Weekly political news round up – Friday 29th November 2013

November 29, 2013 in News by Whitehouse

Public Health England publishes the NHS Atlas of Variation in Diagnostic Services

Public Health England has published the NHS Atlas of Variation in Diagnostic Services. The Atlas contains information on diagnostic service activity from Primary Care Trusts, CCGs and hospitals, spread across 69 different maps of England, allowing for the visual identification of local variations in a variety of diagnostic services, including urodynamic tests.

Urodynamic tests enable clinicians to determine what physical factors are involved in bladder disorders and can be used in the diagnosis of different types of incontinence for which there are different types of treatment.

The report accompanying the Atlas of Variation stated that degree of variation for urodynamic tests observed was ‘large’. In evidencing this, the report started that in 2011/12 the rates of urodynamic tests undertaken (excluding the five PCTs with the highest rates and the five with the lowest) ranged from 0.25 to 4.9 tests per 1000 weighted population. In 2012/13, the rates of urodynamic tests undertaken ranged from to 0.21 to 5.0 tests per 1000 weighted population.

In explaining the large degree of variation, the report commented that while there were geographical and demographic reasons for variation (more older people, closer to tertiary centres of continence and so on), there were a lack of national guidelines about which diagnostic tests needed to be performed in patients with bladder outlet obstruction and incontinence.

Subsequently, the report suggested that there was ‘an urgent need to develop improved professional guidelines and/or agreements on local pathways and models of care’. They also suggested that commissioners must ensure equity of access to services, stating that basic urodynamic tests should be easily and more conveniently carried out in primary care.

Department for Education issues survey to SEN providers assessing readiness for reforms

The Department for Education has announced that it is seeking feedback from service providers regarding their readiness for implementing the special education needs and disability reforms introduced as part of the Children and Families Bill.

In September 2014, all local areas in England will be required to implement key reforms related to the new Children and Families Bill. These changes will impact on the nature and way in which services for children and young people with special educational needs and disabilities (SEND) are delivered, and will include person-centred planning, coordinated assessments and planning processes, and personal budgets.

The survey asks the extent to which providers are aware of the reforms, as well as whether they have been involved in helping to develop these reforms at the local level. Additionally, it asks whether they feel that local authorities and their partners need to prepare for the proposed reforms, and whether providers require additional support to prepare for the proposed reforms.

Answers to written questions on continence care

Labour MP Rosie Cooper has received answers to three written questions to the Health Secretary on continence care:

  • The first question asked what steps he is taking to improve the training of doctors, nurses and healthcare assistants in continence care.

Health Minister Dan Poulter responded that the standard of training of doctors and nurses is the responsibility of the independent regulatory bodies. He said that they were committed to ensuring high quality patient care delivered by health and health care professionals with the knowledge, skills and behaviours required to deal with the medical conditions they will encounter in practice.

He added that health care assistants (HCAs) are not a regulated profession and their training is the responsibility of employers. Health Education England (HEE) has responsibility for promoting high quality education and training that is responsive to the changing needs of patients and local communities and will work with stakeholders to influence training curricula as appropriate. HEE has been tasked with establishing minimum training standards for HCAs by the spring of 2014.

  • The second question asked whether NHS England was responsible for provision of guidance on continence care to clinical commissioning groups.

Care and Support Minister Norman Lamb responded that responsibility for continence services lies with NHS England and clinical commissioning groups (CCGs). CCGs are responsible for commissioning high quality continence service for their local populations and performance managing their providers in the delivery of high quality services. NHS England is responsible for ensuring this happens, and the Government holds it to account for this through the Mandate.

He added that NICE has issued clinical guidelines on the management of urinary incontinence in women (2006) and faecal incontinence in adults (2007), which are supported by commissioning tools. NICE is also developing a quality standard on Faecal Incontinence for publication in February 2014. This guidance is there to support CCGs.

  • The third question asked how many hospital admissions there were for urinary tract infections in 2012; and what the estimated cost to the NHS was of treating such admissions.

Poulter responded that there were 174,863 finished admission episodes where the primary diagnosis was urinary tract infectionin 2011-12 and 184,943 in 2012-13.

He added that the cost of treating hospital admissions for urinary tract infections was not collected centrally, instead providing a table setting out estimates of NHS spend relating to problems of the genito-urinary system.

Answer to written question on health provisions for those with special education needs and disabilities

Liberal Democrat peer Lord Storey has received an answer to his written question asking the Government what were the current means of redress for an appeal regarding health provision for special educational needs and disabilities.

Health Minister Earl Howe responded that the arrangements were the same as for other health service users. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 allow a complaint to be made to an NHS body about the exercise of its functions.

He added that the Children and Families Bill gives a new duty to health services to provide the services set out in an Education, Health and Care Plan, and the National Health Service mandate covering services for children and young people with special educational needs.

PCF responds to NHS England strategy for Innovation, Health and Wealth

November 27, 2013 in Consultations by Whitehouse

The Paediatric Continence Forum has responded to the NHS England Innovation Team’s call for written evidence on the NHS England strategy for Innovation, health and Wealth (IHW), which succeeds the previous Department of Health Strategy published in December 2011.

In April 2013 responsibility for Innovation, Health and Wealth was passed to NHS England. NHS England has thus initiated a review of IHW to understand what has worked and what has not and why.

To view the PCF’s response, please click here.

Weekly political news round up – Friday 22nd November 2013

November 22, 2013 in News by Whitehouse

Update on Children and Families Bill

The Children and Families Bill completed its Grand Committee stage in the House of Lords this week, and the first two days of the Bill’s Report Stage have been confirmed for December 9th and 11th. However, with many issues still unresolved, particularly to Parts 1 and 2 of the Bill on family law, we have learned that the Government do not expect the SEN clauses in Part 3 to begin debate until the second day of Report and not to conclude the debate until a third or fourth day expected in the New Year.

Government publishes further response to report on Mid Staffordshire NHS Foundation Trust inquiry

The Government has published its further response to Robert Francis QC’s report on the Mid Staffordshire NHS Foundation Trust public inquiry. The response, titled Hard Truths: The Journey to Putting Patients First, explains the changes that have been put in place since the initial response was published, and sets out how the whole health and care system will prioritise and build on this. There are also detailed responses to the 290 recommendations made by the inquiry. The Government accepted all but nine of the 290 recommendations. The recommendations which the Government did not accept relate to a statutory duty of candour, regulation of healthcare assistants, and making it a criminal office to obstruct healthcare professionals from exercising a duty of candour.

The Francis Report was published in February 2013, and called for a ‘fundamental culture change’ across the health and social care system to put patients first. There were six core themes that were highlighted for action: culture, compassionate care, leadership standards, information, and openness, transparency and candour.

The Government’s initial response, Patients First and Foremost, published one month later in March 2013, set out a plan to prioritise care, improve transparency and ensure that where poor care is detected, there is clear action and accountability. Since the report was published, the Government and the health service have made initial changes aimed at ensuring better and more frequent inspections, greater independence for the Care Quality Commission (CQC), better standards and more involvement with patients and the public.

This second response includes some improvements designed specifically to reduce catheter-associated infection, as well as general improvements to patient involvement. There was, however, no direct reference to paediatric continence or continence more generally in either volume of the response, though the report did note the review of the Children and Young People’s Health Outcomes Forum, one of several reports commissioned to look at some of the key issues emerging from the Inquiry.

The first section of the report outlines changes that have, or will be made, to prevent problems from arising, while the second section contains the detailed response to each recommendation.

The most relevant changes that are planned by the Government include:

  • The establishment of a new Patient Safety Collaborative Programme by NHS England to spread best practice on patient safety.
  • The encouragement of the use of NHS Safety Thermometer data collection to help inform improvements in some key patient safety areas, including catheter-associated infection.
  • The strengthening of the professional duty of candour to ensure that doctors and nurses and open with patients when mistakes occur, and for professionals to report errors that could have led to harm.
  • Listening to more to patients, including plans to, by December 2013, have 80% of clinical commissioning groups (CCG) commissioning support for patients’ participation and decision in relation to their own care.
  • The promotion a culture of openness by making it clear to patients how they can complaint or get support on making complaints.
  • The development by the Department of Health and Care Quality Commission fundamental standards recommended by the inquiry, in clear language for what it means to patients and service users, for public consultation.
  • For Health Education England (HEE) to lead on ensuring improvements in continuous professional development and appraisals.

Action has already been taken by Healthwatch England and the Local Government Association to launch a tool to help local areas identify what outcomes and impacts a good local Healthwatch could achieve, as well as by the CQC to involve patients in its inspections of hospital ratings.

Various organisations have responded to the Government’s response, including NHS England; the CQC; Health Education England; Healthwatch England; the Royal College of Physicians; and the Royal College of Nursing. In general, these organisations welcomed the Government response and identified some of the work they will take forward over the coming months.

NICE launches consultation on draft quality standard for infection control

The National Institute of Health and Care Excellence has published a draft quality standard on infection control for children and adults receiving healthcare in primary, community and secondary care settings. NICE quality standards are designed to drive measurable quality improvements within a particular area of health or care.

This particular quality standard is aimed at contributing to certain improvements outlined in the NHS Outcomes Framework 2013/14. It seeks firstly to contribute to prevent people from dying prematurely by reducing the amount of lives lost from causes amenable to healthcare in adults and children, and secondly to treat people in a safe environment and protect them from avoidable harm by reducing incidences of healthcare associated infection.

The draft quality standard contains six quality statements about infection control, including two that specifically involve urinary catheters. On this issue, the quality standard seeks to ensure that:

  • People needing a long-term urinary catheter have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of their catheter (statement 4);
  • People with long-term urinary catheters, vascular access devices or enteral feeds are educated about the safe management of their device or equipment, including techniques to prevent infection (statement 6).

NICE is consulting on the draft quality standard. The consultation asks if the draft quality standard accurately reflects the key areas for quality improvement, and also asks a specific question about draft quality statement 4:

  • What are the specific components of the procedures defined that are the main areas for quality improvement?

Commons Health Committee hears oral evidence on the management of long-term conditions

As part of the Commons Health Committee’s ongoing inquiry into the management of long-term conditions, the Committee heard oral evidence from Care and Support Minister Norman Lamb, and Dr Martin McShane, Director of Improving the quality of life for people with long-term conditions, NHS England. There was no explicit mention of paediatric continence, or continence care in general, during the session.

McShane said that he would be working with Health Secretary Jeremy Hunt on long term conditions next year. He criticised the current system saying that while it was successful on health and planned care, the failure to address long-term conditions had resulted in long-term conditions being a significant drain on the health service’s resources.

In response to questioning about the strategy of NHS England in supporting people with long-term conditions, McShane noted that there were three teams in the Department of Health working on long-term conditions, but NHS England’s model under the five domains of care was to use crosscutting programmes where appropriate. He said that the “traditional” approach of publishing a single strategy was not their preferred approach. McShane instead said the approach would be about “how we move the whole system to ensure that people with long term conditions get high-quality care as well as delivering changes to premature mortality and hospital care”.

Royal College of Nursing and the Infection Prevention Society highlight infection control concerns

The Royal College of Nursing (RCN) and the Infection Prevention Society (IPS), a membership organisation of health professionals working in infection prevention and control, have published a joint briefing paper highlighting concerns over ongoing infection prevention and control arrangements in England.

The briefing states that following the structural changes to the health service in April 2013, infection and protection specialists who had been commissioned by primary care trusts to support commissioners were now commissioned by a variety of organisations including the Department of Health, the Care Quality Commission, NHS England (including its area teams), as well as clinical commissioning groups and local authorities, rather than a single body.

This, in combination with the increase in number of NHS commissioning organisations, has raised concerns over a significant variation and a lack of consistency in approach and management. As a result, there are now concerns that infection control could be overlooked or insufficiently supported. Urinary tract infections are briefly mentioned in a section outlining NHS England’s work on infection prevention, where the report notes that UTIs in patients with an indwelling urethral catheter are part of national commissioning for quality and innovation (CQUIN) guidance, using the NHS safety thermometer methodology.

The report includes three recommendations including that commissioning organisations should have in place a formal process to provide assurance to their respective boards of the level of infection prevention support available to them, and to what extent this meets the organisation’s needs.

Tabled written questions on continence care

Labour MP Rosie Cooper, secretary of the continence care APPG, has tabled three written questions on continence care and continence related problems, asking the Health Secretary:

  • How many hospital admissions there were for urinary tract infections in 2012; and what the estimated cost to the NHS was of treating such admissions.
  • What steps he is taking to improve the training of doctors, nurses and healthcare assistants in continence care.
  • Whether NHS England is responsible for provision of guidance on continence care to clinical commissioning groups.

Weekly political news round up – Friday 15th November 2013

November 15, 2013 in News by Whitehouse

Around the sector

Ofsted have announced that their Director of Early Childhood, Sue Gregory, is due to retire. She had been in the role since January 2013, having previously been appointed national director for inspection delivery in 2011, before taking up the role of national director for education in April 2012. Her role will be taken over by two new national directors, Nick Hudson (early education) and Lorna Fitzjohn (childminding).

The Guardian Teacher Network has published an overview of resources to help schools tackle bullying ahead of Anti-Bullying Week, which runs between the 18th and 22nd November 2013.

Update on Children and Families Bill

The Grand Committee of the Children and Families bill has been debating Part Four of the Bill, legislating for childminding agencies, this week. There had been no specific discussion about continence issues.

The final day of the Grand Committee will be November 20th, with the report stage expected for Christmas. It is likely that Royal Ascent will be given early in the New Year.

Department of Health announces refresh of NHS England’s Mandate for 2014-15

The Department of Health has announced the refreshed Mandate to NHS England for 2014-15. Alongside the Mandate, the Department has also published its summary of responses to the consultation that was carried out on the update to the Mandate earlier in the year.

The Mandate to NHS England sets the Government’s ambitions for the NHS, as well as the funding available to achieve and deliver the kind of care people need and expect.

The original Mandate set out objectives from April 2013 to March 2015, but as a result of Francis Report, the publication which detailed the failings of the Mid Staffordshire NHS Foundation Trust and subsequent recommendations, the Department of Health sought to refresh the Mandate; he updated Mandate covers the period April 2014 to March 2015.

Though there was no specific mention of childhood continence issues, or continence issues in general, the Mandate did make reference to the need for joined-up care for children with specific healthcare needs. It also binds NHS England to the Better Health Outcomes for Children and Young People Pledge.

As part of NHS England’s desire to make sure people experience better care, they have set an objective to ‘support children and young people with specific health and care needs’. This will involve NHS England working with Healthwatch England to consider how best to ensure that the views of children, especially those with specific healthcare needs, are listened to.

They have specifically identified that supporting children and young people with special education needs or disabilities is one area with a particular need for improvement. A further NHS England objective is to ensure that children have access to the services identified in their agreed care plan, and that there is  the option for a personal budget based on a single assessment across, health, social care and education where children could benefit from this. This will involve working in a partnership across different services.

The National Children’s Bureau (NCB) and Council for Disabled Children (CDC) have welcomed the news, stating that “the inclusion of the ‘Better Health Outcomes for Children and Young People Pledge’ in the NHS Mandate is particularly welcome for disabled children and those with long term conditions”.

Answer to written questions on the reconfiguration of paediatric services

Conservative MP Jeremy Lefroy received a response to his written questions asking the Health Secretary:

  1. What steps he plans to take to reconfigure general, non-specialist, paediatric services in (a) Stafford and (b) England;
  2. Which NHS organisation has overall responsibility for regional and national critical care infrastructure.

Public Health Minister Jane Ellison said that the configuration of health services across England, including critical care and non-specialist paediatric services, is driven by the local NHS. She said that local commissioners and clinicians were best placed to ensure that services meet the needs of their local population, and to consider where changes might be necessary in order to best meet those needs now and in the future.

She added that all proposals for change were subject to proper and public scrutiny by local authorities, whose health and overview scrutiny committees should work closely with the local NHS throughout the process. These scrutiny committees also have the ability to refer an NHS proposal for change to the Health Secretary for a final decision.

Finally Ellison set out the detail of the arrangements in Stafford in light of the special administrators appointed to oversee Mid Staffordshire NHS Foundation Trust following the failings at that trust.

Weekly political news round up – Friday 8th November 2013

November 8, 2013 in News by Whitehouse

Update on Children and Families Bill

The Grand Committee of the Children and Families Bill has concluded debating the special educational needs (SEN) clauses of the Children and Families Bill this week, with no specific discussion about continence issues.

Discussions have ranged from the issues over how children are supported in early years settings, the role of social care in the new system, the accountability of local authorities for their local offers and the assessment process for children and young people for Education, Health and Care Plans (EHCPs), which look at the needs that a child or young person has within education, health and care.

Alongside the Bill, the Department for Education and the Department of Health are jointly consulting on the Special Educational Needs Code of Practice, which briefly notes that joint commissioning arrangements must include all provision which has been assessed to support children and young people with SEN, including continence supplies. It also notes that the local offer must include information about health profession for children and young people with SEN, including continence services. This consultation closes on Monday, 9th December 2013.

Northern Ireland Department of Health, Social Services and Public Safety announces consultation on paediatric healthcare services

The Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS) has announced a consultation on the paediatric healthcare services provided in hospitals and in the community. While continence is not directly mentioned, appendix A includes a list of specialised paediatric services including neurology and urology.

The consultation follows a review of healthcare services in relation to the interface between hospital and community services for children and young people (from 0-18 years) over the next ten years starting from 2014. This review was steered by a review team led by the Department and composed of healthcare professionals.

The key recommendations from the report include:

  • Recommendation 1 – Information and support should be regularly reviewed in order to ensure the right information and support is available to children and parents so that they can be actively involved in decisions about treatment and care, including self management.
  • Recommendation 2 – The Health and Social Care Board and the Public Health Agency should work with GPs and other primary care and community care services to further improve access to primary and community care for families for those conditions which are more appropriately managed outside secondary care settings.
  • Recommendation 3 – The needs of children as well as adults should be recognised in developing services for people with long term conditions, including transition to adulthood.
  • Recommendation 4 – There should be a development of a regional paediatric network, which should be constituted as an operational network, similar in role and function to the Critical Care Network for Northern Ireland. This will promote equitable access and maximise inpatient capacity.
  • Recommendation 10 – Every child who is admitted to a paediatric department should be seen by a paediatric practitioner at speciality training level 4 or equivalent within four hours of admission and by a consultant within 24 hours of admission.
  • Recommendation 11 – There should be a clearer distinction between general paediatric services and specialist (tertiary) services.
  • Recommendation 17 – The Health and Social Care Board, the Public Health Agency and Health and Social Care Trusts working with the paediatric network should put in place a “step-down” programme of care to facilitate the earlier discharge of children with complex health needs into their local community.
  • Recommendation 19 – The Department should work with regional medical, nursing and allied health professional training providers to ensure that workforce planning and training reflect service needs for children.

The Department has issued a four question consultation asking:

  1. Whether the review provides a firm assessment of the needs for paediatric healthcare services provided in hospitals and the community over the next 10 years;
  2. Whether the enablers for change detailed for paediatric services are appropriate or if there were others;
  3. Whether the 23 recommendations detailed in the Executive Summary were adequate;
  4. Whether there were any important issues that were not addressed that should have been.

The deadline for responses is Friday 31st January 2014.

NHS England calls for written evidence on NHS England Strategy for Innovation, Health and Wealth

The NHS England Innovation Team has issued a call for written evidence on the NHS England strategy for Innovation, Health and Wealth (IHW), which succeeds the previous Department of Health strategy published in December 2011.

In April 2013 responsibility for Innovation, Health and Wealth was passed to NHS England. NHS England has thus initiated a review of IHW to understand what has worked and what has not and why.

They have asked for input into the following three questions:

  1. Have you seen new innovative ways of delivering services introduced in your local NHS in the past two years? If so, have you an example?
  2. What do you think is missing and should be included?
  3. How do you feel your voice could be heard if you have an idea to help deliver new ways of working locally?

Forthcoming NHS England event on future of specialised services

NHS England is holding an event in London, in partnership with the Specialised Healthcare Alliance, to discuss the “future of specialised health services” and how they are to be provided by the NHS over the next five years.

Feedback from the event will be used to inform the development of a five-year strategy in which NHS England aims to set out how specialised services are best provided to improve the patient experience and outcomes, with the background of the financial challenges facing the NHS, and increased demand.

The event will take place in London (location tbc) on the 9th December 2013. We have been informed that places are limited and individuals who wish to attend should email dorothy.chen@shca.info. However, we understand that there will also be the opportunity to make written submissions, and NHS England will publish details of this in due course.

Answer to written questions

Several written questions on support parents and/or carers of disabled children were answered this week:

  • Labour MP Kerry McCarthy has received a response to her written question asking the Health Secretary what assessment he has made of the adequacy of support for parents or carers of disabled children; and whether he would discuss with the Education Secretary steps to improve assessments of these carer’s needs.

Care Minister Norman Lamb responded that he had discussed this issue with Children’s Minister Edward Timpson in the context of both the Care Bill and the Children and Families Bill. He added that policy on supporting disabled children and their families laid with the Department for Education, rather than the Department of Health.

  • Labour MP Kerry McCarthy has received a response to her written question asking the Education Secretary what assessment he had made of the provision of needs assessment for parents or carers of disabled children and the availability of support for such carers.

Children’s Minister Edward Timpson responded that the Department was satisfied that there is a strong framework of support in place, in terms of legislation with the Children Act 1989, and in terms of the services provided by local authorities.

He added that the reforms outlined in the Children and Families Bill, along with wider reforms in education and health, would strengthen the current system for children and young people with special educational needs, including those who are disabled.