27th November 2015

• Osborne frontloads NHS funding in the Spending Review
• BMA enters talks with the Government over junior doctors' strike action
• Surgeons treat over 5 million patients in a year for the first time
• Update on EU medical devices regulation

Osborne frontloads NHS funding in the Spending Review

George Osborne MP this week announced the Government’s Comprehensive Spending Review and Autumn Statement which set out public spending for the next five years. The headline news for the NHS was the plan to frontload extra NHS funding, which will mean the NHS in England will receive around £6 billion added to its budget from 2016, taking the initial additional £2 billion promised at the 2014 Autumn Statement with this week’s pledge of a further £3.8 billion. The NHS ringfenced budget will continue to be increased by smaller increments every year until 2020/21. Overall NHS spending will rise from £101 billion per year in 2015/16 to £120 billion per year by 2020/21.

The Chancellor said that this extra funding will help the NHS to deliver 800,000 more elective hospital admissions, 5.5 million more outpatient appointments, cancer testing within four weeks, and a seven-day NHS within this Parliament. Mr Osborne said that this new financial settlement will fully fund the NHS England Five Year Forward View, and reiterated the expectation that the NHS will find £22 billion in efficiency savings by 2020. He also announced £4.8 billion per year in capital funding to reform urgent and emergency care services and out of hours hospital services, £5 billion for health research including on antimicrobial resistance and dementia, and a £1 billion investment over five years in new technology.

Health education will see cuts of almost £1.2 billion by 2020/21. It is understood this will primarily affect the non-doctor budget with funding for student nurses, midwives and allied health professionals to be reformed to replace grants with loans and to remove the cap on student numbers. Local authorities will be allowed to levy a new social care precept of up to 2% on council tax to be used exclusively to fund adult social care services, which the Chancellor claimed could raise up to £2 billion more for social care across England. Many local government stakeholders have said this will not be enough to cover the social care funding gap. The Better Care Fund (BCF) will also be increased by £1.5 billion by 2019/20. The Government is consulting on options for local authorities to fully fund social care, through the move to 100% business rate retention by 2020. While the Government consults on this potential transfer of public health funding from central to local government, the public health budget will continue to be ringfenced up to 2017/18.

In a joint statement, Miss Clare Marx, President of the RCS, and Professor Jane Dacre, President of the Royal College of Physicians, said: “We strongly welcome the additional £3.8 billion investment the Chancellor is making available to the NHS in the coming year. Although there was no clear update in the CSR today on public health budgets, we remain concerned that any cuts will only increase the pressures facing the NHS and significantly undermine any initial potential savings. We also await further detail about the future funding of health education, which is vital to deliver the NHS the next generation of healthcare staff, as the protection from budget cuts is removed.”

BMA enters talks with the Government over junior doctors’ strike action

Talks ahead of planned strike action began between the BMA junior doctors’ representatives and NHS Employers with the Department of Health this week through the mediation of the independent Advisory, Conciliation and Arbitration Service (Acas). Agreement has not yet been reached, and talks are expected to continue. If industrial action is to go ahead, the BMA’s planned action will begin with a day of emergency-only junior doctor care on Tuesday 1st December, with full walk outs planned for Tuesday 8th and 16th December.

Health Secretary, Jeremy Hunt MP, wrote to Dr Mark Porter, Chair of the BMA Council, earlier this week, agreeing to talks with Acas, saying: “My strong preference is to get round the table and agree with the BMA how we do so in a way that you consider fair, and we are willing to listen and negotiate on any concerns.”

On 19th November the BMA had said "we are keen to avert the need for industrial action, which is why we have approached Acas to offer conciliatory talks with the health secretary and NHS Employers to clarify the conflicting information coming from government over the past weeks." However, while agreeing to the new Acas approach the BMA said it ‘would begin these discussions as soon as possible but Mr Hunt must remove his threat of imposing a contract on doctors in training in England to defer Tuesday’s planned action’.

Following the announcement the Academy of Medical Royal Colleges said it hoped industrial action can now be suspended.

Surgeons treat over 5 million patients in a year for first time

This week the HSCIC released new detailed data on admitted patient care.

The data show that in 2014/15, for the first time, there were over 5 million surgical finished consultant episodes (5.02m), an increase of 0.71 per cent since the previous year (4.98m), and 3.12 per cent since 2010/11 (4.87m). Similarly, the number of surgical admissions has increased to 4.67 million, a 0.58 per cent increase on 2013/14 (4.65m), and a 2.70 per cent increase compared to 2010/11 (4.55m).

Overall there were 15.9 million admissions in 2014/15 (43,500 per day on average), an increase of 2.8 per cent since the previous year (15.5m), and 31.3 per cent since 2004/05 (12.1m). This equates, on average, to 1,200 more admissions per day compared to 2013/14, and 10,400 more per day since 2004/05. 29,260 people per 100,000 population were admitted to hospital in 2014/15, a 21.4 per cent increase since 2004/05.

The average length of stay has been declining since 2004/05 (7.1 days), and continued to decrease, from 5.1 days in 2013/14 to 5.0 days in 2014/15.

Update on EU medical devices regulation

Discussions on the EU Medical Devices Regulation have been ongoing since the EU Council published its proposed amendments to the Regulation in June.

The EU is updating regulations on medical devices, covering a range of technologies, such as X-ray machines, pacemakers and hip replacements. The Regulation being discussed at present will replace existing European directives, and aims to ensure these products are safe, and can be freely and fairly traded throughout the EU.

In the proposal released in June, as recommended by the College, the Council further tightened the rules for approval of notified bodies, which approve medical devices for use in the EU. The proposal also recommended that an online databank be established to allow identification and traceability of devices, monitoring of applications, notified bodies and clinical investigations of devices.

This autumn the Council’s Working Party on Pharmaceuticals and Medical Devices has been meeting to discuss the current proposal and prepare for negotiations with the European Parliament. The Council has published revisions to the proposal, but these have not changed the overall proposal significantly. The aim is for the Council to agree on a proposal before the EU Health Ministers meet in December, and for the Regulations to be adopted in the first half of 2016.