Weekly political news round up – 26th May 2017

May 26, 2017 in News by Whitehouse

Overview

This week, a YouGov poll conducted after the Conservatives’ social care policy was announced suggested that the party’s lead over Labour has narrowed to 5%, giving Labour its highest polling rating since October 2014. Although this is only one poll at the moment, it has attracted significant coverage – particularly as if the swing was replicated nationally, it could result in Theresa May’s majority being reduced from 17 to two. A YouGov poll on voting intentions in Wales has also indicated a 16 point swing towards Labour, putting the party on 44%, when previously the Conservatives had been 10 points ahead.

A decision by NHS Improvement to delay the publication of  figures on the NHS’s financial deficit from 25th May until after the election has been criticised by opposition figures. While NHS Improvement stated unable to published the figures without breaching Cabinet Office purdah rules, the Shadow Health Secretary Jon Ashworth painted the decision as a “cover up to deny the public the true picture of the NHS.” Former health minister Norman Lamb also warned that “the public deserves to know the scale of the financial crisis facing the NHS before they vote.” Calculations published in HSJ suggest that the deficit could be £770 million, although it has been suggested it could actually be higher due to accountancy measures altering the figures.

A poll by the Health Foundation has indicated that a majority of people in the UK would support tax increases to fund the NHS, with 64% of 1,985 agreeing with the suggestion. 88% of people also agreed that the NHS should be protected from funding cuts, while 17% suggested spending should be reduced on other services to pay for the NHS. The Health Foundation labelled these figures “striking”, but highlighted that half of respondents also believe there is waste in the NHS, indicating that efficiencies should still be sought.

Conservatives announce cap on social care costs

Theresa May has announced at a press conference in Wales that the Conservatives’ policy on social care funding will include an “absolute limit” on the amount people will have to pay towards their care, representing a reversal on what was pledged in their manifesto last week. The manifesto had stipulated that its proposals on social care funding were “more equitable, within and across the generations, than the proposals following the Dilnot Report, which mostly benefitted a small number of wealthier people.”

While the Prime Minister defended the proposals during her speech, she said that a cap on care costs will be introduced to “make sure there’s an absolute limit of what people need to pay.” She did not state what the cap on costs would be, saying it would be included in the social care green paper. The previous government had proposed a cap of £72,000, but this was delayed indefinitely due to the inability of local authorities to afford it.

Reacting to the policy change, former deputy Prime Minister Nick Clegg criticised the Conservatives for failing to prove certainty to families on how much they would have to pay towards their care. Analysis conducted by the Resolution Foundation suggested that clarifying that there would be a cap on costs was the right decisions, as “protecting people from excessive financial risks that markets can’t manage to insure against is, after all, one of government’s primary functions.”

Nursing and Midwifery Council agrees to consult on draft nurse education standards

The Nursing and Midwifery Council (NMC) has decided to consult on its draft future nurse standards and education framework at a meeting in Cardiff in this week, after publishing the draft standards on its website. The draft standards also include wider proposals on adopting the Royal Pharmaceutical Society’s single competency framework as the NMC’s standards for proficiency for nurse and midwife prescribers. As such, the NMC will host two consultations on the draft standards, with the consultation on elements relating to continence expected in mid-June.

The elements of the document which relate to continence are outcome 4.4 (p. 24), which states that a registered nurse should “demonstrate the knowledge, skills and ability to act as a role model to meet people’s needs related to nutrition, hydration and elimination, using evidence based nursing care (Annexe B).” Annexe B then lists the following as procedures for the planning, provision and management of evidence based nursing care (p. 36):

Meeting needs for care and support with elimination

  •  observe and assess level of urinary and bowel continence to determine the need for support, intervention, level of independence and the level of independence and self-management of care that an individual can potentially have
  • assist with toileting, maintaining dignity and privacy and managing the use of appropriate aids including pans, bottles and commodes
  • select and use appropriate continence products including pads, sheaths and appliances
  • insert, manage and remove catheters for all genders and assist with self-catheterisation when required *AH,*CH
  • manage bladder drainage
  • assess elimination patterns to identify constipation, diarrhoea and urinary and faecal retention
  • administer enemas, suppositories and undertake rectal examination and manual evacuation when appropriate
  • undertake stoma care and use best practice techniques and products

Norfolk to dual train school nurses and health visitors

Cambridgeshire Community Services NHS Trust, which provides school nurses and health visitors in Norfolk, has decided to provide members of each set of the workforce with additional training to ensure demand for services is met. The trust ascertained that health visitors were addressing the needs of children aged 0-5 and school nurses were primarily working with teenagers, resulting in 5-11 year olds not having their needs met in a “robust” manner. These problems were more acute among children with special educational needs and disabilities.

Subsequently, ten public health nurses with more than two years of experience will undertake dual training over the summer, and will start to work with primary schools which are thought to have pupils with “high needs” in September. The training will focus on preventing mental health problems among teenagers by ensuring that children receive support at an earlier stage. Andrea Graves, clinical lead for Norfolk’s children and young people’s services, said the training “is about early intervention and about supporting those families before they become teenagers and get to a crisis point.”

NHS Right Care estimates £7 million savings for CCG

West Kent CCG has estimated that it could make savings of £7.2 million by making efficiencies identified by NHS Right Care, a programme to target areas of clinical variation for CCGs. The CCG has stated it could make savings by 2019 by targeting five priority areas: frailty; prescribing; musculoskeletal; urgent care; and local care, including mental health. NHS Right Care initially identified £17.6 million of “value opportunities” for the CCG, and it is unclear why the remaining £10 million are not being taken forward.

The CCG has also specified that investment in new care models will be needed for the savings to materialise, and has already consulted and piloted redesigned GP care pathways. The CCG said that addressing patients’ needs “at the right time for optimal impact of care will enable a more responsive service and should improve access”, and will focus on integrated community pathways, reducing unplanned admissions and reducing variation in primary care prescribing.

Number of EU nurses leaving NHS increases by a third

The number of EU nurses who left the NHS in 2016 increased by 38% on the previous year, prompting further concerns of a Brexit-driven workforce shortage. 3,480 EU nurses left the NHS during 2016, accounting for approximately a third of the 9,023 EU staff which left the NHS over the year. 2,396 EU doctors which left. Dame Professor Donna Kinnair, director nursing, policy and practice at the Royal College of Nursing, highlighted that “People will leave if they don’t feel welcome; they don’t know what the outcome of the negotiations will be. We are losing time and the government needs to make this a priority.”

Number of EU nurses leaving NHS increases by a third

The number of EU nurses who left the NHS in 2016 increased by 38% on the previous year, prompting further concerns of a Brexit-driven workforce shortage. 3,480 EU nurses left the NHS during 2016, accounting for approximately a third of the 9,023 EU staff which left the NHS over the year. 2,396 EU doctors which left. Dame Professor Donna Kinnair, director nursing, policy and practice at the Royal College of Nursing, highlighted that “People will leave if they don’t feel welcome; they don’t know what the outcome of the negotiations will be. We are losing time and the government needs to make this a priority.”

Weekly political news round up – 19th May 2017

May 26, 2017 in News by Whitehouse

Overview

This week, the Royal College of Paediatrics and Child Health (RCPCH) warned that a majority of STPs fail to consider health and wellbeing needs among children and young people. Published on Tuesday, the RCPCH report – Sustainability and Transformation Partnerships, part of a short series of reports on child health – has reviewed the 44 published STP plans and exposes severe shortcomings in their approach to children’s and young people’s health. In response, the RCPCH proposes several recommendations moving forward, including ensuring that all STPs “develop, implement and evaluate a strategic plan which meets the needs of infants, children and young people within their respective geographical footprints.”

In other news, the Early Intervention Foundation (EIF), which works to promote research on early intervention for children and young people, has named Dr Jo Casebourne as its new chief executive. Dr Casebourne will replace Carey Oppenheim in August 2017, and joins the EIF from the Institute of Government, where she has led the institute’s work on development and public services.

General election: sector reactions & manifesto speculation

Party leaders address Royal College of Nursing annual conference

The Liberal Democrats have pledged in an address to the RCN’s annual conference – made prior to their manifesto publication – that they would lift the 1% cap on public sector pay and thus end pay restraint for nurses if elected into power on 8th June. The party’s election pledge comes shortly after the Royal College of Nursing (RCN) threatened to consider striking unless the next Government removes the pay cap.

According to the Liberal Democrats’ own estimates, lifting the pay cap and up-rating wages in line with inflation would result in an average salary increase of £527 a year for nurses by 2021. The party’s own analysis also indicates that a newly hired nurse will be £530 a year worse off by 2021 if the cap remains in place, due to rising inflation.

In addition to promising a nursing pay rise, Tim Farron told the RCN’s conference that his party will reinstate student nurse’s bursaries and invest more funds in the NHS. Commenting on the current government’s policy towards the NHS, Mr Farron said he has had enough of the “Conservative Government treating nurses like dirt.” Commenting on the policy, the Liberal Democrats’ financial spokesman Vince Cable said that public sector workers were facing “pitiful increases to pay combined with a Brexit squeeze caused by soaring inflation”.

Despite an invitation, the RCN’s conference was not addressed by a representative from the Conservatives, which the college’s chief executive Janet Davies said left delegates “disappointed, saddened and disrespected”. The RCN subsequently wrote to Theresa May’s office to express their disappointment that she did not address the conference, stating that the nurses present “were keen to hear from the Prime Minister personally” about her plans for the nursing workforce.

Labour’s manifesto launched

Labour formally launched its general election manifesto in Bradford on Tuesday, following a leak of the draft manifesto last week. The party’s spending commitments, detailed in a separate document, total £48.6 billion, which would be funded through a range of additional taxation measures including raising corporation tax to 26% by 2022. Building on the party’s commitment to rule out rises in income tax for those earning below £80,000, the manifesto confirms that Labour would lower the threshold for the 45p additional rate to £80,000 and reintroduce the 50p tax rate for those earning above £123,000, which it predicts would raise £6.4 billion per year.

The health and education policy commitments in the manifesto largely replicate the contents of last week’s draft, although there is one additional commitment to scrap hospital car parking charges. Labour stated that if elected to government, it would:

  • Focus resources on providing care closer to home, including working towards a new model of community care and increasing funding for GP services “to ensure patients can access the care they need”.
  • Offer guarantees for the rights of EU workers in the health and social care sector.
  • Boost capital funding for the NHS, as part of a £30bn commitment in extra funding over the next parliament, “to ensure that patients are cared for in buildings and using equipment that are fit for the 21st century”.
  • Introduce an Office for Budget Responsibility for Health, to scrutinise spending of the health budget, and a new “safety and excellence regulators”
  • Halt and review the STP progress, with local stakeholders included in a re-draft. The party does not pledge to scrap the plans entirely.
  • Create a new index of child health to measure the wellbeing of UK children against international standards – this will include measures of obesity and dental health, alongside mental health and the general health of under-fives. This policy would be supported by £250 million of additional funding, which would also look to increase the number of school nurses and health visitors.
  • Spend an additional £6.3 billion on schools per year by 2021/22. This will encompass a general increase in funding, protection for schools against losses from the new funding formula, free school meals and an arts pupil premium. With the exception of free school meals, this will be paid for through a rise in corporation tax.
  • Implement a “SEND strategy based on inclusivity, and embed SEND more substantially into initial teacher training so that staff, children and their parents are properly supported.”

The healthcare policy commitments are costed at £5 billion per year, including free hospital car parking but excluding higher pay for NHS staff and capital expenditure, while schools’ spending would cost £6.3 billion.

Liberal Democrat manifesto launched

The Liberal Democrat manifesto was also published on Wednesday. As expected, the manifesto set out the Lib Dems as the pro-EU alternative to the Conservatives or Labour, promising to hold a second referendum on the Brexit terms agreed at the end of the Government’s negotiation timetable, with the alternative being to remain in the EU. Beyond a decision to increase all bands of income tax by 1p in the pound to fund health and social care – which would raising approximately £6 billion – and reversing cuts to Corporation Tax and Capital Gains Tax, the manifesto does not look to increase taxation or change income tax bands.

The Lib Dems’ pronouncements on health policy were more detailed than Labour’s, and suggested a greater degree of engagement with stakeholders’ proposals than that seen in Labour’s manifesto. The party pledged that it would:

  • Increase all bands of income tax by 1p in the pound, with the £6 billion generated ringfenced to spend on health and social care. This would eventually be replaced by a dedicated health and care tax, calculated following consultation and potentially from reforming National Insurance contributions.
  • Direct additional investment to “social care, primary care (and other out-of-hospital care), mental health and public health”, as this would be most efficient and effective.
  • Integrate NHS and social care into one service, with the aim of “pooling budgets in every area by 2020 and developing integrated care organisations”. Without referencing the STP process, the manifesto highlights the need to allow local areas to decide how to allocate funds and provide care in their community.
  • Create a cross-party health and social care convention – as the party was campaigning for, along with notable health figures such as Sarah Wollaston, before the election – which would review the long-term sustainability of health and social care finances and workforce.
  • Introduce a statutory independent budget monitoring agency for health and social care, similar to that recommended by the House of Lords’ report on the long-term sustainability of the NHS and echoed in Labour’s manifesto.
  • On education, the Lib Dems would increase spending on schools by almost £7 billion over the next five years to protect per-pupil funding in real terms, and ensure that no school loses out under the national funding formula.
  • Endeavour to identify and support special educational needs and disabilities as soon as possible, accompanied by assessing all new policies for how they impact pupils with SEND.
  • The party would delegate responsibility to local authorities for “local school places planning and repeal the rule that all new state-funded schools must be free schools or academies”.

Conservative manifesto launched

The Conservatives have launched their general election manifesto at an event in Halifax, after trailing several of its key policies in the media overnight. The manifesto sets out “five giant challenges” for government in the long-term: the need for a strong economy; Brexit and a changing world; enduring social divisions; an ageing society; and fast-changing technology.

The most reported announcement from the manifesto was a policy requiring elderly people with assets of more than £100,000, including their home, to pay for their social care. The charge will be enforced regardless of whether people receive care in their home or in a nursing home, which is a change from existing policy which only includes people’s homes as an asset if they are in residential care, and increases the threshold of assets for anyone paying for their care from £23,250. The policy looks to address growing pressures in the social care sector which have had indirect impacts on the NHS – but Sir Andrew Dilnot, who carried out the coalition’s review of social care funding which proposed a cap on care costs, has criticised the policy as removing choice from people in how they pay for their care. The Conservatives made the following policy pledges:

  • A pledge to increase NHS spending by a minimum of £8 billion in real terms by 2022 – however, it should be noted that this does not allocate substantially more funding than that agreed at the 2015 Comprehensive Spending Review. The funding agreement for the NHS remains essentially the same, with the period that it covers extended, and with marginally more fundingan additional £230 million allocated to the revenue budget for 2018/19 to ensure that funding is still increased during that financial year.
  • Supporting the implementation of Sustainability and Transformation Plans, “providing they are clinically led and locally supported”, but acquiescing on the need for legislation if existing legislation is “either slowing implementation or preventing clear national or local accountability”. This effectively commits the Conservatives to legislation reversing many of the provisions of the Health and Social Care Act 2012.
  • Prioritising healthcare professionals from the EU during Brexit negotiations, but increasing the number of UK students in medical training with the intent of reducing this reliance over time.
  • A commitment to extend seven-day GP access across England by 2019, and expanding the use of phone and online consultations.
  • The document reiterates a previous commitment to publishing a green paper on young people’s mental health before the end of the year, and all primary and secondary school teachers will be able to access mental health first aid training by the end of the next parliament.

Responding to criticism of the new schools funding formula, the Conservatives would increase the overall schools budget by £4 billion by 2022 to ensure that no school experiences cuts under the new formula. This will be funded through removing eligibility for free school lunches for all children in the first three years of school, replacing it with a pledge for all primary school children to receive free school breakfasts.

Public Health (Wales) Bill passed through Welsh Assembly

The Public Health (Wales) Bill this week passed through Stage 4 of the legislative process in the Welsh Assembly. The Bill has now entered a four-week intimation period, during which the Counsel General or Attorney General could challenge its legality – however as this almost never happens, the bill is likely to be given royal assent and become law after this four-week period.

The Bill requires local authorities to put in place local toilet strategies across Wales, with each local authority required to prepare and publish a local toilets strategy within one year of when this section of the Bill comes into force. The strategy must include an assessment of the need for toilets in the local authority’s area to be available for use by the public; a statement setting out the steps which the local authority proposes to take to meet that need; and any other information which the local authority considers appropriate.

Local authorities will also have to consult any person it considers is likely to be interested in the provision of toilets in its area that are available for use by the public before it publishes its local toilets strategy.

RCN report highlights decline of school nurse and health visitor numbers

The Royal College of Nursing (RCN) has published a new report – The Best Start: The Future of Children’s Health – which warns that dropping numbers of health visitors and school nurses, together with cuts to public health funding, are “putting children’s health at risk”.

Amongst its key findings, the report records that there has been a decrease of over 1,000 health visitors since 2015, alongside a 16% drop in the number of full-time school nurses between 2010 and 2017. The report depicts a complex picture of workforce changes regionally, resulting from the recommissioning of services by local authorities to a range of providers, and skill mix changes. As some services have moved to providers outside of the NHS, the authors suggest that it has become more difficult to track workforce developments, which in turn hampers effective planning.

The report also suggests that planned reductions in public health funding for 2016-17 fell most heavily on services aimed at improving children and young people’s health, representing 14% of total cuts. There are also variations across England on whether families have access to the mandated universal health visiting service, with children in London the least likely to receive the required number of health visits. The document expresses concern about the increasing workloads for health visitors – with 72% of those responding to in an Institute for Health Visiting survey being concerned about providing inadequate safeguarding and child protection support. Statistics also suggest that school nurses are overstretched, with 29% of respondents to a National Children’s Bureau survey stating they worked across 13 or more schools.

Commenting on the RCN report, the RCN Chief Executive & General Secretary, Janet Davies, said: “There’s a wealth of evidence that ill health in childhood can have a detrimental impact in adulthood. If these cuts continue, we’re heading for more health problems, more inequality and even more pressure on our public services down the line.”

RCN poll shows appetite for pay action

According to a recent poll conducted by Royal College of Nurses (RCN), a majority (78%) of RCN members are prepared to go on strike, and 91% say they will support industrial action short of a strike unless the next government scraps a 1% pay-rise cap. The news came shortly after the RCN argued that the NHS in England lacks as many as 40,000 nurses to fill currently vacant posts. In addition, the union said that the 1% cap on pay rises has meant a real-term pay cut since 2010 of 14%.

The Chair of the RCN Council, Michael Brown, said that “Getting 52,000 NHS members taking part shows the strength of feeling about pay restraint – and the percentage in favour of taking action cannot be ignored.” Mr Brown continued by proposing an emergency resolution calling for a summer of planned protest activity, followed by an industrial action ballot, if the next Government fails to lift the policy of an NHS pay cap.

Chief executive of The King’s Fund warns NHS should embrace STP changes

The chief executive of The King’s Fund, Chris Ham, has urged politicians to back changes to local NHS provision proposed in Sustainability and Transformation Plans (STPs) in order to make health services better and more efficient. Mr Ham’s statement comes in the wake of both individual MPs and political parties promising to halt local A&E unit closures in order to secure votes on 8th June, with Labour going as far as promising to halt and review plans if elected.

In an interview with the Guardian, Mr Ham emphasised that politicians on all sides of the political spectrum should back STPs, particularly those elements looking to centralise urgent and specialist care. Speaking out on the issue, Mr Ham said: “With services like A&E and maternity care, we do not have enough doctors and nurses to be able to offer everything everywhere. This may mean some A&E departments becoming minor injury units and some maternity units needing to be staffed by midwives rather than doctors.”

Every Welsh child to have access to recognised nurse throughout their school education

The Welsh Health Secretary Vaughan Gething AM has announced that every child in Wales will have access to an “identified school nurse and associated health team with a variety of skills”, as part of the new School Nursing Framework being implemented across the country. The school nurses will have responsibility for a secondary school and their cluster primaries, and will be accessible to children outside term time following concerns that some schools only employed nurses during term time.

The nurses will be able to advise students on a number of issues, including physical health; promotion of emotional wellbeing; delivery of national screening and immunisation programmes; safeguarding; early identification and assessment of pupils’ needs; and additional support or signposting to local services for children and young people identified as having additional needs.

The Education Secretary Kirsty Williams AM commented on the announcement, stating that “We want to ensure pupils are aware of what school nurses can do for them and how to find them, to make it easier for children to use the school nursing service and get good advice on their health.”

Weekly political news round up – 12th May 2017

May 26, 2017 in News by Whitehouse

Overview

This week, the Royal College of General Practitioners (RCGP) Wales has warned that patient care must not be forgotten during the election as a result of an overwhelming focus on Brexit. The warning was issued after the RCGP published its general election manifesto last week, which proposed six measures to promote safer general practice. In its warning this week, RCGP Wales urged all politicians to commit to investing more funds for general practice; to boost the GP workforce; and to make sure GPs have the time they need to focus on patient care.

General election: sector reactions & manifesto speculation

Draft Labour manifesto leaked

A draft copy of the Labour manifesto – originally due to be launched next week – was leaked on Wednesday evening prior to being formally approved by Labour’s National Executive Committee and shadow cabinet on Thursday afternoon. Several of the policies have been widely trailed during Labour’s election campaigning, but the manifesto also contains some new proposals. The key headlines for the PCF are:

  • Labour would establish a £250 million Children’s Health Fund to support their child health ambitions, and increase the number of health visitors and school nurses.
  • Labour would implement a “SEND strategy based on inclusivity, and embed SEND more
    substantially into initial teacher training so that staff, children and their parents are properly
    supported.”
  • More than £6 billion in additional funding per year would be allocated to the NHS through
    increasing income tax for the top 5% of earners, raising tax on private medical insurance and
    “halving the fees paid to management consultants.” This would be alongside £8 billion for
    social care over the course of the next Parliament.
  • As already announced, Labour would halt the Sustainability and Transformation Partnership
    process and task local health groups with redrawing them “with a focus on patient need rather
    than available finances”. The manifesto elaborates slightly on the proposed role of a new body,
    NHS Excellence, which would be a “quality, safety and excellence regulator”.
  • Labour would also repeal the Health and Social Care Act and reinstate the Health Secretary’s
    ultimate responsibility for the NHS, as well as a new legal duty on the Secretary of State and
    NHS England.
  • The manifesto says Labour would increase funding for GP services – without stating how
    much, or referencing the GP Forward View – and create a “new model of community care
    which takes into account not only primary care but social care and mental health as well”,
    focused on delivering care closer to home.
  • Labour do not explicitly promise to reverse regional discrepancies resulting from the new
    schools funding formula, instead only promising to allocate “transitional relief to schools set to
    lose out under the new funding formula” and reversing Conservative cuts to education budgets.

In addition, the draft manifesto upholds Labour’s pledges to not increase income tax or National
Insurance contributions for those earning below £80,000 a year, or VAT. Labour would also intend to
eliminate the existing budget deficit within five years.

Labour makes child health policy announcement

Prior to the party’s manifesto being leaked, Labour announced that if it wins on 8th June, it will implement a new health programme to improve health and wellbeing amongst British children, supported by a Child Health Bill. The policy received positive feedback from the Royal College of Paediatrics and Child Health (RCPCH), which urged all parties to focus their attention on improving child health in the UK.

Labour’s child health policy will seek to boost the numbers of school nurses and health visitors, to overcome health inequalities and to provide adequate healthcare for children regardless of socioeconomic background. In sum, Labour’s new child health policy would:

  • Introduce a new Child Health Index, to measure progress on obesity, dental health, under-fives
    and mental health against international standards.
  • Legally require all Government departments to have a child health strategy.
  • Boost the numbers of school nurses and health visitors, to give all children help with
    healthcare.
  • Create a £250 million annual child health fund to support the strategy, by halving the annual
    £538 million cost of management consultancy in the NHS.
  • Provide extra funding for Child and Adolescent Mental Health Services, with counselling in
    every school.
  • End government cuts to public health budgets – £200 million in 2015-16 – by ring-fencing
    them.

Additionally, fighting childhood obesity would be central to the policy. According to shadow health secretary, Jonathan Ashworth, the party would seek to decrease childhood obesity by 50% within ten years and make the UK “the healthiest country in the world to grow up in.” Labour would also release a new childhood obesity strategy within the first 100 days, which will ban junk food advertising from being aired on TV before 9pm.

Commenting on Labour’s announcement, Professor Neena Modi, President of the RCPCH, welcomed the strategy and its attention to child health. Professor Modi said that the proposals “[put] down a marker and signal a clear commitment to improving the health of the nation by focusing on getting it right for children. We hope all parties will show vision and insight in giving child health, and so too the health of the population, the attention it deserves.”

Health Foundation publishes election briefing

The Health Foundation has published two briefings before the General Election on 8th June, analysing the state of NHS and social care financing, and the quality of care provided by the NHS. The key points of the first briefing, which focuses specifically on the finances of the health and social care system, are:

  • Social care needs immediate attention from an incoming government. Despite the extra money
    allocated to social care in the spring budget, the current system is severely under-funded
    and unaffordable for people on low incomes who are ineligible for free care.
  • Funding for the NHS in England needs to increase in the next two years to protect access to
    care and the quality of services for patients.
  • Beyond 2020, the pace of funding growth for the NHS and social care system will need to
    accelerate, taking a greater share of GDP.
  • An independent financial body for the NHS should be established, similar to the Office
    for Budget Responsibility, to lay out the long-term financial outlook for health and social care,
    as recommended by the House of Lords’ committee on sustainability.

The key findings from the Quality of Care briefing were:

  • That waiting times for many urgent and emergency services are at their worst in five years, but
    there is little evidence that quality of care is deteriorating.
  • Standards on cancer and ambulance care waiting times are also decreasing, with the
    proportion of people with suspected cancer waiting less than 62 days between referral and
    treatment having increased by around 5% over the past four years.
  • While quality of care is harder to measure, clear improvements have been made for people
    with stroke, and bowel cancer. Progress against quality standards for people with diabetes
    and suffering from heart attacks has levelled off over the past couple of years.
  • Mental health services – particularly for children – are struggling to meet demand, despite the
    fact that 430,000 people in England completed psychological therapies for conditions such as depression in the first nine months of 2016/17: almost double the number from the same period
    five years ago.

Commenting on the report on healthcare finances, Director of Research and Economics at the Health Foundation, Anita Charlesworth, said: “Government funding plans are not keeping pace with demand and cost, and, as a result, these vital services are showing increasing signs of serious strain.” On quality of care, senior policy fellow Tim Gardner said that “while international comparisons also show… recognised improvements in the quality of care for heart attack and stroke… the NHS is still lagging behind comparable countries on patient outcomes.”

The Foundation will produce a third and final pre-election briefing – on NHS and social care staffing –
shortly.

Liberal Democrats pledge to raise taxes to fund NHS

The Liberal Democrats have pledged they will raise income tax to help fund the NHS and social care if elected on 8th June. According to their own estimates, a raise of one pence on every pound on all income tax bands and on company dividends will raise around £6 billion per year for the NHS and social care. The party suggested this would cost an average of £3 a week and would equate to someone earning £15,000 paying an extra £33 per year, while someone earning £50,000 would pay £383 more.

The pledge of a 1p income tax rise to fund health is a replication of one of the Liberal Democrats policies introduced in the 1990s, which was launched to generate funding towards education. Party leader Tim Farron said that the party is now looking to be “honest with people and say that we will all need to chip in a little more” to pay for health and social care.

Labour and Liberal Democrats announce education funding policies

On Wednesday, Labour and the Liberal Democrats both announced they will allocate multibillion pound funding for schools if either are elected. While the Labour Party claimed it would halt cuts to education through a £20 billion investment in English schools by 2020, the Liberal Democrats pledged they would invest £7 billion over the same time period to “reverse crippling Conservative cuts to school budgets”.

The announcements came in the same week that the Institute of Fiscal Studies stated that protecting schools from real-terms funding cuts would entail raising an extra penny on the basic rate of income tax, equivalent to £3.7 billion. IFS Programme Director Luke Sibieta suggested that this figure would be broken down into £2 billion to protect per pupil spending and £1.7 billion to cover other costs incurred by schools.

Simon Stevens says Five Year Forward View priorities are essential for future of NHS

The Chief of NHS England, Simon Stevens, has reconfirmed his view that the Five Year Forward View, originally published in October 2014 by NHS England, is key for the NHS to provide better social and mental health services. While also confirming his support for the next steps for the Five Year Forward View plan published in March, Mr Stevens said that the five year plan for the NHS will be needed regardless of which party wins the election. Commenting on the forthcoming election, Mr Stevens said that while the NHS will be led by the next government, ”it is pretty clear that the core operational priorities that the NHS set out in the next steps document are the right things for us to be working on over the year ahead.”

Mr Stevens also said that the NHS Confederation conference in June will be used to announce additional measures from the NHS to further change in the operation of the NHS over the coming years. Speaking specifically about primary care, Mr Stevens said: “NHS England will set out practical things on primary care that we now want to see layered in every part of the country in the next 24 months.” He later also added that the NHS will release further opinions on how STP leaders should implement the Five Year Forward View at the local level.

Weekly political news round up – 5th May 2017

May 26, 2017 in News by Whitehouse

Overview

This week, the Nursing Times has published an article shedding light on sectoral responses to last week’s Health Committee report on government preparations for Brexit. Nursing and Midwife Council Chief Executive, Jackie Smith, welcomed the report and said the regulator believed it was “essential” that any changes made to the registration process for EU nurses “come as part of the UK’s Brexit negotiations and not separately”. Likewise, Janet Davies, Chief Executive of the Royal College of Nursing, argued the report “leaves the government with no place left to turn” and that “Patient safety and the supply of nurses must not be adversely affected by Brexit.”

General election: sector reactions & manifesto speculation

BMA publishes election manifesto

On Tuesday, the British Medical Association (BMA) released its general election manifesto – A Vote for Health – calling on all politicians and parties to “outline credible and sustainable plans to safeguard the future of the NHS.” In the face of an ongoing crisis of the NHS, the BMA has previously said it is vital that the 2017 general election does not turn into a ‘Brexit election’.

The BMA’s manifesto covers five demands:

  • Brexit – act now to provide certainty to NHS staff from EU countries
  • Public health – tackle the ongoing crisis
  • NHS funding – match or exceed health funding of leading European economies
  • General practice – deliver on commitment to stabilise the profession
  • NHS pressures – address the pressures with immediate investment

Commenting on the manifesto, the BMA council chair Mark Porter said: “Our NHS is at breaking point
and it would be all too easy for this election to become the “Brexit election” and little else, at precisely
the time when the health service needs the unrelenting focus of politicians from all parties”. He added
that the next government needs to ensure that NHS funding is equivalent to that of other European
nations, and that EU health professionals are “protected from the impact of Brexit”.

Labour would freeze STP process if elected

Labour has announced that it will suspend the NHS’s Sustainability and Transformation Plan (STP)
process if it wins the election on 8th June. According to shadow health secretary Jonathan Ashworth,
Labour will create a new body – NHS Excellence – which would lead a new review into the
reorganisation of the NHS, placing local communities at the heart of any decisions. The pledge
effectively commits Labour to resisting all hospital closures proposed by the plans so far, which could
affect A&E, maternity and paediatric units.

Commenting on Labour’s new election manifesto pledge, Jonathan Ashworth said Labour has “listened
to the hundreds of patients and campaigners up and down the country that have been pleading with
the government to hear their concerns about their local services.” Health Secretary Jeremy Hunt has
responded to Ashworth, calling Labour’s proposal a “nonsensical Jeremy Corbyn idea” and said that
Labour had backed the plans in its last manifesto.

The RCP publishes four-point election plan

The Royal College of Physicians (RCP) has published a four-point election plan which puts patients
“firmly at the centre of Brexit negotiations”. The plan outlines four key calls for the next government:

1. Place patient care at the centre of Brexit negotiations.
2. Invest in, support and value the NHS workforce.
3. Deliver a new financial settlement for the NHS and social care.
4. Support people to live healthier lives by investing in public health.

Commenting on the plan, RCP’s president Professor Jane Dacre said: “With each new government
comes a new opportunity to ensure that the NHS has the resources, people and services it needs to
provide the care that our patients deserve. Patients must be at the centre of decisions made on
healthcare provision, and that includes serious consideration of the implications of Brexit on patient
care.”

RCPCH releases “A vision for 2017”

This week, the Royal College of Pediatrics and Child Health (RCPCH) has published their manifesto for the election, “Child health matters: A vision for 2017”, which urges all parties to put child health care at the centre of the general election. According to the vision, the new government can promote the RCPCH’s aim to improve child health and wellbeing by:

  • Recognising that policies that improve child health and wellbeing represent investment that will result in significant economic return;
  • Recognising the wider determinants of health and wellbeing;
  • Enacting policies that ensure all infants, children and young people have the best start in life;
  • Protecting and modernising health services to meet the needs of infants, children, young people and their families;
  • Making a commitment to well-resourced universal public health services, covering antenatal services, health visiting and school nursing.

Public Accounts Committee labels Department of Health as number one concern

The Chair of the Public Accounts Committee, Meg Hillier, has published her second annual report on the Committee’s work, arguing that the Department of Health stands out as an issue of concern for the next Parliament. The finances of the Department of Health stand at the centre of the report, over which Hillier states her “serious concerns”. According to Hillier, the Department’s timing of releasing its accounts to the House of Commons last year showed it wished “to avoid scrutiny and to hide the true extent of the Department’s financial woes.” She added: “We remain concerned about this year’s accounts which will be laid when Parliament returns after the General Election.”

Commenting on STPs, Hillier argued that STPs are at risk of being seen as a cover for cuts, even where good quality, modern, patient-focused services are being planned and that the lack of transparency throughout the creation process is one reason for this. The report concludes that “there is room for change and improvement in many areas of the NHS but the handling of the finances and the increasing pressures of a growing population mean that its focus is on finance rather than effectiveness. Honesty and clarity over NHS funding is a fundamental before there can be serious change.”

Conservatives make significant gains in local elections

The results of the local government and mayoral elections held across the UK on 4th May have started to emerge, with 4,851 council seats being contested across 88 councils. The counting for many seats did not begin until Friday morning, with results expected throughout the day, but early indications are that the Conservatives have made significant gains in its number of council seats and control of local authorities. By 14:30 on 5th May, the Conservatives had gained 383 seats, while Labour had lost 267 and UKIP had lost 105, winning just one seat. The Liberal Democrats have lost 36 seats, against expectations of more substantial gains at what would be a mid-point from the 2015 election, whereas the Greens gained 19 seats and Plaid Cymru 33.

The Conservatives have so far gained overall control of ten new councils – including Warwickshire, Lincolnshire, Gloucestershire, the Isle of Wight and Monmouthshire, all of which were previously in no overall control. Labour has lost control of Glasgow City Council for the first time in 40 years, after losing all of its MPs in the city in 2015 and constituency seats in the 2016 Scottish Parliament election. Labour has also lost control of six councils, including Blaenau Gwent and Bridgend, but retained control of Cardiff, Newport and Swansea.

The Conservatives have so far won two of the eight mayoral contests – in Tees Valley and the West of England – while Labour succeeded in securing mayoralties in Doncaster, Liverpool City Region and North Tyneside. Turnout in some of the mayoral contests is thought to have been as low as 25%, indicating a low level of public engagement with this new layer of devolution.

Health Foundation warns England could face a shortfall of 42,000 nurses by 2020

In a report released on Sunday, the Health Foundation has warned that England could face a shortfall of 42,000 nurses by 2020, corresponding to 12% of the workforce. The report has analysed the 2016 NHS staff survey and found that almost 50% of nurses are concerned that there are not sufficient staffing levels to allow them to do their job properly. In April, the House of Lords Select Committee on the Long-Term Sustainability of the NHS released its report, which defined the biggest internal threat to the sustainability of the NHS to be the lack of a comprehensive national strategy to secure enough employees for the NHS.

The Health Foundation’s report has examined two critical issues in workforce policy, deemed to pose both immediate and long-term risks to the sustainability of the NHS: staffing numbers and standards; and the future of NHS pay policy. The report highlights that the lack of a coherent workforce strategy which is integrated with funding plans and service delivery models is one of the ‘Achilles heels’ of the NHS.

Commenting on the report, the Director of Research and Economics at the Health Foundation, Anita Charlesworth, said: “We are still not training enough nurses, doing too little to stop nurses leaving, and there seems to be no plan for pay policy following almost a decade of pay restraint. On top of this, the impact of Brexit means that international recruitment – the health service’s usual get out of jail free card for staff shortages – is at risk.” She added: “Whatever the outcome of the election, the new government will have to finally get a grip of workforce planning in the health service.”

Weekly political news round up – 28th April 2017

May 26, 2017 in News by Whitehouse

Overview

This week, research by the Nuffield Trust and Health Foundation has showed that emergency admissions for young people under 25 have increased by 14%, rising from 99,000 to over 110,000 in the decade preceding 2016/17. The Trust said that several of the reasons for these admissions, including asthma, epilepsy and acute tonsillitis, could have been avoided if better care had been given outside of hospital, attributing the increase to GP workforce problems.

General election: sector reactions & manifesto speculation

Unite prepares public health election checklist

The health care union Unite has announced it will prepare an election checklist in order to protect public health budgets from further council cuts. As one of the main drivers for the check list, Unite said it is “seriously concerned” about a consistent fall in staff numbers since a peak in 2015, due to cuts to local authorities’ public health budgets. According to Unite’s workforce figures, the number of health visitors had decreased by nearly 9% since the transfer of commissioning for public health to local authorities in 2015. Additionally, NHS Digital figures show there were 2,561 whole time equivalent (WTE) health visitors in the school nurse workforce in the NHS in October 2016, compared with 2,725 in October 2015.

Commenting on the checklist, Unite lead professional officer Obi Amadi said: “We want to draw up a campaign checklist on public health so that our members can lobby the prospective parliamentary candidates and gain their support for the next parliament”. Ms Amadi also called on the Government to “secure the future” of community nursing by increasing and ringfencing money for the workforce and the “vital work” it carries out with families on a daily basis.

Labour’s NHS election pledges

This week, Jeremy Corbyn sought to put Labour’s record on the NHS at the centre of the election campaign. Revealing its NHS manifesto pledges on Wednesday, Labour promised that a victory on 8th June would mean:

  • Scrapping the 1% pay cap in place this Parliament, so that pay is increased to a “sustainable level” for all NHS staff;
  • Reversing the end of bursaries and introduction of tuition fees planned for August for student nurses and midwives; and
  • Tougher rules on safe staffing levels in NHS settings.

The Shadow Health Secretary Jonathan Ashworth publicised the manifesto pledge on Radio 4’s Today programme, saying that Labour “will give the NHS the funding it needs.” Countering Labour’s comments, Jeremy Hunt stated that while the Government would like to pay NHS staff more, “we have had to face a very difficult period financially” which prevented this.

As previously reported, the current Government’s 1% pay cap for the NHS workforce, due to be in place until 2020, has come under severe criticism from the health care sector. At Unison’s annual health conference in Liverpool this week, members agreed to ramp up their campaign to challenge the Government’s annual pay rise cap. The union’s campaign is set to include lobbying for a least £1 an hour extra for all Agenda for Change staff, and ensuring £10 an hour was the minimum wage the NHS can provide. Earlier in the conference, Unison’s general secretary had said nurses and other NHS staff are “right to feel angry” over yet another 1% pay rise, describing it as “an insult”.

Against this background, Labour’s pledge to scrap the 1% pay cap has been received positively by several health stakeholders. Anita Charlesworth, Director of Research and Economics at the Health Foundation, commented: “With rising inflation, the impact of a cap on pay increases means a fall in the living standards of those working in the NHS. For example, health and social care staff have seen a 6% pay cut between 2010 and 2017, when taking account of inflation. This compares to a 2% reduction across the economy as a whole.”

Polling gap narrows between Labour and Conservatives on health policy’

In stark contrast to previous general election campaigns, when Labour traditionally enjoyed major support over its health and care policies, a survey published by ORB International this week suggests that the Conservatives are closing in on Labour’s previous “NHS advantage”.

While 40% of voters are confident Labour would handle the health service well, 38% think the same of the Conservatives. As Labour just announced its NHS election promises, the poll provides an indication to Labour that not even their traditional “trump card” will be able to stall what many suggest will be a historical victory for Theresa May on 8th June.

RCGP launches general election manifesto

The RCGP has released a six-point General Election manifesto this week, urging that patients care must not take a ‘back seat to Brexit’. The medical body is concerned that as Brexit still dominates the political – and now the election – agenda, critical decisions affecting the NHS and the future of patient care could be overlooked or ignored during general election campaigning.

At the centre of the RCGP’s election manifesto is the worry that patient safety could be at risk unless the status of EU workers is guaranteed. The RCGP suggests that non-UK qualified doctors make up two fifths of the career grade paediatric workforce. Consequently, the RCGP is demanding guaranteed status for EU healthcare professionals already working in the UK – and for it to be made as easy as possible for doctors from the EU to move to and work in the UK.

The Chair of the RCGP, Professor Helen Stokes-Lampard, said: “We are launching our manifesto ahead of those of the political parties to try and influence their campaigns and get the message across that this General Election cannot be a one ticket campaign about Brexit”.

Health Committee publishes report on preparations for Brexit

The Health Select Committee has released a report on the consequences of Brexit for health and social care. The report intends to be the first phase of an inquiry which the Committee began during this Parliament, addressing the immediate issues posed by Brexit for both staff and patients within the health and social care sector.

The report calls for the Government to construct a list of issues that require contingency planning and for health concerns to be “front and centre of the British negotiating priorities”. The report identifies workforce retention and recruitment, and reciprocal health care agreements, as key areas of concern.

Commenting on the impact of Brexit, the report contends: “The impact Brexit will have on people who rely on the EU’s reciprocal healthcare arrangements should not be underestimated […] The Government’s plan for our post-Brexit future should both ensure that health and social care providers can retain and recruit the brightest and best from all parts of the globe and that the value of the contribution of lower paid health and social workers is recognised.”

Responding to the report, president of the Royal College of Physicians, Jane Dacre agreed with the Committee’s recommendations, and similarly called for the Government to “put patients at the heart of Brexit negotiations.”

RCPCH publishes State of Child Health report

The Royal College of Pediatrics and Child Health’s (RCPCH) has warned that a lack of both nurses and doctors specialising in children’s health has recently forced many paediatric and neonatal units to temporarily close to admissions.

RCPCH’s report “The State of Child Health” reveals that shortages of nurses and doctors led to periods of closure to new admissions for 31% of paediatric inpatient units and 41% of neonatal units across the UK in the year to September 2015. The report also highlights a serious shortfall in the paediatric workforce and that staff have failed to keep pace with patient numbers, leading to “dangerous pressure on an already stretched service.”

The report further indicates substantial vacancies at consultant and trainee levels, and a low proportion of academic consultants. It found that there are large variations in which national service standards are being met, and unexplained regional variations in application numbers to paediatric training, and competition ratios, across the country.

Commenting on the report, Professor Neena Modi, President of the RCPCH, said: “The facts speak for themselves: the situation is serious. There simply aren’t enough doctors to meet the needs of infants, children and young people, and advance their healthcare through clinical research”.

Risk remains from chronic lack of nurses, warns union

A snapshot survey of 2,704 nurses across the UK has revealed that a large majority of nurses believe the NHS continues to suffer from “chronic understaffing” and that as a result, patients’ lives are being put at risk. About two-thirds (63%) of nurses surveyed by Unison in February this year say that wards are so undermanned that health care staff are unable to ensure patients receive safe, dignified, and compassionate care. The survey suggested 41% of nurses were caring for eight or more people, which official guidance deem to be the point at which patient safety it put at risk.

Moreover, more than 69% of respondents argued that developing or updating care plans was more likely to be rushed, unfinished, not done to an acceptable standard, or missed entirely due to understaffing. As research by the Royal College of Paediatrics and Child Health also revealed this week, shortages of doctors and nurses who specialise in treating children are forcing health services to turn away patients while demand is rising.

In addition, 54% of surveyed nurses responded they would leave their current job if they could and one in ten said they wanted to quit nursing all together. Commenting on the survey, Union head of health Christina McAnea said: “Nurses aren’t getting enough time to care because they’re so overstretched. It is time the Government showed it cared by introducing minimum nurse to patient ratio. Then nurses wouldn’t have to ration their time, and patients would get the care they deserve”.

Weekly political news round up – 21st April 2017

May 19, 2017 in News by Whitehouse

Overview

This week, the Prime Minister has unexpectedly announced her intention to hold an early general election, which has been approved by Parliament and will be held on 8th June. Figures across the health and education sectors have urged all political parties to consider health and education policy issues during their campaigning, despite the heavy focus on leaving the EU that is likely to materialise. In other news, analysis of the financial performance of Sustainability and Transformation Partnership (STP) areas has been carried out by HSJ.

Prime Minister calls early General Election

The Prime Minister unexpectedly announced her intention to hold an early General Election this week, which will be held on Thursday 8th June. Theresa May said on Tuesday that the decision was the only way to “guarantee certainty and stability for the years ahead” and made particular reference to the negotiations to leave the EU. The following day, the House of Commons voted 522 votes to 13 MPs in favour of activating a clause in the Fixed Term Parliaments Act 2011 – which mandates that elections are held every five years – that allows elections to be brought forward if two thirds of MPs support such a move.

Parliament is now expected to be dissolved on Wednesday 3rd May, posing a tight deadline for passing any legislation before parliament rises for the pre-election purdah period (normally 28 days before election day). Any legislation which is not passed will be “carried over” if there is a continuation in Conservative government. Parliamentary Select Committee inquires will be paused during the pre-election purdah period, but can similarly be carried over.

For several smaller parties, the general election offers the opportunity to take advantage of the more polarised political landscape since the EU referendum. Liberal Democrat leader Tim Farron immediately endorsed May’s proposal, and will view a snap general election as an opportunity to target constituencies which voted to remain in the EU. The SNP abstained on the parliamentary vote on holding the election, with the party’s Westminster leader Angus Robertson stating that while the party believed in fixed-term parliaments, they would not stand in the way of an election.

While Labour leader Jeremy Corbyn also supported the decision, and has begun his campaign with a focus on education, it is widely acknowledged that Labour is significantly divided and lacking in central organisation going into the election. Two polls published on Saturday suggested that the Conservatives hold an unprecedented 21-point lead over Labour – presenting an opportunity for May to deliver a decisive landslide before Brexit negotiations begin in earnest.

General election: sector reactions & manifesto speculation

Since the announcement, a range of stakeholders in the health and education sectors have sought to highlight the need to consider policy issues beyond Brexit during election campaigning. The Chief Executive of Children England, Kathy Evans, pushed this message, stating that “This general election has already been dubbed by some as Brexit Referendum II, but it will still be the election that decides a whole government agenda for the next five years.” The Labour leader Jeremy Corbyn has already sought to appeal to voters concerned about education, beginning his campaign by highlighting that in 2016 40,000 primary age children were taught in classes of 36 or more in England.

On health, GP leaders have urged all parties to “take seriously the workforce and workload crisis in general practice”, amid suggestions that the Government could abandon its pledge to recruit an additional 5,000 GPs by 2020 if re-elected. Dr Chaand Nagpaul, Chair of the BMA’s General Practice Committee, urged GPs to “play our part through MPs and patients that we raise the profile of the NHS as a central issue.” The Chair of the BMA, Dr Mark Porter, also warned that “The NHS must not be pushed to the margins in the focus on Brexit.”

Financial performance of STPs mapped out

An article in HSJ has mapped out the financial performance of each sustainability and transformation partnership (STPs) on a number of different measures. These measures included overspending, meeting or underspending against financial control total targets in 2016/17; and the combined surplus or deficit position of all NHS organisations within STPs at the end of 2015/16. While NHS Improvement (NHSI) has not decided upon the method that will be used to determine overall financial performance for each footprint, the Chief Executive of NHSI, Jim Mackey, suggested that a combination of the two could be used for assessment.

Speaking in an interview with HSJ, Mackey highlighted that overspending does not necessarily equate to poor performance, and challenged providers to “confront some hard decisions in this rather than being locked into [current configurations].” The analysis has been conducted as STP areas have been warned that organisations which spend beyond their control totals will not be able to carry on operating deficits; with Simon Stevens saying last month that in some areas “this may mean explicitly scaling back spending on locally unaffordable services.”

Weekly political news round up – 13th April 2017

May 19, 2017 in News by Whitehouse

Overview

This week, a written parliamentary question on the availability of Changing Places toilet facilities has been answered, and the Government has published Public Health England’s strategic remit and priorities for 2017/18. The Royal College of Nursing has also launched a poll on whether nurses wish to strike over low pay; and the results of a study of GPs by the University of Exeter has indicated that up to two fifths of GPs could quit the profession within five years.

Parliamentary question on Changing Places toilet facilities answered

Labour MP Jim Cunningham has received an answer to his question on the steps the Department for
Communities and Local Government is taking to increase the number of Changing Places toilet
facilities in public places. While the question was originally asked on 17th February and a holding
answer provided on 22nd February, the question was only formally answered this week.

Housing Minister Gavin Barwell, responded that the Government has worked with Mencap, PAMIS,
and the British Toilet Association to “support increased voluntary provision over recent years”, as well
as introducing guidance as part of the Building Regulations in England in 2013. This guidance states
that “In large building developments separate facilities for baby changing and an enlarged unisex toilet
incorporating an adult changing table are desirable.” The minister also highlighted the funding given
by the Government to a website offering information on every registered Changing Place in the UK.

Government publishes PHE strategic remit and priorities for 2017/18

The Government has published the outcome of a review of Public Health England’s (PHE) role and performance and a letter setting out its strategic remit and priorities for 2017/18. The review was primarily conducted to assess the success of the creation of PHE from more than 100 organisations in 2013, and finds that overall PHE “has made good progress with integrating the staff, cultures, working practices and physical assets of the variety of organisations from which it was created”. It also makes a number of recommendations for improving performance further, including developing a plan “to build capability to allow [PHE] to work more effectively with DH and other government departments to support policy development on public health issues”, which is based on the need for PHE to provide the Department of Health with “timely, evidence based and contextualised advice to support the development of health policy at the time decisions need to be made.”

The report further recommended that PHE needs to “ensure that it continues to engage effectively with a broad range of stakeholders”, particularly in light of “potential future changes to the local government funding mechanism for public health spend”. Recommendation 9 also states that “health data should be collected, store and managed to minimise costs, ensure data security and maximise benefits to patients and the public”, and refers to work by Professor Keith McNeil, chair of the National Information Board, which will report on this in May.

The corresponding letter, from the Public Health Minister Nicola Blackwood to the Chief Executive of PHE Duncan Selbie, stipulates that one of PHE’s aims should be to “make the case for prevention with DH and NHS England and work with the NHS and local government to […] help reduce avoidable increases in demand on the NHS.” Specific public health issues which the minister directs PHE to address in the letter include antimicrobial resistance, infectious diseases, obesity, smoking and mental health.

Nurses consider striking over low pay

The Royal College of Nursing (RCN) has opened a poll of its 270,000 members to gather opinions on striking over protracted NHS pay restraint and will announce the result of the poll at its annual conference in May. The poll asks whether members want to strike; take “action short of a strike”, such as not working unpaid overtime and not completing tasks beyond their role; or take no further action. A formal strike ballot would need to follow before action was taken.

The RCN has stated that it believes that pay freezes and caps on pay rises have harmed living standards for nurses and adversely affected recruitment for the profession – with the suggestion that nurses have effectively experienced a pay cut of 14% since 2010, as wages have not risen with the cost of living. The Chief Executive of the RCN, Janet Davies, said that “Nurses should not have to fund the NHS deficit from their own pay packets. Whatever nurses decide, it is becoming clear that their goodwill cannot be relied on indefinitely.” The poll comes following a recent 1% pay increase for NHS staff, which unions strongly criticised.

Poll finds two fifths of GPs could quit within five years

A poll has been published in the BMJ Open indicating that up to two fifths of GPs in some areas of the country could quit within the next five years, leading to warnings of a recruitment crisis for the profession. A poll of 2,000 GPs from the South West of England found that 37% believe there is a “high likelihood” of them quitting direct patient care in this time frame, and 70% were considering a career change which “would negatively impact GP workforce capacity” by reducing their hours spent in direct patient care or taking a career break. Additionally, 14% of the GPs said they had high morale, compared with 54% saying they had low morale.

Professor John Campbell, who led the study with the University of Exeter, suggested that “If GPs have similar intentions to leave or reduce their hours in other regions, as many are reporting, the country needs to take robust action more swiftly and urgently than previously thought.” Responding to the statistics, the Chair of the RCGP Professor Helen Stokes-Lampard said “As well as stepping up efforts
to recruit more GPs and make general practice an attractive profession, it is clear that we also need new initiatives to improve retention – such as those the College presented to the Government last year – implemented as a matter of urgency.”

Weekly political news round up – 7th April 2017

May 19, 2017 in News by Whitehouse

Overview

This week, the Chief Executive of NHS Improvement, Jim Mackey, admitted that “critical” financial targets for the progress of the NHS’s Five Year Forward View will not be met during this year. Mackey said the NHS provider sector will not break even again in 2017/18, and that it lies beyond the control of trusts if the NHS will reach financial balance in 2018/19 or not.

In May last year, the NHS stated that bringing the provider sector back to the planned position in 2016/2017 was of paramount importance, if closing the funding gap is to be achieved. NHS trusts are forecast to end 2016/17 with a deficit of £873 million, way beyond the target of £580 million.

In other news, Labour has challenged the Government’s basis for downgrading of NHS treatment targets, stating that such changes contravene patients’ legal rights under the NHS Constitution. In an interview with Sky News, Labour’s Shadow Health Secretary Jonathan Ashworth said he would ask Health Secretary Jeremy Hunt to clarify the legal reasoning underpinning the move.

Simon Stevens also said he expects waiting times for elective operations to increase marginally as a “trade off” for improvement in other areas, such as hitting the four-hour A&E target. The NHS target is for 92% of patients to be treated within 18 weeks of referral. On meeting treatment targets, Ashworth said he thought the NHS needed up to £5 billion extra funding this year, suggesting the Government should scrap tax cuts in order to pay for the health service.

House of Lords Committee publishes report on long-term sustainability of NHS

On Wednesday, the House of Lords Committee on the Long-Term Sustainability of the NHS published
its report, which was critical of the failure of successive governments to plan effectively for the longterm
future of the NHS. The Committee concluded that a tax-funded, free-at-the-point-of-use NHS is
the most efficient way of delivering health care and stressed that such a system should remain in place
now and in the future.

For that to be feasible, the report recommended that several aspects of the NHS and the delivery of
adult social care must change. This includes the establishment of a new, independent Office for Health
and Care Sustainability, which would investigate health and care needs for the next 15-20 years and
report to Parliament on the impact of changing demographic needs, the workforce and skills mix in the
NHS and the stability of health and social care funding relative to demand.

The report stated that previous funding to the NHS has been “too volatile and poorly coordinated
between health and social care”, resulting in poor value for money and resources being allocated in
ways which don’t meet patient needs. The Committee argued that future health funding will need to
increase at least in line with growth in GDP, and that NHS financial settlements should be agreed for
an entire Parliament to enable effective planning.

The Committee expressed its concerns on the absence of any long-term national plan to “secure the
appropriately skilled, well-trained and committed workforce that the health and care system will need
over the next 10–15 years.”

The Committee made 34 recommendations for change including:

  • The Government should commission an independent review to examine the impact of pay on
    morale and retention of health and care staff;
  • The Government should do more to incentivise the take-up of innovative approaches, and
    make clear that there will be funding and service delivery consequences for those who
    repeatedly fail to engage;
  • National and local public health budgets should be ring-fenced for at least the next ten years,
    as cuts to the public health budget are shortsighted and counter-productive;
  • The NHS Constitution should be redrafted to emphasise that access to the NHS involves patient responsibilities as well as patient rights;
  • Budgetary responsibility for adult social care at a national level should be transferred to a new Department of Health and Care; and
  • NHS England should engage with GPs to examine alternative GP models, including direct employment, as the traditional small business model is no longer fit for purpose.

Responding to the report, Jeremy Hunt rejected the claims that the handling of the NHS has been too shortsighted, saying that the Government has “shown we are willing to take tough action to protect the public’s health – introducing standardised packaging of cigarettes and a soft drinks industry levy, and launching a world-leading childhood obesity plan.”

Elsewhere, Unite’s national officer for health, Sarah Carpenter, praised the report, describing it as both “well-balanced and thought-out, with pragmatic action points”. She called on Hunt to consider the report’s warnings over low pay following last week’s “measly” 1% pay rise for NHS staff. Chris Hunt, Chief Executive of The King’s Fund, also responded positively saying, “‘This bold and thoughtful report should serve as a wake-up call to politicians from all parties to initiate a long overdue debate about how to pay for health and social care in the future”.

STPs to be told how to make integrated care savings

NHS England has commissioned the Midlands and Lancashire Commissioning Support Unit to provide a tailored report to each STP by the end of April, specifying how financial resources can be saved by improving preventative physical and mental health care in local NHS services.

In May 2016, the NHS Planning Guidance asked every local health and care system in England to come together to create their own ambitious local plan for accelerating the implementation of the Five Year Forward View. The blueprints, known as Sustainability and Transformation Partnerships (STPs), focus specifically on long term place-based needs of local populations.

The new reports will support STPs and commissioners to develop smart investment strategies for improving preventative healthcare services, to ultimately save money on emergency care. The reports will contain data sets to help local health services distinguish what areas to focus on, in line with the key priorities set out in the NHS’ Five Year Forward View for Mental Health.

Nursing degree applicants down 23%

Recent figures revealed by the Universities and College Administrations Service (UCAS) show that the number of people applying to study nursing at university in England this year was 23% lower than last year. The drop in nursing students has been slightly sharper in England than in the rest of the UK, which showed an overall decrease of 19% in nursing students last autumn, and has been linked to the replacement of NHS bursaries for nursing students with tuition fee loans.

The decline in mature nursing students, over the age of 25, has been cited as being especially worrying, as these students not only bring highly valued experience to the NHS but are often attracted to jobs within the health care sector that are the hardest to find employees for. The Royal College of Nursing’s Chief Executive, Janet Davies, said that “Plans to transform mental health care rely on these nurses and the government must not allow services to be hampered by the fall.” Davies also criticised the Government’s failure to amend its approach to nursing bursaries despite opposition from the sector, stating that “Tomorrow’s nursing workforce, especially older applicants with young families, have been deterred at the very moment the NHS needs them most.

The figures were published in the same week that the Department of Health’s workforce modelling report was leaked, suggesting that the NHS could be short of more than 40,000 by 2026 as a result of leaving the EU.

New primary care model linked to lower A&E attendance

New data on the “primary care home” model (PCH) for general practice, developed by the National Association of Primary Care (NAPC), shows that areas testing the model have sharply reduced A&E attendances and lower GP waiting times. The model organises health care practices into ‘hubs’ covering 30,000-50,000 patients and builds on interdisciplinary thinking where ‘multidisciplinary teams’ provide patients with more holistic health care services.

Whilst the report does not confirm a causal link between the model and reduced pressure on A&E admissions, NHS England has said it seeks to incorporate the model over the next two years. The NAPC’s Chair Nav Chanan said: “This report provides confidence that the PCH model is helping to make a much needed difference to patients and staff as well as easing pressures on the wider health care system.”

Following this week’s report by the House of Lords Committee on the Long-term Sustainability of the NHS, and increased calls for a more holistic approach to health care provision, the PCH model follows the trend of advocating focus on holistic and preemptive health care to save money for the NHS. The size of primary care hubs advocated by the model was also reflected in the NHS’s next steps for the Five Year Forward View, published last week, which suggested that GP practices should look to come together in networks with 30,000-50,000 patients.

GP practices close in record numbers

Data from NHS Digital has revealed that a record number of GP practises closed last year, forcing more than 250,000 patients to move surgery – representing an increase of 150% from 2014. Of the 92 practices that shut, 58 did so completely, while 34 merged with other local surgeries to pool resources.

The increase has come despite NHS England establishing a £500 million ‘turnaround package’ last year to help prevent practices closing. In November, Health Minister David Mowat pledged that 1,000 practices would receive support in the current fiscal year from a £16 million tranche of the GP resilience fund that CCGs would have to spend by the end of March. However, the NHS has been criticised for not distributing this funding before the end of the 2016/17 financial year.

Replying to the latest figures, GPC deputy chair Dr Richard Vautrey said: “This is yet more evidence of the crisis facing general practice right around the country and is a direct result of unsustainable and unsafe workload pressures, and failures to attract enough doctors in to general practice so that it’s increasingly hard for practices to replace retiring GPs.” He also highlighted that many patients will worry about losing their relationship with their own GP.

Weekly political news round up – 31st March 2017

May 19, 2017 in News by Whitehouse

Overview

This week, NHS England has published a document setting out the next steps for the Five Year Forward View and the development of STPs across England. The Government has also triggered Article 50 and published a White Paper on the Great Repeal Bill, which will repeal the European Communities Act 1972 and transpose EU law into UK law.

The Government has also announced a 1% pay increase for NHS staff, which has been criticised as – because it is below inflation – essentially amounting to a real-terms pay cut. The number of full-time GPs has fallen, and the NHS has made the decision to limit some prescribed medications and products which can be purchased elsewhere.

NHS England publishes next steps for Five Year Forward View

Following the publication of the Five Year Forward View (FYFV) in 2014 and the development of Sustainability and Transformation Plans across England over the last year, NHS England has developed a document setting out the next steps for the Five Year Forward View, and how its key ambitions will be delivered. The headline developments in the document include the abandonment of the 18-week waiting time target for elective operations such as hip and knee replacements; the creation of 150 urgent treatment centres across England to ease pressure on A&E departments; and the requirement for GPs to offer evening and weekend appointments by March 2019.

In coordination with the launch of the plan, the Chief Executive of NHS England gave a speech at Aldershot Centre for Health, taking questions from the media primarily on the removal of the 18-week elective surgery target. He was questioned on whether the NHS needs further funding and why he is not asking the Government for this: in responding to this, he framed the announcements in the plan as “trade-offs” and said “these are the actions we can take with the funding we’ve got.” His reticence in answering these questions, when compared with his forthright discussion of government funding for the NHS in recent months, was also reflected in the document’s statements on NHS finances, saying that “growth in NHS funding has closely followed the ups and downs of wider economy cycles.”

The Royal College of GPs welcomed the re-commitment to the GP Forward View embodied in the document, with Professor Helen Stokes-Lampard saying that “There is a lot of promise and potential in today’s announcement that, if delivered, will be good news for general practice.” She also praised the confirmation that general practice will receive additional funding this year as anticipated. By contrast, the Shadow Health Secretary Jonathan Ashworth endorsed the ambitions on cancer and mental health care contained in the document, but highlighted that “The plan admits the public are ‘concerned’ for the future of the NHS and that the health service is under ‘real pressure’ to cope with rising demand within the current spending envelope.”

Government triggers Article 50

After formally triggering Article 50 on Wednesday, the Government has published a White Paper on the Great Repeal Bill, which will be formally introduced to Parliament in the Queen’s Speech in May. The Great Repeal Bill will revoke the European Communities Act 1972, which gives EU law supremacy over UK national law.

The Bill will create a power to correct elements of domesticated EU law which are perceived to pose problems after leaving the EU, and leaves open the option of having to create a “complete and functioning statute book” if the UK leaves the EU without any deal. Directly applicable EU law where there is no need for secondary legislation (i.e. EU Regulations) will be converted into domestic law, while domestic law that already gives effect to EU law will be preserved (this includes EU Directives). It does say that if a conflict arises between EU-derived law and new primary legislation passed after Brexit, the new legislation will take precedence over the laws preserved, ending the general supremacy of EU law. However, EU-derived law will continue to have priority over UK law passed before Brexit.

As expected, a vast number of statutory instruments will be required to make these elements of EU-derived law work, estimated to be between 800 and 1,000. But ultimately the Government has said that “it is not possible to be definitive at the outset about the volume of legislation that will be needed, as it will be consequent on the outcome of negotiations with the EU and other factors.” Concerns have been raised about the impact of using statutory instruments to implement the changes on the ability of Parliament to effectively scrutinise the process. The White Paper says the Government is looking to balance “the need for scrutiny and the need for speed”, and that the White Paper marks “the beginning of a discussion between Government and Parliament as to the most pragmatic and effective approach to take” in implementing these statutory instruments.

Government announces 1% pay increase for NHS staff

The Government has decided to increase wages for NHS staff by 1% this year, making it the seventh successive year that wages have either been frozen or only increased by 1%. The decision has been criticised by health unions, as it means a real-terms pay cut for NHS staff as inflation is greater than 1% (according to the retail price index, inflation is currently running at 3.2%). The 1% pay cap is due to stay in place until the current parliament ends in 2020.

The latest annual report from the National Health Service Pay Review Body (PRB) stated that “It is clear that current public sector pay policy is coming under stress.” The report implied that pay restraint is resulting in “significant supply shortages in a number of staff groups and geographical areas. There are widespread concerns about recruitment, retention and motivation that are shared by employers and staff side alike.” Janet Davis, chief executive and general secretary of the Royal College of Nursing (RCN), shared the sentiment of the PRB and called the policy a “bitter blow” that will “deter new people from joining the nursing profession as the very moment it is failing to retain staff and European colleagues in particular head for the door.”

The shadow health minister Justin Madders highlighted that the pay cap could unintentionally result in hospitals spending more on agency staffing, despite recent efforts to reduce this area of NHS spending. Meanwhile, the Department of Health has stated: “The dedication and sheer hard work of our NHS staff is absolutely crucial to delivering world-class care for patients. We are pleased to announce that all NHS staff will receive a 1% pay increase.”

Number of full-time GPs falls

While Health Secretary Jeremy Hunt had pledged to recruit 5,000 more GPs by 2020 in the run up to the 2015 general election, figures released by NHS Digital on Wednesday showed the total number of GPs now stands at 34,500 – representing a 0.3% decrease. Despite an increase in other healthcare professionals in general practice, the number of GPs working full time in England has fallen and the overall numbers are stagnating.

The BMA’s education, training and workforce GP lead, Krishna Kasaraneni, said: “There is a great deal of uncertainty as Article 50 is triggered about the future status of doctors and other healthcare professionals from the EU. With almost half of the 10,000 EEA doctors working in the NHS considering leaving the UK because of the referendum result this could further reduce the number of GPs delivering care in the NHS.”

The figures on GP recruitment came in the same week that a Freedom of Information request from the RCN showed that the number of EU nurses registering with the Nursing and Midwifery Council has fallen to fewer than 200 each month, compared to 800 each month in the same period before the EU referendum. The RCN criticised the Prime Minister’s failure to clarify her policy on EU nationals working in the NHS, stating that “Her failure to guarantee their right to remain is leaving soaring numbers heading for the door.”

NHS to limit some prescribed medications and products

The NHS will stop prescribing patients a range of medications and treatments which can be accessed elsewhere in a bid to save money. The treatments which will be impacted include travel vaccinations, cough medicine and medication for upset stomachs. The Chief Executive of NHS England, Simon Stevens, said that spending money on this type of treatments results in a significant amount of waste, which is thought to amount to around £128 million a year. The NHS will instead use the money saved to fund new treatments and therapies.

Next month, NHS England will start reviewing 10 items that it says are “ineffective, unnecessary, [and] inappropriate for prescription on the NHS, or indeed unsafe”, which could include gluten-free foods, treatments for underactive thyroids and high blood pressure, painkillers and suncream. The Department of Health is expected to advise GPs that these treatments are not prescribed.

Professor Helen Stokes-Lampard, the Chair of the Royal College of General Practitioners, said that she “cautiously” welcomed the proposals, as “a blanket ban might well introduce some unfair problems”, particularly for patients who are entitled to free prescriptions. She added: “GPs don’t want to be rationing. It is time that country needs these difficult conversations but we mustn’t put at risk the health of the vulnerable.”

Weekly political news round up – 24th March 2017

May 19, 2017 in News by Whitehouse

Overview

Members of the Welsh Assembly have tabled amendments to the Public Health (Wales) Bill this week, including to the provisions requiring local authorities to produce strategies for the provision of public toilets. Shadow Minister for the Environment and Planning, Angela Burns, tabled an amendment which would require the Welsh Government to publish a national toilets strategy, while UKIP AM Caroline Jones tabled an amendment which would require ministers to guarantee “adequate provision” of public toilets in Wales.

In other news, Department of Health has published its annual mandate to NHS England, reiterating that the NHS will receive £10 billion more above inflation by 2020-21 than in 2014-15 and calling on the NHS to deliver “concrete progress” on the STPs.

Meanwhile, it emerged that Health Education England will cut national funding for workforce development again this year, meaning employers and hospitals will have less to spend on continuing professional development training for nurses, midwives and allied health professionals; and the Liberal Democrats passed a motion at their spring conference calling for an “NHS Passport” to protect the rights of EU citizens in the NHS.

Finally, Theresa May has confirmed that she will trigger Article 50 – and thus the beginning of the Brexit process – on Wednesday 29th March. Once this occurs, the EU will respond by drawing up guidelines on its approach to the negotiations, which the remaining 27 EU countries will need to endorse at an EU summit taking place on 29th April.

AMs table amendments to Public Health (Wales) Bill

Members of the Welsh Assembly have been tabling amendments to the Public Health (Wales) Bill, including to the provisions requiring local authorities to produce strategies for the provision of public toilets.

Shadow Minister for the Environment and Planning, Angela Burns tabled an amendment which would require the Welsh Government to publish a national toilets strategy, including an assessment of the need for toilets across Wales and proposals to meet that need. Ministers would need to publish the strategy within twelve months of the Act receiving Royal Assent. A separate amendment, also tabled by Ms Burns, would require Ministers to consult any person they consider likely to be interested in the provision of public toilets in Wales before they publish the national toilets strategy.

UKIP AM Caroline Jones also tabled an amendment relating to public toilets, which would require ministers to ensure there is “adequate provision” of public toilets in Wales.

Lib Dems call on Government to guarantee EU nurses right to remain in the UK

The Liberal Democrats have passed a motion calling for an “NHS Passport” to protect the rights of EU citizens in the NHS, following a strong increase in the number of EU nurses leaving the UK’s health service. The party, which is currently holding its spring conference, cited Freedom of Information responses from 80 of the 136 NHS acute trusts, which showed that 2,700 EU nurses left the NHS in 2016 – an increase of 68% on the 1,600 EU nurses who left in 2014. Nursing and Midwifery Council figures have also shown the number of EU nurses registering to work in the UK has dropped by 92% since last July, while the Royal College of Nursing says there are 24,000 NHS nurse vacancies left unfilled.

Speaking on the motion, Liberal Democrat health spokesman Norman Lamb said: “It is vital that we reassure NHS staff and social care workers from the EU that they remain welcome and valued in the UK following Brexit. ” He added that the “NHS and care services would struggle to cope if significant numbers of doctors, nurses and NHS staff from the EU left”.

Health Minister David Mowat told the Pulse Live conference taking place in London this week that the Department of Health “unambiguously” wants GPs from the EU to stay and insisted that the Government will meet its target of 5,000 more GPs by 2020. However, he did not address the issue of EU nurses leaving the NHS or guarantee a similar approach to nurses.

Government publishes mandate to NHS England for 2017-18

The Department of Health has published its annual mandate to NHS England, setting out the Government’s objectives and requirements for NHS England, as well as its budget. The mandate was published three months later than usual due to debate between the DH and NHS England over delivery and accountability on sustainability and transformation plans (STPs), financial performance and emergency care. It reiterates that the NHS will receive £10 billion more above inflation by 2020-21 than in 2014-15 – despite this figure being contested by the health sector – and calls on the NHS to deliver “concrete progress” on the STPs.

In a foreword to the mandate, Health Secretary Jeremy Hunt states that 2017-18 should be the year in which “the NHS delivers the productivity and efficiency gains necessary to maintain financial balance”. He notes that the Government has already made £325 million of capital funding available for the best STPs over the next three years and states that a further round of local proposals will be considered in the autumn.

The key objectives by which the Government will assess NHS England’s performance are:

  • Through better commissioning, improve local and national health outcomes, and reduce health inequalities.
  • To balance the NHS budget and improve efficiency and productivity.
  • To lead a step change in the NHS in preventing ill health and supporting people to live healthier lives.
  • To maintain and improve performance against core standards.
  • To improve out-of-hospital care.
  • To support research, innovation and growth.

HEE to further cut funding for post-registration nurse training

Health Education England (HEE) will cut national funding for post-registration training for nurses again this year, according to the public body’s draft budget plans. Last year, HEE reduced funding for workforce development by almost half (from £205 million in 2015-16 to £104.3 million in 2016-17), meaning employers and hospitals have less to spend on continuing professional development training for nurses, midwives and allied health professionals.

HEE’s plans to further cut funding for workforce development were laid about by the body’s finance director, Steve Clarke, in a board meeting last week. Clarke did not reveal how deep the cuts will be, but said HEE will “need to make some tough decisions around workforce development”, including around funding for local workforce action boards and other groups. He also spoke of planned cuts to HEE’s £35m “transformation fund”, which is used for implementing the workforce changes needed to deliver NHS England’s 44 sustainability and transformation plans.

HEE’s budget for the financial year starting in April has not yet been finalised, as the Department of Health has not yet confirmed the amount of funding it will receive or what annual objectives it must meet. However, the DH told HEE at the end of 2015 that its annual budget would be frozen until 2020, and it is on this basis that HEE has prepared its draft plans.