Weekly political news round up – 31st October 2014

October 31, 2014 in News by Whitehouse

Around the sector

The Health Service Journal has speculated that the Department of Health wishes to extend NHS joint commissioning with councils to public health and children’s services.

The Department for Education has published guidance on bullying in schools. The guidance suggests that schools could invest in specialised skills to help their staff understand the needs of their pupils, including those with special educational needs and/or disabilities.

The Department for Education has also published an evaluation of the special educational needs and disability (SEND) pathfinder programme on the provision of personal budgets and integrated resourcing, as outlined in the Children and Families Act 2014 and the subsequent SEND Code of Practice.

Tabled written questions on outpatient coding and paediatric continence

Liberal Democrat MP Paul Burstow has tabled four written parliamentary questions on outpatient coding and paediatric continence, asking the Health Secretary:

  • When the Health and Social Care Information Centre next plans to review the list of treatment function codes for outpatient procedures.
  • What recent discussions he has had with the Health and Social Care Information Centre on the inclusion of a specific treatment function code for paediatric continence.
  • What assessment he has made of the potential financial effect of NHS healthcare trusts failing to properly record data on outpatient procedures.
  • How many hospital admissions there were for constipation in children in 2013; and what the estimated cost to the NHS was of treating such admissions.

Health Service Journal reports Labour could make NICE clinical guidelines mandatory

In an interview with the Health Service Journal, Shadow Health Secretary Andy Burnham has revealed that Labour may consider making NICE clinical guidelines mandatory rather than advisory, should they come to power in 2015.

Burnham stated that Labour would review ways in which NICE could be strengthened, including making all clinical guidelines mandatory, noting that there had been evidence that clinical commissioning groups (CCGs) were opting out of NICE guidelines. He stated that:  “We can’t just have national entitlements broken up… We need to look at how you strengthen NICE. Where they have said something is effective and affordable, on what basis does a local commissioner withhold that from somebody? I’m not comfortable with that. I don’t support that”.

In the same interview, he also stated that CCGs could start to function as the operational arms of health and wellbeing boards, which would assume the role of “signing off” health plans. Burnham said that by having health and wellbeing boards authorise the commissioning of services, the issue of public accountability would be addressed.  Health and Wellbeing boards are made up of councillors, senior council officers and GP commissioners.

Weekly political news round up – 24th October 2014

October 24, 2014 in News by Whitehouse

Around the sector

NHS England has appointed Professor Toby Young as the new National Clinical Director for Innovation. Young, a practising Consultant Urological Surgeon, will be tasked with driving the uptake of proven innovations across the healthcare system.

The Telegraph reports that the new Small Business, Enterprise and Employment Bill will allow head teachers to register two-year-olds as pupils – in the same way as normal school-age children – rather than classifying them as part of separate early years provision. Neil Leitch, chief executive of the Pre-school Learning Alliance, said that “two-year-olds have very specific learning and development needs which differ significantly from those of three- or four-year-olds, and many schools simply won’t have the appropriate physical environment or suitably-trained staff to be able to meet these needs”.

The Department for Education has announced that it will be rolling out the early years pupil premium (EYPP) nationwide from April 2015. Under the EYPP, which is worth a total of £50 million, schools, nurseries and childminders will be given up to £300 for every 3- and 4-year-old from a low-income family to help prevent a performance gap between wealthy and less wealthy children.

NHS England publishes NHS Five Year Forward View

NHS England has published the NHS Five Year Forward View (FYFV) – a strategy which sets out the vision for the future of the NHS. The purpose of the FYFV is to state why change is needed, what that change might look like and how it might be achieved.

It was developed in coordination with a number of health service bodies, including Public Health England, Monitor, Health Education England and the Care Quality Commission, as well as patient groups, clinicians and independent experts.

Although continence is not explicitly mentioned, the strategy suggests that care for those with long term conditions could be improved through a more personalised and integrated health and care system. Also mentioned in the strategy is health innovation, including with regards to devices and equipment. Other areas covered include improving public health, as well as financing and new partnerships to deliver services. Children’s services receive little mention in the document.

In terms of the management of long term conditions, the strategy states that patients will have a greater degree of control over the care that is provided to them. One of the ways in which this will happen is through integrated personal commissioning (IPC) – a new voluntary approach which allows patients with complex needs to plan and pay for their own care using NHS funds.

With regards to the acceleration of useful health innovation, the strategy states that NHS England will work with the National Institute for Health and Care Excellence (NICE) to expand work on devices and equipment and to support the best approach to rolling out high value innovation. It recognises that new devices go through NICE’s assessment processes less frequently than pharmaceuticals.

The strategy rejects further organisational change, noting that there is “no appetite for a wholesale structural reorganisation” in the NHS. As such, it states that any new models of care should occur within current NHS structures, with “one size fits all” approaches something to be avoided. It terms of funding, it notes that a combination of demand, efficiencies and funding would need to be addressed to avoid a projected £30 billion shortfall by 2020-2021.

Responding to the news, Shadow Health Secretary Andy Burnham commented that NHS was in need of “capital investment” to drive service change, but admitted that he had not yet worked out how the funding would be released. Burnham also repeated Labour’s proposals for £2.5 billion in extra funding for the NHS, as well as plans for hospitals to evolve into “integrated care organisations”. He concluded by commenting that the FYFV would not bring about reforms as quickly or extensively as he would like but was nevertheless a “big endorsement of our vision”.

Weekly political news round up – 17th October 2014

October 17, 2014 in News by Whitehouse

Around the sector

Health Service Journal has reported that the leader of the Welsh Conservatives, Andrew Davies AM, has called for directly elected health commissioners to replace local health boards as those responsible for commissioning services. Davies said that: “Directly elected health commissioners, with a mandate from the communities they serve, will be able to reflect local priorities when bringing about the transformation our NHS needs to be fit for the 21st century.”

Writing in Health Service Journal, Labour MP Debbie Abrahams, Parliamentary Private Secretary to Shadow Health Secretary Andy Burnham, has said that Labour’s proposed changes to the commissioning roles of clinical commissioning groups (CCGs) and health and wellbeing boards (HWBs) would be an “evolutionary process, not a big bang”. She added that rather than HWBs assuming commissioning responsibilities immediately, they will only be able to do so once they are assessed as competent.

Health Service Journal has reported that Judith Ellis, the new chief executive of the Royal College of Paediatrics and Child Health (RCPCH) has said that hospital trusts should ensure adequate children’s community services are in place before closing in-patient units, in light of fears that there will be a wave of further consolidations in services as trusts struggle to recruit consultants.

The Department for Education has published statistics showing the levels of development that children aged 0-5 have achieved as part of the Early Years Foundation Stage. It found that in 2014, 94% of all children achieved at least an expected level of development for health and self-care (including toilet training), with 23% exceeding expectations, 71% meeting the expected standard and 6% falling short. This compares with 92%, 20%, 72% and 6% in 2013.

The Scottish Government has announced that spending on Scotland’s health service will increase in real terms by £288 million – taking Scottish health spending above £12 billion for the first time.

Childcare Minister Sam Gyimah has announced that the Government intends to improve access to high-quality early education, particularly for two-year-olds from poor backgrounds.

Care Quality Commission publishes State of Care report 2013-2014

The Care Quality Commission (CQC) has published its latest State of Care report, which examines the state of health care and adult social care in England in 2013-14.

The report found many examples of good and outstanding care, but also found a wide variation in the quality of care that people receive from different providers, in different places and sometimes at different times of the day or week.

Since September 2013, the CQC has been inspecting services based on the five following criteria:

  1. Are they safe?
  2. Are they effective?
  3. Are they caring?
  4. Are they responsive to people’s needs?
  5. Are they well-led?

The report found that whilst most NHS trusts provided services which were largely both caring and effective, there was a high degree of variation and room for improvement in the other areas.

In particular, the CQC identified that variation in basic safety was a “serious problem”, identifying a lack of effective safety processes and a lack of a culture and that learns from mistakes and near misses. It found that “far too many hospitals” had safety standards and the majority required improvement to be considered safe. Of the overall key questions rating for acute hospitals that the CQC published up to the end of August 2014, 8 of 82 safety ratings were inadequate, with 57 requiring improvements. The CQC labelled this level of poor performance as “shocking”.

One case study used to highlight poor case involved a woman who was not prompted or helped to the toilet and was left wet every night, which resulted in two urinary tract infections and subsequent confusion.

Also identified was a variation in the quality of leadership, which it believed was vital at all levels in ensuring better quality and safety overall. It was determined that 60% of hospitals needed to improve on leadership.

The report outlines suggestions for what providers should do and what the public should do. It is suggested that providers should be proactive in analysing what good care looks like, rather than waiting for a CQC inspection, and that they should act swiftly as one system to protect people from poor care. On the other hand, the report said that the public should actively use CQC’s ratings and reports to make choices about their care, whilst also using their voice to give feedback on both good and poor care.

Health Secretary Jeremy Hunt calls for investment in safer care

Health Secretary Jeremy Hunt has called for hospital managers to invest in safer care. The announcement comes following both the CQC State of Care report 2013-14, and a report published by Frontier Economics, commissioned by the Department of Health, which found that the cost of preventable poor care ranged from £1 billon to £2.5 billion annually. It also found that 800,000 patients – one in 20 of all admitted to hospital – suffered harm that could have been avoided.

According to the study, urinary tract infections caused by catheters resulted in an average of 10 extra days in bed, at a cost of £2,523 per patient. This amounts of a total cost to the NHS of £67m a year – or the equivalent of pay for 1,300 nurses.

Speaking at Birmingham Children’s Hospital, Hunt said that “if you’re short on money, poor care is about the most wasteful and expensive thing you can do”, adding that he wanted “every director of every hospital Trust to understand the impact this harm is having not just on their patients, but also on their finances”. He stated that patient experience/safety and finances were “two sides of the same coin”.

Unannounced spot checks in Welsh hospitals did not reveal systemic concerns about patient care

The Welsh Government has published a report which outlines the findings of unannounced spot checks to test standards of care, including continence care, in district general hospitals across Wales. The new report, which found “no systemic issues of concern”, follows on from the Trusted to Care report which highlighted poor quality of care in two health boards in Wales.

Specifically regarding continence care, the report found that patients’ fundamental toileting needs were being met, stating that inspectors “witnessed a breadth of practice positively supporting patients’ toileting needs”, but that there were areas which needed improvement.

With regards to product provision, whilst there was high and “mainly appropriate” use of continence pads, including a good selection, these were not always stored discreetly. For catheter usage, the report found that use was “appropriate for the needs of patients”.

The report suggested that there were two key challenges for staff in their efforts to promote good toileting and continence care. Firstly, the layout of wards was problematic and encouraged reliance on bed pans rather than access to toilets. Secondly, there were wards where the dependency of patients was particularly high and where nursing staffing levels made it difficult to respond to all patients in a timely manner.

It was also identified that the ‘All Wales Continence Bundle’ was not used in many areas, with some citing the amount of paperwork and duplication as reasons for non-use.

National Institute for Health and Care Excellence launches consultation on updating the Public Health Quality Improvement Guide for prevention and control of healthcare-associated infections

The National Institute for Health and Care Excellence (NICE) has launched a consultation on the outcome of a review to determine whether the Public Health Quality Improvement Guide for the prevention and control of healthcare-associated infections (PH36) should be updated.

The draft review proposal recommended that the Quality Improvement Guide should only undergo a terminology and indicator refresh, as no new policies or guidance had been identified that invalidated the existing quality improvement statements, and that intelligence gathered suggested that the content is still relevant and useful.

The review itself focused largely on a policy search to identify any new key documents that are aimed at organisational and management factors impacting on healthcare-associated infections, as well as a search of new NICE guidance and existing publications. No relevant documents were identified, and no mention was made in the review to catheters or other relevant medical devices.

The deadline for comments is Thursday 30th October 2014. Please do let us know if you have any comments by Thursday 23rd October so we can incorporate these into a response.

It is expected that the final decision date for the review will be in December 2014.

Ofsted launches consultation on overhaul of school inspections

Ofsted has announced that it is has launched a consultation on a new common inspection framework for the inspection of maintained schools, academies, further education and skills providers, non-association independent schools and registered early years settings. The proposals are designed to streamline the transition that children make between settings as they grow up.

Whilst it is proposed that there should be a broad uniformity in inspection criteria for all settings, specific additional judgements will be made for specific types of settings (early years, six form and further education). The proposals state that schools with nursery settings will continue to receive a separate grade for that provision. Separately from this consultation, the Small Business, Enterprise and Employment Bill states that schools’ provisions for two-year-olds on the Early Years Register will now be inspected as part of a school inspection using the new common inspection framework.

The framework states that inspectors must consider how educational settings will meet the need of disabled children and learners and those with special educational needs. Despite this, no specific grade will be given.

The deadline for responses to the consultation is Friday 5th December 2014.

Commenting on the proposals, Purnima Tanuku, Chief Executive of the National Day Nursery Association (NDNA), warned that the move by Ofsted to standardise inspections across school-based nurseries, schools and further education colleges could lead to further “schoolification” of the early years.

Weekly political news round up – 10th October 2014

October 10, 2014 in News by Whitehouse

Around the sector

Baroness Hughes has stood down as Labour frontbench spokesperson on Children and Education in the House of Lords; she has been replaced by education whip Baroness Oona King.

Forthcoming events

Both the House of Commons and the House of Lords are set to return on 13th October, following the end of party conference season.

Overview of the Liberal Democrat party conference

The Deputy Prime Minister and Leader of the Liberal Democrat Nick Clegg has delivered his keynote speech at the Liberal Democrat party conference in Glasgow; the final conference before the general election in May 2015.

Mr Clegg outlined the Liberal Democrat’s plans for the next Parliament in a one hour long speech covering a wide range of policies including tax, education, energy and mental health. A key focus of his speech was on mental health policy. Mr Clegg said that the second class status given to mental health in the NHS threatens “the opportunities available to hundreds and thousands of our fellow citizens.” He pledged that the Liberal Democrats will introduce national waiting times for patients with mental health conditions so that a person experiencing psychosis for the first time will be seen within two weeks.

Mr Clegg also announced that the Liberal Democrats will protect the NHS budget in real terms, as well as raise an extra £1bn every year, by ending three different tax breaks which benefit the highest earners.

On education, Mr Clegg highlighted the party’s achievements in government – notably the Pupil Premium – and reiterated plans to make teacher qualification mandatory and expand free school meals to all pupils of primary age.

On tax, Mr Clegg said the Liberal Democrat’s priority was to raise the personal allowance threshold to £12,500 from 10,500. He also highlighted the party’s success in raising the personal allowance from just under £6,500 to £10,500 in the last Parliament.

Weekly political news round up – 3rd October 2014

October 3, 2014 in News by Whitehouse

Around the sector

The Department for Education has published “The young person’s guide to the Children and Families Act 2014”, outlining the main changes and provisions of the Act and how they may affect children and families. It provides a simplified outline of how the Act helps children and young people with special educational needs or a disability, as well as an outline of changes to the role of the Children’s Commissioner.

The Department of Health has published two factsheets on the transfer of 0-5 children’s public health commissioning to local health authorities.  One of the factsheets outlines changes to the commissioning of the National Healthy Child Programme, whilst the other outlines the financial issues of the transfer of commissioning duties to local authorities.

The Institute of Education has published research which has found that the behaviour of many children with disabilities often worsens between the age of 3 and 7 – the period where they first start school. Notably, the study found that children with disabilities encountered increasing difficulties in terms of hyperactivity, emotional problems and interactions with other children. The report concluded that disabled children might have fewer behavioural issues in their early years if more schools introduced stringent anti-bullying measures and other support strategies. It also recommended that better support is provided for parents of children with an impairment or special educational need, as such interventions have “very substantial” long-term benefits.

NHS England has announced that, effective from 1st October 2014, children (and adults) in receipt of NHS Continuing Healthcare will now have a “right to have” a personal health budget. This builds on the “right to ask” for a personal health budget that patients have had since April 2014. Personal health budgets are an allocation of NHS money to individuals with identified health needs, which allow them to buy services or products which they believe will enable them to meet specific goals around health and wellbeing.

Forthcoming events

Both the House of Commons and the House of Lords are set to return on 13th October, following the end of party conference season. The final major party conference before the 2015 election, the Liberal Democrat party conference, will take place from 4th to 8th October.

Overview of Conservative Party conference – health and education

The Conservative’s final party conference before the 2015 general election took place in Birmingham this week, with speeches being given by Prime Minister David Cameron, Health Secretary Jeremy Hunt and Education Secretary Nicky Morgan. Below are summaries of their speeches:


Prime Minister David Cameron

In his speech, Cameron announced that a Conservative government would ring-fence the NHS budget in real terms, whilst asserting that the delivery of a successful health service was closely tied to strong economic performance. Making references to his own family’s experiences of the NHS, and echoing Health Secretary Jeremy Hunt, the Conservative leader accused Labour of “spreading complete and utter lies” about the Conservative Party’s record on, and plans for, the NHS.

Cameron promised to continue reform of the education sector, presenting his party as one unafraid to “take on those who get in the way of high standards”.

The headline policies of Cameron’s speech were plans to raise the tax-free allowance from £10,500 to £12,500 by 2020, and plans for the 40p income tax threshold to be raised from £41,900 to £50,000, also by 2020.

Health Secretary Jeremy Hunt

In his speech, Health Secretary Jeremy Hunt he announced plans to provide patients with seven days a week access to GPs by 2020, with appointment hours being extended to between 8am and 8pm. In order to make this a reality, he also confirmed plans to train and retain an extra 5,000 GPs.

Hunt also announced the reintroduction of the requirement for every patient to have their own named, personal GP. He noted that this would be beneficial to those with chronic conditions and complex needs, who would no longer have to explain their condition to different practitioners. Medical records would also be available online.

Discussing funding, Hunt said that NHS spending had increased more – in real terms – since the Coalition came to power in 2010 than by the £2.5 billion spend outlined by Labour leader Ed Miliband at the Labour party conference last week. He warned against significant extra funding at the expense of balancing the budget, noting that “you can’t fund the NHS if you bankrupt the economy”.

Hunt argued that Labour had turned the NHS into “national political football”, accusing them of “scaremongering” about claims that the NHS was being privatised.

Education Secretary Nicky Morgan

Nicky Morgan gave her first speech to a Conservative arty conference as Education Secretary. In her speech, Morgan expressed her sympathy for the workloads of teachers, promising to find ways for teachers to spend more of their time in the classroom teaching and offering an olive branch to the teaching unions to discuss these concerns.

Although very little was revealed by way of specific policies, Morgan did indicate strongly indicate the direction she wanted to lead her department in: repair relations with teaching unions and teachers themselves; apply a greater focus on 0-5 and post-18 education; end Michael Gove’s “obsession” with curriculum and exams reform; and ease the rate of school reform and allow the momentum already generated to keep up the academisation of the sector.

Welsh Government announces draft budget for 2015-2016

The Welsh Government has announced its draft budget for 2015-16.

Although the budget is £1.5bn lower in real terms than 2010-11, an extra £425m of funding is being provided for the NHS over the next two years. Of the £425m being delivered, £200m will be delivered in 2014-15, with £225m being delivered in 2015-16.

The extra funding comes following the publication of an independent report by the health think-tank the Nuffield Trust in June 2014, which found that rising costs, increasing demand, an ageing population and a growth in the number of people experiencing chronic conditions was placing an increasing challenge on all parts of the system and required an innovative response. The extra funding seeks to enable the NHS in Wales to maintain its delivery services, whilst it continues to reform and reshape services.

As Labour do not have a majority in the Welsh Assembly, the budget will likely be passed following a deal with the Liberal Democrats involving extra funding for schools in poorer areas.