Weekly political news round up – 26th September 2014

September 26, 2014 in News by Whitehouse

Around the sector

In an interview with the Health Service Journal, Shadow Health Secretary Andy Burnham has announced that healthcare regulator Monitor will be placed in charge of overseeing the financial sustainability of whole health economies and driving integration between different organisations, should Labour win the election in 2015.

The Department for Education has published statistics on the planned expenditure on schools, education, children and young people’s services by local authorities, for the financial year 2014 to 2015. The statistics showed that planned local authority expenditure for two year olds is set to virtually double from £281.8 million to £563.3 million, with expenditure for three and four year olds increasing by £46.1 million to £1,980.9 million.

Forthcoming events

Parliament has been recalled to discuss matters in the Middle East, with both Houses still set to return to discuss all business on 13th October. Party conferences will be taking place on the following dates:

  • Conservative  – 28th September to 1st October
  • Liberal Democrat – 4th – 8th October

Overview of Labour Party conference – health and education

Labour’s final party conference before the 2015 general election took place in Manchester this week, with speeches being given by Labour leader Ed Miliband, Shadow Health Secretary Andy Burnham and Shadow Education Secretary Tristram Hunt. Below are summaries of their speeches:

Labour leader Ed Miliband

In his speech, Miliband announced that should Labour win the election in 2015, they would repeal the Health and Social Care Act 2012 and introduce a £2.5 billion NHS ‘time to care fund’. Part of this fund would be used to recruit 20,000 more nurses, 8,000 more GPs and doctors, 5,000 more care workers, and 3,000 more midwives. In order to pay for the reforms, Miliband said that there would be a crackdown on tax avoidance – including avoidance by hedge funds, a mansion tax on homes worth above £2 million, and more fees imposed on tobacco companies.

Miliband also announced a commitment to reform the House of Lords in order to make it a representative senate. In terms of devolution, Miliband only mentioned that more power would be devolved to local government. He also promised to raise the minimum wage to £8 an hour by 2020, and to lower the voting age from 18 to 16.

Shadow Health Secretary Andy Burnham

Building on Miliband’s speech the day prior, Burnham criticised the Government’s “top-down reorganisation” of the NHS and what he considers as a plan to “run it down, break it up, sell it off”. In addition to reiterating the pledge to repeal the Health and Social Care Act, he stated that that hospital and other NHS bodies will evolve over a 10-year period into “NHS Integrated Care Organisations”, coordinating all care – physical, mental and social, provided from home or from hospital. He also stated that patients and relatives will have a single contact person for all their needs and a personalised care plan to reflect these needs.

Prior to his main speech, Burnham spoke at a fringe event and said that local government would take a lead in commissioning health services under a Labour administration, in a model that would re-establish “the link between health and education, health and planning, health and leisure, but crucially health and housing”.

Shadow Education Secretary Tristram Hunt

Education Secretary Tristram Hunt’s speech stated that Labour would end the Conservative “attack” on Sure Start, and increase free childcare from 15 hours per week to 25 hours per week for the 3 and 4 year old children of working parents, with the support continuing into primary years. He added that disadvantage begins in the early years, and that inequality must be tackled early to address the gap, especially for those with special educational needs.

Department of Health publishes guidance for Health and Wellbeing Boards on children with special educational and complex needs

The Department of Health has published guidance for Health and Wellbeing Boards (HWB) on supporting children with special educational needs and disabilities (SEND) to get joined up care from local services.

It highlights that from September 2014, the Children and Families Act 2014 requires local authorities and clinical commissioning groups to work together to secure services for children and young people – up to the age of 25 – who have SEN or a disability. Each CCG has a statutory duty to co-operate with the relevant local authority, in a co-ordinated assessment of the needs of the individual child or young person assessed as having special educational needs and agree an individual outcomes-focused Education, Health and Care (EHC). It notes that cooperation must also occur for children who have a disability but might not qualify as having special educational needs.

Specifically, the guidance states that HWBs should, or may wish to:

  • Recognise that local services must seek to meet a wide range of disabilities and complex needs, far wider than the cohort of children who would qualify for an EHC plan.
  • Consider how local health services are meeting the needs of children and young people with long-term conditions.
  • Act as a forum for strategic discussions between local authorities and CCGs.
  • Act as a system driver where here there are existing formal joint commissioning arrangements between a local authority and CCG or CCGs

In developing joint strategic needs assessments (JNSAs) and joint health and wellbeing strategies (JHWS), the guidance advises that HWBs:

  • Consider how integrated approaches to meeting local need care provide better outcomes for the child and their family
  • Work with their CCG members to identify local needs, drawing on previous commissioning plans and strategies, and utilising their commissioning support units and local providers of paediatric services as key contacts.
  • Seek to address the issue of the absence of key data on outcomes for children with complex needs, highlighting this as a barrier to effective local commissioning.

The guidance provides HWBs with a number of questions that they should think about when considering how their work supports children and young people with special educational needs and disabilities locally. These include questions about:

  • Whether HWBs are engaging with local children with a wide range of conditions
  • Whether their Joint Health and Wellbeing Strategy specifically refers to children and young people with complex health needs
  • To what extent the needs of children and young people with complex health needs or special educational needs are already addressed in existing multiagency strategies and plans.

The guidance also calls for better utilisation of parent carer forums to help HWBs collect both quantitative and qualitative evidence to feed into the JSNA and JHWS, as they provide specialist knowledge of the wide range of services children access and can provide insight into how services can be better integrated across health, education and social care. It also suggests that parent carer forums work with commissioners to make sure services are commissioned that meet their children’s needs and help commissioners monitor how well these services are provided.

Liberal Democrats publish policy paper on public services

The Liberal Democrats have published a policy paper, Protecting Public Services and Making Them Work For You, in advance of the Liberal Democrat conference in October. Although the paper is relatively broad in scope, it suggests a number of important changes to health services – most notably stronger commissioning powers for Health and Wellbeing Boards (HWBs).

In particular, it suggests that HWBs should take over NHS England’s current responsibility for commissioning GPs in their area, and potentially wider responsibility for local services. It argues that HWBs are better placed to commission services than national bodies as they are more democratically accountable than NHS England, given that there is greater scope for involvement by patients, residents and local services. As such, the paper does not prescribe an exact way in which HWBs should take a lead in local commissioning, stating that it is a matter for themselves to organise locally.

Where clinical commissioning groups (CCGs) and local authorities must collaborate, the paper argues that HWB should act as a forum for agreeing approaches, or could even be given direct commissioning responsibility. It also argues that HWBs should be able to amend the commissioning plans of local commissioners.

National Institute for Health and Care Excellence publishes Evidence Update on infection control

The National Institute for Health and Care Excellence (NICE) has published an evidence update for NICE clinical guideline 139, the ’prevention and control of healthcare-associated infections in primary and community care’.

Evidence updates are intended to increase awareness of new evidence amongst individuals, managers and commisioners, rather than replace current NICE guidance. They do not provide formal practice recommendations.

Six items were selected for the evidence update, following a three year evidence search conducted between April 2011 and April 2014. Of the six, only one item (covering vascular access devices) was identified as having a potential impact on the guidance.

New evidence was found for long-term urinary catheters, specifically the maintanence of catheters and other indwelling devices, but this was found not to have a potential impact on guidance. It was found that people in community care who have both feeding devices and urinary catheters were most at risk of infection with antibiotic-resistant microorganisms. Those with one of the two were more at risk than those without.

Royal College of Physicians publishes five point plan for the government

The Royal College of Physicians (RCP) has published their five point plan for the next government.

The RCP called on the next government to increase health service funding in order to avoid a ‘crisis in care’, stating that the level of funding was a political choice that impacts on the level of care available to patients. It also suggested that the next government should make medical education and training a priority when designing health services, stating that good care in the future depended on good training now.

In terms of long term planning, the RCP said that the next government should avoid ‘big bang’ changes to national NHS structures, instead focusing on achieving long-term transformation. They also called for a national programme for sharing good practice, and the promotion of clinical leadership and clinically led quality improvement projects.

National Institute for Health and Care Excellence publish quality standard on nocturnal enuresis

September 23, 2014 in News by Whitehouse

The National Institute for Health and Care Excellence (NICE) has published their quality standard on nocturnal enuresis.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.

This quality standard covers the assessment and management of nocturnal enuresis (bedwetting) in children and young people aged 18 years or younger.

It was launched on 18th September 2014 and is available here.

Weekly political news round up – 19th September 2014

September 19, 2014 in News by Whitehouse

Around the sector

The Department for Education has published statistics on the characteristics of childcare and early years provision, including the number of staff with formal qualifications. The statistics showed an increase in the number of paid staff in full day care settings with level 3 qualifications (which enables them to supervise other staff and work unsupervised with children) or above, from 75% in 2008 to 84% in 2011 and 87% in 2013. The number of paid staff in full day care settings with level 6 qualifications (the equivalent of a BA degree) also increased, from 11% in 2011 to 13% in 2013.

National Institute for Health and Care Excellence publishes nocturnal enuresis quality standard

Alongside the formal launch of the Paediatric Continence Commissioning Guide on Thursday 18th September, the National Institute for Health and Care Excellence (NICE) has published quality standard 70, which covers the assessment and management of nocturnal enuresis (bedwetting) in children and young people aged 18 years or younger.

This quality standard was introduced to help improve the quality of life and psychological wellbeing of children, young people and their families and carers.

NICE launched a consultation on a draft version of the quality standard on 25th April 2014. The draft quality standard contained three quality statements, which stated that:

  1. Children and young people (aged 5-18 years) who are bedwetting have an initial assessment that includes their bedwetting pattern, daytime symptoms, fluid intake, toileting pattern and any physical, social, emotional or developmental issues.
  2. Children and young people (aged 5-18 years) and their parents and carers if appropriate, have a discussion about initial treatment with an alarm or desmopressin when bedwetting has not improved after changing their daily routine.
  3. Children and young people (aged 5-18 years) whose bedwetting has not responded to treatment with an alarm or desmopressin or both are referred for a specialist paediatric continence review.

The final quality standard contains five quality statements, which state that:

  1. Children and young people who are bedwetting have a comprehensive initial assessment.
  2. Children and young people have an agreed review date if they, or their parents or carers, are given advice about changing their daily routine to help with bedwetting.
  3. Children and young people and their parents or carers if appropriate, have a discussion about initial treatment if bedwetting has not improved after changing their daily routine.
  4. Children and young people who are bedwetting receive the treatment agreed in their initial treatment plan.
  5. Children and young people whose bedwetting has not responded to courses of initial treatments are referred for specialist review.

Following the consultation process, quality statements two and four were added, whilst all three draft quality statements received slight modifications.

The consultation period ran until 27th May 2014. During this period, the PCF submitted a response which made the following key points:

  • ‘Healthcare professionals’ is not properly defined in the statement; it does not say who should deliver frontline services (e.g. GPs, school nurses, community nurses, etc.). This should be amended.
  • Sometimes there are problems with the availability of products, such as alarms, which negatively impact treatment outcomes. This should be highlighted in the quality statement.
  • In the definition of terms for quality statement 3, the definition of terms states that paediatric continence services “may be a dedicated paediatric service or integrated with adult continence services”. This should be amended to state that paediatric continence services should be led by a paediatric continence nurse specialist and comprised of a multi-disciplinary team.
  • For quality statement 3, an amendment should be made that provides a timescale for non-response to treatment following a referral to a paediatric continence service.

Following the consultation, NICE have subsequently made the following amendments:

  • Healthcare professionals are now clarified as being GPs, school nurses and community nurses.
  • Quality statement 4 (access to treatment) was added. In particular, it states that “any delay in their agreed treatment being available, for example as a result of local waiting lists or treatment policy, may put families under unnecessary pressure and have a negative impact on the outcomes for children and young people”.
  • Quality statement 5 (non-response to treatment) was amended to remove references to adult continence services, and it was added that an example of a paediatric continence service would be one that is delivered by a multidisciplinary team trained in managing continence problems in children and young people..
  • Quality statement 5 (non-response to treatment) was also amended to provide greater detail on what should happen if there is no response to treatment. It now states that: “bedwetting has not responded to treatment if the child has not achieved 14 consecutive dry nights or a 90% improvement in the number of wet nights per week”. Furthermore, a sentence has been added which states that desmopressin should be withdrawn for 1 week after 3 months of treatment to check if dryness has been achieved.

Scotland votes ’No’ in independence referendum

Scotland has voted against becoming an independent country, following a referendum held on Thursday. With over 3.6 million votes cast – a turnout of 84.6% – the ‘No’ campaign prevailed by a double-digit margin of 55.3% to 44.7%. The margin of victory was much higher than expected, especially given the surge towards ‘Yes’ in opinion polls in the run up to the referendum.

Prime Minister David Cameron made a statement shortly after the outcome was declared, in which he announced that plans were to be drawn up for a greater devolution of powers to all four nations in the UK.

As promised by the three main parties prior to the referendum, Cameron announced Scotland will receive greater devolution powers with regards to tax, spending and welfare. Lord Smith of Kelvin will oversee the process, with the detail of the proposals set to be agreed by November, with draft legislation being published by January 2015.

Cameron added that similar proposals will be developed for England, Wales and Northern Ireland, within the same timeframe. Although there are many details still to be decided, this is likely to mean that Scottish MPs will be barred from voting on issues that only affect England, with the intention for this to eventually apply to Welsh and Northern Irish MPs.

To work towards these new arrangements, Cameron announced that William Hague, Leader of the House of Commons, has been assigned to set up a cross-party Cabinet Committee to draw up the proposals. He added that he hoped that these proposals would be agreed by November, with draft legislation being published by January 2015.

Little specific information was revealed about plans for Wales and Northern Ireland, with Cameron stating that more power will be given to the Welsh Government and Welsh Assembly, and that work needed to be done in Northern Ireland to ensure that devolved institutions function effectively.

Government publishes response to Health Select Committee report on Long Term Conditions

The Government has published its response to the House of Commons Health Select Committee’s report into long-term conditions, which was published in July 2014. The response welcomes the findings of the report, largely reiterating areas where the Government has made progress in developing a framework for addressing long term conditions.

The response argued that clear objectives to address long term conditions had been set out in the Mandate to NHS England, and that these were measured against the NHS England Annual Report and the Department of Health’s annual assessment. It also highlighted that NHS England’s effectiveness in dealing with long-term conditions, amongst other conditions, is measured against indicators in the NHS Outcomes Framework. Further detail on NHS England’s strategic approach, such as the implementation of the House of Care – a model of person-centred coordinated care, was also laid out in NHS England’s Business plan, Putting Patients First 2014-16 – 2015-16, published in March 2014.

Discussing the Committee’s assessment that it recognised the benefits to the patient of a health and care system that offered “robust support” for self-management of long-term conditions, the response highlighted that it was “committed to embedding self-care and support for self-management approaches throughout the NHS”. The response said that NHS England planned to publish a supported self-management guide for people with complex care needs and frailty later in 2014.

In response to the Committee’s concern about the “apparent downgrading of the role of, and reductions in the numbers of, clinical nurse specialists”, the Government said that although it recognised the role of clinical nurse specialists in proving expert care, support and advice to patients, it was for local commissioners and providers to be “content that they are providing specialist skills and expertise in the most appropriate and sensitive way for their local populations”.

Labour releases pre-manifesto document

The Labour Party have released their pre-manifesto document, which will serve as the basis for the final general election manifesto and will be discussed during the Labour Party conference next week. A high-level document, it includes a dedicated section on health and social care with a strong focus on “whole person care”.

Although the pre-manifesto makes no explicit reference to continence, the key policies laid out are as follows:

Health and Care

The next Labour Government will:

  • repeal the Health and Social Care Act to ensure that the NHS is free at the point of contact, and does not prioritise private patients
  • end Monitor’s role as economic competition regulation and scrap Section 75 regulations that force services to be put out to tender
  • ensure all outsourced contracts for services, including under the Health and Social Care Act 2012, are properly managed to ensure they are meeting clinical and financial standards
  • ensure that existing and future procurement projects for public infrastructure and services are scrutinised and action taken to ensure they deliver best value for money for the taxpayer and the NHS
  • guarantee a single named contact for the co-ordination of an individual’s care needs.

Role of providers

Labour want to reduce the purchaser provider split across the NHS to enable local providers to determine how services should be delivered. As a result:

  • all Trusts – Foundation, NHS and Community – will need to be accountable to the public and operate within a collaborative and integrated system not a “free market free for all”
  • the mixed economy of Trusts and Foundation Trusts will need to be reviewed so that all service providers are fully integrated to deliver the whole-person care agenda in a collaborative, not competitive, way, which is fully accountable to the public

Health and Wellbeing boards

Labour want health and wellbeing boards to play a more important role in commissioning:

  • “Health and Wellbeing Boards will have a central role in the commissioning process for people with long-term conditions, disability and frailty – people whose care is often most fragmented and who are heavy users of health and care services.”
  • “The Health and Wellbeing Board would be responsible for creating a local collective commissioning plan for this group of people [those with long-term conditions, disability and frailty] – within a nationally defined outcome framework for the development of whole-person care – with a duty on CCGs and Local Authorities to enact the collective commissioning plan.”

Integration

Labour want to “break down the organisational and cultural barriers between those involved in providing, commissioning and planning care.” At the same time, they support a system where physical health, mental health and social care are joined up into a single service, coordinating all of a person’s needs. They state this can be achieved in a number of ways:

  • By providing incentives for joint working through a single budget to fund services through a ‘year of care’ tariff
  • They plan to develop new funding mechanisms for health and social care providers based on “delivering quality, equitable and integrated services and incentivising health promotion and preventative care.”
  • A Labour Government will abolish the system of “any qualified provider” and create a national entitlement, written into the NHS Constitution, to ensure that patients get legal rights to access the services they need.

Service reconfigurations

“Labour acknowledges that there will be occasions where there is a strong clinical case for changes to hospital services that will improve care. What matters is that service reconfigurations, and changes to the way that health services are provided, are evidence-based and clinically led, not purely financially driven, and that the local community is consulted early and frequently.”

Changes Labour support:

  • the culture of the NHS – ensure communities are given a real say in shaping the future of their local services, including hospital reconfigurations
  • “reverse the introduction in the Care Act of sweeping powers to force changes to services across an entire region without proper public consultation” – this implies Labour will repeal clause 119 of the Act if they get elected
  • extend Freedom of Information legislation to cover all organisations delivering public service contracts, including the private sector
  • will consider ways of strengthening the role of members within Foundation Trusts and work to better engage and involve NHS staff in Trust membership.

Institute for Public Policy Research (IPPR) publishes report on the self-management of long-term conditions

Left-leaning think-tank the Institute for Public Policy Research (IPPR) have published a report which found that more needs to be done to recognise and support the huge amount of self-management done by people with long-term conditions and their carers, and to enable people to work in partnership with healthcare providers to agree the services that fit their needs. The report was based  on a survey of over 2,500 people with long-term conditions, which asked them about their attitudes towards and experience of the management of their conditions.

The report found that patients with long-term conditions had great expertise in managing their conditions, but that this was not currently being recognised by the healthcare system. It said that more needed to be done to acknowledge patients’ expertise on the effects of their condition(s) on their lives, and to marry it with expert medical advice, so that patients have more of a say over the services they receive.

 

Issues were raised in the report about the lack of information and support. The survey found that just over a third (37%) of respondents were not satisfied with the day to day management of their condition(s), and of these, a relatively high proportion had not been given information and support when they were diagnosed. Moreover, over three-quarters (77 per cent) of respondents believed that more of their healthcare could and should be managed independently at home – but they said that a lack of support and information was holding them back from doing so.

In terms of recent government developments to help those with long term conditions, notably personal health budgets, around a third of respondents (35%) thought that they would be useful. According to the survey, some respondents said that they had not heard of them or did not know what they were.

The report concluded that the current system was not designed and delivered in a way which prioritised patient empowerment, and in some cases hindered it. It found that there was little systematic evidence of patient empowerment being embedded – of it driving service design, and shaping strategies and service delivery across the board.

Below is a list of relevant recommendations:

  • It should be guaranteed that everyone diagnosed with a long-term condition – at the point of diagnosis and regular thereafter – is offered information, advice and coaching about how best to self-manage their condition. NICE should also develop patient-friendly equivalents of each clinical guidance note relating to long-term conditions.
  • Everyone diagnosed with a long term condition should be able to access peer-to-peer support. Organisations operating in each local health economy – including voluntary sector organisations – should work together to enable the provision of peer-to-peer support mechanisms in communities.
  • Everyone with a diagnosed long-term condition should be guaranteed a healthcare plan covering their physical health, mental health and social care needs, into which they have substantial input and which they develop in partnership – and jointly agree – with their healthcare professional or care coordinator.

The King’s Fund publishes priorities for next government

Influential health think-tank the King’s Fund has published its priorities for the next government, which include: meeting the financial challenge of the health care system; transforming services for patients; improving quality of care; and reforming the NHS.

Financial challenges

According to the document, the next government will enter office with the NHS facing “financial meltdown”. Although it states that “good progress” had been made in delivering £20 billion in productivity improvements, it also highlights most of the savings have been found by limiting staff salary increases, reducing prices paid to hospitals for treatments, and cutting management costs. The document argues that there is no more scope for further cuts in these areas. As such, it argues that savings should come through changes to clinical practice and more sophisticated approaches to incentivising NHS organisations to improve efficiency.

It also recommends that the next government should establish a ring-fenced health and social care transformation fund to be used to develop new community-based services and to cover double-running costs during the transition between old and new models of care. In line with the recommendations made in the King’s Fund health and social care commission report, published in September 2014, the King’s Fund also recommends radical tax reforms, including limiting some universal benefits for older people, to pay for the costs required.

Transforming services for patients

The report highlights that in order to meet the needs of an ageing population and the growing number of people with long-term conditions, barriers between primary and secondary care, physical and mental health, health and social care need to be overcome in order to provide integrated care. It states that these ambitions need both financial and political backing – arguing that the government and local politicians must be “much braver” in supporting changes to services where there is a clear case for change.

Improving quality of care

The King’s Fund states that a shift is need to involve patients more closely in decisions about their care. It states that patients must be fully informed about their options, and that personal budgets to deliver personalised care could be used more widely.

NHS reform

It is stated that a “fundamental shift” is needed in NHS reform, which learns from what has worked here and around the world. The current approach identified by the King’s Fund, which involves top-down structural reorganisation and frequent changes in direction have “got in the way” of the long-term commitment need to deliver transformational change. Instead, it suggests that ministers should focus on general policy direction, with local leaders focusing on improving the quality of services and developing new models of care. Reform, it argues, should involve engagement with frontline staff.

Weekly political news round up – 12th September 2014

September 12, 2014 in News by Whitehouse

Around the sector

Welsh First Minister Carwyn Jones has announced the appointment of Vaughan Gething AM as Deputy Minister for Health, as part of a cabinet reshuffle.

The Department for Health and Department for Education have jointly published a guide for health professionals on the relevant aspects of the SEND code of practice. The guide highlights and clarifies areas of the Code of Practice which are relevant to health professionals, such as: joint working across education health and care, the local offer, health in early years and schools, and educational health and care (EHC) needs assessments and plans. While the guide places no extra responsibilities on settings and does not strengthen the Code, it is welcome as it should make it easier for health professionals to digest the new reforms and adds a little more detail on how the Government envisage the new SEND system to work.

Children and Young People Now has reported that the Council for Disabled Children (CDC) has called for local authorities to be given time to fully implement the special educational needs and disability reforms introduced in the Children and Families Act 2014. Despite the official start date of the reforms being 1st September 2014, Christine Lenehan, Director at the CDC, said that “there’s a good degree of basic awareness among local authorities, but they are at different stages of actually implementing [the reforms].

A Westminster Hall debate was held on Monday where MPs discussed the provision of nursery schools in the UK. Members of the Education Select Committee, including Labour MP Pat Glass and Conservative MP Stuart Graham, commented that successive governments had neglected nursery schools despite their effectiveness in admitting and integrating students with special educational needs.

Commons passes legislative reform on clinical commissioning group joint committees

The House of Commons has passed a legislative reform order to amend the NHS Act 2006 to allow clinical commissioning groups (CCGs) to form a joint committee when exercising their commissioning functions jointly. The reforms also allow CCGs to exercise their commissioning functions jointly with NHS England, and to form a joint committee when doing so.

Care and Support Minister Norman Lamb argued that the existing the lack of provision for CCGs to form joint committees prevented them from working in the most effective and efficient way. As things function currently, he highlighted that CCGs either had to delegate responsibility to a person attending a committee in common to make decisions, or they had to go back to their own CCG and then have a further committee to endorse the proposal that had been discussed at the committee in common. This was, he argued, complex, burdensome and expensive.

He also argued that the lack of power for CCGs to exercise their functions jointly with NHS England was causing inflexibility, noting that it had an effect on the commissioning of better out-of-hospital services.

Lamb stated that these reforms would not impact on the emphasis on local decision making as joint committees could decide that any agreements would require unanimity as opposed to a simple majority. Furthermore, he said that expected CCGs setting up joint committees would adhere to existing arrangements to involve patients and the public in plans about commissioning arrangements, as well as the requirement to specify in their constitutions the arrangements made for the discharge of their functions.

Shadow Care and Older People Minister Liz Kendall commented that CCGs have reported that they are coming under increasing pressure from NHS England and fear that their autonomy is being driven way. The reforms, she claimed, would force them into committees and taking decisions that they may not think are in the best interests of local people. She also raised questions about how joint committees would be accountable to patients, the public, local Healthwatch, and health and wellbeing boards.

Lamb responded that the legal duties of CCGs remain unchanged, and nothing is being done to put any pressure on a CCG to enter any arrangement with other CCGs or with NHS England. He said that any CCG feeling pressure is free to resist it, clarifying that joint committees were voluntary arrangements, and that if NHS England wanted to enter into a joint committee with a CCG, then the CCG would be free to reject the proposal.

Responding to the concerns about accountability, Lamb said that when they act in a joint committee, CCGs will be subject to the same duties as when they act on their own and the accountability that they face will be the same. He added that although there were concerns that joint committees might not meet in public, this does not mean that meetings will take place behind closed doors.

NHS Confederation launches manifesto for 2015 General Election

The NHS Confederation has published a manifesto outlining what it believes are the essential components of a new health and care system and how they might look and be experienced by people using and working in health and care, and the wider public. The 2015 Challenge Manifesto: a time for action, has been endorsed by 21 organisations, including the Royal College of General Practitioners, the Royal College of Nursing and the Royal College of Physicians.

Although the manifesto does not make any specific reference to continence – instead focusing on more general issues – it does stress the importance of self-managed care. It states that such care should be valued as much as care managed by healthcare professionals, adding that people with long-term conditions should feel confident and equipped  to play a far greater role in managing their own condition(s), empowered by new technologies and professionals who work in partnership with them.

The manifesto subsequently calls on all parties to commit to supporting a national sector-led programme to support health and social care organisations to adopt participation, personalised care and support planning, shared decision making and supported self-management approaches for all who would benefit.

Also discussed in the manifesto are areas such as the prevention of poor health, better mental health care services, more effective workforce support and planning, and the need for better funded services.

Weekly political news round up – 5th September 2014

September 5, 2014 in News by Whitehouse

Around the sector

The Liberal Democrats have announced that they will provide 15 hours of free childcare every week to all two year olds by 2020, should they form part of the Government in 2015. They also stated that they wanted to increase the free childcare offer to all children aged nine to 24 months where both parents are working, before later increasing the maximum hours funded by the state from 15 to 20 hours per week.

The Department for Education has published a guide for early years providers on the relevant aspects of the Special Educational Needs and Disability Code of Practice. The guide highlights and clarifies areas of the Code of Practice which are relevant to early years providers, such as: information on the Local Offer, the Early Years Foundation Stage framework, the progress check at age two, SEN coordinators and education, health and care (EHC) assessments and plans. While the guide places no extra responsibilities on settings or does not strengthen the Code, it is welcome as it should make it easier for early years workers to digest the new reforms and adds a little more detail on how the Government envisage the new SEND system to work in early years settings.

Forthcoming events:

The House of Commons will rise again for party conference season on 12th September

NHS England publishes Integrated Personal Commissioning (personal budgets) partnership prospectus

NHS England has published a prospectus seeking partnership opportunities between CCGs, local authorities and voluntary sector partners for the extended personal budgets programme – known as Integrated Personal Commissioning (IPC).

The IPC programme, which commences in April 2015, will bring together health and social care funding around individuals, enabling them to direct how it is used. Targeted at people with complex needs, including those with multiple long-term conditions and children eligible for education, health and care (EHC) plans, it seeks for a personalised approach to address acknowledged problems in the current care provision of patients. The programme is based on two core elements: person centred care and prevention of costly negative health outcomes.

It builds on the existing personal budget programme implemented under the previous government, as well as the more recent personal health budget programme. It recognises that progress in the development of personalised approaches which consider NHS and local government expenditure as a whole, such as EHC plans being implemented as part of the special educational needs and disability reforms, have been limited in general. The IPC programme will consider the inclusion of all NHS spend, including specialised commissioning.

The IPC programme will run for a minimum of three years, beginning in April 2015. Sites wishing to participate in the programme will need to have person-centred planning support and personal health budgets in place from this date, and will also be expected to contribute to national evaluation. As part of the programme, interested areas would be involved in developing and testing models which link what matters to people – person-centred outcomes as reported by patients/carers – to financial reimbursement.

Successful applicants will benefit from a combination of direct, joined-up senior sponsorship from NHS England, Public Health England and local government, and help on key issues such as the financial model, information governance, risk stratification, care planning, personal budget systems, and evaluation. Planned funding is in place for around 10 demonstrator sites during part of 2014/15 through 2016/17, although this may be higher depending on interest and the quality of applications.

Applications must be made jointly by one or more CCG and local authorities and at least one voluntary sector partner. In order to obtain an application form, an email expressing interest must be sent to england.ipc@nhs.net by 19th September 2014. Application forms must demonstrate how partners will fulfil a number of criteria, and must be returned to NHS England by 7th November 2014.

King’s Fund publishes report from the Commission on the Future of Health and Social Care in England

Health think-tank The King’s Fund has published the final report of its Commission on Health and Social Care, A new settlement for health and social care, calling for a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services. The report rejects the idea of new NHS charges and private insurance options in favour of public funding for health and social care.

To fund such a change, the Commission recommends that higher public spending should be paid for through tax and National Insurance increases, reallocating funds from other areas of spending and changes to prescription charges. In the short term, the Commission proposes that the winter fuel payment and free TV licences be means tested, and that National Insurance at a reduced rate be levied for those who work past pension age. National Insurance would be paid at a higher rate for those over 40 and those on higher wages.