Weekly political news round up – 30th May 2014

May 30, 2014 in News by Whitehouse

Around the sector

The National Children’s Bureau has announced the appointment of Anna Feuchtwang as its new chief executive. Feuchtwang had previously been chief executive of the international development charity EveryChild since 2004, and until 2011, was also chair of Bond – a network of over 300 international voluntary organisations. She will replace Dr Hilary Emery, who will leave at the end of September.

Ofsted has announced that it plans to bring the management of all school and further education inspections in-house from 2015. The current system of inspection, which involves Ofsted contracting private companies to carry out inspections on their behalf, has attracted criticism over poor quality in recent months.

Nuffield Trust publishes report highlighting disparities in the quality of nursery provision

The Nuffield Trust has published a report which found that private and voluntary preschools catering for children in disadvantaged areas were of lower quality than those serving children in more advantaged areas.

Although the report, which was produced by researchers from Oxford University, found that there were noticeable differences in the quality of literacy, numeracy and communication, there were only very small differences in terms of the provision of mealtimes, toileting and health and safety practices (personal care routines). In these areas, the quality provided by private and voluntary settings serving the most and least deprived areas and children was broadly comparable.

The report attributes the difference in quality to the number of graduates working in settings and recommended that the enhanced training of graduates may help them to meet the greater needs of disadvantaged children. It also recommended that the next Government promotes school based nurseries as a means of addressing the early education gap, particularly in deprived areas. Finally, it also recommended the re-introduction of the Early Years Foundation Stage grade in school inspections in order to capture the quality of early years provision.

Weekly political news round up – 23rd May 2014

May 23, 2014 in News by Whitehouse

Around the sector

The Department for Business, Innovation and Skills has announced that Ofsted has reduced the volume of all its website guidance related to childcare by a quarter as part of an anti-bureaucracy exercise. It clarified that only two key documents had to be read, amounting to just 33 pages in total – a figure down from the 1,100 pages that providers believed they had to read before. The announcement follows a consultation with childcare providers which found that providers believed the existing guidance to be too confusing.

The Welsh Government has announced that Dr Andrew Goodall has been appointed as Chief Executive of NHS Wales and Director General for Health and Social Services. Goodall replaces David Sissling, who left the role at the end of March 2014.

Answer to written question on the Early Years Foundation Stage

Shadow Children’s Minister Lucy Powell has received an answer to her written question asking the Education Secretary asking for the names of the 43 early years providers who have been granted full or partial exemptions from the learning and development requirements of the Early Years Foundation Stage framework.

Children’s Minister Elizabeth Truss responded that there were only two circumstances in which exemptions to the learning and development requirements of the Early Years Foundation (EYFS) framework. These were:

  • When a provider is a good or outstanding independent school; and
  • When the provision is governed by established principles relating to learning and development and those cannot be reconciled with an element of elements of EYFS, for example in Steiner schools (which provide a significantly different approach to education than other schools).

Truss also provided a list of 40 schools that were given exemptions and the reason for this. Of these 40 schools, 33 were exempt as they were Steiner schools, 1 was exempt as it was a Russian nursery and 6 were exempt due to their Ofsted rating.

Weekly political news round up – 16th May 2014

May 16, 2014 in News by Whitehouse

Around the sector

BBC News has reported that Russell Hobby, the General Secretary of the National Association of Head Teachers, has raised concerns that schools in England could struggle to implement guidance published at the end of April on duties for schools to provide support for children with medical conditions. Hobby said that the timescale of the implementation of the guidance would be troublesome, and that staff may struggle to take on the extra medical responsibility. He also said that the guidance did not appreciate that access to school nursing services varied regionally.

Health Education England (HEE) has announced that it has appointed Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, as HEE’s senior national clinical lead for children and young people’s health. Dr Cass, who has a longstanding involvement at national level in policy development for children’s healthcare, was appointed to take forward HEE’s Mandate commitment to deliver an improvement in the health of children and young people.

National Institute for Health and Care Excellence publishes constipation in children and young people quality standard

The National Institute for Health and Care Excellence (NICE) has published Quality Standard 62, which covers the diagnosis and management of idiopathic constipation in children and young people (from birth to 18 years).

This quality standard was introduced to help decrease the rates of accident and emergency department attendance and unplanned hospitalisation for constipation in children and young people, and to decrease the rates of recurrent constipation and/or impaction in children and young people. The quality standard also recognises that continence problems can have a significant emotional impact on children and young people, and thus seeks to provide parents and carers with sufficient advice to help children and young people manage their constipation to a level that they deem satisfactory.

A draft quality standard was published for consultation on 10th December. The draft quality standard contained five quality statements which said that:

  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 receive oral macrogols 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 final quality standard contains six, rather than five, quality statements. The final quality statements state that:

  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 receive oral macrogols as first-line treatment.
  3. Children and young people with idiopathic constipation starting disimpaction therapy have their treatment reviewed by a healthcare professional within 1 week.
  4. Children and young people with idiopathic constipation starting maintenance therapy have their first treatment review by a healthcare professional within 6 weeks.
  5. Children and young people with idiopathic constipation starting laxative treatment, or their parents or carers, receive written information about laxatives.
  6. Children and young people with idiopathic constipation that does not respond to initial treatment within 3 months are referred to a healthcare professional with expertise in the problem.

Following the consultation process, draft quality statement 3 has been replaced by quality statements 3 and 4, while draft quality statement 4 is now quality statement 5, and draft quality statement 5 is now quality statement 6.

The consultation period ran until 14th January 2014. During this period, the PCF submitted a response which made the following key points:

  • Draft quality statement 3 should be amended to state that the healthcare professional must be “appropriately trained”, by which PCF means a healthcare professional, trained in paediatrics, who has a good level of understanding of the range of continence issues.
  • Draft quality statement 5 should be amended to recommend that upon referral, those with idiopathic constipation should be treated by professionals within the context of community based paediatric service that treat other conditions such as daytime incontinence and nocturnal enuresis, plus advice on toilet training. The service should include working with children with learning difficulties and physical disabilities.

NICE subsequently made the following amendments:

  • Quality statements 3 and 4 now include a definition for healthcare professionals. They are defined as “GPs, school nurses, health visitors, practice nurses, continence advisors, and paediatricians”.
  • Quality statement 6 has been amended to state that rather than being referred to a specialist, those who do not respond to treatment should be referred to a “healthcare professional with expertise in the problem”. This is defined as “a healthcare professional with an interest and/or training in the diagnosis and treatment of constipation in children and young people. This may be, but is not limited to, a specialist continence nurse, community paediatrician or GP with a special interest”.

Answer to written question on incontinence

Labour MP Jim Dobbin has received an answer to his written question asking what assessment has been made of the findings of the recent Global Forum on Incontinence into improving health and social care in incontinence.

Care and Support Minister Norman Lamb responded that no assessment has been made of the findings of the recent Global Forum on Incontinence (GFI) into improving health and social care in incontinence. In spite of this, he added that the Government applauded the work of the GFI and what it is doing to give patients and care givers a better quality of life.

Lamb added that NHS England will be taking forward a major programme of work through the Primary Care Strategy; it has established a working group on continence and will provide an update for the All Party Parliamentary Group for Continence Care on 24th June 2014.

He also reiterated the work that has been done by the Department of Health with regards to continence, including commissioning NICE to develop guidelines, quality standards and support tools on continence issues, as well as the policy paper published in April on primary care.

Answer to written question on toilets for disabled people

Liberal Democrat Peer Baroness Thomas of Winchester has received an answer to her written question asking the Government what steps they are taking to ensure accessible toilets for disabled people in buildings other than private dwellings comply with published national standards

Communities Minister Baroness Stowell of Beeston responded that Part M of the Building Regulations requires that reasonable provision is made for accessible toilets where relevant types of building work are undertaken. The building control body is responsible for ensuring that relevant building work complies with this requirement.

She added that provisions in the Equality Act 2010 require those providing a service to the public to make a “reasonable adjustment”, so that disabled people are not placed at a “substantial disadvantage” compared to non-disabled people. She said that only a court could decide what is “reasonable” in any particular case. In spite of this, she said, Part 4 of the Equality Act 2010 (Disability) Regulations 2010, prescribes circumstances in which it is not reasonable for such a body to remove or alter a physical feature which was provided in or in connection with a building to assist with access to the building or the use of facilities and which satisfy the relevant design standard.

Weekly political news round up – 9th May 2014

May 9, 2014 in News by Whitehouse

Around the sector

Research conducted by the Scottish Government has found that high quality nursery education helps improve academic and social performance at school at all ages. The report was published 100 days before the Scottish Government will increase the amount of funded early learning and childcare for three and four-year-olds in Scotland from 12.5 hours per week to almost 16 hours.

Department for Education publishes guidance on supporting pupils at school with medical conditions

The Department for Education has published guidance and advice to ensure that pupils with medical conditions receive appropriate support. The guidance is a mix of statutory requirements and non-statutory advice intended to assist and guide. This guidance relates to Section 100 of the Children and Families Act 2014, which places a duty on governing bodies of maintained schools, proprietors of academies and management commitments of pupil referral units (PRUs) to make arrangements for supporting pupils at their school with medical conditions.

The role of governing bodies
The guidance makes it statutory that governing bodies must ensure that arrangements are in place to support pupils with medical conditions. These arrangements must have regularly reviewed policies, plans and procedures in place to make sure that they can be properly and effectively implemented.

When deciding what information should be recorded on individual healthcare plans, the governing body should consider:

  • The medical condition, its triggers, signs, symptoms and needs;
  • The pupil’s resulting needs, including medication, and other treatments, times, facilities and equipment. They must also consider environmental issues such as crowded corridors, etc;
  • Specific support for a pupil’s educational, social and emotion needs;
  • The level of support needed (some children will be able to take responsibility for their own health needs). If a child is self-managing their medication, this should be clearly stated with appropriate arrangements for monitoring;
  • Who will provide this support, their training needs, expectations of their role and confirmation of proficiency to provide support for the child’s medical condition from a healthcare professional; and
  • Separate arrangements or procedures required for school trips or other school activities outside the normal school timetable that will ensure the child can participate.

Staff training
It is statutory that governing bodies must ensure that sufficient staff have received suitable training and are competent before they take on responsibility to support children with medical conditions. It is advised that training should be sufficient to ensure that staff are competent and have confidence in their ability to support pupils with medical conditions, and to fulfil the requirements as set out in individual healthcare plans.

Self-management
Governing bodies must ensure that the school’s policy covers arrangements for children who are competent to manage their own health needs and medicines. It is advised that children should be allowed to carry their own medicines and devices and should be encouraged to take responsibility for managing their medicines and procedures.

Unacceptable practice
No specific practice is labelled as unacceptable in the guidance, but several practices are given as “generally not acceptable”, such as, amongst others, assuming that every child with the same condition requires the same treatment, preventing pupils from drinking, eating or taking toilet or other breaks whenever they need to in order to manager their medical condition effectively. It is also considered general unacceptable to require parents, or otherwise make them feel obliged, to attend school to administer medication or provide medical support to their child, including toileting issues.

Weekly political news round up – 2nd May 2014

May 2, 2014 in News by Whitehouse

Around the sector

BBC News has reported that charities believe the changes to special educational needs in England are being implemented too quickly. Mark Lever, Chief Executive of the National Autistic Society, has said that the details of the reforms are yet to be finalised, and he was particularly concerned that some details – such as how families would challenge decisions about support for their children – were still under review. Dan Scorer, Head of Policy and Public Affairs at Mencap, said that professionals had only a few months’ notice of their new obligations before having to meet them.

Study finds that hundreds of children over five are still wearing nappies in school

A study by the National Foundation for Educational Research has found that hundreds of children aged 5 and over are still wearing nappies in class. The survey of head teachers and staff, commissioned by Sky News, asked about their experiences of children who did not have an identified special educational need or recognised medical condition coming to school in nappies. 602 teachers in primary schools responded, while the 561 secondary school teachers responded.

Almost one in 10 (9%) of heads and senior staff said that in the past year a child aged between five and seven had worn a nappy to their school. The figure was one in 20 (5%) for classroom teachers. For those who had seen a child aged seven to eleven wearing a nappy, the figure was almost one in 20 (4%). One per cent of classroom teachers surveyed had experience of older children in nappies.

Anne-Marie Middleton, a deputy head teacher from Dover, said: “we’re seeing more and more children wearing nappies. We find that more and more children have an issue with toilet (training further up the school)”. She claimed that the busy lives of parents are often at the root of the problem, with pupils arriving at school without many basic skills including toileting, or being able to use a knife and fork.

Department for Education publishes summary of survey on the implementation of the two year old provision in school

The Department for Education has published a summary of some of the key findings from a baseline survey of 47 schools carried out as part of an implementation study examining what works in developing and delivering two year old provision in schools. The findings show the different delivery approaches of schools offering provision for two year olds and the support needs they identify.

An important finding was that of the schools that reported encountering unexpected costs (ten) and substantial delays (19) in setting up or starting to deliver provision, four gave examples of the need to improve their building and toilet facilities in particular. It was also found that 18 schools reported adapting their washing/changing/toilet facilities ‘a lot’ and thirteen ‘a little’ to make them appropriate for two year olds.

The survey found that 13 of the 47 schools that responded found that it was challenging to develop their workforce in order to provide high quality (level of experience and training) staff with capacity to meet the needs of two year olds. It was reported that during a workshop in November, a number of schools said that they found it difficult to recruit staff with relevant experience. Those who had recruited staff externally had to deliver subsequent in-house training to raise their standards. Other schools said that they were concerned that there was not enough funding to provide the one to one staffing that was required for supporting children with special educational needs.

The table below reflects respondents’ confidence that their staff could address the personal care needs of two year olds and support their transition to greater independence in toileting and self-care. 1 is not confident and more training is required and 5 is very confident and no training is required, the following numbers were provided as a percentage:

Confidence 1 2 3 4 5
Respondents 2 2 11 21 64

Department of Health publishes the Children and Young People’s Health Outcomes Forum annual report 2013/14

The Department of Health has published the Children and Young People’s Health Outcomes Forum (CYPHOF) annual report for 2013/24. The Forum was established in January 2012 to develop a strategy to help deliver world leading healthcare outcomes for children and young people. The latest report found that while there had been some notable improvements in measured outcomes for children and young people over recent years, evidence still suggests that improvements are happening at a slow rate in the UK compared to other countries in Northern and Western Europe.

Early intervention

The report welcomed the support being provided to families with young children through the increased focus upon health visiting and the Family Nurse Partnership, and stated that the Forum intends to keep pushing for investment in prevention and early intervention. However, it added that there was a lack of equivalent support, to that provided to the 0-5s, for those aged 10-19/25 years. It stated that the profile of the role schools play in early intervention should be raised, and that there should be a common purpose between the education sector and the health service that goes much wider than simply prevention and early intervention

There was praise for the introduction of joint education, health and care plans being introduced as part of the Children and Families Act 2014, but it was assessed that still too often there was a disconnect between the education sector and the health service. The report found that the result of this disconnect is that those with long term conditions fail to receive the relevant support at school because information is not shared by the NHS or because that information is not being used by the school.

The report welcomed the duty imposed on schools by Section 100 of the Children and Families Act 2014 to make arrangements for supporting pupils at school with medical conditions. It stated that both the NHS and the education sector needed to work on improving co-ordination at a local level and we think that there is a role for organisations at national and local level to encourage positive relationships between schools and the health service.

Integrating services

The Forum highlighted that children and young people with complex health and care needs, including those with life limiting/life threatening and palliative care needs, and disabled children, are often dealing with a number of health issues and therefore rely on there being an integrated, multi-agency approach to support them. It praised the progress being made through the Children and Families Act 2014 where a statutory framework is being introduced for joint commissioning by local authorities and Clinical Commissioning Groups for education, health and care services for disabled children and those with special educational needs.

The report criticised the slow progress in linking health, education and social care data through the use of the NHS Number (a number that is assigned to all people registered with the NHS) to assist the provision of better integrated services. In particular, it said that organisations needed to upgrade their IT systems to incorporate the NHS number in their records databases.

Workforce, education and training

The report stated that Health Education England (HEE), which took over responsibility in April 2013 for ensuring that the health workforce has the right skills, behaviours and training, has a major role to play in ensuring positive outcomes for children and young people. It argued that improvement on a number of vital indicators would not be easy to achieve without significant progress on workforce, education and training issues. The Forum added that it needed to investigate whether the children’s workforce is right in terms of numbers, skills and culture and that they would be keen to work with HEE on these issues.

The Forum’s initial report found that despite general practices being the most frequent point of contact, too often the needs of children and young people were not being met. The Kennedy Report identified that many GPs had little or no formal paediatric training.

Engaging with children and young people

The Forum said that they were pleased that senior appointments were made across the health system on patient engagement, ensuring that children and young people’s voices were sought and taken into account at the highest level when planning, delivery and expecting services. One example of an appointment would be the Care Quality Commission’s (CQC) appointment of Dr Sheila Shribman as a lead advisor on the design of the inspection regime for children and young people’s services.

In spite of the positive developments, the Forum said that it was “not well sighted” on how organisations such as Clinical Commissioning Groups, Health and Wellbeing Boards, and Local Authorities demonstrate how they are engaging effectively with children and young people.

Health outcomes

The report highlighted that recent developments, including the decision by the Children and Maternal Health Intelligence Network to develop a benchmarking tool that brings together all relevant indicators within the Public Health Outcomes Framework and the NHS Outcomes Framework, has made it easier for those concerned with children and young people’s healthcare.

However, it added that there was a need for transparency on how NHS England will hold Clinical Commissioning Groups to account against outcome measures. It stated that NHS England’s performance assessment of Clinical Commissioning Groups should include assessment against a common framework of agreed outcomes for children and young people.

Plan for 2014

Relevant parts of the Forum’s work plan for 2014 include:

  • Ensuring that the incentives for service development incentivise prevention, early intervention and safe and sustainable services:
    • Work with all system organisations to understand how funding flows are impacting on patient care or service provision and work with them to ensure future development of Payment by Results currencies and tariffs for child health related areas incentivise safe and sustainable services.
  • Ensuring that children and young people’s services are accountable at a national and local level and knowing this is working on the ground:
    • Work with key system players to fully understand accountability in the new system and how this is understood by all elements including, crucially, children, young people and families.
  • Data sharing and integration – there is a lack of coherent data and a system that links outcomes of children and enables them to be tracked:
    • Work with the Department of Health, Department for Education and local agencies (such as the Association of Directors of Children’s Services, the Local Government Association and SOLACE) to make progress on the Forum’s recommendation for using the NHS Number as an identifier in health, education and social care;
    • Contribute to Children’s Health and Wellbeing Partnership’s work on integrated care and support for children and young people;
  • Ensuring that the appropriate children and young people’s health outcome indicators are in place and that progress against the indicators, including regional variations, is reviewed:
    • Use the Forum’s Annual Summit to review progress (a) against the outcome indicators for children and young people including regional variations, and (b)on the development of outcome indicators for children and young people previously recommended by the Forum;
    • Invite senior representatives from health system organisations, and others that have a role to play in improving health outcomes, to Forum meetings so that we can better understand progress made on children and young people’s issues, their plans for the future and how the Forum can assist them;
    • Work with key gaps in indicators.

Responses

Both the National Children’s Bureau (NCB) and the Royal College of Nursing (RCN) have issued responses to the report.

Dr Hilary Emery, Chief Executive of the National Children’s Bureau, said that it was necessary to “accelerate progress to ensure there is better data on the experiences of children using health services”, and that health professionals, and GPs in particular, “need better paediatric training to support those in their care, and we need better joining-up of services”.

Dr Peter Carter, Chief Executive and General Secretary of the RCN, added that “this highlights that specific health care provision for children and young people in the UK remains inadequate”. He suggested that “improved planning, more integrated working, and sufficient investment in the right nursing staff and services will go a long way towards ensuring better health outcomes for future generations”.

Department of Health publishes Government’s mandate to Health Education England for 2014-2015

The Department of Health has published the Government’s mandate to Health Education England (HEE) for April 2014 to April 2015. The mandate sets out the priority areas for HEE in the delivery of its functions, and reflects updated strategic objectives around workforce planning, health education and training and development.

Although the mandate makes no reference to continence, it does provide a set of obligations for HEE with regards to long-term conditions. It states that HEE must ensure that training supports healthcare staff to help individuals and their families better manage their own conditions. In particular, the mandate states training should reflect the increasing role of carers, the importance of self-management of long-term conditions, and the supportive roles that wider communities can play. It also notes that HEE should assess the extent to which existing education, training and ongoing development enables staff to support self-care and self-management and report on the current position of any changes needed by October 2014

HEE’s mandate recognises that an effective voice for patients, services users and the public is needed to ensure that safe, dignified and compassionate care is delivered. As part of making sure that the public does have a voice, HEE should ensure that they and the Local Education and Training Boards (LETBs) seek advice on proposed reforms from patient and public representatives.

In order to fulfil the Government’s ambitions for child health, HEE must work with bodies that set curricula, such as the professional bodies and professional regulators, to seek to include compulsory work-based training modules in child health in GP training. Furthermore, HEE must work with the Royal College of General Practitioners and Royal College of Paediatrics and Child Health to develop a bespoke training course to allow GPs to develop a specialist interest in the care of young people with long-term conditions for introduction by September 2015.

By 2014, HEE should employ a senior national clinical lead for maternity, children and young people’s health to co-ordinate education, training and workforce development to reduce variability and ensure high quality staff training everywhere.

HEE should also be taking forward the pledge it signed up to in Better health outcomes for children and young people and has a commitment to ensuring that services are delivered for children and young people in the right place by a properly educated workforce. It was specifically noted in the mandate that it should include appropriate support across primary, secondary and community care for children with long-term conditions.