Weekly political news round up – 25th September 2015

September 25, 2015 in News by Whitehouse

Around the sector

Norman Lamb MP (Lib Dem), former Care Minister at the Department of Health, has warned that the NHS will collapse within two years unless there is an immediate multibillion pound cash injection into the system. During his keynote speech at the Liberal Democrat party conference, he outlined a proposal to create a new NHS tax, to be highlighted on every payslip and that would allow local councils to increase taxes if additional spending is needed on health services in their area.  Lamb also warned against delaying the additional funding promised by the Government until 2019-20, as he believes that this will be too late. He predicted that “the next two years will make or break the NHS and the care system.”

Jeremy Corbyn appoints junior shadow health ministers

Following his victory in the Labour leadership election, the majority of Jeremy Corbyn’s appointments for his Shadow Health team have been released, and include the following figures:

  • Heidi Alexander MP – Shadow Secretary of State for Health
  • Luciana Berger MP – Shadow Minister for Mental Health
  • Andrew Gwynne MP – Shadow Minister for Public Health
  • Barbara Keely MP – Shadow Minister for Older People, Social Care and Carers
  • Justin Madders MP – Shadow Minister (Health)
  • Rt Hon Lord Hunt of Kings Heath – Shadow Minister (Health) and Shadow Lords Spokesperson (Health)

Luciana Berger’s appointment as Shadow Minister for Mental Health has been widely praised as recognising the importance of mental health and improving provision for it across the NHS. Barbara Keeley’s former role as chair of the All Party Parliamentary Group on Social Care will stand her in good stead for her new role.

NICE to sponsor new NHS vanguards

NICE is to sponsor four of the 29 vanguard sites designated to pilot the new models of care described in the NHS Five Year Forward View. As a sponsor, NICE will act as a sounding board for the vanguard sites and will advocate for them as necessary at a national level. The vanguard sites will also be given assistance with using NICE guidance and quality standards in their work to improve the quality of the care they are commissioning and providing. NICE will also use the experience of the sites to inform its own products. NICE will sponsor:

  • West Wakefield multispecialty community provider (MCP) – This site aims to provide a fully integrated, seven-day primary health and wellbeing service, using digital technology to ensure that patients have access to the service that they require.
  • Sutton enhanced health in care homes vanguard – This site aims to create a holistic model of care by setting up multidisciplinary teams of medical, nursing, social care and voluntary sector professions to help deliver the care needs of residents.
  • Whitstable MCP – This site will build on ongoing work to integrate primary, community and acute care with the objective of providing care as close to home as possible and in the most appropriate setting.
  • Mansfield and Ashfield acute care system, This site aims to deliver a whole integrated system of hospital, community, social and primary care by moving from a hospital-based system of urgent care to a home-based one of proactive care.

Sir Andrew Dillion, Chief Executive of NICE, said the sponsorship will help the sites develop innovative approaches while allowing the health body to review how the experience of partnerships might help shape and inform future guidance and advice products.

Health Education England warns against its removal from protected NHS budget

Ian Cumming, the Chief Executive of Health Education England (HEE), has warned that removing HEE from the protected NHS budget will result in cuts to frontline NHS services.

Following reports that HM Treasury was considering redefining the ring-fence on NHS spending to apply only to NHS England’s commissioning budgets, Cumming noted that the majority of money spent from HEE’s £4.9 billion budget went directly to NHS trusts that employed trainee junior doctors; any cuts would therefore have a direct impact on NHS provider organisations. Cumming estimated that between £3 billion and £3.5 billion of the budget directly funds NHS trusts, while the remaining indirectly funds NHS services and university undergraduate education.

NHS Confederation’s calls on the Government to reverse cuts to public health spending

The NHS Confederation has called on HM Treasury to outline a multi-year funding plan for the NHS in the upcoming Spending Review, providing certainty on healthcare funding over the next five years.

In its submission to HM Treasury’s consultation on the Spending Review, the organisation called on cuts to the public health grant to be reversed and sought assurances that at least £4 billion of additional funding will be available to the NHS by 2017/18. This follows on from the sudden announcement in June that the 2015/16 public health grant to local authorities would be reduced by £200 million.

Weekly political news round up – 18th September 2015

September 18, 2015 in News by Whitehouse

Health Select Committee holds evidence session on the work of Health Secretary Jeremy Hunt

The Health Select Committee held an evidence session yesterday on the work of the Health Secretary. The session saw evidence from Health Secretary Jeremy Hunt, as well as two Department of Health officials: David Williams, the Director General of Finance, Commercial and the NHS and Jon Rouse, Director General of Social Care, Local Government and Care Partnerships.

The committee interrogated Hunt about the wisdom of his intentions for seven day services and the practicality of implementing £22bn of efficiency savings by the end of this Parliament, along with what innovations will be made in primary care and new technologies across the NHS. Ultimately there were few new policy details given, besides further clarification of Hunt’s aims for seven day services in primary care, as well as a possible technology fund.

Hunt stressed during the session that the £22bn of efficiency savings per year by 2020, as identified in the Five Year Forward View, were the “biggest efficiency exercise in the NHS’s history”. He said that efficiencies could be made in procurement, the use of land, pay restraint and early diagnosis of costly conditions like cancer and diabetes. Hunt added that Lord Carter’s ongoing work into NHS productivity will see additional savings made.

Health think-tanks issue warnings over NHS financial challenges

Three leading health think-tanks – the King’s Fund, the Nuffield Trust and the Health Foundation – have issued warnings over the future of NHS finances in their submissions to the Spending Review due this autumn.

The King’s Fund said that the government’s commitment to increase the NHS budget by £8 billion a year by 2020, as identified in the Five Year Forward View, is welcome but constitutes the “absolute minimum” requirement to maintain standards of care. It added that it will not pay for new commitments such as seven day services, and that it is essential that the £8 billion is front-loaded from 2016/17 to avoid a decline in performance and quality. The King’s Fund also called for a dedicated transformation fund to pay for productivity improvements and support the development of new care models. It described the £22 billion of efficiency savings by 2020, also identified in the Five Year Forward View, as “hugely ambitious” and called on the NHS to engage staff at all levels to deliver better value at lower cost by changing the way that clinical care is delivered.

The Health Foundation argued that the current NHS model is not fundamentally unaffordable or unsustainable, but requires substantive reform to the delivery of care and the approach to improving productivity. It said that the task facing the government is to place the health service on a more sustainable footing in the longer-term, and that this required public and political consensus on longer-term funding levels and options for the NHS. It also claimed that it was “not clear” that the introduction of seven-day services would be cost effective.

The Nuffield Trust’s response noted that although the additional £8 billion per year is a “generous settlement in the context of wider spending cuts”, it will be outpaced by constantly rising health care costs and patient numbers, as well as a struggle to maintain standards. It identified that the Carter Review into NHS operational productivity outlined avenues for further efficiency savings, but said that other ways of making savings, such as curbs on pay and staff numbers, were approaching their limits. It warned that excessive focus on financial concerns could lead to a more regulated, top-down NHS that puts money above quality of care and also inhibits innovation.

HM Treasury may redefine the ring-fence on NHS spending to apply only to NHS England’s Commissioning budgets

The Health Service Journal has reported that senior figures from the Nuffield Trust and the King’s Fund have been given direct indications by government officials that the Treasury is redefining the ring-fence on NHS spending to apply only NHS England’s commissioning budgets, rather than to the entire Department of Health budget. This would mean that budgets for health organisations such as Public Health England and Health Education England are not protected by the Government’s commitment to increase NHS spending by £8 billion in real terms by 2020-21.

Nigel Edwards, Chief Executive at the Nuffield Trust, said this new definition would allow the Department of Health to remove money from training, public health, and research and development without breaching their promise on spending on the NHS. This, he said, was a departure from past practice where the Coalition Government defined its commitment to protect health spending in real terms as applying to the Department of Health’s total departmental expenditure limit (TDEL), and not only to NHS England.

In response to the comments, a Treasury spokesman said the Government has taken actions to protect the funding the NHS receives and increase the Department of Health’s budget in real terms year on year, and there are absolutely no plans to change this. He however did not respond to the Health Service Journal’s direct question about whether the commitment to an £8bn real terms increase applied to the Department of Health’s budget, or only to that of NHS England. The spokesman said the forthcoming Spending Review will set out how the Government will continue to invest in priority public services, including the NHS.

Weekly political news round up – 11th September 2015

September 11, 2015 in News by Whitehouse

Around the sector

The National Audit Office has produced a short guide to the Department of Health, which contains a series of infographics outlining the structure of the Department of Health, what it spends and how it spends it, as well as information on staffing levels, major programmes and developments and planned changes.

The Scottish Government has announced trials will be set up over the next two years looking at different ways to deliver primary and community care. First Minister Nicola Sturgeon announced that ten health centres in Scotland will form ‘community care teams’ and test different ways of delivering healthcare, including local surgeries working together, GPs and health professionals like physiotherapists working in multidisciplinary teams, and the provision of treatment that would ordinarily be provided by doctors.

Health Secretary Jeremy Hunt has told the Health Service Journal that an NHS provider’s mark of quality is the CQC rating that it has received, rather than whether it has foundation trust status. Hunt also revealed that he may seek to change the law to allow any trust that has been rated good or outstanding by the CQC to have foundation trust status.

Consumer healthcare champion Healthwatch England has announced that chief executive Katherine Rake will be leaving the organisation. A search for a replacement for Rake, a founding member of Healthwatch England, will begin shortly.

Data published by Network Rail has showed that train stations across the country are making hundreds of thousands of pounds each year from charging for public toilets. London Victoria made £2.3m from charging for toilets over the last three years, with Euston making £1.8m, and King’s Cross £1.4m. The article states that Liverpool Lime Street made a £200,000 profit from charging for toilets.

Answers to written questions on continence care

Labour MP Rosie Cooper, who is chair of the Continence Care APPG, has received answers to six written questions to the Health Secretary on continence care.

  • The first asked if he will take steps to ensure that the Care Quality Commission’s (CQC’s) regulatory standards include verification of continence care treatment standards in (a) hospitals and (b) care homes.

Public Health Minister Jane Ellison responded that a lack of adequate continence care could breach a number of CQC fundamental standards, including: ensuring treatment is tailored to patients need and preferences; ensuring patients are treated with dignity and respect; and ensuring that people do not suffer any form of abuse or improper treatment. She added that the CQC considers continence as part of its inspections “wherever appropriate”, and that if a specific concern over continence care is raised, then the inspection would focus on this issue in greater detail.

  • The second asked if he will direct NHS England to place an obligation on clinical commissioning groups (CCGs) to contractually deliver quality continence care in England.

Ellison responded that the responsibility for commissioning continence services sits with NHS England and CCGs. She said that the Mandate to NHS England requires it to deliver improvements to enhance the quality of life for people with long term conditions, including those with incontinence. She added that the dual responsibility should ensure continued improvements in the quality of continence care in England.

  • The third asked if there are plans to commission a national audit of continence care for young and elderly people.

Ellison responded that there are no plans to commission an audit of continence care for the young or elderly, but that the NHS England Excellence in Continence Care Programme Board will publish a commissioning framework to improve the commissioning of continence care services.

  • The fourth asked when the Department of Health will publish its Excellence in Continence Care Commissioning Framework.

Ellison responded that NHS England will published the framework by October 2015.

  • The fifth asked if he will take steps to ensure Public Health England promotes good continence care via a national awareness campaign.

Ellison responded that Public Health England recognises the impact that continence problems have and will ensure that all relevant public health programmes and public health nurse leadership programmes are aware of the impact.

  • The sixth asked what the average waiting time is for an assessment of patients with continence problems.

Ellison responded that this information is not held centrally.

Answer to oral question on variations in health outcomes for children under the age of five

Liberal Democrat Mental Health Spokesperson Baroness Tyler of Enfield has received an answer to oral question asking the Government what plans they have to tackle the variations in health outcomes nationwide for children under the age of five. When asking her question, Baroness Tyler made reference to the National Children’s Bureau report, Poor Beginnings, which found that child health outcomes are a postcode lottery.

Health Minister Lord Prior of Brampton responded that the Government is committed to giving every child the best start in life, noting that the variation identified in the report is “extremely important”. He added that it was up to local authorities to tackle variation, and that they will be heavily supported by Public Health England to do this.

Liberal Democrat Health Spokesperson Baroness Walmsley asked why the Government has decided that the collection of early years foundation stage profile data is no longer statutory, and asked how the Government will monitor the development of child development.

Lord Prior said that figures stating that 40% of children have not reached the right development age by the time they enter reception class is “serious” and that he will consider Baroness Walmsley’s comments.

Labour peer Lord Beecham asked what the Government’s response is to concerns by the Royal College of Nursing about the reduction in the number of school nurses. He asked what assurance the Minister can give that the reduction in the public health budget will not lead to a further reduction in the number of school nurses

Lord Prior responded that he had not seen these figures on school nurses but that he will look into the issue.

National Children’s Bureau publishes report on health inequalities amongst under-fives in England

The National Children’s Bureau has published a report on health inequalities amongst under-fives in the UK, focusing on four key metrics of young children’s health and wellbeing – obesity, tooth decay, injury and ‘school readiness’. The report, which was published in advance of the transferral of health visiting services to local authorities in October 2015, found that the health and development of children under five varies dramatically between different parts of England, with a child living in one area far more likely to be condemned to poor health than another living relatively close by. However, the report found that the link between growing up in a deprived area and poor health is not inevitable, as several areas have better than average child health despite being less prosperous.

Development and school readiness is measured using the Early Years Foundation Stage (EYFS), which sets out what constitutes a “good level of development” and states in particular that children must be able to use the toilet independently. The report noted that the North East had the lowest proportion of children reaching a good level of development by the end of reception (four to five years old), followed by the East Midlands and North West, with the South East and South West having the highest levels.

The report recommended that the Department for Education and Department of Health work together to produce a renewed early years strategy focusing on child health, and that Public Health England and the Department of Health investigates reasons for variation. It also recommended Government monitors the transfer of health visiting services to ensure local areas jointly commission early years provision effectively, and that the Government considers reviewing plans to replace the Early Years Foundation Stage profiles with the new baseline assessment for children starting school.

Weekly political news round up – 4th September 2015

September 4, 2015 in News by Whitehouse

Around the sector

Research published in the British Journal of General Practice has found that GPs are often unsure of their roles and responsibilities in supporting children with long-term conditions, despite seeing themselves as co-ordinators of their care. The research suggested that improving communication between services involved in caring for these patients would help clarify the role of GPs and boost their confidence. It also suggested that children with long-term conditions should have a named GP assigned to their family ‘at diagnosis’, who will take the lead on communicating with secondary care.

The Welsh Government has announced that Dr Ruth Hussey will be retiring as chief medical officer and medical director for Wales in spring 2016. The chief medical officer provides independent professional advice on health and care matters to Welsh ministers, with Dr Hussey recently leading work on the Public Health (Wales) Bill. A replacement will be announced in due course.

Department of Health launches consultation on draft national framework for children and young people’s continuing care

The Department of Health has launched a consultation on the draft national framework for children and young people’s continuing care. This draft framework provides an update on the 2010 edition, and provides guidance for clinical commissioning groups (CCGs) and local authorities on the process for assessing, deciding and agreeing packages of continuing care for children and young people (birth to 17 years), whose needs are long term and possibly resource intensive, and cannot be met by universal or specialised services.  It sets out the principles that should be followed by local commissioners, and has been updated to take into account changes in the commissioning system since 2012, as well the provisions of the Children and Families Act 2014.

The guidance comprises of three chapters: an introductory chapter focusing on the definition of continuing care and the responsibilities of CCGs; a step-by-step guide to making an assessment and decision; and the Children’s Decision Support tool to support the local determination of packages.

The draft framework states that CCGs are responsible for leading the process of identifying the continuing care needs of a child or young person for whom it has commissioning responsibility for. Where children require services commissioned by a local authority or other partners, the CCG is responsible for leading the process. The CCG is required to identify a named point of contact for the commissioning of the children and young people’s continuing care process.

As outlined in the draft decision support tool (available in chapter 3 and separately here), continence care is one of the 11 domains of care that health assessors should consider when assessing the needs of a child or young person. Assessors are required to consider how different but interrelated needs across more than one domain can complicate the child or young person’s overall care needs and result in sufficient complexity, intensity or risk to demonstrate continuing care needs. Specifically, it defines the following aspects of bladder and bowel dysfunction by level of need (low, moderate, high, priority – unchanged from 2010):

Low:

  • Continence care is routine on a day-to-day basis and age appropriate; or
  • incontinent of urine but managed by other means, for example, medication, regular toileting, pads, use of penile sheaths; or
  • is able to maintain full control over bowel movements or has a stable stoma, but may have occasional faecal incontinence; or
  • has a stoma requiring routine attention.

Moderate:

  • Doubly incontinent but care is routine; or
  • self-catheterisation; or
  • has a stable stoma but may have occasional faecal incontinence

High

  • Continence care is problematic and requires timely intervention by a skilled practitioner or trained carer; or
  • intermittent catheterisation by a trained carer or care worker; or
  • has a stoma that needs extensive attention every day

Priority

  • Requires peritoneal dialysis or haemodialysis to sustain life.

Nursing Times investigation finds school nursing services will face major upheaval

An investigation by the Nursing Times has found that various local authorities nationwide are currently drawing up specifications for a single public health service for 0 to 19 year olds, which will replace existing school nursing services and result in job losses for school nurses and other public health nursing staff. These plans are being developed ahead of the full transferral of public health commissioning to local authorities in October, when the responsibility for health visiting will be transferred.

Derbyshire County Council has proposed to cut its school nurse funding from £3.6m in 2014-15 to £3.1m in 2015-16 – a £500,000 reduction. Durham County Council has made plans to put its school nursing service out to tender as part of a proposed revised service for 0 to 19 year olds. Similarly, school nurses at Staffordshire and Stoke-on-Trent Partnership Trust are to face redundancy, with Ealing Council to cut school nursing services by 50% over the next three years. South Tees, Redcar and Cleveland Borough Council have decided to run their school nurse service in-house, with a view to redesigning services at a later point, as the contract retender process for school nursing services received no bids.

Sharon White, professional officer at the School and Public Health Nurses Association, described the cuts as “worrying” as “school nurses play a critical role in identifying, supporting and referring children to other services”. White said that local authorities were using external auditors who did not take into account qualitative information – including the views of children and young people and their families – when advising on the redesign of services.

Department of Health launches consultation on refreshing the Public Health Outcomes Framework

The Department of Health has launched a consultation on refreshing the Public Health Outcomes Framework. This framework provides a high level overview of public health outcomes, at a national and local level, supported by a broad set of indicators. These indicators cover the proportion of children achieving a good level of development by the end of reception, as well as other areas like life expectancy. They act as a tool for local transparency, accountability and benchmarking.

There are currently 68 public health indicators, with over 140 sub-indicators. There are two overarching indicators and 66 more focused indicators grouped into four domains: improving the wider determinants of health; health improvement; health protection; and healthcare public health and preventing premature mortality. A full list of indicators can be found here.

This consultation asks whether there are any significant gaps in policy priorities and asks for proposals for a small number of indicators and sub-indicators. It also asks which indicators no longer reflect a public health priority, and whether the Public Health Outcomes Framework, NHS Outcomes Framework and the Adult Social Care Outcomes Framework can be better aligned. This consultation will not consider calls for large numbers of new indicators, nor will it consider changes in the number and scope of the domains of the Public Health Outcomes Framework.

Scottish Government outlines policy and legislative priorities for 2015-16

The Scottish Government has published its Programme for Government, which sets out the policies, actions and legislation that it will take forward in 2015-16, including its plans for health.

A new national clinical strategy for the NHS in Scotland will be developed in the autumn, setting out an overall vision for the development of clinical services over the next 15 to 20 years, establishing how the health service can best support patients and how that change might be shaped at the national, regional and local level. This strategy will be subject to “wide engagement” with the health profession and patient groups.

A further £50 million will be invested in the Primary Care Fund, on top of the £10 million due to be invested by the end of 2015-16. The fund will enable GP practices to test new ways of working, as well as support a drive to recruit GPs and pharmacists, and ensure community-based services are delivered by an appropriate range of health and social care professionals. The Scottish Government will also test out new models of primary care in at least 10 sites across urban and rural Scotland, with the aim of enabling care as close to home as possible, delivery of care by a professional with the most appropriate skills, and a reduction in hospital admissions.

Other policy objectives include further investment in mental health services, regulation of private healthcare clinics providing services such as Botox, the introduction of an alcohol framework, the strengthening of whistleblowing arrangements, and a further investment in health visiting services of £41.6 million over four years.