Oxford NHS cancer centre loses scanning contract to private firm

Doctors express disgust after eminent hospital fails to win tender for PET-CT services.

Guardian 6th March 2019

NHS chiefs are pushing through plans to let private companies take over scanning services that are vital in treating cancer patients, having told ministers last week that privatisation was harming patient care.

Despite its international reputation for cancer care, Churchill hospital in Oxford has lost its contract to carry out PET-CT scans to InHealth, a private company, as part of the tendering process, the Guardian can reveal.

Doctors at the hospital said they were “disgusted” by the loss of the contract, warning that people receiving cancer treatment in the hospital will have to be taken by ambulance to two new locations at which InHealth’s scanners will be located. The decision has raised questions about NHS England’s professed desire to end the outsourcing of patient care, which it outlined in a detailed policy document released at a board meeting last week.

The Churchill is the first NHS hospital to lose out as a result of NHS England deciding in 2016 to put positron emission tomography-computed tomography services out to tender. The 3D scans of inside the body help doctors spot tumours and check if cancer treatment is working.

NHS England initiated the tender process to save money. However, major teaching hospitals, including King’s College hospital in London, and cancer hospitals such as the Christie in Manchester, are also at risk of having PET-CT services handed to the private sector.

NHS England has invited profit-driven companies to bid against NHS trusts for contracts to provide PET-CT scanning in 11 different areas of England.

Labour demanded that the health and social care secretary, Matt Hancock, block the sell-off.

“This latest NHS privatisation exposes as utterly hollow the health secretary’s promises to parliament that there will be no privatisation on his watch,” said Jonathan Ashworth, the shadow health and social care secretary.

“Just last week, NHS England claimed it wanted to bring an end to the constant tendering of contracts that the Lansley reorganisation ushered in. Patients will therefore consider it bewildering this privatisation has been allowed to proceed.”

Oncologists at the Churchill are “very concerned” by InHealth – a British company that already provides diagnostic services to the NHS – starting to provide PET-CT scans to the 2 million people who live in the Thames Valley area.

The hospital, which has performed that role since 2005, will now have to hand back the two scanners it leases in order to produce the images.

“Another provider might offer scans more cheaply, but will they match the quality?” an oncologist said.

“We’re worried people may end up needing rescanning and, at the end of the day, ultimately it is patients who will suffer.”

The expertise of the Churchill’s nuclear medicine department in undertaking high-quality PET scans will be lost to the NHS, the doctor added.

Specialist cancer doctors at Oxford University hospitals NHS trust, which runs the Churchill, said they have “concerns about the potential impact on the safety and quality of patient care at the loss of the current PET-CT service at the Churchill”.

They added: “If the service was no longer provided here, it would mean that very sick patients at the Churchill would need to travel off-site for a scan, which could have a negative impact on their health.”

Paul Evans, who runs the NHS Support Federation, which monitors privatisation of healthcare, said: “There’s a jarring contradiction between the proposals to privatise these cancer services and recent statements from NHS England about the failure of this kind of tendering.

“PET-CT is of crucial importance in the management of patients with cancer. So why risk the care of patients by taking this service away from a world-renowned centre with an established team of experts in the field, working together within the NHS, to move the service into the private sector?”

InHealth did not respond to requests for comment.

NHS England insisted existing EU-wide procurement law meant it had to tender the services. “The law is as yet unchanged in the way we recently recommended it should be, so in the meantime, existing procurement rules apply. In the Thames Valley, this particular process means two new sites being introduced for this particular scanning,” a spokesperson said.

Guardian March 6th 2019

………

Anyone hoping from the Guardian headline (28 Feb 2019 ‘Scrap laws driving privatisation of health service, say NHS bosses’) that Simon Stevens and those running NHS England are really about to stop NHS privatisation  will see that privatisation is going on, full steam ahead. 
 
NHS England board said “We propose that the regulations made under section 75 of the Health and Social Care Act 2012 should be revoked.” NHS England’s excuse that until this happens, existing EU laws on compulsory procurement must apply is simply untrue. 
They can stop the tendering – and haven’t – at a ‘stroke if a ministerial pen’, as Peter Roderick (barrister and member of NHS Reinstatement Bill Steering Group), explains in a Guardian letter 8th January 2019:​  
 
‘A repeal of the 2012 Health and Social Care Act is long overdue, but it is not necessary to repeal key sections of it in order to end “automatic tendering” (Time to curb privatisation of care, NHS chiefs tell PM, 8 January). The act only empowers the government to require tendering and the requirement is imposed under secondary legislation – the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013. These can be revoked with the stroke of a ministerial pen.
 
Getting rid of these and abandoning the intended long-term “integrated care provider” contracts would start to give some credibility to claims that privatisation of the NHS in England is ending.
Peter Roderick
London
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Four hour waiting times to be scrapped?Campaigns against NHS centralisation and closures; Support for Birmingham Care Workers.

1) Patients Association appeals for survey responses:

A report in The Times has suggested that the four-hour A&E target could be scrapped. It is known that standards across four areas of care – A&E, elective surgery, cancer and mental health – are being reviewed by Professor Stephen Powis, NHS England’s Medical Director. This review was part of the deal under which the Prime Minister announced additional funding for the NHS last summer.
It is not clear whether the review will produce any major changes, though many rumours have swirled in the media in recent weeks. Its initial findings are expected to be published this spring. The review prompted the Patients Association to run a survey on waiting times and other targets. Scroll down until you find link for the survey:

Many in the NHS credit existing waiting times targets with eliminating the longest waits and serving as a good barometer of wider health service performance. However, the target has not been hit since July 2015 as hospitals deal with rising numbers of older, sicker patients.
The target to discharge, admit or transfer 98 per cent of patients arriving in A&E within four hours was introduced in 2004 and set at 95 per cent in 2010.

Lucy Watson, Chair of the Patients Association, said:
“It’s essential that patients’ views should be listened to and acted on through genuine consultation before any major change to what the NHS provides. Whilst a change to performance standards in A&E might not be seen as a major change the impact for patient experience and safe care for patients could well be major. When patients wait over four hours to be admitted in an A&E department they are often waiting in corridors and on trolleys, and the department is so busy that the staff are struggling to care for all the acutely unwell patients waiting . Lack of timely access to treatment leads to poorer outcomes for patients.”

2) Relevant to our campaign to stop centralisation of all acute stroke wards to University Hospital Coventry and Warwickshire and to keep stroke wards open at Warwick and George Eliot Hospitals is article in ‘Independent’ on similar campaigns elsewhere:

‘NHS campaigners are joining forces around the country in a last-ditch bid to save “vital” emergency services from closing, i can reveal. Grassroots campaigns in Kent, Shropshire and Dorset are among those mounting further challenges to save A&E, maternity and stroke units as well as mental health beds. They have formed a closer network having seen campaigners in the south west being given the green light this week to mount a second legal challenge against proposed cuts. Defend Dorset NHS lost a judicial review last year.

Read more at: https://inews.co.uk/news/health/nhs-hospital-cuts-campaign-groups-stop-closures/.

3) We support the struggle by Care Workers in Birmingham against Birmingham City Council cuts. Their dispute has been ongoing for over a year. We have sent £50 to Unison in support of care workers’ action.

There is a rally in support of the Care Workers and Bin Workers on Tuesday 12 March, 6.30pm:

NHS Long-term Plan

Our critique of the NHS Long-term Plan. Here is the KONP YouTube Channel video with a short interview with Gay Lee, of Lambeth KONP together with the live-streamed video of the NHSE Board meeting 31/1/2019 where she spoke so brilliantly about the plan and the absence of serious plans for the NHS workforce.
It’s on Twitter and Facebook too – so please share:
Also: the two posts this week on migrant charges

https://keepournhspublic.com/news/dont-ask-migrants-to-pay-the-nhs-was-set-up-to-serve-us-all/

And related issues and the NHS latest performance figures:

 

Warwickshire County Council agrees to support the Integrated Care System, February 19th 2019

Warwickshire County Council (WCC) held a special meeting to debate the NHS, and the Integrated Care System, on 19th February 2019, around a motion put forward by Cllr. Les Caborn,  portfolio holder for Adult Social Care and Health, WCC..

The motion reads:

This Council believes that an integrated care system focused on communities is the right way forward for the health and wellbeing of citizens in Warwickshire.

SWKONP has attempted to persuade WCC to place major amendments to this motion.

Anna Pollert, SWKONP Chair, held meetings on Thursday 14th February with Labour and Lib Dem councillors to discuss their possible support for the following amendment, suggested by John Lister editor of newspaper ‘Health Campaigns Tother’:

Suggested amendment: Delete “an” and “system” from line 1,  and add at end:

“However Council also believes that a system delivering integrated care needs to be open, transparent and accountable to the people of Warwickshire, and must therefore establish a board to take its policy decisions which includes representation from the public, which meets in public, is subject to the Freedom of Information Act, and which publishes its board papers. None of these are part of the current proposals for “integrated care systems”.

“This Council further notes that despite the early rhetoric on the need to include councils in their deliberations, not one of the 44 Sustainability and Transformation Plans offered any serious proposals to address the financial problems of funding social care, or any significant influence for local councils, without which “integration” is simply an empty word

“Council notes that even now joint working with local government is only mentioned once, fleetingly, in the NHS Long Term Plan published last month. It is clear the local authorities have once again not even been consulted on the Plan, which simply suggests there is a “clear expectation” that “local authorities, the voluntary and community sector and other partners” will wish to participate (p30).

“Councils are elected bodies with a duty to stand up for the interests of local people: any support for integrated care has to be conditional on securing changes that ensure councils can play this role within them, rather than meekly rubber-stamping plans drawn up and implemented without consultation by the NHS.”

Report on WCC Meeting February 19th 2019.

Guest speakers from the NHS and voluntary sector, the public and councillors debated the motion and SWKONP members Bill Kaye, Dennis McWilliams, Anna Pollert, Martin Drew and John Lister spoke for three minutes each on the ICS.

SWKONP contributions can be seen on WCC Webcast at 1hr 4 mins in: https://warwickshire.public-i.tv/core/portal/webcast_interactive/394887

Anna sent the following press release to the local press:

SWKONP Press release 19th February 2019 SWKONP attends Warwickshire County Council debate on health and social care

Members of South Warwickshire Keep our NHS Public joined the public debate at Warwickshire County Council’s special meeting on health and social care, and its motion to support the Integrated Care System.

Anna Pollert, Chair of SWKONP, pointed out that we all support greater integration of health and social care, but a major barrier to their integration is that health care is free, but social care is not and is means tested. ‘For integration to really work’, she said, ‘social care must be properly funded and brought into public provision, free at point of use’. She also explained that what had not been mentioned in the Council’s discussion on greater ‘integration’, was the Integrated Care Provider contracts to run Integrated Care Systems. ‘These would be multi-billion pound contracts for 10-15 years, and open to public/private partnerships – with potential slippage to privatisation. If ICSs are not Trojan Horses for privatisation, NHS England should insist that the contract can only go to an NHS body or other statutory provider’.

SWKONP member, Martin Drew, turned to the starvation of social services, which, he said ‘are on the critical list. Coventry and Warwickshire will have reduced adult social care spending by £13.5m by 2020 with an extra £398,000 of cuts to disability services. Since 2010, £7 billion has been slashed from England’s care budgets with a swingeing £700 million cut to care budgets in 2018-19. This has ramped up the pressure on GP surgeries, A&E departments and other NHS services.’ How could integration work with a starved social care system?’

SWKONP supported councillors who demanded proper resources and transparency. John Lister, health campaigner and editor of Health Campaigns Together argued that local councils needed a proper input into plans:  ‘a system delivering integrated care needs to be open, transparent and accountable to the people of Warwickshire, and must therefore establish a board to take its policy decisions, which includes representation from the public, which meets in public, is subject to the Freedom of Information Act, and which publishes its board papers. None of these are part of the current proposals for “integrated care systems”. Councils are elected bodies with a duty to stand up for the interests of local people: any support for integrated care has to be conditional on securing changes that ensure councils can play this role within them, rather than meekly rubber-stamping plans drawn up and implemented without consultation by the NHS.”

Cllr. Helen Adkins (Labour) also sent out the following press release:

PRESS RELEASE: FOR IMMEDIATE RELEASE

19/02/19
Warwickshire County Council passes Labour amendment asking the government for more money for Health and Social Care

This Tuesday, Warwickshire County Council held a Public Interest Debate which focused upon Health and Social Care in Warwickshire. The original Tory motion asked for backing for a formalisation of an integrated care system for Warwickshire. The Labour amendment, which was passed, called for more money from central government to fund such a move. This amendment comes in the light of the fact that the 2% extra levy being used to prop up Social Care for the past 5 years will end this financial year, leaving a short-fall which will have a devastating impact on the people of Warwickshire.

Labour Group spokesperson for Health and social Care, Cllr Parsons, who moved the Labour amendment, stated ‘Whilst we support the motion for an integrated Health system, it is impossible to deliver it without proper funding. There is a crisis in funding in Adult Social Care and Health and furthermore, the extra levy topping funding in this area comes to an end at the end of this year, which leaves a gap in funding which is already stretched.’ Labour Cllr Webb added, ‘We want a strong, healthy and vibrant NHS to care for the people of Warwickshire. An integrated system should be adequately and sustainably funded.’

The meeting included presentations by a number of guest speakers and an opportunity for the pubic to speak. Anna Pollert, of Keep Our NHS Public, spoke at the meeting and was pessimistic about the relevance for the formulisation of an integrated care system. She argued, ‘I do not think the County Council should support the Integrated Care System, another top-down re-organisation by NHSE and only a new name for Accountable Care Systems, the successors to the STPs. The positive-sounding word ‘integration’ hides the fact that these new ‘systems’ are still Trojan Horses for cuts and rationing of health-care, as the STPs were. ICSs will harden the fragmentation of the NHS, begun as the 44 STP footprints, into around 40 ICSs across the country. Where will the unified, comprehensive system of the National Health Service go? ICSs will be based on an Integrated Care Provider (ICP) contract, which will run for 10-15 years, be open to public/private partnerships. They will be multi-billion £ contracts, and attractive to major health corporations. If NHS England really wanted to assure the public there would be no risk of a private contractor getting the contract, they should insist that the contract can only go to an NHS body or other statutory provider.

Martin Drew, also of Keep Our NHS Public added, ‘Like motherhood and apple pie, integrating the Care System sounds like a good thing, like joined up thinking is always a good idea. Just one problem, it ignores reality: the crises across the board in health and social care caused by chronic underfunding and understaffing. Integrated Care will do nothing to address the urgent need for a major transplant of money. Coventry & Warwickshire STP, sorry, accountable care system/organisation, sorry Better Health, Better Care, Better Value/ Integrated Care Partnership will have cut £270 million during the present 5 year reconfiguration plan. As demand has risen because of an ageing population, every area has had to cut services and increase waiting times. Children’s Centres closed, A& E waiting times ballooned, mental health services continue to be starved of funding, local voluntary sector support charities have had funding cut by up to 60%. Above all, as Niall Dickson CEO of NHS Confederation stated, “Public Health and Social Care provided by local authorities are the elephants in the room. These vital services are absent in the public debate about the provision of an effective care system. Yet these services are cornerstones of the new out of hospital services. Social services are on the critical list. Coventry and Warwickshire will have reduced adult social care spending by £13.5m by 2020 with an extra £398 000 of cuts to disability services. ’

Councillor Parsons ended the debate with a call for the end to means testing for Social Care and for the NHS to remain free at the point of delivery, providing care from the cradle to the grave.

Result: Despite SWKONP attempts to explain the hidden agenda of the ICS – ie the Integrated Care Provider Contract, which removes accountability and opens the door to further privatisation, the motion was carried, although with the Labour amendment to ask government for more money.

……….

Meanwhile, with no mention anywhere in the news, the Integrated Care Provider Contract Regulation has been sneaked through by the government to enable ICPs (Integrated Care Providers) to get established. In a previous incarnation they were STPs, then ACOs but as the US association began to tarnish their reputation the name was changed to Integrated Care Systems.

https://www.legislation.gov.uk/uksi/2019/248/pdfs/uksiem_20190248_en.pdf

This is 9 pages long but you could just look at paragraphs 7.6, and its casual dismissal of the possibility of privatisation, saying only that the Long Term Plan expects these contracts to be run by public/statutory bodies; see also 7.10 for the same non-committal approach to privatisation. Otherwise see  7.8, 7.9, and 12.3. 12.3 also suggests private business won’t be implicated (i.e. involved).

………………..
Local news: Leamington Observer 21st February 2019: Infant Mortality Rates on the Rise. The article points to cuts to the bone of services to parents of young children, including the planned closure of 25 of 39 children’s centres, following a £67 m cut in funding.

 

The new contract recognises the GP crisis – but it has a hidden agenda

Pulse 5 February 2019 Dr Kailash Chand

In the new five-year GP contract, general practice has finally received sufficient funding from the Government that, on the surface, claims to offer a solution to the incredible strain that has been undermining patient care for the best part of a decade.

Plans are laid out for an expanded workforce, for tackling the avalanche of paperwork and for rescuing practices that face collapse.

It also provides support for doctors buckling under this strain, with services to help address burnout and stress, and pledges to introduce a range of other professionals – such as pharmacists, physiotherapists and nurses – to the workforce, in a bid to help share the workload.

It represents the first time in years the severity of the crisis has been recognised – and we should therefore welcome the additional investment and many of the measures agreed by the BMA and NHS England.

In particular, the pledge to fund indemnity for all GPs and general practice staff – something I have been pleading for, for a long time – is important.

But the big question is will these measures deliver what patients want: better access and sustainable services in their local practice? Will this lift the sinking morale of the profession?

I am old enough to recall when a new GP contract for GMS practices was agreed in 2004.

After the initial wave of happiness it didn’t take long for joy to turn to tears.

There was a gradual realisation that the political agenda was to break up the traditional model of general practice and move to a new business-like approach of providing primary care.

This model sacrificed GPs’ independent contract status, while killing off continuity of care.

I believe this new contract is a continuation of that ideology.

It is designed as an endgame – with the final stages seeing the GP workforce replaced with low-paid pharmacists, physiotherapists and nurses.

One of my bigger concerns is that all practices are being asked to join a network – designed on a business healthcare model, complete with clinical lead and governance processes – by July.

Large healthcare companies could step in and start running them, with GPs becoming salaried and terms and conditions being dictated by private providers.

With more than 100,000 full-time posts vacant across NHS hospitals, there is also the question of where the nurses and other clinical staff will be found to supplement GPs.

I hope I am wrong, but I believe that the new contract as it stands has a hidden agenda – and is not a panacea or saviour of general practice, despite all the pronouncements of its merits.

Dr Kailash Chand is a retired GP in Tameside

On the face of it, this is a credible vision, bringing together a number of different strategies in a genuine effort to help general practice.

This new contract is designed as an endgame – with the final stages seeing the GP workforce replaced with low-paid pharmacists, physiotherapists and nurses.

Health Service Journal: Stroke units could close under new NHS England plans

  • 126 stroke units may be cut to 80, research suggests
  • Stroke Association CEO says reconfigurations “will save lives”
  • Plans may face resistance from clinicians, the public and politicians

A planned major reorganisation of stroke services could see the number of acute units in England cut by more than a third, with patients going to more specialised centres, HSJ understands.

Experts have said this will reduce the number of deaths and disabilities from the condition.

The NHS long-term plan said it wants “sustainability and transformation programmes and integrated care systems to reconfigure stroke services into specialist centres” within the next five years.

No numbers were attached to the proposals, but the Stroke Association charity, which supports and is involved in development of the plan, told HSJ that independent modelling suggested the number of stroke units should be cut from 126 to around 80 “hyper acute” and specialist units. These would be composed of around 30 neuroscience centres and 50 hyper acute stroke units (see box below).

Funded by the National Institute of Health Research, the research findings would likely leave the majority of the population facing travel times of up to 45 minutes. But it would also cut the current post code lottery of access to the best stroke treatments.

NHS England’s long-term plan said: “Areas that have centralised hyper-acute stroke care into a smaller number of well-equipped and staffed hospitals have seen the greatest improvements [in patient care].”

NHS England did not comment on the scale of centralisation being planned, but HSJ has seen documents that suggest its national clinical director of stroke, Professor Tony Rudd, has been supportive of the modelling work in his clinical/academic work in south London.

The NHS plan said reconfiguration will help it boost the number of people receiving life-changing thrombectomies from one per cent to 10 per cent of stroke patients by 2022. It also said it will help deliver “amongst the best performance in Europe for delivering thrombolysis” by 2025.

High profile service consolidations in London and Greater Manchester are widely credited with preventing dozens of deaths each year.

However, reconfiguring stroke services has proved challenging in the past, as they often come up against political and public resistance. In 2014, NHS England talked of plans to replicate the London and Greater Manchester models across England, but the ambition has yet to be realised.

Juliet Bouverie, who is chief executive of the Stroke Association and was also involved in the long-term plan, said: “It is a significant reconfiguration [but] given the delays and non-starters over the last few years in attempts at reconfiguring stroke care, we would want this plan implemented quickly.”

She pointed to improvements in care for other conditions such as trauma and cardiac care through centralisation, and added: “We know changes to or reductions in numbers of units can sound worrying but evidence tells us it will save lives by ensuring more people are able to access the treatment they need.”

Professor Rudd said: “The long-term plan for the NHS will give 100,000 people better access to stroke care, with services designed around individual communities to be agreed as part of local implementation plans in the coming months.”

Eight new neuro science centres

HSJ understands the reconfiguration of stroke units will have two aspects.

Firstly, NHS England wants to increase the number of neuro science centres (which include specialist stroke care) in England from the current 24. This would help ensure greater access to mechanical thrombectomies, a life changing treatment that can remove blood clots from the brain of stroke patients and prevent lifelong disabilities.

The independent modelling led by researchers at the University of Exeter suggests these would need to increase to 30 to allow for equitable access. The 18 centres outside of London would likely remain with the six located in London dropping to four.

No final decision has been made on the location of the additional eight centres.

Secondly, NHS England wants to reconfigure the remaining 102 stroke units into hyper acute stroke centres. The modelling suggests around 50 HASUs would be needed with each admitting at least 600 patients a year. The remaining 52 units would be either decommissioned, repurposed for rehabilitation or used for less intensive acute care.

Currently, stroke is the fourth biggest killer in England, leaving almost two-thirds of survivors with a disability.

…………

SWKONP COMMENT:

We know that Coventry and Warwickshire plan to close the acute stroke wards at Warwick and George Eliot hospitals and centralise all stroke care at the overcrowded University Hospital Coventry and Warwickshire. We have demanded proper risk assessment regarding travel times, and asked a good many more risk-assessment questions, but have had no satisfactory response. The only study to say centralisation saves lives in England is based in London and Manchester – cities where travel time differences between local and central stroke units are around 5 minutes – unlike rural areas and the area of Warwickshire and Coventry, where travel to UHCW could exceed 45 minutes.

National Audit Office report: NHS financial sustainability January 18th 2019

National Audit Office report: NHS financial sustainability

Publication details:

ISBN: 9781786042378

HC: 1867, 2017-19

Published date: January 18, 2019

NHS financial sustainability

The report examines whether the NHS is on track to achieve financial sustainability.
Background to the reportThis is our seventh report on the financial sustainability of the NHS. In our recent reports, in December 2015, November 2016 and January 2018, we concluded that financial problems in the NHS were endemic and that extra in-year cash injections to trusts had been spent on coping with current pressures rather than the transformation required to put the health system on a sustainable footing. To address this, local partnerships of clinical commissioning groups (CCGs), NHS trusts and NHS foundation trusts (trusts) and local authorities were set up to develop long-term strategic plans and transform the way services are provided more quickly.

In June 2018, the Prime Minister announced a long-term funding settlement for the NHS, which will see NHS England’s budget rise by an extra £20.5 billion by 2023‑24. Between 2019-20 and 2023-24, this equates to an average annual real-terms increase of 3.4%. The government asked NHS England to produce a 10-year plan that aims to ensure that this additional funding is well spent. In return for this extra funding, the government has set the NHS five financial tests to show how the NHS will do its part to put the service onto a more sustainable footing.

Content and scope of the report

In this report on financial sustainability in the NHS, we:

  • summarise the financial position of NHS England, CCGs and trusts (Part One);
  • look at the financial flows and incentives in the NHS and whether these encourage long-term financial sustainability (Part Two); and
  • examine how local partnerships of health and care organisations are progressing, and what the Department of Health & Social Care, NHS England and NHS Improvement are doing to support them (Part Three).

 

Report conclusions

This report covers 2017-18, so we first conclude on financial sustainability for that year. We consider that the growth in waiting lists and slippage in waiting times, and the existence of substantial deficits in some parts of the system, offset by surpluses elsewhere do not add up to a picture that we can describe as sustainable. Recently, the long-term plan for the NHS has been published, and government has committed to longer-term stable growth in funding for NHS England.

In our view these developments are positive, and the planning approach we have seen so far looks prudent. We will really be able to judge whether the funding package will be enough to achieve the NHS’ ambitions when we know the level of settlement for other key areas of health spending that emerges from the Spending Review later in the year. This will tell us whether there is enough to deal with the embedded problems from the last few years and move the health system forward. Let’s hope there are not too many strings attached.

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