Weekly political news round up – 30th January 2015

January 30, 2015 in News by Whitehouse

Around the sector

Health Service Journal has reported that commissioners have voiced concern that their efforts to integrate services will be hampered by “enforced” competition, after Monitor released a report, summarised in last week’s monitoring, warning them against rolling over existing community services contracts. Steve Kell, co-chair of NHS Clinical Commissioners, commented that “we know from our members that CCGs are not automatically rolling over community services contracts, but are actively improving local services by finding and developing local solutions”. He added that the report from Monitor “highlights the significant gap between their rhetoric and reality”.

The Nuffield Trust and the King’s Fund have published a joint report examining how CCGs are functioning as membership organisations, which found that almost half (47%) of CCG leaders surveyed as part of the research felt that they did not have the time necessary to fulfil their existing role in the CCG. Holly Holder, fellow in health policy at the Nuffield Trust, said that “our fieldwork and survey revealed this is waning and there are some worrying signs emerging over strained resources – both time and money”.

Children and Young People Now has reported that leading early years professionals have signed a petition calling for the Department for Education to abandon plans to introduce baseline academic assessments for children who enter reception classes at primary school. The petition follows concerns raised by the sector that baseline assessments could lead to early years settings focusing on academic development rather than general development.

The Guardian has reported on a poll by the Key, an independent organisation that provides advice and support to school leaders and governors, which found that more than a third of heads felt their schools were not fit for purpose, with six in 10 having a desire to improve or repair their buildings. Of the 1,104 school leaders who responded to the survey, 40% said that they wanted to add/improve pupil facilities, such as toilets.

The Welsh Government has announced that Professor Sally Holland has been appointed as the new Children’s Commissioner for Wales. Professor Holland is currently a Professor at the School of Social Sciences at Cardiff University, and is the Director and founder of CASCADE Children’s Social Care Research Centre. She has received international critical acclaim for enabling children and young people to represent their own views through active participation in her research.

Public Health England (PHE) has published a framework designed to help enable local areas deliver their public health role for children and young people (aged 10-24). The framework calls for a reduction in health inequalities, in particular through offering support for all young people and their families using mainstream services, such as the promotion of pathways for onward referral into targeted and specialist provision as appropriate. It subsequently asks councillors and health and wellbeing boards whether their respective bodies are doing enough to ensure the issues identified in the framework are being adequately dealt with.

NHS England Director for Patients with Long Term Conditions discusses continence

Dr Martin McShane, NHS England’s Director for Patients with Long Term Conditions, has written a blog post on the NHS website in which he outlines the need to improve the profile of continence care.

McShane said that he would be working with colleagues from the Nursing Directorate to support work and raise the profile of continence care. He added that those within the directorate have launched a programme of work, Excellence in Continence Care, to support commissioners to recognise the value that better continence care brings, both to the system and to the individual

In his blog post, he notes that there are over 14 million people who have bladder problems and 6.5 million with bowel control problems, noting that the magnitude of the number and the scope for improvement. He also outlines the benefits that improving continence services can bring, including a reduction in admissions to care settings, fewer emergency admissions to secondary care with urinary tract infections, a reduction in prolonged use of costly incontinence products through low cost interventions, and a better quality of life for patients.

Labour publishes 10 year plan for health and social care

The Labour Party has published their 10 year plan for health and social care, which seeks to address the current challenges facing the NHS by prioritising the restoration of the heal service’s core values, investing in staff so that they have time to care for patients, integrating care, giving patients new rights to access care, addressing mental health, and preventing ill health.

There was no explicit mention of continence, or child health care services (with the exception of mental health), with most of the relevant policy announcements being made in an accompanying speech and question and answer session with Shadow Health Secretary Andy Burnham.

In his speech, Burnham spoke in favour of “a national system” which “allows us to set out in a fair way what people are entitled to and thereby to control those costs.” He said that “people don’t want postcode lotteries in health care” or “an NHS that sits in judgment on people’s lifestyle, with arbitrary restrictions on operations, or saying that people with two cataracts can only have clear sight in one eye.” He went on to call for the role of NICE to be strengthened, saying “if a service or medication is judged clinically necessary, effective and affordable, everyone should get it”.

He added that Labour would set up a wide-ranging review of NICE which will look at reforming the NICE technology appraisal process and setting tougher rules on implementing NICE guidance.

During a question and answer session, Burnham said that clinical commissioning groups did have a future in the NHS and were “here to stay”, reiterating an announcement in October 2014 that they would have their commissioning responsibilities split with health and wellbeing boards, noting that the commissioning system would “evolve and grow”.

Burnham also said that Labour would be extending the Freedom of Information act to cover any provider of NHS services.

Department of Health, Social Services and Public Safety publishes review of Northern Ireland’s health service

The Northern Irish Department of Health, Social Services and Public Safety (DHSSPS) has published the Donaldson Review, which examines the application of health and social care governance arrangements in Northern Ireland.

The review, which was led by Sir Liam Donaldson, the former chief medical officer of England, found that perceptions amongst politicians and the public that Northern Ireland had fundamental safety problems which are worse than the other parts of the UK were unfounded. However, it found that there were a number of longstanding, structural elements of the Northern Irish care system that fundamentally reduced its quality and safety, particularly with regards to the configuration of health facilities serving rural and semi-rural populations.

Ten recommendations were made in the report:

  1. Some local hospitals must be closed as they cannot adequately meet demand with sufficient quality.
  2. Commissioning should be redesigned to make it simpler and more capable of reshaping services for the future. A choice must be made to adopt a more sophisticated tariff system, or to change the funding flow model all together.
  3. The role of pharmacists and paramedics should be expanded in order to prevent an increasing number of people, often with multiple chronic conditions, accessing emergency services.
  4. A programme should be established to give people with long-term illnesses the skills to manage their own conditions. This should be properly organised with a small full-time coordinating staff.
  5. Health care services should be more strongly regulated, with a focus on inspections to increase patient safety, clinical effectiveness, patient experience, clinical governance arrangement, and leadership.
  6. Incident reporting must be improved, including the introduction of a duty of candour and a portal for patients to make incident reports.
  7. A Northern Ireland Institute for Patient Safety should be established to carry out analyses of reported incidents, ensuring front-line staff have skills in recognising sources of unsafe care and the improvement tools to reduce risks, and initiating a major programme to building safety resilience into the health and social care system.
  8. Metrics should be established in order to allow for the benchmarking of clinical performance.
  9. A small Technology Hub should be established to identify the best technological innovations that are enhancing the quality of safety and care around the world.
  10. Patient voice should be strengthened through giving organisations representing patients and clients with chronic diseases a more powerful and formal role within the commissioning process, with the precise mechanism to be determined by the DHSSPS.

Weekly political news round up – 23rd January 2015

January 23, 2015 in News by Whitehouse

Around the sector

NHS England has published three handbooks (service components), designed for commissioners and health care professionals, to provide practical support for good long-term conditions (LTC) management. The handbooks contain information to help identify cohorts of people with LTCs who are most vulnerable, as well as delivery personalised care and develop an effective multidisciplinary team.

Health Service Journal has reported on a study by market analyst LaingBuisson, which found that independent sector providers could be providing up to 50 per cent of community services by 2020, assuming that the emerging outsourcing culture in the NHS is not eliminated by political influence. The latest figures from 2012-13 show that 31 per cent of the £9.7bn NHS funding for community health services in England was paid to non-NHS providers.

BBC News has published an overview of each of the five main political parties’ plans for NHS spending in England.

Ofsted has announced that from April 2015, it will inspect early years initial teacher training providers, which provide training for those working with children up to five years of age. Early years settings are responsible for ensuring that children meet a number of development goals by the time they reach five, including ensuring that they are able to use the toilet independently.

Healthcare regulator Monitor publishes report on commissioning better community services for NHS patients

Healthcare regulator Monitor, an executive non-departmental body of the Department of Health, has published a report, intended mainly for commissioners , examining how clinical commissioning groups (CCGs) are commissioning community services as their contracts expire, also exploring why these findings mean that it is especially important for commissioners to engage effectively with patients. This report was based off a questionnaire sent by Monitor to all CCGs seeking information about their community services contracts and how they intend to improve services, which received responses from 147 CCGs.

The research found that almost two-thirds of responding CCGs reported that they are in the process of reviewing and redesigning some or all of their community services provided in their area, with some CCGs saying that they rolled over their contracts in 2014 to allow themselves more time to review service lines and clinical evidence, and engage with patients, providers, clinicians, local authorities and others to understand new ways of providing care that will work best for patients. Other commissioners said they are reviewing services to understand whether their current provider is offering quality care and value for money.

Improving community services

The research found that in order to improve the functioning of community services, commissioners were working with local health economies to:

  • identify patients with complex needs and co-ordinate their care through teams involving general practitioners (GPs) and  other clinicians drawn from different types of services
  • define the outcomes desired for patients and change incentives for providers so that they are more focused on achieving those outcomes
  • commission pathways of care or care for certain populations, such as older people, using contracting models that bring different providers together

It was also identified that commissioners believed their greatest challenge in improving community services is a lack of robust activity, cost and quality data. It notes that the recording of data for community services has been poor historically as a wide range of community services are paid for with  fixed-sum payments, which has resulted in providers being given little incentive to understand the costs of individual services. Furthermore, it was identified that commissioners found it difficult to know whether providers are delivering value money. In some cases, it was found that commissioners believed that a lack of robust activity and cost data has hampered efforts to determine costs for new pathways of care, or for particular populations.

The report subsequently warned that there is a risk that some commissioners will roll over their community services contracts indefinitely without exploring whether alternative models of care or providers would be better for patients.

Engagement for improving services

The findings of the report suggest that effective engagement with patients is critical to improving community services. It notes that because most community services are provided under contracts with an annual fixed-sum payment that does not vary based on activity or quality of services, providers may lack incentives to ensure they are delivering quality care for patients. It subsequently suggests that commissioners need to think creatively about how to engage with people who use community services, including better use of patient feedback.

This study reemphasises that the quality of community services can only be improved if there is better data on patient activity and the cost of procedures and treatment. It is also useful to see that commissioners recognise this as an obstacle for them to commission better services.

Scottish Government announces plans for stakeholder engagement programme to develop the NHS strategy for beyond 2020

Scottish Health Secretary Shona Robinson has announced that the Scottish Government will be launching a stakeholder engagement programme inviting politicians, as well as patients, families, clinicians and other groups to help develop a longer term 10 to 15 year plan for the NHS in Scotland, to succeed the existing Scottish Government’s 2020 Vision. She also announced that the Scottish Government will be producing a refreshed plan to reach the 2020 Vision.

Robinson commented that she wanted to “try and reach as much consensus around what we want our Health and Social care systems to look like over those longer time frames and the steps we need to take to get there”, which would include “planning what capacity is required where and what the workforce will need to look like to deliver these new services in a different way, so the role of the professional bodies and the Royal colleges will be key to informing that work”.

She said that the engagement will be on-going, but that she hoped that a broad agreement on the plan would be reached by autumn 2015.

The Health Foundation projects a shortfall of £65bn for the NHS by 2030/31

The Health Foundation, an independent health policy charity, has published research which has found that the NHS will face a funding shortfall of £65bn by 2030 unless the successive governments address the funding issue.

It is suggested that the budget for the NHS will need to rise by 2.6% a year above inflation between 2015-16 and 2030-31 in order to maintain standards and avoid rationing access to treatment. For the next parliamentary session, it was identified that £8bn was likely to be the minimum amount needed to maintain the quality and range of services.

The briefing called for rapid progress to be made on implementing the Five Year Forward View (FYFV), published by NHS England in October 2014, noting that there had been too great a focus on short-term cost savings such as pay restraint and reductions in the tariff payments to hospitals for the care they provide.

Weekly political news round up – 16th January 2015

January 16, 2015 in News by Whitehouse

Around the sector

Health Service Journal has reported that Dr Hilary Cass, the president of the Royal College of Paediatrics and Child Health (RCPCH), has warned that a failure by the NHS to reconfigure paediatric services and centralise paediatric inpatient units has left it with a model of care that is “wrong for children and that we can’t sustain”.  Cass also suggested that the NHS “fundamentally reimagine the workforce”, with more paediatricians working in the community rather than plugging the acute care gap. She noted that an increase in the number of children’s nurses would be in line with the NHS Five Year Forward View.

The Department of Health has published a factsheet outlining information about the development of an outcome measure of child development at age 2 – 2½. This outcome measure is intended to enable the Department of Health to monitor year to year changes in child development across England. Data for the outcome measure will be collected from April 2015.

Every Disabled Child Matters publishes manifesto for 2015 election

Every Disabled Child Matters has published their manifesto for the 2015 election, outlining what they would like to see the next Government do to help children and young people with disabilities.

The manifesto calls for a new cross-departmental strategy that sets out the Government’s vision for addressing the needs and concerns of disabled children, young people and their families. It recommends that the strategy should identify a ministerial lead in each department who will be responsible for reporting on the potential impact of that department’s policies on disabled children, young people and their families and how the department is progressing in implementing the cross-departmental strategy.

On health policy specifically, the manifesto recognises the poor experience of the healthcare system by disabled children and young people, and suggests that health service commissioners, Health and Wellbeing Boards and providers prioritise the integration of services between health, social care, education and other services.

Weekly political news round up – 9th January 2015

January 9, 2015 in News by Whitehouse

Around the sector

The Independent has reported that the Liberal Democrats have pledged to address the £8 billion funding gap facing the NHS “in full” by redirecting the gains of predicted economic growth into public services. Deputy Prime Minister Nick Clegg announced that the Liberal Democrats will provide the precise details of how the funding gap will be addressed in the near future.

Children’s charity 4children, which is the Department for Education’s strategic partner for early years and childcare, has called on a future government to ensure the provision of affordable childcare. The call comes following a survey by the charity which found that many parents paying for childcare were considering leaving work to care for their children themselves, cutting back on treats for their children, and cutting back on essentials to pay for childcare costs.

NHS England publishes Forward View into Action: Planning for 2015/16

NHS England, in collaboration with Public Heath England, Monitor, the NHS Trust Development Authority, the Care Quality Commission and Health Education England, has published the Forward View into Action: Planning for 2015/16, a new planning guidance for the whole NHS system. The guidance outlines the action which the NHS will be taking in relation to the recommendations made in the Five Year Forward View (FYFV).

Although continence is not explicitly mentioned, the recommendations in the guidance include investment in prevention of illness; financial investment in the transformation of primary care and local health economies.

The guidance also states that some of the key conditions for future transformation across local health economies are likely to include a strong primary and out-of-hospital care system, with well-developed planning about how to provide care for people with long term conditions in primary care settings and in their own homes, with a focus on prevention, promoting independence and support to stay well.

Regarding the management of long-term conditions, the guidance states that integrated personal commissioning (IPC) will provide an integrated ‘year of care’ budget that will be managed by people themselves, supported, where required, by councils, the NHS or a voluntary sector organisation.

Regarding the acceleration of useful innovation, the guidance states that NHS England and NICE will develop a deployment model for new technologies in 2015. This will include consideration of the process and criteria used to identify topics for NICE assessment that relate to NHS England-commissioned services. The goal is to develop a structured method for introducing new technologies following NICE approval—for example, operational pilots to generate real world evidence about how to most effectively to introduce new therapies or diagnostics.

Regarding patient choice, the guidance states that commissioners and providers should work together and with patient groups to understand current delivery, and make significant further strides to honour patients’ entitlements to choose.

The planning guidance also require leaders of local and national health and care services to take action on five fronts, including:

  • how £480 million of the £1.98 billion additional investment will be used to support transformation in primary care, mental health and local health economies;
  • making clear that local NHS organisations must work together to ensure patients receive the standards guaranteed by the NHS Constitution, including the NHS’s longstanding promise to give patients choice over where and how they receive care, and the statutory duties of NHS England and CCGs to promote choice.
  • underlining the NHS’s commitment to giving doctors, nurses and carers access to all the data, information and knowledge they need to deliver the best possible care;
  • details on how the NHS will accelerate innovation to become a world-leader in genomic and genetic testing, medicine optimisation and testing and evaluating new ideas and techniques.

In implementing the recommendations in the guidance, all health and social care organisations must work together to develop locally owned and agreed plans with deadline for the final plans from the CCGs, NHS England, NHS Trusts and FTs set for the 10th April 2015.