Weekly political news round up – 11th November

November 11, 2016 in News by Whitehouse

Overview

This week, the Welsh Assembly published the draft Public Health (Wales) Bill which is now going to the Committee stage to hear evidence on its provisions; and attention has been given to the increasing trend for local authorities to integrate health visitors and school nurses into wider public health services to make efficiency savings. A Parliamentary Written Question also asked what the Government’s opinion was on the Children’s Commissioner’s recent report on the impact of bureaucracy on school nurses.

Outside of politics, six Swansea doctors said they are seeing “shocking” under-development in Welsh children, with many children entering school without toilet training or the ability to brush their teeth. The Health Foundation, Nuffield Trust and the King’s Fund issued a joint statement on the Autumn Statement; and finally, the Public Accounts Select Committee confirmed they will be holding inquiries into NHS financial sustainability and integrating health and social care in early 2017.

Parliamentary and political developments

Public Health (Wales) Bill draft published

The Public Health (Wales) Bill is now being debated by the Welsh Assembly, after a draft of the Bill was introduced on Tuesday. It focuses on promoting children and young people’s health through its measures on smoking; intimate piercing; pharmaceutical services; and provision of toilets.

A local toilets strategy is presented in the Bill, which will make it statutory for local authorities to prepare and publish a local toilets strategy that must include:

  • An assessment of the need for toilets for public use in the local authority’s area;
  • A statement on the steps the local authority proposes to take to meet that need; and
  • Any other information the local authority considers appropriate.

“Toilets” include changing facilities for babies and disabled persons. Councils must review the toilet strategies after each local election and publish their revised strategies. Any person who is likely to be interested in the provision of local toilets in a local council’s area must be consulted by the local authority before it publishes its local toilets strategy. As part of this consultation process, the local authority must make a draft local toilets strategy available to interested parties.

Rebecca Evans, Welsh Minister for Social Services and Public Health, in her statement on the Bill to the Assembly, said that besides minor technical changes the Bill contains the original provisions considered by the previous Assembly and will cover a “number of important public health issues”. On public toilet provision, Evans assured other AMs that the Welsh Government will be issuing guidance to local authorities to help develop their local toilet strategies. Caroline Jones, a UKIP AM, asked the Minister why the Bill does not place a duty on councils to provide public toilets, to which the Minister replied that the strategy must also include how the local authority will meet the needs of its local area.

The Bill will now go to the Health, Social Care and Sport Committee for consideration of its general principles. They will be meeting five times over the next two months to hear evidence from professionals and Rebecca Evans. It will then be debated in Plenary sessions where the general principles will be refined.

Local authorities intend to reform public health nursing services

The moves by local authorities to change public health visiting and school nursing services, due to funding cuts to their budgets, has received coverage in the Nursing Times this week. Manchester City Council is one local authority planning to integrate 0-19 health services with other early intervention work to make efficiency savings; the council estimates that it could save £500,000 in 2018-2019 if a new health visitor contract is created.

The move is part of a new, wider early years delivery model, which will see teams of health visitors, early years’ workers and school staff operating out of twelve “hubs” based in or next to schools. Manchester City Council opened a consultation on the plans on 3rd November, and has urged local people to have their say before it ends on 15th December. Other councils such as Solihull, Slough and Essex also plan to redesign and integrate children’s public health services into other services.

Parliamentary Written Question asked about school nurses

In a Parliamentary Written Question tabled this week, Lord Taylor of Warwick, a non-affiliated peer, has pressed the Government on bureaucracy facing school nurses. Lord Taylor asked: “what assessment they have made of comments by the Children’s Commissioner for England on the impact of bureaucracy on the ability of school nurses to promote children’s well-being”.

Lord Nash, Parliamentary Under-Secretary of State for Schools in the Department for Education, replied that Public Health England published a model specification for commissioning services to inform decisions around the commissioning of school nurses. The minister also said that professional pathways and guidance to support local delivery of school nursing services provided by PHE is currently under review by stakeholders, including National Health Service England, and is expected to be published in Spring 2017.

According to the minister, technology could be used to address the burden of paperwork, as many services are now using technology and digital platforms to improve productivity and access, particularly for young people who are more technology-literate than others.

Clinical developments

Welsh children showing significant under-development

Doctors from six GP practises in Swansea have voiced concerns about the “shocking” under-development being exhibited by Welsh children. The GPs said that increasingly, children starting primary school have not been toilet trained; have limited speech; and do not know how to brush their teeth. Last year, 35% of children aged four in Swansea did not meet the expected level of development when they started in schools, with some schools finding only a quarter of children reaching average development indicators.

The six doctors have subsequently recruited a specialist worker to help families stop underdeveloped parenting skills repeating across generations. Dr Ruth Dare said many parents lack basic parenting skills because they have not experienced “stable, consistent” parenting in their own childhoods. The work builds on the focus of the Swansea Healthy City Partnership, which is concentrating its efforts on the first 1,000 days of children’s lives.

Nuffield Trust, the Health Foundation and the King’s Fund’s issue joint statement on the Autumn Statement

The Nuffield Trust, the Health Foundation and the King’s Fund have produced a joint statement on what they believe the 2016 Autumn Statement should prioritise in the health sector. It includes updates to the joint impact assessment of the 2015 Spending Review on the NHS and social care the three organisations carried out. The statement contends that the upcoming Autumn Statement must address the “critical state” of social care, as the publicly funded system is facing a £1.9 billion funding gap for 2016-2017 which is significantly impacting on the performance of the NHS. The assessment also disputes the Government’s belief that the NHS will receive £10 billion between 2015/16 and 2020/21, as analysis show that the Department of Health’s budget will increase by only £4 billion in real terms and will fall to 6.9% of GDP by 2020-2021.

The joint statement reiterates the arguments recently put forward by the Health Select Committee, the Public Accounts Committee and Simon Stevens, Chief Executive of NHS England, that the Autumn Statement must address the social care crisis and that the “£10 billion” figure is inaccurate.

Weekly political news round up – 4th November 2016

November 4, 2016 in News by Whitehouse

Overview

This week in Parliament, the Chairs of the Health Committee and Public Accounts Committee challenged the “£10 billion” figure that the NHS will supposedly receive by 2020-2021; and the House of Commons debated chronic urinary tract infections. Outside of Parliament, a GP Online article gave an in-depth account of managing, treating and referring paediatric bed-wetting; and Dr Penny Dobson, Chair of the PCF, blogged about continence problems for Public Health England’s week of action on continence. Finally, the Nursing Times reported on increasing concerns over the Department of Health’s new nursing advisory post.

The PCF has also launched its own Twitter account this week, under the username @PaedContForum. Using the Twitter account will present us with an opportunity to engage with supporters and policymakers, and raise further awareness of paediatric continence issues. If you use Twitter, please do take a look at our account and follow us!

Parliamentary and political developments

Chairs of Health Committee and Public Accounts Committee challenge government statements on NHS spending

The Health Committee has written to the Chancellor of the Exchequer this week, asking the Government three questions on NHS funding. Alongside questions on social care and capital resources, the Committee asked whether the Government will “look at the NHS funding settlement for the middle years of the Spending Review, and commit to providing the resources the health services needs to meet rising demand”. The Committee also said that the Government’s claim it has provided an additional “£10 billion for the NHS” is misleading when scrutinised, because it can only be reached when an additional year is added to the spending review period. The Chair of the Committee, Dr Sarah Wollaston MP, argued that part of the increase in funding to NHS England is offset by reductions in funding in other areas of health spending. This means that between 2015/16 and 2020/21,
the Department of Health’s budget will only increase by £4.5 billion.

Additionally, Meg Hillier MP, in her capacity as Chair of the Public Accounts Select Committee, has also written to the Prime Minister this week expressing the committee’s concern about the NHS budget. Ms Hillier explained that she is “dismayed” that the Government denied that there is a problem with NHS finances in its response to Dr Wollaston, despite the large body of evidence suggesting otherwise. The letter states that the mismatch between resources and patient demand has been predicted by NHS Improvement, NHS England and other independent analysts, and it has been widely recognised that the 4% a year efficiency saving from the NHS budget is unsustainable.

Chronic urinary tract infections debated in the House of Commons

Catherine West MP, Shadow Minister for Foreign and Commonwealth Affairs, secured an adjournment debate on Friday on the inadequacies of current tests for chronic urinary tract infections in the House of Commons Chamber. Ms West highlighted that “dipstick tests” have been used for 60 years and are known to be deficient, yet guidelines have not changed. Ms West’s constituency of Hornsey and Wood Green is home to Professor Malone-Lee’s clinical research in diagnosing chronic UTIs, and concerns were raised throughout the debate on the future of his integral work, which is currently being review by the Royal College of Physicians. She asked Nicola Blackwood, Parliamentary Under-Secretary of State for Health, the following questions:

  • Will she meet with Ms West and other MPs concerned about the ineffectiveness of existing guidelines to
    discuss the matter in more detail; and
  • Will she agree to have a meeting with representatives from patient groups.

]In her response, the Health Minister acknowledged the importance of the subject raised by Ms West and welcomed the Labour Party leader Jeremy Corbyn to the debate (although the latter did not speak). She described how current NICE guidelines have not yet addressed the issues of UTI detection that has been raised by Professor Malone-Lee, but NICE has been asked to consider his work when next reviewing UTI guidance. Ms Blackwood also agreed to meet with both interested MPs and patient representative groups to discuss the issue further.

Clinical developments

GP Online reports on managing nocturnal enuresis

GP Online has published an article this week on the prevalence of nocturnal enuresis; contributing factors to its development; and useful interventions in primary care. It stresses differentiating between primary monosymptomatic nocturnal enuresis (PMNE) and nocturnal enuresis (NE) with associated daytime symptoms, as the former means the bedwetting is an isolated symptom of bladder dysfunction.

The article lists many different causes of night-time bedwetting, including a functionally small capacity bladder and family histories, with the chance of a child having an overactive bladder rising to 77% if both parents have previously been affected by the same condition. To treat NE, it advises that addressing daytime symptoms can help resolve night-time problems, alongside charting a child’s sleep patterns and medicinal intake.

Management of PMNE does not usually start until a child is seven years of age, and it is usually based on the underlying causes of the incontinence problem. For NE treatment, the article states that motivation levels of a child can be significant; for children above the age of ten, NE may cause psychological problems; and that the medicine nocturnal plyuria can increase success rates by 60%.
For children who cannot be treated in primary care, they should be referred to community enuresis clinics or hospital-cased specialists. Indications for referral include:

  • Daytime symptoms requirement further assessment;
  • Symptoms of bladder outlet obstruction;
  • Any other symptoms of bladder dysfunction, including recurrent UTIs; and
  • Children with intractable PMNE despite treatment.

PCF Chair blogs about continence problems for Public Health England week of action

The Chair of the PCF, Dr Penny Dobson, has written a blog post which has been published as part of Public Health England’s week of action on helping children with continence problems. In the post, Dr Dobson highlights the crucial role which school nurses play in assessing children with bladder and bowel problems and initiating first line treatment, as well as their ability to “break through the barriers” of embarrassment experienced by many of these children.

The post also references the work of Dr Katie Whale at the University of Bristol, whose detailed study of twenty children and young people with continence problems found that many try to hide their problems as part of the fear of being bullied if they were “found out”. Dr Dobson highlighted the need for properly commissioned and integrated paediatric continence services to help these children and young people and to avoid “the disruption and frustration families experience when going to separate clinics”.

Concerns raised about limitations of new government nursing post

Nursing and workforce experts have told the Nursing Times that the new nursing and midwifery post created in the Department of Health may not have the ability to provide the high-level advice required of the role to properly advise on government decisions. Despite the Government committing to creating the position in light of the disbandment of the nursing and midwifery advisory unit, the new post was labelled a “little victory”. Professor Jane Ball, nurse research fellow at Southampton University, said it would be cause for concern if the post is not “at least on the same level as the nursing officers who previously offered government advice”. Professor Ball also noted concerns about reducing the advisory capacity from a unit of seven people to a singular advisory post.

Weekly political news round up – 28th October 2016

November 4, 2016 in News by Whitehouse

Overview

This week in Parliament, the transcript of the oral evidence session on NHS finances held by the Health Select Committee has been published, during which the NHS chief executive Simon Stevens clashed with Secretary of State for Health Jeremy Hunt on the amount of funding that the NHS will receive over the next three years. Mr Stevens and the Committee believe the figure is nearer to £4.5 billion as opposed to the £10 billion the Health Secretary suggested. The Government has also responded to the Health Select Committee’s report on primary care, which commits to the creation of a General Practice Forward View for the nurse workforce.

Outside of Parliament, the King’s Fund has released its assessment of the NHS’s Five Year Forward View, which has found that national bodies are using transformation funds to cover deficits as opposed to introducing and supporting new care models; and Scotland’s public services watchdog Audit Scotland has warned NHS Scotland is being hampered by staffing pressures and unprecedented savings targets.

A new school nursing text messaging service, known as ChatHealth, has been launched by Evelina London Children’s Hospital in Southwark and Lambeth secondary schools after the service’s success in Cumbria and other regions; and research carried out by the Local Government Association has found one quarter of hospital admissions could be prevented if proper community treatment was administered. Finally, Professor Ian Cummings, Health Education England chief executive, has put forward his support of regulating the new nurse associate role.

Parliamentary and political developments

Health Committee hears evidence on NHS finances

Last week, the Health Select Committee heard evidence for the one-off inquiry into the Department of Health and NHS finances from Jeremy Hunt MP, Secretary of State for Health; Simon Stevens, Chief Executive of NHS England; Jim Mackey, Chief Executive of NHS Improvement; and David Williams, Director General of Finance and Group Operations for the Department of Health.

Dr Sarah Wollaston MP, Chair of the Committee, asked Mr Stevens whether he believes the NHS has been given all the funding it has asked for as the Health Secretary has claimed. Mr Stevens outlined that the original estimate of how much funding the NHS needs in five years’ time was £8 billion – £12 billion, depending on various factors such as efficiency levels and investment in services. He said that in the five-year period, the NHS has received the “lower end” of the £8 – £12 billion, but for the next three years the NHS will not receive the funding it has previously requested – with the actual amount of additional funding suggested to be around the £4.5 billion mark.

Because of this, from 2017-2020 the NHS has a “bigger hill to climb”. 2018-2019 is likely to be the most “pressured year” financially due to negative levels of per person funding. The Committee said that there was broad agreement that if additional funding was to be given to the NHS, social care should be prioritised. Mr Hunt declined to comment on the contents of the forthcoming Autumn Statement, but conceded that financial pressure is particularly acute in the social care system. He advocated speeding up the integration of health and social care to achieve more efficient services and decrease unnecessary hospital admissions.

Government Response to Health Select Committee report on Primary Care

The Government has published its response to the Health Select Committee’s fourth report on primary care for the 2015-2016 parliament session, which welcomes the Committee’s focus on general practice and the services it provides. The Government acknowledged that access to primary care is vital and that it is committed to improving access to GP services as part of the seven-day NHS plan. £175 million has been invested in the GP Access Fund and there are now 57 schemes covering 2,500 practices which have benefited from improved access and transformational change. The main measures which the report advocates are:

  • Increasing funding for primary medical care by £2.4 billion per year by the end of 2020-2021;
  • Increasing the number of GPs through offering new incentives;
  • A new practice resilience programme should be produced to support struggling practices;
  • Local STPs should address workload and workforce issues; and
  • New models of care should be tested by multi-specialist provider vanguards and GP Access Fund sites.

The report also recommends that Health Education England, NHS England and the Royal College of Nursing develop a plan for primary care nursing, akin to the ten-point plan for general practice. HEE is leading the development of a general practice nursing strategy, which is due to be announced in late autumn 2016. The General Practice Forward View sets a minimum of £15 million to be invested in a development strategy. It will include: improving training capacity in general practice; increasing the number of pre-registration nurse placements; measures to improve retention; and support for return to work schemes for practice nurses.

Clinical developments

ChatHealth launching in Southwark and Lambeth after Cumbrian success

The Evelina London Children’s Hospital has become the first London hospital to roll out ChatHealth, a text messaging service that allows secondary school children to message school nurses for health advice and support. ChatHealth was trialled in Leicestershire, and has also found success in Cumbria after the Cumbria Partnership NHS Foundation Trust launched the new scheme in September, which has treated more than 60 children. Some of the messages have resulted in face to face meetings between the children and nurses involved.

Each school in Southwark and Lambeth has been allocated a visiting nurse who will manage the service. These nurses are part of a wider school nursing team and are based in local community health centres where they answer pupils’ messages. Pupils can ask for advice on a range of issues and even make an appointment with a school nurse through a text message. Janet Powell, director of nursing at Evelina London, believes that utilising technology in health services will hopefully “engage young people who may otherwise be difficult to reach”.

Research reveals that a quarter of hospital admissions are unnecessary

The Local Government Association has published research that shows up to one in four people admitted to hospital could be attended to elsewhere if community services were improved. The report suggests that approximately 26% of hospital admissions “could have been avoided if opportunities to intervene had been available or not missed” and that looking after people at home or in the community could lead to 45% of decisions on patient care being made more efficiently. It could also save the health and care system more than £1 billion by 2020.

The LGA has said it will be prioritising more funding for adult health and social care in its submission to the Treasury ahead of the Autumn Statement, which will be delivered on 23rd November. Councillor Izzi Seccombe, Chair of the LGA’s Community and Wellbeing Board, said in response to the findings that savings “would be achieved by shifting resources to support living more independently”. Commenting on social care, Councillor Seccombe emphasised her belief that the social care provider market cannot carry on as it stands, with wider implications for pressure on the health service.

Health Education England advocates regulation of nursing associate role

Professor Ian Cumming, chief executive of Health Education England, has said that nursing associates should be regulated, but he did not state which national body should regulate the role. The Nursing and Midwifery Council (NMC) has previously said it could be the regulator and would subject the new role to the same regime as registered nurses currently experience, with regards to revalidation, fitness to practice and standards. A HEE consultation on nursing associates found that the NMC was the most popular candidate for being the responsible body, but a decision cannot be made until the scope of practice is defined and risks to patient safety have been assessed by national bodies.

However, the Health Secretary Jeremy Hunt also said in an interview with Health Service Journal this week that the UK’s departure from the EU lends the Government the opportunity to reform professional regulators such as the NMC. Mr Hunt criticised the NMC for the speed they deal with issues, but conceded that Parliament has also failed to find time to make legislative changes to improve the situation. There is therefore “a Brexit induced opportunity here because we will have to relook at all the regulations post-Brexit.”