Weekly political news round up – 30th October 2015

October 30, 2015 in News by Whitehouse

Around the sector

The Academy of Medical Royal Colleges has published a letter to Chancellor George Osborne calling on him to reverse the proposed £200 million cut to local authority public health budgets. The letter highlights analysis by the Faculty of Public Health suggesting that the knock-on cost to the NHS could be in excess of £1 billion. The letter has been co-signed by organisations like the Association of Directors of Public Health, the British Dental Association, and the Royal College of Nursing.

The Care Quality Commission has revealed that plans to inspect every general practice and out of hours primary care service in England by September 2016 are running behind schedule, and that further planning is required to confirm whether all independent health services can be inspected by the end of December 2016.

Research by the University of York’s Centre for Health Economics has found that the introduction of an electronic booking system for general practices making outpatient appointments resulted in a reduction in non-attendances by 15.8% and a reduction in referrals of 3% in 2009.

The Scottish Government has published a universal health visiting pathway in Scotland for pre-birth to pre-school, which presents a core home visiting programme to be offered to all families by health visitors as a minimum standard. It provides an outline of when each visit should be made, how long each visit should be, the purpose of each visit, national assessment tools to be utilised, and intended national/local outcomes. Core issues for each visit are outlined (how a child should grow up and develop, what is needed from the child’s carers, wider aspects of the child’s life, and their overall need for support).

Five north London CCGs – Camden, Islington, Barnet, Enfield and Haringey – have discussed forming a federation or joint committee to decide on issues such as the redesign of their primary care pathways to enable common standards and reduce variation, as well as acute services redesign and changes to mental health care provision. The CCGs said that they are considering a “potential north central London sub-regional London devolution application”, with a view to address a potential £408 million funding gap.

Shadow Health Secretary Heidi Alexander has revealed that although the NHS needs more than the £8 billion of additional funding by 2020 promised by the Government as part of the Five Year Forward View, she does not know how Labour would fund any further spending. Alexander added that she will need to discuss the matter with her colleagues in the shadow Treasury team and review the requirements of the NHS and care system.

Alexander has also appointed Ben Nunn as a new political advisor. Nunn’s role will focus on Labour’s health communications, but will also involve some policy work. Tom Whitney, who previously worked for former shadow health secretary Andy Burnham, will continue to advise her on policy

Answers to written questions on continence

Conservative MP Glyn Davies has received answers to four written questions on continence, which asked the Health Secretary:

  • What estimate his Department has made of the number of people with (a) urinary incontinence and (b) faecal incontinence in England.
  • What steps his Department is taking to improve the quality of care provided for people with incontinence in the UK.
  • What progress his Department has made on raising awareness and promoting understanding of incontinence amongst (a) health and social care staff and (b) the general public; and if he will make a statement.
  • What estimate his Department has made of the number of people living with (a) urinary incontinence and (b) faecal incontinence in (i) Northern Ireland, (ii) Scotland and (iii) Wales.

Public Health Minister Jane Ellison responded that a 2008 survey by the Bladder and Bowel Foundation found that there are over 14 million adults with bladder problems and 6.5 million with bowel problems in the United Kingdom. She added that the Department of Health does not collect information specific to Northern Ireland, Scotland and Wales as this is a matter for the devolved administrations.

She said that the Healthcare Quality Improvement Partnership (2010) found that the best clinical outcomes are achieved through providing integrated continence services across primary, secondary and care home settings. She said that its study also found that there is an ‘urgent need’ for improved practice for those with continence problems through the development of commissioning frameworks, evidence-based training for health professionals and patient empowerment. She outlined the benefits of integrated provision:

  • A better quality of life and more independence
  • Less reliance on pads and products by using alternative treatments
  • A reduction in admissions to hospitals and care homes
  • Fewer complications such as UTIs, faecal impact and skin breakdown
  • A reduction in costs.

Ellison said that the NHS England Excellence in Continence Care Programme Board’s commissioning framework, due to be published during 16th November during Self Care Week, will enable commissioners to work in collaboration with providers to address shortfalls in continence care. She said that the framework, which has been produced in partnership with patient and public advocates, clinicians and partners from the third sector.

Ellison highlighted that this will supplement existing NICE guidance on urinary incontinence, faecal incontinence, and lower urinary tract symptoms in men.

Department of Health launches consultation on the Government’s mandate to NHS England to 2020

The Department of Health has launched a consultation on the principles for the Government’s 2016/17 mandate to NHS England, which will set out the Government’s objectives for NHS England, as well as its budget. The consultation document sets out, at a high level, how the Government proposes to set the mandate to NHS England for this parliament, with the mandate itself due to be finalised in light of consultations and subject to the outcome of the spending review on 25th November.

The document sets out the Government’s main priorities for the health and care system as a whole, which are:

  • Preventing ill health and supporting people to live healthier lives – tackling obesity and preventable illness, and improving the quality of life for people with long-term conditions such as diabetes and dementia
  • Creating the safest, highest quality health and care service – securing high quality health and care services and 7-day hospital care
  • Maintaining and improving performance against core standards while achieving financial balance – ensuring the NHS meets the needs of patients and operates within its budget
  • Transforming out-of-hospital care, ensuring services outside hospital are more integrated and accessible – by 2020, every patient has routine access to a GP in the evenings and at weekends, as well as effective 24/7 access to urgent care
  • Driving improvements in efficiency and productivity – reducing waste of inefficiency
  • Supporting research, innovation and growth – influencing global health priorities

The overarching ambition within the mandate is to improve outcomes. It states that the mandate will make clear that NHS England should work with CCGs to reduce variations in care quality and outcomes at a local level. It notes that work is underway with health think-tank the King’s Fund to develop a new scorecard to provide transparency about comparative quality of care and outcomes for different CCG populations. It establishes that by 2020, the Government wants to see improvements across all parts of the NHS Outcomes Framework, together with reduced variation in quality at a CCG population level.

The document outlines the mandates core aims: setting NHS England’s contributions to the goals above, in line with the Government’s manifesto commitments; endorsing NHS England’s Five Year Forward View; increasing public accessibility to the mandate; and establishing CCG budget allocations for three or more years.

Health Select Committee launches inquiry into public health post-2013

The Health Select Committee has launched a short inquiry into the Health and Social Care Act 2012 reforms on public health since 2013.

The Committee will look at the impact of the structural changes at an overarching level, and is likely to consider in particular:

• The delivery of public health functions
• The effectiveness of local authorities in delivering the envisaged improvements to public health
• The public health workforce
• Public health spending

The Committee also plans to hold a small number of individual “case study” evidence sessions, focusing in greater depth on specific service areas or aspects of public health provision.

Weekly political news round up – 23rd October 2015

October 23, 2015 in News by Whitehouse

Around the sector

The Institute for Health Visiting has published advice for local authorities on the role of health visitors and opportunities for them to contribute to the prevention of ill health. It outlines that health visitors are the most common avenue for parents to turn to for support, stressing that health visitors are available for everyone rather than those ‘at risk’. The briefing also highlights the value that health visitors play in the early identification of additional needs and extra support.

Children’s charity 4Children, which is the Department for Education’s strategic partner, has published research showing that 64% of 1,000 children’s centres questioned have had their budgets cut this financial year. The research also found that 130 children’s centres are at risk of closure.

Tabled written questions on continence

Conservative MP Glyn Davies has tabled four written questions on continence, asking the Health Secretary:

  • What estimate his Department has made of the number of people with (a) urinary incontinence and (b) faecal incontinence in England.
  • What steps his Department is taking to improve the quality of care provided for people with incontinence in the UK.
  • What progress his Department has made on raising awareness and promoting understanding of incontinence amongst (a) health and social care staff and (b) the general public; and if he will make a statement.
  • What estimate his Department has made of the number of people living with (a) urinary incontinence and (b) faecal incontinence in (i) Northern Ireland, (ii) Scotland and (iii) Wales.

Westminster Hall debate on accessible toilet availability

A Westminster Hall debate was held this week on accessible toilet availability for disabled or incontinent adults and older children. The debate, which was secured by Labour MP Toby Perkins, focused largely on the provision of Changing Places toilets; which are larger than standard accessible toilets and have extra features such as large bins, changing benches and non-slip floors.

Perkins’ speech highlighted that families of children with continence problems have to organise family outings based on whether there are sufficient toileting facilities in the vicinity of where they are travelling. He added that 900,000 children have continence problems – many of whom are not considered disabled, but still require appropriate space for changing.

Perkins said that providing good toilet access is a “moral obligation that we have as a civilised society to disabled people and their families”, and that poor general access to Changing Places toilets had health-related cost implications, and also impacted on tourism. Perkins subsequently asked the minister whether the Government has any plans to amend building relations to make changing places toilets mandatory in large public buildings, and whether it would investigate setting up a fund to subsidise the construction of these toilets.

SNP Health Spokesperson Dr Philippa Whitford commented that a high number of people will be affected by poor access to high-quality toilets in the future, given that the UK is facing ageing population with a rising number of people with stomas and “other problems of urinary and faecal support”.

Communities Minister Marcus Jones responded that the Government recognised the importance of accessible toilets for disabled people, and that most people take their availability for granted. He stressed that any new Changing Places toilets must be placed strategically rather than widely, as building a Changing Places toilet in the wrong location would be a “missed opportunity”. However, he said that the Department for Communities and Local Government (DCLG) has commissioned research into how well toilet provision in building regulations is working, which includes specific reference to the need for Changing Places Toilets. He said that the Government will consider reviewing current guidance in light of the research.

King’s Fund survey finds that NHS trust finance directors and CCG leads agree local authority cuts impacting on their local health economy

A survey by influential health think-tank the King’s Fund of 90 NHS trust finance directors, and 50 CCG finance leads has found that 88% and 80% respectively agreed that cuts to local authorities have adversely affected their local health economy. One CCG which responded complained of disinvestment in public health and increased pressure on NHS-funded continuing care. The CCG also said that there is “no real partnership working in evidence”, with local authorities free to close services with no threat of scrutiny; however there is intense scrutiny from local authorities of disinvestment plans made by CCGs. A second CCG said that cuts are leading to some “very concerning financial driven decision-making, which is against the strategic direction of the health and social care system”.

NHS England chief executive Simon Stevens discusses NHS finances and the autumn spending review

At the NHS England 2015 annual general meeting this week, NHS England chief executive Simon Stevens outlined five tests to assess whether the autumn spending review on 25th November has delivered for the NHS.

The first test will be whether the £8 billion a year by 2020 promised by the Government as part of the NHS Five Year Forward View will be front loaded. This links in with the second test, which is whether the Government’s “new asks” – such as 7 day GP services – are “consistent with the phasing of the new investment”. Stevens warned that failure to front load the additional funds will lead to the Government delaying the implementation of these “new asks”.

The third test will be whether the NHS receives “continuing political support” for the “realistic but broad set” of the £22 billion of efficiencies due to be made in the next few years. The fourth relates to social care funding, and the fifth relates to tackling obesity.

NHS clinical commissioning group membership organisation calls for more support to deliver the Five Year Forward View

NHS Clinical Commissioners, a membership organisation of clinical commissioning groups (CCGs), has developed a series of five key asks for policymakers to help give CCGs the freedoms and flexibilities they need to transform local healthcare and focus on the big issues: sickness prevention, health inequality and healthcare targeted to the needs of the patient.

The document, Local solutions to national challenges, outlines that CCGs should be freed from centralised reporting in order to work to prioritise local population health, and that there should be recognition that diverse geographies need diverse local solutions such as developing health and wellbeing boards and developing co-commissioning. It criticises the “top-down” approach of NHS England, stating that CCGs need a more collaborative partnership with national bodies, and that some CCGs need practical support for area such as IT. The document also calls for better financial stability for CCGs.

Lord Carter of Coles contacts 137 hospital trusts to outline individual savings targets

Labour peer Lord Carter of Coles, who is chair of the NHS Procurement and Efficiency Board, has contacted 137 hospital trusts to provide them with individual savings targets as part of his review into NHS operational productivity and efficiency. Carter will spend the next six weeks visiting key figures in hospital trusts to discuss the targets, before they are made public.

Lord Carter has also broken down savings by speciality, enabling a benchmark for what each hospital should be doing in each department. The breakdown can be found below:

  • General medicine £381m
  • Obstetrics and gynaecology £362m
  • Trauma and orthopaedics £286m
  • Pathology £256m
  • Cancer services £255m
  • Emergency medicine £254m
  • General surgery £235m
  • Community nursing £217m
  • High cost drugs £213m
  • Paediatrics £209m

Lord Carter’s interim report, published in June, found that £5 billion a year could be saved by 2019/20. It found wide variation in spending across medicines, items such as dressings and syringes, facilities and utilisation of staff.

Paediatric Continence Commissioning Guide – updated October 2015

October 19, 2015 in News by Whitehouse

The PCF has developed a tool to support the commissioning of integrated,community-based, paediatric continence services, called the Paediatric Continence Commissioning Guide.

The Paediatric Continence Commissioning Guide has been accredited by the National Institute of Health and Care Excellence (NICE), and endorsed by the Royal College of Nursing (RCN), the Royal College of Paediatrics and Child Health (RCPCH) and the Community Practitioners’ and Health Visitors’ Association (CPHVA).

Initially published in September 2014, it has been updated following its interim review. The updated document can be found here.

Weekly political news round up – 16th October 2015

October 16, 2015 in News by Whitehouse

Around the sector

NICE chairman Professor David Haslam told delegates at the NICE annual conference in Liverpool on Tuesday that although NICE guidance represents the ‘gold standard’ of treatment and that health care professionals should take it ‘very seriously’, it ‘may not be appropriate for every patient’. He said that guidance is not intended to ‘replace a doctor’s clinical judgement’ or the joint decisions that they make with their patients about their specific needs. He added that NICE’s role is to ensure clinicians and social care professionals are supported to give the best care to people.

Professor Haslam also gave an interview to GPonline during the NICE annual conference in which he revealed that NICE will invite GPs to establish a specialist advisory group to communicate the biggest problems with the NICE guidance system. The group will also explore how to make guidelines more accessible, how to allow GPs to contribute more to guidelines and if NICE should establish a GP ‘jury’ to help finalise guidelines.  Haslam said that a list of potential GP members – who are independent of NICE – have already been identified and will be invited to join the group shortly.

The Department for Education has published the early years foundation stage profile (EYFSP) results for the 2014 to 2015 academic year, showing that 66.3% of children achieved a good level of development – an increase of 5.9% on 2014. The statistics also showed that a record 91.2% of all children have achieved the early learning goal for health and self-care, which includes a requirement for children to manage their own basic hygiene and personal needs successfully, including dressing and going to the toilet independently

Ofsted has revealed a correlation between early years inspection outcomes and the proportion of staff within each setting who are qualified to level three (the equivalent of an A Level). The study found that settings with 75% or more staff qualified to level or three or above tended to perform better in Ofsted inspections than those with 75% that do not have the same qualifications. 14% of providers receiving an ‘outstanding’ rating had 75% or more staff at level three or above, compared to 8% for the other group. The difference was significantly smaller for providers with a ‘good’ rating – 71% compared to 69%.

Written parliamentary questions on continence care and commissioning

Conservative MP Henry Smith has received answers to three written questions to the Health Secretary on continence care and commissioning.

  • The first asked what discussions he has had with NHS England regarding (a) commissioning of continence services and (b) guidelines for continence services

Public Health Minister Jane Ellison responded that the Health Secretary meets with representatives from NHS England regularly to discuss a wide range of issues, including the commissioning of local NHS services.

  • The second asked how many catheter associated urinary tract infection related deaths there were in the last three years

Ellison responded that the information is not available in the format requested.

  • The third asked how many people were admitted to hospital as an emergency case with acute retention of urine due to a blocked Foley catheter in the last three years.

Ellison responded that this information is not available centrally as Hospital Episode Statistics cannot identify blocked catheters or the type of catheter used.

Ofsted and Care Quality Commission launches consultation on SEND inspections

Ofsted and the Care Quality Commission (CQC) have announced that local public services are to be assessed on how well they fulfil their responsibilities to children with special educational needs and disabilities (SEND). The new form of inspection will begin in May 2016. For the first time, inspectors from Ofsted and the CQC will evaluate how local authorities, nurseries, schools, further education establishments, and health services identify children and young people with SEND. They will also evaluate how well they provide services to meet these needs in nurseries, schools and further education colleges, and through specialist services, such as speech and language therapy, physiotherapy and mental health services. Local areas will not receive an overall graded judgement, but reports will include recommendations and priority areas for improvement. The inspection reports will also highlight particular strengths and good practice in local areas, to encourage other areas to model similar practices.

In relation to this announcement, a consultation has been jointly launched by Ofsted and the Care Quality Commission. It sets out the principles under which the two inspectorates propose to undertake these joint inspections, and seeks views on a number of suggested approaches. The consultation asks for responses to the following proposals for the following inspection methodologies:

  • Proposal 1 Inspectors will evaluate how effectively the local area identifies disabled children and young people and those who have SEN. This will take into account factors such as the timeliness of assessment and identification, information provided from an assessment in helping to understand a child’s needs, how well the child and parent/carers were involved in the assessment, and how whether educational professionals worked well together during their assessments.
  • Proposal 2 – Inspectors will evaluate how effectively the local area meets the needs and improves the outcomes of disabled children and young people and those with SEN. This evaluation will include children and young people’s progress towards their next stage of education or employment, independent living, participating in society and being as healthy as possible. It will take into account how satisfied children and parents/carers are that their needs are being met.
  • Proposal 3 – A wide range of information will be used to evaluate the effectiveness of local area arrangements: this will include the views of children and young people, parents and carers, recent inspection reports and visits to a number of local education and health service providers
  • Proposal 4 – A wide range of approaches will be used during the inspection to obtain the views of disabled children and young people, and their parents and carers, including meetings, online questionnaires and social media

Ofsted and the CQC are seeking the views from all those with an interest in SEND. The consultation will close on 4 January 2016. The outcome of the consultation will be published in early 2016.

NHS England chief executive Simon Stevens address Kings Fund’s Integrating Care conference

NHS England chief executive Simon Stevens addressed the Kings Fund’s Integrating Care conference on Tuesday, in which he discussed the November Spending Review as well as the latest NHS foundation and non-foundation trust quarterly finance reports which showed large deficits.

Stevens said that any money made available to the NHS in the November Spending Review will only be available to organisations that plan collaboratively on population health-orientated geographically-based partnerships, making four-year plans with delivery milestones from 2016 to 2020. He added that the Spending Review announcement will be an opportunity to “move away from transactional payment approaches”, and get organisations to plan in health economics to 2020.

Stevens also said that “if we lose control of our finances, we lose control of our destiny”. He said that provider overspends are caused by increased workforce costs, rather than unexpected emergency demand.

Dr Arvind Madan appointed as NHS England’s director of primary care

NHS England chief executive Simon Stevens has announced the appointment of Dr Arvind Madan as NHS England’s new director of primary care. Dr Madan is currently a practising GP at the Hurley Group, a large multi-site general practice and urgent care provider. In his new role, he will also serve as a deputy national medical director to Sir Bruce Keogh.

Stevens also announced that Cally Palmer has been appointed as NHS England’s national cancer director, and that Dr Jonathan Fielden has been appointed as NHS England’s new director of specialised commissioning.

Stevens commented that these appointments will help “turbo-charge” the implementation of the Five Year Forward View.

Shadow Health Secretary Heidi Alexander asks urgent question on NHS financial performance

Shadow Health Secretary Heidi Alexander asked an urgent question to the Health Secretary on Monday, on whether he would make a statement on the financial performance of the NHS in light of the publication of the first quarterly financial results of NHS foundation trusts and other NHS trusts which showed an increase in the overall level of spending deficit.

Care Quality Minister Ben Gummer responded that the financial position of the NHS is “undoubtedly challenging”, but noted that the Government has promised an extra £8 billion for the NHS by 2020 in order to help address the £30 billion resource gap identified in the Five Year Forward View. He said that efficiency savings must also be made, specifically with agency staffing and mandatory central agreements.

Alexander quizzed Gummer whether it is possible to deliver safe patient care whilst also making savings. She also asked how the Government will fund seven day services.

Gummer responded that there are numerous NHS trusts which have balanced their books whilst also providing good patient care. He also rejected claims that the Government is not providing the NHS with enough funding, stating that the Government provided the NHS with an extra £2 billion in the autumn statement last year – £300 million more than was requested.

Conservative MP Helen Whately, who is also a member of the Health Select Committee, commented that the NHS could and should make better use of its resources through better procurement, the use of technology and the employment of permanent staff. She asked what steps the Government is taking to drive the pace and scale of the changes.

Gummer responded that it would be a “dereliction of duty” to “pour money” into an unreformed system. He said that the Government needs to move at pace to bring in the changes necessary to transform the health system.

Other MPs raised questions covering areas like mental health, social care, GDP spending on healthcare compared with other countries, regulation by the Professional Standards Authority, A&E waiting lists, training places for local nurses and doctors, PFI contracts, and local issues. Gummer did not directly answer a question by Health Select Committee chair Dr Sarah Wollaston on whether the £8 billion of extra funding would be front loaded.

Care Quality Commission publishes annual State of Care report on the health services it inspects

Healthcare regulator the Care Quality Commission (CQC) has published its annual report on the state of the health and social care services that it inspects, which highlighted the adverse impact of increasing budgetary pressures on the quality of care but stressed the importance of strong leadership. The report did not explicitly reference continence, but did reference high-level issues of relevance such as patient safety and primary medical services.

The CQC identified safety as its greatest concern, and was critical of the 6% of primary medical services which were rated as inadequate for safety. The report highlighted that there are a substantial number of services that have been rated as requiring improvement for safety, because there is more they could do to ensure a better safety culture.

The report expressed concern about the high number of services that have been rated inadequate, totalling 7% of all inspections across primary care, secondary care and mental health. It also identified large differences in the quality of care they receive – both between different services from the same provide rand between different providers.

An assessment of primary medical services found that there is a need for GP practices to review access to medical advice and treatment to ensure that they are in line with patient’s needs. The report also noted that GP practices deliver a better quality of care when they share learning and provide joined up care through multi-professional networks.

The report stressed that improvements can be made, emphasising that re-inspections after six months have found improvements in the quality of care, and that surveys of providers stated that they found that CQC reports to be useful. The report also stated that care be provided despite financial limitations, provided there is excellent leadership.

2015 NICE Shared Learning Award given for work on the management of urinary incontinence in women

Royal Cornwall Hospitals NHS Trust has won the 2015 NICE Shared Learning Award for its work on improving the management of urinary incontinence in women.

NICE said that the trust had conducted an audit of care which found that its provision of treatment had been “irregular and inconsistent”, did not follow NICE guidance, and had an overly complex referral pathway. The trust subsequently developed an ‘easy step guide’ for referral to simplify the pathway, also arranging teaching sessions with GPs every six months, and introduced a rolling annual audit on compliance with NICE guidance. A multidisciplinary team was also set up to ensure reviews of surgery or invasive treatment, in accordance with NICE advice.

The increased compliance led to less unnecessary urodynamic testing before conservative management, and in turn less physical and emotional stress for patients.

Report criticises ‘fragmented’ SEND system

A new report, written by the education think-tank LKMco and commissioned by the Driver Youth Trust, has warned that provisions for young people with SEND are becoming fragmented – despite reforms which aimed to provide a “simpler and more joined up” system.

The reports, The Joining the Dots, outlines a number of changes since 2010 that have affected children with SEND and their families, including the Academies Act 2010, which enabled more schools in England to become academies, free from local authority control, as well as changes in 2012 aimed at ending disparities in school funding. Additionally, in September 2014, a new SEND code of practice came into force in England, with the stated aim of putting pupils at the centre of their education planning. “The dominant rhetoric behind reform has been that of “autonomy”,” says the report. “Autonomy allows new players to work with schools and some provision has improved substantially as a result. Yet an autonomous environment is also a risky one: in relation to SEND we find that while some schools have thrived, others are struggling to provide high-quality teaching and additional support for their learners.”

The report was particularly critical of many Local Offers – which are supposed to provide comprehensive information on local provision for pupils with SEND – and accuses a number of local authorities of publishing inadequate information on provision for children with SEND. Analysis found that a quarter of councils’ published Local Offers were “unfinished or incomplete”.

The report makes 22 recommendations, which include:

  • Changes to initial teacher training to ensure newly qualified teachers can support SEND pupils
  • Regional School Commissioners monitoring SEND information reports and identifying schools that need support
  • School leaders making it clear that SEND pupils’ achievement is a whole school priority rather than just the domain of specialist staff
  • The National Audit Office commissioning a full evaluation of Local Offer policy and practice
  • The Department for Education introducing an annual SEND award with a prize to celebrate schools that make effective use of SEND funding.

The paper also recommends that Ofsted should have further powers to check on how schools are helping pupils with SEND. The Ofsted framework now explicitly states that inspectors will consider the progress of SEND pupils in schools, but the Driver Youth Trust wants inspectors to be able to commission a review of how SEND funding is spent in an individual school if necessary, in the same way that they can commission a review of pupil premium funding in a school to find improved approaches. In order to do this, the report recommends that all inspectors receive training on identifying SEND good practice or use specialists as part of inspection teams.

Weekly political news round up – 9th October 2015

October 9, 2015 in News by Whitehouse

Around the sector

Healthcare regulators Monitor and the Trust Development Authority have published their quarterly performance reports on NHS foundation trusts and non-foundation NHS trusts (available here and here), which show a deficit of £930 million for the first three months of the financial year (April to June 2015) – more than their entire overspend last year. Commenting on the financial and operational pressures facing NHS foundation trusts, Monitor described the current level of deficit as “not affordable”, with the regulator due to work with national partners to provide “intensive support” to mitigate the risks that they currently face.

Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, has rejected claims that funding shortages are to blame for substandard care and called on doctors and nurses to “step up to the plate” to help address a lack of leadership in the NHS. Sir Mike said that if he was given a choice between better leadership or more money, he would choose better leadership, as this would be a “major contribution” to dealing with the financial problem. He added that the best performing trusts were the ones with no difficulty getting clinicians to take on leadership roles.

The Royal College of Nursing has published the results of a survey of nurses, which found that 56% of respondents believed that they spend too much time on non-nursing duties, with 59% saying that they are too busy to provide the level of care that they would like. The survey also found disillusionment amongst nurses with their career, with 45% stating that they would recommend nursing as a career, 31% stating that they are seeking a new job, and 25% looking to leave health care completely.

The Department of Health has announced the appointment of Jim Mackey as chief executive of NHS Improvement, which was created earlier this year to merge the functions of healthcare regulators Monitor and the Trust Development Authority into a single body. NHS Improvement will now act as the single regulator for foundation and non-foundation trusts, and is unrelated in function to previous NHS bodies with the same name. Mackey is currently chief executive of Northumbria Healthcare NHS Foundation Trust and will take up his position full time from 1st November 2015.

Conservative Party Conference 2015: news round up

This week the Conservatives held their annual party conference in Manchester, which speeches from Health Secretary Jeremy Hunt and Education Secretary Nicky Morgan – summaries of which can be found below:

Health – Health Secretary Jeremy Hunt

Jeremy Hunt addressed the conference on Tuesday, giving a short speech stressing continuity in approach.

Hunt’s speech focused on high level issues. He suggested that safer care is more cost effective, and that the NHS should eliminate unsafe care and make efficiencies whilst raising standards at the same time. He referenced the £750m scheme to improve primary care premises and technology to allow practices to expand and modernise.

Hunt also implied that he will be focusing more on avoidable deaths as well as the weekend effect (where patients admitted to hospital during the weekend are more likely to die than those admitted during the week), arguing that while the estimated 200 avoidable deaths in NHS hospitals each week is not bad by international comparisons, more could be done to tackle it. He reiterated his previous emphasis on eliminating the blame culture from the NHS and making it easier for staff to report examples of poor care to improve standards.

Hunt also said that junior doctors must work with the Government to address the pay-related issues arising from proposed changes to their contracts, as well as discussing 7 day GP services, local authority work in supporting social care and public health programmes, and the MyNHS website, which will show how good local GP surgeries are, how safe local hospitals are and so on.

Education – Education Secretary Nicky Morgan

Nicky Morgan also delivered her conference address on Tuesday, in which she criticised, the newly appointed Shadow Education Secretary, Lucy Powell’s to place schools back under local authority supervision. Morgan also announced that parents will be given the right to request that schools provide childcare for the full working day during term time and in the holidays, with schools being obliged to take “reasonable steps” to ensure that such care is supplied.

Morgan’s speech also addressed areas such as academic standards, the ability of head teachers in good and outstanding schools to exercising freedom in running their schools, the expansion of free schools, as well as praise for teachers and other education staff.

NHS England launches consultation on two public engagement documents

NHS England has launched a consultation on two documents: a draft over-arching patient and public participation policy, and a draft accompanying statement of arrangements and guidance for involving the public in commissioning. The development of these documents will be overseen by the Task and Finish Group, chaired by Lord Victor Adebowale.

The first document is for patients and the public, and for NHS England staff, and broadly outlines NHS England’s approach to participation. It states that relationships with the public will be treated with equality and respect, NHS England will proactively seek participation, bring all talents to the table, respect beliefs and opinions, recognise contributions, and use plain language to share information. It also states that NHS England will look at what has worked in the past, give feedback as soon as possible and give thought to planning.

The second document is for NHS England staff, and for the public to understand how NHS England involves them in the commissioning of services. It outlines the core set of involvement initiatives, including frameworks for patient and public participation for each of NHS England’s commissioning responsibilities, avenues of reaching different communities (NHS England Youth Forum, the Equality Delivery System, Healthwatch England, CCG Lay members, and so on). It outlines how NHS England uses insight to influence commissioning, such as the GP Patient Survey, the inpatient survey, Patient Reported Outcome Measures (PROMS), the Friends and Family Test, and so on. It also outlines the monitoring arrangements for NHS England to determine when and where patient and public involvement is necessary, for example, if there are plans being developed to reconfigure or transform services. It states that patient involvement is more likely if there is a high likelihood and severity of impact on the public, outlining that public involvement should not typically be a stand-alone exercise (e.g. a formal consultation open for 12 weeks), but should involve ongoing dialogue.

The document also outlines the corporate infrastructure for public involvement in governance (board meetings and committees) and communication with the patients (newsletter, NHS England’s website, and social media). Flow charts of the public involvement assessment process, the public involvement assessment form and a case study outlining NHS England’s consideration process for public engagement are included as appendices.

Weekly political news round up – 2nd October 2015

October 2, 2015 in News by Whitehouse

Around the sector

The Department of Health has published guidance for local authorities on the commissioning of public health services for children aged 0-5. The guidance explains regulations for the mandatory delivery of the five key child development reviews as set out in the Healthy Child Programme, which are: antenatal health visits, new baby reviews, the six to eight week assessment, the one year assessment, and the two to two and a half year review.

BBC News has reported that NHS regulators Monitor (which focuses on foundation trusts) and the Trust Development Authority (which looks at non-foundation trusts) have delayed publishing their financial information for the first financial quarter of April to June 2015 as “the figures need more work”. The article highlighted that the latest figures indicate that foundation trusts have a deficit of £249m, with non-foundation trusts facing a deficit of £800m.

Community and Social Care Minister Alistair Burt has emphasised to GPonline that the Government will provide further investment in primary care, particularly general practice, to help it fulfil its obligations and redress its balance between secondary care.

Labour Party Annual Conference: news round up

The Labour Party held its 2015 annual conference in Brighton this week, which heard speeches from newly elected Labour leader Jeremy Corbyn and members of his shadow government – in particular Shadow Health Secretary Heidi Alexander and Shadow Education Secretary Lucy Powell. Below is an overview of the relevant aspects of the speeches by latter two.

Shadow Health Secretary Heidi Alexander

Alexander’s speech to the Labour Party conference – her first major one since being appointed to her role earlier this month – was light on policy and high on rhetoric. She said that the NHS is in “deep trouble” and implied that she will campaign for immediate increases to NHS funding as a way of addressing the £30 billion resource gap identified in the Five Year Forward View, rather than supporting the £22billion efficiency savings target. Alexander said that efficiency savings meant cuts to staff and wages, as well as the rationing of treatments.

She added that there is a need for a “strong and united opposition” to provide alternative to the Government’s plans for the NHS, and warned Health Secretary Jeremy Hunt that if he pushed plans forward to put patient care at risk he would face the “fight of his life”.

Alexander also emphasised that politicians have a duty of care to NHS staff, claimed that the NHS is “not for sale” to private providers, and called for an increased emphasis on mental health services and social care provision.

Shadow Education Secretary Lucy Powell

Powell emphasised in her speech that education is at the heart of Labour’s vision for a better society and that there is no better way to give every child a great start in life. She criticised Education Secretary Nicky Morgan, who she said “hasn’t had a new idea in a long time”, and said that the Conservatives are stuck in “old ideological thinking” when it came to the classroom. She added that Labour will ensure strong local oversight and accountability of all schools, including academies.

Powell also discussed free schools, the potential reintroduction of grammar schools, school places, childcare, and post-16 education.

Local Government Association publishes resource for local authorities on commissioning public health services for children aged 0-5

The Local Government Association has published an overview of the work that is being done locally and nationally to safely transfer 0-5 public health commissioning from NHS England to local authorities. It also offers questions for local authorities to consider when commissioning these services.

The document highlights that NHS England has been working with local authorities to identify service expenditure levels, with the Department of Health (DH) subsequently published funding allocations for local authorities. These allocations are not rigid, with the DH stating that they may engage in local conversations about in-year adjustments as a result of local circumstances. The DH also stressed the importance of moving public health funding towards a need based model rather than historic spend model, and has commissioned the Advisory Committee on Resource Allocation to develop a needs-based funding formula as part of a wider public health grant – applicable from 2016/17.

The document states that health and wellbeing boards should use the opportunity to take a “fresh look” at their local vision for the health and wellbeing of babies and young children to ensure that the transfer adds value to local efforts to address health inequalities. The report states that they will need to evaluate the current services landscape and decide on the specific role that health visiting will play and how this can be integrated with other services to improve and protect the child health.

The resource argues that CCGs, children’s services, public health and NHS England must work together to ensure commissioning is joined up and that there is a strong focus on prevention and early intervention. Particularly, they must ensure that the needs of 0 to 5 children are reflected in the Joint Strategic Needs Assessment, that the commissioning strategy for health visiting and Family Nurse Partnerships is embedded as part of the Joint Health and Wellbeing Strategy and that the health and wellbeing board takes a proactive approach to the health of babies, very young children and their families. Similarly local authorities should to develop a whole systems approach to join up services to support young children and school-aged children aged 5 to 19 years and their families through the delivery of integrated pathways, using a range of competent and skilled practitioners such as early years staff, health visitors, midwives, family nurses and school nurses.

The checklist of questions for local authorities asks them whether they have considered their future commissioning strategy, whether they have appointed a lead for overseeing the transfer beyond 2014, whether commissioning arrangements reflect NICE guidance, and whether they are familiar with the roles of health visitors and family nurses.