for fair and decent pay for NHS workers.”

12.16pm: NHS staff in England and Northern Ireland will strike for 48 hours in January over a pay dispute.

Members of 11 unions, including Unison and the GMB, will strike or 12 hours on 29 January, between 9am and 9pm. They will then work to rule between 30 January and 24 February, before a 24-hour strike on 25 February.

Unions have already taken strike action in October and November. This third round of action is in protest at the government’s decision to reject the a 1 per cent pay rise for NHS staff as recommended by the Pay Review Body and that many staff will not get a pay increase in 2015-16.

11.39am The four regions selected as ‘pathfinders’ to pilot aspects of the care.data patient record sharing programme will not begin extracting patients’ data until the project’s watchdog is satisfied that outstanding concerns surrounding patient consent and GPs’ legal responsibilities are addressed, a report has said.

The Independent Information Governance Oversight Group, led by national data guardian Dame Fiona Caldicott, has laid out 27 questions about the programme’s implementation.

11.19am The national data guardian, Dame Fiona Caldicott, and the Independent Information Governance Oversight Panel have reported on the current state of preparation for the ‘pathfinder stage’ of the care.data programme.

10.37am In case you can’t quite read some of the speech bubbles on our Christmas cover, NHS England chief executive, Simon Stevens (who is definitely not the messiah) is telling the assembled throng of health service worthies who are hanging on his every word: “You don’t NEED to follow ME! You’ve got to think for yourselves. Now, sod off!”

10.10am NHS England has dropped a controversial scorecard that was supposed to help it make decisions about whether to fund treatments for a number of rare conditions.

It will also launch a 90 day consultation in January on its approach to choosing which treatments to commission, meaning patients will not be able to gain routine access to drugs for months.

NHS England developed the scorecard earlier this year to compare the merits of different treatments, but in a paper presented at its monthly board meeting on Wednesday it confirmed it would not be used in the 2015-16 commissioning round.

9.30am Good morning and welcome to HSJ Live. Seeing as its the last Friday before Christmas, we begin the day with HSJ’s 2014 “Christmas cover”.

This year’s cover is lovingly ripped off from an idea by HSJ comment editor Andy Cowper, who himself ripped off Monty Python’s Life of Brian.