Weekly political news round up – 27th June 2014

June 27, 2014 in News by Whitehouse

Around the sector

NurseryWorld has reported that Children’s Minister Edward Timpson told Inside Government’s Special Educational Needs and Disability (SEND) conference that the “acid test” of the SEN reforms success would be the joint commissioning of services provided for children with SEN. He added that “if we can get this right we will get a better relationships between [all parties]…, better outcomes and save on costs.” He added, “There must be a greater ability for those working in pre-schools to draw health services in”.

Children and Young People Now has conducted a survey of seven leading year years and children’s organisations, asking what they believed the top three policy priorities should be ahead of the 2015 general election. The organisations, which included Barnardo’s, the National Day Nurseries Association and the Pre-School Learning Alliance, said that they wanted increased government investment in the early years sector, as well as an increased investment in training and continued professional development of childcare professionals.

Scottish Government announces 500 new health visitors by 2017-2018

The Scottish Government has announced that a total of 500 new health visitor posts will be created over the four years until 2017-2018. Health Secretary Alex Neil said that £40m would be spent over four years to create new posts, as well as to further educate  existing health visitors.

The announcement was backed by the Royal College of Nursing Scotland and Unite CPHVA in Scotland, who have both been involved in campaigning and discussions leading to this announcement. Both organisations will be assisting in taking forward the Scottish Government’s plans.

Commenting on the announcement, Health Secretary Neil said that “as front-line NHS workers, working with people to reduce health problems from an early age, these new health visitors will play a key role in the Scottish Government’s efforts to reduce health inequalities”.

Children and Young People’s Minister Aileen Campbell added that “Health visitors who support infants and their parents and carers in the earliest years of life play a key role in delivering a universal service to children and families and the Scottish Government is committed to supporting them”.

Health Service Journal reports that Health Education England is planning a “drastic” reorganisation

The Health Service Journal has reported that Health Education England (HEE) is planning a “drastic” reorganisation in an attempt to reduce its spending by 20 per cent. A paper was leaked to the HSJ which highlighted the proposals and motivation for reorganising HEE, which commissions training for healthcare professionals.

The paper said that HEE “often feels to staff and stakeholders like 14 organisations with a national body called HEE and 13 local bodies”, which in turn meant that “a number of functions of HEE [are] being carried out 14 times differently, which is not financially or culturally sustainable”.

In addition to expected cuts to senior staff salaries, the 13 boards will have their current “semi-autonomous freedoms” replaced by a new “cross HEE model”. Furthermore, each board will be expected to appoint the chief executive of a local provider to the position of vice chair. The national body will create four new national directors responsible for a number of boards, who will report directly to Peter Cummings, HEE’s chief executive.

According to the HSJ, the paper aims to address variations in contracts between universities, external suppliers and other functions such as estate management and the recruitment of healthcare students.

Weekly political news round up – 20th June 2014

June 20, 2014 in News by Whitehouse

Around the sector

The Welsh Government has appointed Dr Mike Shooter as the independent reviewer of the role and function of the Children’s Commissioner in Wales. Dr Shooter, a former consultant in child and adolescent psychiatry, will also look at the impact of the Children’s Commissioner, conduct a review of the legislation around the role, and look at its governance and accountability. He will soon announce a call for evidence and will report back to the Welsh Government with his findings in December 2014.

The Times has reported that a study commissioned by the Royal College of Nursing has found that district nursing is on course for “extinction”. The study found that three quarters of district nurses do not have time to care for people properly, and that half the district nurses in England have left their roles in just over a decade. The RCN said that the problem will only worsen as a third of district nurses are over 50 and heading towards retirement.

BBC News has reported that research conducted by the University of London’s Institute of Education has found that primary schools pupils in England with special educational needs are twice as likely as other children to endure persistent bullying. The study found that 12% of seven-year-olds with SEN felt bulled all the time, compared with 6% of non-disabled peers

NICE publishes four-year surveillance review of clinical guideline 99 – constipation in children and young people

The National Institute for Health and Care Excellence (NICE) has published their 4-year surveillance review of clinical guideline (CG) 99 – constipation in children and young people. This review, which is the first substantial one undertaken since the CG was published in 2010, found that the guideline should not be considered for an update at this time.

By way of background, NICE undertakes two different types of review every 2 years. One is more substantial than the other.

The first surveillance process is at the 2-year, 6-year and 10-year time points following initial publication of the document. These reviews, which do not call for the views of the original Guideline Development Group members, are less-resource intensive and are intended to be done relatively quickly.

More substantial reviews are done at the 4-year and 8-year dates after publication. These reviews consider whether the guideline is still appropriate, or whether it needs to be updated in light of new evidence. During this process, the original guideline development group members (who helped produce the guideline), will be surveyed to get their opinions on the existing guideline, recent developments in the topic area and their knowledge of any new important evidence since the original publication. The NICE Information Services team are tasked to conduct a literature search across a range of databases.

Reviews have five possible outcomes, which are:

  • Substantial update – the update will follow the standard guideline development process, much like a new clinical guideline would. The update would be consulted on.
  • Rapid update – discrete changes will be made following an assessment by the Updates Standing Committee. Draft recommendations would be consulted on.
  • No update – no changes will be made. A consultation will be held if this happens.
  • Transfer to static list – clinical guidelines that have undergone a review and been recommended for ‘no update’ will be considered for the static list. Guidelines on the static list will only be assessed every five years. A consultation will be held on this decision.
  • Withdraw the guideline – the guideline will no longer apply. Stakeholders will be consulted.

In the case of CG 99, it was decided that there was no update to be issues. As such, a consultation has been launched where stakeholders will be able to input their views into whether or not the decision was correct, and suggest changes where appropriate.

The consultation closes on Friday 27th June 2014.

If the decision is maintained that there will be no update, then CG 99 will next be reviewed briefly in 2016, and reviewed again more substantially in 2018.

Conservative MP Dr Sarah Wollaston elected Chair of the Health Select Committee

The Speaker of the House of Commons has announced that Conservative MP Dr Sarah Wollaston has won the election for Chair of the Health Committee, following the recent resignation of Stephen Dorrell. Her appointment takes effect immediately.

She received 226 votes, 31 more than Phillip Lee, the Conservative MP for Bracknell.

 

In her first interview as Chair, Dr Wollaston outlined to the Health Service Journal her priorities for the Committee over the next few months. She said that she would like the Committee to look at whistleblowing, patient safety and the safeguarding of patient records. In spite of this, she highlighted that these areas reflected her own personal views, and that any actual enquiries would be decided by a vote of the majority of the committee.

Prior to entering parliament in 2010, Wollaston had worked as a GP and had also been an examiner for the Royal College of General Practitioners.

Health Service Journal reports that CQC has been asked to consider take responsibility on patient safety by NHS England

The Health Service Journal has reported that there have been preliminary discussions between the Care Quality Commission (CQC) and NHS England over transferring the patient safety directorate to the CQC. The directorate was created following the abolition of the National Patient Safety Agency in 2012.

Under Section 13 of the Health Act, NHS England is responsible for gathering and disseminating information relating to patient safety. However, Section 13 also states that NHS England can delegate these functions to other organisations.

David Prior, chair of the CQC, told the Health Select Committee last year that the CQC felt that patient safety should be with them rather than with NHS England.

Weekly political news round up – 13th June 2014

June 13, 2014 in News by Whitehouse

Around the sector

The Department for Education has published the final draft of the SEN Code of Practice, which will need to be approved by Parliament before it comes into effect in September. Very few changes were made to the previous draft in April, the most notable being that all mainstream schools are recommend to have a governor with the specific responsibility of holding the school to account on its SEN provision. It is likely that the debate on the Code will happen in early July.

The Department for Education has published details relating to the reception baseline assessment. Baseline testing was introduced as part of the government’s new accountability and assessment framework which measures the progress of primary school pupils with new performance descriptors, and will be introduced from 2016. Unlike with the Early Years Foundation Stage profile, children will only be assessed on academic ability.

Care Quality Commission publishes report into the transition from children to adult health services

The Care Quality Commission (CQC) has published a report, From the Pond into the Sea, analysing the transition that young people face when they move from children’s health services to adult health services. The report found that the transition process is variable and that previous good practice guidance has not always been implemented, leaving confusion at the lack of information, support and services available. The findings come following interviews by the CQC with 180 young people, or parents of young people, between the ages of 14 and 25 with complex health needs.

Findings          

In terms of the transition process, the report found that the information and preparation provided by children’s services to young people and parents about the changes they face when transitioning was inconsistent and poor. It found that there was a general lack of understanding of the transition process by both young patients and by some of the professionals delivering car, with some professionals unaware of guidance and protocols for transition. One key complaint there was no lead professional to support young people during their transition, meaning that was that parents and young people often had to tell their story repeatedly to numerous professionals.

General information on different funding arrangements was found to be unclear, with some parents and young people unaware of money they could receive following the move to adult services. Disagreements over responsibility for funding meant that young people were left without equipment services, respite and other requirements during their transition. When funding was assessed, some found that the assessment was being made by professionals with no former knowledge or connection with the young people and their family.

Those interviewed revealed that there were often no transition plans at all, and where they did exist, they were of variable quality. When planning did happen, it often started late, which sometimes resulted in delayed decisions and gaps in case. Poor coordination between children’s and adult health services was a factor.

The report found that only 54% of young people preparing for transition and their families felt that they had been involved as much of they wanted to be. It found that services often relied too much on parents and families, with parents telling the CQC that they felt abandoned by health and social care services. With regards to carers, the carers believed was a limited assessment of their needs, and only a limited understanding of what was important to them during the transition time.

Adult and children’s healthcare professionals who were interviewed believed that they were competent to meet the specific needs that they were trained for, which the young people and parents agreed with. However, professionals did not feel equipped to manage the transition process as they lacked knowledge about age-specific needs in relation to their complex needs. Moreover, parents did not have a great deal of confidence in adult services and young people often believed that the care provided for them in this setting was not appropriate for them.

Outside of health settings, the report found that the provision of services to meet other needs, including social care, life skills, and educational needs, was often not well co-ordinated and relied on the parents and carers of young people to take the lead. Services themselves were often found to be developed without the involvement of young people and their families.

In general, the transfer to adult services was considered to be a negative experience. It was found that there was no evaluation or quality checking of the outcome of the transition planning for individual young people and their parents.

Recommendations

The report subsequently made four overarching recommendations, which were that:

  1. Commissioners must listen to and learn from young people and their families.
    1. Local authorities and CCGs, when planning for new legislation relevant to the transition arrangements for young people from children’s health services, must check the implementation of best practice guidance and be clear about the responsibilities in each area.
    2. Local authorities and CCGs must ensure they agree a clear process to ensure taken about funding and funding responsibility are taken in a timely and coordinated manner.
    3. Commissioners and local authorities should ensure that they have accurate and up-to-date local data to ensure that complex health needs are known and planned for.
    4. Joint Strategic Needs Assessment should include the needs of young people transitioning to ensure there is data on who will require input from multiple health services.
  1. Existing good practice guidance must be followed to ensure young people are properly supported through transition.
  1. GPs should be more involved, at an earlier stage, in planning for transition.
    1. A new enhanced service for general practice will be introduced in 2014/15 for people with complex health and care needs at high risk of unplanned admission to hospital. This will be under the supervision of a named, accountable GP.
    2. All information about the health care of a child or young person should be shared with their GP.
  1. Adolescence/young adulthood should be recognised as an important developmental phase across the health service – with NHS England and Health Education England taking a leadership role.
    1. Services should be tailored to the needs of this specific group, and provided by staff trained in the specific needs of young people.

Next steps

As the report received the support of NHS England, Health Education England, the Department of Health and the Royal College of General Practitioners, these organisations will set out their expectations for how these improvements and recommendations will be delivered.

Debate on the transition between children and adult health services

In an oral questions session, Shadow Health Spokesperson Lord Hunt of Kings Heath asked Health Minister Earl Howe what action the Government was taking to ensure continuity in the standards of care for teenagers with long-term health conditions transferring to children’s services to adult services, as recommended in the Care Quality Commission report From the Pond into the Sea (summarised above).

Earl Howe responded that as part of the Government’s pledge in 2013 to improve health outcomes for children and young people, plans had been developed to co-ordinate care around young people with complex needs in order deliver the best experience of transition to adult services. He said that the partners to the pledge – including NHS England and Health Education England – were working to deliver this. He added that the mandate to NHS also called for improvements to the transition between children’s and adult services.

He added that plans were underway by NHS England to develop service specifications across the range of commissioning models: specialised commissioning, CCG secondary and primary care commissioning, adolescent mental health and special educational needs, and learning disability. He said that these will translate examples of best practice and published outcomes into specifications for commissioning to hold providers to account for the delivery of robust transition services with measurable quality standards attached to them.

 

In terms of stakeholder engagement in the development of these specifications, Earl Howe praised the Children and Young People’s Health Outcomes Forum for highlighting the need for new outcome indicators to measure transition, and the work it has done in asking the National Network of Parent Carer Forums to develop a narrative of what good integrated care looks like.

Earl Howe said that the Government was addressing “the full range” of complex needs in children and young people. He added that Health Education England (HEE) will be working with the Royal College of General Practitioners (RCP) and the Royal College of Paediatrics and Child Health to develop a training course that will allow GPs to develop a specialist interest in the care of young people with long-term conditions. The course is scheduled to be implemented in 2015, and will include an emphasis on the transition from childhood.

Weekly political news round up – 6th June 2014

June 6, 2014 in News by Whitehouse

Around the sector

BBC News has reported that Conservative MP Stephen Dorrell has stepped down as chair of the Health Select Committee with immediate effect. Dorrell, who was Health Secretary between 1995 and 1997, said that he wanted to contribute to the debate on the health service in the run-up to the 2015 election from a “less overtly political position”. The ballot to replace him as chair will take place on Wednesday 18th June, provided there is more than one candidate.

Children and Young People Now has reported that several early years organisations, including the National Day Nursery Association and the Professional Association for Childcare and Early Years, have criticised Ofsted for treating early years as a “second class service” by failing to bring inspections of early years settings back in house. Ofsted had announced last week that they planned to bring inspections for all schools in house amid accusations of poor quality inspections by contracted companies.

Health Education England publishes 15 year strategic framework for 2014-2029

Health Education England (HEE) has published Framework 15, its strategic framework for 2014-2029. This strategic framework, which was unveiled at the NHS Confederation Conference between 4th and 6th June, acts as a guide as to how HEE should invest its £5 billion yearly budget in education and training programmes for the current and future workforce.

The strategic framework identifies areas where health care has changed in the last 15 years and how it is likely to change in the following 15 years. From this, it has developed six strategic assumptions:

  1. The need for a workforce fit for the future, able to meet the needs of patients of today and tomorrow.
  2. The necessity to plan for an uncertain future.
  3. The workforce is both a key enabler and driver of change in health and must be integral to all future planning and investment decisions if the opportunities to improve care are to be realised
  4. Maintaining current approaches to investment and training will perpetuate current models of care.
  5. Basing HEE’s long-term workforce strategy on anticipated needs of patients is the best chance of creating a successful NHS.
  6. The distinction between the present and the future is a false one in health: today’s workforce will be working ten, twenty, thirty years from now, and have a duty to serve both the patients of today and tomorrow.

In particular, it has identified that in response to the increasing number of people with multiple long term conditions, the health workforce needs to develop a greater degree of flexibility.

Specifically, the framework identifies that the current way in which HEE plans, commissions, runs and regulates education and training programmes encourages a trend towards greater specialisation. Whilst it emphasises that specialists are needed, it said that HEE should take care to ensure that the future workforce maintains a greater degree of generalism and adaptability, and is able to respond to and adopt the latest research and innovation that could benefit patients. It highlighted that in the future, where possible, the NHS should seek to reduce the number of specialists an individual patient is required to see.

Subsequently, it was identified that the strategic framework should do following:

  • Provide the conceptual framework for how HEE approaches problems and identifies solutions, ensuring our focus remains on the patient.
  • Guide the decisions HEE makes in the short term, such as the annual workforce planning process and the priorities in our Business Plan.
  • Inform HEE’s longer-term work programme, including taking forward The Shape of Training Review and piloting life-cycle workforce planning for children and young people.
  • Enable HEE’s board and the public to assess HEE’s actions against HEE’s expressed strategic ambitions, and to challenge us if we veer off course.

Provide the basis for more detailed conversations with our partners and stakeholders about the challenges and opportunities ahead.

National Institute for Health Research publishes article on health outcomes for children with neurodisability

The National Institute for Health Research (NIHR) has published a research article on what children and young people with neurodisability want from their healthcare, and what clinicians seek to achieve from treatment.

Through engaging with 54 children and young people with neurodisability, an unrelated group of 53 parents in focus groups and interview, and over 200 health professionals, it was agreed that the key health outcomes were: communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. Parents of children with learning disability also rated behaviour, toileting and safety as important.

Regarding toileting, parents believed that it was a priority because of the logistics of changing children who were not continent; parents saw continence and independent toileting as opening up a greater range of social opportunities. Parents interviewed raised concerns about the poor quality of continence products, stating in particular that they wanted continence products which would not leak when their children soiled themselves in public.

The research identified that existing measurements for NHS outcome performance – questionnaires called patient-reported outcome measures (PROMs) – did not accurately measure the outcomes for children and young people with neurodisability. It was discovered that few PROMs had been tested specifically with children and young people with neurodisability, and that parents reacted unfavourably to these questionnaires. With regards to continence, it was suggested that outcomes could be best measured by quantitative means rather than through self-reported methods like questionnaires.

It was concluded that further consultation with young people, families and professionals is warranted to support using PROMs to measure NHS outcomes. It also concluded that more research needed to be conducted to test PROMs with different age groups and conditions.

Family and Childcare Trust publishes 10 year review of Government’s 2004 childcare strategy

The Family and Childcare Trust has published a review of the Government’s 10-year childcare strategy, Next Steps for Early Learning and Childcare, published in 2004. The report concludes that the strategy is no longer fit for purpose and fails to address the needs of young children and their families a decade on.

The report subsequently makes a series of recommendations based on the four broad aims of the 2004 strategy – choice and flexibility, availability, quality and affordability – in a bid to bring childcare policy up to date. Regarding the quality of childcare, the report recommends that the Government should ensure:

  • All early years staff are qualified to Level Three and all settings should be graduate-led.
  • The creation of a permanent workforce development fund to support improvements in staff qualifications.
  • That funding of free early education places should be used to lever up quality, with providers’ funding linked to achieving quality standards.
  • Local government should be responsible for quality improvement in their area and build local early years quality networks to support providers.

The report concluded that the Government should commit to a new childcare strategy, and that they should set up an independent review of childcare funding.

Pre-school Learning Alliance publishes report on findings of Early Years Agenda survey

The Pre-school Learning Alliance has published a report on the findings of the Early Years Agenda survey. The survey, which received 1270 responses in total, asked early years practitioners to share their views on key areas of early years policy, including: schools, funding, qualifications, childminder agencies and Ofsted. The findings showed that, in general, early years practitioners believed there to be numerous problems with the Government’s reforms of the early years sector.

Respondents were asked whether they felt the Government adequately consults with the sector when introducing or changing early years policy. It was discovered that just 3% believed this to be the case, with 89% of believing this not to be the case. Respondents argued that the Government has made little or no attempt to develop an adequate understanding of early years issues and that the sector is used as “political football”. Concerns were also raised that Government policy is largely driven by a need to cut costs, rather than provide high quality care and education.

On individual issues, the survey found that only 18% of respondents agreed with the Government’s decision to make the Early Years Foundation Stage (EYFS) profile non-statutory and replace it with mandatory baseline assessments (in numeracy, literacy and communication) at the beginning of reception. 55% of respondents disagreed with the decision, while 27% said that they did not know or had no opinion. Some respondents warned that the plans for formal assessment would lead to children being labelled as failing too easily and too early.

Regarding Ofsted, the survey found that one a scale of one to ten (with one being extremely unconfident and ten being extremely confident), the average confidence rating that early years practitioners had in Ofsted was 4.7. The report highlighted that these findings appeared to contradict Ofsted’s own data on early years provider views on inspections: the results of its most recent survey in 2012/13 found that 93% of respondents agreed or strongly agreed that they were happy with the way their inspection was carried out. In justifying their concerns, early years practitioners highlighted that they believed Ofsted inspections to be inconsistent, and largely dependent on whichever individual inspector happened to conduct a particular inspection.

Queen’s Speech 2014

The State Opening of Parliament took place on Wednesday morning, which marks the start of the 2014/15 Parliamentary year. This will be the final State Opening before the next General Election.

During the ceremony the Queen’s Speech was delivered to Parliament – outlining the Bills which will be brought before Parliament in the next parliamentary year. The Prime Minister and Deputy Prime Minister said beforehand that the speech would be “unashamedly pro-work and pro-business”.

The speech itself included announcements regarding work, pensions and business, as well as some changes to the legal system, educational attainment, housing, social care and energy. There was no mention of any business related to health care.

The full list of Bills is as follows:

New

  • Small Business, Enterprise and Employment Bill
  • National Insurance Contributions Bill
  • Infrastructure Bill
  • Pensions Tax Bill
  • Private Pensions Bill
  • Social Action, Responsibility and Heroism Bill
  • Childcare Payments bill
  • Slavery Bill
  • Armed Forces Bill
  • Serious Crime Bill
  • Recall of Members of Parliament Bill

Draft

  • Draft Governance of National Parks and Broads Bill
  • Draft Riot (Damages) bill
  • Draft Protection of Charities bill

To be reintroduced

  • Wales Bill
  • High-speed Rail Bill
  • Criminal Justice and Courts Bill
  • Deregulation Bill
  • Finance No. 2 Bill
  • Consumer Rights Bill

Although there was no specific mention of business relating to health care, it was announced that a new bill would be introduced, the Childcare Payments Bill, that provide parents earning less than £150,000 a year with a tax free subsidy of £2,000 per child aged 12 or under. As part of the Bill, the existing employer-supported childcare scheme will be repealed. It was also announced that the provision of free childcare for the most disadvantaged two-year-olds would be extended.