Weekly political news round up – 5th February 2016

January 29, 2016 in News by Whitehouse

Around the sector

The Department of Health has announced that it will reduce non-senior staff numbers from 1,800 to 1,200-1,300 by April 2017, and that staff at three London offices will move to the Department’s main office in Richmond House. A spokesperson for the Department said that it will “begin a new programme of modernisation, starting now” with Dame Una O’Brien commenting that “it is only right that the Department of Health should take its fair share of the efficiency savings”.

The National Audit Office has published a report on the supply of NHS clinical staff in England, which found that current arrangements are “fragmented” and “do not represent value for money”, with Health Education England recommended to take a more proactive approach to addressing the variations in workforce pressures in different parts of the country. The report also found that NHS trusts have capacity to reduce spending on temporary staff, which it found were an inefficient use of resources, and that there should be a better effort to recruit nurses from overseas.

The Communities and Local Government Select Committee has published a report on devolution looking to the next five years and beyond. The report found that, despite a “strong appetite” for people to be included and consulted on in the development of local devolution proposals, there was a “significant lack of public consultation and engagement at all stages in the devolution process” – particularly with health devolution. It also identified that the Government’s approach to devolution has “lacked rigour as to process: there are no clear, measurable objectives for devolution”.

Health Education England’s (HEE) chief executive Ian Cumming commented that the Spending Review has had “a significant impact on every line of the workforce plan”, adding that HEE may have, for example, commissioned “an extra couple of hundred” adult nurses were it not for the changes.

Forthcoming events

The House of Commons and House of Lords both rise for recess on 11th February 2016, and will both return on 22nd February 2016.

Westminster Hall debate on changes to local government funding

Former Shadow Care and Support Minister Liz Kendall held a Westminster Hall debate this week on changes to the levels of local government funding. Adult social care and associated issues dominated the debate, with many MPs also raising more local concerns of cuts to their own constituencies. Reductions to public health services were raised on a few occasions during the debate, with limited references to services exclusively for children.

Kendall asked whether the Minister could confirm that the additional responsibilities that the Government is considering giving councils by 2002 including funding for all public health services, as well as attendance allowance and the administration of housing benefit.

Shadow Communities and Local Government Minister Steve Reed commented that the Government has “cut some NHS budgets, handed them over to local government to take the blame and included that figure in the core spending power so that it does not look like spending has fallen by so much overall”.

Simon Danczuk, nominally a Labour MP, but currently suspended from the party, said that budgetary reductions in his constituency of Rochdale have been particularly severe, noting proposed cuts to the public health grant – which he said provides vital support to community health improvement – would be “devastating”.

Communities and Local Government Minister Marcus Jones responded by reiterating that the Governments needs to “make more savings” to “finish the job of eliminating the largest deficit in post-war history”. He said that the reductions to central funding are part of the Government’s ambitions for local government to be entirely funded by 2020 – with 100% retention of business rates, as well as fees and charges raised by councils. He also claimed that local government’s core spending power will remain “virtually unchanged over the Parliament” – from £44.5 billion in 2015-16 to £44.3 billion in 2019-20.

Answers to written questions on urinary tract infections and urinary incontinence

Conservative MP Glyn Davies has received answers to five written questions to the Health Secretary on urinary tract infections and urinary incontinence.

  • The first asked how many people were admitted to hospital for catheter-associated urinary tract infections in each of the last five years; and what the cost was of treating those people.
  • The second asked how many people were admitted to hospital for urinary tract infections in each of the last five years; and what the cost to the NHS was of treating people so admitted in each such year.
  • The third asked how many people were diagnosed with urinary incontinence in each of the last five years; and what the cost to the NHS was of treating that condition in each such year.
  • The fourth asked how many people were diagnosed with urinary incontinence in each clinical commissioning group area in each of the last five years; and what the cost was of treating that condition in each such area in each such year.

Public Health Minister Jane Ellison responded that the Department of Health does not hold information on the number of people admitted to hospital for a catheter-associated urinary tract infection, urinary tract infection or urinary incontinence. Instead, she provided tables of finished admission episodes (the first period of admitted patient care under one consultant within one healthcare provider) in the last five years for a primary diagnosis of each condition. These can be found below:

Year

Catheter-associated UTI

UTI

Urinary incontinence

2010-11

215

168,581

27,797

2011-12

294

174,818

26,751

2012-13

447

184,924

24,938

2013-14

641

187,594

23,498

2014-15

942

195,282

20,969

Ellison added that the costs to the NHS of treating people with UTIs and urinary incontinence is not available centrally. She provided the estimated total costs of kidney or urinary tract interventions and urinary incontinence or other urinary problems reported by NHS trusts and foundation trusts, 2010-11 to 2014-15 (£ millions). These can also be found below:

Year Kidney or urinary tract interventions Urinary incontinence or other urinary problems
2010-11 370.5 28.2
2011-12 398.9 28.1
2012-13 432.4 27.8
2013-14 464.8 28.3
2014-15 506.5 27.6
  • The fifth asked how many people were admitted to hospital for falls and fractures associated with urinary incontinence in each of the last five years; and what the cost to the NHS was of treating people so admitted in each such year.

Ellison responded that the Department of Health does not hold information on the number of people admitted to hospital for falls and fractures associated with urinary incontinence, and related costs.

Answers to written questions on special educational needs

Shadow Children’s Minister Sharon Hodgson has received answers to two written parliamentary questions to the Education Secretary on special educational needs.

  • The first asked if the Department for Education will issue a ‘notice to improve’ to local authorities where Ofsted has identified significant concerns over provision for children with special educational needs or disabilities in a local area.

Children’s Minister Ed Timpson responded that the Department for Education intends that a combination of local accountability measures, data and analysis and independent inspection will show how the SEND system is performing, which parts are working well and less well and whether outcomes are improving for children and young people. He added that the DfE will consider the findings of local area inspections and assess where additional support may be required.

  • The second asked if protocols are in place for the sharing of information between officials in her Department and Ofsted on the outcome of Ofsted inspections of provision for children with special educational needs or disabilities in a local area.

Timpson clarified that both Ofsted and the Care Quality Commission will publish outcomes form the local area SEND inspections.

Answer to written question on national clinical directors

Shadow Schools Minister Nic Dakin has received an answer to his written parliamentary question to the Health Secretary asking how many national clinical directors will be appointed after April 2016, and what areas these will cover.

Life Sciences Minister George Freeman said that NHS England will be supported by 17 national clinical directors – 14 of which have been advertised and will be newly appointed, with three continuing in post into 2016/17 (maternity and women’s health, learning disabilities and innovation). These roles are:

Major Programmes Service Improvement Population Groups
Cancer Cardiac Services Children, Young People and Transition to Adulthood
Mental Health Stroke Older People and Integrated Person-Centred Care
Diabetes and Obesity Respiratory
Learning Disabilities End of Life Care
Urgent and Emergency Care Diagnostics, including imaging and endoscopy
Maternity and Women’s Health Musculoskeletal
Innovation Dementia
Emergency Preparedness and Critical Care

 

 

Weekly political news round up – 22nd January 2016

January 22, 2016 in News by Whitehouse

Around the sector

The Department of Health has appointed Chris Wormald as its new permanent secretary. Currently permanent secretary at the Department for Education, Wormald will replace Dame Una O’Brien when she leaves her position at the end of April 2016. Wormald’s successor at the Department for Education will be announced in due course.

Newly merged healthcare regulator NHS Improvement has revealed the intended executive team structure once it begins operations in April. There will be four executive regional managing directors, as well as an executive medical director, executive director of nursing, executive director of improvement, as well as directors of resources, strategy and corporate affairs.

The Guardian has published an article looking at the impact of “invisible illnesses” on student life. The author, who has an overactive bladder, said that the condition gave her “crippling anxiety” and caused her to miss lectures. She commented that it affected her social life, and alienated her from others.

Public Health England publishes guidance for local authorities on the commissioning of health visiting and school nursing services

Public Health England has published guidance for local authorities on the commissioning of health visitors and school nurses, for the delivery of public health services for children aged 0 to 19. This guidance outlines that school nurses and health visitors can contribute to year-on-year improvements in the number of children achieving their potential, through better school attendance, by identifying and referring continence problems. It also clarifies that CCGs and NHS England are the bodies required to offer ongoing treatment for continence problems. The guidance is split over four separate documents, all of which were prepared by Wendy Nicholson.

Both references to continence are in the second guidance document, which provides a model specification for health visitors and school nurses to deliver the 0-19 Healthy Child Programme. It also outlines the aims and objectives of the service, sketching broadly what the public health nursing service should deliver (delivering public health interventions, treating people with dignity and respect, etc.)

This document contains a section called “locally defined strategies to achieve outcomes”, which lists several outcomes aligned with contributing year-on-year improvements to the wider determinants of health – one of which is the number of children and young people developing and achieving their potential, through improved rates of school attendance. The “identification of continence issues and referral to appropriate services” is listed under “suggested strategies and data sources” to take this forward.

The guidance also states that “commissioning clinical support for enuresis or incontinence lies with NHS England and clinical commissioning groups”, emphasising that there will need “to be joint working and collaboration with local authority commissioners and providers of public health nursing services”

The other three documents do not reference continence. The first outlines background information on the commissioning and service model for the Healthy Child Programme, an outline of the legal duty of local authorities to commission services for children, and an overview of how the health visiting model has changed in recent years. It provides an overview of the service model for health visiting and school nursing, as well as a diagram of how commissioning responsibilities operate for the health and wellbeing of children aged 0-19.

The third covers measuring performance and outcome measures for the transformed health visiting and school nursing models. This sets out a number of high impact areas, the numerators and denominators, the methods of measurement, and the collection and reporting responsibility and arrangements. For health visiting, this covers areas such as managing minor illnesses and reducing accidents (based on rates of emergency admissions), as well as health wellbeing and development (percentage of children who score above the cut off in the five domains of child development) and others. For school nursing, it covers school attendance, but mainly areas such as self-harm, smoking, HPV vaccination, STIs, alcohol and obesity.

The fourth provides references to relevant NICE guidance and other evidence, as well as key policy documents and pathways.

Answer to written question on incontinence diagnosis

Democratic Unionist MP Jim Shannon has received an answer to a written question asking the Health Secretary how many people were diagnosed with incontinence in each of the last five years.

Public Health Minister Jane Ellison responded by providing data on the diagnosis of urinary incontinence and faecal incontinence resulting from a hospital admission, for the years 2010-11 to 214-15. She said that this data does not include figures on the diagnosis of incontinence made in primary care settings. She clarified that admissions do not represent the number of patients, as a person may have more than one admission within the period.

Below is a summary of the data:

Year Urinary Incontinence Faecal Incontinence
2010-11 27,797 4,973
2011-12 26,751 5,200
2012-13 24,938 5,768
2013-14 23,498 5,753
2014-15 20,969 5,774

Tabled written questions on urinary tract infections and urinary incontinence

Conservative MP Glyn Davies has tabled five written parliamentary questions to the Health Secretary on urinary tract infections and urinary incontinence.

  • The first asked how many people were admitted to hospital for catheter-associated urinary tract infections in each of the last five years; and what the cost was of treating those people.
  • The second asked how many people were diagnosed with urinary incontinence in each of the last five years; and what the cost to the NHS was of treating that condition in each such year.
  • The third asked how many people were diagnosed with urinary incontinence in each clinical commissioning group area in each of the last five years; and what the cost was of treating that condition in each such area in each such year.
  • The fourth asked how many people were admitted to hospital for falls and fractures associated with urinary incontinence in each of the last five years; and what the cost to the NHS was of treating people so admitted in each such year.
  • The fifth asked how many people were admitted to hospital for urinary tract infections in each of the last five years; and what the cost to the NHS was of treating people so admitted in each such year.

Department of Health publishes children and young people’s continuing care national framework

The Department of Health has published its updated children and young people’s continuing care national framework. This guidance is for clinical commissioning groups when assessing the needs of children and young people (0 to 17 years) whose complex needs cannot be met by universal or specialist health services.

It sets out advisory criteria for those assessing needs. Included in the framework is a care domain covering continence care that assessors must use to indicate a level or need to inform a care package. This can be found below:

 Description Level of need
Continence care is routine and typical of age.

 

No additional needs
Incontinent of urine but managed by other means, for example, medication, regular toileting, pads, use of penile sheaths;

or

is usually able to maintain control over bowel movements but may have occasional faecal incontinence.

Low
Has a stoma requiring routine attention;

or

doubly incontinent but care is routine;

or

self-catheterisation;

or

difficulties in toileting due to constipation, or irritable bowel syndrome; requires encouragement and support.

Moderate
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.

or

requires haemodialysis in hospital to sustain life.

High
Requires dialysis in the home to sustain life. Severe

This has several small changes from the draft version, most notably that having a stoma requiring routine attention is now a moderate need.

Healthwatch England undergoes structural changes to its governance

An investigation by Health Service Journal has found that the role and independence of healthcare consumer champion Healthwatch England has been “downgraded”. Rather than reporting directly to the Department of Health, the body will now report internally to the Care Quality Commission. Both the chair and chief executive have left, with the latter to be replaced by a “national director”.

Former Care Minister Norman Lamb commented that the changes have amounted to a “downgrading of the organisation” and “therefore potentially a diminished voice of the patient and public in the system”. Lamb added that he believed the changes were an attempted “rationalisation” of Healthwatch England with the CQC to save money.

Healthwatch England emphasised that its role as patient champion is written into statute and that the delivery of its statutory functions will not change. This was echoed by the Department of Health, which said that Healthwatch England’s reorganisation only amounted to “small governance changes”.

 

 

Weekly political news round up – 15th January 2016

January 15, 2016 in News by Whitehouse

Around the sector

Community and Social Care Minister Alistair Burt has issued a statement to the Health Select Committee as part of the Committee’s inquiry into primary care. The statement highlights the challenges facing general practice, notably an ageing population, high public expectations, financial constraints and changing structure in general practice. It outlines the importance of general practice, as well as the need for seven day services. It also sets out NHS England’s steps to support general practice, including more funding, less bureaucracy, a bigger workforce and better access.

NHS England has published the funding allocations for each CCG from 2016-17 to 2020-21. The figures show that six CCGs that have been deemed to be overfunded – Camden, Central London, West London, Sunderland and Isle of Wight – will receive the minimum funding increase of 1.39% in 2016-17, which is lower than the 1.6% needed to match inflation. Other CCGs that have been deemed underfunded, – notably Bedfordshire and Corby – will see funding increases of 9.7% and 9.4% each. 38 groups will see their allocation rise by more than 5% in 2016-17.

The All Party Parliamentary Group on Nursery Schools and Nursery Classes has been launched to examine the importance of nursery education how high-quality provision can be best achieved and measured, and whether structural changes could benefit providers. Beatrice Merrick, chief executive of Early Education, commented that she looked forward to working with the APPG to “build public understanding of the importance of maintained nursery schools in supporting children, especially those with special educational needs and disabilities”.

Patient groups have expressed their concern about the reduction in the number of national clinical director positions.  Sue Browning of the Spinal Injuries Association said that the decision not to appoint a replacement for Professor Charles Greenough as national clinical director for spinal conditions counted as a “regressive step”. Arlene Wilkie of the Neurological Alliance said that removing the neurology national clinical director showed that these conditions were being treated as “lowest priority”.

Tyne and Wear NHS Foundation Trust has announced that a mobile app that it developed to tackle childhood constipation – ‘Poo goes home to Pooland’ – is to be considered for a national award. The app, which was launched last summer and has been downloaded thousands of times, was developed in response to demand for a leaflet of the same name – one of the most popular downloaded documents from the Trust’s Patient Information Centre.

Tabled written parliamentary question on incontinence diagnosis

Democratic Unionist MP Jim Shannon has tabled a written question asking the Health Secretary how many people were diagnosed with incontinence in each of the last five years.

Health Secretary Jeremy Hunt responds to complaints about the NHS mandate consultation process

Health Secretary Jeremy Hunt has responded to a letter by Health Select Committee chair Dr Sarah Wollaston, in which she highlighted concerns about the Department of Health’s process for consulting on its mandate to NHS England for 2016-17 – most notably the short time period for the consultation.

Hunt said that the consultation on the mandate was not a consultation on the future of the NHS, as he noted it had been construed by some, but on the objectives that it set for NHS England. He added that there is no statutory requirement to consult with the public on the mandate, and that the Department of Health’s consultation went further than was necessary.

He also rejected complaints that the consultation was not adequate publicised by outlining that it had been tweeted by the Department of Health, briefed to the Health Service Journal and circulated through a number of Department of Health and NHS bulletins. He noted that despite the short consultation period, the Department of Health received an “unprecedented” 130,000 responses compared to the normal 200-300 received in previous years with longer consultation periods. He also said that the short consultation period was necessary given the circumstances of the Spending Review and the time required for the NHS to develop its plans until 2020.

Answer to written question on the number of health visitors

Shadow Public Health Minister Andrew Gwynne has received an answer to a written question asking the Health Secretary how many health visitors there were in each month since May 2010.

Health Minister Ben Gummer responded with data of the number of full-time equivalent health visitors, which you can find below:

2010 2011 2012 2013 2014 2015
January 8,142 8,141 9,069 10,124 11,643
February 8,114 8,207 9,113 10,267 11,838
March 8,054 8,199 9,133 10,383 12,077
April 7,886 8,396 9,076 10,389 11,929
May 8,092 7,851 8,384 9,149 10,382 11,850
June 8,027 7,803 8,303 9,124 10,350 11,744
July 7,965 7,714 8,287 9,103 10,298 11,690
August 7,907 7,677 8,284 9,066 10,265 11,642
September 8,017 7,941 8,692 9,550 10,800 11,895
October 8,098 8,004 8,932 9,770 11,102
November 8,144 8,065 9,000 9,920 11,239
December 8,125 8,065 9,025 9,959 11,268

Weekly political news round up – 8th January 2016

January 8, 2016 in News by Whitehouse

Around the sector

Health Education England (HEE) has published its commissioning and investment plan for 2016/17, which predicts that the NHS will train and recruit an at least additional 80,000 healthcare staff over the next five years. Of these, 5,381 will be doctors and registrars intended for general practice. This means that the Government is set to meet its target to recruit an extra 5,000 GPs by 2020.

Healtwatch England has compiled a list of its priorities for 2016, based on a suvery of 152 local Healthwatch organisations. The top five include mental health service, primary care services (access in particular), social care services, better integeration between health and social care, and also better timed and supported hospital discharge. Healthwatch England’s top public priority was 2015 was improved access to primary care services.

A letter by nurse academics, patient representatives and former NHS directors of nursing has warned against proposals for a “nursing associate” role, which they believe fails to recognise the functions and value of registered nurses. The letter notes that the proposed role makes a false distinction between clinical skills and “hands-on” care requiring less knowledge. It outlines that the complexity of patients’ care needs means that tasks which appear to be simple, such as washing a patient, requires skill and knowledge for it to be done effectively.

Labour leader Jeremy Corbyn announces Shadow Cabinet reshuffle

Labour leader Jeremy Corbyn has announced a small reshuffle of his shadow cabinet. The shadow health team has remained unchanged, but Jenny Chapman has replaced Pat Glass as Shadow Childcare Minister. Glass was appointed as Shadow Europe Minister, replacing Pat McFadden, who was sacked.

Below are the other changes of note:

  • Emily Thornberry has replaced Maria Eagle as Shadow Defence Secretary
  • Maria Eagle has replaced Michael Dugher as Shadow Culture Secretary
  • Emma Lewell-Buck has been appointed as Shadow Devolution Minister

The reshuffle was not well received by some Labour MPs, with three junior shadow ministers choosing to resign. The details of these are below:

  • Andy McDonald has replaced Jonathan Reynolds as Shadow Rail Minister
  • Kate Hollern has replaced Kevan Jones as Shadow Defence Minister
  • Fabian Hamilton has replaced Stephen Doughty as Shadow Foreign Minister

NHS England announces changes to the structure of national clinical directors

NHS England is asking for feedback on its draft framework for patient and public participation in primary care commissioning. This framework describes how NHS England involves patients, carers, service users and the public in primary care commissioning at national, regional and local levels. It acts as an information resource on options for engaging with patients and the public, rather than strict guidance.

The framework outlines the recent changes to primary care commissioning, notably the shift towards co-commissioning between CCGs and NHS England. The delegation of duties within co-commissioning can vary, with some CCGs taking full legal and funding responsibility, others establishing joint committees with NHS England to make decisions on primary medical services, and others having some input but leaving the legal and funding responsibilities with NHS England. NHS England’s arrangements in this framework only apply where NHS England has some responsibility for commissioning.

The framework also provides an overview of the commissioning cycle, noting that the vast majority of patient and public involvement happens at the contract negotiation stage. The framework outlines how NHS England involves people in primary care commissioning at a local and regional level, including through patient participation groups, local Healthwatch, CCGs, and local health and wellbeing boards, as well as through the national level, such as online consultations and reference groups.

The framework highlights that special engagement methods are required for some groups, such as the disabled and children and young people. Methods to engage these groups include the NHS Youth Forum, working with CCGs to identify potentially excluded groups, and outreach to these groups.

A short questionnaire on the draft framework has also been published. This questionnaire asks how the framework can be improved, how well it fits with other NHS England resources, what is missing and what would help implement this framework.

NHS England seeks feedback on draft NHS England framework for patient and public participation in primary care commissioning

NHS England has published job adverts for 14 national clinical director (NCD) roles, in advance of the expiration of the majority of NCD contracts this March. The 14 positions will sit alongside NCD roles for maternity and women’s health, as well as learning difficulties, which were recruited at different times to the main tranche. The new NCD structure is as below:

Major programme NCDs

  • Learning disabilities
  • Cancer
  • Mental health
  • Diabetes and obesity
  • Urgent and emergency care
  • Maternity and women’s health

Service improvement NCDs

  • Cardiac services
  • Stroke
  • Respiratory
  • End of life care
  • Diagnostics, including imaging and endoscopy
  • Musculoskeletal
  • Dementia
  • Emergency preparedness and critical care

Population group NCDs

  • Children, young people and transition to adulthood
  • Older people and integrated person centred care

This suggests that NHS England will not retain the following eight NCD posts:

  • Neurology
  • Spinal disorders
  • Gastrointestinal and liver disease
  • Pathology
  • Rehabilitation and recovery in the community
  • Renal disease
  • Trauma
  • Rural and remote care

Of note is the departure of Dr Martin McShane as national clinical director for long-term conditions and mental health, following the expiration of his three-year contract. McShane has joined private consultancy and commissioning firm Optum.

Department for Communities and Local Government publishes draft equality statement on the impact of the 2016/17 local government finance settlement

The Department for Communities and Local Government has published a draft equality statement assessing the potential effects of the 2016/2017 local government finance settlement. The draft statement notes that reductions in central funding may lead to service reductions which have a greater impact on people who share a protected characteristic (disability, gender, race, religion, sexual orientation etc.) or more protected groups (such as children and young people, older people or disabled people). However, it was outlined that the new approach to central funding, which factors in councils’ business rates and council tax, may reduce the impact of the settlement and provide greater protection for some councils providing children’s services and adult social care.

The draft statement concludes that the funding changes “could, without mitigating action and depending on spending decisions made by authorities, have an adverse equalities impact on persons who share a protected characteristic”. It adds, however, that “there is not sufficient evidence” to identify a “substantial” equalities impact.

BBC News highlights NHS England’s call for improved continence services

January 5, 2016 in News by Whitehouse

BBC News has published an article highlighting NHS England’s call to improve continence services, following on from the publication of NHS England’s Excellence in Continence Care (EICC) guidance in November 2015. A short piece was also broadcast on BBC Breakfast (not available on BBC iPlayer), which included an interview with continence patient advocate Jacq Emkes.

The BBC News article reiterated the major messages of the EICC guidance, including the need for better training for all staff, and for patients to be told more about what treatments and support are available. The article outlines that “millions of people in England experience problems with continence but many are not getting the support they need”, and that people “suffer in silence” as they are too embarrassed to talk about the issue.

In the short interview on BBC Breakfast, Jacq Emkes – who acted as a patient advocate member of the EICC programme board – said that she initially “didn’t know who to turn to for help”, but eventually discovered her local continence service, which gave her advice on the different products available. She said that continence problems changed her life and wellbeing “hugely”, and called for greater knowledge and awareness.

The PCF are members of the EICC programme board and worked to ensure that NHS England’s guidance had a strong child focus.