Weekly political news round up – 25th July 2014

July 25, 2014 in News by Whitehouse

Around the sector

The House of Commons has now risen for its summer recess, and will return on 1st September 2014. The House of Lords is still sitting, and will rise after business on 30th July 2014.

The Early Intervention Foundation has published its Guidebook – an online resource designed to provide advice for professionals developing early intervention programmes. It seeks to support commissioners of services, policy-makers and practitioners to base their choices on the best available evidence, as well as more tacit considerations of circumstance and implementation. New programmes are added through an identification of effective programmes, or through an online submission process that allows individual programme developers to contact the Early Intervention Foundation directly.

NurseryWorld has reported that members of the National Day Nurseries Association and the Pre-school Learning Alliance have told s House of Lord’s Committee on Affordable Childcare that the childcare sector was “being led down a path dictated by economics”. In terms of workforce, the Committee also heard that early year’s teachers were not on equal terms with qualified teachers, and that more needed to be done to ensure there is a career path and structure for those coming into childcare.

The Government has announced that Conservative MP Sam Gyimah has been appointed as the minister responsible for childcare and early years.

The Department of Health has published a factsheet for parents outlining the role and support offered by health visitors and school nurses.

Healthwatch England issues warning on impact of ‘Super CCGs’ on local involvement in health services

Healthwatch England has issued a warning that the healthcare professionals who run Clinical Commissioning Groups (CCGs) are forming new bodies called ‘Super CCGs’, that will result in more limited involvement of local people in making decisions about their health services.

Local Healthwatch organisations have found that the healthcare professionals responsible for running CCGs, including GPs, are forming joint decision making bodies with those running neighbouring CCGs in order to make decisions on health services at a regional level. Unlike normal CCGs, Super CCGs are not subject to local scrutiny and accountability measures, and are being accused of failing to engage with the public.

Although setting up Super CCGs is difficult, the Draft Legislative Reform CCG Order 2014, which is currently going through parliament, will make the process easier.

Local Healthwatch organisations have informed Healthwatch England that the establishment of Super CCGs is symptomatic of a wider cultural issue within CCGs of a reluctance to engage with their local population on major decisions about redesigning services.

As such, Healthwatch England will be contacting the Health Secretary to outline the following concerns:

  • Disengagement with local accountability mechanisms such as Health and Wellbeing Boards
  • Poor current public engagement by CCGs and the emerging committees in common
  • Major decisions, such as models for service reconfiguration, being taken in closed sessions of the committees
  • Insufficient planning for future public engagement and the vital conversations around service reconfiguration that will directly result from decisions made by the committees in common.

Healthwatch England is also calling on the Health Secretary to consider the following before agreeing to the new legislation:

  • Introduce a mandatory seat for local Healthwatch on any joint committee
  • Place a duty on all lead CCGs to have due regard for existing local priorities and plans
  • Ensure all CCGs sign up to act within existing local accountability mechanisms, even if it means being held to account by a Health and Wellbeing Board outside of their jurisdiction.

Office for the Children’s Commissioner launches consultation on the promotion and protection of children’s rights in schools

The Office for the Children’s Commissioner (OOC) has launched a consultation which seeks to look at how schools, as well as other organisations who deliver education services, can best promote and protect children’s rights in what they do. It also seeks to identify how the education system can achieve this, as well as identify examples of best practice in schools and see how these could be spread more widely.

The OOC has listed a set of proposals for the characteristics of a rights-promoting educating system, stating what schools should do. Of interest for the PCF are the following:

Schools are at the heart of the education system and so:

  • Should be orderly and calm places, where all children are safe, able to learn, and where there are high expectations of respect and behaviour from all members of the school community.

When things go wrong:

  • If, for any reason, children are unable to attend school, they should receive an alternative form of education which allows them to achieve and develop in the same way as if they were in a mainstream school. This should cover all those unable to attend school, including, but not limited to:
    • those who have long-term medical or mental health needs
  • Where a child or group of children is let down by the system, children and parents should have a meaningful system of redress. This redress will only be meaningful if it:
    • is run in the interests of the child and enables them to have their voice heard and given due weight
    • possesses the powers to put right the harm caused by unlawful unreasonable activity
    • enables the system to learn from cases to make it less likely that they will be repeated.

The consultation asks seven questions, including whether stakeholders agree with these proposals, and whether there are any that should be added or removed.

NHS England publishes first Annual Report and Accounts for 2013/14

NHS England has published its first Annual Report and Accounts for 2013/14, which sets out its achievements in the last year and aspirations for 2014/15. The report features key milestones since its inception in April 2013, the annual accounts and a Directors’ report.

Although the report does not specifically mention continence, it does outline what has been done to improve health outcomes in each of the five domains of the NHS Outcomes Framework. There are three domains relevant for the PCF:

Domain 2: Enhancing quality of life for people with long term conditions.

The report highlighted that NHS England has been working with local systems to develop five-year strategic plans to implement the Better Care Fund. It also highlighted that NHS England has made progress on the roll-out of personal health budgets, which seek to give people more control over the health care and services they require.

Domain 4: Ensuring people have a positive experience of care.

The report stated that had been “rapid progress” in measuring and understanding the experiences of patients, specifically noting the introduction of the Friends and Family Test.

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm.

The report stated that NHS England had been working with local and national partners to improve the quality of clinical care. It notes the launch of the Patient Safety Alerting system and an increase in data submitted to the NHS Safety Thermometer, which found a reduction in the incidence of ‘harms’ recorded – the number of patients free from harm is now 93.6%, up from 92% last year.

In response to the report, Health Secretary Jeremy Hunt said that the NHS Outcomes Framework would be reviewed during summer 2014. He said that the review would update the framework for 2015-16 by improving, adding and removing existing indicators, and also indicate a direction of travel for future indicator development.

Answer to written question on support for young children with disabilities

Democratic Unionist Party MP Nigel Dodds has received an answer to his written question asking the Education Secretary what steps she is taking to provide more effective support to children with disabilities in their formative years.

Children’s Minister Edward Timpson responded that a fully integrated early years and health review, due to be implemented from 2015, would help to pick up potential difficulties early and ensure that support plans are in place for tackling disabilities.

He added that the reforms set out in the Children and Families Act 2014 and the new 0-25 Special Educational Needs and Disability (SEND) Code of Practice would support the integrated review. These reforms, Timpson said, would provide streamlined and transparent support for children with SEND and their families from birth to adulthood.

Timpson also said that that all maintained nurseries, schools and colleges must work with the local authorities to develop a ‘local offer’. This will outline support across health, education and care, to children and young people with SEND and what to do if things go wrong or parents and young people are unhappy with the support they are receiving.

Weekly political news round up – 18th July 2014

July 18, 2014 in News by Whitehouse

Around the sector

The King’s Fund has published its Quarterly Monitoring Report on NHS performance. It notes that, in its fourth year of effectively no real increase in funding and undiminished urgency to generate more care to meet growing demands, the NHS is under “huge pressure” and its finance directors are growing increasingly pessimistic about the financial position of health organisations and local health economies. The report also highlights an increase in the nursing workforce to nearly 315,000 over the past six months – the highest on record – meaning hospitals now face a difficult choice about whether to balance the books or maintain quality of services.

The SEND Code of Practice debate in the House of Lords was rescheduled and will now take place in the Grand Committee on Monday 21st July at 3.30pm.

SEND Code of Practice passed in the House of Commons

Following a debate by the Eight Delegated Scrutiny Committee, which lasted less than an hour, the SEND Code of Practice has been passed by the House of Commons. With the Code now approved, with the backing of Labour, it will be debated in the House of Lords before it is finally passed.

Shadow Children’s Minister Steve McCabe used the debate to quiz Children’s Minister Edward Timpson on a series of issues, some of which were relevant for the PCF, including:

–       Why it is not mandatory for all young children with complications around the time of birth to undergo early screening protocols by specialist paediatricians?

–       What is being done to ensure that intervention and support by health services and local authorities genuinely amounts to a co-ordinated, joined-up service?

–       The bodies subject to carrying out the Code have been given only a short amount of time to implement it and train their staff.

–       The Minister should commit to review the Code, with public consultation, and should provide timescales on the review.

–       It had been suggested that the Code is weaker than its predecessor because it is unable to show a clear journey through the SEN system. The Code should be a “living document subject to more regular revision”.

–       There does not appear to be a strategic assessment of the children and young people’s workforce on a national level.

In response Timpson said he would keep an open mind about the need to review the Code, suggesting that it is a live document and the Government will be constructive about the need to address issues that emerge as the reforms imbed. He also said the Department will work with Ofsted to look at the accountability of the system, including a multiagency approach, to ensure that inspections of SEN are much more holistic than they have been previously. Timpson added that Ofsted will look at the journey of a child through the system, rather than each specific condition.

On the issue of the identification and support of 0-3s, Timpson reiterated that the two-year-check is in place to establish developmental concerns – although did not explain how the needs of children younger than two will be addressed.

Responding to McCabe’s concerns about early screening protocols for certain conditions, Timpson said that he would be happy to raise the issue with the Department of Health, as it falls within their domain.

On the topic of joined up health, education and social care, Timpson said that not only were provisions in place through the Children and Families Act, but also through the Care Act 2014 and the NHS mandate, which specifically names SEN as one of the things against which health providers will be judged. The two Acts and the NHS mandate, he said, were pulling health, education and social care towards a much more integrated approach.

The Minister also confirmed that guides for parents, young people and children on the most relevant aspects of the Code to them will be published in August. Timpson went on to inform the Committee that the provisions on supporting young people in custody, which will come into effect in April, will be brought to Parliament in the New Year. Notably personal budgets were not discussed in any detail, suggesting that the Government is no longer keen on promoting them as a key aspect of the reforms.

Prime Minister David Cameron announces ministerial reshuffle

Prime Minister David Cameron has announced a reshuffle of Conservative ministers within the Government. Ministerial reshuffles involve the removal of selected ministers from their positions, followed by the appointment of their replacements from within that department, from other departments, or from outside of government.

The latest reshuffle has been the largest of Cameron’s premiership, with one of the most notable features being the appointment of a significant number of women to ministerial positions.

Below is an outline of the changes announced:

Department of Health

There has only been one change to the ministerial makeup of the Department of Health, with George Freeman being promoted to Life Science Minister – a position split between the Department of Health and the Department for Business, Innovation and Skills.

The key ministers, Health Secretary Jeremy Hunt, Health Minister Daniel Poulter, Public Health Minister Jane Ellison, all retain their positions.

The composition of the Department of Health’s ministerial team is now as follows:

  • Health Secretary – Jeremy Hunt
  • Care and Support Minister – Norman Lamb
  • Health Minister – Dr Daniel Poulter
  • Health Minister – Earl Howe
  • Public Health Minister – Jane Ellison
  • Life Sciences Minister – George Freeman (with the Department for Innovation, Business and Skills)
  • PPS to the Health Secretary – Tobias Ellwood
  • PPS to the Health Secretary – Andrew Jones
  • PPS to the Department of Health’s ministerial team – Andrew Jones

Department for Education

Michael Gove has been replaced as Education Secretary by Nicky Morgan, who had previously been Financial Secretary to the Treasury. Gove has been appointed as Chief Whip.

Nick Gibb returns to the Department for Education as Education and Childcare Minister, replacing Liz Truss, who is now the Environment Secretary.

Children and Families Minister Edward Timpson retains his role, and therefore will continue to oversee the implementation of the Children and Families Act 2014 and the SEND Code of Practice.

Former Skills and Enterprise Minister Matthew Hancock has been appointed as Energy Minister and has been replaced by Nick Boles, who had been Planning Minister at the Department for Communities and Local Government.

Sam Gyimah was also appointed as Education Minister, although his portfolio has yet to be revealed.

The composition of the Department for Education is as follows:

  • Education Secretary – Nicky Morgan
  • Schools Minister – David Laws
  • Skills and Enterprise Minister – Nick Boles
  • Children and Families Minister – Edward Timpson
  • Education and Childcare Minister – Nick Gibb
  • Schools Minister – Lord Nash
  • Education Minister – Sam Gyimah (portfolio not yet specified)
  • PPS to the Education Secretary – VACANT

 

Weekly political news round up – 11th July 2014

July 11, 2014 in News by Whitehouse

Around the sector

Conservative MP Robert Jenrick has been appointed as a member of the Health Select Committee. Jenrick was elected as an MP in June 2014 and does not have a background in health.

The SEND Code of Practice will be scrutinised by a Delegated Legislation Committee (DLC) on Thursday 17th July. This is the last step in the legislative process for the SEND reforms.  A DLC is a general committee of the House of Commons that allows for debate of a statutory instrument. It does not approve or reject delegated legislation; rather a vote is taken on the legislation in the House.

The debate in the House of Lords was rescheduled and will now take place in the Grand Committee on Monday 21st July at 3.30pm.

NHS chief executive discusses plan to give patients financial control of their own care

New NHS chief executive Simon Stevens has discussed the introduction of a new Integrated Personal Commissioning (IPC) programme designed to extend the provision of personal health budgets to include a wider group of patients with specific health needs. From April 2015, people with long term conditions (including frail elderly people), children with complex needs, people with learning difficulties, and people with severe and enduring mental health problems will be offered personal health budgets to spend as they see fit on health and social care services.

Personal health budgets, which had previously only been available to a small group of patients eligible for NHS Continuing Care, allow patients to purchase health and social care services in the community. Patients will receive anywhere from a few hundred points to in excess of £1000, with those with very complex needs receiving more than that. Patients would not automatically receive cash payments into their bank accounts but would control the budget, which will be provided after a care plan is agreed with their doctors.

Plans to extend the scheme, which is intended to increase patient power and reduce long term expenditure, have been in development for some time. The Children and Families Act 2014 already legislated that children who hold an education, health and care plan will be able to access a personal health budget.

Stevens said that the new budgets will only be made available if local councils and clinical commissioning groups (CCGs) agree to work together to fund them. Although participation is voluntary, he said he expects both bodies to set aside their usual mutual suspicion over which of them should pay for what elements of care needs.

NHS England will now work with partners in local government, CCGs, patient groups and the voluntary sector to develop an IPC Prospectus which will be published at the end of July. This will formally invite local expressions of interest in jointly developing and participating in the IPC programme from April 2015.

Parliamentary inquiry into childcare for disabled children publishes report criticising existing provision

The Parliamentary Inquiry into Childcare for Disabled Children has published a report revealing that disabled children are being denied educational and social opportunities. The inquiry was co-chaired by Conservative MP Robert Buckland and Labour MP Pat Glass, and was supported by Every Disabled Child Matters, Contact a Family, the Family and Childcare Trust and Working Families.

The inquiry focused on affordability, availability and inclusion, quality, and access and information.

Affordability

The inquiry found that parents of children with disabilities are charged higher than average fees for childcare, resulting in many parent carers giving up work. Moreover, the inquiry found that adequate funding is often not available to parent carers or providers to support the extra costs of high needs or one-to-one support for disabled children.

Availability and inclusion

According to the report, providers had poor support to access additional training, resources and physical adaptations. In terms of policy provision, the inquiry found that the sufficiency duty in the Childcare Act 2006, which required local authorities to secure sufficient childcare for working parents, did not compensate for the market’s problems with providing childcare for disabled children.

Quality

From the evidence collected, it was found that there was a significant shortfall of knowledge, skills and confidence in providing quality care and education to disabled children in the childcare and early years workforce, with 33% of parent carers responding that the lack of experienced staff was the reason for not accessing childcare. In policy terms, there was criticism that there was a “lack of focus” on ensuring that early years practitioners had the professional qualifications and guidance to deliver the best outcomes for disabled children.

Access and information

The inquiry found that parents sometimes engaged in a three way dialogue with their local authority for additional support. It also found parent carers were confused about what support they could expect, and local authorities were confused about what the childcare system should deliver for disabled children and young people.

Recommendations

The inquiry made three overarching recommendations:

A cross-departmental review of funding to identify where support must be improved to meet the extra costs of childcare for disabled children and remove barriers to access, followed by pilots of flexible approaches to delivering support.

  • The introduction of a requirement for local authorities to publish as part of the SEND Local Offer clear information for parents and providers on access to childcare inclusion support.
  • Making clear that all eligible disabled children aged two, three and four can access their full 15 hours of free early education and clarify the arrangements for redress for parents.

 

Weekly political news round up – 4th July 2014

July 4, 2014 in News by Whitehouse

Around the sector

The Department of Health has published six short documents to support local authorities and other stakeholders through the transfer of responsibility for commissioning children’s public health services, including visitors, from NHS England to local authorities from 1st October 2015. One of the documents focuses on the two year old review (integrated review), where health visitors carry out a full assessment of a child’s development at the age of 2 to 2 and a half. The document outlines what it is, why it is required and how it will be measured.

The Commons Public Accounts Committee has published a report which has criticised Monitor, the regulator for foundation trusts, for only employing seven people from a clinical background out of a total staff of 337. Labour MP Margaret Hodge, chair of the Public Accounts Committee, said that Monitor’s effectiveness is “undermined by a lack of frontline NHS experience”.

Ofsted has published a letter to schools from Sir Michael Wilshaw, Ofsted’s chief inspector, informing them that school-based nurseries and reception classes will now receive separate graded judgements on their effectiveness. The changes follow a consultation by Ofsted in which they asked whether early years and post-16 education should have their own separate assessments. The formal outcome of the consultation, however, is yet to be published.

The Guardian has reported that the Local Government Association (LGA) has criticised the proposed £200 million worth of cuts by the Department for Education’s to the education services grant, a fund paid to councils to cover school improvement and other education functions. The LGA said that the reductions will harm the school improvement sections of councils, many of which have already suffered deep cuts in recent years but still face pressure from Ofsted inspectors and parents to reform schools.

Health Select Committee publishes report on managing the care of people with long-term conditions

The Health Select Committee has published a report on their inquiry into the management of long term conditions (LTC) by the NHS and social care system in England. The inquiry looked at the strategic direction of services, clinical care for people with LTCs, and how the system can best deliver care for people with LTCs.

The report emphasised the financial impact of LTCs, highlighting that 70% of the total expenditure on health and care in England was associated with the treatment of just 30% of the population with one LTC or more. It stressed that the situation was only likely to worsen, with the number of people with LTC set to increase from 15 million to 18 million by 2025 – a cost increase of £5 billion to the system between 2011 and 2018.

Continence was not discussed explicitly by the committee, but a number of their findings are of more general interest.

Strategic direction of services

In assessing the strategic direction of services for LTC, the Committee found that four of the nine progress indicators used to measure four objectives for the management of LTCs could not be measured, as there was little reliable data available to do so (health-related quality of life for people with LTC, the health-related quality of life for carers, the proportion of people feeling supported to manage their condition, and the effectiveness of post-diagnosis care in sustaining independence and improving quality of life). The Committee subsequently called for greater clarity in the setting of baseline indicators and greater transparency and rigour in the measurement of progress against these indicators.

It also found that NHS England had not taken forward a national approach to strategic planning for LTCs, despite taking over the responsibility for developing work on a cross-government strategy for LTCs from the Department of Health in 2013. As such, the Committee concluded that the strategic response from the Government and NHS England to the pressures arising from increased incidence of LTCs was “unclear and lacks urgency”.

Clinical care for people with long-term conditions

The Committee identified several areas of concern in clinical care for people with LTCs. In particular, the Committee claimed that the current definition of LTCs used by the Department of Health had resulted in the condition being treated rather than the person as a whole. For people with multiple LTCs, it meant that their care was unstructured, uncoordinated and problematic.

Consequently, the Committee found that care pathways needed to be rebalanced to provide greater integration of treatment across all care settings, as well as support for patients to manage their own conditions. It was subsequently recommended that individual care planning models centred on the needs of patients should be adopted.

The report said the Committee believed that there had been a systematic and cultural shift towards greater personalisation of health and care services, and greater involvement of service users in constructive discussions about how their LTCs are treated. It identified that there was scope to increase the choice patients have over the ways their conditions are treated, and highlighted that the challenge for commissioners was now how they should evaluate and measure the effectiveness of treatment where patients feel it is likely to be effective.

Discussing staffing, the Committee found if more treatment of LTCs is to take place in primary and community care, then the recruitment and workforce planning required must take place as a matter of urgency, in particular to address a work force shortfall in primary care already identified by the Centre for Workforce Intelligence.

Managing the system to deliver better long-term conditions care

The Committee discussed the level of practical support given to commissioners to support the design of services which promote community-based care and provide for the integration of health and social care in the management of long-term conditions. In their findings, they highlighted that while for some long-term conditions, such as diabetes and epilepsy, there was a wealth of third-party guidance and support for commissioners, support for commissioners in the form of surveys and engagement with patients did “not presently exist on any significant scale”.

Despite identifying the Government’s aim of reducing the number of unplanned acute admissions for conditions which could be better treated in primary or community care, the Committee found that they were “not convinced” that focusing on measures to reduce admissions to the acute sector will effectively address the underlying issues in management of LTCs which seem to drive patients with chronic conditions into acute care.

They found that despite widespread understanding that patients with LTCs can be better and more effectively treated in primary and community care, they have not found any conclusive evidence that a large-scale shift in services will provide clinical or economic benefits, though a change in service mix may well be beneficial overall in supporting those with LTCs. As such, they recommended that long-term studies should be commissioned looking at the effectiveness and economic benefit from integrated services for the management of LTCs.

The Committee said that reducing the activity of acute hospitals on LTCs, and their income from such activity, is bound to have a consequential impact on services. The Committee said that the likely impact of service redesign on the acute sector in particular must be explicitly recognised and openly debated, in order to secure broad public understanding of, and agreement to, proposals for change.

Health Education England launches consultation on reorganisation of internal structure

Health Education England (HEE) has launched a consultation on proposals for the reorganisation of its internal structure. Although these changes will not impact on the role and function of HEE, which is to provide leadership and coordination for the education and training for health care workers, they do mean changes in responsibilities in senior management.

HEE highlighted that these changes were prompted by an annual budget reduction of 20%, as well the shift in organisation type from a Special Health Authority (SpHA) to a Non-Departmental Public Body as part of the Care Act 2014. HEE also stated it wished to create a “One HEE programme”, which addressed complaints that HEE felt more like fourteen organisations rather than one, resulting in a duplication of functions.

The consultation document emphasises that the thirteen Local Education and Training Boards (LETBs) will continue to remain the local footprint of HEE. The role and functions of LETBs will remain the same on 1st April 2015; the only changes proposed are ones related to staffing and senior management structure.

The most pertinent proposal is the introduction of an LETB Director. The LETB Director will replace the role of Managing Director, and also assume some of the functions of Director of Education and Quality. It will report directly the appropriate National Director (based on geography) rather than HEE’s Chief Executive.

It is also proposed that each LETB Director will be responsible for appointing a Post Graduate Dean, who will work across the spectrum of health so to ensure that the provision of education reflects changing service models and delivers the integrated workforce. The document states that this will provide significant clinical leadership to the work on developing educational frameworks and assessments, based on care pathways and patient flows.

In order to enhance the alignment between the local and the national, HEE will appoint four new National Directors (by geography). The National Directors will act as a bridge between local LETBs and the Executive Team.

Included in the proposals are plans to appoint a provider chief executive to be a member of a new national advisory body called the Provider HEE Advisory Group (HEEAG). The purpose of this group will be to supplement HEE’s current national structure through the addition of a new advisory group to strengthen the voice of local providers at a national level.

The consultation consists of four questions:

What is the most appropriate geography for the National Directors with local oversight?

  1. Should a clinical qualification be a requirement for the LETB Director role?
  2. How should LETBs be represented on the Provider HEE Advisory Group (HEEAG)?
  3. What should the reporting and accountability arrangements be for the new posts of Head of Finance and Director of Education and Quality?

Welsh Affairs Select Committee announces inquiry into cross-border health arrangements

The Welsh Affairs Select Committee has announced an inquiry into cross-border health arrangements between England and Wales and the experience of patients who rely on services on each side of the border. The inquiry comes over a year after NHS Wales and NHS England agreed a Protocol for Cross-border Healthcare Services to ensure smooth and efficient interaction between the NHS on either side of the England-Wales border. However, assessments have not been carried out on how well this has been functioning so far.

The Committee is seeking written evidence on the following relevant issues:

The impact of policy divergence in the health systems of England Wales on cross-border healthcare services

  • The experience of patients in England and Wales who are reliant on the use of healthcare services on the other side of the border
  • The case for sharing of resources and facilities
  • The impact of the Protocol for Cross-border Healthcare Services
  • Any lessons that can be learned from other cross border health arrangements