Weekly political news round up – 31st July 2015

July 31, 2015 in News by Whitehouse

Around the sector

The Liberal Democrats have announced its frontbench spokespeople following the election of Tim Farron as party leader. Former Care Minister Norman Lamb has been appointed as Spokesperson for Health, while John Pugh MP has been appointed as the Spokesperson for Education. Cllr Dorothy Thornhill has also been appointed as Local Government Spokesperson.

The Five Year Forward View Partners launch support package and publish programme of support for Vanguard sites

Support package

The Five Year Forward View (FYFV) Partners have this morning published an initial support package for the first eight of the twenty-nine vanguard site launched in March this year. A total of £60 million has either been allocated to these sites, or agreed in principle. This funding has been taken from the £200 million transformation fund given to the NHS to implement the visions set out in the NHS FVFV.

The remaining funding will be allocated later in the year, with some going to sites trialling new models of urgent and emergency care, as announced last week. Some funding will also be allocated to the acute sector collaboration vanguards, which have not yet been identified.

These sites will, in return, be expected to deliver efficiency savings beyond those required by the NHS as a whole by the end of 2017-18.

Programme of support

The Partners have also published a programme of support that will be available to vanguard areas. The support programme has been developed following the Partners’ engagement with vanguard leaders, including two-day visits to all 29 sites in April and May 2015. The Programme focuses on eight areas, these are:

  • designing new care models;
  • evaluation and metrics to assess the effectiveness of new care models;
  • integrated commissioning and provision – helping vanguards break down barriers between the purchaser and provider of healthcare;
  • empowering patients and communities – it will be a requirement for vanguards to demonstrate patient involvement;
  • harnessing technology;
  • workforce redesign;
  • local leadership and delivery, including learning from international exemplars; and
  • communications and engagement.

Each area will be led by a sector expert, alongside a local vanguard leader, to refine what is being offered so that the sites can fully be tailored to the area’s needs.

The new care models team will also produce the first draft of a standard contract for multispecialty community providers, and another for primary and acute care systems by December, as part of the support programme.

The support package also noted that the current system of quality payments, such as commissioning for quality and innovation, the quality and outcomes framework and the quality premium, “will need to be reimagined and simplified, in order to create aligned, whole system incentives that support new care models”.

Plans for a Manchester specific NICE guidance and ‘Sunshine Act’

The Greater Manchester Medicines Management Group (GMMMG) has set out proposals to change the commissioning of medicines and pharmacy in Greater Manchester. The proposals include establishing a new relationship with a regional team at NICE to potentially modify medicines and prescribing guidance specifically for Greater Manchester.

The Group has also proposed introducing a version of the “Sunshine Act”, which requires medical supply organisations to collect and track all financial relationships with clinicians and report them to the Government. Government ministers have also indicated that they will consider the introduction of such legislation at a national level.

Other areas being considered include the creation of a regional “market access team” to deal with drugs and technology firms. Simon Wootton, Vice Chair of GMMMG, said sales played a key part of the “soft education” between sales representatives and NHS liaison teams. He said he would prefer it to all be transparent and coordinated.

Monitor to retain responsibility for regulating NHS service in Greater Manchester

Monitor will still be responsible for regulating NHS services in Greater Manchester following an agreement with the leaders of the Greater Manchester devolution project.

Ian Williamson, Interim Chief Officer for the project, said a new regulation model was still needed for the region, with input from local leaders. This model will allow regulators to focus more on the broader “health system approach”. Discussion are currently taking place however to finalise new arrangements in this area.

Greater Manchester will still have responsibility for national bodies although it will not seek different performance targets, as it will still be subject to the NHS Constitution.

Manchester NHS devolution plans flawed as voluntary organisations are not involved

The Association of Chief Executives of Voluntary Organisations (Acevo) has criticised the Government’s plans to devolve power for health and social care spending to Greater Manchester because voluntary organisations have not been included in the plans. A memorandum of understanding on the subject said that the “role of the third and private sector in the arrangements [for devolution] … remains to be determined”. Acevo’s Chief Executive, Sir Stephen Bubb, said that the voluntary sector was essential for health and social care services in Manchester because of cuts to care budgets.

Charities play a role in providing social care for children, the elderly and vulnerable adults, including supplying “meals on wheels” and befriending services for older people, help for homeless teenagers and transport for those that need it. With ministers currently holding talks with the Sheffield, West Yorkshire and Liverpool city regions over receiving devolved powers based on the model pursued by Manchester, the inclusion of voluntary services into Manchester’s devolution plans may set a precedent with consequences that will reach beyond

Dr Sarah Wollaston seeks further information from the Government on its announcement to delay the cap on care costs

Following last week’s announcement that the Government will postpone plans to implement the cap on care costs for four year, Sarah Wollaston, Chair of the Health Select Committee, has written to the Health Secretary to express concern over the way the announcement was made. Dr Wollaston sought explanation on a number of issues, including whether plans to raise the threshold for assets that would be disregarded in assessing eligibility for a cap have also been delayed. She then asked the Government to clarify whether there were plans to introduce new arrangements in April 2020 to address the circumstances where self-funders effectively subsidies those whose care is paid for by the local authorities.

Responding to Dr Wollaston’s concerns, the Health Secretary Jeremy Hunt said the implementation of the cap on care costs was delayed following consultation earlier in the year, which highlighted concerns about the timing of the reforms, and were later reiterated in the letter by the LGA. He said delaying implementation will allow local authorities time to focus on delivering the reforms that were already implemented in April this year.

With to clarification on whether plans to also raise the asset threshold for assets in assessing eligibility for a cap will also be delayed, Hunt confirmed that it would, with the limits remaining at their current levels of £23,250 for the upper limit and £14,250 for the lower limit.

Hunt reiterated that that the Government intends to use the additional time to work with the financial sector to explore what more can be done to support people with their care costs

The Department of Health publishes revised NHS Constitution and Handbook to the NHS Constitution

The Department of Health has updated both the NHS Constitution and Handbook to the NHS Constitution.

Both documents have been updated following the Government’s consultation on updating the NHS Constitution. The NHS Constitution sets out the rights for patients, public and staff, and outlines NHS commitments to patients and staff, and the responsibilities that the public, patients and staff owe to one another to ensure the NHS operates fairly and effectively.

The Handbook to the NHS Constitution outlines the standards below which care and treatment must not fall, as well as the quality and safety of care requirements that all registered health and adult social care providers must meet. Below are an overview of the guide to the relevant revised text of NHS Constitution

  • ‘You have the right to be protected from abuse and neglect, and care and treatment that is degrading’. The Handbook states that all providers must insure that they have, and implement, robust systems and processes that make sure that people are protected. Staff should also be aware of their individual responsibilities to prevent, identify and report abuse when providing care and treatment.
  • ‘You have the right to transparent, accessible and comparable data on the quality of local healthcare providers, and on outcomes, as compared to others nationally’.  The Handbook states that this transparency will help patients to make informed choices about their care, and will also help to drive improvement in quality. The Handbook highlights the introduction of the requirement for providers to display ratings received from CQC in all premises. The Handbook also notes that the My NHS website is continually being updated with new information.
  • ‘You should aim to find alternate sources of care or assistance for patients when you are unable to provide this (including for those patients who are not receiving basic care to meet their needs).  – The Handbook states that where a patient is in need of basic care that the NHS provider is unable to offer, the provider should either ensure that it is provided by others or inform someone who is in a position to take the appropriate action. In the event that the provider is unable, within an acceptable time, to provide treatment or care needed by a patient, the patient should be referred to a provider who is able to do so, or be advised where such treatment or care can be obtained.  Where a patient prefers a reasonable alternative to the treatment they are offered, the patient should either be referred to a provider who can offer the alternative, or be offered advice as to where the alternative might be found.
  • ‘The NHS commits to make decisions in a clear and transparent way, so that patients and the public can understand how services are planned and delivered.’ The Handbook states that Local Authority and Health and Wellbeing Boards will bring together all of the key local system leaders of health and wellbeing, including local councillors, directors of public health, commissioners of adult social care and children’s services, CCGs and local Healthwatch. The aims will be for them to undertake Joint Strategic Needs Assessments (JSNAs) and to develop Joint Health and Wellbeing Strategies (JHWSs) which inform local authority, CCG and NHS England commissioning plans.

Health Select Committee launches inquiry into primary care

The Health Select Committee has launched an inquiry into primary care. The inquiry will consider whether the Department of Health and its arms’ length bodies have developed the policies needed to ensure that high quality care is consistently available to patients at the point of need.

In doing so, the inquiry will look into issues including:

  • The quality and standards of care for patients
  • Demand and access (including out of hours access and proposals for 7 day access)
  • Funding (including local and national distribution of resourcing)
  • Commissioning
  • Future models of care as piloted by the Five Year Forward View Vanguards
  • Workforce: current and future challenges (including recruitment, retention, training, skill mix, contractual models, workload and pay).

Weekly political news round up – 24th July 2015

July 24, 2015 in News by Whitehouse

Around the sector

The Royal College of Nursing (RCN) Scotland has published a short report highlighting the importance of senior nurses, calling for a coherent national approach in Scotland to the development of advanced nursing practice, and investment and support to develop the workforce in the future. Theresa Fyffe, RCN Scotland Director, said that “given pressures within health and social care, senior nurses working in clinical decision making roles will be crucial to success”.

The Department for Communities and Local Government and the Department for Business, Innovation & Skills have published further detail on the devolution deal for Cornwall. The document sets out that Cornwall Council, the Council of the Isles of Scilly, NHS Kernow (which covers the whole of Cornwall) and other local partners will work with the Government, NHS England and other national partners to co-design a business plan to move towards the integration of health and social care across Cornwall. Despite the devolution of responsibilities, NHS England and local organisations will still remain accountable for meeting its full range of statutory duties.

Government outlines approach to the 2015 Spending Review

HM Treasury has published a document outlining the Government’s approach to the 2015 Spending Review. This document identifies areas of priority spending, as well as areas where the Government thinks a further £20 billion of savings can be made to achieve deficit reduction. The outcome of the Spending Review will be published on 25th November.

The Spending Review will prioritise spending on the following core outcomes:

  • promoting innovation, choice, competition and greater collaboration in public services
  • promoting growth and productivity, including through radical devolution of powers to local areas in England
  • delivering high-quality public services, such as the NHS
  • promoting choice and competition
  • driving efficiency and value for money across the public sector

The document sets out detail on the Spending Review’s approach to areas such as public services, economic growth, criminal justice, and better financial management. The document reiterates the Government’s commitment to increasing NHS funding by £8 billion a year by 2020, with the NHS in return delivering £22 billion of efficiency savings in the same period. The document highlights that efficiency savings will be made as a result of Lord Carter’s review of operational productivity in NHS trusts, and also states that the additional investment in the NHS will be spent on ensuring a 7-day service by 2020, with the aim of delivering better outcomes in areas such as cancer, dementia and mental health.

As part of the Spending Review, HM Treasury is inviting government departments to model two scenarios of 25% and 40% savings in real terms by 2019-2020.

Spending Review 2015 is also asking interest groups, individuals and representative bodies to provide HM Treasury with a “Spending Review representation”, which is an evidence-based written document which suggests new ideas for policies or reforms for inclusion as part of the Spending Review. Ideas suggested should consider the following factors:

  • likely effectiveness and feasibility
  • public spending implications and value for money
  • wider macroeconomic implications (for economic stability and growth)
  • legislative and operational requirements
  • sectoral and distributional impacts
  • administrative and compliance costs and issues

In addition to this, the Government will organise a series of events over the summer to discuss and debate various aspects of public spending, which will hear from a wide range of experts across various areas.

Tabled written questions on continence care

Labour MP Rosie Cooper has tabled six written questions on continence care, asking the Health Secretary:

  • If he will take steps to ensure that the Care Quality Commission’s regulatory standards include verification of continence care treatment standards in (a) hospitals and (b) care homes.
  • When his Department plans to publish its Excellence in Continence Care Commissioning Framework.
  • What plans he has to commission a national audit of continence care for young and elderly people.
  • If he will take steps to ensure that Public Health England promotes good continence care via a national awareness campaign.
  • If he will direct NHS England to place an obligation on clinical commissioning groups to contractually deliver quality continence care in England.
  • What the average waiting time is for an assessment of patients with continence problems.

Health Select Committee holds first oral evidence on the current issues facing NHS England

The Health Select Committee held its first oral evidence session with senior NHS England officials on issues facing NHS England.

The evidence session, the first for the new Health Select Committee following the general election, heard evidence from Simon Stevens, Chief Executive of NHS England, Sir Bruce Keogh, National Medical Director and Jane Cummings, Chief Nursing Officer, covering a wide range of issues affecting the NHS including financial performance of the NHS, prevention and public health, the NHS workforce and staffing, urgent and emergency care, mental health services, and the post-Francis Review progress on changing NHS culture.

There were no new announcements or insights that were relevant to the PCF, however please see attached a briefing document providing a general overview of the key issues that were discussed.

Department of Health publishes annual assessment of NHS England for 2014-15

The Department of Health has published its annual assessment of NHS England for 2014-15, which found that NHS England has made “good progress” against the mandate given to it by the Department of Health despite ongoing financial challenges.

In particular, the assessment praised NHS England’s work with patients, healthcare professionals and commissioners to provide practical support for the good management of long term conditions, quoting a 2014 GP Patient Survey which found that 63.7% of patients with one or more long term conditions feel that they receive enough support to help them manage their condition. Praise was also given to progress made to enhance patient experience and reduce health inequalities, as well as to the progress made to improve mental health services, access to GP records, dementia care and diagnosis, and better transparency. However, the survey also found that although progress has been made on patient and public involvement and health inequalities, more has to be done.

The assessment highlighted particular challenges ahead, most notably ensuring that patients are able to access urgent and emergency care services all year round, all around the country, as outlined in the NHS Constitution. Other areas include developing a strategic approach to the care of children and young people, as well as ensuring that CCGs are appropriately supporting children and young people with special educational needs and disabilities, and that a research culture within NHS England must be developed.

Department of Health publishes outcome of the first triennial review of NICE

The Department of Health has published the outcome of its first triennial review of the National Institute for Health and Care Excellence (NICE), which overall found that NICE performed well in the delivery of its necessary functions and is highly valued by stakeholders. The report described NICE as an “efficient organisation” that “compares well with other public bodies” and “identifies issues and seeks to address them early”.

Stage one of the review, which looked at whether the functions undertaken by NICE are necessary, confirmed that they were and that the organisation’s current form is appropriate. However, the review also recommended that NICE works with the Department of Health and Cabinet Office Commercial Models team to explore opportunities for the greater expansion of NICE International and NICE Scientific Advice, and see whether these functions could be delivered more effectively through a different model.

Stage two of the review, which looked at performance, communication and engagement, efficiency and governance issues, identified a further 11 high-level recommendations. Below is a summary of the relevant recommendations:

  • Support the health and social care system through developing a set of key performance indicators, and through working with NHS England, Public Health England and the CQC to align the approach to the implementation of NICE guidance and recommendations [by the end of 2015].
  • The Department of Health should establish whether NICE should be the single body for clinical and cost effectiveness appraisals [by April 2016].
  • Following the findings of the Accelerated Access Review, consider any appropriate changes to NICE’s methods and processes [by April 2016].
  • Ensure that patients, service users and other stakeholders are aware of NICE’s role and functions [by April 2016].
  • Make its approach to supporting patients more transparent [throughout 2015/16].
  • Improve communications with social care stakeholders, including exploring alternative approaches to developing products to better suit the audience’s needs [throughout 2015/2016].
  • Review its partnership agreement with the MHRA and publish the agreement [by April 2016].
  • Work with NHS England to secure the application of a commitment in the Partnership Agreement to using NICE guidance in the centralised and devolved commissioning arrangements [by July 2016].
  • Clarify its roles and responsibilities to stakeholders [throughout 2015/16].

National Audit Office publishes review of the capability and capacity of the Care Quality Commission

The National Audit Office (NAO) has published a review of Care Quality Commission’s (CQC’s) capacity and capability to regulate the quality and safety of health and adult social care. The review found that the CQC has made “substantial progress in the face of sustained criticism”, but that “significant challenges” lie ahead if it is to demonstrate effectiveness and value for money.

The review came as part of a three-year transformation programme by the CQC, which was initiated in 2013-14 following severe criticisms from both the NAO, which found in 2011 that the CQC did not provide value for money, and the House of Commons Public Accounts Committee, which said that the CQC was a “long way off” becoming an effective regulator. Specific complaints by both organisations focused on a lack of strategic direction and leadership, insufficient skills and capacity, and a failure to quickly and strongly intervene in failing providers.

The review identified improvements to the CQC’s regulatory model, which led to “strengthened” inspections of hospitals, adult care providers and GPs, as well as a better use of data for planning inspections and better staff recruitment. However, the review recommended that work continue on staff recruitment, including the development of a better learning culture for staff, as well as better information sharing and an agreement with the Department of Health over quantifiable performance measures.

Senior NHS England figures believe NHS England will only reach £15 billion of the £22 billion efficiency savings target

Senior NHS England figures have told the Observer that they believe that NHS England will only be able to achieve £15 billion of the £22 billion of efficiency savings required to fill the £30 billion resource gap by 2020, as identified in the Five Year Forward View. One unnamed figure described the £22 billion target as “overly ambitious and not very realistic”, while another described it as “pie in the sky”. The senior figures are said to be bracing themselves for a “bruising battle” with ministers over an additional £7 billion of funding per year; ministers have told NHS England not to expect more than the £8 billion a year already promised.

Department for Education publishes summary of responses to SEND funding consultation

The Department for Education has published a summary of responses that it received to a consultation on the distribution of SEND funding, which ran between November 2014 and February 2015. The responses covered three areas:

National to local level funding distribution

Many respondents felt that existing proxy factors such as low prior attainment, income deprivation and so on provide a reasonably fair and equitable distribution of funding between local authorities. Moreover, respondents suggested using health data, such as low birth rates, low immunisation rates, infant mortality, and hospital admissions for mental health conditions and so on. Other proxy factors suggested included applying for different types of SEND, pupil population, ethnicity and pupil mobility.

A number of respondents felt that using a formulaic method for determining funding allocation was the right and fair approach. However, others thought that the wide spread of local circumstances would make introducing a formulaic approach problematic. The most common types of SEND that were thought to be best handled above the level of individual local authorities included multiple and complex needs, and low incidence SEND, such as those children and young people with augmentative and alternative communication needs.

Those in favour of collaboration between local authorities said that it should be encouraged through the sharing of emerging practice in commissioning and provision, or through policy initiatives and legislation.

Local to institution level funding distribution

Some respondents argued that formula factors should not be used as proxies for institutions’ need to spend on children and young people with SEND, as the SEND population is statistically small compared with the overall pupil population. Others felt that introducing an institution-level formula that was more prescriptive than the current system would require very detailed and robust data on both type and level of need. Respondents were reasonably happy with the use of deprivation and prior attainment to allocate resources for pupils with high incidence SEN who do not have statements/EHC plans.

There was a general consensus that the use of proxy measures and pre-determined bands of funding was the simplest, fairest, most transparent and most efficient method to distribute funding, provided that adequate thought was given to the criteria. However, concerns remained about how such criteria would take account of pupils with complex needs and high costs.

Some respondents felt that the funding being allocated from social care budgets and local NHS budgets is not being sufficiently directed to meet the needs of the children and this creates an adverse impact on educational outcomes.

Local authorities’ approaches to capital investment

Those responding stated that often, spending tends to be reactive and targeted where it has been identified that there is a specific need, because of the limited funds available. It does not anticipate future need, other than through general population projections, and capital expenditure decisions were often based on an “invest-to-save” business case to avoid out of authority residential placements

Primary Care Workforce Commission publishes report on the future of the primary care workforce

The Primary Care Workforce Commission, which was commissioned by Health Education England at the request of Health Secretary Jeremy Hunt, has published its report into the future of the primary care workforce in England. The report outlines a series of measures around recruitment, cooperative working and greater training to tackle the major challenges facing primary and community care services, notably an increasing workload, an ageing population, and complex medical problems being diagnosed and managed in the community.

The report suggests that long and short term strategies should be devised to recruit and retain nurses and GPs, with pharmacists playing a greater role in the helping people manage long term and minor illnesses. It called for the wider use of physician associates and healthcare assistants to relieve pressure of GPs, as well as better administrative support. Also included were recommendations for 24-hour community nursing services, and for practices to better analyse their clinical case-mix when deciding care.

Further recommendations were also made to encourage consultants to keep in direct contact with primary care staff to offer them support and advice, make a better use of IT, and coordinate activities between general practices. Other recommendations include measures to provide support for people with particular needs, such as children, the deprived, those with mental health problems, those in care homes and those with challenging health and social care needs. The report also suggested longer GP consultations, choice over clinicians and better training opportunities for primary care staff.

Think tanks call for extra funding to support transformative changes in the NHS

Influential health think-tanks the King’s Fund and the Health Foundation have issued a call for an extra £1.5 – 2.1 billion a year in dedicated funding by 2020, above the extra £8 billion already promised by the Government, to establish a “transformation fund”. This fund will see the establishment of a single body to oversee the investment of transformative changes in the NHS, which should support investment in four key areas essential for transformation: staff time, programme infrastructure, physical infrastructure and double-running costs. It has been suggested that the fund is split in to two phases: the first phase (2016/17 – 2020/21) will look to achieve higher rates of efficiency growth, as well as new models of care; the second phase would focus on the widespread roll-out of the successful new models of care.

Left-leaning think-tank the Institute for Public Policy Research (IPPR) issued a similar call, recommending a transformation fund of £4 billion a year by 2020 – again above the extra £8 billion of funding already promised, but with this money being spent on an acceleration of personal health budgets to enable better self-management of long term conditions. The IPPR’s report also called for further devolution of health and social care, as seen in Greater Manchester, as well as a better culture and training for healthcare workers to provide new models of care.


Weekly political news round up – 17th July 2015

July 17, 2015 in News by Whitehouse

Around the sector

Ofsted has published its Early Years Annual Report 2015, which states that the quality of early years education has increased, with 72% of settings now rated as good and 13% as outstanding – up from 66% and 12% last year. The annual report also stated that the proportion of children reaching a “good level of development” by the end of reception, as measured through the Early Years Foundation Stage (EFYS) framework, has increased from 52% to 60%. The EYFS framework includes independent toilet use as an early learning goal.

Tim Farron has been elected as leader of the Liberal Democrats, following an all-member ballot which saw him compete with former Care and Support Minister Norman Lamb for the leadership. Farron received 56.5% of the vote, with Lamb receiving 43.5%. Farron was elected as an MP for Westmorland and Lonsdale in 2005, and served as Liberal Democrat president between 2011 and 2014. Prior to 2010, he served as the Shadow Environment Secretary, Shadow Home Affairs Minister and Shadow Children and Families spokesperson.

Ahead of a one-off evidence session with Ofsted chief inspector Sir Michael Wilshaw, the Education Select Committee has issued a call for short written submissions on the work of Ofsted across schools, early years and children’s social care. Submissions must be submitted by midday on Tuesday 1st September, with the evidence session to be held on Wednesday 16th September.

Forthcoming events

On 21st July, the Health Select Committee will be holding its first oral evidence session on the current issues affecting NHS England. The evidence session will hear from three NHS England senior officials: chief executive Simon Stevens, national medical director Sir Bruce Keogh, and chief nursing officer Jane Cummings.

The House of Commons will rise for summer recess on 21st July 2015, with the House of Lords doing the same on 22nd July. This means that there will be no parliamentary business until both houses return on 7th September, before both rise again for party conference season on 17th September.

Health Secretary Jeremy Hunt outlines the direction of reform for the future of the NHS

Health Secretary Jeremy Hunt has provided an overview of the direction of reform for the future of the NHS in England. Hunt’s speech covered a broad range of areas, including patient-centred care, better transparency in the healthcare system, choice for patients in choosing their doctor, and seven-day services. He also announced that healthcare regulators Monitor and the Trust Development Authority (TDA) will be merged into a new organisation called NHS Improvement, led by current NHS England Deputy Chairman Ed Smith.

Discussing patient-centred care, Hunt said that the Mid-Staffordshire scandal had highlighted that too much bureaucracy had allowed many patients to fall through the system and that this needed to be reformed. To address this issue he said that a profound cultural change was needed to move away from a culture of excessive performance targets had demoralised staff.  He said that rather than patient-centred care the NHS should strive to be “more human”.

Hunt also announced that NHS England will come up with concrete proposals to make sure that there is choice and control over services offered for those with long term conditions, as well as maternity and end of life care. He added that GPs will have to tell patients the CQC rating and average waiting time of hospitals they are being referred to, and that patients will have a greater choice in choosing their GP practice through the New Deal for General Practice, which will increase primary care capacity.

Finally, Hunt outlined that seven-day services would be enabled in part through reforming the consultant contract to prevent them from opting out of working at weekends, and that the majority of hospital doctors will be expected to be on seven-day contracts by the 2020.

London agrees on proposals to for the devolution of public services

Health Service Journal has reported that Mayor of London Boris Johnson and borough council leaders have agreed on proposals which will see the devolution of a wide range of public services from central government. These proposals include plans for the pooling of health and social care budgets at borough level, with plans for the transformation of services and the use of NHS assets to be developed at a “sub regional level”, while a “pan-London…cash support regime” would take over the provision of support to NHS providers with deficits from the Department of Health.

Department for Communities and Local Government confirms devolution deal for Cornwall

The Department for Communities and Local Government has confirmed that a devolution deal has been agreed with Cornwall, which will give it control of integrating health and social care services, as well as other areas like bus services, adult skills and regional investment. The devolution deal will see NHS Kernow (which covers the whole Cornwall), Cornwall Council, the Council of the Isles of Scilly, as well as other local partners, work with NHS England to develop a business plan to move towards the integration of health and social care.

Answer to written question on urinary tract infections

Conservative MP Tom Pursglove has received an answer to his written question asking the Health Secretary what guidance and information is available to (a) NHS healthcare workers, (b) patients and (c) carers of patients who regularly suffer from urinary-tract infections (UTIs).

Public Health Minister Jane Ellison responded that guidance is available from a number of sources, including from NICE, which published a quality standard on the treatment of UTIs in adults in June, and Public Health England (PHE), which has also published primary care antibiotic guidance which covers the treatment of uncomplicated UTIs. She added that PHE has also developed guidance on the diagnosis of UTIs, which is being reviewed this year.

Department of Health publishes independent report on NHS leadership

The Department of Health has published a report by Conservative peer Lord Rose, Better leadership for tomorrow: NHS leadership Review, which looks at how better leadership can be fostered in the NHS, and how strong leadership can transform hospital trusts and equip clinical commissioning groups to deliver the Five Year Forward View.

The report identifies a number of leadership problems that have been unaddressed by successive governments, which the NHS has the resources to deal with – these include:

  • Workforce management – There are weaknesses in identifying, assessing and managing staff in a consistent manner
  • Change – Levels of change remain unsustainably high which s places competing demands throughout the NHS’s leadership and management
  • Administrative burdens – Administrative, bureaucratic and regulatory burdens are becoming unsustainable for NHS managers
  • Insufficient management capability – There is a lack of leadership capacity to deal with the scale of the reforms and restructuring that has been undertaken
  • No single vision – There remains a lack of a single vision and common ethos throughout the NHS
  • Career direction – There is a need for better career development and training management careers across medical, administrative and nursing

The report makes a series of recommendations, which are based on the pre-condition that two fundamental changes are introduced:

  1. The introduction of a single service-wide communication strategy within the NHS to cascade and broadcast good, and occasionally less favourable, news and information and best practice to NHS staff, Trusts and CCGs.
  2. The creation of a short NHS handbook/map, summarising succinctly the NHS’s core values, which would be published throughout the NHS.

The recommendations cover performance bureaucracy reduction and better training, as well as performance management and management support. Recommendations on reducing bureaucracy include merging the Trust Development Agency and Monitor – a recommendation acted on with the formation of NHS Improvement, as well as a review of the demands on regulators and oversight bodies and how these can be harmonised.

Research highlights the financial pressures facing the NHS

The Healthcare Finance Management Association (HFMA) has published the findings of a survey of the NHS finance directors and chief finance officers of 117 (47%) of provider trusts, and 79 (37%) clinical commissioning groups (CCGs). The report concluded that there is increasing financial pressure across the NHS, with the most severe deficits in the acute sector.

The survey found that there was a small underspend of £151m (0.2% of allocation) across all the CCGs, which was attributed to “significant one-off items”, and that excluding these items, there was a net overspend within the CCG sector. NHS foundation trusts reported a £349m deficit for the year ending 31st March 2015, compared with a planned net deficit of £10m, with NHS trusts reporting an aggregate net deficit of £473m – an increase on the planned net deficit of £408m.

Weekly political news round up – 10th July 2015

July 10, 2015 in News by Whitehouse

Around the sector

NHS England has announced that Dame Barbara Hakin, NHS England’s national commissioning operations director, will retire at the end of the year. Dame Barbara is currently responsible for overseeing the operational delivery through NHS England’s regional and local teams, and previously helped oversee the development of the commissioning architecture of the NHS. NHS England chief executive Simon Stevens will be appointing a successor to Dame Barbara in a reshaped national director role, on a similar timetable to the appointment of a combined chief executive for Monitor and TDA.

Influential health think-tank the King’s Fund has published a report identifying areas where NHS services can be improved in the future whilst also delivering savings. The report found that there needs to be a reduction inappropriate care and variance in the levels of care, such as overprescribing of antibiotics in primary care and better adherence to diabetes guidance. It also found that early diagnosis and better support for long-term conditions would be more cost effective and produce better outcomes, and that there needs to be better support for people transitioning between services.

Communities Minister Baroness Williams has written to peers stating that the Government wishes for combined authorities to “jointly” hold NHS powers, rather than having them devolved completely. She said that the Government will seek an amendment to the Cities and Local Government Devolution Bill which gives “a power to attach conditions or limitation on a transfer of functions from a public authority to a combined authority”.

Department of Health publishes response to consultation on updating the NHS Constitution

The Department of Health has published the Government’s response to its consultation on updating the NHS Constitution, which ran from February 2015 to April 2015. The NHS Constitution sets out the rights to which patients, the public and staff are entitled, and the responsibilities owed to each other to ensure that the NHS operates fairly and effectively.

The consultation asked for comments on 14 proposed changes to the Constitution, which were intended to enhance patient safety and choice, as well as to increase transparency amongst healthcare providers. The PCF submitted a response which highlighted the need for early intervention and properly commissioned, integrated paediatric continence services. The response argued that the Constitution needed to recognise that children and adults are different as both have unique needs, and that the Constitution should more rigorously enforce adherence to national guidelines.
Only minor changes were made to the text of the Constitution. Of the 14 wordings that were consulted on, six remained unchanged, with one proposed change being withdrawn and very minor changes the other seven. Below are the changes will are relevant for the PCF:

  • Patients will be at the heart of everything the NHS does’ is now ‘The patient will be at the heart of everything the NHS does’.
  • ‘You have the right to be protected from abuse, neglect and care that is degrading’ is now ‘You have the right to be protected from abuse and neglect, and care and treatment that is degrading’.
  • ‘You have the right to transparent, accessible and comparable data on the quality of local healthcare providers, as compared to others nationally’ is now ‘You have the right to transparent, accessible and comparable data on the quality of local healthcare providers, and on outcomes, as compared to others nationally’.
  • ‘You should aim to help patients find alternate sources of assistance when you are unable to provide the care or assistance a patient needs’ is now ‘You should aim to find alternate sources of care or assistance for patients when you are unable to provide this (including for those patients who are not receiving basic care to meet their needs)’.

As stated in the Government’s response, a more detailed guide to patients and staff on the contents of the Constitution will be provided in the 150-page Handbook to the NHS Constitution, which is due to be published towards the end of July.

Health and Education Select Committee membership update

Following elections within the political parties for membership the Commons select committees, Whitehouse understands that the makeup of the health and education select committees will be as below (* denotes chair):

Health Select Committee Education Select Committee
Dr Sarah Wollaston MP* Conservative Party Neil Carmichael MP* Conservative Party
Helen Whately MP Conservative Party Caroline Nokes MP Conservative Party
Dr James Davies MP Conservative Party Lucy Allan MP Conservative Party
Andrea Jenkyns MP Conservative Party Michelle Donelan MP Conservative Party
Andrew Percy MP Conservative Party Suella Fernandes MP Conservative Party
Maggie Throup MP Conservative Party Lucy Frazer MP Conservative Party
Liz McInnes MP Labour Party Ian Austin MP Labour Party
Diana Johnson MP Labour Party Kate Hollern MP Labour Party
Rachael Maskell MP Labour Party Ian Mearns MP Labour Party
Emily Thornberry MP Labour Party Kate Osamor MP Labour Party
Paula Sherriff MP Labour Party Marion Fellowes MP Scottish National Party
Dr Philippa Whitford MP Scottish National Party    

Answer to written questions on continence care

Labour MP Madeleine Moon has received answers to two written questions to the Health Secretary on continence care.

  • The first asked what estimate the he has made of the number of attendances at A&E because of (a) urinary tract infections, (b) catheter-related infections and (c) stoma care issues in each of the last three years.

Public Health Minister Jane Ellison responded that this information is not collected, as the diagnosis system used to inform the Hospital Episode Statistics accident and emergency data (A&E) set is not detailed enough to classify these conditions.

  • The second asked how many continence advisors were employed in the NHS in each year since 2005.

Care Quality Minister Ben Gummer responded that the Department of Health does not collect this information.

Tabled written question on guidance and information on urinary tract infections

Conservative MP Tom Pursglove has tabled a written question asking the Health Secretary what guidance and information is available to (a) NHS healthcare workers, (b) patients and (c) carers of patients who regularly suffer from urinary-tract infections.

Summer Budget 2015

Chancellor George Osborne has this week delivered the summer 2015 Budget. Many of the announcements it contained were heavily trailed in the media in the proceeding days and weeks, but this did not prevent a significant number of surprising policy developments emerging.

Announcements relevant for the PCF were largely reiterations of previous announcements, with the Chancellor reconfirming that the NHS in England will receive an additional £8 billion funding per year in real terms by 2020, as requested in the Five Year Forward View. Osborne explained that the extra investment will support a step change in safety, quality and access. He also said that public sector pay rises to will be limited to 1% over the next four years.

However, Osborne did announce that devolution deals are being discussed with the Sheffield City Region, Liverpool City Region, and Leeds, West Yorkshire and partner authorities, which would see the creation of directly elected mayors as part of devolution. He also said the Government is making “good progress” towards a devolution deal with Cornwall, which Health Service Journal reported will see Cornwall Council and Kernow CCG (which covers Cornwall) manage a £2 billion pooled budget combining health, welfare and social care spending by 2020.

As expected, the Budget saw substantial cuts to welfare provisions. Working-age benefits will be frozen for four years; tax credit and universal credit support to be limited to first two children from April 2017; and 18-21-year-olds will not be entitled to claim housing benefit automatically. Similarly predicted were increases to personal tax allowances to £10,600 this financial to £11,000 next year, the raising of the 40p tax threshold to £43,000 from next April; and reforms to pensions and inheritance tax policies.

Other announcements that had been speculated on prior to the budget speech included the replacement of student grants with loans from next year; a reaffirmation of the Conservative’s pre-election commitment that £8bn in extra NHS funding would be provided by 2020; and an announcement of further progress in the Government’s plans to devolve power to city administrations.

However, much of what followed was not trailed in advance. The cut in corporation tax from 20 per cent to 19 per cent in 2017 and 18 per cent in 2020 was unexpected, but the real shock came with the announcement of the bringing in of a new National Living Wage (NLW). The wage will be compulsory from those aged over 25, and will start at £7.20 in April 2016, rising to £9 per hour by 2020. This scheme, designed to undermine Labour’s claim to be the “party of the workers”, was followed by a Government commitment to spend two per cent of GDP on defence – a move intended to placate the demands made by many Conservative backbenchers.

Overall, this budget can be considered to be one of the most radical in recent memory, and will likely prove a challenge for Labour to counter in the coming months.

Welsh Government publishes a green paper on changes to the NHS in Wales

The Welsh Government has published a green paper outlining a series of policy proposals and ideas for potential changes to the NHS in Wales. The green paper asks fifty questions on areas such as patient engagement, common standards for Welsh NHS services, changes to healthcare inspectorate bodies, and the sharing of information between healthcare providers.

Although the green paper does not directly make reference to continence, there are some proposals on healthcare quality that may be of interest to the PCF. In particular, the green paper asks:

  • Whether health boards and NHS trusts should be required to set up patient panels and participation groups when discussing service change.
  • Whether community health council (CHC) activity should be refocused on representing the patient voice and on providing advocacy services.
  • What legislation can be produced to ensure quality is at the forefront of all decisions and joint decisions by healthcare organisation.
  • Whether a framework should be established to legally require all NHS organisations to adhere to a consistent set of standards, based on existing standards, which are currently advisory rather than statutory.
  • Whether Healthcare Inspectorate Wales should be made more independent, or even merged with Care and Social Services Inspectorate Wales to form a single healthcare inspectorate.
  • Whether there should be a statutory duty of candour, and what legislative steps can be taken to improve the investigation of complaints.

The green paper also asks for comments on changes to the finance and governance arrangements for the NHS in Wales, including borrowing powers for health boards, the publication of summarised accounts, planning duties and the appointment of board members.

Weekly political news round up – 3rd July 2015

July 3, 2015 in News by Whitehouse

Around the sector

BBC News has reported that a 16 year old girl from Cornwall has died from a cardiac arrest caused by chronic constipation. Speaking at the inquest, consultant paediatric Dr Paul Davis said that although death from constipation is rare, there had been “long term failures to treat a patient adequately” but “professionals had done their best for her”. Her mother commented that her daughter’s death could have been prevented had she been designated a “support person, a professional person” to build a relationship with.

Communities Minister Baroness Williams has revealed that Health Secretary Jeremy Hunt will be able to overturn “wrong” decisions made about health care by Greater Manchester and other cities with devolved health powers. Williams added that although he would not overrule for the sake of it, decisions with “negative consequences” could result in intervention.

Health Education England has announced plans to train an addition 23,000 full-time equivalent new nurses by 2019, based on workforce levels in 2014-2015. Of the new nurses, 2600 will be mental health nurses, 13,000 will be adult nurses, 5900 will be children’s nurses, and 1500 will be learning disability nurses.

Gary Porter, a senior Conservative councillor and the new head of the Local Government Association (LGA), has called the government’s decision to increase the health service budget in real terms “bizarre” and “short-termist”. He called for less pressure to protect the NHS, instead calling for £3 billion of the £8 billion a year earmarked for health by 2020 to be spent on adult social care to help avoid hospital admissions.

The LGA and NHS Clinical Commissioners (NHSCC) have jointly published call to action for health and wellbeing boards (HWBs) to “deliver much more for the populations they serve”. The document sets out what a good HWB looks like, and outlines measures that local leaders, the LGA and NHSCC, as well as the Government, should take to enable HWBs to be more effective.

The Care Quality Commission has published the findings of a survey of 19,000 children and young people between eight and 15, who received inpatient or day case care in 137 NHS acute trusts during August 2014. Although experiences of continence needs were not sampled, the survey found that 82% of respondents said hospital staff talked to them about their care in a way they understood. However, only 35% of parents/carers said they were encouraged to be involved in decisions on their child’s care and treatment.

Nursing Times has reported that the Government has missed its target to recruit 4,200 extra health visitors by the end of March 2015. Despite this, there are almost 4,000 more health visitors now than there were in May 2010, with Dr Cheryll Adam from the Institute for Health Visiting calling the increase a “fantastic achievement”.

Update on the Continence Care APPG

The Continence Care APPG held a meeting on 24th June to re-group, elect officers and engage with new MPs. The APPG’s members discussed the Excellence in Continence Care Programme Board, and stressed that the main outcome of the board’s work should be to ensure that continence is included in the CCG contract in order to ensure better service provision. Labour MP Rosie Cooper and Crossbench peer Baroness Greengross offered help to ensure the delivery of the board’s work.

Other discussion points included concern about education and training gaps; and the diversity around product provision, its inequity and waste that could be reduced.

King’s Fund calls for £8 billion extra funding to be front-loaded early

In advance of the Budget on 8th July 2015, influential health think-tank the King’s Fund has called for the Government’s promised £8 billion of extra funding per year for the NHS by 2020 to be front-loaded early in the parliament.

The King’s Fund has warned that if the Chancellor George Osborne does not announce additional funding, the patient care will suffer or the Department of Health will overspend its budget this year. This warning comes following a survey by the King’s Fund of NHS finance directors, which found that two-thirds of trusts are forecasting a deficit – a figure that rises to almost 90 per cent among acute trusts. Furthermore, despite the additional £1.25 billion funding announced in the Autumn Statement in December, the King’s Fund estimates that NHS provider deficits could top £2 billion this year, indicating that the NHS as a whole is heading towards deficit.

Government announces proposals for “English votes for English laws”

Commons Leader Chris Grayling has announced proposals which would give English MPs, and in some cases English and Welsh MPs, the power to veto legislation on issues which only affect England, and in some cases Wales, in devolved matters such as health and education.

Under the proposals, all MPs will continue to be able vote on every bill, however bills being discussed at Committee stage must be discussed only by English MPs, with the party make-up of each committee to reflect the number of MPs each party has in England. Where sections of legislation relate only to England or England and Wales, agreement of a “Legislative Grand Committee” will be required.

These changes will only affect the House of Commons, with procedures in the House of Lords due to remain unchanged. The only difference will be that there will be an addition veto when Lords amendments are considered in the Commons. Where those amendments will affect England, or England and Wales only, they will need both English and UK MPs to support to pass, which Grayling described as “double majority”.

The proposals mean that MPs from Scotland will have a diminished influence on matters which are currently devolved, such as health and education. SNP leader Nicola Sturgeon subsequently accused the proposals of showing “great disrespect” to Scotland.