Weekly political news round up – 19th December 2014

December 22, 2014 in News by Whitehouse

Around the sector

Health Service Journal has reported that NHS England has approved plans to use £1.1 billion of the extra £2 billion worth of additional funding for 2015-16 to bring underfunded clinical commissioning groups closer to their “fair share” of allocations. The commissioning budgets had previously been set in December last year, but were revised following the announcement by Chancellor George Osborne in the autumn statement of £2 billion of additional funding for the frontline NHS in England in 2015-16.

Health Service Journal has reported that six of the seven CCGs in Sussex have written to NHS England criticising the “apparent confusion and lack of clarity” in its proposals for primary care co-commissioning. Commenting on commissioning proposals announced last month, the letter noted that the “financial and legal facets of the proposed new commissioning models must be clearly described by the current commissioner, before any transfer of responsibility can occur”. The signatories said that they were concerned about the impact that co-commission could have on service delivery.

The Department for Education has published two easy-read guides regarding changes to the SEND system: one for children and young people and one for parents. Both guides were jointly developed by the Department for Education and Mencap, with help from parents and young people with learning disabilities.

Welsh Health and Social Care Committee publishes report: Access to medical technologies in Wales

The Welsh Health and Social Care Committee has published its final report on its inquiry into access to medical technologies in Wales, following a consultation period ran between July 2013 and October 2013 and oral evidence sessions held throughout 2014. The Committee found that, in general, the NHS in Wales lacked a strategic coordinated approach to technology evaluation and adoption. The key recommendation was the establishment of an all-Wales body to appraise and prioritise new technologies.

The Committee’s report also recognised that the NHS in Wales needed better engagement with industry and that better training for NHS staff to ensure that they understand new medical technologies. It said that the procurement of medical devices based on short-term financial decisions had a detrimental effect on the introduction of new treatments and techniques.

Below are a list of relevant recommendations made by the Committee to the Health Minister, asking him to:

  • Identify a more strategic approach to medical technology adoption. This should be driven by clinical and population need, and provide equity of access to appropriate new treatments.
  • Ensure that a strategic approach to medical technology development and adoption encompasses primary and community care voices.
  • Ensure that NICE guidance on medical technologies is disseminated within NHS Wales in a timely way and fully taken into account when planning and delivering services.
  • Ensure that the uptake of recommended medical technologies across Wales, including those recommended by NICE, is measured as part of a formal audit process.
  • Give consideration to adding mechanisms to maximise the benefits of new medical technology for patients across Wales by ensuring that NHS staff can access appropriate training.
  • Set out the actions he will take to ensure that NHS Wales’ financial structures and budgetary processes can effectively support appropriate medical technology adoption. This should include reference to longer-term planning and ensuring closer alignment between capital and revenue funding.

The Welsh Government must also issue a response to the Committee’s report, which we will monitor for.

Weekly political news round up – 12th December 2014

December 12, 2014 in News by Whitehouse

Around the sector

The Department of Health has published a series of service specifications as part of the NHS public health functions agreement, which sets out the arrangements under which the Health Secretary delegates responsibility to NHS England for certain public health services. These aim to improve public health outcomes and reduce health inequalities, and contribute to a more sustainable public health and care system. Included is a service specification on the commissioning of children’s public health services from pregnancy to age five. This outlines the services that NHS England will commission for children under five, including the Healthy Child Programme and health promotion and prevention interventions, and notes which improvements should be made and how services should be delivered.

The Department of Health has published a document outlining the proposed funding allocations for local authorities for the commissioning of children’s zero to five public health services from 1st October 2015 to 31st March 2016. It asks local authorities to consider their proposed allocation and if there are any issues to be raised.

Ofsted has published its annual report for 2013/14, which is based on the findings of more than 7,000 inspections of schools, colleges and further education institutions and skills providers during 2013/14. The report on schools found that although most schools monitor closely the progress of disabled pupils and those with SEN in their academic subjects, less attention is paid to the progress they make in developing personal and social skills and in becoming more independent.

The Care Quality Commission (CQC) has published a report outlining how complaints and concerns fit into the CQC’s new regulatory model. It also presents early findings on the state of complaints handling in hospitals, mental health services, community health services, GP practices, out-of-hours services and adult social care services. It found that there was “far too much poor practice” in NHS providers’ responsiveness and treatment of people who make complaints, but that more data was needed to provide a truer picture of the state of complaints.

Health Education England has announced that Professor Martin Roland will chair its Primary Care Workforce Commission. The Commission was set up at the request of the Health Secretary due to the future health and care system requiring greater emphasis on community, primary and integrated services, and to ensure the primary care workforce is ready to meet changing healthcare needs. It will focus on patient and population need; emerging models of care to respond to the population need; maximising new skill sets; education and training.

Department of Health publishes response to NHS Outcomes Framework Review

The Department of Health has published the updated version of the NHS Outcomes Framework for 2015-2016. A draft version of the updated NHS Outcomes Framework consulted on between August and September 2014, to which the PCF submitted a response outlining the need for an indicator on childhood continence. Following the consultation, several minor changes were made to update the existing set of indicators, but there was no inclusion of an additional indicator for childhood continence.

The NHS Outcomes Framework itself is a set of 64 indicators which measure performance in the health and care system; it presents a national-level narrative on how the NHS in England is working. It is not intended to be an exhaustive list of health indicators, but rather a set of outcomes that together form an overarching picture of the current state of health and care services in England.

Alongside the updated framework, the Department of Health also published a summary of responses that it received to each question, and their subsequent response to stakeholder comments.

The PCF’s response focused on question 11, which asked whether we agreed with the long term direction that the Department of Health is taking regarding indicators for children and young people in the Outcomes Framework. Specifically, it noted that the prevelance and impact – both personal and financial – of continence problems in children and young people meant that inclusion was warranted.

The Department of Health noted that responding stakeholders believed that there were too few new measures relating to children, other than an indicator on tooth extraction. It also highlighted that stakeholders wanted to see greater progress to develop measures for children and young people.

Responding to stakeholders views, the Department of Health noted that further development of indicators is dependent on identifying or creating reliable data sources. They added that it was “very much” the Department’s intention to fill the gaps for children in the NHS Outcomes Framework, and that the Department was keen to liaise closely with the Children and Young People’s Health Outcomes Forum and other stakeholders in order to keep abreast of progress on developing new indicators.

The Department’s response noted that poor and inadequate data sources are a barrier to creating reliable indicators. In order for the PCF to push to include paediatric continence as an indicator in the future, it will first be necessary to ensure that better data collection is established for issues such as constipation and enuresis.

Government publishes Mandate to NHS England for 2015-16

The Government has published its Mandate to NHS England for 2015-16, which sets out the direction and ambitions for the NHS over the next year and beyond, as well as the funding available to the kind of care that people need and expect. It provided confirmation of NHS England’s revenue budget, confirming the Government’s announcement in the Autumn Statement of additional funding.

The Mandate for 2015 to 2016 carries forward all existing objectives from the previous mandate (2014 to 2015), but with two key updates to existing objectives. The Government now expects NHS England to progress with providing joined up health and social care services through the Better Care Fund, and to introduce access and waiting time standards for mental health services by 2016.

It also states that by March 2016, the Government expects NHS England to ensure that people live well for longer, those with long term conditions have an enhanced quality of life, and people experience better and safer care. It also seeks to ensure that the NHS is free to innovate and makes better use of its resources. Below is a summary of the relevant areas:

Enhancing the quality of life of those with long term conditions

The Mandate states that NHS England must become “dramatically better” at involving patients and their carers, and employing them to manage and make decisions about their own care and treatment. It states that achieving this objective would mean that:

  • far more people should have developed the knowledge, skills and confidence to manage their own health, so they can live their lives to the full;
  • everyone with long-term conditions, including people with mental health problems, should be offered a personalised care plan that reflects their preferences and agreed decisions;
  • and patients who could benefit from it should have the option to hold their own personal health budget as a way to have even more control over their care.

Freeing the NHS to innovate

The Mandate also notes that NHS England must consider how to best balance different ways of enabling local and national delivery, including:

  • leading the continued drive for efficiency savings, while maintaining quality, through the Quality Innovation Productivity and Prevention (QIPP) programme;
  • spreading better commissioning practice, including redesigning services, open procurement and contracting for outcomes, to ensure consistently high standards across all areas of commissioning;
  • the power of its expertise and its professional leadership, working with partners such as the Royal Colleges;
  • its ability to bring NHS organisations together across larger geographical areas, not as the manager of the system, but as its convener;
  • its ability to work in partnership with local authorities and commissioners, particularly through health and wellbeing boards;
  • its duties and capabilities for engaging and mobilising patients, professionals and communities in shaping local health services;
  • and the transformative effect of information and transparency, enabling patients to make fully informed decisions, and encouraging competition between peers for better quality.

There are very few specific ambitions related to children, with the majority of the messaging focusing on the need to help give children the best start in life. It adds that the Government is committed to recruiting an additional 4,200 health visitors by 2015, and that it will work with NHS England and Healthwatch England to consider how best to ensure that the views of children, especially those with specific healthcare needs, are listened to.

The Government also published an updated version of the mandate to NHS England for 2014-15, which includes a non-recurrent increase to the revenue budget for NHS England for 2014-15, and a minor reallocation of resource from capital to revenue.

Department of Health publishes the Dalton review: examining new options and opportunities for providers of NHS care

The Department of Health has published the report of the Dalton review, an independent review led by Sir David Dalton, which investigated ways to secure the clinical and financial sustainability of providers of NHS care through offering new options for organisational forms. It found that although there have been successes in the NHS over the last decade, not all NHS providers have improved at the same rate, resulting in an “unacceptable extent of variation in quality of care across the country”. It notes that all patients should expect and receive reliable standards of care, no matter where they live.

The Review recognised that there should be no national blueprint or approach for providers. Building on NHS England’s Five Year Forward View, it notes five key themes that should be considered, as well as a number of recommendations for taking these themes forward. The themes are:

  1. One size does not fit all – organisational forms should develop to deliver the models of care which best suit local circumstances.
  2. Quicker transformational and transactional change is required – transformational change must be simple, quick and driven by a number of organisations (NHS England, CCGs, Department of Health, etc.) working together
  • Ambitious organisations with a proven track record should be encouraged to expand their reach and have greater impact – leaders of successful organisations should become ‘system architects’.
  1. Overall sustainability for the provider sector is a priority – long-term solutions must be provided for the 93 NHS Trusts which will not reach the required standards to become Foundation Trusts.
  2. A dedicated implementation programme is needed to make change happen – NHS leaders should develop awareness and knowledge of the available models and implementation approaches through shared learning, and there should be a programme of demonstrator sites that can stimulate and accelerate change.

Weekly political news round up – 5th December 2014

December 5, 2014 in News by Whitehouse

Around the sector

NHS England has announced the appointment of nine regional Directors of Commissioning Operations across England. The announcement follows plans unveiled in October 2014 to streamline and align the functions and structures which allow NHS England to work more effectively – both nationally and regionally – to minimise duplication and make more effective use of resources.

Health Service Journal has reported that Health Secretary Jeremy Hunt has called for a significant increase in community and primary care nursing posts as part of a drive to boost services outside of hospitals. Hunt told the Chief Nursing Officer for England’s summit last week that “what we want to see over the next five years is better out of hospital care”, adding that “we need to look at the nursing manpower outside hospitals as well and it’s going to be a very important part of the transformation”.

Building on this, GP Online has reported that three quarters of CCG chief financial officers (CFOs) plan to invest in community health services in order to tackle rising NHS cost pressures. The poll by the Healthcare Financial Management Association found that 39% of CFOs thought their organisation’s year-end financial position would be worse than last year’s. Across all NHS bodies, the survey found that 94% of CFOs expected the quality of NHS services to hold up next year despite the financial pressures.

Children and Young People Now has reported that three local authorities have been awarded £7.6m of government funding to delivery early intervention projects for young children and their families. Croydon Council has been awarded £1.5m from the Department for Communities and Local Government’s £90m Transform Challenge Award to take forward its Best Start initiative, which will bring together health and early intervention services, including health visitors and family support, into a single multi-agency programme designed to support families with children under five.

Answers to written questions on continence care

Labour MP Rosie Cooper has received an answer to two written questions to the Health Secretary on continence care.

  • The first asked what estimate his Department has made of the proportion of pressure ulcers that are caused by poor continence care.

Care and Support Minister Norman Lamb responded that NHS England has not made an assessment of the proportion of pressure ulcers that are caused by poor continence care. He added that maintaining skin integrity and maintaining continence are both aspects of fundamental care.

Lamb said that the NHS Safety Thermometer, which is a measurement tool to support patient safety improvement, records the presence or absence of both pressure ulcers and urinary tract infections in patients with a catheter. He noted that these two harms were selected as focus by the Department’s Quality, Innovation, Productivity and Prevention (QIPP) programme as they are common, and because there is a clinical consensus that they are preventable through appropriate patient care.

  • The second asked 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.

Health Minister Dan Poulter responded that the Code was being redeveloped, with the Nursing and Midwifery Council advising that it would be published in early 2015.

He added that the Code had little to do with specific tasks or clinical procedures, noting that it was not about the detail in a nurse’s or midwife’s clinical expertise, but about conduct, behaviour, ethics and professionalism. Finally, he said there have been a number of high profile reports in the healthcare sector which have all impacted on the nursing and midwifery professions and the revising of the Code.

Cooper is a member of the Continence Care APPG and has a long-standing interest in these issues.

Healthcare regulator Monitor launches consultation on proposals to reform the costing of NHS services

Monitor, the regulator for health services in England, has launched a consultation on proposals to reform the costing of NHS services for 2015-2021. Monitor has identified that costing processes vary considerably between care providers, with classifications of human and physical resources and activities, costing allocations and the datasets used for cost and quality management not consistent. They also identified that not all providers’ costing systems can provide detailed information about costs at the level of individual patient care.

Monitor is proposing the following changes to NHS costing over the next seven years, which would be phased in gradually, with acute and ambulance services first, followed by mental health services, then community health services:

Trusts and licensed independent providers of acute, ambulance, mental health and community services adopt an improved, transparent and intuitive costing method, based on agreed standard definitions and rules. This method should provide consistent and accurate cost information about individual patients across the NHS, leading to better cost management and price and payment regulation.

  • A single national cost collection replaces the three existing cost collections. This improvement would be made possible by all care providers adopting the proposed costing method, since it would accurately capture their costs of education and training, research and development and commercial activities, as well as patient care.
  • The regulator argues that the changes could enable “big improvements” in quality and efficiency: providers would be able to see better where they can save money with no impact on patients, and reinvest savings to improve quality; wider benchmarking of detailed costs would give lower performing providers a clear idea of where and how to take action to catch up with the leaders; taking action would reduce variations in NHS care quality and improve standards of care overall.

Monitor have noted that they are particularly keen to hear feedback on:

  • whether providers would like us to develop a central accreditation system for assuring the capability of local PLICS systems
  • what respondents think of the order proposed for service areas over the three four-year phases of the overall implementation programme, i.e. first acute and ambulance services, then mental health and community services
  • what respondents think of the proposed pace of implementation for each service area.
  • what respondents think of the proposal that independent providers should be subject to the same requirements, and follow the same timelines for implementation, as NHS trusts and foundation trusts.

Health Secretary Jeremy Hunt gives statement to the House of Commons on the implementation of the NHS Five Year Forward View

Health Secretary Jeremy Hunt has given a statement to the House of Commons in which he outlined the Government’s plan for the implementation of the NHS Five Year Forward View (FYFV).

In his speech, Hunt said that the Government’s plan was based on four pillars: a stable and growing economy; models of care for an ageing population; embracing innovation and eliminating waste; and compassionate care.

Discussing how the FYFV would be funded, Hunt rejected Labour’s plans of a mansion tax and tobacco levies, noting that the NHS should be funded through consistent prudent economic policy. He said a only a strong, stable economy could pay for the growing costs of the NHS and social care system, re-iterating Chancellor George Osborne’s announcement of an extra £1.7 billion worth of funding for the NHS.

Hunt noted that in order to develop and implement models of care more suited for an ageing population, focus had to be placed on prevention as much as cure,  helping people to stay healthy without allowing illnesses to deteriorate to the point where they need expensive hospital treatment. Hunt used the opportunity to reject further top-down reorganisation of the NHS, specifically making CCGs part of local government, as suggested by both the Liberal Democrats and Labour, noting that he understood that there was opposition to further strucutral changes to the NHS. Hunt said that the Government would be launching a £1 billion investment fund in primary and community care facilities over the next four years. He also said that from the £1.7 billion revenue funding announced, £200 million would be made available to pilot the new models of care set out in the FYFV.

Hunt said that the NHS had been too slow to adopt and spread innovation, due in part to those buying health care not having the information to see how much smart purchasing can contain costs. He said that from next year CCGs will be asked to collect improved financial information, including per-patient costings.

Hunt noted that the precise level of savings for areas such as producrement, agency staff, the collection of fees from international visitors and reducing litigation will be achieved through consultation with NHS partner orgasniations over the next sixth months.

He also announced that in order to encourage innovation, the Government would, in collaboration with NHS England, give local authorities and CCGs indicative, multi-year budgets as soon as possible after the next spending review. He said he expectected NHS England and Monitor to follow this by modernising the tariff to set multi-year prices and make the development of year-of-care funding packages easier.

For the final pillar, the improvement of training and safety for new doctors and nurses, Hunt announced that the Department would be launching a national campaign to reduce sepsis ,and also responding to the recommendations made in the follow-up Francis report.

Department of Health launches consultations on role and performance of arm’s length bodies

The Department of Health has launched a consultation on the role and performance of both the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare Regulations Authority (MHRA), as part of its triennial review of its arm’s length bodies.

These reviews are intended to gauge how the department’s arm’s length bodies are performing, whether they are providing good value, whether they should continue in their current form, and the effectiveness of these organisations in interacting with stakeholders.

Specific questions of interest for the MHRA’s review include:

  • How well does the Agency respond to relevant public health issues, e.g. safety issues with products, product defects, or new priority concerns?
  • How well does the Agency support innovation and what more could be done?

The department will also be holding workshops in London, where stakeholders can share their views in person.

The dates for the NICE workshops are:

  • 8th December – 14.30-16.30
  • 18th December – 11.00-13.00

The dates for the MHRA workshops are:

  • 11th December – 10.00-12.00
  • 5th January – 10.00-12.00
  • 7th January 10.00-12.00

British Journal of General Practice publishes research criticising lack of quality outcome indicators for paediatrics

GP Online has reported on research published in the British Journal of General Practice (£) which found that the lack of paediatric indicators in the NHS’s Quality and Outcomes of Framework (QOF) could slow down improvements in primary care for children.

Researchers found that 10.9% of GP consultations are with children, but that only 1.2% of QOF indicators relate specifically to children. They argued that introducing valid new quality indicators for treatment of children in primary care is “feasible but difficult”. The researchers subsequently drew up 69 potential new indicators based on professionals concerns and existing national guidelines, but only 35 were deemed valid and feasible to introduce by a clinical expert group, of which seven were deemed to be based on clinical data.

Dr Richard Vautrey, deputy chairman of the British Medical Association (BMA) General Practice Committee, said that “this research has shown how difficult it is to produce good quality indicators and the ones produced have a weak evidence base”. He added that “we need to move away from a narrow focus on QOF as being the only way to recognise quality of care as there are many other ways commissioners could support and fund practice quality development, including through local enhanced services”.

Autumn Statement 2014

The Chancellor of the Exchequer George Osborne made his last Autumn Statement of this Parliament to the House of Commons on Wednesday. Setting out the grounds on which the General Election will be fought, the Chancellor provided an update on the Government’s plans for the economy based on the latest forecasts from the Office for Budget Responsibility (OBR), also published on Wednesday.

The OBR figures revised up the Government’s deficit forecasts for this year and next, with the deficit expected to reach nearly £91.3 billion this year and £75.9 billion next year, which the Chancellor said would lead to a £23 billion surplus in 2019/20.

The UK economy is predicted to grow by 3% this year – an increase from the 2.4% predicted a year ago and the 2.7% forecast in the Budget. The growth forecast is then downgraded for the next three years.

The Chancellor explained that while the UK economy is currently performing against a “difficult global backdrop”, the Government’s “long term economic plan” was working. He revealed that the forecast for the British economy being presented demonstrates the UK to be the “fastest growing of any major advanced economy in the world”. Osborne disclosed that the UK deficit remains “too high”, stating plans to “tighten the public finances a little” in order to lessen the country’s debts.

The key measure announced in the Chancellor’s statement was the reform of stamp duty for residential properties. The statement also focused on the regeneration of northern England with the promise of new money for infrastructure, transport and science in the region.

Although the Autumn Statement contained no announcements which would directly affect the provision of milk to children, there were announcements which would impact on the provision of childcare in the UK. Announced were plans to double the Childcare Business Grant to £2 million in order to cover 2015-16, which will help to support the creation of childcare places, as well as further provisions to increase childcare support for families claiming Universal Credit.

For health, the  Autumn Statement included a formal announcement of £2 billion in additional funding for the frontline NHS in England in 2015-16, as part of a multi-year £3.1 billion UK-wide investment in the future of the NHS.

Of the £2 billion, £1.5 billion will be spent on frontline patient care, with funding going to improve local NHS services. Meanwhile £200 million will be spent on a transformation fund in 2015-16 to deliver the first year of the ‘Five Year Forward View’ – NHS England’s vision for the next five years. It was stated that this fund will kick-start the work needed to develop new ways of caring for patients to improve the integration of GPs community services and hospitals.

The funding announcements come in the context of Health Secretary Jeremy Hunt’s statement to the House of Commons on Monday, in which he emphasised that funding was required in order for the NHS to be better equipped to handle the rising healthcare costs associated with an ageing population.