Weekly political news round – 15th July 2016

July 18, 2016 in News by Whitehouse

Overview headlines

A study has been published suggesting that a symptoms-based clinical rule more-effectively predicts whether children will have Urinary Tract Infections (UTIs) than GPs’ clinical judgement. The research – the Diagnosis of Urinary Tract Infections in Young Children (DUTY) – examined 7,000 children with UTIs in primary care settings, and found that a symptom score was a more accurate predictor of infections than clinical diagnosis by GPs. Fever was also found to not be predictive of a UTI.

The King’s Fund has also warned that staffing levels will need to be reduced if the NHS’s finances are to be better controlled, after the deficit for the last financial year was confirmed as £2.4 billion. Helen McKenna, senior policy advisor at the King’s Fund, stated that “It is no longer credible to argue that the NHS can continue to meet increasing demand for services, deliver current standards of care and stay within its budget. This is widely understood within the NHS and now needs to be debated with the public.”

New Prime Minister retains Jeremy Hunt as Health Secretary

It was confirmed this week that Jeremy Hunt will remain as Secretary of State for Health in Theresa May’s new Cabinet. Conjecture was raised that Hunt was set to lose the post or move to another position within the Government, but the assurance in an official press release that he will continue in his previous role will provide a degree of continuity in the Department’s leadership.

However, the appointment of Phillip Hammond as Chancellor of the Exchequer could change the financial settlement for the NHS agreed by his predecessor, George Osborne. Although the commitment of £8bn of additional funds by the end of the parliament is likely to stay, the frontloading of this money may be delayed to accommodate adjustments in economic forecasts. Hammond seems set to avoid the stringent fiscal targets that characterised George Osborne’s time as Chancellor, could look to borrow to invest in public services, and has confirmed he will not impose an emergency budget as a result of the decision to leave the EU.

Elsewhere, Nicky Morgan has been replaced as Secretary of State for Education by Justine Greening. Greening was deemed a Conservative moderniser when first elected in 2005, and has garnered substantial experience since then: as a Shadow Minister at the Treasury and Communities and Local Government; then serving in Treasury, Transport and International Development briefs once in government. Her tenure at the Department for Education will be defined by how successfully she incorporates control of higher education and skills into its remit.

It is noteworthy that Ms Greening has no experience in the education sector, having never worked on the front line nor served in the Conservative education team. However, she will be the first Education Secretary to have been educated at a comprehensive school. At the time of writing it has not yet been confirmed whether the junior ministers in the Department for Education have retained their posts.

NICE updates guidance on diagnosis and management of UTIs in under 16s

NICE has updated its guidance on the diagnosis and management of UTIs in under 16s, renaming it from ‘urinary tract infection in children: diagnosis, treatment and long-term management’. The guidance does not cover children who are diagnosed with other kidney, bladder or urinary problems; children with improperly-functioning immune systems; children in intensive care units; or the long-term management of repeated UTIs in sexually active girls. The guidance was published in 2007, and the supporting evidence was updated in 2013.

The guidance separates the symptoms and signs of UTIs into infants younger than 3 months and infants and children older than 3 months; while urine testing strategies are categorised according to infants younger than 3 months, older than 3 months but younger than 3 years, and for children 3 years or older. It recommends that infants younger than 3 months with a possible UTI should immediately be referred to a paediatric specialist, and this should be considered for infants and children older than 3 months with acute infections. The full guidance can be found here.

Government to consider ending family health checks

Public Health England has been commissioned by the Department of Health to review the mandatory provision of five health checks to families, which will cease to be provided in March 2017 if the decision is not reviewed. The examination of the system had been due to begin in the autumn but has been brought forward; and will explore the options of renewing mandation, amending the number of visits required or removing the obligation to provide visits. The review is also looking at: what impact the transfer of commissioning for children’s 0-5 public health services to local authorities has had; the desire for the health checks to be mandated; the evidence of service transformation; and risks to the sustainability of the health services.

Fears have been expressed that a lack of a mandatory requirement to conduct the health visits will result in struggling local authorities reducing the number of visits or scrapping them altogether. Dave Munday, professional officer at Unite’s Community Practitioners and Health Visitors Association, has suggested that these cuts could increase pressure on other children and family services within the community; and argued that the Government should actually be looking to increase the number of visits conducted. The review is expected to report in the autumn, and submissions can be made here.

Physician associates “unlikely to fill essential workforce gaps”

The Health Foundation has released a report on NHS staffing, suggesting that roles such as physician associates are unlikely to ease workforce pressures in the NHS and that funding should instead be supporting existing roles. The report branded positions such as physician associates “headline grabbing” new roles, and intimated that despite a previous pledge to increase the number of training places for physician associates by more than 200% in 2016/17, “only 11 full-time equivalent PAs” were employed in general practice last year.

The report’s authors also warned that the vote to leave the EU could worsen NHS staffing problems. The findings were accompanied by statistics indicating that the percentage of patients who find it easy to reach their GP by phone has fallen for the fourth year in a row, to 70.1% (from 78% in 2012) – further suggesting workforce pressures. The proportion of patients who reported being able to get a GP appointment has also fallen by 2.9% since 2012, and happiness with practice opening hours has fallen by 5%.

Weekly political news round up – 8th July 2016

July 18, 2016 in News by Whitehouse

Overview headlines

The Minister of State for Community and Social Care, Alistair Burt MP, has announced he will resign from his position in September once the next Prime Minister comes into office. Mr Burt did not give a specific reason for his resignation, confirmed during a session of health questions, but said it was not a sudden “post-Brexit resignation”. Elsewhere, junior doctors within the BMA have voted to reject the Government’s latest contract offer, resulting in the Secretary of State for Health insisting he will impose the contract.

Public health cuts worst affecting children’s services

Analysis by HSJ has suggested that children’s services are experiencing the greatest difficulties as a result of cuts to public health funding and other spending by local authorities. The research found approximately £50.5 million of spending cuts related to public health spending in 2016/17 – which could equate to more than £100 million if the figure is extrapolated to all councils with public health responsibility and included cuts not yet agreed by councils. This may also represent a 4% cut to public health spending for the 2016/17 financial year.

Nearly 14% (£7 million) of the decrease was for services specifically for children and young people such as health visiting and school nursing – compared with a 6.5% reduction in 2015/16 – reflecting concerns around health visiting raised when commissioning responsibility for this transferred to local authorities last year. Although some NHS commissioners have taken over some decommissioned services, this is not universal and has not generally been extended to services for children and young people yet.

School nursing in London borough risks being entirely withdrawn

In addition to this, the London borough of Bromley is alleged to be considering withdrawing its school nursing services altogether as part of a review of “the nature and provision of all of [its] children’s health services”. The suggestion has arisen from school nurses in the borough, currently employed by the social enterprise Bromley Healthcare, to look for new jobs as its current contract for school nursing will not be renewed after March 2017.

Bromley Council has defended its review of school nursing provision, saying that it believes it can “achieve better value for money as well as improved services for children and young people in Bromley. A local councillor suggested that previous reassurances that the council would seek “alternative sources of funding” for the provision have not emerged.

New Shadow Education Secretary appointed

The Labour Party has appointed a new Shadow Education Secretary, Angela Rayner MP, following the resignations of Lucy Powell MP and her successor Pat Glass MP. The upheaval resulted from the disagreements within the Labour Party regarding the future of Jeremy Corbyn as leader. Rayner was first elected in 2015 and has been promoted from the position of Shadow Pensions Minister to her current role.

The appointment of Angela Rayner was shortly followed by a strike by teachers in England over school funding; which was accompanied by accusations that the Education Secretary Nicky Morgan has been “deceiving the public” over school funding cuts. The comments, made by the acting general secretary of the National Union of Teachers, Kevin Courtney, argued that her use of the term “real terms protection” for school budgets does not reflect the cuts that headteachers are being forced to make to spending.

Warnings continue over the impact of Brexit on the NHS

Parliamentarians have continued to scrutinise the impact of the decision to leave the EU this week, with the newly appointed Shadow Health Secretary Diane Abbott hosting a debate on NHS Spending to examine the claim that leaving would allocate an additional £350 million of spending to the NHS. Ms Abbott also criticised the failure of those who campaigned to leave the EU to defend their claims about NHS spending following the result, inferring they misled the public in the process.

Moreover, the impact of Brexit on the value of the pound could result in an additional £900 million bill for the NHS over the next 12-18 months, due to the consequences of suppliers increasing their prices. This has led to calls for better procurement practice among providers, such as discussing supply deals in collaboration rather than repeatedly for individual trusts. The future of David Cameron’s flagship seven-day access programme has also been called into question, with NHS England’s national adviser on new models of primary care suggesting it will not be “anybody’s priority” once he has handed over to his successor.

Weekly political news round up – 1st July 2016

July 1, 2016 in News by Whitehouse

Overview headlines

This week the former Health Secretary, Lord Lansley, has called for NHS funding to be increased in the Autumn Statement, arguing that his expectation while Health Secretary was that the small real terms increases to funding would only be temporary. He said that the need for greater annual rises in funding “is now inescapable”; and further diminished the expectation that funding recovered from the EU once the UK officially leaves could be delivered to the NHS. Lord Lansley also stated he did not think it likely that the £22 billion of efficiency savings being sought from the NHS could be achieved in this parliament.

EU referendum: political consequences

Following the confirmation of the UK’s decision to leave the EU on 24 June, it was subsequently announced by the Conservative back bench 1922 Committee that the process to select a new party leader will be complete by 9 September. The formal process of withdrawing from the EU will then begin under a new leader, with significant debate around whether and when the UK will invoke ‘Article 50’, which would give the EU formal notice of its intent to withdraw from the organisation.

The outcome of the referendum has had great implications for British politics. Early riders in the Conservative Party leadership contest include: Justice Secretary, Michael Gove MP; Home Secretary, Theresa May MP; Work and Pensions Secretary, Stephen Crabb MP; former Defence Secretary, Liam

Fox MP; and Minister at the Department for Energy and Climate Change, Andrea Leadsom MP. A vote among MPs will see the field narrowed to two candidates, who will be subjected to a vote among the Conservative Party membership. In an unexpected announcement shortly before nominations closed, the former Mayor of London Boris Johnson MP confirmed he would not be contesting the leadership, despite seemingly staking his support for the ‘Leave’ campaign on the expectation of doing so.

The Labour Party has also experienced substantial upheaval, as many Labour MPs have accused party leader Jeremy Corbyn MP of lending halfhearted support to the ‘Remain’ campaign – which they allege resulted in many traditional Labour voters choosing to leave. Corbyn experienced an unprecedented swathe of resignations from his Shadow Cabinet following the disagreements, and lost a vote of no-confidence among the Parliamentary Labour Party on 28 June by a margin of 172 to 40 MPs. Potential-challengers include former-shadow Work and Pensions Secretary, Owen Smith and former-shadow Business Secretary, Angela Eagle. Despite strong rumours, Deputy-Leader, Tom Watson elected not to challenge Corbyn.

Diane Abbott appointed Shadow Health Secretary

Following Jeremy Corbyn’s decision to sack his Shadow Foreign Secretary, Hilary Benn MP, early on Sunday 26 June, many members of the Shadow Cabinet resigned from their positions. These included the Shadow Health Secretary, Heidi Alexander. Alexander was replaced by Diane Abbott, the MP for Hackney North and Stole Newington.

Abbott has been an MP since 1987 and contested the Labour leadership in 2010. Abbott then served as Shadow Minister for Public Health between 2010 and 2013, before being appointed as Shadow Secretary of State for International Development by Corbyn in 2015. She competed to be selected as Labour’s candidate for the 2016 London Mayoral election, coming third in the ballot.

Abbott’s parliamentary contributions on health naturally had a public health focus during her period as Shadow Public Health Minister, before becoming Shadow International Development Secretary. In

February 2015 she moved a backbench business debate on ‘mental health and well-being of

Londoners’, highlighting concerns around mental health funding. She has also considered the costs to the NHS of drugs and obese patients.

It is worth noting that while Corbyn has appointed some replacements for those ministers who have resigned, given the extent of resignations it may be that he is unable to recruit enough Labour MPs to fill all vacant positions. It is quite likely that Corbyn will face a leadership contest following this week’s events, and if successful in removing him as leader this new Shadow Cabinet may not be in place for a significant period of time.

Questions on continence products answered in House of Commons

Two written questions on continence products have been answered in the House of Commons this week. Both questions were tabled by Alison Thewliss MP (SNP, Glasgow Central). The first asked the

Chancellor of the Exchequer “what the annual revenue arising from VAT on incontinence products is”, and was answered by the Financial Secretary to the Treasury, David Gauke MP. Mr Gauke stated that “VAT arising from the sale of incontinence products and VAT that is recovered on the purchase of incontinence products is not separately itemized on the VAT return, so the requested information is not available.” He did elaborate that incontinence products are sometimes supplied at the zero rate of VAT, such as for over the counter sales for personal use.

The second question asked the Secretary of State for Health “what the annual cost to NHS services is of purchasing products used in the management of continence care.” George Freeman MP, the Minister of State for Life Sciences, clarified that the information is not collected centrally as NHS trusts are responsible for procuring goods and products.

Ms Thewliss has asked several previous parliamentary questions on the inclusion of incontinence pads as a zero-rated product for VAT purposes, in the context of charging VAT for sanitary products such as maternity pads. These questions indicate she is broadening her focus to continence care more widely.

Department of Health reorganises directorates

The Department of Health intends to reorganise its directorates, combining the four separate directorates for digital, technology, local government and social care into one new community care directorate. This is thought to be effective from 1 July and will be overseen by the Permanent Secretary, Chris Wormald. Overall, the directorate will have responsibility for social care; disability; community, mental health and seven day services; medicines and pharmacy; digital and data; technology; and the chief social worker.

The change is part of the Department’s drive to save money by 2020, in the same vein as its decision to scrap its nursing advisory unit. This decision has continued to be contested this week, with a parliamentary petition being launched and receiving more than 1,000 signatures. The scrutiny of the decision by the Chair of the Health Select Committee, Dr Sarah Wollaston MP, through a series of parliamentary questions, are yet to be answered by the Government. The Royal College of Nursing is also strongly opposed to the closure, with one member saying “It has become clear our government intends to sideline the views of nurses with the closure of the policy unit.”

Brexit will worsen NHS staff shortages

The NHS Confederation has warned that the vote to leave the EU could imminently result in NHS staff shortages, as EU staff could be put off from taking new jobs in the health service or be tempted to return home by the result. The organisation states that if any of the 130,000 EU NHS workers left – representing 10% of doctors and 5% of nurses – it could worsen staff shortages already affecting the NHS. The Public Accounts Committee estimated earlier this year that NHS England may already require 50,000 additional staff.

The director of the NHS Confederation’s European office, Elisabetta Zanon, said “There is a real risk the uncertainty and the falling value of the pound will make [EU workers] think again” about working in the UK. A range of senior healthcare figures, including the Health Secretary Jeremy Hunt and the medical director Sir Bruce Keogh, emphasised that EU health workers should be made to feel welcome following the vote. These sentiments were further embodied in a Twitter campaign, #LoveOurEUStaff.