Weekly political news round up – 24th June 2016

June 27, 2016 in News by Whitehouse

This year’s NHS Confederation conference took place last week, with key NHS figures addressing thousands of representatives in the healthcare sector. During his address, NHS England Chief Executive Simon Stevens informed delegates of the Government’s plan to “re-set” NHS funding in July. Mr Stevens admitted that the £8bn committed in the Spending Review was insufficient, and the NHS needed closer to £21bn extra to plug the funding black hole. He added it was unlikely any more funding will be announced and called for any additional funding to be made available to social care. Stevens reiterated that the Five Year Forward View called for between £8bn and £21bn by 2020, and since its publication social care has deteriorated and will continue to do so due to Whitehall cuts to local council budgets.

EU referendum result

The referendum on the UK’s membership of the EU has seen ‘Leave’ secure a win by a narrow margin. 51.9% of the population voted for Britain to leave the EU, with 48.1% voting to remain. In an official statement, the Prime Minister, who has led the, announced that he will resign by the Conservative Party Conference on 2nd – 5th October. The formal process of withdrawing from the EU will then begin under a new leader. The new Prime Minister will need to establish a stable Government as soon as possible in order to calm financial markets, and begin in earnest the UK’s EU exit negotiations.

The Chancellor has confirmed he will not hold an Emergency Budget in the summer, as previously speculated, but did not rule out the possibility of his successor imposing the corresponding spending cuts and tax increases later this year. Although there will be an attempt to continue the legislative agenda as outlined in the recent Queen’s Speech, it is likely that both the direct and indirect repercussions of the vote to depart the EU, and the Prime Minister’s decision to resign, will dominate the political landscape. We would also reasonably expect an incoming Prime Minister to conduct a Cabinet reshuffle, which will affect the ministerial teams at all government departments including the Department of Health.

There are questions now to be resolved over the migration status of the many thousands of EU workers in the NHS, and how the Government will recruit further workers in future. There have been suggestions from the ‘Leave’ campaign this morning that further investment promised for the NHS may not materialise – which when accompanied by potential spending cuts from an emergency budget, could worsen pressure on the health sector. This is undoubtedly speculation at present, with more certainties likely to emerge over the coming weeks.

Continence needs underlined for World Continence Week

Six blog posts have been published on NHS England’s website highlighting continence needs, as part of World Continence Week. One, by Sarah Elliott, the Regional Chief Nurse for NHS England in the South, detailed the obstacles that have been encountered in translating best practice for continence care into a clear commissioning plan for a continence pathway. She also called for “a social movement to bring about the changes we need to see that will deliver excellence in continence care services and guide people to the help they need to manage their bladder and bowel problems.”

Another post was written by Chloe Smit, a continence nurse in South East London who has also encountered continence issues herself. Chloe explained her experiences, having had pain while urinating throughout since the age of three and being repeatedly diagnosed with UTIs before receiving appropriate treatment from a urodynamics specialist. Both Chloe’s and Sarah’s posts emphasised the need to ensure individuals with continence issues know how to access appropriate and timely care.

World Continence Week also received coverage in the Express, which reported on Coloplast’s poll of adults on continence issues. The survey found that 35% of adults had “laughed so hard they had wet themselves”; while 46% would feel embarrassed to discuss continence issues with a doctor, and 27% believing incontinence only affects elderly people. Duncan Watson, director of Continence at

Coloplast, stated that “Talking about incontinence could help save the NHS money and improve people’s lives. No-one needs to suffer in silence.”

Finally, the Daily Mail gave coverage to a poll by the Urology Foundation which found that 60% of respondents would be embarrassed to talk about urinary incontinence. The article featured comments from Tamsin Greenwell, a urological surgeon at University College London, who pointed to the isolation felt by many people with continence issues and the pressure of the cost of incontinence pads.

Funding for postgraduate nursing qualifications could be scrapped

There are worries that the Government’s plans to reform healthcare education funding could also entail removing funding for postgraduate nursing qualifications from next year, which are necessary to become a health visitor, school nurse or district nurse. The Department of Health is understood to be exploring introducing loans for these qualifications – similar to the plans being considered for other nurse and midwifery courses – or using higher-level apprenticeships, funded through an employer levy. Concerns have been expressed that this could discourage nurses from pursuing further qualifications, due to the debt they may already assume from undergraduate courses.

Crystal Oldman, chief executive of the Queen’s Nursing Institute, called for a debate and consultation on the proposals to avoid the “significant risk that patient safety will be compromised.” The plans have been revealed in the same week that a letter to the Prime Minister from healthcare leaders was published, calling for the plans to scrap bursaries for student nurses and midwives to be reconsidered. The letter was signed by the Royal College of Nursing, the National Union of Students, the Royal

College of Midwives, Unison and Unite, and stated that “continuing with [the plans] as they stand would be nothing short of reckless.”

Decrease in school nurses discussed at RCN conference

The Royal College of Nursing has discussed its poll on the decline in the number of school nurses at its annual conference in Glasgow, attributing the fall to the worsening of the mental health crisis among children. Following a 10% decrease in the number of school nurses since 2010 – to 2,700 nurses for 9 million pupils – 28% now work more than their contracted hours each day. 68% also stated there were too few school nurses to provide sufficient care for children and young people in their area.

39% of nurses surveyed believed they had too few resources for their work, and 30% reported spending most of their time on administrative tasks. Janet Davies, chief executive of the RCN, spoke of the issue in the context of mental health problems, saying that “Only by investing in school nursing and wider mental health services, can this crisis be tackled and children be given the best chance possible of leading happy and healthy lives.”

Chair of Health Committee tables parliamentary questions on scrapping nursing advisory unit

The Chair of the Health Select Committee, Dr Sarah Wollaston MP, has tabled several parliamentary questions scrutinising the Department of Health’s plans to scrap its nursing and midwifery advisory unit. The questions were tabled alongside the RCN’s annual congress, which voted to press for a “strong, permanent and expert” nursing voice within the Department. Dr Wollaston asked the Secretary of State for Health:

  • “what steps he plans to take to ensure nurses are consulted on his Department’s future policies after the proposed closure of the Nursing, Midwifery and Allied Health Professions policy unit in his Department”;
  • “what mechanisms he plans to put in place to ensure ministers receive impartial nursing advice after the proposed closure of the Nursing, Midwifery and Allied Health Professions policy unit from his Department”; and
  • “whether (a) staff and (b) external stakeholders were consulted on the proposal to close the

Nursing, Midwifery and Allied Health Professions policy unit in his Department.”

Weekly political news round up – 17th June 2016

June 21, 2016 in News by Whitehouse

In the news

The debate surrounding the potential impact of voting to leave the EU has continued this week, with the chair of the NHS Confederation and former Health Secretary Stephen Dorrell advising that the NHS cannot afford the potential economic instability that could accompany Brexit. At the NHS Confederation’s conference in Manchester, Mr Dorrell argued that the NHS needs secure and stable funding to facilitate “building a sustainable society where we help people stay well, focusing on health and care in a place, rather than single institutions working in silos.”

Meanwhile, a study by the University of Sussex has found that seven-day GP opening could reduce the number of A&E attendances and admissions, particularly among older and affluent patients, by 10% across the week and 18% on the weekend. However, GP leaders have cautioned that the seven-day access pilots that the study utilised were only able to operate with “significant additional, short-term funding” and were worsening GP access at other points in the week.

Parliamentary written questions on paediatric continence services answered

This week, the PCF has had two written parliamentary questions on incontinence in children and young people answered by the Parliamentary Under-Secretary State for Health, Jane Ellison MP. Both questions were tabled by Neil Gray MP, who the PCF met with in January 2016.

The first question asked what steps the Department of Health “is taking to reduce the number of inappropriate referrals to hospital settings for bladder and bowel problems in children and young people”. In her reply, Ms Ellison stated that children and young people with continence issues should have access to community based assessment and treatment services “whenever possible”, and referred to the Excellence in Continence Care commissioning framework as outlining the appropriate pathways for assessment, diagnosis and treatment and the principles for a good design of service. She also specifically referenced the PCF’s Paediatric Continence Commissioning Guide as providing “a specification for paediatric continence services and in particular community based services.”

The second question asked “what the cost was of emergency admissions for bladder and bowel problems amongst children and young people aged 19 and under in each of the last five years.” Ms Ellison specified that the information “is not available in the format requested for England”, and instead directed to the information available from reference costs. This is the average unit cost to NHS hospital trusts in England “of providing defined services to patients in a given financial year”, which is collected by healthcare resource group and covers bowel problems and bladder disorders in separate chapters. Ms Ellison clarified that many, but not all, of these collections differentiate between children and adults, but did not specify whether bladder and bowel treatments are covered by this.

Department of Health to scrap nursing advisory team

The Department of Health has allegedly decided to remove its nursing, midwifery and allied health professions policy unit, meaning it will not have any embedded professional advisors beyond the chief medical officer and the chief social worker. Although the Department will continue to receive advice from NHS England’s chief nursing officer Jane Cummings, the proposal has generated criticism as it needs the “sound objective impartial advice” that the unit provides.

The proposal has not yet been officially confirmed by the Department, but is thought to be part of its drive to find efficiencies by 2020. It would entail the removal of the unit’s director, mental health adviser, nursing and midwifery adviser, and allied health professionals’ adviser; and comes just three years after Sir Robert Francis QC urged for nursing’s opinions to be strengthened within the NHS. Unison’s head of nursing, Gail Adams, argued that the decision sends “an appalling message to the [nursing] profession”.

Survey finds 12.5% of practice nurse positions are vacant

A survey of 718 GPs conducted by Pulse has found that there is an average vacancy rate of 12.5% for practice nurses. The findings mirror those for GP vacancy rates, recently found to be 12% in a Pulse study, and have generated calls for a plan to increase the number of practice nurses. GPs are worried that there is already an impending “demographic time bomb” among practice nurses, as many are due to retire over the next few years; and that Government plans to scrap bursaries for student nurses and replace them with loans could deter people from entering the profession.

Dr Richard Vautrey, deputy chair of the GPC, argued that the existing and potential further shortage is “linked to the historic failure to invest in primary care nurse training including the failure to fund training grants to training practices, as well as the longstanding focus on secondary care nursing at the expense of primary and community care nursing recruitment.” Kathryn Yates, the Royal College of Nursing’s professional lead for primary and community care, echoed these calls for plans to increase the number of practice nurses.

 

Weekly political news round up – 10th June 2016

June 16, 2016 in News by Whitehouse

In the news

The Nuffield Trust has published research warning that problems with workforce morale pose a greater risk to the NHS than financial difficulties – with staff shortages, disputes with Government and bullying contributing to a “toxic mix” in the health service. The report implies that pressures are straining the personal affinity staff feel for the NHS, amounting to a “psychological contract” that could be irrevocably broken if corrective action is not taken.

Health Select Committee holds final evidence session for public health inquiry

The Health Select Committee has held its final evidence session on public health post-2013, taking evidence from figures including: Professor Lisa Bayliss-Pratt, Director of Nursing at Health Education England; Jane Ellison MP, Parliamentary Under-Secretary of State for Public Health; and Duncan Selbie, Chief Executive of Public Health England. Although the majority of the session focused on issues such as prevention and immunisation, there were several underlying themes of relevance to the PCF.

Of greatest importance was Duncan Selbie’s suggestion that, in an effort to better coordinate work between different government departments to improve public health, he has offered departmental permanent directors the opportunity to appoint a senior public health professional in their department. This professional would have a similar role to previous regional directors of public health who were embedded in the Department of Health and partnered with other Departments; and so taking the Department of Education as an example, would have involvement in coordinating public health efforts within schools.

Earlier in the session, Professor Bayliss-Pratt stated that as part of HEE’s ‘Making Every Contact Count’ strategy, the organisation is “influencing the curriculum of all the professionals to ensure that we get health promotion and health prevention within the undergraduate curriculums.” These efforts were said to include e-learning tools. Professor Bayliss-Pratt also contended that working in public health is a “popular choice”, as people appreciate the opportunity to work in their local communities – contrary to other opinions presented to the Committee, suggesting that public health is having more difficulty with recruiting due to concerns around workforce mobility, career progression, cuts in posts and downgrading of posts.

Concerns raised over health visitor training figures

The Community Practitioners and Health Visitor’s Association (CPHVA), part of the Unite union, has cautioned that places on health visiting courses are going unfilled because public health funding cuts are damaging the profession’s future prospects. Health Education England (HEE) has confirmed that 12% fewer training places than the 1,042 target will be commissioned in 2015/16, which CPHVA says is down to less training places being required by employers.

The CPHVA also believes that local authority funding cuts are further affecting demand, given the transfer of responsibility for commissioning health visitors to councils last year. HEE has defended the decline in commissioned training places, saying it is a result of rapid growth in the number of health visitors between 2011 and 2015. The CPHVA nonetheless highlights several examples of universities that normally offer 10-12 places filling half or none of these.

London Assembly passes motion calling for student nurse bursary cuts to be abandoned

The London Assembly has passed a motion, by 16 votes for and 6 votes against, calling for the Government to end its proposed scrappage of bursaries for student nurses and midwives from September 2017. The policy, which the Assembly argued is driven by a short-term “desire to save money”, would impose a loan and fees system on student nurses rather than the existing bursary system which does not need to be paid back.

The Assembly further appealed to the Mayor of London Sadiq Khan, the Assembly’s chair Tony Arbour and the chair of the Health Select Committee, Dr Sarah Wollaston MP, to write to the Health Secretary protesting the changes. It is estimated that there are 10,000 nurse vacancies in London; and the Royal College of Nursing welcomed the Assembly’s attempts to prevent this from worsening. The RCN also called for the Government to work to “identify a fair, effective and sustainable funding system for nursing education”.

NHS takes prominent place in debates over EU referendum

The Shadow Health Secretary Heidi Alexander, who is campaigning for the UK to remain in the EU, has highlighted the contribution that EU nurses make to the NHS and argued that this should be considered when voting in the referendum. Alexander pointed to the 52,000 EU nationals working in the NHS, along with the potential for a £10.5 billion cut to the Department of Health’s budget in the event of Brexit, as evidence of the dangers posed to the NHS by leaving the EU – questioning whether it is a risk the NHS can afford to take “when hospital wards are already dangerously understaffed, when the care system is already in crisis”.

The Shadow Health Secretary’s intervention was accompanied by the chair of the Health Select Committee Dr Sarah Wollaston MP – who had been campaigning for the UK to leave the EU – changing her position to support remaining for the sake of the NHS. Dr Wollaston expressed discomfort with the Leave campaign’s assertion that Brexit would return £350 million a week to the UK which could be given to the NHS, saying the claim “simply isn’t true” and that she couldn’t campaign for the group while it made that claim.

PCF coordinates letter to NHS England Chief Executive

June 3, 2016 in Activity, News by Whitehouse

PCF coordinates letter to NHS England Chief Executive

The PCF has coordinated a letter to Simon Stevens, Chief Executive of NHS England, to express concerns about the poor state of NHS community-based services for children and young people with continence problems. To see the letter’s recommendations and signatories, please click the link below.

PCF Letter to Simon Stevens

Weekly political news round up – 3rd June 2016

June 3, 2016 in News by Whitehouse

Extent of public toilet closures revealed

Freedom of Information requests submitted by the BBC have found that ten UK councils no longer maintain any public toilets due to ongoing financial constraints. The requests revealed that as four out of five councils have reduced spending on public toilets since 2011, areas such as Newcastle, Merthyr Tydfil and Wandsworth no longer have any public toilets, while 22 councils – including Manchester, Stockport and Tamworth – only have one public toilet still open. Tourist areas such as the Highlands and Pembrokeshire are the best served by public toilets.

Raymond Martin, managing director of the British Toilet Association, has repeated his organisation’s consistent call for legislation to mandate the provision of public toilets as a human right, as it is not currently a legal requirement for councils to do so. Mr Martin also highlighted that more than 1,700 toilets have shut in the UK over the past decade. James Morrison, chief executive of Independent Age, suggested that councils should not be able to close public toilets without a “well-publicised, wellmanaged community toilet scheme” urging shops and restaurants to make their toilets open to the public.

 

Health Select Committee hold evidence session on public health post-2013

The Health Select Committee have held an oral evidence session focusing on the structures, organisation, funding and delivery of public health following the Health and Social Care Act. The Committee took evidence from public health officials from across England; and while it primarily discussed issues around screening and immunisation, the wider themes of community health were also considered. The witnesses immediately emphasised that public health is now a “fractured and very complex system”, leaving many elements of coordination down to working relationships and goodwill, which poses risks in the long-term.

The key line of discussion for paediatric continence came from Professor Kate Ardern, Wigan Council’s Director of Public Health. Professor Arden underlined public health grant reductions as an area of concern and suggested that because health protection is prioritised within budgets, more minor areas such as continence services will be more vulnerable to cuts. She further asked the Committee to consider how public health workers can be upskilled to best suit community needs, saying it “is a challenge because I do not think we are necessarily that good at workforce planning.”

 

CQC opens consultation on NHS Patient Survey Programme

The CQC has opened a consultation on the NHS Patient Survey Programme, seeking opinions on proposed changes to content and frequency of the surveys for the first time. Of greatest relevance to the PCF are the proposals to pilot a new community health services survey, and to make permanent the children and young people’s survey previously piloted. These areas have been chosen as information on them is currently limited, and the suggested programme would allow for more detailed comparison to be made of service experiences at the local and national level.

The document accompanying the consultation stated that there is a currently a gap in the knowledge surrounding community health services which the new survey would intend to fill.  The CQC propose reviewing suitable areas to focus on, such as district nursing. The children and young people’s survey would be completed by children themselves, and has been chosen for pursuit as the pilot provided “useful information about the quality of paediatric services that is not available from any other source.” The first survey would be completed in 2016, reporting in 2017, and would be run every two years.

The consultation document also specified that the CQC are developing a new model called ‘CQC Insight’, used to coordinate data and information used in the ongoing monitoring of quality of care. The model would identify the key information needed to indicate good performance, and trigger followup action when concerns are raised about care. The CQC is also looking to collect feedback on the accessibility and value of the current survey programme.

Energy drinks that cause bedwetting banned in schools

A headteacher in a Scottish secondary school has banned energy drinks from his school premises due to the side effects they cause, including exacerbating anti-social behaviour and bedwetting. Melvyn Lynch informed parents at his school that the energy drinks, such as Red Bull and Monster, would be confiscated if pupils were found with them, citing the difficulties they can cause in sleeping properly. As well as bedwetting, the drinks can cause insomnia, anxiety, headaches, nausea, heart palpitations and lead to longer-term health issues including diabetes.

Weekly political news round up – 27th May 2016

June 3, 2016 in News by Whitehouse

Care Quality Commission publishes five-year strategy

The Care Quality Commission (CQC) has published its strategy for 2016-2021, explaining how it will change its inspection regime with consideration for the £32 million budget cut it will face by 2020. The PCF responded to the CQC’s consultation on the strategy in February 2016. It focuses on four priorities:

  • Encourage improvement, innovation and sustainability in care;
  • Deliver an intelligence-driven approach to regulation;
  • Promote a single shared view of quality; and
  • Improve our efficiency and effectiveness.

Under the third priority, promoting a single shared view of quality, the CQC stated that while it will work with partners, providers and the public to “agree a definition of quality”, it will also “encourage providers to develop their own quality assurance based on the five key questions and to share this with us as part of an ongoing conversation about quality.” The PCF argued that a set of central criteria should be implemented to promote a shared view of quality, following a consultation – and the strategy implies that the CQC will not be as stringent on this measure as the PCF advised.

As has already been publicised, the CQC intends to target more resources into assessing poorly-performing services than services where “care quality is good and likely to remain so.” This again does not address the PCF’s suggestion that providers with good services with poor elements should still be followed up. The strategy confirmed the CQC will analyse “how well providers deliver care for specific population groups”, but did not say how or when these population groups will be chosen.

Finally, although the strategy states that the CQC will “Co-produce our plans with people who use services, their carers and representative organisations”, as well as work with Healthwatch, advocacy organisations and the voluntary and community sectors, it was not specified how groups which may be reluctant to volunteers their experiences would be reached.

Health Education England will trial nursing associates

Health Education England (HEE) has confirmed it will start training 1,000 nursing associates in 2017, after the results of its six-week consultation showed a definite “appetite” for the role in the nursing profession. The new role will act as an intermediate role between healthcare assistants and registered nurses, and while further workshops will be needed to determine its full scope, 54% of respondents said they wanted the profession to be regulated rather than just registered.

The identified benefits of introducing the role included patient safety, public reassurance, accountability, professional credibility and the administration of medicines. The consultation’s responses suggested nurse associates should be trained to the equivalent of foundation degree level, which could be provided through an apprenticeship. Concerns were also raised that the role would be used as a substitute for recruiting more nurses, and that there would not be enough funding available to cover the role.

In a separate development, a report by NHS Clinical Commissioners has highlighted the “critical” role that nurses play on CCG governing bodies, which has changed significantly from that originally envisioned. The paper argued that nurses provide “a valuable voice for the patient while at the same time giving a critical clinical perspective”; and recommended that these nurses are able to regularly hold discussions with staff to best represent their opinions in commissioning decisions.

Community pharmacy closures would burden GPs

A group representing the English community pharmacy sector has published research indicating that government proposals that could result in one in four pharmacies closing would place a significant burden on GPs. Pharmacy Voice, which published the research conducted by YouGov, said that 29% of people who would normally obtain advice from a pharmacy for minor ailments would go to their GP instead. This figures rises to as much as 80% of people in deprived areas, such as Fleetwood in Lancashire.

The Government’s proposals, while closing many pharmacies, would redirect funding to ensure that everyone can access a community pharmacy. Approximately 80-90% of an average pharmacy’s funding comes from the NHS, and the proposals would reduce the amount spent on pharmacies by £170 million. The chief executive of Pharmacy Voice, Professor Rob Darracott, said that people are increasingly using pharmacies to access health services as well as for collecting medicine.