Weekly political news round up – 28th November 2014

November 28, 2014 in News by Whitehouse

Around the sector

The National Children’s Bureau has launched a toolkit which provides support to local early years and health teams as they undertake improved and streamlined approaches to reviewing children’s development at age two. The resource pack provides advice on some of the key factors local areas may need to consider in designing and delivering integrated reviews, with information on assessment tools, staffing and possible formats. It can be found here.

Influential health think-tank the King’s Fund has published a report laying out the evidence available to help guide the reconfiguration of clinical inpatient services in England. Building on reviews of service reconfigurations by the National Clinical Advisory Team (NCAT), it notes in general that reconfiguration is an “important but insufficient” approach to improve quality, and that it should be used alongside other measures to strengthen delivery of care and to instil an organisational culture of improvement. Furthermore, it states that any proposal to reconfigure clinical services needs to have come out of a process with strong engagement from clinicians, public and politicians.

The King’s Fund also published a report proposing that an additional £2 billion will be required for 2015-16. The report said that “unless this money is found in the Autumn Statement, patients will bear the cost as staff numbers are cut, waiting times rise and quality of care deteriorates”.

In a speech to the think-tank Centre Forum, Schools Minister David Laws MP announced that should the Liberal Democrats be part of the next government, they would ensure that Early Years Teachers can secure qualified teacher status and that they would promote this standard across the sector. Laws also revealed that an aim of the Liberal Democrats is to significantly increase pay in the early years sector, starting with staff working in settings serving areas of high disadvantage.

The Department for Education has also launched an information campaign to encourage parents who are eligible for free childcare to enrol their children

Labour MP Rosie Cooper tables written question on continence care

Labour MP Rosie Cooper has tabled a written question asking the Health Secretary whether the revised Nursing and Midwifery Code will include provisions on bowel and bladder care to take account of the findings of the Francis Report on poor continence care.

Department of Health publishes NHS reference costs for 2013 to 2014

The Department of Health has published a document containing NHS reference costs for 2013 to 2014. Reference costs are the average unit cost to the NHS of providing defined services to NHS patients in England in a given financial year, and are collected annually by the Department. The document gives a comprehensive picture of how 244 NHS providers (98 NHS trusts and 146 NHS foundation trusts) spent £58.3bn delivering healthcare to patients in 2013-14.

Below is an overview of data for urinary incontinence and other urinary problems, both with and without interventions:

Currency Description Spells National Average Unit Cost Lower Quartile Unit Cost Upper Quartile Unit Cost Inlier Spell Bed Days Excess Spell Bed Days Data Submissions
Urinary Incontinence or Other Urinary Problems, with Interventions, with CC Score 7+     1,459  £     5,113  £          3,929  £          5,848         21,962        1,513                  137
Urinary Incontinence or Other Urinary Problems, with Interventions, with CC Score 3-6     2,815  £     2,472  £          1,887  £          2,759         15,932        2,000                  147
Urinary Incontinence or Other Urinary Problems, with Interventions, with CC Score 0-2     3,421  £     1,644  £          1,321  £          1,745         12,021        1,265                  141
Urinary Incontinence or Other Urinary Problems, without Interventions, with CC Score 8+        320  £     4,057  £          2,613  £          5,013           3,734           177                  112
Urinary Incontinence or Other Urinary Problems, without Interventions, with CC Score 5-7        511  £     2,657  £          1,813  £          3,086           3,367           509                  127
Urinary Incontinence or Other Urinary Problems, without Interventions, with CC Score 2-4     1,064  £     1,935  £          1,353  £          2,366           4,348           798                  140
Urinary Incontinence or Other Urinary Problems, without Interventions, with CC Score 0-1        891  £     1,560  £          1,086  £          1,794           2,719           569                  132

The dataset showing the cost of procedures nationally (as above) can be found here, with further datasets available here.

Scottish First Minister Nicola Sturgeon announces Cabinet reshuffle

The new Scottish First Minister Nicola Sturgeon has announced a reshuffle of the Scottish Cabinet, with changes being made to the portfolios for health and education.

Health

Shona Robison has replaced Alex Neil as Cabinet Secretary for Health, Wellbeing and Sport; Neil has moved to become Cabinet Secretary for Social Justice, Communities and Pensioners’ Rights.  Robison had previously been the SNP’s Party Spokesperson on Health between 2003 and 2007, before becoming Minister for Public Health in 2009 and Minister for Public Health and Sport in 2011.

Maureen Watt has replaced Michael Matheson as Minister for Public Health, who has moved on to become Cabinet Secretary for Justice. Watt had most recently served as Minister for Schools and Skills between 2007 and 2009, having been elected as an MSP in 2006.

Education

Angela Constance has replaced Michael Russell as Cabinet Secretary for Education and Lifelong Learning, who has exited the Cabinet. Constance had previously been Minister for Youth Employment, and was Minister for Children and Young People briefly in 2011.

Aileen Campbell will continue as Minister for Children and Young People, but will be temporarily replaced by Fiona McLeod whilst she is on maternity leave.

Weekly political news round up – 21st November 2014

November 21, 2014 in News by Whitehouse

Around the sector

The Daily Mail has reported on that Chief Whip Michael Gove has written to Conservative MPs to tell them that it is unlikely that they will be required in the House of Commons on Thursdays in the lead up to the May 2015 general election. Other parties are expected to follow the Conservative lead. Given that the House does not normally sit on a Friday, MPs will now only attend the Commons for three days a week. The reduction comes as a result of the Coalition Government running out of major legislation to pass that both the Conservatives and Liberal Democrats can agree on.

The Department for Education has published a statistical release outlining the percentage of children who achieved a good level of development in the early years foundation stage profile (EYFSP) in England for 2014. The EYFSP is made up of 17 early learning goals (ELG), with the statistical release showing that 87% of boys and 94% of girls were achieving at least their expected level for the health and self-care ELG, which states that children must be able to go to the toilet independently.

NICE publishes four-year surveillance review of clinical guideline 111: nocturnal enuresis – the management of bedwetting in children and young people

The National Institute for Health and Care Excellence (NICE) has published their 4-year surveillance review of clinical guideline (CG) 111: nocturnal enuresis – the management of bedwetting in children and young people. This review, which is the first substantial one undertaken since the CG was published in 2010, found that the guideline should not be considered for an update at this time.

The PCF submitted a guideline development group (GDG) questionnaire as part of the surveillance review, which noted that the PCF had conducted an FOI survey in 2014 revealing inequalities of access to paediatric continence services. More importantly, the questionnaire noted that the PCF had produced a commissioning guide to combat these inequalities.

Whilst the surveillance review recognised both of these points, the review document itself provides a link to the outdated 2010 version of the commissioning guide rather than the 2014 version. This may indicate that those conducting the surveillance review believed that we were referencing the 2010 version, despite our questionnaire response clearly highlighting the launch of the 2014 version.

By way of background, NICE undertakes two different types of review every 2 years, with one type of review being more substantial than the other.

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

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

Reviews have five possible outcomes, which are:

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

In the base of CG 111, it was decided that no update would be issued. As such, a consultation has been launched where stakeholders will be able to input their views into whether or not the decision was correct, and suggest changes where appropriate.

The consultation closes on Friday 5th December 2014.

If the decision is maintained that there will be no update, then CG 111 will next be reviewed briefly in 2016, and reviewed again more substantially in 2018.

Northern Irish Department of Health, Social Services and Public Safety launches consultation on Service Framework for Children and Young People

The Northern Irish Department of Health, Social Services and Public Safety (DHSSPS) has launched a consultation on the Service Framework for Children and Young People. The seventh in a planned series of Service Frameworks, it seeks to improve the health and well-being of children, their carers and families by setting 34 standards in relation to a number of areas, including acute and long-term conditions and childhood disability.

The Service Framework will be used by a range of stakeholders including commissioner’s statutory and non-statutory providers, and the Regulation and Quality Improvement Authority (RQIA) to commission services, measure performance and monitor care. This particular Service Framework notes that early intervention should be offered to families when problems or conditions are detected. It also states that co-operation between hospitals is essential for the safe delivery of paediatric medical and surgical services.

The overarching standards within the Framework make very little reference to specific conditions, and none to continence. There are two existing overarching standards on which the PCF may wish to comment:

Overarching standard 16 in section 6 (children and young people with acute and long term conditions) states that children and young people with long term conditions should have access to high quality, evidence-based care, where they are treated as close to home as possible, while ensuring that their care is of the highest quality. The performance indicator for the overarching standard is a reduction in unplanned emergency admissions in under 18s for asthma, epilepsy and diabetes. As this overarching standard gives reference to specific conditions, there is likely scope for inclusion of continence.

Overarching standard 24 in section 7 (children with disability) states that all parents and young people should receive information about medicines prescribed and that this should be discussed with them. It notes that the medication should be regularly reviewed with health care teams to ensure the most effective outcomes. A list of what constitutes a medicine is given, but there is no reference provided to medical devices.

Department for Education publishes implementation study for the integrated review at age two

The Department for Education has published a report which looks at different approaches adopted by pilot areas to bring together the Early Years Foundation Stage (EYFS) progress check at age 2 with the Health Child Programme (HCP) at age 2 to 2-and-a-half into an integrated process.

The EYFS progress check is a statutory requirement for all providers delivering childcare to two year olds within the EYFS Framework, whilst the HCP is delivered universally to children in order to measure their health and development. The Integrated Review seeks to address concerns that parents were receiving conflicting advice about their children, and that problems were not being identified as early as they could be. Pilots were launched in January 2012 in five local authority areas to develop approaches towards delivering Integrated Reviews.

The study found that successful Integrated Reviews required two lead health individuals from health and early years working together closely to drive implementation forward, even though a lack of common electronic systems was a problem. Although resource intensive, having early years and health staff delivering their own parts of the review and having joint discussions with parents was considered viable. Having the review delivered by early years staff only, as trialled in one pilot area, proved to be problematic as health visitors were determined to be important for accurate clinical judgements.

In terms of outcomes, the study noted that it was too early to form conclusive judgements about whether or not the approaches piloted were more effective in achieving early identification of need, compared with the separate early years and health reviews. Nevertheless, it was found that the Integrated Review improved joint working, mutual understanding, working relations and information sharing between health and early years staff. Although most pilot areas reported increased costs, to varying degrees, many of those involved in the Integrated Review process believed that it could potentially support early intervention and deliver longer-term cost savings.

The Integrated Review also saw greater involvement with parents, with pilot areas achieving “considerable success” in identifying, inviting and engaging with parents, compared to HCP reviews.

The study noted that there were barriers to early years staff being able to advise on service referral and offer follow up support. These barriers include: access to children’s central records; lack of full knowledge about services to refer children on to; and other services not always trusting referrals from early years practitioners.

With regards to findings, the report noted that the Integrated Review was particularly effective in pilot areas when it was developed alongside a consideration of the wider service pathway for 0-5s. Furthermore, it was found that without appropriate services and systems to deliver early intervention to families, any support needs identified will not be met, however good the Integrated Review model is. Sufficient funding for support services is critical to this.

The report recommended that it would be beneficial if there were a set of key principles that may need to be met by the Integrated Review, but without being too prescriptive. These principles will not specifically mention any particular conditions that should be identified, but instead outline that all children are entitled to a high quality and comprehensive assessment, that clear service pathways should be available throughout the review process, and that parents are provided with easy to understand information about relevant local services, pathways and processes.

National Audit Office warns over council cutbacks

The National Audit Office (NAO) has issued a report warning that whilst local authorities have so far broadly coped well with funding cuts, many are now showing signs of financial stress and the Department for Communities and Local Government (DCLG) has a limited understanding of authorities’ financial sustainability. In all, the report states that one in six councils are not expected to deliver services within budget this year, and more than half of all councils are at risk of financial failure within the next five years. The NAO’s research also shows that one in four councils have had to make unplanned service reductions this year to keep within budget, and there are indications that they may not be able to deliver further cuts without a radical transformation of services.

The Government will have reduced its funding to local authorities by an estimated 28 per cent in real terms between 2010-11 and 2014-15. Further planned cuts will bring the total reduction to 37 per cent by 2015-16, excluding the Better Care Fund and public health grant.

With regards to the DCLG’s awareness of the financial situation of local authorities, the report concludes that the department “does not monitor in a coordinated way the impact of funding reductions on services, and relies on other departments and inspectorates to alert it to individual service failures. In consequence, the department risks becoming aware of serious problems with the financial sustainability of local authorities only after they have occurred.” Margaret Hodge, chair of the Public Accounts Committee, which will scrutinise the auditors’ findings, said she found it extraordinary that the DCLG had little idea whether local authorities were at risk of financial failure, and she warned of “potentially disastrous” consequences.

Patients Association calls for radical change to health ombudsman

The Patients Association has published a report in which it claims that the NHS ombudsman – the independent service that investigates patients’ complaints – is “wholly ineffective and failing families”. The Parliamentary Health Service Ombudsman (PHSO) is accused of failing to handle complaints of poor care by families, who they say have been “let down”. The PHSO, the last resort for those complaining about unfair or poor service from the NHS in England, is undergoing a modernisation scheme. Last month it revealed it had investigated 2,199 cases in 2013/14 – six times more than the previous year. But Patients Association deputy chief executive Jacqueline Coles, writing in the report, said the NHS Ombudsman had “failed to adapt” to modern demands. As a result, it will no longer be referring callers on the charity’s helpline to the watchdog.

Office of the Children’s Commissioner publishes report on the rights of disabled children and young people in England

The Office of the Children’s Commissioner has published a report on the rights of disabled children and young people in England, which looked at the views of 34 children and young people and their perceptions about the realisation of their rights as outlined in the UN Convention on the Rights of Persons with Disabilities (UNCRPD). It found that, in general, children and young people with disabilities feel that there is a lack of understanding about the issues they face from society and government.

More specifically, the children interviewed believed that society held an unhelpful, negative stereotype of disabled people that was perpetuated by books, television and the media. They believed that it was difficult to get their views taken serious, noting barriers to communicating with others, including professionals and service providers, due to a lack of training and awareness for the professionals in communicating with disabled children and young people.

To address this, children said that they wanted greater advocacy services, a government led awareness-campaign focused on the general public’s awareness of the rights and needs of disabled children, as well as information for them about their own rights.

Amongst the six recommendations in the report was a call for greater training and support (beyond what is currently offered) for teachers in the form of mandatory teacher training, in order to ensure that they have the skills and practical tools to deliver an inclusive education.

 

Weekly political news round up – 14th November 2014

November 14, 2014 in News by Whitehouse

Around the sector

The Department of Health has published a factsheet for health practitioners, providers and local authorities on changes to the Healthy Child Programme and the Health Visiting Programme, importance of health visiting and the transfer of service commissioning for 0 to 5 year olds to local authorities from 2015. The Department of Health later published a more detailed factsheet containing a summary table of what commissioning responsibilities exist and where they will be on 1st October 2015, which is available here.

The Department for Education has announced that 4Children Chief Executive Anne Longfield has been appointed as the next Children’s Commissioner for England. Longfield, who will replace current Children’s Commissioner Maggie Atkinson, will take up her post on 1st March 2015. Education Secretary Nicky Morgan commented that Longfield had a commitment to championing children’s rights and safeguarding their interests – particularly the most vulnerable.

The National Institute for Health and Care Excellence (NICE) has announced that the Department of Health has begun its 3-year review of NICE. The first stage of the review, conducted by ministers, will examine the continuing need for NICE, and whether it is still appropriate in its current form. Should it be determined that NICE should continue, a second stage of the review, which will include a public consultation, will assess whether NICE is operating effectively and in line with the recognised principles of good corporate governance.

The Department for Education has also published a letter, co-signed by Children’s Minister Edward Timpson and Children’s Health Minister Dr Dan Poulter, to CCG and Health and Wellbeing Board Chairs, as well as lead members for children’s service and local authority chief executives, about the special educational needs and disabilities (SEND) reforms. The letter draws their attention to joint commissioning by local commissioners in the interests of children and young people with SEND, as well as the local offer (where local authorities are required to consult with families and providers of services for those with SEN), and Education, Health and Care (EHC) plans.

The Department for Education has published an early years benchmarking tool, which provides data for all local authorities on funded early education. It allows for comparison between local authorities on early years funding, take up, quality and outcomes of early years education, alongside contextual data on the number of under 5s and the deprivation rank for each local authority.

Department for Education launches consultation on the future of changes to the distribution of special educational needs and disability funding

The Department for Education has launched a consultation the future distribution of SEND funding. Accompanying the consultation document is a paper containing a number of hypothetical profiles of children with SEND; and a pack of information about children and young people with SEND by local authority – including data on attainment, funding and health: the Department for Education are interested in any conclusions contributors may draw from this data.

The consultation is part of wider efforts to address the often uneven distribution of education funding across the country. The first element of this reform emerged in July, when Schools Minister David Laws MP announced changes to the distribution of funding for mainstream schools within local authorities’ dedicated schools grant for next year. The Department for Education intends that any changes made to the SEND funding system will support the reforms contained in the Children and Families Act 2014. Current thinking within the departments is to move towards a system where funding distribution is more formulaic and less based upon historical allocation. Ultimately, the government intends to implement a national funding formula covering all schools spending.

The Department for Education is particularly interested in any local knowledge that would inform the national debate, particularly with regards to national variations of assessment outcomes for children and young people with similar needs. Submissions containing such comparisons could use actual cases of children and young people with different types of SEND who have moved and been treated differently, or hypothetical examples which can be derived from the profile paper that accompanies the consultation document.

Public Administration Select Committee publishes report on relationship between the Government and public bodies

The House of Commons Public Administration Select Committee (PASC) has published a report on the relationship between Government and arm’s length bodies, which found that arm’s length Government was “confused and opaque”. It noted that organisational forms and names were inconsistent, with no agreement on how many bodies exist, and accountability arrangements erratic (with some being accountable to ministers and others to Parliament).

Arm’s length bodies are organisations that delivers a public service, but are not ministerial government departments, and which operate to a greater or lesser extent at a distance from ministers. Non-departmental public bodies (such as NICE), NHS bodies (such as NHS England) and inspectorates (such as Ofsted) fall under the definition of arm’s length bodies.

The report suggests that the Government conduct a review of arm’s length bodies and introduce a clearer taxonomy between constitutional bodies, independent public interest bodies, departmental sponsored bodies, and executive agencies. There are also concerns raised on the appointment of individuals to the boards, as well as on whether someone should be reappointed, with the Chair of Ofsted being the recent example of this. The report also stresses that Government reforms to enhance accountability have been limited and have focused mainly “on a transactional notion of accountability, without enough emphasis on the human factors that contribute to the success of arm’s length bodies”. The Cabinet office is called to develop better sponsorship skills for its staff and not resort to micromanagement. The Committee makes the following recommendations:

  • Simplification and better taxonomy: the report cites the blurred lines and complexity of the existing system, citing the example of the CQC and Ofsted who, while performing duties of a similar nature, are classified differently, adding that it is also unclear whether they are independent of ministerial influence or not. It is recommended that the Government adopt a taxonomy and include each body under one or other category, while the introduction of consistent naming conventions is also proposed. All bodies should be included in an online “Directory of Governance” together with budgets, board meeting minutes etc.
  • Reforms have taken place in an uncoordinated fashion: in cases where public bodies have been reformed, this has not taken place in coordination with civil service and health reforms while it is questionable whether the reforms have resulted in increased accountability. The report welcomes triennial reviews and calls for them to be applied to executive agencies, non-ministerial departments, public corporations, and NHS bodies but at the same time cautions against them becoming “Christmas trees” on which “more and more additional aims are hung, intended to right all wrongs”. The reviews should instead focus on the relationship between the public body and its sponsoring department.
  • Unclear relationships between sponsoring departments and public bodies: the PASC calls for a clear understanding of statuses, roles and relationships, pointing out that it was “unacceptable” that it took the Department of Health two years to update its “accountability system statement”, which meant that NHS England (currently the largest public body) had two years of unclear accountability relations. Central government and public bodies should also have good relations that extend beyond holding leaders to account into sharing good practice and encouraging, motivating, and rewarding the leadership of public bodies. Overall, departments should strive to build good relationships with the bodies they sponsor and include in their annual reports the effectiveness of their sponsorship of arm’s-length bodies.
    • Particularly for NHS England it is recommended that: “The oversight and accountability arrangements for NHS England should be kept under review by select committees, the National Audit Office, and others.”
  • Appointments are not sufficiently transparent, representative, or accountable: the report highlights that “encouraging good people to apply is a challenge” and calls on the Cabinet Office to publish a list of unregulated public appointments and set out the rationale by which some appointments are regulated and some are not. It is also suggested that the Government review its decision to end the presumption of non-reappointment, while effort must be made to ensure greater diversity among appointees. The Cabinet Office should also bring together the Centre for Public Appointments and the Public Bodies Team to ensure a more coherent policy in this area.
  • Bodies accountable to Parliament: Parliament should provide clear information on what public bodies it is responsible for and the Chairs of non-ministerial departments should be the ones answering the Parliamentary Questions put to them on behalf of the Chair of the relevant select committee.
  • Increase transparency: the report stresses that accountability documents “should be free from jargon and set out in simple and graphic form”, while updated statements of accountability arrangements should be included in the annual reports of public bodies. Holding meetings open to the public should also be encouraged.

NHS England publishes document on the future of primary care co-commissioning

NHS England has published its Next steps towards primary care co-commissioning document, which outlines how co-commissioning will work, including the announcement that a national framework for conflicts of interest will be published as statutory guidance in December 2014. The document stresses that co-commissioning will be crucial in shifting investment from acute to primary and community services, while delivering efficiencies through allowing for a better alignment between primary and secondary care commissioning.

The document lays out three co-commissioning models that CCGs can adopt, which can range from greater involvement in primary care decision-making to joint commissioning arrangements and delegated commissioning arrangements. CCGs will be given the power to design local incentive schemes, which can function as alternatives to the Quality and Outcomes Framework, although NHS England will still set national rules and collect data to monitor performance.

  • Greater involvement: this model would mean that CCGs could participate in discussions about all areas of primary care. No new governance will be put in place to accommodate this, with the model relying on good relations between CCGs and their local area team.
  • Joint commissioning (for 2015-2016 this will only extend to general practice services): CCGs could either form a joint committee or “committees in common” with their area team. It is also expected that a member of the local Healthwatch and a member of the local Health and Wellbeing Board (HWB) will be attending committee meeting in a non-voting capacity to mitigate conflicts of interest, while CCGs and area teams can consider pooling their budgets, if they so wish.
  • Delegated commissioning: CCGs to assume control of a number of primary care functions through establishing a primary care commissioning committee to oversee the exercise of the delegated functions. To address potential conflicts of interest, a local HealthWatch representative and a local authority representative from the local HWB will have the right to join the delegated committee as non-voting attendees.

The document also states that co-commissioning arrangements will be subject to a revised assurance process that would form part of the existing one for CCGs. This revised process will be co-developed with CCGs to ensure continuous evaluation of the implementation of co-commissioning arrangements.

Finally, the document reiterates that Integrated Personal Commissioning (IPC or personal budgets) will be extended as of April 2015, while CCGs will be have the opportunity to co-commission some specialised services through a joint committee from 2015-2016.

CCGs are invited to review their intentions and indicate their preferred co-commissioning arrangement in January 2015. For the joint commissioning model the deadline is 30th January, while for the delegated model the deadline is 9th January. There is no deadline for the greater involvement model. Arrangements are expected to be implemented from 1st April 2015, although the delegated commissioning arrangements can be implemented in 2015-2016.

NICE launches consultation on draft quality standard for urinary tract infections in adults aged 16 and over

The National Institute for Health and Care Excellence (NICE) has launched a consultation on a draft quality standard for urinary tract infections in adults. NICE quality standards are designed to drive measurable quality improvements within a particular area of health or care where a need has been identified.

This particular quality standard covers the management of suspected community-acquired bacterial urinary tract infections in adults aged 16 and over. It covers both adult women and men, including people with indwelling catheters and people with other medical conditions such as diabetes. However, it does not address medicine to prevent urinary tract infection after urinary tract examination or surgery or the treatment of recurrent urinary tract infection.

In stating why the quality standard is needed, NICE said 10-20% of all women experienced a symptomatic urinary tract infection at some time, with the incidence rate highest in young women. In spite of this, it noted that urinary tract infection incidence increases with age for both services, with an estimated 10% of men and 20% of women over the age of 65 years having asymptomatic bacteriuria. It notes that for adult men most infections are complicated and are related to abnormalities of the urinary tract.

It also states that in people with an indwelling urethral catheter, antibiotics do not generally eradicate asymptomatic bacteriuria.

The quality standard is intended to both reduce emergency admissions for acute conditions that should not usually require hospital admission and improve health-related quality of life. There are six draft quality statements, which state that:

  1. Adults aged 65 years and over have a full clinical assessment before being diagnosed with a urinary tract infection.
  2. Adults with catheters are not diagnosed with a urinary tract infection by dipstick testing.
  3. Adults with a urinary tract infection not responding to initial antibiotic treatment have a urine culture.
  4. Non-pregnant women and adults with catheters who have asymptomatic bacteriuria are not offered antibiotics.
  5. Adults with catheters are not offered antibiotic prophylaxis to prevent symptomatic urinary tract infections.
  6. Men who have upper urinary tract infection are referred for urological investigation.

There is also a seventh quality statement which currently acts as a placeholder, pending the outcome of the consultation. This placeholder will focus on recurrent urinary tract infections, which is an area that has been prioritised by the Quality Standards Advisory Committee.

The consultation subsequently asks for views on seven questions.

On the quality standard in general:

  1. Does this draft quality standard accurately reflect the key areas for quality improvement?
  2. If the systems and structures were available, do you think it would be possible to collect the data for the proposed quality measures?
  3. For each quality statement what do you think could be done to support improvement and help overcome barriers?

About the individual quality statements:

  1. For draft quality statement 1: Is there any evidence that this is not already being carried out in general practice?
  2. For draft quality statement 2: Is there evidence to suggest dipstick testing is commonly used to diagnose urinary tract infections in adults with catheters?
  3. For draft quality statement 6: Is there any evidence that men with upper urinary tract infections are not being referred for urological investigations?
  4. For draft placeholder statement 7: Do you know of any evidence-based guidance that could be used to develop this placeholder statement? If so, please provide details. If not, would new evidence-based guidance relating to recurrent urinary tract infections have the potential to improve practice? If so, please provide details.

Weekly political news round up – 7th November 2014

November 7, 2014 in News by Whitehouse

Around the sector

The Health Select Committee has announced that it will be holding an oral evidence session on the Care Quality Commission as part of its accountability hearing for 2014. Although there is no formal call for evidence, the Committee announced that it would be pleased to receive written submissions on the work of the CQC in advance of the hearing. The deadline for submissions is Friday 21st November 2014.

Education Secretary Nicky Morgan has announced that 4Children Chief Executive Anne Longfield is the Department for Education’s preferred candidate to be appointed as Children’s Commissioner for England, replacing Maggie Atkinson, whose term of office comes to an end on 28th February 2015. Longfield’s nomination will be subject to a hearing by the Education Select Committee on 11th November. Suggestions on the priorities for the next Children’s Commissioner should be submitted using the Twitter hashtag #OCCintray.

The Royal College of Nursing has announced that it has elected Cecilia Anim as President and Rod Thomson as Deputy President. Both will take up office on 1st January 2015 and will serve for two years. Anim is a sexual health nurse and Thomson is Director of Public Health for Shropshire.

Labour leader Ed Miliband has announced a reshuffle of his Shadow Cabinet, with Alison McGovern, a former Shadow International Development Minister replacing Lucy Powell as Shadow Childcare Minister.

The UK Government has submitted their fifth periodic review report to the United Nations (UN), which looked at how successful the UK has been at implementing the UN Convention on the Rights of the Child (CRC). A fact sheet on the CRC can be found here.

Answers to written questions on paediatric continence and recording outpatient procedures

Liberal Democrat Paul Burstow has received answers to four written questions on paediatric continence and outpatient procedures to the Health Secretary:

  • The first asked 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.

Health Minister Dan Poulter responded that paediatric continence had not been submitted for consideration as a new treatment function. He stated that guidelines for the proposal and acceptance of new Treatment Functions could be found here, adding that proposals for new Treatment Functions can be sent to the Health and Social Care Information Centre enquiries email address.

  • The second asked when the Health and Social Care Information Centre next plans to review the list of treatment function codes for outpatient procedures.

Poulter responded that in order for codes relating to new treatment functions to flow to the Secondary Uses Service, the national repository for secondary care data, a revision to Commissioning Data Sets was required. He said that the last revision was in September 2012 and there were no plans for a subsequent version in the near future.

  • The third asked 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.

Poulter responded that in 2012-13, Hospital Episode Statistics for England recorded 13,037 admissions with a primary diagnosis of constipation, for patients aged 18 years or under. He said that admissions do not represent the number of patients, as one person may have more than one admission with the period. He noted that NHS England did not collect information centrally on the cost of treating these admissions.

  • The fourth asked what assessment he has made of the potential financial effect of NHS healthcare trusts failing to properly record data on outpatient procedures.

Poulter responded that information was not collected centrally, and therefore no assessment has been made. He noted that the Audit Commission published a report in April 2012, By definition – Improving data definitions and their use by the NHS. The report identified that the decision as to whether activity should be recorded (and paid) as an inpatient or outpatient is down to local discretion, yet its impact on finances can be “considerable”.

NHS England publishes paper outlining proposed changes to the co-commissioning of primary care

NHS England has published a paper ahead of NHS England’s board meeting which outlines proposed developments in changes to the co-commissioning of primary care.

The paper, which was written by Ian Dodge, National Director for Commissioning Strategy, states that there had been a great deal of interest from CCGs to a call by NHS England for CCGs to take on an increased role in the commissioning of primary care services. In particular, the paper stated that primary care co-commissioning would help create a joined up, clinically-led commissioning system which delivers integrated out-of-hospital services based on the needs of local populations.

In terms of future commissioning arrangements, it said that CCGs could pursue three possible models: greater involvement in primary care decision-making; joint commissioning arrangements; and delegated commissioning arrangements. It added that these options were supported by the “great majority” of CCGs consulted at the NHS Assembly Annual event in October 2014, and that NHS England should develop these three models further.