Weekly political news round up – 10th March 2017

March 10, 2017 in News by Whitehouse

Overview

This week, Chancellor of the Exchequer Philip Hammond presented his first – and last – Spring Budget to the House of Commons. The Budget contained a handful of notable policy decisions for health and social care, including £325 million of capital funding to support Sustainability and Transformation Plans (STPs), £100 million of capital investment for A&E departments and £2 billion for social care – but these did not match the demands of the health sector. Stakeholders such as the Royal College of Nursing and the Local Government Association welcomed the funding announcements, but highlighted the need for further measures to resolve the wider financial difficulties in health and social care.

In other news, Health Education England (HEE) Chief Executive Professor Ian Cumming has said he expects a further 2,000 new nursing associate trainees to start two-year training programmes in 2018. Some 1,000 trainee nursing associates started programmes at pilot sites across England in January, with a further 1,000 due to begin at more test sites in April. Speaking at a HEE board meeting, Professor Cumming said the organisation will be working with employers to understand how the forthcoming apprenticeship levy can fund a faster roll-out of the programmes in the future.

Meanwhile in a blow to the Government’s plans, the House of Lords has voted in favour of another amendment to the European Union (Notification of Withdrawal) Bill, to allow Parliament a veto over the outcome of negotiations. The Government has said it will attempt to overturn the Lords’ amendments when the Bill returns to the House of Commons next Monday. Any “ping pong” over the Bill’s final wording will conclude next Wednesday, and so is not expected to delay Article 50 being triggered.

Spring Budget 2017

Chancellor of the Exchequer Philip Hammond has this week presented his Spring Budget to the House of Commons. As previously announced, this was the last Budget to be made in the spring. The first Autumn Budget is due later this year and will be followed by a Spring Statement from 2018. The Office for Budget Responsibility (OBR) confirmed better than expected growth rates, with the growth forecast for the UK economy for 2017 rising to 2% from the 1.4% predicted last November, and government borrowing is expected to be approximately £16.4 billion lower this year than previously anticipated.

The Chancellor announced increases to National Insurance for self-employed people to bring contributions in line with that for employed workers, making the case that lower NI paid by self-employed workers is estimated to cost approximately £5 billion this year. The policy has since prompted substantial backlash from backbench Conservative and Labour MPs, with the Prime Minister now stating that a vote on the changes will take place in the autumn.

Health and Social Care

In an unexpected boost for the NHS, the budget announced £325 million of capital funding to support the “strongest” Sustainability and Transformation Plans (STPs) over the next three years. The Chancellor said the funding will go towards areas such as building new healthcare premises and investing in new technology, which many STPs have said is crucial to ensuring their new models of care are successful. A further round of capital funding for STPs will be announced in the autumn, again predicated on the “strength” of an STP.

The budget also includes £100 million of capital investment in 2017/18 for A&E departments. This funding is expected to deliver an urgent treatment centre, based on the model of Luton and Dunstable University Hospital Foundation Trust, in every A&E in England, which will triage patients and send them to the appropriate healthcare professional. The Chancellor said the money “will enable trusts to invest in measures to help manage demand on A&E services”, and could include locating GPs within A&E departments.

 Responding to growing pressure from MPs and stakeholders across the political divide, the Chancellor also announced that the Government will provide an additional £2 billion for councils for adult social care between 2017/18 and 2019/20. £1.2 billion of the new funding will be available in 2017/18, followed by £800 million in 2018/19 and £400 million in 2019/20. A Green Paper on a long-term solution for social care funding will be published later this year.

Education

As expected, the Government announced £320 million of new funding to expand its free schools programme, which will enable new selective schools to be created. This will support the creation of up to 140 new free schools, 30 of which will open by September 2020. In addition, children in receipt of free school meals will now be entitled to free school transport to the nearest selective school in their area – a measure designed to further support the expansion of selective schools.

Reaction

Responding to the Budget, Labour leader Jeremy Corbyn accused the Government of producing “a Budget of utter complacency about the state of our economy” and said the Budget did not provide the funding necessary to end the “state of emergency” in social care. Shadow Chancellor John McDonnell said the Budget will do “nothing to fix the NHS crisis”.

 The Royal College of Nursing’s (RCN) Chief Executive Janet Davies echoed these views, stating that the “Chancellor missed an opportunity to give the NHS the level of investment he knows it needs.” She welcomed the financial support for STPs, but called on the Government to clarify the number of plans that will benefit from the new funding and guarantee that it will be directed towards “struggling community services”.

 Local Government Association Chairman Lord Porter said the £2 billion for adult social care “marks a significant step towards protecting the services caring for the most vulnerable in our communities over the next few years”, but warned that a local government funding gap of £5.8 billion by 2020 will require further cuts to local services, including social care. He said the “social care crisis is far from over” and suggested the Government’s Green Paper is the “last chance” for a long-term solution.

New funding for children with SEND

Minister for Vulnerable Children and Families Edward Timpson has this week announced £215 million of funding to increase school capacity for children with special educational needs and disabilities (SEND). The Government have allocated at least £500,000 for every council to expand and improve their special educational needs and disabilities (SEND) provision, with more than half receiving at least £1 million. Councils will have full control over how they invest the money to improve education for pupils with SEND, but will be expected to consult local parents, carers, schools, and other stakeholders before making decisions. They will also be obliged to publish a plan showing how they will spend the funding.

Mr Timpson said the Government is determined to build a country “where every child has an equal opportunity to reach their full potential regardless of their background, and any‎ challenges they may face.” He said the new funding will “enable local councils to build new classrooms and improve facilities for pupils‎, ensuring that no child is left behind.”

HEE publishes plan to attract more nurses to primary care

Health Education England (HEE) has published a plan to improve the recruitment, retention and return of general practice nurses (GPNs), following concerns that an increasing shortage of practice nurses, and an impending retirement bubble, is adding to the workforce pressures in general practice. HEE’s ‘General Practice Nursing Workforce Development Plan’ sets out 17 recommendations, including a national campaign to raise understanding of general practice nursing role across healthcare organisations, schools, colleges and the public; an increase in the number of pre-registration nurse clinical placements in general practice; and recruitment and support schemes to attract newly qualified nurses. Of greatest relevance for the PCF, it suggested GPNs and school nurses running joint school/general practice wellbeing initiatives on school premises to raise awareness.

HEE stated in the report that improving recruitment and retention of general practice nurses is largely the responsibility of individual GP practices, GP federations and emerging new care models, including multi-specialty community providers. It said that clinical commissioning groups, and training hubs being developed by Health Education England as part of efforts to support and develop general practice, will nevertheless have “a crucial part to play” in ensuring the workforce remains sustainable.

Dr Peter Lane, the GP who chaired the group of experts responsible for the report, said the general practice nursing workforce of today provides “an essential, high standard of care to their local populations and are invaluable members of primary care teams”. He said the report “offers clear guidance and steps that can be taken to improve general practice nurse recruitment and retention, and encourage nurses to return to the profession.”

Latest NHS staff survey highlights concerns over understaffing

NHS England have published the results of their latest staff survey, showing that almost half of NHS workers believe the service is understaffed and that this affects their ability to provide care. Out of 409,000 responses, 47%  of staff said they disagreed with the statement: “There are enough staff at this organisation for me to do my job properly.” Only 32% agreed with the statement. Meanwhile, 60% of staff reported coming to work in the previous three months despite feeling unable to perform their duties or the requirements of their role, and 59% of staff reported working unpaid overtime each week. The proportion of staff feeling unwell because of work-related stress is at its lowest reported level in five years, but still stands at 37%.

 The RCN’s Chief Executive Janet Davies said the figures show how NHS staff are “straining to hold things together”. She urged the Government to provide the NHS with the funding necessary to keep patients safe and wards appropriately staffed, adding that ministers should offer nurses and health care assistants a pay rise in line with the cost of living. She said: “Unless the Government shows it values those working under immense pressure and taking care of patients when they are most vulnerable, people will be deterred from joining the nursing profession and others will feel no choice but to leave it.”

Weekly political news round up – 3rd March 2017

March 10, 2017 in News by Whitehouse

Overview

The Treasury has asked Government departments to model fresh 3% and 6% cuts to their budgets, as part of the “efficiency review” announced last year to find £3.5 billion of savings by 2020. Speaking ahead of next Wednesday’s Spring Budget, Treasury minister David Gauke said there has been “considerable progress” towards this target, but that the Government will need to go further to ensure that departments are delivering “maximum value” for taxpayers’ money. Ring-fenced budgets for schools and the NHS will not come under review, the Treasury said, and savings made by local government cuts will be used to ease pressures on social care.

The announcement arrives amid growing pressure on the Government to resolve the financial difficulties facing health and social care. Speaking in a House of Commons debate on Tuesday, Public Accounts Committee (PAC) Chair Meg Hillier MP pointed out that the PAC, Health Committee and Communities and Local Government Committee are united in their view that the Government need to make funding for health and social care a top priority.

In other news, the House of Lords has voted to amend the European Union (Notification of Withdrawal) Bill to guarantee EU nationals’ right to stay in the UK after Brexit. The Government had hoped to see the Bill through the Lords without challenge and has indicated it will seek to overturn the amendment. The Bill will now return to the House of Commons, with any “ping pong” between the two Houses over its final wording likely to take place on 13th and 14th March.

Welsh Assembly debates public toilet provisions of Public Health (Wales) Bill

The Welsh Assembly has held its first debate on the Public Health (Wales) Bill, providing Assembly Members (AMs) with the opportunity to examine the general principles of the Bill before it is opened to amendment by the Health, Social Care and Sport Committee. The Bill’s provisions requiring local authorities to produce strategies for the provision of public toilets proved a key talking point during the debate, with AMs calling on the Welsh Government to go further and place a legal obligation on authorities to provide public toilets.

Opening the debate, Minister for Social Services and Public Health Rebecca Evans said that the Bill’s requirement for local authorities to prepare local toilet strategies “will encourage new and creative ways of addressing a complex public health issue”. She noted the Health, Social Care and Sport Committee’s concerns around access to information on toilet provision, and said her department will work to produce information to assist the public in locating local toilet facilities.

These statements did not satisfy members of the Health, Social Care and Sport Committee, who reiterated concerns raised in their report on the Bill. UKIP AM Caroline Jones described the Bill’s public toilet provisions as a one of her “biggest disappointments”. She said the fact that the Bill simply requires councils to prepare a public toilet strategy will do nothing to improve provision or allay the concerns of those affected by the lack of provision. She indicated that most stakeholders who gave evidence to the health committee felt that there should be a statutory duty placed upon local authorities to implement the public toilet strategies if there is to be real improvement.

Responding to the debate, Ms Evans said that local authorities will be expected to think about people passing through – not just the local population – when preparing their local strategies. She did not address Ms Jones’ concerns, opting instead to repeat her department’s commitment to improving access to information on public toilets. She suggested the Government work in partnership with AMs to develop a national map of public toilets, adding that officials are currently examining the infrastructure required to collect the appropriate data from local authorities and incorporate this into existing mapping tools.

Health visitor checks to remain mandatory

Public Health England has announced the continuation of the requirement for local authorities to commission five universal health visiting checks for families. These checks, which commence at 28 weeks of pregnancy and continue up until the age of two and a half, became mandatory when the commissioning of the Healthy Child Programme transferred from the NHS to local authorities in October 2015. The regulations which introduced mandation are due to expire this month, but a Public Health England (PHE) review found that all stakeholder groups, commissioners, providers and professionals wanted checks to remain mandatory.

Commenting on the announcement, Public Health Minister Nicola Blackwood said: “Health visitors support families to give children the best possible start in life, that’s why we have taken strong action to making these services mandatory across the country.” The Local Government Association welcomed PHE’s announcement, but raised concerns about delivering the checks in the future climate of reduced funding. Chairman of the LGA Community Wellbeing Board Cllr Izzi Seccombe said that cuts to councils’ public health grants threaten to undermine the work they are doing to “ensure all children have the best start in life”. She said: “If councils are to continue to deliver mandatory health checks the Government must commit to providing ongoing funding to support this vital service.”

Public Accounts Committee calls for “united effort” to tackle NHS challenges

The Public Accounts Committee has published the report for its inquiry into the financial sustainability of the NHS, calling for a “united effort” to tackle the financial sustainability challenges facing the NHS. The Committee emphasised the right of taxpayers to have “an honest, grown-up conversation about future finance and service provision”, which it says has been hampered by contradictory public statements from the Government and NHS England around the amount of additional NHS funding allocated for the rest of this parliament.

The report warns that efforts to restore financial stability are affecting patients’ access to services and their experience of care.  It said meeting day-to-day spending through “repeated raids” on the NHS’s capital budget reserved for long-term investments could have damaging consequences, adding that the Government must do more to convince the public that STPs are about delivering transformation and efficiencies, rather than “a cover for cuts in services”.

Committee Chair Meg Hillier argued that “the Government’s sticking-plaster approach is not sustainable, will not enable the NHS to get ahead of the problems it faces, and represents neither good value to taxpayers nor the best interests of patients.”

MPs including Ms Hillier and the Chairs of Health Committee and Communities and Local Government Committee reiterated many of these points during a House of Commons debate on Tuesday. Health Committee Chair Dr Sarah Wollaston pointed out that this is the third year in a row in which there have been transfers from capital to revenue budgets. She argued that this mechanism is unsustainable and risks undermining the transformation process.

Key recommendations outlined in the Public Accounts Committee’s report include:

  • The Department of Health, NHS England and NHS Improvement should publish an assessment of whether there is the “capacity in NHS bodies to deliver everything they are expected to within the agreed timeframes” by March 2017.
  • The DH, NHS England and NHS Improvement should set out a recovery plan by March 2017 which targets those NHS bodies and health economies in severe financial difficulty.
  • The DH and NHS England should report back to the Committee by July 2017 on what they have done to understand the association between financial performance and the impact on patient care.
  • In its analysis of the 44 STP footprints, due by the end of March 2017, NHS England and NHS Improvement should set out how they will support organisations to deliver real transformation in the areas where plans fall short.
  • The DH, NHS England and NHS Improvement should publish by March 2017 its assessment of whether there is the capacity in NHS bodies to deliver everything they are expected to within the agreed timeframes.

Stevens: STPs will end purchaser-provider split

NHS Chief Executive Simon Stevens has said the Sustainability and Transformation Plans (STPs) will end the purchaser-provider split in healthcare, during an evidence session with the Public Accounts Committee this week. Stevens told MPs that between six and 10 STPs are set to become Accountable Care Organisations (ACOs), which will “effectively end the purchaser provider split” and bring about “integrated funding and delivery for a given geographical population” for the first time since 1990.

Mr Stevens is understood to be in discussion with STPs including Frimley Health, Lancashire and South Yorkshire about the possibility of listing them as developing ACOs in the Forward View delivery plan due to be published this month. He also spoke of plans to appoint STP leads who will be responsible for the governance of organisations in their areas, including local CCGs and the local NHS England staff. However, he dismissed the suggestion that additional legislation or funding would be required to implement the STPs, stating that the Five Year Forward View delivery plan being drawn up by NHS England is predicated on existing arrangements. He also said that formal lines of accountability will remain the same for STPs.

Weekly political news round up – 24th February 2017

March 10, 2017 in News by Whitehouse

Overview

The Urology Trade Association (UTA) has this week called on ministers to reconsider a decision not to review implementation of NHS England’s continence guidance, after a parliamentary question tabled on behalf of the PCF in December revealed that the Department of Health has not audited the effect of the NHS’s Excellence in Continence Care guidance. The UTA, which represents the manufacturers of urological devices, cited a fall in the number of referrals to specialist urology services as evidence that patients could be seeing non-specialist district and practice staff, rather than specialist urology services.

Elsewhere, NHS Improvement has published provider sector figures indicating that NHS trusts have accrued a deficit of £886 million for the first nine months of 2016/17. The regulator predicts that this could be reduced to between £750 million and £850 million by the end of the financial year. The provider sector had aimed to keep its deficit below £580 million following a £2.45 billion deficit last year, but the chief executive of NHS Providers, Chris Hopson, criticised the “wafer-thin” margin of error which this was predicated on.

Finally, the Department for Communities and Local Government (DCLG) has published the final local government finance settlement, confirming that that the Government will not provide any new funding for councils in 2017/18. The Local Government Association responded that councils, the NHS and care providers are in desperate need of new government funding for social care. It said that by “continuing to ignore these warnings, social care remains in crisis and councils and the NHS continue to be pushed to the financial brink.”

Trade association calls on Government to review implementation of NHS continence guidance

The Urology Trade Association (UTA), which represents the manufacturers of urological devices, has called on ministers to review the implementation of NHS England’s Excellence in Continence Care guidance, after a question tabled on behalf of the PCF last year revealed the Government has failed to assess the implementation of the guidance. Conservative MP Sir David Amess asked the Department of Health whether it had held discussions with NHS England on auditing the effect of the guidance on paediatric continence services. Health Minister David Mowat responded that “The department has had no formal discussions with NHS England on auditing the effect of its guidance Excellence in Continence Care on the quality of paediatric continence services.”

The UTA cited responses to Freedom of Information (FOI) requests from 113 acute NHS trusts in England to warn that patients could be struggling to access specialist urology support. The number of referrals to specialist urology services increased by eight per cent between the period 2013/14 and 2015/16. However, the figures also revealed a fall in referrals between 2013/14 and 2015/16. The UTA warned that this could mean patients are being seen by district and practice staff lacking specialist training, rather than specialist urology services.

Responding to the figures obtained by the UTA, Patricia McDermott, chair of the Association of Continence Advice and a consultant clinical nurse specialist in urology in Guernsey, said that “continence care requires a higher priority than it currently receives.” She said that poor continence care is both distressing for individuals and costly for the NHS, adding that “effective community-based continence services can save valuable NHS resources whilst restoring dignity to people and improving quality of life.”

House of Lords debates nursing workforce

The House of Lords debated the nursing workforce this week, after Labour Peer Lord Clark of Windermere asked what plans the Government have to eradicate the shortage of trained nurses in the NHS and care sector.

Citing reports that the NHS is short of 24,000 nurses and that nursing applications have undergone a 23% reduction, Lord Clark urged the Government to reinstate the bursary scheme at university for nurses, or at least promise nurses who qualify and spend several years working in the health service that they will have their tuition fees reimbursed. In response, Health Minister Lord O’Shaughnessy claimed that there are 6,500 more full-time equivalent nurses and health visitors than there were in 2010, and that there has been a 15% increase in the number of training places offered. He also said that the new nursing apprenticeship route could allow up to 1,000 additional nurses to join the NHS each year.

When Labour Peer Baroness Pitkeathley asked what progress is being made with training nurses who can work across health and community services, Lord O’Shaughnessy responded that the number of nurses with general qualifications who are capable of working across multiple specialties and different sectors has risen. He also denied that there has been a drop-off in the number of EU nationals joining the NHS workforce since the referendum, but said it was “clearly sensible” to reduce the UK’s reliance on overseas nurses each year. He said that the Government is working to do this through additional training places and through retention and return to work schemes.

NHS loses 6 per cent of school nurses in a year

The number of school nurses working in the NHS in England has dropped by 6% in a year, according to NHS workforce statistics. The number of school nurses dropped from 2,725 in October 2015 to 2,561 in October 2016. The data also reveals an 8.7% drop in the number of whole-time equivalent health visitors working in the NHS, which fell from 10,309 in October 2015 to 9,410 twelve months later.

Commenting on the figures, health publication Nursing Times pointed out that the decline in staffing levels took place in the twelve months after the commissioning of public health services fully transferred over to local authorities, in October 2015. It said the data confirms fears that ongoing cuts to council public health budgets are leading to a significant reduction in nurses working in children’s services.

Dr Cheryll Adams, Executive Director of the Institute of Health Visiting, warned that further reductions to the NHS health visiting workforce could lead to the same unsustainable staffing levels seen in the mid-2000s. She said that when the Government cut health visiting in 2005, many health visitors went off sick or looked for other jobs due to what they felt were large and unsafe caseloads. She said that this “will be starting to happen again when cuts are planned.”

King’s Fund calls for STPs to be developed into “credible plans”

The Sustainability and Transformation Plans (STPs) need to be strengthened and developed into “credible plans”, according to a report published this week by The King’s Fund. The STPs are the main vehicle for transforming health and care services in England in line with the NHS Five Year Forward View, but have attracted significant criticism due to a lack of funding, limited public consultation, and controversial decisions such as hospital closures or downgrades.

The King’s Fund defended the STPs, stating that they “offer the best hope for the NHS and its partners to sustain services and transform the delivery of health and care”. However, while the think-tank recognised that the 44 STPs submitted in October are wide-reaching – proposing changes in areas from prevention through to acute and specialised services – it said these must now be developed into coherent plans, with clarity about each STP footprint’s top priorities.

The report outlined several recommendations, including that:

  • The NHS should improve engagement with staff, patients, local authorities and the third sector in discussing the proposals.
  • The governance and leadership of STPs needs to be strengthened and more realistic timescales adopted for implementation.
  • National bodies should work together to support the NHS and local authorities to implement the plans and send out consistent messages on what they now expect.
  • Proposals to transform services provided in the community should be a high priority, and new care models being developed by vanguards need to be supported and spread to other areas.
  • The Government should recognise the need for additional resources for the NHS and social care if the STPs are to deliver the proposed transformations in care, given the financial and operational pressures the NHS now faces.
  • Changes to the law are needed to amend aspects of the Health and Social Care Act 2012 that are not aligned with the Five Year Forward View, particularly in relation to market regulation.

Commenting on the report, Royal College of Nursing Chief Executive Janet Davies expressed support for the ambitions of the STPs – preventing ill health, joining up services and delivering care closer to home – but said that a lack of “proper resourcing” risked undermining these aims.  She said that the RCN have “ongoing concerns about the way STPs have been developed so far, behind closed doors”, adding that the involvement of nurses and other health and care staff in the STPs will be vital to their success.

Weekly political news round up – 17th February 2017

March 10, 2017 in News by Whitehouse

Overview

This week, the Health, Social Care and Sport Committee published the transcript of an evidence session on the Public Health (Wales) Bill, in which Committee members questioned a Crohn’s and Colitis UK representative on the Bill’s provisions for public toilets. Andy McGuinness, Crohn’s and Colitis UK’s social policy and public affairs officer, said that the provisions requiring local authorities to the local toilets strategies would help address the lack of public toilets provision in Wales, but that the absence of a statutory obligation on local authorities to ensure access to toilets means there will always be some council that under-deliver.

In another development stemming from the Public Health (Wales) Bill, the Welsh Finance Committee published its report on the financial implications of the Bill’s provisions. This states that the Committee “has concerns as to whether the production of strategies alone would lead to improved public access to toilets, and therefore whether the investment would represent value for money.”

The British Medical Association have featured prominently in broader headlines: firstly, for declaring that NHS organisations will need £9.5bn of capital funding to create the infrastructure necessary to successfully deliver; and secondly, for that NHS organisations will need £9.5bn of capital funding to create the infrastructure necessary to successfully deliver; and secondly, for warning that Brexit-induced uncertainty is creating “serious instability” for the NHS and calling for staff from the EU to be given the right to remain.

Elsewhere, NHS England has confirmed that the NHS RightCare programme has been working alongside Sustainability and Transformation Plan (STP) footprints to encourage planning and change; and a petition on the parliament website to ‘save’ the children’s nursing degree has gained over 13,000 signatures, just a week after it was launched.

HSCS Committee takes evidence on Public Health (Wales) Bill

The Welsh Health, Social Care and Sport Committee has published the transcript of an evidence session on the Public Health (Wales) Bill, which took place in January. Among the items on the agenda were the Bill’s provisions requiring local authorities to produce strategies for the provision of public toilets. The Committee took evidence on this issue from Andy McGuinness, the social policy and public affairs officer of Crohn’s and Colitis UK.

UKIP AM for South Wales West Caroline Jones initiated the Committee’s questioning of Mr McGuiness by asking for his views on access to information about public toilets. Mr McGuiness answered that the level of information available to people on local authority websites is a “mixed bag”, with some councils providing little to no information on their websites. He noted that the Bill contains provisions for local authorities to improve access to information, but said that the Government “should provide access through a united one-Wales approach”, as there is “no point in having 22 different local solutions”. He said the Bill should require Government to work with local authorities to collect information on public toilets, which could then be published online. This information could also be used to analyse the gaps in current service provision, he said.

When Ms Jones asked how the needs of toilet provision can be effectively met at a time when local authorities face significant financial pressures, Mr McGuinness responded that the lack of public toilets is a real issue in Wales – particularly for people with continence issues – and that the Welsh Government’s figure of 950 public toilets needs to be doubled. He said that the local toilets strategies will go some way to addressing this issue, but noted that the lack of a statutory obligation on local authorities to ensure access to toilets means there will always be some that under-deliver. He suggested that it would be “naïve” to introduce a statutory duty on local authorities to provide public toilets directly given the lack of available funding, but said the Government must “think a bit more intelligently for us to come up with intelligible solutions”.

In response to a further question from Ms Jones about how the Bill can ensure third party organisations provide access to toilet facilities, Mr McGuiness said he has called for the introduction of a duty to co-operate with local authorities to ensure that third parties do provide access. This issue was taken up by Labour AM for Merthyr Tydfil and Rhymney Dawn Boden, who asked Mr McGuinness how the allocation of the public facilities grant scheme has changed since being introduced in 2009, and what the impact of these changes has been. Mr McGuinness said the public facilities grant had been ring-fenced, making £200,000 available for local authorities to give to local businesses, with £500 for businesses to open their local toilets. He said that this was then un-ringfenced in 2012/13, meaning that many local authorities have used the funding for other priorities. When Ms Boden asked whether he thought £500 was sufficient incentive, he suggested that it was not.

The final question of the session came from Plaid Cymru AM for Ynys Môn, Rhun ap Iorwerth, who suggested that allowing local authorities to charge for the use of toilets as a way of overcoming limited funding, and asked Mr McGuiness about concerns he had expressed about this. Mr McGuiness responded that about 50 per cent of the stakeholders Crohn’s and Colitis UK had spoken with would be happy to pay a small fee, because then at least those toilets would be available, but said it is a question of dignity. He said that people with Crohn’s and colitis can need access to a toilet up to 10 or 20 times a day and that charging these people creates a real barrier for access.

Finance Committee report on Public Health (Wales) Bill published

This week, the Welsh Finance Committee published its report on the Public Health (Wales) Bill. While the HSCS Committee scrutinised the provisions of the Bill as a whole, the Finance Committee focused only on the Bill’s financial implications. Key points from their analysis of the provisions requiring local authorities to produce strategies for the provision of public toilets are provided below.

The Committee’s report notes that while Bill requires local authorities to produce a strategy for the provision of public toilets, it does not include a statutory obligation on local authorities to provide public toilet facilities, due to concern about the costs of capital investment and maintenance of increased provision. Citing the Welsh Government Regulatory Impact Assessment (RIA), it states that the Bill would nevertheless result in additional costs of just over £451,900, of which £442,900 would fall upon local authorities.

A number of local authorities expressed concern that the proposal to develop strategies would not achieve the policy aims on its own. The Finance Committee’s report echoes this point, stating that the Committee “has concerns as to whether the production of strategies alone would lead to improved public access to toilets, and therefore whether the investment would represent value for money.” It recommended that the Welsh Government review the effectiveness of the provisions relating to public toilets in improving access to facilities and the value for money they represent.

STPs using NHS RightCare approach

NHS England papers from the board meeting last week confirm that the NHS RightCare programme has been working alongside Sustainability and Transformation Plan (STP) footprints to encourage planning and change, and will continue to do so in 2017. CCGs, STPs and their stakeholders have been drawing on the NHS RightCare approach to identify key pathway and system priorities, plan and deliver change, according to the papers.

The NHS RightCare approach is designed to support local health economies in understanding where opportunities exist for improvement, and is based on three core principles: intelligence, or using data to highlight variation and identify areas of opportunity; innovation, or working in partnership with organisations, patient groups and other programmes to test new concepts and influence policy; and implementation, or supporting health economies to embed sustainable change that improves population health.

The papers from last week’s board meeting state that early adopters of the RightCare approach proved that it delivers improvements more efficiently. This paved the way for an accelerated roll-out national level in 2016, with 65 local health economies having received support since February and the remaining 144 economies joining the programme in November.

BMA advocates greater funding for delivery of STPs

NHS organisations will need £9.5bn of capital funding to create the infrastructure necessary to successfully deliver the STPs, according to analysis published by the British Medical Association (BMA) this week. The analysis, which is based on responses to FOI requests from 37 of the 44 footprint areas, found that over half of the footprints have told NHS England they will need more than £100m of up front funding, and a handful have quoted capital needs
of more than £500m.

The BMA said that with budgets under significant pressure, NHS leaders are unlikely to have the capital required to deliver the STP projects. It warned that the annual capital allocation of £4.8bn awarded to the Department of Health from 2016/17 to 2020/21 in the latest spending review is being transferred to cover hospital deficits and will be taken up by other demands.

Commenting on the findings, Royal College of Nursing (RCN) Director of England Tom Sandford praised the aspirations of STPs, but said “the lack of any financial commitment from the Government is their Achilles heel.” He added that the RCN remains concerned that these plans “will be used to make savings, and short-term cuts to hospital beds and community services will be made without any plans for the long-term change envisaged by NHS England.”

Petition to protect children’s nursing passes 13,000 signatures

A petition on the parliament website to ‘save’ the children’s nursing degree has gained over 13,000 signatures, just a week after it was launched. Orla McAlinden, a children and young people’s nursing educator, set up the petition on 9th February in the hope of protecting children’s nursing from moves towards a more ‘generic’ model for nurse education.

The petition comes after a 2015 review of nursing education – the Shape of Caring review – recommended that students receive two years of general training, before specialising in a specific area such as children’s nursing in the third year of their degree. This pathway stands in contrast to the current model, in which students can specialise in children’s nursing from the beginning.

Ms McAlinden called on people to sign the petition, stating that “moves are afoot to make nursing a generic pathway – getting rid of children’s nursing, despite clear evidence of its worth.” She added that “our children need and deserve appropriately skilled/educated children’s nurses, not generic nurses (adult) with some limited experience and knowledge.”

As the petition has passed the 10,000 signatures mark, ministers must now publish a written response on the parliament website. If the petition goes on to gain 100,000 names, MPs may then also hold a debate on the subject, as happened recently as result of a petition on nursing pay.

Weekly political news round up – 10th February 2017

March 10, 2017 in News by Whitehouse

Overview

The struggles of the NHS have featured prominently in the media this week, after it emerged that the number of patients facing “long waits” for routine operations rose by 163% in four years. Nine in ten hospitals have also had unsafe numbers of patients on their wards this winter; and record numbers of patients have waited more than four hours in A&E. Speaking in a BBC interview at the end of the week, Health Secretary Jeremy Hunt said there is “no excuse” for some of these problems, and that it was vital to treat more people “at home and in the community” to ease the burden on hospitals. He highlighted the Sustainability and Transformation programme already under way, but conceded that this could take time.

Mr Hunt’s comments on NHS transformation arrived after the Royal College of GPs (RCGP) published its interim assessment of the GP Forward View (GPFV), which determines that STPs have not given sufficient recognition to the funds or efforts needed by general practice to implement required changes. The College states that many STPs “fail to cover the GP Forward View in any detail” despite its importance to supporting general practice and thereby delivering the intentions of the STPs. The report further highlights that “alarmingly, a number of STPs appear to plan for a reduction in the number of GPs, contrary to the vision of the [GPFV]” and calls on the Government, NHS England and STP footprint leaders to prioritise the implementation of the GPFV.

Finally, the Times reported that the Government is planning to merge the Nursing and Midwifery Council (NMC) and General Medical Council (GMC) into one “super-regulator”, as part of a major overhaul of professional regulation. A consultation on the Government’s proposed reforms is expected within the next two months.

Government planning to merge NMC and GMC

The Government is planning an overhaul of professional regulation that would see the Nursing and Midwifery Council (NMC) and General Medical Council (GMC) merged to form a super-regulator covering more than a million staff, according to a report in the Times this week. Under the current system, the NMC is one of nine regulators overseeing healthcare professionals, with each having separate standards, codes of conduct and investigatory methods. These range from the NMC, which regulates more than 600,000 nurses and midwives, to the General Chiropractic Council, which regulates just 3,000 practitioners.

Concern has been mounting that this system is confusing for patients, after a public inquiry into the neglect of hundreds of patients at the Mid Staffordshire trust found that the system was too fragmented to spot emerging scandals. The fear is that the dispersion of regulatory authority has resulted in people not knowing where to complain when they have been mistreated by health professionals.

Ministers are said to be considering a number of options to resolve this issue. Under one option, the nine regulators would merge to form one organisation, which would register all health professionals and carry out disciplinary procedures. Under an alternative option, the GMC and NMC would merge into a core regulator, while dentists’, pharmacists’ and opticians’ regulators would combine to form a “High Street health” regulator. A third body would then cover professions such as podiatrists, osteopaths and physiotherapists.

The news of the Government’s plans follows the second reading debate of the Regulation of Health and Social Care Professionals Bill. This is a Private Member’s Bill introduced by Labour Shadow Health Spokesperson Lord Hunt, who hopes to make the Government bring the legislation covering healthcare professionals together under one legislative framework. During the debate, Lord Hunt criticised the Government’s lack of action around regulation of healthcare professionals, despite previously accepting the recommendations of a Law Commission review on this subject. In response, Government Whip Baroness Goldie announced that the Government will consult on “radical reforms of professional regulation across the UK” within the next two months.

Minister answers parliamentary question on Changing Places toilet facilities

SNP MP Richard Arkless has received an answer to his written parliamentary question on the Changing Places toilet facilities. His question asked whether the Department for Communities and Local Government (DCLG) has assessed the potential merits of Changing Places toilet facilities in public places, and whether it will include requirements for such facilities in any future disability strategy.

DCLG Minister Gavin Barwell responded that the Government supports steps to increase the number of Changing Places toilets. He said that “Research into the effectiveness of the guidance which supports Building Regulations’ requirements for access for non-domestic buildings is currently being finalised”, and that this covers the provision of Changing Places toilets. He said the research will be published in due course and that the Government will consider carefully any findings relating to Changing Places toilets.

PHE pilots online space on Knowledge Hub

Public Health England (PHE) is piloting a space on knowledge-sharing website Knowledge Hub to share information about local public health knowledge and intelligence products and services. Knowledge Hub is the UK’s largest platform for public services, and will provide geographical PHE Centres with a means of helping partners to keep up to date with health intelligence in their area and take part in discussions.
PHE’s space on Knowledge Hub will feature:

  • Information about PHE’s local knowledge and intelligence service, including local health intelligence reports and analysis, newsletters and signposting guides;
  • Opportunities to participate in discussion forums and share information; and
  • Links to other PHE intelligence tools and resources

To join the Knowledge Hub, it is necessary to open an account and register with a local group.

NAO criticises lack of progress in health and social care integration

The National Audit Office (NAO) has warned that progress in health and social integration has been slower than envisaged and has not delivered all the expected benefits for patients, the NHS or local authorities. As a result, it argued that the Government’s plan for integrated health and social care services across England by 2020 is at “significant risk”.

The NAO said the Better Care Fund, the Government’s main integration tool for health and social care, had improved joint working but failed to achieve its potential as a result of increased demand for care and constrained finances. The fund had a £5.3 billion budget to encourage the NHS and councils to work more closely together, but the NAO found that it had failed to achieve the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity.

The NAO also criticised the “vanguard” sites proceeding under the Sustainability and Transformation process. It concluded that NHS England’s ambition to save £900 million through introducing seven new care models “may be optimistic”, as their impacts are still being evaluated. It noted that an array of initiatives are examining options for transforming care and creating a financially sustainable care system, but said these suffer from poor governance and oversight.

Weekly political news round up – 3rd February 2017

March 10, 2017 in News by Whitehouse

Overview

This week, the Government published its Brexit White Paper 24 hours after MPs voted in favour of the European Union (Notification of Withdrawal) Bill at Second Reading. The White Paper is based on the twelve negotiating principles which Theresa May outlined last month, and has faced criticism for not elaborating on the future rights of EU nationals living in the UK. The Second Reading of the European Union Bill contained little of relevance to the health sector, although several MPs expressed anger that leaving the EU would not generate the additional £350 million per week in funding for the NHS that was promised.
Elsewhere, MPs held a debate on nursing pay after a petition urging the Government to scrap an NHS pay cap of 1% surpassed 100,000 signatures. The Royal College of General Practitioners has also called for swift government action to ensure that GPs and their patients are protected from further practice closures and cuts to services; and Universities and Colleges Admissions Service said that degree applications for nursing have fallen by 23%.

Government publishes Brexit White Paper

The Government has published its White Paper on ‘the United Kingdom’s exit from and new partnership with the European Union’, following the acknowledgement that it would do so the previous week. The White Paper is largely constructed around the twelve points covered in the Prime Minister’s speech on the Government’s negotiating objectives for leaving the EU, given on 17th January, and has been criticised for not elaborating on details omitted from that speech, such as the future rights of EU nationals living in the UK. There was also no mention of the NHS or healthcare more widely in the White Paper, providing further uncertainty for the NHS, which relies on a significant number of EU nationals working in the UK.

The White Paper was published after the Second Reading debates of the European Union (Notification of Withdrawal) Bill on Tuesday 31st January and Wednesday 1st February. During these, a number of MPs expressed their anger that the claims perpetuated by some figures while campaigning to leave the EU – that leaving the EU would generate an additional £350 million per week in funding for the NHS – have not materialised.

Although this stage of the parliamentary vote to trigger Article 50 passed, Labour experienced substantial difficulties in achieving a unanimous party position on the vote. Despite a three-line whip being issued, 47 Labour MPs voted against the motion, including four shadow ministers who consequentially resigned and three Labour whips. The final vote following the Third Reading of the debate is due to take place next Wednesday, and Labour MPs such as the Shadow Business Secretary Clive Lewis have suggested they may resign if Labour’s amendments to the Bill are not incorporated at that stage.

MPs debate nursing pay

MPs have this week debated nursing pay in Westminster Hall, after a petition urging the Government to scrap an NHS pay cap of 1% surpassed the 100,000 signatures needed to trigger parliamentary debate. Opening the debate, Labour MP Catherine McKinnell called the impact of the pay cap “harsh”, adding that it is causing nurses to leave the profession they love. She said that while London is now short of 10,000 nurses, two fifths of nurses living in the capital plan to leave as they are unable to pay their rent.

Former Shadow Health Secretary Andy Burnham agreed with Ms McKinnell, arguing that the Government are pushing NHS staff beyond their limits. He noted that NHS nurses worked beyond their contracted hours, and said that goodwill was reaching its limit in the face of increasing demand. Several others also called on the Government to end its policy of pay restraint, including Conservative MPs Dan Poulter and Richard Fuller. Dr Poulter argued that pay rises for front-line staff of 0% or 1% are “unacceptable”.

Responding on behalf of the Government, Health Minister Philip Dunne denied that NHS nurses are
“undervalued”. He said that while NHS staff “undoubtedly deserve a cost of living increase”, the “Government must recognise that the financial and quality challenge facing the NHS is unprecedented.” He acknowledged that the pay cap is “challenging”, but said that staff had reported to him that “they want to know that the right number of staff will be working alongside them in the hospital or community setting”, and suggested that if the Government had given nurses more than the 1% annual pay rise, it could have resulted in fewer positions being available.

RCGP calls for urgent action to support frontline GPs

The Royal College of General Practitioners (RCGP) has acknowledged the progress being made to deliver the Five Year Forward View at the national level, but said that swift action is needed to ensure that GPs on the ground and their patients are protected from further practice closures and cuts to services. The RGCP’s interim assessment of the GP Forward View acknowledges that substantial progress has been made, highlighting initiatives such as a £16 million NHS GP health service launched this week for GPs to access free confidential advice, but criticises the lack of progress on issues such as practice resilience.

Of particular concern is the lack of impact of the £16 million GP resilience programme announced in July 2016, which was designed to support struggling practices that are finding it difficult to recruit, and in some cases facing closure. The report finds that although £16 million was allocated to the programme for 2016, only £2.5 million had been spent by the end of December. Now, it is urging for this underspend to be carried over into 2017. The 44 Sustainability and Transformation Plans which local areas set out last year also came in for criticism, with the report finding that many fail to mention the GP Forward View at all, while others simply refer to it in passing – and some in fact plan a reduction in the GP workforce.

RCGP Chair Professor Helen Stokes-Lampard said: “The overriding message to government and decision makers is to prioritise general practice as they push forward in shaping the NHS for the future of patient care. We are seeing progress at a national level – we need to see it at local level, we need to see it having a positive impact on the front line of patient care in the community, and we need to see it benefiting our patients.”

Nursing degree applicants fall 23%

The Universities and Colleges Admissions Service has said that degree applications for nursing have fallen 23% this year, after a bursary for nursing students was scrapped. Official UCAS figures show that applicant numbers for nursing courses across the UK fell by 20% from 54,270 in January 2016 to 43,590 in January 2017. The largest drop in applicants occurred in England – where the figure dropped by 23% – but there was also an 11% fall in those from Wales, 7% from Scotland and 4% from Northern Ireland.

Responding to the news, the Royal College of Nursing said it had warned the Government that the decision to charge fees to nursing students in England, and replace NHS bursaries with student loans from September 2017, would result in decreased applications, but that the Government had not listened.

RCN Chief Executive & General Secretary Janet Davies said: “The nursing workforce is in crisis and if fewer nurses graduate in 2020 it will exacerbate what is already an unsustainable situation.” Davies pointed out that fewer EU nurses are coming to work in the UK since the Brexit vote, and that by 2020 nearly half the workforce will be eligible for retirement. She added that “with 24,000 nursing vacancies in the UK, the Government needs to take immediate action to encourage more applicants by reinstating student funding and investing in student education”.

Weekly political news round up – 27th January 2017

March 10, 2017 in News by Whitehouse

Overview

This week, news has been dominated by the Government’s introduction of the European Union (Notification of Withdrawal) Bill to the House of Commons, which will be used to confer power on the Prime Minister to invoke Article 50 to leave the EU. The Bill has been allocated two days for its Second Reading debate on Tuesday 31st January and Wednesday 1st February, before being considered and concluded in Committee between Monday 6th February and Wednesday 8th February. The current suggestion is that the Second Reading in the House of Lords will take place on Monday 20th February, before completion of the Bill’s passage by mid-March.

The introduction of the Bill followed the Supreme Court’s decision that Parliament should give its approval before official negotiations on leaving the EU begin, dismissing the Government’s argument that this isn’t needed. The Labour leader Jeremy Corbyn will impose a three-line whip on the passage of the Bill so as “not to block Article 50”, but a number of MPs have said they will vote against it, including the former leadership contender Owen Smith. The Government will also publish a White Paper on its ambitions for negotiations, but there is not currently a commitment to publish this before the passage of the legislation.

The Health Secretary Jeremy Hunt has appeared before the Health Select Committee to give evidence on the impact of Brexit on healthcare. Health Committee Chair Dr Sarah Wollaston wrote to Hunt in December warning that leaving the EU will have major consequences for a wide range of health and social care issues, including public health, but Hunt told the Committee that his department is well prepared.

In other news, the Scottish Government has published a consultation seeking views on draft guidance on Healthcare in Schools; Labour MP Catherine West received an answer to her written question on diagnosis of chronic urinary tract infections; a survey of head teachers has shown that school budgets are in serious difficulties; and the Royal College of Paediatrics and Child has launched a report calling for Government to reverse cuts to public health.

Hunt gives evidence on impact of Brexit on healthcare

Health Secretary Jeremy Hunt appeared before the Health Select Committee this week to give evidence on the impact of Brexit on healthcare, taking questions on how the Department of Health and NHS planned to deal with this.

Responding to a question on the DH’s capacity to handle leaving the EU, Hunt said that the department has a director who is full-time on Brexit and a Brexit programme, and that the department has “done a review of every area of departmental policy to see which ones are going to be affected”. He said an estimated two-thirds of DH officials will have some involvement with Brexit policy at some levels, stating that “we are confident we have enough resources to deal with Brexit.”

Hunt also acknowledged that leaving the EU will have implications for the NHS. He said the UK will need staff from Europe in the short term but that he wants the country to become “self-sufficient” in its number of doctors. He also suggested that the benefits of increasing medical training places will not be felt until the middle of next parliament.

However, figures showing that the number of EU nurses coming to the UK has fallen 90% since the Brexit vote might cause some to question whether this increase will happen soon enough. Released after Hunt’s appearance in front of the Health Committee, the statistics from the Nursing and Midwifery Council show that the number of nurses and midwives from other European nations joining the register to work here dropped from 1,304 in July to 101 last month.

Commenting on these figures, Janet Davies, chief executive of the Royal College of Nursing, said: “With 24,000 nursing vacancies across the UK, the NHS could not cope without the contribution from EU nurses. Without a guarantee that EU nationals working in the NHS can remain, it will be much harder to retain and recruit staff from the EU, and patient care will suffer as a result.”

Answer received to written question on diagnosis of chronic urinary tract infections

Catherine West MP (Labour, Hornsey and Wood Green) has received an answer to a written question on diagnosis of chronic urinary tract infections. Ms West’s question asked how many patients have been diagnosed with chronic urinary tract infections over the last 12 months. In response, Health Minister David Mowat said that there were 196,692 finished hospital admission episodes with a primary diagnosis of urinary tract infections in England in 2015/16.

Scottish Government seeks views on Healthcare in Schools guidance

The Scottish Government has published a consultation on draft guidance on Healthcare in Schools, the purpose of which is to inform local policy development between NHS boards, education authorities, schools and other partners in supporting children and young people with healthcare needs in schools.

Chapter two of the guidance is most relevant for the PCF, as this sets out the rights and responsibilities of all concerned with healthcare in schools, including the school health team. This states that the role of the school health team is “to provide support to children, young people and their families in school and provide advice, guidance and sometimes support on supporting healthcare needs in school.” These functions will be provided by a team of staff employed by the NHS board working collaboratively with the education authority within schools and communities, and (among others) may include healthcare support workers, community children’s nurses, and other registered nurses working within schools.

Chapter 5 of the guidance is also states that “staff in schools and the wider school health team must make reasonable adjustments to ensure that children and young people with healthcare needs are enabled to participate in the opportunities that learning provides.” This includes school trips, sporting activities and work placements.

School budgets near “breaking point”, survey warns

A survey of more than 1,000 schools by the National Association of Head Teachers (NAHT) shows that two-thirds of schools are making ‘significant’ cuts or dipping into reserves to stave off deficits, with four in five school leaders stating that budget cuts would have a negative impact on standards. The Government said it had protected the core schools budget in real terms, but the NAHT’s Breaking Point survey for 2016-17 shows that the number of schools in deficit has risen to 18% – up from 8% in 2015. The findings show that 71% of head teachers balance budgets by making cuts or using reserves; 72% fear budgets will be unsustainable by 2019; and 85% save money by spending less on new equipment.

Heads indicated that the main cost pressures are policy changes, including the decline in local authority services and the abolition of a central government grant which allows councils to support schools supporting greater numbers of pupils with mental health issues. NAHT general secretary Russel Hobby said the funding schools receive is not keeping up with the expenditure they face. Citing a 2015 Institute for Fiscal Studies report, he said the Government’s funding commitment equates to the first real terms cut in education spending since the 1990s. The Shadow Education Secretary Angela Rayner argued that it was wrong to impose a choice on schools between whether to cut school staff or invest in new equipment on head teachers.

Dr Geraldine Walters gives interview on new NMC standards

Dr Geraldine Walters, the Nursing and Midwifery Council’s (NMC) director of nursing and midwifery education, standards and policy, has given an interview to the Nursing Times on the NMC’s revised pre-registration nurse training standards. The standards are currently being developed to better reflect requirements placed on nurses, having last been updated in 2010, in a review led by Professor Dame Jill Macleod-Clark which will consult nurses in the spring. Dr Walters said that the updated standards need to provide clarity on the “exact set of clinical skills and tasks newly qualified nurses should be able to do”.

Dr Walters also highlighted that due to changes to the skill mix of healthcare professionals – which will soon grow to include nursing associates – students need to be better prepared to deliver more care in the community. She said that the NMC is considering incorporating some of the components of the specialist community public health nursing training, given to health visitors and school nurses, into pre-registration education. Beyond this, the updated standards are expected to focus on mentoring requirements and the potential for defining a standard set of clinical tasks necessary for all students to do by the end of their training.

RCPCH: cuts to public health budgets disproportionately affect children’s services

The Royal College of Paediatrics and Child Health (RCPCH) has published a report warning that cuts to public health budgets in England are disproportionately affecting children’s services and putting early intervention at risk.

The College’s annual “State of Child Health” report stated that there have been improvements in child health in recent decades, but indicated that the UK still lags behind much of Europe in areas such as infant mortality, smoking during pregnancy and breastfeeding rates. The report called on the UK Government should develop a child health and wellbeing strategy, adopt a ‘child health in all policies’ approach, and reverse public health cuts to address this.

The report attached particular importance to school nurses, stating that “school nurses play a vital role in early identification and intervention, preventing more serious problems later in life” – and that “these services must be preserved”.