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Whilst the surveillance review recognised both of these points, the review document itself provides a link to the outdated 2010 version of the commissioning guide rather than the 2014 version.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.