Weekly political news round up – 25th March 2016

March 25, 2016 in News by Whitehouse

Around the sector

Former Cabinet Office Minister David Law has claimed that ahead of the publication of the Five Year Forward View, NHS England chief executive Simon Stevens was pressured by the Treasury to reduce his demand for additional NHS funding from £16 billion to £8 billion. After initially asking for an additional £16 billion, Stevens was allegedly told that “there was no way that the Prime Minister and Chancellor would sign up to an impossible and excessive commitment” and that he needed to “get it down to a more deliverable sum”.

The Department of Health has sent accountancy firms to 20 NHS organisations, including provider trusts and CCGs, to “support the health group accounts”. A senior unnamed figure in an NHS consultancy said that the move was “an act of desperation” by the Department, and that directors of finance are under “loads of pressure” from central government to do “accountancy stuff” that they are “not comfortable with”.

The University of York Centre for Health Economics has published an analysis of medical spending and hospital inpatient care in England over the last 15 years, which found that inpatient care has been “substantially driven” by the underlying morbidity and age of the population in conjunction with improving health care technology. More specifically, it found that: expenditure for elective and emergency inpatient care broadly follows activity rather than unit costs, expenditure is concentrated in individuals with multiple diseases, and health care activity rises substantially in the period before death.

Welsh Chief Medical Officer Dr Ruth Hussey has retired after almost four years of providing independent professional advice to the First Minister and the Welsh Government about healthcare. An announcement on Dr Hussey’s successor will be made shortly.

Adam Roberts, head of economics at the Health Foundation has written in the Guardian that the NHS is in the midst of a “financial hurricane” due to three reasons. The first is disappointing poor economic growth that has led to a continued fall in public spending; the second is changes to public sector pensions, which will increase pressure on NHS providers; and the third is that there have been no further announcements of additional funds to help the NHS realise financial stability this year.

The Department for Education has published letters to local authorities, academy trusts and maintained schools about the Educational Excellence Everywhere white paper. The letters outline the motivations behind the Government’s push to reform education – to provide a world-class education and give greater power to school leaders – whilst outlining the key elements of the proposals. These include, replacing Qualified Teacher Status with more challenging accreditation, requiring all schools to become academies, and recruiting and training the best school leaders.

A report by the government commissioned Migration Advisory Committee has criticised the Department of Health, Health Education England and NHS trusts for ignoring obvious warning signs indicating that a nationwide shortage of nurses was being driven by a desire from central government to save money. Committee chair Professor Sir David Metcalfe said that the Department of Health “needs to get its act together”, and that there is “no good reason why the supply of nurses cannot be sourced domestically”.

Forthcoming events

Both Houses of Parliament are now in recess and will return on 11th April 2016.

Answer to written question on an awards scheme for schools supporting children with SEND

Conservative MP Tim Loughton has received an answer to a written question asking the Education Secretary if she will establish an awards scheme for schools that have excelled in supporting children with special educational needs and disability, similar to the scheme for pupil premium awards.

Children’s Minister Ed Timpson responded that the Department for Education will be exploring options for how to identify and promote excellent SEND practice in schools, as part plans for reviewing its strategy for improving SEND provision announced in the Educational Excellence Everywhere white paper. Timpson added that he would be “happy to receive” any specific proposals from Loughton.

Weekly political news round up – 18th March 2016

March 18, 2016 in News by Whitehouse

Around the sector

NHS England has announced 44 areas in which local NHS providers, clinical commissioning groups (CCGs), local authorities and other health and care services have come together to develop sustainability and transformation plans (STPs) to help deliver the Five Year Forward View. These “STP footprints” take into account factors including geography, the scale in which change will be delivered, existing footprints of change, the financial sustainability of organisations in an area, and leadership capacity and capability to support change.

Two research papers published in BMJ Quality and Safety have found that “pushy” patients are more likely to be misdiagnosed by doctors. The study found that doctors who felt under pressure from aggressive patients, or those questioning their competence, were more like to expend energy on the problematic behaviour and therefore have less capacity to focus on the medical issue.

Public Health England has published ‘child health profiles’ for each local authority and CCG in England, which provides a snapshot of child health using key health indicators, enabling for comparison locally, regionally and nationally. Each profile contains comparative data on mortality, those achieving a good level of development at the end of reception, rates of obesity and hospital admissions for injuries, mental health, as well as other health indicators.

The Public Accounts Committee has published a report on the sustainability and financial performance of acute hospital trusts, which found that the financial health of these trusts has “significantly worsened in the last three financial years” and that their “finances look set to deteriorate further”. The Committee found that the target for trusts to make 4% efficient savings across the board is “unrealistic” and that “better data is needed for more informed savings and efficiency targets”. It identified that “there is much to do to produce the convincing plan necessary for the NHS to get itself back into financial balance”.

The Royal College of Physicians (RCP) has criticised plans to introduce seven day services in the NHS in England, with RCP president Professor Jane Dacre commenting that “if we have neither enough trainees nor consultants to run the service now, how are we going to implement a safe seven-day service?” Research by the RCP last year showed that four in 10 vacant posts for consultant physicians went unfilled, whilst one in five consultants reported gaps in their junior doctor rotas.

The Royal College of Paediatrics and Child Health (RCPCH) has announced that it will be holding a workshop on Thursday 14th April to discuss the planned implementation of the SNOMED CT clinical coding system in hospital and GP settings across in England, as required by NHS England. The RCPCH argued that the introduction of SNOMED CT will help clinicians obtain timely information about patients to help better understand care outcomes and enable comparisons.

David Pannell, chief executive of Suffolk GP Federation – the largest GP federation in England, has criticised NHS England and CCGs for not taking sufficient action to develop general practice. Pannell said that there had been “lots of talk but no action” on encouraging GP federations and networks through contract changes, noting that “lots of us have really struggled because we’re all dressed up and [have] nowhere to go”.

Forthcoming events

The House of Lords will rise for Easter recess on 23rd March and the House of Commons will rise on 24th March – both will return on 11th April.

NICE launches consultation on a draft quality standard for promoting health, social and emotional wellbeing in children under five

NICE has launched a consultation on a draft quality standard for promoting health, social and emotional wellbeing in children under five. The draft quality standard focuses on aspects of health and social care that are commissioned locally, with a scope to cover home visiting, childcare, early intervention services in children’s social care, and early education. It does not cover vulnerable children who may need additional support, nor does it cover clinical treatment or the role of child protection services.

The draft quality standard contains three quality statements:

  • Statement 1. Parents and carers of children under 5 are offered a discussion during each of the five key visits about factors that may pose a risk to their child’s social and emotional wellbeing.
  • Statement 2. Children under five with identified risks to their social and emotional wellbeing, and their families, receive tailored support.
  • Statement 3. Children are offered an assessment of their speech and language skills at their 2–2 ½ years integrated review

The PCF submitted a response to the topic engagement exercise for this quality standard, arguing that toilet training should be provided through health visiting services to help prevent continence produces from occurring later in childhood.

Continence is now referenced under quality statement 2, where it is outlined that children under five with identified risks to their social and emotional wellbeing should be offered specialist support services, such as mental health, continence and special educational needs services and speech and language therapy.

NICE’s accompanying briefing paper on the development draft quality standard indicated that continence was added as a direct result of the PCF’s response. The briefing paper listed the Paediatric Continence Commissioning guide as a “key development source” and quoting recommendation 1.7 directly, with continence being listed as a “specific area for quality improvement”.

In the context of statement 2, the consultation asks what are the potential risks that should be acted upon and what support should be provided.

Welsh Government publishes National Urology Implementation Plan

The Welsh Government has published the National Urology Implementation Plan (NUIP) for urology services in the Welsh NHS. This document aims to improve patient experience and deliver sustainable services by requiring Welsh health boards to better understand and measure demand, capacity and activity in urology and establish a patient experience measure for urology services in Wales. A subsidiary aim is to prevent unnecessary referrals to secondary care through advocating better use of community based services.

The NUIP covers all urology services, including continence services, but also those for kidney, bladder and prostate disease, impotence, infertility, cancer and reconstruction of the genito-urinary tract. There are no references to catheters within this document.

There are three primary drivers for service change:

  • Clinical value prioritisation – making sure that only the right patients are managed in secondary care
  • Integrated care – establishing collaborative care groups and empowering patients to manage their health
  • Best in class – measuring value for money and benchmarking against top performing organisations

As part of clinical value prioritisation, the NUIP recommends that health boards maximise the use of community continence services to include effective management of continence resources, including staff and products (it is not clear whether this refers to catheters and/or containment pads). It notes that health boards should establish processes to prevent referral into secondary care of patients who will gain little benefit from the referral.

The NUIP also outlines that health boards should take a holistic approach to care, which includes targeting risk factors for urological disorders. In particular, it outlines that obesity is a risk factor for incontinence, and recommends that health boards ensure that there are a suitable range of weight reduction support services available to local communities.

As part of the drive towards integrated care, each health board will be required to establish “collaborative care groups” to manage the flow of patients between primary and secondary care. These will include local professionals, patients and service managers, and will oversee patient streams and referral thresholds, and where necessary triage referrals before submission to secondary care, and establish services to improve patient activation and decision making.

Welsh Assembly votes against Public Health (Wales) Bill

The Public Health (Wales) Bill has been rejected by the Welsh Assembly on the final day of proceedings before the May elections, and will not become law. The vote had been tied, with the presiding officer casting the deciding vote against the legislation.

The Bill would have required local authorities to improve their local toilet provision through developing a local toilets strategy. The Bill would have also introduced pharmaceutical needs assessments (PNAs) to Wales. The PCF submitted written evidence to the Welsh Health and Social Care Committee shortly after the Bill was announced, which stressed the importance of consulting with stakeholders when developing local toilet strategies and when creating and reviewing PNAs.

The Bill had been expected to pass, but was derailed at the last minute by Plaid Cymru to teach Labour a “lesson”, following controversy of perceived disrespectful comments by Labour about Plaid Cymru. There were also objections over the anti-smoking provisions by the Liberal Democrats and Conservatives. Both the British Medical Association and the Royal College of Nursing, amongst others, have described the news as “disappointing” and called on the next assembly to “put aside game playing” and develop a long-term public health strategy.

Department for Education and Department of Health publish guidance on the SEND code of practice

The Department for Education and Department of Health has published guidance for CCGs, local authorities (LAs) and health professionals on their statutory duties as outlined the Children and Families Act 2014 and the SEND code of practice.

The guidance outlines that these organisations have a responsibility to coordinate the most appropriate support for those with SEN, including the necessary equipment, strategies and interventions to “support the child’s progress and build self-esteem and confidence”. It also specifies that CCGs and local authorities should include procedures in education, health and care plans to resolve disputes over care between their organisations, and details the advice that must be given to parents, carers or children and young people on how to coordinate care and request personal budgets.

Budget 2016

Chancellor George Osborne  delivered his Budget 2016 speech to Parliament this week, stressing the themes of “acting now to avoid paying later” and “doing the right thing for the next generation”. The Budget document itself is available here.

This year’s Budget contained few notable measures, but rather reaffirmed that the Government will maintain its current course: reiterating and in some cases expanding on known priorities. Largely this is because of trepidation surrounding the forthcoming referendum on Britain’s European Union membership.

There were no announcements that will directly affect the PCF, with very few health related announcements in general. Below is a summary of announcements of interest:

The Government will now require all schools to become academies by 2020, or to have an academy order in place to convert by 2020.  Osborne announced in his speech that Education Secretary Nicky Morgan will launch a white paper tomorrow setting out the further improvements that the Government will make to the quality of education.

Children’s hospitals in Manchester, Sheffield, Birmingham and Southampton will also receive funds raised from banking fines to pay for projects on eye care, emergency trauma and MRI scanners. The only other health announcements related to the extension of the defibrillator grant scheme, child prosthetics, and a duty on hand-rolling tobacco by an additional 3% above the current escalator.

Other announcements

Discussing the UK’s economic situation, Osborne outlined that the Office for Budget Responsibility (OBR) downgraded its GDP growth predictions for the UK amid challenging global economic circumstances. The UK’s GDP is now estimated to grow by 2.0% in 2016, 2.2% in 2017 and 2.1% in each year until 2020, with inflation predicted at 0.7% in 2016 and 1.6% in 2017. Osborne was keen to emphasise that despite slightly downgraded economic predictions, the UK is still predicted to grow faster than any other well developed industrialised nation.

The OBR also predicted that borrowing will fall from £55.5 billion in 2017/18 to £21.4 billion 2018/19, before reaching a budget surplus of £10.4 billion in 2019/2020.

Osborne emphasised that the OBR’s growth forecasts were predicated on Britain remaining in the EU, outlining the OBR assessment that a vote to leave the EU will “usher in an uncertain period” which could have negative implications on business and consumer confidence, with greater volatility in financial and other asset.

We will monitor for any post-Budget developments that may be of relevance for the PCF.

Below is a summary of other policy announcements of interest in the Chancellor’s speech:

Childhood obesity: the introduction of a sugar levy on the soft drinks industry in two years’ time, subject to public consultation. This levy will raise £520 million, to be spent on doubling the amount of sport in primary school and funding longer school days in secondary school to facilitate extra sport. The devolved nations will receive equivalent funding, as health and education are devolved matters.

Business tax reform: loopholes will be closed, with overall reductions in business rates to attract multinational corporations and ensure that they pay taxes in the UK – measures which will raise an additional £9 billion in revenue. The rate of corporation tax will be reduced from 20% to 17% by April 2020. There will also be changes to small business rate relief worth £7 billion, with half of small businesses seeing their rates reduced or withdrawn all together.

Tax avoidance: more work will be undertaken to shut down various loopholes, with public sector organisations now required to ensure that their employees pay the tax that they should. Tax avoidance measures are estimated result in an additional £12 billion of revenue by 2020.

Devolution: negotiations are underway for devolution deals for Edinburgh and Swansea, with Manchester set to receive additional powers in relation to criminal justice. The Greater London Authority will move towards a full retention of business rates from April 2017 – three years earlier than planned.

Weekly political news round up – 11th March 2016

March 11, 2016 in News by Whitehouse

Around the sector

Lisa Bayliss-Pratt, Health Education England’s Director of Nursing, has told NHS trusts that they cannot use nursing associates as a substitute for registered nurses. However, she rejected claims that nursing associates would increase risks to patients, and that they would have consistent standards of education designed to increase patient safety. Nursing associates are expected to be based at band three or four and sit between healthcare assistants and registered nurses, and will be able to provide direct patient care under supervision of existing registered nursing staff.

The Public Accounts Committee has published a report assessing access to general practice in England. It found that whilst most patients trust their GP and have a positive experience of getting and booking appointments, their ability to get an appointment has declined in recent years and the proportion of patients reporting problems accessing general practice has increased. The report found that younger people, those from minority ethnic groups and those in deprived areas have poorer access. It called for measures to increase the number of GPs and make better use of technology, as well as to ensure best practice is applied more widely.

The Royal College of Paediatrics and Child Health (RCPCH) has published the findings of a workforce survey, which found a need to increase the number of paediatric trainees as a result of more paediatricians choosing to undertake research or take parental leave. The report subsequently called on the Government to increase the number of paediatric trainees and for Health Education England (HEE) to work with the RCPCH and bodies across the UK to better ensure training places are better mapped.

The House of Commons library has published a briefing paper overviewing the structure of NHS England, the responsibilities of each body and several of the key issues facing the health service. A brief overview

Ofsted and the Care Quality Commission publish a response to its consultation on the inspection of local area SEND provision

Ofsted and the Care Quality Commission have published a joint response to its consultation on its proposed framework for the inspection of local area SEND provision, which it consulted on between October 2015 and January 2016.

The PCF submitted a response which called for Ofsted and the CQC to inspect how well staff work across health and education to provide joined up care, and to take into account the views of children on the identification. The PCF also called on inspectors to assess how satisfied parents and carers are with the level and accessibility of their local service provision, with an emphasis on ensuring that care is integrated. Furthermore, the PCF called on inspectors to conduct an overview of commissioning arrangements in the local area, and that local partners like Healthwatch should be consulted with to gauge existing concerns (if any).  Finally, the PCF called on the CQC to ensure a wide range of options to engage with parents, including a roundtable discussion.

Ofsted and the CQC noted that the overall response to all four of their proposals were “very positive”. Below is a summary of the responses for each proposal, as well as what the CQC and Ofsted will do in light of the consultations findings:

Proposal 1: how effectively a local area identifies children and young people with SEND

There was a “very strong” agreement that inspectors should evaluate how timely the local area identifies needs, and how accurately and weekly needs are assessed. There was also an agreement that the inspection framework should focus on the quality and usefulness of information provided for the purpose of assessment and how well parents, families, children and young people were included in the assessment. Some respondents felt that the proposal should inspect the work of health and social care as well.

Inspectors will now:

  • Evaluate how effectively local areas communicate so that all parties understand how needs are identified and decisions are reached;
  • Give particular emphasis to involvement in strategic joint commissioning and involvement in the assessment of their own case;
  • Report on the local areas effectiveness in supporting children and young people with specific needs; and
  • Inspectors will examine how the local area takes account of children and young people’s wishes and feelings when making decisions.

Proposal 2: how effectively the local area meets the needs and improves the outcomes of children and young people with SEND

There was “considerable” agreement that the progress that children and young people make towards the next stage of education or life should be evaluated based on their starting points, and that this should be a key area that Ofsted and the CQC inspect. Respondents felt that wider outcomes should be considered, including aspects such as improved health and employability. There was also very strong agreement from parents and from children and young people that inspectors should take into account their views about how satisfied they are that their needs were met, with parents agreeing that the impact of early diagnosis and intervention should be evaluated.

Inspectors will now:

  • Review education, training, health and social care outcomes as well as academic outcomes;
  • How well the local areas’ processes, culture and ways of working add value to young peoples’ progress, taking account of their starting points;
  • Review the breadth of needs catered for by a local area;
  • How well the local area meets the needs of specific groups; and
  • Ensure that the local offer examines the clarity of decisions on identifying need and the resources allocated to support needs.

Proposal 3: a wide range of information will be used to evaluate the effectiveness of local area arrangements in identifying children and young people who have special educational needs and/or disabilities

Respondents agreed that inspectors should engage with parents, carers and children and young people to inform their evaluations. Moreover, respondents also said that inspectors should examine how well schools, other providers and the local area met their statutory obligations, and ensured that all staff were trained and knowledgeable. Some respondents commented about a lack of reference in the proposals to an evaluation of joint commissioning between education, health and social care.

Inspectors will now:

  • Evaluate how well the local area knows it is fulfilling its statutory duties and meeting children and young people’s needs and improving outcomes;
  • Assess how well children and young people’s life chances and being enhanced by the support and services they receive;
  • Include an examination of case studies, inspection reports and tribunal data, as well as evidence of outcomes; and
  • Consider how well those responsible for provision understand the key strengths and issues in the local area.

Proposal 4: a wide range of ways will be used during the inspection to obtain the views of children and young people with SEND, and their parents and carers

Some respondents expressed concern about who would select parents and young people from whom views would be gathered, with some suggesting that children and young people who are receiving support and did not have an EHCP or statement should also be included. Respondents requested that inspectors give good notice to parents to request to meet and discuss their views, with others suggesting that parent forums, support groups and other bodies who represent parents should be asked to contribute to inspection.

Inspectors will now:

  • Meet with groups of parents and carers that are representative of the local area;
  • Use the views of parents to inform their evaluation of the effectiveness of the local area;
  • Give five days’ notice of the inspection; and
  • Be recruited with a relevant processional background in SEND.

Ofsted and the CQC will now develop an inspection framework and the inspection handbook, which will provide guidance on how they will inspect. The first inspections will take place from May 2016.

Answers to written questions on disabilities in schools

Shadow Children’s Minister Sharon Hodgson has received an answer to a written question asking the Education Secretary what estimate she has made of the cost of including data by type of disability in the school census.

Children’s Minister Ed Timpson responded that no estimate has been made of the cost of including data by type of disability in the school census, and the DfE is exploring if there are other ways of capturing details of pupils’ disability.

Answers to written questions on Ofsted and the Care Quality Commission

Shadow Children’s Minister Sharon Hodgson has received an answer to a written question asking the Education Secretary how much additional funding for 2016-17 her Department has allocated to (a) Ofsted and (b) the Care Quality Commission 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 for the financial year 2016-2017, the DfE allocated £1,057,675 of funding to enable them to meet the costs of their inspections of local areas’ effectiveness in fulfilling their new special educational needs and disabilities duties.

Weekly political news round up – 4th March 2016

March 4, 2016 in News by Whitehouse

Around the sector

A study by Coloplast, based on Hospital Episode Statistics, found that there were over 66,000 hospital admissions for constipation across all age groups in 2014/15, of which 48,409 were unplanned emergency admissions and 17,798 were elective patients, with a total of 15,319 day cases. An accompanying survey found that 35% of patients said that they would wait to see if their symptoms cleared up before speaking to their GP, and 45% would not seek medical help at all. The survey also found that 20% would be embarrassed to talk to their GP about issues with their bowels, with more than 10% reporting that they could not identify the symptoms of constipation.

The National Children’s Bureau, Action for Children and The Children’s Society have jointly published a report, Losing in the long run, which projects that government funding for early help services will be reduced by 71% – from £3.2 billion to less than £1 billion – between 2010 and 2020. Particularly affected will be children’s centres, short breaks for disabled children, and information and advice for young people and family support. A survey of 500 local authority councillors revealed that 59% believed that a reduction in government funding will mean a reduction in these services, even though 87% said that early intervention is a high priority for their community.

The Guardian has reported that there were 23,433 vacant nursing posts and 6,207 vacant doctors posts in December across England, Wales and Northern Ireland – the equivalent of a vacancy rate of 7% for doctors and 10% for nurses compared with an average vacancy rate of 2.7% across the economy as a whole. Ian Cumming, chief executive of Health Education England, said that about half the vacant nursing posts will be filled by agency and temporary staff, as well as recruitment from overseas.

A poll by BBC Wales has suggested that health (33%) is the biggest single issue affecting the way that people will vote in the Welsh Assembly elections in May, followed by jobs (24%), immigration (14%), the economy (11%) and education (10%). Despite the priority given to health, 29% believed that the Welsh NHS is run by the UK Government.

The Royal College of Nursing (RCN) has launched a new website where nurses are encouraged to share case studies of successful public health schemes that they have been involved with, following an RCN survey which found that commissioners wanted more input from public health nurses.

Ofsted has announced that it will directly control the selection, training and management of early years inspectors from April 2017, following the expiration of contracts issued to Tribal and Prospects. Nick Jackson, Ofsted’s director of corporate services, said that this will allow early years inspections to be brought into line with schools and further education and skills.

The Health Services Committee of the Faculty of Public Health (Royal Colleges of Physicians of the United Kingdom) has published a report which found that the capacity and capability of public health specialists within local authority based public health teams is not “sufficient in quality or quantity” in some geographical areas. This assessment was based on anecdotal evidence and a 2015 survey of CCGs. The Committee found that public health specialists have value in supporting clinical-led commissioning, but these specialists require better training – with greater exposure to NHS environments – and that reported capacity issues should be “monitored” with steps taken to ensure an effective delivery of core functions.

NICE launches surveillance review on CG54 – urinary tract infections in under 16s: diagnosis and management

NICE has launched a surveillance review on clinical guideline 54 (CG54), the diagnosis and management of urinary tract infections in the under 16s. This review will assess whether or not the guideline should be updated to reflect any changes in practice since the guideline’s last surveillance review in 2013.

CG54 does not cover children with urinary catheters in situ, as well as children with neurogenic bladders, children already known to have significant pre-existing uropathies, children with underlying renal disease (for example, nephrotic syndrome), immunosuppressed children, and infants and children in intensive care units. It also does not cover preventive measures or long-term management of sexually active girls with recurrent UTI.

The surveillance review will take approximately six months to complete, with a surveillance report due to be published by NICE in June/July 2016. This report will communicate NICE’s decision on whether the guideline should be updated, and provide commentary on approximately three articles felt to be of particular interest within this topic.

Should NICE determine that no update is required, then it will be required to launch a two-week consultation with stakeholders to gauge their opinions on the decision. If NICE decides to update the guideline, then it will not consult on the changes.

Survey finds that clinical commissioning groups lack confidence in health and wellbeing boards to deliver change

NHS Clinical Commissioners, the membership organisation of clinical commissioning groups, has conducted a survey of its members assessing their perspectives of their local health and wellbeing boards (HWBs). The 350 responding members generally indicated that they did not associate their HWB with change, with many respondents raising concerns over their value.

Below is an overview of the findings from CCG chairs and chief officers:

  • 89% of respondents felt that to some extent that HWBs are a place of open discussion;
  • 94% of respondents felt to some extent that HWBs are a place of discussion but not action;
  • 34% of respondents felt that HWBs to no extent provide a joined up approach to commissioning;
  • 41% of respondents felt that HWBs completely failed to drive strategic decisions about long term population needs;
  • 53% of respondents felt that HWBs created an environment which is conducive to effective local decision making;
  • 63% of respondents felt that HWBs were not to any extent associated with delivering real change;
  • 34% of respondents did not feel that HWBs created an equal partnership of health and care commissioners; and
  • 69% of respondents felt that HWBs represented partnership working to some extent.

The findings from all CCG member respondents are broadly in line with those from chairs and chief officers, but with a greater proportion – between 10 and 20% – responding that they could not make an assessment.