Weekly political news round up – 26th February 2016

February 26, 2016 in News by Whitehouse

Around the sector

The Daily Mail has published an article looking at the causes and consequences of bedwetting. The article, which includes contributions from Nick Madden and Brenda Cheer, outlines potential solutions such as laxatives, reducing water intake before bedtime, using bedwetting alarms, and taking desmopressin.

The Local Government Association, NHS Providers and Monitor have jointly published a briefing outlining how Health and Wellbeing Boards are using different mechanisms to engage with local providers to join up the strategic commissioning of healthcare. Using case studies, it identified that the most successful Health and Wellbeing Boards were the ones that invested time in building relationships, were flexible with their engagement and evidence, and were clear on the role of stakeholders and the purpose of their engagement with them.

GPonline has reported that there will be a £220 million funding increase in the GP contract for 2016/17, delivering a 1% pay uplift and reimbursement to meet rising expenses faced by practices, including higher CQC fees, practice upkeep and staffing costs. The General Practitioners Committee also secured a commitment to a national strategy to reduce bureaucracy and manage service demand, as well a commitment to end the quality and outcomes framework by 2017.

NHS regulators Monitor and the NHS Trust Development Authority, which will merge to form NHS Improvement from April 2016, has published its third quarterly performance report for 2015/16 . The report found that 131 out of 138 hospital trusts are running a deficit; with all NHS trusts running a £2.26 billion overspend.

Influential health think-tank the King’s Fund has published a report arguing that England lacks a coherent and integrated strategy for quality improvement, despite multiple well-meaning initiatives over the last 18 years. It criticises the emphasis on inspection to provide quality assurance rather than continuous quality improvement, with a failure to invest time and resources into supporting staff to improve care from within the NHS. The paper suggests that NHS organisations build in-house capacity for quality improvement and adopt scientifically grounding methods for delivering improvement, as well as the creation of a “modestly sized” national centre of expertise to support NHS organisations, led by managers and clinicians who have delivered quality improvement.

Disability charity Sense has published a report into access to play opportunities for disabled children with multiple needs. The report identified the lack suitable changing facilities as a key issue for families, with many families calling for toilet facilities with full size changing beds and track hoists.

NHS England has earmarked £156 million of its contingency funds and underspend to help the Department of Health break even in 2015/16. The move follows reports by NHS England of underspending worth £295 million for the commissioning system for this financial year, up from £145 million in the previous month.

Answers to written questions on urinary tract infections

DUP MP Gavin Robinson has received answers to four written questions to the Health Secretary on urinary tract infections:

  • The first asked what assessment has been made of the health benefits of cranberries and their role in preventing the incidence of urinary tract infections in women and children;
  • The second asked what steps the Department of Health has taken to promote the consumption of cranberry products to prevent simple infections such as urinary tract infections; and
  • The third asked what assessment the Department of Health has made of the potential role of cranberries in reducing the frequency of prescribing antibiotics for simple infections such as urinary tract infections.

Public Health Minister Jane Ellison responded that the Department of Health has not taken steps to promote the consumption of cranberry products, as research published in 2012 assessing the effectiveness of cranberry products in preventing urinary tract infections found no objective evidence for the effectiveness of cranberries.

Ellison added that the Department of Health commissioned the Wellcome Trust to undertake a review of alternative treatments in 2014, which concluded that whilst many approaches have potential, there is a continued need for conventional antibiotics to treat the majority of infections for the foreseeable future.

  • The fourth asked what assessment the Department of health has made of the cost to the NHS of antibiotics used to treat urinary tract infections in each of the last three years.

Life Sciences Minister George Freeman responded that information on why a drug has been prescribed is not collected.

Answer to written question on incontinence pads

Crossbench peer Baroness Greengross has received an answer to a written question asking the Government whether clinical commissioning groups (CCGs) and NHS trusts are responsible for the funding or provision of incontinence pads to residents of (1) care homes for personal care, and (2) care homes with nursing care.

Lords Health Minister Lord Prior of Brampton responded that there is no legal requirement to provide incontinence pads, with the criteria for the provision of continence products set by individual CCGs. He added that NHS England recently published the Excellence in Continence Care guidance for commissioners and providers to help support CCGs, which he said encourages “much greater” collaboration between health and social care.

Department of Health publishes delivery plan for 2015-2020

The Department of Health has published a shared delivery plan outlining the Department of Health’s and its agencies’ priority objectives for 2015 to 2020. This plan outlines the Department’s overall vision – to provide a sustainable, high quality, integrated health service which is free at the point of use, champions patient power, and acts a world leader in innovation – as well as its 10 key objectives. These are summarised below:

  1. Improving out-of-hospital care – a greater investment in primary care, integration of health and social care, parity between mental and physical health, support for carers, and improved access to 24/7 GP services.
  2. Creating the safest, highest quality healthcare services – a roll-out of seven day services in hospitals, ensuring that the CQC identifies poor care and sets out action to improve it, reducing health inequalities for physical and mental health, improving cancer care, and better end of life services.
  3. Maintaining and improving performance against core standards while achieving financial balance – increasing the NHS’s funding by £8 billion by 2020, implementing the Carter Review recommendations, and supporting the Sustainability and Transformation Fund.
  4. Improving efficiency and productivity of the health and care system – reducing waste, implementing the Five Year Forward View and the Carter Review, and recovering the costs of healthcare from overseas visitors
  5. Preventing ill health and supporting people to live healthier lives – supporting people in giving up smoking and alcohol, as well as encouraging them to eat healthily, reducing obesity and improving diabetes management, and supporting those with long-term conditions get back into work.
  6. Supporting research, innovation and growth – fostering growth in the life sciences industry, implementing the findings of the Accelerated Access Review, increasing the use of cost-effective new medicines and technologies, taking forward the 100,000 genomes project to improve diagnosis and treatment of cancer and rare diseases, and prioritising dementia research.
  7. Enabling people and communities to make decisions about their own health and care – increasing partnership working between the voluntary and statutory sectors to reduce health inequalities, better information on the safety record of NHS services, access to electronic health records and ensuring doctor appointments and repeat prescriptions are available online.
  8. Building and developing the workforce – recruiting and retaining health professionals and ensuring that hospitals are properly staffed.
  9. Improving services through the use of digital technology, information and transparency – better information on the safety record of NHS services, access to electronic health records and ensuring doctor appointments and repeat prescriptions are available online.
  10. Delivering efficiently: supporting the system more efficiently – developing a new operating model and organisation design to enable flexibility in policy making, reducing accommodation costs, and improving IT infrastructure and management.

Welsh Government publishes summary of responses to its Green Paper on the Welsh NHS

The Welsh Government has published a summary of responses to its consultation on its Green Paper on the NHS in Wales, which ran from July 2015 to November 2015. The PCF submitted a response calling for better working within the health service and between the health service and other bodies, and a better framework for ensuring the uptake of NICE guidance.

The overarching observations by the Welsh Government include the need for a health system which is preventative and maintains wellbeing and independence, with person-centred information and services. There was recognition that the health and social care system should be more inclusive of third sector involvement, with a greater focus on strengthening existing systems than introducing new ones, as well as a need for further health legislation to complement other legal frameworks. Feedback was broken down by subject and the relevant areas summarised below:

Promoting health and wellbeing

The PCF’s response called for better collaboration between the health service and other services, such as education, with guidance encouraging and enforcing this.
The Welsh Government said that there was low appetite for further regulation, but that there was a desire to enable local collaboration in planning and meeting people’s health and wellbeing needs – particularly supporting the work of primary care clusters and encouraging joint working with social care, independent and third sector providers. The Welsh Government also identified a desire to promote a joint-working culture through training, vision, plans, meetings and accountability across health and social services.

Engaging with citizens

The PCF called for the Welsh Government consider developing an information hub where stakeholders can submit guidance and best practice to inform service redesign, highlighting in particular the Commissioning Guide. The PCF also called on health boards to establish permanent engagement mechanisms, but warned against a national expert panel as members may not be able to fulfil public engagement functions.

The Welsh Government recognised that respondents felt more work is needed to ensure engagement, with respondents wanting a clear engagement framework for ensuring the public are involved at every level. Respondents were generally split over legislating for permanent engagement mechanisms, with some respondents highlighting that this would result in person-centred services and others arguing that existing mechanisms are sufficient. Similarly, respondents were split over a national expert panel, with some believing that it would bring a consistent focus to reviewing service change and others believing that responsibility should still remain with the Minister.

Quality and co-operation

The PCF argued that a better utilisation of clinically approved guidance would be more suitable to drive improved quality than introducing additional legislation, but that uptake of this guidance is contingent in part on the level of resources provided to NHS organisations.

The Welsh Government highlighted that respondents agreed that legislation was not effective in addressing quality, with the main contributors to improved quality being cultural, training, resource and education. It also recognised the PCF’s recommendation that adopting best practice would be more effective in driving up quality than just legislation.

Quality in practice – meeting common standards

The PCF argued that the Welsh Health and Care Standards framework provides a good foundation for delivering good standards of care, but that a lack of a statutory compliance requirement undermines it.

The Welsh Government noted that respondents largely agreed the need to ensure that NHS services have a duty to comply with the Health and Care Standards framework. Some respondents felt that the standards, which were recently refreshed (now including references to continence, following a response from the PCF), need to be embedded and further reviewed before changes are introduced.

Other areas discussed in the Green Paper include the need to improve the quality of services through further legislation, a desire amongst respondents for a statutory duty of candour to drive a culture of openness and honesty, as well as better information sharing, a more comprehensive inspection and regulation of health services, as well as various issues around health board governance and leadership.

Weekly political news round up – 19th February 2016

February 19, 2016 in News by Whitehouse

Around the sector

Research by the Health Foundation has revealed that 79% of UK GPs have suggested that a  patient’s care had been adversely affected by a lack of integrated between different health and care providers within the last month – higher than the average of 49% of GPs across 11 other countries. The research also found that GPs are more likely to report problems coordinating care with social services or community health organisations, with 70% of GPs finding it ‘somewhat or very difficult’ – higher than any of the 11 nations covered in the research.

The Scottish Government has announced that it will develop a new public health strategy to determine national priorities and coordinate the contributions made by public health professionals across the NHS and other bodies. The development of a national strategy was one of the recommendations of the independent review of public health in Scotland, which called for the Scottish Government to be clearer about its public health priorities and deliver them in a more coherent manner.

The National Children’s Bureau has compiled materials on the new integrated review for two-year-olds, to assist staff working directly with young children and those managing and designing services. The Experiences of Practices resources, based on the experiences of practitioners in the pilot areas of Islington and Warwickshire, provide information on working with parents, involving the child and using the ages and stages questionnaire.

A poll by GPOnline of 303 GP partners has found that 33% of respondents have seen a decrease in the quantity of public health services – specifically weight manage, smoking advice, sexual health and contraception –commissioned from their practice since these services were transferred to local authorities in April 2013. Just 13% of respondents said that services had increased, whilst the remaining indicated that they did not know. Some respondents also felt that decisions to cut back on services were made with “less understanding of health priorities and more based on money”.

An international study of children’s life satisfaction has ranked England 13th out of 16 countries. Co-ordinated in England by York’s Social Policy Research Unit found that eight-year-olds in England were only happier than those in South Korea, Nepal and Ethiopia, with particular issues being body image, relationships with teachers, dissatisfaction with school performance, locale and family life.

A survey of stakeholder opinions of Public Health England (PHE) has found that just 31% of local authorities believe that PHE understood their priorities well in 2015/16 – a decrease from 52% in 2014/15 and 56% in 2013/14. The proportion of local authorities which were “very satisfied” with PHE’s support fell from 17% in 2014/15 to 7% in 2015/16. In particular, local authorities found a lack of notice in relation to national announcements “very frustrating” and that PHE has a narrow definition of public health (smoking, obesity etc.).

The Department for Education is set to reduce the voluntary and community sector grant scheme, which was introduced in the previous Government and has provided over £200 million worth of funding within the past five years. The Department declined to outline further details of the reductions.

 

Forthcoming events

The House of Commons and House of Lords are currently in recess and will return on Monday 22nd February 2016.

Scottish Government publishes its 15 year National Clinical Strategy

The Scottish Government has published its National Clinical Strategy for health and social care services in Scotland. This strategy provides a high-level overview of the direction required for the Scottish health service over the next 15 years, rather than specific actions to be undertaken. The strategy does not reference continence directly.

The strategy calls for an “increased diversion” of resources to primary care and community care, with primary care to be increasingly delivered by multi-disciplinary teams with strong integration with local authorities, as well as independent and third sector providers. It recognises that there will be an increased demand for the management of long-term conditions, and outlines that investment in primary care will help support self-management, increase levels of independence, enable care that is person centred rather than condition focused, and reduce the risk of admission to hospital. The strategy recognises that healthcare systems from around the world with strong primary care services produce better overall outcomes for people, better experiences of managing conditions, and a “lower and more proportionate” use of resources.

The strategy asserts that financial challenges mean that there will be constraints on what can be achieved with the anticipated future resources, stressing that increased investment in health services does not always bring about improvements in health.

The strategy also outlines the need to reduce health inequalities between the most advantaged and least advantaged, as well as the need to recruit more doctors and nurses as a large number of both will be retiring within the next 10 years. The strategy also outlines the need to reform secondary care to provide better post-discharge support, with surgeries provided in more specialist settings. The strategy also emphasises the importance of digital technology.

Research by the King’s Fund shows that the financial position of NHS trusts is deteriorating

Influential health think-tank the King’s Fund has published its quarterly NHS monitoring report, which found that NHS trusts are likely to face a £2.3 billion deficit by the end of 2015/16 – an increase of around £300m from the King’s Fund’s last projection in October 2015. 67% of the NHS trust finance directors surveyed expect to overspend by the end of this year – including 89% of acute trusts.

The report also found that 53% of NHS trust finance directors believe that the quality of care in their local area has worsened in the past year, and that 53% of NHS trusts are concerned that they will not be able to meet nationally-imposed caps on their agency staff spending.

Weekly political news round up – 12th February 2016

February 12, 2016 in News by Whitehouse

Around the sector

Following recognition that it was unlikely to balance its books this financial year, the Department of Health has received an additional £205 million on top of the £116.3 billion allocated to its 2015-16 budget. This is the second year in a row the Department has required a bailout, suggesting that the Commons’ Public Accounts Committee may examine its overspend.

Think-tank the Health Foundation has published a report showing a continued sluggishness in the productivity of acute hospitals in England. Although overall productivity of acute hospitals increased by 0.3% between 2009/10 and 2014/15 – an average rate of 0.1% per year, activity growth and input growth have converged, leading to a very low level of annual average productivity growth. This study does not include outpatient activity, or providers of mental health and community services, which the think-tank conceded might underestimate the true rate of acute productivity.

Former Care and Support Minister Norman Lamb has warned that Lord Carter of Coles’ proposals to improve NHS operational productivity in acute settings, as outlined in his report published last week, could be used to “drive down staffing numbers to unsafe levels”. Think-tank the Nuffield Trust has warned that Lord Carter’s new staffing benchmark could leave many wards understaffed.

Hilary Garratt and Dr Ruth May have been appointed as deputy chief nursing officers for England. Garratt is currently director of nursing for NHS England, with May currently director at Monitor – the regulator for NHS foundation trusts, which is due to form part of NHS Improvement in April 2016. May has also been confirmed as executive director of nursing at NHS Improvement.

Research by the National Union of Teachers and the Association of Teachers and Lecturers has found that teachers have significant doubts as to the accuracy and value of the baseline assessment for four year olds, which assesses their reading, numeracy, writing and children’s social and emotional development. The research found that 59.5% of teachers did not believe the assessment is an accurate and fair way to assess children’s development, and that 71.1% did not believe the baseline assessment to help identify the needs of SEN children.

The Department of Health has published the public health grant allocations for local authorities for 2016 to 2017, as well as the conditions for using the money – notably that local authorities should be satisfied that there is a public health benefit from the use of the funds.

Kingsley Manning has stepped down as chair of the Health and Social Care Information Centre (HSCIC). Since 2013, Manning has provided oversight and counsel to HSCIC’s executive team. A new chair will be appointed in due course.

Forthcoming events

The House of Commons and House of Lords have risen for recess and will return on 22nd February 2016.

Tabled written questions on urinary tract infections

Democratic Unionist MP Gavin Robinson has tabled four written parliamentary questions to the Health Secretary on urinary tract infections:

  • The first asked assessment the Department of Health has made of the cost to the NHS of antibiotics used to treat urinary tract infections.
  • The second asked what assessment the Department of Health has made of the role of cranberries can play in reducing the frequency that antibiotics are required to be prescribed for simple infections such as urinary tract infections.
  • The third asked what steps the Department of Health has taken to promote the consumption of cranberry products to prevent simple infections such as urinary tract infections.
  • The fourth asked what assessment has been made of the health benefits of cranberries and their role in preventing the incidence of urinary tract infections in women and children; and if he will make a statement.

Tabled written questions on incontinence pads

Crossbench Peer Baroness Greengross has tabled a written question asking the Government whether Clinical Commissioning Groups and NHS trusts are responsible for the funding or provision of incontinence pads to residents of (1) care homes for personal care, and (2) care homes with nursing care.

Nuffield Trust publishes erport on the future of child health services

Influential health think-tank the Nuffield Trust has published a report assessing the current state of child health in the UK and the quality of care received, as well as how emerging models are responding to these issues. Continence is not directly mentioned in the report.

The report identified that the nature of child health services has changed, with a shift in focus over the last 45 years from acute infectious illness towards chronic long-term conditions. In spite of this, the provision of health care services is still “heavily hospital focused and reactive”, with serious concerns existing about child health outcomes and the quality of care children and young people receive. It identifies that outcomes for children in the UK have not advanced as fast as elsewhere.

The report is critical of the disparity of attention received in comparison to adults, noting that new models of care have tended to focus on adults. However, it has also identified an emergence of a variety of different models of children’s health services over the last few years – many of which offer different ways of managing the needs of children with acute and chronic conditions. Despite the emergence of these models, there is a lack of understanding of how they work and whether they could lead to an improvement in care quality.

These models of care have a focus on understanding the needs of different sections of the child population and organising carer to meet these needs, as well as strengthening early and easy access to appropriate expert paediatric assessment in the community. These models understand how children and families use the health system, and help them to use it more effectively. They also cover a wider range of community settings, encouraging early, proactive intervention in a joined up manner

The new models of care have emerged in response to problems with existing services, particularly the increasing use of hospitals to treat conditions that could be dealt with in other settings, due in part to financial pressures facing primary care, as well as capacity issues, confidence, knowledge and skills, and disjointed care provided between hospitals and the community.

The report concludes that an ‘ideal’ child health system is one that understands the specific needs of children and is designed to address them. It includes access to high quality paediatric expertise and multidisciplinary teams in the community, with linked-up information, communication and data, as well as a prioritisation of health literacy and education for children and their families in addition to professionals.

Health Select Committee holds first evidence session of its inquiry into public health post-2013

The Health Select Committee held its first evidence session of its inquiry into public health after 2013. The session heard from Jonathan McShane (Public Health System Group/Local Government Association), Julie Wood (NHS Clinical Commissioners), Dr Andrew Furber (Association of Directors of Public Health), Professor John Ashton CBE (Faculty of Public Health), Martin Smith (Society of Local Authority Chief Executives).

The session covered a broad range of high level, structural issues. Continence was not mentioned, with few condition specific services being mentioned – only sexual health services, smoking cessation and alcohol reduction. Commissioning and the public health workforce was also mentioned, but only in a very general manner. Other topics mentioned include system resilience to large scale public health threats (flu and mass shootings), immunisation and screening, a potential sugar tax, and devolution bringing additional opportunities to join up services.

Conservative MP James Davies asked what impact in-year budget reductions and the transfer of health responsibilities has had on the public health workforce. Respondents noted that some local authorities reported a 58% reduction in staffing capacity, with the impact variable across local authorities but still “very significant”.

Conservative MP Andrew Percy and Labour MP Ben Bradshaw both queried the sharing of data between clinical services and local authorities. Respondents said that clinicians did not always have access to local authority data due to information governance issues, with one respondent noting that one his local authority colleagues operated on the mantra of “in god we trust; everyone else must have data”.

Labour MP Emma Reynolds asked what impact the removal of the ring-fence from 2018 would have on service delivery. Respondents generally said that prevention elements of public health services get “squeezed out”, with a mixed response being provided on whether the ring-fence should continue. One respondent said that it should continue, whilst another claimed that ring-fencing encouraged the siloing of funds.

Labour MP Paula Sheriff asked whether local authorities adopted an approach to commissioning that was simply “buying and retendering”. Respondents said that local authorities were better at commissioning than PCTs, especially for sexual health and smoking cessation services, given that local authority have better experience of commissioning services with limited budgets.

There was also a general discussion on health and wellbeing boards, where respondents noted that hospital consultants have complained about not knowing what the role of these boards are, stressing that they would like to have input.

Around the sectorNHS England publishes guidance for providers on delivering the Five Year Forward View

NHS England has published guidance for all NHS trust provider boards and senior leadership teams on delivering the Five Year Forward View. It outlines the challenges and changes for the NHS, the activities that providers must undertake, examples of how providers are already delivering these, and an overview of support that providers can expect from NHS Improvement.

The guidance requires that providers must focus on improving service quality and access whilst improving finances. It states that the “vision for 2020 is that all NHS providers will have balanced their books and released significant efficiency savings, maximising value for patients and improving the quality of care”, noting that providers must achieve the “best possible” outturn position in 2015/16 and develop a plan for 2016/17 based on agreed control totals. It emphasises that acute trusts will need to plan to achieve the savings of up to 10% of their expenditure identified in the Carter Review. In particular, it stresses the need to transform services – working in cooperation with other organisations – to ensure sustainability, which will involve an eventual shift of emphasis in NHS financial, regulatory and performance management processes from individual organisation performance to the performance of whole local health and care systems.

The guidance identifies that providers do not currently have enough capability to achieve the above objectives, and that they must increase their capability by investing in workforce and leadership, and in technology, innovation and research. Providers will need to recruit, develop and retain the right workforce for the future – covering leadership and clinical staff. Providers must invest in technology – particularly better information systems, but also through using digital technology to support research and innovation.

NHS Improvement will help facilitate these improvements by developing a new oversight model to develop relationship with providers to help these providers improve. These relationships will be carefully developed to ensure that provider leadership has space to innovate and take well-managed risks. NHS Improvement will also work with CQC and NHS England to create a single, simple definition of success for providers – covering quality, finance and use of resources, operational performance, leadership and strategic change. To reduce variation, NHS Improvement will support all trusts in developing the capability to apply evidence-based improvement approaches – covering the sharing of expertise and dedicated support for providers in, or at risk of being in, special measures.

Answer to written question on Ofsted and the CQC’s joint inspections of SEND provision

Shadow Children’s Minister Sharon Hodgson has received an answer to her written parliamentary question to the Education Secretary asking how much specific additional funding the Department for Education has provided to Ofsted and the Care Quality Commission (CQC) to support their inspection of the effectiveness of local areas in fulfilling their new special educational needs and disabilities duties.

Children’s Minister Ed Timpson responded that the Department for Education has allocated £349,087 of funding to Ofsted and the CQC to meet the costs of developing these inspections. He added that the Department for Education will provide Ofsted with funding to support this activity over the next five years.

NHS team to be established to identify the best clinical products to inform procurement decisions

The NHS Business Services Authority and the Department of Health are recruiting for a nine member NHS clinical evaluation team – made up of NHS clinicians and support staff – that will “extensively” engage with NHS workers to identify clinical products that “provide a high level [of] patient care and best outcomes for the NHS”. This team will be independent of medical suppliers and NHS Supply Chain, and from April 2016 will report into the existing national clinical reference board. It is not currently clear whether the team will be looking at primary care, secondary care, or both.

 

The team will assess products from a procurement perspective to determine whether they can be purchased more efficiently, such as through block contracts. The team’s findings will feed into a broader project aligned with Lord Carter’s review of NHS productivity, which is looking to make £300m of efficiency savings by October 2018. The team’s work will also inform the future development of national clinical specifications across various product categories.

PCF attends Public Policy Exchange event on transforming health outcomes for children and young people

February 5, 2016 in News by Whitehouse

PCF vice chair Nick Madden attended a Public Policy Exchange Symposium on a system wide response to transforming health outcomes for children and young people, which took place on 16th September 2015.

Nick gave a presentation about problems associated with childhood continence, such as bullying, impaired school performance etc. Also discussed were current issues including those relating to school nurses and the activities of the PCF – including the Commissioning Guide for Paediatric Continence, engaging with MPs, updating the Continence Needs Assessment for Chimat and producing Minimum Standards for paediatric continence care in the community.

The event also heard from:

Sadia Hussain, Senior Early Intervention worker, in the baby intervention team, in Dagenham. She discussed the identification of mothers and babies with potential problems and follow-up until 2 years; this covered health and safeguarding. She made the point that early intervention is more effective and cheaper than dealing with problems. They also ensure liaison between midwives and children’s centres.

Joe Hayman, Chief Executive PHSE Association. The association provides support for over 10,000 teachers and others working in state and independent schools. The topics he listed included female genital mutilation, chlamydia etc.  but not continence.

There was then a general discussion including mention of school nurses. PHSE does involve school nurses and covers CAMHS, continence and sexual health. It was unclear how actively involved parents are in PHSE generally. It was pointed out, by a school nurse, that some of her colleagues cover up to 8 schools, which she calculated allowed 67 seconds per child. There was also the comment that the school entry medicals aren’t completed until half way through the school year.

Dr Marilena Korkodilos, deputy director, Public Health England spoke about health inequalities, but nothing particularly related to continence.

Emily Fox, had struggled with anorexia throughout her teenage life, but is now a campaigner for youth mental health and has founded the Albatross Connection. She has broadcast and written about youth mental health and is starting a psychology degree. She was helped by treatment working on a farm in Kenya. In a subsequent discussion with her she agreed with the point made by a lay member of the EICC board that clinics labelled ‘continence’ are not likely to attract people, citing the fact that GUM clinics sound less off-putting than other more specific labels covering that area of health.