Weekly political news round up – 29th April 2016

April 29, 2016 in News by Whitehouse

Around the sector

The Health and Social Care Information Centre (HSCIC) has published “experimental statistics” on the general practice workforce, providing an overview of the total numbers of GPs between 2005 and 2015, as well as nurses (including different types of nurses), patients, and operating practices. It shows that the number of GPs has increased from 31,901 in 2005 to 34,055 in 2015, and that the number of full time equivalent (FTE) nurses has increased from 72,990 in 2005 to 88,275 in 2015.

Health Secretary Jeremy Hunt has revealed that his current position is likely to be his last major job in politics. He said that he would be kept awake at night if he knew that he did not do the right thing to “help make the NHS one of the safest, highest quality health care systems in the world”. He explained that his position as Health Secretary is never a popular one and whoever is in the role is “never going to win a contest for being the most liked person”, but that he is “absolutely determined” to deliver the Conservatives’ manifesto commitments.

Answer to written question on integrated paediatric continence services

Labour MP Rob Marris has received an answer to a written question asking the Health Secretary what discussions he has had with NHS England on the commissioning of integrated paediatric continence services.

Public Health Minister Jane Ellison responded that NHS England’s Excellence in Continence Care commissioning framework, which was published in November 2015, outlines a pathway for the assessment, diagnosis and treatment of continence problems for all ages, including children.

She added that the commissioning framework references the 2014 Paediatric Continence Commissioning Guide, which provides a specification for paediatric continence services that puts integration at its heart. She also highlighted that the Excellence in Continence Care Programme Board, which produced the commissioning framework, includes paediatric continence specialists and representation from the Paediatric Continence Forum. She said that the Programme Board continues to oversee the implementation of the framework.

Tabled writen questions on school nurses providing levle one paediatric continence services

Conservative MP Michael Tomlinson has tabled three written questions to the Health Secretary on school nurses providing level-one paediatric continence services, asking:

  • What assessment his Department has made of the capacity of school nurses to offer basic support for children with continence problems since the transfer of school nurse commissioning to local authorities.
  • What discussions Public Health England has had with NHS England on the commissioning of school nurses offering level one paediatric continence services since the transfer of school nurse commissioning responsibilities to local authorities.
  • What discussions he has had with the Secretary of State for Education on ensuring that children attending educational settings have access to on-site support for continence problems.


NHS England’s continence care lead urges commissioners to engage with patients

Sarah Elliott, NHS England’s lead for continence care and the regional chief nurse for NHS England (South), has written a blog post urging commissioners to work with people with continence problems to better understand their needs and offer them the “right treatment and support”.

Elliott said that her biggest priority is to make sure that commissioners understand the burden of continence needs within their local population, engage with patients and work in collaboration with providers. She highlighted that continence problems affect a wide range of people including children, pregnant women and women who have had children, those with neuropathological problems or musculoskeletal problems and men who have had a prostatectomy – and that there can be “considerable psychological impact” to continence problems.

Elliott added that she was “heartened” to see Excellence in Continence Care patient advocate Jacqueline Emkes receive the patient advocate award at the National Continence Care Awards, for supporting patients and health professionals to improve continence care. She said that Emkes’ story and experience helped the Excellence in Continence Care Programme Board understand what the NHS can do to ensure better management of continence problems. She urged commissioners to talk to people like Emkes when they are designing continence pathways, and with partners to ensure local plans considers people’s needs and offer the right treatment and support.

Elliott highlighted an initiative between Somerset CCG and Somerset Partnership NHS Foundation Trust as evidence of good practice in improving continence services. Working together, they introduced ambulatory care clinics which provide local care in rural areas, where travel time is a significant factor for both patients and community nurses. These clinics provide ongoing support for catheterised patients, through regular appointments for routine catheter changes and emergency catheter care within clinic hours.

Ofsted and Care Quality Commission publish local area SEND inspection framework and guidance for inspectors

Ofsted and the Care Quality Commission (CQC) have published their local area SEND inspection framework, as well as their guidance for inspectors on how to carry out the inspections. The publication of these documents follows Ofsted and the CQC’s response to their consultation on this topic, published in March 2016, which outlined a number of changes to the framework in response to comments by stakeholders.

The framework provides an overview of the inspections’ purpose. This is: to evaluate how well a local area carries out its statutory duties to support children and young people with SEND, and report for service users, providers, commissioners and the Education Secretary as to how well their local area is performing. The framework stresses that the local area, rather than just the local authority, is being expected; this covers the local authority, clinical commissioning groups, public health, NHS England, early years, schools and further education provides.

The framework also provides the legal basis for the inspection, appropriate action that must be taken after the inspection (working with local areas to deliver improvements, writing to local areas to make them aware of the outcome, publishing the report on the CQC and Ofsted’s websites), the criteria for inspecting local areas (at least once every five years), and the focus of the inspection. The framework provides an overview of a brief overview of the composition of the inspection team (a children’s services inspector from the CQC and an Ofsted inspector with specialist knowledge), as well as their conduct during inspections and the expectations of local areas and providers to co-operate.

The handbook provides greater detail on each aspect of the framework. It overviews what should be done before and during the inspection – focusing on safeguarding issues, gathering the evidence available and the views of children, young people and parents and carers – as well as visits to providers and services, quality assurance, complaints and activity after the inspection. The handbook provides a comprehensive evaluation schedule setting up the types of inspection evidence and considerations that guide inspectors in judging the effectiveness of meeting its responsibilities under the Children and Families Act 2014, as outlined in the SEND Code of Practice. There are no condition specific assessments suggested in the handbook.

Scottish Labour launches its election manifesto

Scottish Labour has published its manifesto for the 2016 Scottish Parliamentary elections on 5th May, which calls for called for an investment in Scotland’s future, notably through investment in education and other public services.

The manifesto outlined that a Scottish Labour government should extend the minor ailment service in community pharmacies, enabling them to visit their pharmacist for low-level prescribing and provide advice to those who would otherwise visit a GP. Scottish Labour also committed to investing more in advanced nurse practitioners, and will guarantee an appointment to a GP surgery within 48 hours. For education, the manifesto outlined that Scottish Labour would “stop the cuts” to schools, nurseries, colleges and universities and protect the education budget in real terms for the lifetime of the next Parliament. There was no mention of special educational or additional needs in the document.

NHS England agrees deal to broaden the use of patient activation measures

NHS England has agreed a deal to broaden the use of patient activation measures (PAM) to reach up to 1.8 million people with long-term conditions, as part of its self-care programme.

Around 40 NHS organisations, including new care model vanguards, clinical commissioning groups, local authorities and primary care organisations and their partners, have been invited to apply for free access to a PAM license. These organisations can then use to introduce PAMs to help them understand the activation level of their local population and tailor their services according to individuals’ needs, thus helping them lead better lives at a lower cost to the system. Five CCGs and the UK Renal Registry have been testing PAMs since 2014.

‘Patient activation’ describes the knowledge, skills and confidence a person has in managing their own health and care. According to evidence cited by NHS England, when people are supported to become more activated, they benefit from better health outcomes, improved experiences of care and fewer unplanned care admissions.

The closing date for applications is midday on 17th May 2016.

Healthwatch England pubishes case study of action taken to improve the experiences of children with SEND

Healthwatch England has published a case study of the actions that Healthwatch Slough has taken to improve the experiences of children with SEND, which including topics that were used to engage with parents/carers, the findings of the engagement, subsequent action taken, and the results of these actions.

The case study outlines that Healthwatch Slough engaged with children and young people with SEND, their parents and others supporting with them, and asked for their views and experiences. It also looked at previous feedback on SEND services and conducted mystery shopping to find out how easy it was to find information about SEND services in Slough online. Families told Healthwatch Slough that there is a lack of information about support groups available to parents and carers, there were limited social activities and clubs for SEND children, there needed to be better coordination between care professionals and schools, and that people generally felt that their views were not listened to or acted on.

Healthwatch Slough published a report in its findings, which recommended that information is made easier to access, that children and young people, as well as their parents and carers are encouraged to speak up, and that there are more activities and groups available for families in Slough. This report was shared with the council, children’s services, the Care Quality Commission and Slough Clinical Commissioning Group. The chief executive of the Children’s Service Trust later responded to each recommendation, and told Healthwatch Slough that it would look at opportunities to strengthen what is commissioned and promote more widely other activities and services that are available.


Weekly political news round up – 22nd April 2016

April 22, 2016 in News by Whitehouse

Around the sector

The Department of Health has announced that the Health and Social Care Information Centre (HSCIC) will be renamed NHS Digital, effective from 1st July 2016. The HSCIC is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care.

The Care Quality Commission’s budget for 2016/17 will be £236 million rather than the £245 million expected a few months ago – a reduction of £9 million, according to its draft business plan. The CQC will have four priorities for the year: completing its much delayed inspection programme; updating its approach to inspection; developing its internal capabilities; and evaluating its impact and value for money.

The Department for Education has announced the appointment of Jonathan Slater as its new permanent secretary, following the departure of Chris Wormald to become the Department of Health’s permanent secretary. Slater, who will take up his position on Tuesday 3rd May, is currently the director general of the Economic and Domestic Affairs Secretariat at the Cabinet Office.

Answers to written questions on the prevalence of paediatric continence problems

Labour MP Grahame Morris has received a grouped response to four written questions on the prevalence of paediatric continence problems, namely:

  • How many emergency admissions there were for bladder and bowel problems amongst children and young people aged 19 and under in each of the last five years?
  • What estimate his Department has made of the number of children and young people aged between (a) five and six, (b) seven and nine, (c) 10 and 15, and (d) 16 and 19 with nocturnal enuresis in England?
  • What estimate his Department has made of the number of children and young people aged between (a) four and seven, (b) eight and 10 and (c) 11 and 16 with faecal incontinence in England?
  • What estimate his Department has made of the number of children and young people aged between (a) five and six, (b) seven and 10, (c) 11 and 15, (d) 16 and 18 and (e) 19 and 24 with daytime urinary incontinence in England?

Public Health Minister Jane Ellison responded that information on nocturnal enuresis and daytime urinary incontinence in England is not available in the format requested. However, she provided the following data based on Hospital Episode Statistics obtained from the Health and Social Care Information Centre:

Table 1: Count of emergency finished admission episodes (FAEs) with a primary diagnosis of (a) incontinence and (b) constipation, where the patient age was 19 years and under, 2010-11 to 2014-15

Year Nonorganic enuresis Nonorganic encopresis Stress incontinence Other specific urinary incontinence Faecal incontinence Unspecified urinary incontinence Constipation
2010-11 2 0 8 6 16 77 10,469
2011-12 0 0 3 6 23 65 10,315
2012-13 1 2 4 11 16 66 10,534
2013-14 1 0 0 5 21 64 11,043
2014-15 3 2 2 5 15 85 11,501

Table 2: Count of FAEs with a primary diagnosis of faecal incontinence, for patients aged between (a) 4 to 7 years (b) 8 to 10 years and (c) 11 to 16 years, 2014-15

Year Age 4-7 Age 8-10 Age 11-16
2014-15 45 20 18

Table 3: Count of FAEs with a primary diagnosis of urinary incontinence, for patients aged between (a) 5 to 6 years, (b) 7 to 10 years (c) 11 to 15 years (d) 16 to 18 years and (e) 19 to 24 years, 2014-15

Year Age 5-6 Age 7-10 Age 11-15 Age 16-18 Age 19-24
2014-15 350 946 719 141 170

Table 4: Count of FAEs with a primary diagnosis of nonorganic enuresis, for patients aged between (a) 5 to 6 years (b) 7 to 9 years (c) 10 to 15 years and (d) 16 to 19 years, 2014-15

Year Age 5-6 Age 7-9 Age 10-15 Age 16-19
2014-15 0 1 5 0

Tabled written questions on paediatric continence services

Labour MP Rob Marris has tabled a written question asking the Health Secretary what discussions his Department has had with NHS England on the commissioning of integrated paediatric continence services.

Answers to written questions on urinary tract infections

Labour MP Catherine West has received a grouped answer to two written questions on urinary tract infections, asking the Health Secretary:

  • What guidance his Department issues on what evidence should be used to determine basic treatment for people presenting with acute urinary tract infections; and
  • What steps he is taking to ensure that patients with chronic acute urinary tract infections can access appropriate treatment on the NHS.

Public Health Minister Jane Ellison responded that NHS commissioners, rather than the Department of Health, are responsible for making decisions on individual treatments. She added that these decisions should factor in guidance by NICE – in this case the NICE guideline on urinary tract infections (available here). Ellison also highlighted that NHS England published its Excellence in Continence Care guidance in November 2015 to help improve the care and experience of people with continence issues (available here).

NHS England publishes the General Practice Forward View

NHS England has published the General Practice Forward View (GPFV), which outlines a £2.4 billion a year plan to “stabilise and transform” general practice. The GPFV sets out steps to support the redesign of primary care, expand the GP and primary care workforce, as well as steps to reduce workload and develop GP infrastructure. Child health only received very scarce mention. Below is a summary of developments of relevance for the PCF:

Care redesign

£500 million of recurrent funding will be invested by 2020/21 to provide extra primary care capacity across England, as well as support the integration of extended access with out of hours and urgent care services. There will be a £171 million one-off investment by CCGs starting in 2017/18 for practice transformational structure, with the introduction of a new voluntary multispecialty community provider contract from April 2017 to integrate general practice services with community services.


NHS England and Health Education England (HEE) will receive an extra £206 million to double the growth rate of the medical workforce and create an extra 5,000 doctors working in general practice by 2020. GP training recruitment rates will be increased to 3,250 a year, with major domestic and recruitment campaigns, bursaries and training opportunities. There will also be an additional £112 million investment to deliver a further 1,500 pharmacists in general practice by 2020, with funding for an extra 3,000 mental health therapists. HEE will invest in the training of 1,000 physician associates to support general practice.


NHS England will invest £30 million in a new ‘Releasing Time for Patients’ development programme to support practices free up time. The GPFV outlines that some practices have already identified assisting patients in managing minor self-limiting illnesses themselves, as a way of taking this forward. The GPFV also outlines that by 2016, NHS England will have launched a national programme to help practices support people with long term conditions to self-care – offering support to those with low levels of knowledge, skills and confidence manage their own health and wellbeing.

The GPFV also outlines plans for £900 million of capital investment and support for NHS premises developments and maintenance.

These ambitions will be supported by a £2.4 billion a year investment in general practice by 2020/21, with total investment rising from £9.6 billion a year in 2015/16 to over £12 billion a year by 2020/21 – a 14% real terms increase. This includes capital investment amounting to £900 million over the next five years, which will be supplemented by a sustainability and transformation package worth over £500 million over five years. Investment in primary care will increase nationally, as CCGs build community services and new care models in line with the Five Year Forward View.

Health Select Committee publishes report on primary care

The Health Select Committee has published its report on primary care, following an inquiry conducted over the second half of 2015. The reported drew conclusions on patient experience of primary care, as well as delivering new models of care, building the primary care workforce, and primary care funding. There were very few references to paediatrics and child health more generally.

The PCF submitted written evidence that argued that poor commissioning arrangements by CCGs, as well as a lack of access to good care pathways, placed a significant burden on primary care practitioners when handling paediatric continence problems. Although the PCF’s response was not directly referenced, the final report found primary and community care staff will need to work more closely with those in secondary care and improve communication. Below is a summary of the general findings of the report.

The report identified that although primary care is “highly valued” by the public it is “under unprecedented strain and struggling to keep pace with relentlessly rising demand”, and will need to “adapt it if it to meet the rapidly rising and changing demands of patients living with increasingly complex health problems”. Patients generally viewed primary care positively, with the report citing evidence by consumer healthcare champion Healthwatch showing that 85% of doctors and 87% of nurses were rated positively in terms of listening to patients. However, the report also identified problems accessing general practice – notably with waiting times and an inability to get same day appointments. The Committee recommended that pilot programmes should be carried out on weekend appointments.

The reported also noted that the Committee heard “worrying evidence” about the “longstanding variation in quality across primary care”, noting that the CQC is working with the Royal College of General Practitioners and the British Medical Association making efforts to identify and address this issue. The report called on NHS England, the CQC, the General Medical Council and Local Education and Training boards to work together to reduce bureaucracy and better devote time to patient care.

The report identified issues with recruitment, noting that it is “far from certain” that sufficient numbers of GPs and nurses will be available to build new teams and improve patient access, outlining that “much greater efforts” to recruit, train and retain the primary workforce will be required in the future. The report also identified that further clarification is need about how the manifesto commitment to deliver seven-day access to services will be delivered in light of a workforce shortfall.

The report identified Government must prioritise the training, development and retention of not only more GPs, but wider multi-disciplinary teams working within a more integrated system of care. The report found that these teams not only harness the skills of GPs, but also practice nurses, pharmacists, physicians’ associates, mental health worker and physiotherapists. It was identified that patients would benefit more from the better use of technology to assist communication with and between clinicians, with a “pressing need” to improve continuity and safety through the use of electronic patient records.

The report noted that funding for primary care has fallen behind as a share of the overall NHS budget, with the Five Year Forward View providing a “very limited” uplift in expenditure on primary care.

Overview of devolved manifestos

The Scottish National Party (SNP), Welsh Labour and the Welsh Conservatives have published their manifestos ahead of the elections in Scotland, Wales and Northern Ireland on 5th May 2016. As with the previous update, Whitehouse has provided summaries of policy commitments on issues related to child health relevant for the PCF.

Scottish National Party (SNP)

The SNP’s manifesto promises to develop a new 10-year child and adolescent health and wellbeing strategy, covering both physical and mental wellbeing. The manifesto also outlines that the SNP will introduce a new framework for families and disabled children to ensure that children get the right support from birth to adulthood. There is also a commitment to recruit an extra 500 health visitors by 2018 so that every child receive a health development check at 30 months. More generally across health, the NHS revenue budget will rise by £500 more than inflation by the end of the next parliament, with the structure and regulation of health boards – and their relationships with local councils – to be reviewed. There will also be an investment in GP and nurse recruitment, better access to pharmacists, and longer GP opening hours. There were no commitments relating to children with special educational needs in educational settings.

The general theme of the SNP’s manifesto is to continue the journey towards a “fairer, more equal and prosperous Scotland”, which focuses on investing in children, health and social care, and the economy. The SNP also outlined ambitions to use new tax powers to expand the economy and lift people out of poverty.

Welsh Labour

In a shorter than average manifesto, Welsh Labour has promised to invest more money per person in health and social services in Wales than is currently being invested in England. There were no commitments related to child health, with others relating to organ donation, diagnostic waiting times, cancer treatment, developing the social care work force, and investing in the capacity of community pharmacies to deal with minor ailments. There were no commitments relating to children with special educational needs in educational settings.

Welsh Labour hopes to provide a government that “will be there for you and your family at the moments that matter”, outlining that schools will be better funded, the NHS will be modernised and not privatised, and support will be provided for the small business that drive the economy.

Welsh Conservatives

In a similarly short manifesto, the Welsh Conservatives have outlined that they would introduce an Additional Learning Needs Bill, which will “improve conditions and resources for children with additional learning needs, enabling them to achieve their potential”. This Bill will clarify the dual role of Special Educational Needs Coordinators and Additional Learning Needs Coordinators. It would also implement a system of early effective and appropriate intervention to ensure that children have every opportunity to learn effectively according to their specific needs.

The Welsh Conservatives would appoint a dedicate nurse in every Welsh secondary school, college and university. There was little else specifically child health related, with commitments to increase NHS expenditure, increase the number of doctors and specialist nurses, as well as directly elect health commissioners for each Welsh health board.

The Welsh Conservatives’ hold a ‘one nation’ ambition which delivers the same policy ambitions as the UK government – one which focuses on jobs, education and NHS investment. The manifesto stresses the importance of protecting public services and providing support for small businesses.

Weekly political news round up – 15th April 2016

April 15, 2016 in News by Whitehouse

Around the sector

NHS England has published an updated version of its framework for patient and public participation in primary care commissioning. Following a submission by the PCF, the updated framework now recognises children and young people with long-term conditions as a group that faces specific barriers to participation in primary care commission and has specific needs that must be taken into account.

Dame Julie Moore, chief executive of University Hospitals Birmingham and Heart of England NHS trusts has accused the NHS of “gross incompetence”, calling on many of her peers to be sacked, and suggesting that NHS managers have been allowed to advance their careers whilst avoiding responsibility. Dame Julie blamed previous governments for centralising powers, leading some staff towards inactivity as they were “waiting for a command from God on high” instead of showing initiative.

The National Union of Teachers (NUT) and NASUWT have criticised education ministers for failing to listen to teachers when drawing up plans for the reception baseline assessment, which was subsequently put on hold after research found that the tests were not reliable enough. These assessments are intended to measure children’s numeracy and literacy skills at ages four and five, and have been criticised for potentially leading nurseries and other early years settings to focus on academic rather than general development.

Think-tank Reform has published a report on the future of general practice calling for “integrated commissioning bodies” to replace the existing fragmented system of commissioning involving NHS England, CCGs and local authorities. It called for whole-population care contracts to be capitated, with commissioners able to attach bonus payments to incentivise improved care in specific areas. It also suggested a more diverse workforce, where pharmacists and nurses could administer meetings instead.

The Faculty of Public Health has published its good public health practice framework for 2016, which assists public health professionals to understand what good practice in public health looks like. It does not make reference to continence or any specific medical conditions.

Tabled written questions on the prevalence of childhood continence problems

Labour MP Grahame Morris tabled four written on the prevalence of childhood continence problems, asking the Health Secretary:

  • How many emergency admissions there were for bladder and bowel problems amongst children and young people aged 19 and under in each of the last five years.
  • What estimate his Department has made of the number of children and young people aged between (a) five and six, (b) seven and nine, (c) 10 and 15, and (d) 16 and 19 with nocturnal enuresis in England.
  • What estimate his Department has made of the number of children and young people aged between (a) four and seven, (b) eight and 10 and (c) 11 and 16 with faecal incontinence in England.
  • What estimate his Department has made of the number of children and young people aged between (a) five and six, (b) seven and 10, (c) 11 and 15, (d) 16 and 18 and (e) 19 and 24 with daytime urinary incontinence in England.

Public Health England publishes its four-year strategic plan

Public Health England has published its four-year strategic plan, broadly outlining its objectives to 2020 and how it hopes to work with other bodies to achieve them. PHE will focus on issues such as obesity, screening and immunisation, scientific research and workforce planning. Below is a summary of its planned activities with each of its partner organisations relevant for the PCF:

Local government

  • Supporting local government in delivering better health outcomes.
  • Supporting political leadership in local authorities.
  • Maximising the potential of devolution deals.
  • Aligning PHE’s products and services to local government’s needs.
  • Developing an economic tool to support local and national investment decisions on evidence-based interventions.
  • Supporting the commissioning of public health services for children aged 0-5, particularly reviewing mandated universal health visitor reviews by autumn 2016, and assess the benefits of the expanded and transformed health visitor service.
  • Working with the Chartered Institute of public Finance and Accountancy and HM Treasury and a range of key stakeholders to develop a model for demonstrating the return of investment in prevention.


  • Providing knowledge and analysis to support the development of local sustainability and transformation plans by the end of June 2016.
  • Leading the public health prevention work stream of the maternity transformation programme.
  • Working with local government and NHS bodies to secure a reduction in variation and the best outcomes for each locality.

The public

  • Delivering the information service for parents and the Start4Life campaign, addressing maternal and early years health.

Developing PHE as an organisation

  • Creating a national centre of expertise for public health science, to be operational between 2019 and 2024.
  • Developing the capability of PHE to support local devolution agreements.
  • Various improvements to vaccines and emergency preparedness.
  • Supporting PHE staff to develop professionally.

The strategy also outlines PHE’s strategy for global health, its plans to take forward scientific research on genomes, its plans to develop a new public health workforce strategy, and leadership programme. Actions with the national government include contributing to the Government’s childhood obesity strategy, and supporting the development of new strategies on tobacco control and so on.

Scottish Conservatives published 2016 general election manifesto

The Scottish Conservative Party has published its manifesto for the Scottish Parliament elections in May 2016.

The core elements of the manifesto include protecting NHS spending and boosting mental health support, empowering school leaders to close the attainment gap, and making childcare more flexible. Other areas of focus include protecting family finances, closing the disability employment gap, establishing a new crisis family fund, tackling anti-social behaviour, building homes and reducing fuel poverty. There are no references to continence and little mention of child health in general.

On the health care system, the Scottish Conservatives outlined its ambitions to:

  • Secure NHS funding through a health guarantee that ensures that the health budget rises annual by whatever is the highest of out inflation, 2% or Barnett Consequentials – this would mean an additional £15 billion for the NHS by the end of the Parliament.
  • Reintroduce prescription charges for those who can afford them, with children and those with long-term conditions exempt.
  • Review input targets for the NHS to assess which help more people “survive and get better”.
  • Support the expansion of the minor ailment service, which will see community pharmacists at the heart of primary care.
  • Support a universal GP-attached health visiting service, extended to the age of seven, which will see an additional 500 health visitors hired over the next four years.
  • Introduce recovery centres to take press of emergency departments.
  • Invest £300 million in improving mental health treatment over the next Parliament.
  • Explore devolving disability benefits more locally.
  • Improve end of life care.

In education, the Scottish Conservatives outlined that they would improve the provision of flexible childcare, give school leaders more decision making powers, attract high quality teachers, tackle the engage gap, support underperforming students, and invest in further and higher education.

Plaid Cymru publish 2016 election manifesto

Plaid Cymru has published its manifesto for the Welsh Assembly elections in May 2016, outlining its three main ambitions to improve healthcare in wales, develop a better education system from “cradle to career” and develop a strong economy. There were few references to child health.

Plaid Cymru will seek to reduce the historic divide between the health and social care and create a “people-powered” health service, centred on the patient, putting prevention and healthy living at the heart of its strategy. To do this, Plaid Cymru will:

  • Replace the 7 existing local health boards with a new community NHS delivered through regional combined authorities, to be inspected by a new system independent of government
  • Create a new national network of acute and specialist hospitals, which may be run directly by the Welsh Government or by an arms-length NHS board.
  • Introduce free personal care for the elderly within the first two years of government, including abolishing all fees for non-residential care and charges with dementia diagnosis.
  • Abolish all social care charges for the elderly within a second term.
  • Develop a network of NHS-run medical care homes in communities throughout Wales, where a “plethora” of elderly services will be available from traditional residential services.
  • Introduce targeted public health interventions on smoking, soft drinks, fruit and vegetables, hearing loss, drugs and asthma.
  • Improve early diagnosis of cancer, as well as encourage quicker treatment, better vaccinations and access to new medicines and treatment.
  • Recruit 1,000 extra doctors, increase capacity in medical schools, and recruit 5,000 nurses.
  • Invest in mental health services, ambulance services, medical research and technology.
  • Reducing the number of NHS managers.

In education, Plaid Cymru will agree a national strategy for raising standards of educational attainment in Wales, create a single national centre for initial teacher training, encourage parents to become more involved in their child’s learning, and invest more in early education.

Welsh Liberal Democrats publish 2016 election manifesto

The Welsh Liberal Democrats have published its election for the Welsh Assembly elections in May 2016, with the three main priorities of increasing NHS staffing levels, reduce the size of school classes, and creating an “opportunity economy” which helps businesses grow and assist people to buy their own homes. There are no specific focus on child health.

For health more generally, the Welsh Liberal Democrats will:

  • Build a future proof health and social care system, through developing a national workforce and training strategy and investing in general practice.
  • Ensure that the NHS is available when need through improving access to medical treatments and improving cancer outcomes by establishing a national cancer awareness campaign supporting a national cancer director.
  • Improve mental health by legislating for a parity of esteem between mental and physical health, as well as improving funding for mental health services.
  • Improve care for the elderly through supporting older people through the emergency hospitalisation process, supporting investment in community care, and training clinicians for elderly people and tackling age-related illnesses.
  • Improve social care services through ensuring that staff are properly supported and that social care applications can be fast tracked.
  • Improve public health service by abolishing Public Health Wales and transferring responsibility and funding for public health to local government, ensuring that pharmacies play a full role at the heart of public health and their local communities, that schools have access to a nurse, appoint good health champions and identify a local pharmacist to oversee issues relating to medicines taken by pupils, and that physical activities are promoted to tackle obesity in Wales.
  • Empower patients by providing them with a mix of information, action plans, structured education and training, and access to specialist advice from trained health care professionals and volunteers, as well as ensuring access to health professionals such as physiotherapists and occupational therapists.

For education, the Welsh Liberal Democrats propose reducing infant class sizes, expanding the pupil premium and increasing access to university.

Weekly political news round up – 8th April 2016

April 8, 2016 in News by Whitehouse

Around the sector

The Department of Health has published the NHS Outcomes Framework for 2016 to 2017, which sets out the indicators that will be used to hold NHS England to account for improvements in health outcomes over the next year. The Framework is unchanged from last year, and includes indicators on the proportion of people feeling supported to manage their long-term condition (indicator 2.1), improving people’s experience of outpatient care (indicator 4.1) and improving people’s experience of integrated care (indicator 4.9).

The Daily Mail has published an article suggesting that osteopathy, a therapy where practitioners treat and prevent health problems by moving, stretching and massing a person’s muscles and joints, could improve help improve problems such as constipation in children. The article quotes research by Dr Iona Bramati-Castellarin of 49 families that found that massages showed statistically significant improvements in their digestive issues.

An NHS England commissioned review of the December 2015 collapse of the Cambridgeshire and Peterborough CCG contract with Uniting Care Partnership has recommended that NHS England review its approach of allowing CCGs to enter into large complex novel contracts without any oversight from NHS England.

Think-tank the Social Market Foundation (SMF) has published a report which calls on the Government to establish an Office for Patient Outcomes (OPO), to act as an “independent”, authoritative and more complete” source of data about NHS patient outcomes. The SMF argues that the OPO would be low-cost and high-impact, building on many of the strengths of the present system while providing more “patient-friendly information and a sharper accountability for improving patient outcomes.

Research by influential think-tanks the King’s Fund and the Nuffield Trust on GP attitudes towards CCGs has found that GP leaders want to remain in their role, and view CCGs as an influential part of the local health economy. However, GPs also felt that CCG managers and NHS England are more influential than they are, with only 20% of GPs without a formal role in the CCG able to influence decisions. Moreover, 80% of GPs without a formal role in the CCG were negative or neutral about the introduction of co-commissioning, with the proportion of GPs on their CCG governing who feel highly engaged in their work falling from 83% in 2013 to 64% in 2016. The study is based on six CCGs.

An Oxford University study has found that the overall workload in general practice has increased by 16% over the past seven years, with the majority of the increase being handled by GPs rather than practice nurses. The research has led experts to call for an increased share of the primary care workload to be undertaken by nurses, including a “major shift” away from a “doctor-centric” model to one with “more and varied” clinical support staff working in collaboration with GPs.

Chris Ham, chief executive of the King’s Fund, wrote in the Guardian that NHS leaders believe the financial position of the NHS to be worse than official figures suggest, which do not factor in the cost of new commitments such as seven-day working or increases in pension contributions for staff. One NHS leader asked Ham whether government ministers are “in denial” or “simply unaware of the impact of their actions on the ground”.

The Department for Education has decided that the reception baseline assessment will not be used as a starting point to measure pupil progress, in light of the findings of a comparability study that found they were not reliable enough. These assessments are intended to measure children’s numeracy and literacy skills at ages four and five, and have been criticised for potentially leading nurseries and other early years settings to focus on academic rather than general development.

Forthcoming events

The House of Commons and House of Lords will both return from recess on Monday 11th April 2016.

NHS England publishes list of new national clinical directors and associate national clinical directors

NHS England has published an updated list of its 18 national clinical directors (NCDs), as well a list of its seven newly created “associate” NCDs. The appointments follow NHS England’s decision in November 2015 to reduce the number of NCD to facilitate a move to a more “streamlined” system, with the majority of NCDs replaced.

Dr Jackie Cornish’s role has retained her position as NCD children, young people and the transition to adulthood, while Claire Lemer has been appointed as associate NCD for children and young people. Lemer is a consultant in general paediatrics at the Evelina Children’s Hospital in London, and has been working on a project to improve everyday healthcare (primary/secondary) for children in Southwark and London. Lemer trained in paediatrics but has a background in public health and health policy.

A direct replacement has not been appointed for Dr Martin McShane, who was NCD for long-term conditions and responsible for continence. It has not been revealed which NCD is now responsible for continence. Below is a summary of the appointments:

National Clinical Directors

Cancer Chris Harrison
Children, young people and the transition to adulthood Jacqueline Cornish
Cardiovascular disease prevention Matt Kearney
Dementia Alistair Burns
Diagnostics and imaging Erika Denton
Emergency preparedness and critical care Bob Winter
End of life care Bee Wee
Heart disease Huon Gray
Learning disability Dominic Slowie
Maternity review and women’s health Matthew Jolly
Mental health Tim Kendall
Muskuloskeletal services Peter Kay
Obesity and diabetes Jonathan Valabhji
Older people Martin Vernon
Respiratory services Mike Morgan
Stroke Tony Rudd
Trauma Chris Moran
Urgent care Jonathan Benger


Associate National Clinical Directors

Children and young people Claire Lemer
Diabetes Partha Kar
Elective care Ramani Moonesingh
Mental health (perinatal) Jo Black
Mental health (perinatal) Giles Berrisford
Mental health (secure) David Fearnley
Older People Dawn Moody


Weekly political news round up – 1st April 2016

April 1, 2016 in News by Whitehouse

Around the sector

Health Secretary Jeremy Hunt has revealed that his biggest mistake so far was to rely too heavily on inspections to improve poor care, and that it took him “a while” to understand that the most important thing that any organisational leader can do is think about how to change culture. He added that he had “shied away” from cultural changes as they “felt so nebulous and also impossible to do”.

Mayor of London and Conservative MP Boris Johnson has revealed that should he succeed David Cameron as Prime Minister, he would give the NHS independence from direct political control and name NHS England chief executive Simon Stevens as its first governor general. Johnson has already created an advisory group to refine the idea, the members of which would serve on the NHS’s equivalent of the Bank of England’s monetary policy committee.

Greater Manchester has become the first region in England to gain control of its health and social care budget. The Greater Manchester Strategic Partnership is comprised of 37 organisations, including hospital trusts, NHS England, and the 10 borough councils and commissioners, and is chaired by Lord Peter Smith. Its main priorities will be to improve school readiness, reduce the number of low-weight babies being born, reduce the effects of poverty, and cut rates of heart disease, cancer, respiratory disease and falls amongst older people.

Figures from the Health and Social Care Information Centre (HSCIC) show that the number of nurses and health visitors in England increased by 0.9% last year to 281,000 (an increase of 1.1% from 2009), while the number of managers rose by 6.5% to 20,300 (a decrease of 21% from 2009). The Royal College of Nursing called the increase “meagre” and “hard to understand” against a backdrop of “increasing patient demand and services”.

Ian Dodge, NHS England national director for commissioning strategy, has announced that he expects “nearly all” CCGs to have taken on delegated co-commissioning responsibilities for primary care by 2017-18. There are currently 114 CCGs will fully delegated responsibilities.

NHS England has published a list of 41 senior figures from across health and social care who will lead on the development of sustainability and transformation plans (STP) in the 44 STP footprint areas – three are leads are still to be confirmed.

BBC publishes article on childhood constipation

The BBC has published an article on childhood constipation, which stresses that importance of providing proper diagnosis, referral and treatment to ensure that children are free of accidents and can live more independently. The article quotes an estimate by ERIC that between 5% and 30% of children suffer from constipation but that it normally goes unrecognised, highlighting that GPs are “failing to diagnose the problem properly” and not referring to a specialist when they should, with some of the advice being provided by them being incorrect.

Rhia Favero from ERIC commented that dietary changes may help to solve the problem, but that this cannot be seen as a panacea. She said that dehydration is more often the problem and that children are holding on and not going to the toilet at school, with fever or medication also factors. She added that children can experience a painful experience going to the toilet and it then becomes a vicious cycle of not wanting to go, suggesting that children get a “decent amount of exercise” and have a toilet routine in place.

Dr Anton Emmanuel, a consultant neuro-gastroenterologist at University College London, agreed that increasing fibre intake does not always work and that if it does not for one patient, then they should try something else. He said that doing pelvic floor exercises and undertaking biofeedback sessions can help deliver better outcomes. He stressed that “constipation is just a symptom” and that clinicians and the public should understand “the mechanism of the individual because it is not the same for everyone”.

NHS England publishes CCG improvement and assessment framework for 2016/17

NHS England has published a new improvement and assessment framework for CCGs, which will replace the existing CCG assurance framework and CCG performance dashboard from 2016/17 onwards. Child health is only mentioned in the context of mental health, obesity and diabetes.

The new framework will be used to assess the performance of individual CCGs and is intended to provide a greater focus on assisting improvement. It has been designed to supply indicators for adoption in sustainability and transformation plans as markers of success. It better aligns with NHS England’s mandate and planning guidance, with better public visibility and seeks to reach beyond CCGs, enabling local health systems and communities to assess their own progress from ratings published online.

The new framework assesses performance against a prescribed set of high level indicators. NHS England said that the new framework was not designed to be fully comprehensive, recognising that “all organisations have finite capacity for change” and that “an excessive number of indicators would inevitably dilute the impact of the framework”.

The indicators form part of four separate domains, which are:

  • Better health – looking at how the CCG is contributing towards improving the health and wellbeing of its population. It focuses on personalisation and choice (including the number of people with a long-term condition feeling supported to manage their condition), health inequalities, diabetes, obesity, smoking, falls, anti-microbial resistance and carers.
  • Better care – focusing on care redesign, performance and constitutional standards, as well as outcomes. It looks at urgent and emergency care, primary care (including the management of long-term conditions), elective access, 7 day services, care ratings, as well as maternity care, dementia, cancer, learning disabilities and mental health.
  • Sustainability – looking at how the CCG is remaining in financial balance, and is securing good value for patients and the public from the money it spends. It focuses on estate strategy, allocative efficiency, new models of care, and financial sustainability.
  • Leadership – assessing the quality of the CCG’s leadership, the quality of its plans and how well the CCG works with its partners, with a focus on sustainability and transformation plans.

The new framework outlines six clinical priority areas, which will be overseen by independent groups whose chairs are:

  • Mental health – Paul Farmer, chief executive of Mind
  • Dementia – Jeremy Hughes, chief executive of the Alzheimer’s Society
  • Learning disabilities – Rob Webster, chief executive of the NHS Confederation and Gavin Harding, learning disability advisor at NHS England
  • Cancer – Sir Harpal Kumar, chief executive of Cancer Research UK
  • Diabetes – Chris Askew, chief executive of Diabetes UK
  • Maternity – Baroness Cumberlege, chair of the National Maternity Review

NHS England expects to retire indicators in areas where CCGs have made the greatest strides, introducing new indicators as required. Data for each of the indicators “nearly all” of the indicators on MyNHS will be available “at least quarterly”, which will enable everyone to see what is working and what is not. NHS England’s national and regional teams will work to ensure that the framework is discussed with all CCGs during the year. These indicators will form the main source of evidence to support the joint work between NHS England and CCGs. CCGs will continue to be assessed over the course of a full year, with NHS England noting that it is “unrealistic” to expect any CCG to perform well against every indicator.

An operating manual is due to be published providing the underpinning operational detail behind the framework.

NHS England publishes business plan for 2016/2017

NHS England has published its business plan for 2016-17, setting out its priorities for the coming year. The business plan is built on three guiding principles: constancy of purpose and priorities; developing coherent national support for locally led improvement; and solving today’s issues by accelerating tomorrow’s solutions through introducing new models of care.

There are 10 priorities in total, which have been split into three groups. These have been summarised below, with the most relevant areas for the PCF highlighted:

Improving health – closing the health and wellbeing gap

  1. Improving the quality of care and access to cancer treatment
  2. Upgrading the quality of care and access to mental health and dementia services
  3. Transforming care for people with learning disabilities
  4. Tackling obesity and preventing diabetes

Transforming care – closing the care and quality gap

  1. Strengthening primary care services
  2. Redesigning urgent and emergency care services
  3. Providing timely access to high quality elective care
  4. Ensuring high quality and affordable specialised care
  5. Transforming commissioning

Controlling costs and enabling change – closing the finance and efficiency gap

  1. Controlling costs and enabling change

Strengthening primary care services

By the end of March 2017, NHS England must work with Health Education England to increase the size of the GP workforce by 5,000 and recruit an additional 5,000 other clinical and non-clinical staff. NHS England will also test a voluntary alternative contact for general practice – the multispecialty community providers (MCPs) contract – enabling GPs to join with neighbouring practices and community nurses, hospital specialists and pharmacists to deliver better integrated care to reduce pressure on A&E and reduce unnecessary hospital admissions. By the same deadline, NHS England will offer evening and weekend access to general practice for at least 20% of people across England.

Transforming commissioning

Throughout 2016/17, NHS England will continue to track the progress of vanguard sites that trial new models of care, with support for the design and delivery of the sustainability and transformation planning process to enable the spread of new care models. NHS England will also support the development of MCPs and primary and acute care systems (PACs).

By October 2016, NHS England will also develop a detailed strategy and delivery plan to increase the number of personal health budgets and integrated personal budgets for those with the complex needs to between 50,000 to 100,000 by 2020/21. NHS England will also support the roll out of full primary care co-commissioning to the majority of CCGs throughout 2016/17.

Controlling costs and enabling change

Throughout 2016/17, NHS England will ensure that CCG operational plans outline how the first year of efficiency requirements can be made to reach a balanced financial position, whilst the five year plans will need to show how planned efficiencies can be delivered across each local health economy. NHS England will also invest in science, technology and innovation, referencing genomics, molecular diagnostics and personalised medicine.

During 2016/17, NHS England will also launch a patient supported self-management programme targeted at patients with long term conditions to include peer support, care planning and self-management. Additionally, NHS England will develop a NHS citizens’ active communities alliance – a network of people interested in sharing good practice around involving communities in health care.