Weekly political news round up – 27th November 2015

November 29, 2015 in News by Whitehouse

Around the sector

The National Children’s Bureau has launched a website for children and young people providing a guide to their rights under the NHS Constitution and videos explaining the importance of applying those rights in practice. It was developed with the input of over 100 children and young people – including disabled children, and those with long term conditions, mental health issues and those in local authority care. The website was funded by the Department of Health.

Forthcoming events

The Welsh Health and Social Care Committee will publish its report on the general principles of the Public Health (Wales) Bill on Monday 30th November.

Spending Review and Autumn Statement 2015

Chancellor George Osborne this week delivered the Autumn Statement and Spending Review to Parliament. The Autumn Statement is the government’s second annual update on its taxation and spending plans. The Spending Review provides a five-year view of the government’s spending plans, setting the budgets for all the government departments. This is the first time that both have been set out in one speech since 2007.

Osborne revealed that the deficit has decreased to 3.9% of national income for this year, falling to 2.5% next year, 1.2% in 2017/18 and reaching a surplus of 0.5% of national income in 2019/20. The UK will borrow £73.5bn this year, then £49.9bn next year, £24.8bn in 2017/18 and reaching a surplus by 2019/20. The UK will grow 2.4% this year, with a prediction of 2.4% in 2016 and 2.5% in 2017.

Ahead of the Spending Review, each government department was asked to model for cuts of between 25% and 40%, with agreements reached over the past week.

Health

As announced earlier this week, NHS England will receive a frontloaded £3.8 billion next year from the £8 billion promised by the Government in the Summer Budget, on top of the extra £2 billion announced in last year’s autumn statement – a total close to £6 billion. The Spending Review document noted that this will help deliver seven day services in primary care and in hospitals.

Part of the additional funding will come from within other areas of the Department of Health, with the Chancellor announcing in his speech that there will be a 25% cut to central department spending (although this has been calculated by health think-tank the Health Foundation to be closer to a 21% cut in real terms). Health Education England, responsible for the education and training of health professionals, will receive a budget cut of £1.2 billion, part of which will be made up of converting bursaries for nurses into student loans.

The Spending Review outlined that the £200 million cuts to the public health grant will continue over the next five years, with the ringfence on spending maintained for at least the two next years. The Government intends to consult on options to fully fund local authorities’ public health spending from their retained business rate receipts, as part of the move towards 100% business rate retention. It was also noted that Public Health England will support local authorities to deliver efficiencies.

Education

The Spending Review indicates that the Government will reduce local authority roles in running schools and remove “a number of statutory duties”. The Government will consult on the policy and funding proposals in 2016.

The Government will also introduce scrap the current school funding formula, and introduce a new national funding formula for schools, high needs and early years, so that funding is “transparently and fairly” linked to children’s needs. Other reforms include a £23 billion investment in school buildings, opening 500 free schools, creating 600,000 school places, as well as refurbishing over 500 schools, and investing in school places for children with special educational needs and disabilities.

Weekly political news round up – 20th November 2015

November 20, 2015 in News by Whitehouse

Around the sector

NHS England has revealed that it may reduce the number of national clinical directors. There are currently 23 national clinical directors, with some understood to have “much busier briefs than others”. It is expected that a reorganisation will result in a new “slimmer” setup and more focus on “big ticket areas” such as cancer and other long-term conditions. No final decisions have yet been taken, but changes are expected to be implemented when secondment agreements for most national clinical directors end on 31st March 2016.

A major study on bullying in secondary schools, conducted and published by the Department for Education, has found that 30,000 fewer year 10 children in England are subject to bullying compared to 2005 – a percentage reduction from 41% to 36%. For children in the year 9, the percentage reduction was 43% to 36%. The study also found that a higher proportion of children with SEN encountered bullying compared to those without SEN – 46% to 36%. It also found that 11% of children have been cyberbullied since the DfE started recording data on this in 2014.

The Department of Health has published its reference costs for 2014-15, setting out where over £61.2 billion has been spent by NHS providers in 2014-15, as well as the average unit cost to the NHS of providing defined services to NHS patients in England.  The document shows an increase in expenditure recorded in this manner from £58.3 billion in 2013-14 – the equivalent of 4.9% and representing 55.4% of the £110.6 billion total NHS revenue expenditure. It shows increases in the costs of day case treatments (£698 to £721), outpatient attendances (£111 to £114), A&E attendances (£124 to £132), as well as elective and non-elective inpatient and excess bed day costs.

NHS England’s latest financial report, covering the six months to the end of September, forecasts a £44 million underspend on “primary care and secondary dental” services – a contrast to the previous report covering four months to July, showing a full spend in 2015-16. Richard Murray, director of policy at influential health think-tank the King’s Fund, commented that, as in recent years, NHS England will be “relying on underspending in primary care to manage overspending in specialised commissioning and acute services”.

Jim Mackey, the chief executive of newly created healthcare regulator NHS Improvement (a merger of Monitor and the NHS Trust Development Authority), has described the £22 billion of efficiency targets as “unachievable and…stupid”. Mackey also said that forthcoming figures on NHS finances – said to show a £1.5 billion deficit rising to £2 billion by the end of the financial year – were “awful”.

NHS England publishes Excellence in Continence Care commissioning framework

NHS England has published the Excellence in Continence Care commissioning framework – providing guidance for commissioners, providers and health professionals on how best to guide people to manage continence problems. It was produced following recognition by NHS England of the necessity for nationwide improvements for people with continence problems.

This guidance, which is advisory, will “help support best practice in continence care, promoting equal access to services and treatment for all”. The purpose is to promote consistent practice, improve the experiences of people with continence needs, drive advances in clinical outcomes and reduce health inequalities. NHS England engaged with CCG and NHS trust officials, as well as bodies like the Royal College of General Practitioners and the Association for Continence Advice, to produce the document.

The framework notes that containment products such as absorbent pads are “costly, can affect a person’s dignity and do not offer a long-term solution”, and “should not be offered in the long term”. It also warns that indwelling urinary catheters are associated with infection that can “lead to illness, hospital admission and even death”. It suggests that the continence service teaches patients how to self-catheterise intermittently. The framework does not make reference the Drug Tariff.

The framework outlines a pathway including assessment, diagnosis and treatment to recovery where possible. It identifies the groups who are at most risk of continence problems and outlines what a good continence service should deliver for standards and outcomes.

It highlights the importance of providing access to information, advice and treatment, as well as the ability of the workforce to work in a person centred way. It outlines minimum standards for the workforce involved in continence care, along with the specific roles and responsibilities of continence team members, including the patient, family and carers.

It recommends outcome measurements to determine the effectiveness of actions taken. It provides information to members of the public who may need guidance on accessing services for themselves, or for their families. It outlines the benefits of improving continence care, such as a better quality of life, less reliance on pads and products, a reduction in admissions to hospitals and care homes, fewer complications like UTIs, and a reduction in costs.

Eight steps have been set to implement this guidance:

  • Ensure commissioning intentions focus on continence needs for people of all ages and includes both bladder and bowel.
  • Ensure that commissioners and providers have a full understanding of local need relating to continence care through effective engagement with the public, service users, patients, carers and families.
  • Implement a baseline assessment of local continence care provision considering best practice.
  • Develop continence care pathways that meet local need.
  • Ensure outcome measures are in the contracting, quality assurance and performance monitoring of commissioned services.
  • Monitor and evaluate the outcomes of commissioning intentions for continence care.
  • Deliver continuous improvements in continence care via an improvement trajectory.
  • Ensure the commissioning process provides community based integrated services.

Healthcare Financial Management Association publishes survey of NHS financial officers showing a lack of confidence in addressing the £30 billion resource gap

The Healthcare Financial Management Association (HFMA) has published the results of a survey of chief finance officers (CFOs) from provider trusts and clinical commissioning groups, which found a continued deterioration of financial performance across the NHS in England. Analysing perspectives on the £30 billion resource gap identified in the Five Year Forward View, it found most CFOs want the £8 billion of extra funding by 2020 to be frontloaded; it also highlighted a lack of confidence in the NHS’s ability to achieve £22 billion of efficiency savings.

The survey found that 50% of CCG CFOs do not believe the £5 billion of savings outlined in Lord Carter’s interim report on NHS productivity are achievable, with 49% unsure and 1% believing they are achievable. Meanwhile, 49% of CCG CFOs believe the new models of care in the Five Year Forward View will not meet the remaining £17 billion funding gap, with 49% unsure, and 2% confident.

The survey found little confidence amongst CFOs that the NHS can deliver the same quality of care as it is currently doing within the £8 billion of promised funding. 67% of CCG CFOs believe that this could be achieved if the £8 billion is frontloaded, with 0% believing so if it is not frontloaded.

88% of CCG CFOs and 93% of trust finance directors do not think there are effective financial arrangements in place to manage financial risk across their local health economies. Finance directors overwhelmingly agree that the organisations in their area do not have sufficient baseline financial resources for them to implement the Five Year Forward View or other long-term financial plans without additional support.

Despite pessimism about the financial position of the NHS, 88% of finance directors do not expect the quality of patient services to reduce in 2015/16 – 72% believe it will stay the same, 16% believe quality will improve, 9% think quality will deteriorate and 3% do not know. However, they are more pessimistic about 2016/17 – 68% of respondents do not expect quality to deteriorate, 28% believe quality will reduce, and 4% are unclear how quality will change.

To address the financial challenges ahead, 80% of CFOs plan to introduce integrated/redesigned pathways across community, mental health and acute services, with 75% investing in community services to avoid hospital admissions, and 71% investing in primary care. For trusts, 79% of finance directors said they would reduce pay costs from agency staff, 70% would make cost savings across procurement, and 68% would reduce unnecessary clinical variation.

CCG CFOs and trust finance directors both identified risks in achieving their 2016/17 financial plans. CCGs identified increasing demand (74%), prescribing costs (67%), and increases in emergency care (67%) as the three main risks to achieving their financial plans. Finance directors from all sectors felt that waiting times (74%) and access to services (63%) were the most vulnerable areas due to the current financial challenges.

Report warns of mental health consequences of bullying

The Anti-Bullying Alliance has reported that a new survey it has conducted indicates that more than a quarter of young people bullied at school say it impacted on their mental health. Over a third of the 16-25 year olds surveyed said that being bullied made them feel angry or withdrawn and more than a quarter of young people said they experienced body image anxieties. A fifth simply avoided school or college as a way of coping with bullying. Many of the 1,500 young people polled said the effects of bullying have continued to cast a shadow over their lives after leaving school. Almost 40 per cent said it had had a negative effect on their ability to form personal relationships.

Over 40 per cent of young people said access to a supportive teachers trained in dealing with bullying would have made a difference. However, 70 per cent of the 170 teachers surveyed said there was inadequate support for schools working with children with mental health issues and over half would value better training.

 

Welcome to the PCF website

November 15, 2015 in Admin by Whitehouse

Working to improve services for children and young people with bladder and bowel problems; campaign activities, government policy change,  resources and tools to support service commissioning.

School Nursing Campaign

November 15, 2015 in News by Whitehouse

The Paediatric Continence Forum has launched the School Nursing Campaign, in response to local authorities nationally withdrawing continence from the remit of school nurses. Further information can be found on our campaigns page, available here.

Weekly political news round up – 13th November 2015

November 13, 2015 in News by Whitehouse

Around the sector

Influential health think-tank the King’s Fund has published a policy paper calling for “fundamental changes” to the role of commissioners to enable the development and implementation of new systems of care. It outlines that commissioning in the future needs to be strategic and integrated, and based on long-term contracts tied to the delivery of defined outcomes. It notes that “scarce commissioning expertise” needs to be brought together in footprints much bigger than those currently covered by CCGs, while retaining the local knowledge and clinical understanding of GPs.

The King’s Fund has also published a briefing on the impact of devolution on health care in England, making particular reference to devolution in Greater Manchester and Cornwall. The think-tank concluded that devolution will lead to less fragmentation, the breaking down of local barriers to change, and an increased focus on the wider determinants of health. However, it also concluded that the changes would not constitute “genuine devolution” but rather delegation, as formal accountabilities will remain with NHS bodies. It also warned that devolution will not be a “silver bullet” and that significant upfront investment and time will be required.

Local Government Association has published a collection of short essays from system leaders on the improvement of care for children following the transfer of public health commissioning responsibilities for under-fives to local government. Included are essays by NHS England’s chief nursing officer Viv Bennett, the Association of Directors of Public Health president Dr Andrew Furber, and various senior staff from local authorities. The essays in general identify the changes as an opportunity for joined up commissioning and a more effective Healthy Child Programme, but stressed that bodies must work together to make the changes result in effective outcomes. Ingrid Wolfe, co-chair of the British Association for Child and Adolescent Public Health, said that although the transition has been “controversial to many”, this is common for big changes.

Conservative MP William Cash has tabled an Early Day Motion (EDM) ahead of World Toilet Day 2015, on 19th November 2015. The EDM notes that there are 2.5 billion without access to basic sanitation and 700 million without access to safe water. It calls on the government to increase the proportion of its bilateral foreign aid spent on water, sanitation and hygiene.

Public health organisations react to decision to cut public health budgets by 6.2% across the country

Public health organisations have said that the blanket 6.2% cuts to local authorities, confirmed at the start of November, will lead to a reduction of school nursing services and health visiting services.

Nicole Close, the chief executive of the Association of Directors of Public Health said that in areas where councils are tied to long-term contracts that are not due for renewal, they will likely make cuts to smaller nurse-led services, including breastfeeding support, weight management and mental health.

Dame Sarah Cowley, trustee of the Institute for Health Visiting, said that the cuts could “sour” relationships between health visitors and local authority commissioners. She said that the cuts have “put everyone in a state of despair” about how to convince the Government that the cuts to health services run contrary to the Government’s call for better preventative services.

Ros Godson, professional officer at the Community Practitioners and Health Visitor’s Association, suggested that local authorities will start to withdraw nurses from non-statutory services and where commissioning overlaps with NHS England – such as the school immunisation programme. Godson said that she can see local authorities saying “not in our remit”.

Local authorities welcome the transfer of child public health commissioning from national government

Local authority directors of public health and children’s services have welcomed the transfer of commissioning responsibilities for child public health services from national government.

Debbie Barnes, director of children’s services at Lincolnshire County Council, called the changes a “huge opportunity” and said that these will enable more services to be commissioned around local authority population boundaries. She said that commissioning changes will lead to the development of closer links between services like children’s centres and health visiting, as well as school nursing services. She said that the current system of having a health visitor working with 0-5s and schools nurses working with 5-16s was a model that required more cohesion.

Dr Bruce Laurence, director of public health for Bath and North East Somerset, said that any changes will not be made “just for the hell of it”. He added that councils working with their local CCGs will now control “pretty much all of the child health world”.

Dominic Harrison, director of public health at Blackburn and Darwen, said that local authorities should not insist on numbers of professionals, but should instead insist on the achievement of “x, y and z outcomes”. Dr Virginia Pearson, director of public health at Devon County Council said that the recommissioning of services should focus on “creative solutions”.

NHS England chief executive Simon Stevens reiterates call for extra NHS funding to be frontloaded

NHS England chief executive Simon Stevens has reiterated his call for £8 billion of additional funding for the NHS by 2020 to be frontloaded in the Spending Review on 25th November, amid concerns that current NHS funding arrangements for the next two years will not be workable.

Stevens commented that he is in discussions with Chancellor George Osborne on this issue, but that “considerably more progress is needed” and that agreements on funding for spending reviews “usually come down to the wire”. He added that investment now would manage current financial pressures, kick-start service redesign, and enable major savings later in the parliament.

Shadow Health Secretary Heidi Alexander responded that Stevens is “absolutely right” to issue a warning about the pressing need for the NHS funding crisis to be addressed, arguing that unless there is an urgent and significant injection of money into the NHS, then standards of care will “go backwards”.

Children’s Minister Ed Timpson addresses Council for Disabled Children annual conference

Children’s Minister Ed Timpson has addressed the Council for Disabled Children’s annual conference, which centred upon addressing questions relating to the future of SEND reform. In his address, Timpson re-stated his three reasons for the SEND reforms which were introduced last year. He noted, firstly, that families were having to fight too hard for resources within a system which does not work for them; secondly, that children with SEN do not do as well in early years education as they should do; and thirdly, that the system as it previously stood did not encourage education, health and social care agencies to work together for the benefit of children and families.

He was keen to emphasise that it had been “emboldening” to see so many people who have worked hard in support of the Government’s reforms, but stated that they were still very much a work in progress. Timpson said: “We know that these reforms will take a while to embed but with continued support – and challenge – from the parents, children and young people at the heart of them, I’m confident we will continue to see changes which empower, support and enable children and young people reach their full potential.”

Specific issues he raised as being in need of further work were the quality of local offers; areas relating to accountability; and the plans to implement joint Ofsted and Care Quality Commission local area inspections. Timpson also noted the priority his department was placing on children’s mental health, and highlighted the commencement this month of a joint pilot with NHS England to train single points of contact across 27 Child and adolescent mental health services (CAMHS) areas and in more than 250 schools. He concluded by stating that he was prepared to “keep listening, make adjustments where necessary, but above all, continue to put the case for why the vision set out almost five years ago has to be made a reality”.

 

Weekly political news round up – 6th November 2015

November 6, 2015 in News by Whitehouse

Around the sector

A Freedom of Information request by Plaid Cymru has found that there are 1,250 nursing vacancies across Wales, with Aneurin Bevan University Health Board (covering south east Wales) having 260 posts empty – the equivalent of 7% of its workforce. Tina Donnelly, director of RCN Wales, commented that health bodies might be considering reducing nurse staffing due to financial concerns.

The Department of Health has confirmed that local authorities will receive a blanket 6.2% reduction in their public health budgets, following the decision by HM Treasury to cut the total local authority public health grant by £200 million. The Department of Health consulted on a number of options, with the eventual chosen option being their preferred option. The vast majority of local authorities responded that they preferred to see a formula devised where local authorities with the biggest surpluses received the biggest cuts.

Public Health England has published its Public Health Outcomes Framework quarterly data update for November 2015, which shows an increase in the percentage of children achieving a good level of development by the end of reception to 60.4% from the last update. A good level of development is measured according to the Early Years Foundation Stage (EYFS), which includes an assessment of whether children can to the toilet independently.

The Department for Education has published a summary document linking to data sources on children and young people with special educational needs in England. The document provides information on the expected update date of for each document, and the frequency of updates. The document covers the prevelance and characteristics of SEN in England, Early Years Foundation Stage Profile data, as well as attainment at difference stages of schooling, in addition to absence rates.

National Institute for Health and Care Excellence launches consultation on quality standard for promoting health and wellbeing in early years

The National Institute for Health and Care Excellence (NICE) has launched a topic engagement exercise for the development of a quality standard on promoting health and wellbeing in early years.

Quality standards are a set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care.

This topic overview outlines that the quality standard will cover supporting the health, social and emotional wellbeing of children under five years old, through home visiting, childcare and early education. It will also cover vulnerable children who have, or are at risk of, health, social and emotional problems and require additional support.

NICE is seeking comments on the key areas for quality improvement, with five areas which stakeholders consider as having the greatest potential to improve quality of care. It asks what specific aspects of care or service delivery should be addressed, and what action can be taken to improve quality.

Northern Irish Health Minister Simon Hamilton outlines changes to the Northern Irish health and social care system

Northern Irish Health Minister Simon Hamilton has outlined changes to the health and social care system in Northern Ireland, in response to the publication of the Donaldson Report in January 2015 and the subsequent consultation on its recommendations.

Hamilton said that he will abolish the Health and Social Care Board, which decides where the majority of the Northern Irish health budget is spent. Instead, he wants future financial decisions to be made by the Department of Health, Social Services and Public Safety (DHSSPS) and by the five regional health trusts. He said that this will not lead to big savings, or differences on the ground, but will improve efficiency and accountability.

Hamilton also rejected the recommendation to appoint an international panel of experts to decide on the number of hospitals, and will instead appoint Northern Irish experts for a “clinically led conversation”. He said he wants to convene a health summit involving all parties to develop a consensus approach to transforming health and social care in Northern Ireland, as well as establish a transformation fund that supports innovation, collaboration and prevention.

The report by Sir Liam Donaldson, the former chief medical officer for England, found that there were a number of longstanding structural elements within the Northern Irish care system which fundamentally impacted its quality and safety, such as the configuration of health facilities serving rural and semi-rural populations. Ten recommendations were made, including setting up an international panel to review and configure health and social care services in Northern Ireland (which may involve closing hospitals), redesigning commissioning, expanding the role of pharmacists and paramedics, a programme for long-term condition management, better incident reporting, metrics for benchmarking clinical performance, the establishment of a technology hub and better patient involvement.

The PCF submitted a response to the consultation on the Donaldson Report, which ran between February and May 2015. The PCF’s response called for the DHSSPS to clarify the commissioning process to make it more transparent for patient and clinician groups to feed into. The PCF also called for the DHSSPS to publish an updated version of its long-term conditions plan – Transforming Your Care – to be inclusive of continence care, with a specific child based element. The PCF also called for specialist nurses to also have their role expanded, along with the recommended changes to pharmacists and paramedics, and suggested that the DHSSPS establish a forum like the NHS England Excellence in Continence Care Programme board to look at improving continence commissioning in Northern Ireland.

Welsh Government agrees to establish a new body to plan NHS Wales workforce education and training

Welsh Health Minister Mark Drakeford has announced that the Welsh Government has agreed to establish a single body for NHS Wales workforce planning, development and the commissioning of education and training. A final decision on the establishment of the group is set to be made, pending a final decision by a group to look at the costs and benefits to moving to a single body. It is expected that this work will take six months to complete and will be supported by a stakeholder reference group.

Further details on the proposals will be announced once the Diamond Review of Higher Education Funding and Student Finance is completed in September 2016.