Weekly political news round up – Friday 20th December 2013

December 20, 2013 in News by Whitehouse

Around the sector

The Royal College of Paediatrics and Child Health has published a survey of newly qualified paediatric consultants which found that 10% had left the country to find work, while 22% were on temporary contracts, compared to 3% of doctors working in paediatrics as a whole. This survey follows concerns that the difficulty for consultants gaining a job in their field will lead to a negative impact on recruitment.

The Belfast Health and Social Care Trust has announced that it has recalled 1113 urology patients as a precautionary measure following a review of a number of patient notes. The patients who were recalled attended Belfast City Hospital for a bladder camera test / cystoscopy during 2012 and 2013. Trust Medical Director Tony Stevens said that the standard of care they had received was ‘not what we would have expected’.

Update on Children and Families Bill

This week the second day of the Report Stage of the Children and Families Bill took place, which discussed the early clauses of part three relating to SEN reform. The discussions saw the “wholly or mainly” issue resolved as well as a debate over joint commissioning for children and young people without Education, Health and Care (EHC) Plans. The Government has also made a series of concessions to the Bill, including tabling amendments to allow EHC Plans to function in youth detention settings, although these will not be debated until the next scheduled session of the Report Stage on 7th January when the House of Lords returns.

Debate on inclusion

An amendment tabled by Lord Low to place a legal requirement on local authorities to encourage access to an inclusive school system for disabled children was defeated by the Government after it was put to a division. Shadow Education Minister Baroness Hughes offered her support for Lord Low, describing it as a “matter of legislative housekeeping” that would “drive the major strengthening of the code of practice on inclusion which is required”.

The inclusion debate also saw concerns raised over draft regulations under Clause 34 that allow a child or young person to be placed in a special school without an EHC assessment and plan on an indefinite basis, provided that the placement is reviewed termly.

Scope of the Bill partially expanded to include disabled children and young people

Lord Nash also introduced Government amendments to expand the scope of the Bill to include disabled children and young people within the Bill’s joint commissioning arrangements, review functions, and local offer duty, acknowledging the concerns raised by the Every Disabled Child Matters campaign. The expansion did not go as far as including disabled persons within EHC Plans;

Wholly or mainly issue resolved

Following concerns that had been raised regarding the issue of “wholly or mainly”, relating to the circumstances in which provision that would otherwise be health or social care provision should be treated as special educational provision, the Government introduced amendments to further clarify their intention to maintain the current case law following the legal advice provided to them by the Royal College of Speech and Language Therapists.

National Institute of Health and Care Excellence publish topic overview for nocturnal enuresis in children and young people

Healthwatch England has announced that it is seeking responses to draft elements of its strategy for 2014-16. Included in the strategy are draft rights and responsibilities for patients, as well as Healthwatch England’s organisational vision, mission and strategic priorities.

The proposed strategic priorities include plans to promote the design and delivery of services around the needs of a person. This will involve Healthwatch England working with those who deliver services to ensure that they engage with all individuals and communities, especially those with complex needs. Furthermore, the consultation document highlights that Healthwatch England intends to aim for better identification of consumer concerns and complaints, and additional plans to promote improved handling of concerns and complaints.

The most relevant draft consumer rights include: the right to a safe; dignified and quality service; the right to choose from a range of high quality products and services; the right to be listened to; and the right to be involved in the decision making process of care.

The consultation asks a series of questions whether the respondent agrees with the rights and responsibilities outlined in the document, as well as the outlined vision, mission and strategic priorities.

Healthwatch England launches consultation to help develop its strategy for 2014-16

The National Institute for Health and Care Excellence (NICE) has now published the topic overview for nocturnal enuresis as part of the topic engagement exercise. The topic overview describes core elements of the quality standard, including the topics covered, key source guidance used to underpin potential quality statements, any related quality standards, published current practice information and national or routine indicators and performance measures.

The topic overview states that the quality standard will cover the management of nocturnal enuresis (bedwetting) in children and young people up to 19 years of age.

The primary development source will be the existing NICE clinical guideline 111 on nocturnal enuresis, published in 2010. NICE has also deemed related quality standards 36 (urinary tract infection in infants, children and young people under 16, published in 2013) and 15 (patient experience in adult NHS services, published in 2012). Furthermore, a future quality standard on child abuse and neglect has also been deemed related (the consultation on the draft scope for this quality standard is due to commence in May 2014).

NICE is interested in receiving views on what the key areas are for quality improvement that stakeholders want to see covered by this quality standard. In particular, NICE has asked for respondents to prioritise up to five areas that have the most potential to improve the quality of care, stating the specific aspects of care or service delivery that should be addressed.

NICE has said it is essential to provide evidence or information that care in the suggested key areas is poor or variable and requires improvement.

Following the close of the topic engagement exercise, the quality standards advisory committee will meet to discuss comments in February 2014. The consultation on the draft quality standard will take place between the 25th April and 27th June 2014, with the quality standard published on the 18th September 2014.

National Children’s Bureau publishes survey results on the assessment of health reforms

The National Children’s Bureau has published the results of a survey conducted in conjunction with the NHS Confederation, which asked child health care professionals for their assessment of the reforms to health services made since April 2013.

The survey found that 66% of respondents believed that acute care was still given priority over prevention, while 89% felt that schools’ potential to support good child health was not yet being fully utilised. The survey also found that 51% of respondents disagreed with the statement that there was a shared agenda for promoting children’s health and wellbeing across national government and its arms-length bodies. Furthermore, 75% believed that the reforms did not remove structural barriers to integrated commissioning of health, social care and other children’s services.

In spite of the concerns, the survey revealed that 63% of recipients were positive about their local health and wellbeing board’s ability to engage the right people to improve services for children.

Following the report, the NCB and the NHS Confederation have called for cross agency working to be supported through greater clarity of responsibilities and facilitation of joined up commissioning and delivery of services.

Care Quality Commission appoints former National Clinical Director for children to plan CQC inspection for child services

The Care Quality Commission (CQC) has appointed Dr Sheila Shribman to support its plans for inspecting specialist children’s and young people’s health services. Shribman will lead a small team to design methodology for CQC’s revised inspection programme, which involves planning how the CQC inspects specialist children’s services including stand-alone hospitals, linking this with children’s services at a local level.

Dr Shribman was previously National Clinical Director for children, young people and maternity at the Department of Health until April 2013, when she was replaced by Dr Jacqueline Cornish.

Answer to written question on provisions for disabled children under the Children and Families Bill reforms

Liberal Democrat MP Mike Thornton has received an answer to his written question asking the Education Secretary what arrangements local authorities and their partner commissioning bodies in England are making to ensure adequate education, health and social care provision for disabled children who are not eligible for education, health and care plans once the Children’s and Families Bill becomes law.

Children’s Minister Edward Timpson responded that the Children and Families Bill makes provision for local authorities and their partner clinical commissioning groups to make joint commissioning arrangements for the education, health and social care provision to be secured for children and young people with special educational needs, whether or not they have education, health and care plans.

He added that on Wednesday 11th December 2013, the Government tabled amendments to the Children and Families Bill, currently being considered by the House of Lords, to extend the joint commissioning provisions and other key elements of the Bill to include disabled children and young people without special educational needs. This, he said, would help to ensure improvements in the planning, commissioning and reviewing of provision for all children and young people who are disabled or have special educational needs when, subject to Parliament, the Bill becomes law.

Weekly political news round up – Friday 13th December 2013

December 13, 2013 in News by Whitehouse

Around the sector

Children and Young People Now has reported that the Every Disabled Child Matters (EDCM) group, a campaign group comprising Mencap, Contact a Family, Council for Disabled Children and the Special Educational Consortium has criticised the draft SEN code of practice, arguing that it fails to deliver the government’s promised joined-up system of support for families, and could undermine other aspects of the Children and Families Bill that place a greater emphasis on joint working and improving outcomes. In particular, they argue that it fails to provide schools, health services and local authorities with clear information about their responsibilities under the bill, or best practice on how to make the new system work. EDCM also complained about alleged poor accountability and a weak statutory framework for those without an education, health or care plan.

Children’s Minister Edward Timpson gave a speech this week to the Local Government Association special educational needs conference discussing how local areas can prepare for special educational needs reforms. He discussed the changes made as part of the Children and Families Bill, as well as the work of local pathfinders and the provision of funding for early intervention. There was, however, no specific mention of continence in children.

NICE begins consultation on draft quality standard for constipation in children and young people

NICE has now published a draft quality standard for constipation in children and young people, and is now accepting responses to the consultation on the draft quality standard.

The draft quality standard contains five quality statements outlined below:

  1. Children and young people with constipation receive a full assessment before a diagnosis of idiopathic constipation is made.
  2. Children and young people with idiopathic constipation (where there is no clear reason why the child is constipated) receive oral macrogols (laxatives) as first-line treatment.
  3. Children and young people with idiopathic constipation undergoing laxative treatment have their treatment reviewed by a healthcare professional.
  4. Children and young people with idiopathic constipation undergoing laxative treatment receive a written personalised management plan.
  5. Children and young people with idiopathic constipation who do not respond to initial treatment within 3 months are referred to a specialist.

The consultation is seeking feedback on the five quality statements outlined above, and is seeking responses on five questions. Of the five, there are two general questions about the statements:

  1. Does this draft quality standard accurately reflect the key areas for quality improvement?
  2. If the systems and structures were available, do you think it would be possible to collect the data for the proposed quality measures?

The other three questions relate to specific statements:

  1. For quality statement 3: Is one review type often carried out better than the other or do both types of treatment review need equal levels of improvement?
  2. For draft quality statement 4: What is the most important piece of information that should be provided as part of a written personalised management plan?
  3. For draft quality statement 5: Is it clear what ‘respond to initial treatment’ means?

Update on the Children and Families Bill

This week Children’s Minister Edward Timpson and Health Minister Dan Poulter jointly wrote to local authority and health leaders with about the proposed enactment of the SEN reforms, which including an ‘implementation pack’ offering guidance. The pack includes a timeline for implementation, information on the resources and support that can be accessed from a variety of organisations (such as the Council for Disabled Children) and examples of best practice.  The pack also revealed that a “lead for SEN reform” would be confirmed in post before March 2014.

The joint letter from the Minister also confirmed that the Pathfinder Champion programme, which identifies the pathfinders who have made strong progress in developing their programmes, will continue until March 2015, several months after the reforms are expected to come into force. We understand that this could mean that local authorities will be expected to develop and publish their local offers before the pathfinders have finally reported on the best practice for doing so, which could lead to a significant variation in standards.

The pack offers some guidance and case studies on how local authorities and health bodies may support the identification of children and young people with SEN, particularly at key points such as in the early years through the progress check at age 2, the integrated health check and through the healthy child programme. While we believe this guidance is arguably quite vague, it does show recognition by the Department of how crucial early identification and intervention is for children and young people with SEN.

A timeline outlining the implementation of the new approach is given in slide four of the accompanying PowerPoint presentation. It states that, prior to the legislation coming into force in September 2014, preparations must be made including the development of the local offer; processes for assessment; planning and EHC plans; the identification of services that would be provided through personal budgets; as well as plans for joint commissioning and local information, advice and support. After the reforms have come into force, regular reviews of the local offer, and annual reviews of EHC plans will be required, as well as reviewing the general success of the reforms.

Concerning ‘readiness’ of local authorities in implementing the SEN reforms overall, as of October 2013, slide five revealed that 1% of local authorities had completed preparations, 35% had made good progress, 63% were at the early stages, and 2% had not started.

Slide 7 of the presentation shows the mixed progress that local authorities have made across different aspects of implementing SEN reform, revealing that local authorities are generally making better progress on their readiness for engaging with joint commissioning partners and parents than they are engaging the voluntary sector and recruiting families to trial the reforms.

Figures provided on slide 6 show that understanding of the reforms is generally growing but that accountability arrangements are falling behind.

PCF responds to SEN Code of Practice consultation

December 9, 2013 in Consultations by Whitehouse

The Paediatric Continence Forum has responded to a joint consultation being conducted by the Department for Education and the Department of Health on the Special Educational Needs (SEN) Code of Practice.

The draft 0-25 SEN Code of Practice is statutory guidance which will be accompanying the Children and Families Bill. This Bill proposes replacing SEN statements (for schools) and Learning Difficulty Assessments (for young people in further education and training) with single 0-25 Education, Health and Care Plans.

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

Weekly political news round up – Friday 6th December 2013

December 6, 2013 in News by Whitehouse

Around the sector

The left-leaning think tank, the Institute of Public Policy Research, has published a report, Towards whole person care, which looks at the best ways to integrate health and social care, and criticises Government efforts in this area. It particularly focuses on the financial incentives which the IPPR argues means that there is an incentive to treat people in hospital, rather than in the community. Instead, the report suggests five “person-centred guarantees” including a single point of contact for all care needs.

Autumn Statement 2013

Chancellor of the Exchequer George Osborne has made his annual Autumn Statement to the House of Commons on Thursday 5th December, in which he set out the state of the UK economy based on analysis and projections by the Office for Budgetary Responsibility (OBR), and announced new policy measures the Government will take aimed at boosting growth in the economy and developing sustainable public finances.

As part of the Statement, George Osborne told the House that “Britain’s economic plan is working”, as he projected GDP growth of 1.4% this year and 2.4% in 2014. This indicated a marked improvement from projections in March this year, where the OBR forecast that growth would be 0.6% in 2013. The Chancellor also confirmed a forecast for a “small” surplus for 2018-19, stating that the deficit had fallen from 11% back in 2010 to 6.8% this year.

While the Autumn Statement focused particularly on public finances, support for businesses and employment support for young adults, Osborne did make one point which of interest regarding urology and continence care.

The Autumn Statement included changes to Government departmental resource budgets for 2014-15 and 2015-2016, with most departments seeing a fall in budget of 1.1% in 2014-15 and 2015-16, the Department of Health and NHS have received no reductions in their budgets.

Responding to the news, Anita Charlesworth, chief economist at the Nuffield Trust, argued that in spite of no departmental cuts being made to the NHS in the Autumn Statement, there were still going to be financial pressures on its budgets, stating that “although the health service faces upward cost pressures of around four per cent each year, this tight fiscal picture and the deep cuts seen by other departments make it likely that NHS funding will not increase over this period. We have estimated that this will lead to a further funding gap of around £30 billion by 2021-22”.