Weekly political news round up – 9th December 2016

December 9, 2016 in News by Whitehouse

Overview

In a report published on Tuesday, the Health Foundation and Advancing Care Quality Alliance argued that the answer to delays and duplication across health and social care is ‘whole system flow’ – a coordinated approach to ensure that people, information and resources are in the right place at the right time. The report argues that Sustainability and Transformation Plans (STPs) and current financial challenges present an opportunity for a serious focus on tackling flow across NHS and social care systems. It warned that the challenges involved in doing so should not be underestimated, but said that the benefits to productivity, quality of care and patient experience would be substantial.

HSJ has identified several NHS Trusts that NHS Improvement figures indicated were on track to meet their financial targets, but which internally have revised their year-end forecast down by up to £20m. The official forecast for the provider sector at the end of September suggested a year-end deficit of £670 million, which, while worse than the planned deficit of £580 million, is within the £800 million commissioners are reserving for a worst case scenario. Experts have warned the outturn could be significantly worse, however, due to the number of trusts which have heavily back-loaded controversial savings plans. HSJ’s analysis suggests this will indeed be the case.

National Assembly committee launches inquiry assessing GP clusters

The Health, Social Care, and Sport Committee of the Welsh National Assembly is to conduct an inquiry into how GP clusters are developing across Wales. The terms of reference for the inquiry explain that professional bodies in Wales believe that general practice is at crisis point, with excessive workloads, an ageing workforce and challenges facing recruitment and retention. The committee’s inquiry will investigate how these problems could be resolved through the 64 GP clusters – groups of GPs and practices which collaborate to improve local health, determined by Local Health Boards – being developed across the country. Specifically, the committee will address:

  • How GP cluster networks in Wales can assist in reducing demand on GPs and the extent to which
    clusters can provide a more accessible route to care;
  • How health and care professionals fit into the new cluster model and how their contribution can be
    measured;
  • The current and future workforce challenges; and
  • How funds are being used to reduce the pressure on GP practices, improve services and access
    available to patients.

Chair of the Committee, Dai Lloyd AM, said: “We intend to establish a picture of what primary care looks like in Wales, where it is heading and what needs to be done to ensure it is fit and healthy enough to provide the high quality services people across Wales need.”

Children’s services contract award to independent-led partnership

It has been confirmed that a new contract to provide children and young people’s community services including school nursing, worth £34.6 million a year, in Bristol and Southern Gloucestershire has been awarded to a partnership of non-profit and NHS providers. Commissioned by Bristol CCG, the partnership – which is led by the Community Interest Company (CIC) Sirona Health, and includes Bristol Community Health CIC, Avon and Wiltshire Mental Health Partnership NHS Trust, and University Hospitals Bristol NHS Foundation Trust – has been providing the children’s community services since April 2016 under an interim contract after the previous one with North Bristol Trust ended. The contract will also cover health visiting, child and adolescent mental health services
and community nursing.
Sirona’s chief executive Janet Rowse said of the new contract: “We know that joined up services across areas and across physical and mental health services will be key to ensuring we can meet the needs of children and their families, which is why our partnership working is so important to us. She added that it was crucial for the partnership to work together “with children, young people and their families so we understand what they want, what they need and how they would like the services to be provided.”

GPC helps LMCs demand GP Forward View investment

The BMA’s General Practitioners Council (GPC) has sent a 13-point checklist of GP Forward View spending commitments to Local Medical Committees (LMCs) to help local GP leaders hold CCG spending plans being drawn up this month to account. NHS England guidance states that CCGs have until 23rd December to detail how they will meet funding commitments set out in the GP Forward View, which pledged to deliver a £2.4 billion annual increase in GP funding by 2020/21 and to restore the share of NHS funding spent on general practice to at least 10%.

The GPC hopes that in supplying a checklist, LMCS will ensure that local spending plans specify how access to general practice will be improved; how transformational support funding will be spent to help general practice; and how ring-fenced cash for training ‘care navigators’ and medical assistants, and promoting online consultations, will be spent.

GPC chair Dr Chaand Nagpaul said: ‘The GPC has produced a checklist of GP Forward View commitments to enable LMCs and practices to hold CCGs to account, and ensure that the resources in the GP Forward View are delivered in a timely manner, to frontline staff. This is vital to relieve pressure on practices, as a recent BMA survey found that eight in 10 GPs say that workload pressures mean they are struggling to provide safe, quality patient care.’

Nursing and Midwifery Council reacts to Government’s request to regulate nursing associates

The Nursing and Midwifery Council (NMC) has reacted to Jeremy Hunt’s request that it regulate the new nursing associate role, saying that it will consider the issue at its next council meeting on 25th January. In an interview with the Nursing Times, the NMC’s CEO and registrar Jackie Smith said the regulator’s decision hinges on a range of factors, including whether it could afford to regulate associates, and how doing so would impact on its wider programme of work.

She said: “Some of the issues I expect the council will want to raise are who is paying for this, and how is it going to be done, how long will it take, is the Department of Health going to give us the changes to legislation we need [to set up the system] and what is happening to these people while they are undergoing their training?” Ms Smith was careful to highlight that that the NMC was not being asked about the appropriateness of regulating nursing associates, however, saying that the issue at stake was whether the NMC had the capacity to do so.

Weekly political news round up – 2nd December 2016

December 5, 2016 in News by Whitehouse

Overview

This week, the Health Secretary Jeremy Hunt has accused NHS leaders of a “misjudgement” when calling for further funding for the health service, given the settlement reached with the NHS in the Five Year Forward View. Mr Hunt also separately announced the Government’s approval of a new nursing degree apprenticeship, which could take on apprentices from September 2017. The Treasury Committee has also discussed NHS funding difficulties in an evidence session on the Autumn Statement; and the closure of a children’s continence clinic in Greenwich, including comments from PCF member Dr Anne Wright, has been featured in the Nursing Times.

Jeremy Hunt accuses NHS leaders of “misjudgement” in calling for more funding

The Health Secretary Jeremy Hunt has this week said he thought it a “misjudgement” that NHS Providers have asked for additional funding so soon after the settlement reached in the Five Year Forward View. Responding to comments from NHS Providers’ chief executive Chris Hopson – who called for funding increases as NHS trusts “simply cannot deliver all that they are being asked to deliver on the funding available” – Mr Hunt pointed out that it has been less than a year since the NHS received “the biggest settlement that any government department got”. He added that asking for more funding risked the NHS not being at the table in future discussions, as “people will say, ‘whatever we do it’s not enough’.”

Mr Hunt particularly criticised suggestions that the assumptions made in the Five Year Forward View were wrong as it presents the NHS and Department of Health as being divided. He said: “The moment you say, ‘actually we don’t think that plan is the right plan’, you remove the biggest single reason for the Treasury to fund the NHS, which is the idea that the whole of the NHS, this huge organisation, has united behind a plan which they think is the right one for the future.” He concluded by calling for a “big effort” to reduce “inappropriate demand” on services next year, and questioned why activity had increased by 3.1% this year when demographic changes only accounted for 0.7% of additional pressure.

Health Secretary announces new nursing degree apprenticeship

Health Secretary Jeremy Hunt yesterday announced a new nursing degree apprenticeship, enabling aspiring nurses with different levels of qualifications and experience to work towards the qualification while working. Speaking at NHS Providers’ annual conference, he said that the Department for Health had approved the nursing apprenticeship standard this week. As a result, Mr Hunt said that nursing apprentices could be “working on wards, out in communities and across clinical settings” as soon as September 2017. Those who successfully complete the nursing apprenticeship standard will go on to become nursing associates. This role will not replace registered nurses, but support and complement them to enable existing nurses to “spend more time using their more specialist training to focus on clinical duties”.

However, Mr Hunt expressed his agreement with those who have called for statutory professional regulation of nursing associates, following a number of concerns that had been raised over their responsibilities, such as administering medicines. . He said he had written to the Chair of the Nursing and Midwifery Council to ask them to regulate the role as a “necessary and proportionate requirement”, and would start work on the necessary legislation as soon as possible.

Treasury Committee discusses NHS funding in Autumn Statement evidence session

The Treasury Select Committee held an evidence session on the Autumn Statement this week, taking evidence from the Director and Deputy Director of the Institute of Fiscal Studies, Paul Johnson and Carl Emmerson. Questions on the lack of attention paid to the NHS and social care in the statement were raised by Rachel Reeves MP, who highlighted Mr Johnson’s statement that the Chancellor will not be able to avoid the calls for additional funding for health and social care for much longer. Mr Johnson elaborated that his anecdotal understanding of NHS funding was that indirect cuts to social care spending through local government funding reductions has resulted in “significant” pressure on the NHS.

Ms Reeves also questioned Mr Johnson on the controversial promise that leaving the EU would free up an additional £350 million a week to spend on the NHS; he stated that “Leaving the European Union in itself will not free up £350 million a week. That does not mean that the Chancellor cannot find that within his new fiscal headroom.” The recent disagreements over the accuracy of the amount of additional funding the Government claims to have allocated to the NHS over the course of this parliament were also discussed. Mr Emmerson agreed with the committee that the figure is smaller than the £10 billion claimed by the Government, and perhaps even smaller than the £6 billion estimated by the committee.

Closure of children’s continence clinic in Greenwich reported in the Nursing Times

The closure of a children’s continence clinic in Greenwich, and its handling by the local NHS trust, has been reported in the Nursing Times this week. The Greenwich Children’s Continence Clinic was operating three half-day clinics and four drop-in sessions each week when it was closed at the end of August, serving approximately 300 children and young people. Oxleas Foundation NHS Trust closed the service with the intention for GPs to take over offering this support, but a report by Healthwatch Greenwich published in November concluded that the trust failed to inform families or GPs that the change would be happening. The report also questioned the ability of local GPs to provide this specialist care.

Dr Anne Wright, a consultant paediatrician at the nearby Evelina London Children’s Bladder Clinic and member of the PCF, described the knock-on effect that the clinic’s closure has had on nearby services. Dr Wright said that the subsequent referrals “are not appropriate for a tertiary setting and few general paediatric departments in secondary care have the expertise.” A spokesperson for Oxleas Foundation NHS Trust said that the trust had alerted both the CCG and the council to the fact that a new contract for 0-19 public health services tendered by the local authority did not include a renewal of the continence service.

Weekly political news – 25th November 2016

December 5, 2016 in News by Whitehouse

Overview

This week, five Parliamentary Written Questions on continence asked by Dr Sarah Wollaston and Rosie Cooper have been answered, detailing what has been done to promote the Excellence in Continence Care guidance and the training healthcare professionals receive in continence care. The Chancellor delivered his 2016 Autumn Statement, which had no mention of NHS and social care funding; and the National Audit Office and the UK Statistics Authority have scrutinised NHS finances.

Answers to written questions on continence

Dr Sarah Wollaston, Chair of the Health Select Committee, has received answers to her three questions about incontinence. The first question asked what has NHS England done to promote the Excellence in Continence Care Guidelines to (a) clinical commissioning groups (b) patient groups and (c) the general public; and the second requested information on which CCGs have put the guidelines into practise since they were published in November 2015.

Health Minister David Mowat, responded that that NHS England does not currently have information on which CCGs have used the guidance, but he “anticipates” that NHS England will audit CCGs in the future to gain this information. He also said that NHS England issued a press release and secured significant media coverage to launch the guidance and has since promoted it to different audiences, such as special interest groups and professional societies.

Mowat also highlighted key stakeholders who form the Excellence in Continence Care Board. He went on to say that the membership of the Board has evolved over time and that it supports NHS England to raise awareness of the guidance to relevant stakeholders.

The third question asked if the Nursing and Midwifery Council will include mandatory bowel and bladder care training for pre- and post-registration nurses in its revised curriculum. Health Minister Philip Dunne, Minister of State for Health, replied that the NMC is an independent body responsible for discharging statutory duties, including setting standards of education, training, conduct and performance. As a professional regulator, it does not have responsibility for developing or revising a curriculum because education institutions do this.

He goes onto detail that the code for nurses and midwives stipulates that people, effective practise, safety, professionalism and trust must be prioritised; and that people must be treated as individuals through upholding their dignity by delivering fundamental care. This includes providing nutrition, hydration, bladder and bowel care, physical handling and hygiene.

Continence APPG Chair Rosie Cooper also received answers to two written questions about the training healthcare professionals receive on incontinence issues. The first question asked whether healthcare assistants are required to undertake mandatory continence care training as part of their basic training.

Health Minister Philip Dunne responded that while the content of initial healthcare assistant training is decided independently by NHS trusts, new healthcare assistants and social care support workers must gain a Care Certificate within the first twelve weeks of their employment. The Care Certificate standards provide the foundations for continence care training; for example, standard five stipulates working in a person-centred way, which requires a carer to act on pain and discomfort experienced by patients. This includes ensuring equipment or medical devices are functioning, like catheter tubes. Carers should also minimise environmental factors causing pain or discomfort, including wet or soiled clothing or bed linen. However, continence care is not specifically mentioned in the Care Certificate.

The second question asked if continence care training has become a mandatory part of a nurse’s curriculum since the publication of the Francis Report. Dunne said that the Department of Health is not aware that continence care training has become a mandatory part of the nurse training curriculum. He added that the Nursing and Midwifery Council is the body in charge of setting standards for nursing education, training, conduct and performance. The NMC published the professional standards it requires nurses and midwives to uphold in March 2015, and has not updated it since.

Dunne’s answer went on to detail that NHS England’s Excellence in Continence Care guidance should be used by all health professionals as a framework for continence care; and that it enables commissioners to work in collaboration with providers and others to address shortfalls in continence care.

Chancellor delivers 2016 Autumn Statement

Philip Hammond, Chancellor of the Exchequer, has made his debut Autumn Statement, which will also be the last – from 2018 the Government will make fiscal changes in an Autumn Budget, and will use a new Spring Statement to provide an evaluation of Government spending as opposed to make policy announcements and reforms.

Hammond did not address health issues as part of his statement and announced no extra funding for health or social care. Please find below a summary of the main highlights from the 2016 Autumn Statement.

OBR forecasts

The Office for Budget Responsibility’s latest report on the UK’s economic and fiscal outlook shows that economic activity grew 2.3% in 2016; and employment rates are at 74.5%. However, GDP growth is predicted to slow to 1.4% in 2017 due to the economic turbulence expected to occur when Brexit negotiations begin; it is estimated that it will recover to 2% by 2020. Hammond highlighted that the OBR believes there is more uncertainty in their estimates due to uncertainty caused by Brexit.
Policy decisions

  • Corporation tax will fall to 17%, as had been previously announced.
  • The new National Productivity Investment Fund will be the basis for a fiscal framework that will target productivity; transport; digital communications; research and design; and housing. It will provide £23 billion extra spending between 2017/18 and 2021/22. £2.3 billion will be given to a new Housing Infrastructure fund by 2020/21, which will deliver up to 100,000 new homes. An additional £1.4 billion will be given to create 40,000 affordable homes. Addressing the housing crisis will has wide implication for health and social care, meaning the investment is welcomed.
  • Research and development will receive £4.7 million additional funding by the end of this Parliament. The Industrial Strategy Challenge fund, a cross-disciplinary fund to support collaborations between business and science, and innovation, applied science and research will be further supported through awarded grants.
  • The minimum wage will be increased from £7.20 to £7.50 from April 2017, and the tax threshold will be revised from £11,000 to £11,500. £1.8 billion from the Local Growth Fund will also be given to all English regions, as the Government reaffirmed its commitment to devolution.

Responding to the statement, Shadow Chancellor John McDonnell said that it placed on record the “abject failure of the last six wasted years” and “offers no hope for the future”. Mr McDonnell claimed that the statement was evidence that “the so-called long-term economic plan has failed”. Additionally, he urged Mr Hammond to face up to the “extreme Brexit fanatics” in the cabinet and insisted on Britain keeping tariff-free access to the single market.

In Parliament after the statement, Labour MP Luciana Berger, asked why health spending was not addressed or even mentioned. Hammond replied that the Government has already confronted health spending through its commitment to giving the NHS £10 billion in additional funding by the end of the current Parliament.

Others have also criticised the decision to provide no funding relief to the NHS or the social care sector. Councillor Izzi Seccombe, Chairwoman of the Local Government Association’s Community Wellbeing Board, said: “The Government’s failure to act today means social care remains in crisis […] and the NHS continues to be pushed to the financial brink”. Richard Murray, Director of Policy for The King’s Fund, said there is not enough funding “to maintain standards of care, meeting rising demand and transform services”.

National Audit Office warns Government about the NHS’s financial performance

The National Audit Office, the independent watchdog for Government departmental finances, has published a report on the financial stability of the NHS. It found that in 2015-2016, the financial performance of NHS bodies worsened, with more than two thirds of NHS trusts in deficit and an increasing number of CCGs unable to adhere to budgets. Among the key findings for 2015-2016:

  • NHS England, CCGs, NHS trusts and NHS foundations trusts have a net deficit of £1.85 billion;
  • 66% of NHS trusts and NHS foundation trusts are in deficit;
  • 15% of CCGs reported a cumulative deficit;
  • £2.4 billion was given in additional funding to NHS trusts and NHS foundation trusts as a cash injection, loan, or other financial support; and
  • NHS trusts, NHS foundation and CCGs must make £14.9 billion in savings by 2020-2021 to close the estimated £22 billion gap between patients’ needs and resources.

The continued deterioration of the NHS’s financial performance was deemed unsustainable by the NAO in December 2015, which called the problems the NHS faces “endemic”. The report found financial stress on the NHS to be correlated with access to services and quality of care, as the association between a trusts’ financial performance and Care Quality Commission rating showed that trusts achieving lower ratings also reported poorer average financial performance. Spending on agency staff has slowed down, but spending is still significant: on average trusts spent 7.6% of their total staff costs on agency and contract staff.

The report states that plans to close the estimated £22 billion gap between patients’ needs and resources have not been adequately tested, which throws into doubt whether the savings can be achieved. Additionally, the larger than expected deficit for the previous financial year means that the NHS must implement sustainability plans from an unexpected and disadvantaged starting point. Overall, the NAO makes the following recommendations to the Department for Health, NHS England and NHS Improvement:

  • Test the assumptions in national plans and local sustainability and transformation plans;
  • Produce a realistic efficiency and savings targets for local bodies;
  • Produce an evaluation of the impact and risks to future financial stability of the one-off measures used to manage the 2015-2016 financial position;
  • Develop an analysis of the impact of social care funding and the cost of implementing seven-day services on the NHS; and
  • Provide an assessment of whether current and planned incentives are helping local bodies work together and plan for long-term financial sustainability.

Meg Hillier, Chair of the Public Accounts Select Committee, called on Prime Minister Theresa May to address the realities the NHS faces in tomorrow’s 2016 Autumn Statement. Councillor Izzi Seccombe, Chairwoman of the Local Government Association’s Community Wellbeing Board, said that the figures show the “unprecedented financial pressure” the health system and social care system is under; and Amyas Morse, Head of the NAO, repeated that the “financial problems are endemic” and unsustainable.

UK Statistics Authority tells Government to be more accurate about NHS funding

The UK Statistics Authority has told the Government to be more precise and clear about NHS funding, after it investigated the claim that the NHS will receive £10 billion in funding by between 2015/16 and 2020/21. Jonathan Ashworth, Shadow Secretary of Health wrote to the authority asking for an investigation of the figure.

In its response, the UKSA said that confusion has been caused because while NHS England spending is rising, other elements of the Department of Health budget are decreasing, meaning the net spending increase across all Department of Health bodies will not be £10 billion by 2020/21. It pointed out that while the Department of Health has been open when asked about the nature of the estimated real terms increases in health spending and its split between NHS England and the Department’s overall budget, the Government refers to total health spending figures less frequently. The letter explains that that over the five years of the current Parliament, it can be estimated in constant 2015/16 prices that the Department of Health budget will rise by £4.5 billion in real terms.

HM Treasury has been asked to investigate whether it can present estimates for NHS England and total health spending separately. The authority has promised to explore ways of producing the figures in different ways that will provide more clarity around sources, time periods and what is being measured.

Weekly political news round up – 18th November

December 5, 2016 in News by Whitehouse

Overview

This week, three Parliamentary Written Questions have been asked by Dr Sarah Wollaston that address the use of NHS England’s excellence in continence care guidelines by CCGs, patient groups and the general public; and bowel and bladder care training for pre- and post-registration nurses. Philip Hammond, Chancellor of the Exchequer, has also replied to the Health Select Committee’s letter on the Autumn Statement.

Outside of Parliament, the assistant nurse role that is due to be introduced in England in December 2016 has come under heavy criticism after research published by the British Medical Journal suggested a link between increased patient mortality and changes to skill level mix in hospitals. Chris Hopson, chief executive of NHS Providers, has also written to the Chancellor ahead of the Autumn Statement declaring that the health service cannot carry out its responsibilities if the current level of funding is maintained.

Three Parliamentary Written Questions asked about continence care

Dr Sarah Wollaston, Chair of the Health Select Committee, has asked three questions about the NHS England excellence in continence care guidelines and bowel and bladder care training for nurses. As they were posed to the Secretary of State for Health on Tuesday 15th November, we expect they will be replied to early next week.

The first question asks what has NHS England done to promote the excellence in continence care guidelines to (a) clinical commissioning groups (b) patient groups and (c) the general public; and the second requested information on which CCGs have put the guidelines into practise since they were published in November 2015. The third question asks “if the Nursing and Midwifery Council will include mandatory bowel and bladder care training for pre- and post-registration in the new revised curriculum”.

Philip Hammond replies to Dr Sarah Wollaston MP’s letter regarding NHS finances

On 26th October Dr Sarah Wollaston, Chair of the Health Select Committee, wrote a letter to Philip Hammond, Chancellor of the Exchequer, regarding the Committee’s concerns about the NHS’s finances. The Chancellor’s reply has now been published, detailing that he was pleased to meet with Dr Wollaston and wanted to respond in writing to the issues she raised and present the Government’s position.

In response to apprehension over the accuracy of the £10 billion figure the Government has said the NHS will receive by 2020-2021, the Chancellor explained that the figure has been determined using 2014-2015 as a baseline, which is also what was used in the Five Year Forward View. He details that Dr Wollaston raised issues with the Department of Health budget, however the Government decisions regarding health funding have focused just on the NHS.

The letter addresses concerns raised about the NHS and the Autumn Statement. First, the Chancellor commits to giving the Department of Health more than £20 billion of capital investment over the Spending Review period; and states that capital investment proposals in sustainability and transformation plans are currently being considered by NHS England.

The letter also adds that local authorities will be receiving £3.5 billion of new support by 2019-2020, which will allow them to increase social care funding by the end of the current Parliament. Lastly, Mr Hammond states that the NHS will receive an increase in real term funding in each year of the Spending Review, but the frontloaded settlement to begin the Five Year Forward Review means the size of the increase will be higher in the early years of the Spending Review.

Report into new nursing associate role reveals danger to patient mortality

A report on the relationship between mixing nursing skill levels in European hospitals and mortality, patient ratings and quality of care has been published by the British Medical Journal. Researchers believe it is “not in the public interest” to have varying nurse skill levels in hospitals, as they found replacing qualified nurses with nursing assistants was linked to an increase risk of patient deaths.

The new nursing role was announced in December 2015 by the Department of Health, and is designed to work alongside healthcare support workers and qualified nurses, and focus on patient care. However, the BMJ’s report sheds light on the dangers associated with using varying levels of qualified nurses: for every 25 patients, replacing one professional nurse with a nursing assistant is associated with a 21% increase in the probability of dying in a hospital, compared with average nurse staffing levels and skill mix.

The Department of Health has questioned whether the findings are reliable;, however the study used data from acute hospitals in England, Ireland, Belgium, Spain, Finland and Switzerland. Survey responses from nurses working in more than 240 hospitals numbered over 13,000, in addition to patient responses from 180 hospitals. Discharge data from 275,000 patients who had undergone a surgical procedure was also used in the data analysis.

NHS England is introducing the new role in December 2016 across England. Health Ministers have supposedly rejected the criticism, and said the new role is in addition to investment in fully qualified nurses. Professor Peter Griffiths, a Southampton University researcher from the study, explained: “Our study suggests that the NHS needs to focus on achieving safe registered nurse staffing levels as a means to achieve better [health] outcomes”.