NHS funding could be linked to patient feedback under new plans, with poorly performing services that “don’t listen” penalised with less money.
As part of the “10 Year Health Plan” to be unveiled next week, a new scheme will be trialled that will see patients asked to rate the service they received – and if they feel it should get a funding boost or not.
It will be introduced first for services that have a track record of very poor performance and where there is evidence of patients “not being listened to”, the government said.
This will create a “powerful incentive for services to listen to feedback and improve patients’ experience”, it added.
Sky News understands that it will not mean bonuses or pay increases for the best performing staff.
NHS payment mechanisms will also be reformed to reward services that keep patients out of hospital as part of a new ‘Year of Care Payments’ initiative and the government’s wider plan for change.
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Do you want AI listening in on chats with your doctor?
Speaking to The Times, chief executive of the NHS Confederation Matthew Taylor expressed concerns about the trial.
He told the newspaper: “Patient experience is determined by far more than their individual interaction with the clinician and so, unless this is very carefully designed and evaluated, there is a risk that providers could be penalised for more systemic issues, such as constraints around staffing or estates, that are beyond their immediate control to fix.”
He said that NHS leaders would be keen to “understand more about the proposal”, because elements were “concerning”.
Health Secretary Wes Streeting said: “We will reward great patient care, so patient experience and clinical excellence are met with extra cash. These reforms are key to keeping people healthy and out of hospital, and to making the NHS sustainable for the long-term as part of the Plan for Change.”
In the raft of announcements in the 10 Year Health Plan, the government has said 201 bodies responsible for overseeing and running parts of the NHS in England – known as quangos – will be scrapped.
These include Healthwatch England, set up in 2012 to speak out on behalf of NHS and social care patients, the National Guardian’s Office, created in 2015 to support NHS whistleblowers, and the Health Services Safety Investigations Body (HSSIB).
The head of the Royal College of Nursing described the move as “so unsafe for patients right now”.
Professor Nicola Ranger said: “Today, in hospitals across the NHS, we know one nurse can be left caring for 10, 15 or more patients at a time. It’s not safe. It’s not effective. And it’s not acceptable.
“For these proposed changes to be effective, government must take ownership of the real issue, the staffing crisis on our wards, and not just shuffle people into new roles. Protecting patients has to be the priority and not just a drive for efficiency.”
Elsewhere, the new head of NHS England Sir Jim Mackey said key parts of the NHS appear “built to keep the public away because it’s an inconvenience”.
“We’ve made it really hard, and we’ve probably all been on the end of it,” he told the Daily Telegraph.
“The ward clerk only works nine to five, or they’re busy doing other stuff; the GP practice scrambles every morning.”
Axel Rudakubana’s brother feared he would kill a family member two years before the Southport attack, an inquiry has heard.
Dion Rudakubana, who is two years older than his brother, said Axel has a “short temper” and was prone to “violent outbursts”, hitting him regularly when they were children.
He said Axel’s behaviour escalated after he was expelled from the Range High School in Formby, Merseyside, in 2019 and their parents had “lost control”.
The public inquiry into the Southport attack heard by the time he left for university in 2022, Dion feared his brother would kill a family member.
In messages sent to a friend when he returned to the family home for Christmas, Dion said: “My brother doesn’t show mercy, my dad just has to try not to die… We hide knives to mitigate that factor.”
He told the inquiry there were times the police would be called out and recalled one incident when “my father was holding my brother off”.
“I remember being scared somebody was going to die… my dad,” he says.
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Image: (Left to right) Bebe King, Elsie Dot Stancombe and Alice da Silva Aguiar. (Pic: Merseyside Police)
Rudakubana was 17 when he murdered Elsie Dot Stancombe, seven, Bebe King, six, and Alice da Silva Aguiar, nine, in a knife attack on a Taylor Swift-themed dance class on July 29 last year.
Eight other children, who cannot be identified because of their age, were also injured, along with yoga instructor Leanne Lucas, who was leading the dance class, and businessman John Hayes, who was one of the first people on the scene and tackled the killer.
Giving evidence from a remote location by video-link, Dion’s voice could be heard but he could not be seen at Liverpool Town Hall.
After swearing on the Bible, he told how he and his brother grew up in Cardiff after their parents Laetitia Muzayire and Alphonse Rudakubana came to the UK from Rwanda and were granted asylum.
Image: Flowers left at a memorial for the victims
Dion says the genocide had a “very heavy influence on them” but he doesn’t feel he was “traumatised” by his parents’ experiences.
His mother and father studied for degrees and moved to Southport in 2013 because his mother got a job, while his father started working as taxi driver because “he was not finding work in the area he studied in”, Dion said.
He told how Axel was resentful of him after they had to move schools because of his health issues.
Dion said Axel was physically bigger, and he felt “increasingly wary” of his younger brother who would regularly hit him and smash plates and glasses in their home.
Dion said the last interaction he had with his brother was in the summer of 2023, when Axel threw a metal bottle at him, but luckily he had already closed the door.
In his witness statement, Dion compared his brother with the “sociopath” played by Javier Bardem in No Country For Old Men, who kills ten people over the course of the film.
“I watched it recently and it concerned me,” he told the inquiry, which continues on Wednesday.
The “extraordinary bravery” of the LNER worker who intervened during a mass stabbing on a train on Saturday has been hailed by his company.
Samir Zitouni, 48, also known as Sam, was last night fighting for his life after trying to stop a knife attacker who targeted passengers on a busy train.
He was injured while trying to protect passengers during the mass stabbing on Saturday’s 6.25pm LNER service from Doncaster to London King’s Cross.
Deputy Chief Constable of British Transport Police (BTP), Stuart Cundy, said CCTV from the train showed the man’s actions “were nothing short of heroic and undoubtedly saved people’s lives”.
The train operator said he has been a “valued member” of staff for over 20 years, working on board as a customer experience host.
David Horne, managing director at LNER, said: “In a moment of crisis, Sam did not hesitate as he stepped forward to protect those around him.
“His actions were incredibly brave, and we are so proud of him, and of all our colleagues who acted with such courage that evening. Our thoughts and prayers remain with Sam and his family. We will continue to support them and wish him a full and speedy recovery.”
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His family also shared a message, thanking those who had shown the “overwhelming support” they have received and calling him a “hero”.
They said: “We have been deeply touched by the outpouring of love and kindness shown to Sam, and by the many well wishes for his recovery.
“The care provided by the hospital and the support from his colleagues at LNER has been incredible. We are immensely proud of Sam and his courage. The police called him a hero on Saturday evening, but to us – he’s always been a hero.”
Image: Forensic investigators at Huntingdon train station in Cambridgeshire
Police investigation
A man, Anthony Williams, 32, of no fixed abode, has been charged with 11 counts of attempted murder over the mass stabbing and another attack earlier at an east London station.
British Transport Police (BTP) said Williams had been charged with attempted murder and possession of a bladed article in connection with an incident on a Docklands Light Railway train in the early hours of 1 November.
A victim suffered facial injuries after being attacked with a knife on a train at Pontoon Dock station, the force added.
The suspect left the location before police arrived.
Home Secretary, Shabana Mahmood, said police in Cambridgeshire were investigating whether the same man committed “further offences” before.
British Transport Police are also investigating three other incidents which they believe are linked to the train attack and London stabbing.
Those incidents, which took place on Friday and Saturday, are:
• 7.10pm, Friday: The stabbing of a 14-year-old boy in Peterborough city centre. The teenager was taken to hospital with minor injuries and has since been discharged
• Around 7.10pm, Friday: A man with a knife entered a barbers in the Fletton area of Peterborough. This was not reported to the police until two hours later
• 9.25am, Saturday: A man was seen with a knife again at the Fletton barbers. The police were called while the man was at the scene and officers arrived within 18 minutes but were unable to find the man.
Williams was remanded in custody on Monday when he appeared at Peterborough Magistrates’ Court.
To understand why Rachel Reeves stood up at 8am in Downing Street in an unprecedented news conference to foreshadow the budget, you need to understand the depth of the problems facing the chancellor.
In 22 days, she must perform the biggest U-turn it is possible for a chancellor to make.
She must hike taxes to the tune of tens of billions of pounds, having promised in the election manifesto that this would not be necessary, and reiterated this promise under a year ago after an initial £40bn of rises.
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Has the public heard the warning?
Not many inhabitants of Number 11 would stay in post if they had to make such a pivot.
But Sir Keir Starmer cannot lose her and know for sure that he also stays in place.
So Ms Reeves is battling for her credibility – and ultimately the survival of this government. The stakes are high.
So back to this morning. Ever since the summer, those in Westminster have known tax rises are on the way in the autumn budget. A Treasury source told me that pitch-rolling for the budget began in July – yet their issue is that to date, almost no-one had noticed.
The subject of the budget was an omerta as recently as the Labour conference a month ago – it simply wasn’t on the agenda in Liverpool.
Image: Chancellor Rachel Reeves delivered a highly unusual pre-budget speech in Downing Street. Pic: PA
The first public acknowledgement that she was looking at taxes was in an interview with me on Sky News three weeks ago. She has intermittently revisited the subject subsequently, but quite bluntly, the public haven’t yet noticed.
As recently as last week, people in the Treasury were acknowledging to me that the public are as yet unprepared for the tax shock expected on the scale on 26 November.
So this morning’s event was designed to be shock and awe – an 8am news conference is designed to jolt Westminster and the viewing public to attention, because inside the Treasury they are “desperate” – their words – to get the public watching.
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Rigby: Reeves speech ‘unprecedented’
The format allows her to look in control, like a stateswoman in Downing Street making arguments on her terms, even though these are arguments she has been forced into.
So the job of this morning was to educate the public that tax rises are coming, but also put them on notice that this could involve a breach of manifesto promises by raising one of income tax, national insurance, corporation tax or VAT – and then to try and lay the blame anywhere but at the feet of this government.
She also wants to give some hope – by giving a sense of what priorities she would protect.
So what to make of the arguments she made?
‘The impact of Tory austerity, their botched Brexit deal and the pandemic on Britain’s productivity is worse than feared’
Is it really all the Tories fault?
Ms Reeves made an argument today about how lower growth is responsible for Britain’s economic ills, and listed causes with a long tale going back many years for it. This is true, but isn’t strictly the reason for her problems at this budget.
On 26 November, she must fill a £20bn-£30bn “black hole” – that’s the extent to which she is in on course to breach her own self-imposed borrowing limits, known as fiscal rules.
Many of the components of the black hole cannot be put at the door of the Tories. Here’s why:
She must find £10bn to account for policy decisions the government has been pushed into – a failure to push through welfare reform, a U-turn on winter fuel payments, a likely rollover of fuel duty.
She is likely to have to find a further £5bn for decisions she is likely to take – scrapping of the two-child benefit cap, help for energy bills and an emergency injection for redundancy bills and strike coverage costs.
So £15bn of the black hole cannot be blamed on the Tories.
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Badenoch says Reeves is ‘just making excuses’
A further £2bn-£4bn for additional debt interest costs is a consequence of the higher borrowing just since the March spring statement – again not the Tories’ fault – and also wants £10bn to give herself a bigger buffer to exit the doom loop.
Ms Reeves has greater scope to argue that the productivity review has longer-term causes, but this is likely to be offset by better wage news, and there is an argument that Labour could have foreseen the productivity downgrade before the election because the Office for Budget Responsibility figures were out of line with other forecasters.
So this is a tricky case to sustain, even though the government has no choice but to make it.
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Sam Coates and Anne McElvoy discuss the UK’s economic ‘doom loop’.
‘Protecting our NHS, reducing our national debt and improving the cost of living’
The news is grim – but this is the chancellor’s promise of what she is going to prioritise. But what does this amount to?
NHS: I understand this is not a promise of new money for waiting lists in this budget. Ms Reeves is actually making a political argument about the need to not U-turn on last year’s £22bn a year NHS investment – although the public may not hear it.
Cost of living: Partly this is an argument about investment already made in things like breakfast clubs. But with CPI inflation at 4.1%, it’s a major concern – but not one that can be tackled without government spending many billions. There will be some help for energy bills, but not the tens of billions that Liz Truss put towards such schemes. So this risks disappointment.
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Watch the chancellor’s speech in full
Reducing debt: It is not about to go down. Her fiscal rules mean she is going to be reducing debt as a percentage of GDP – and even then, only debt on some things, as the fiscal rules spell out some exemptions. So the actual amount we borrow from the markets will continue to grow.
Does it work?
Today is about saying with a louder megaphone things we already knew. She declined to say whether ultimately she will break the manifesto, or what will happen.
She has, however, candidly started a conversation that needed to begin.