Weekly political news round up – 25th August 2017

August 25, 2017 in News by Whitehouse

Overview

This week, the Royal College of Nursing has highlighted the risks posed by children’s health by falling numbers of school nurses. HSJ has published a revision of its list of the 100 most powerful figures in health policy, while the Nuffield Trust has conducted analysis of test sites of the primary care home model. NHS England has also announced an international GP recruitment programme to expand the GP workforce.

Royal College of Nursing highlights risks from falling school nurse numbers

The Royal College of Nursing (RCN) have advised that falling numbers of school nurses could put children with long-term health conditions at risk and prevent them from participating fully in school life. Statistics from NHS Digital have indicated that the number of school nurses has declined by 550, or 19%, since 2010 to 2,433 full-time school nurses. More than 100 of these nurses have left the profession so far this year, and the RCN have expressed concerns that children with conditions such as asthma, epilepsy and diabetes risk receiving inadequate care as a result.

The RCN’s professional lead for children and young people’s nursing, Fiona Smith, said that because these children may face medical emergencies at school, “Without the right training, guidance and support from school nursing services, teachers could be completely unprepared for this kind of situation – putting children’s lives at serious risk.”

HSJ publishes list of 100 most powerful health policy figures

HSJ has published a new version of its annual list of the 100 most powerful figures in health policy, which includes 32 new entries and a significant drop for prominent healthcare leaders such as the Chief Executive of NHS Improvement, Jim Mackey, and the Permanent Secretary at the Department of Health, Chris Wormald. The list is normally published at the end of each calendar year, but has been revised to reflect political changes emanating from the general election and the growing importance of Sustainability and Transformation Partnership (STP) leaders. The accompanying analysis says that many of the revised rankings have been driven by the growing prominence of workforce representatives and officials leading efficiency programmes.

Professor Matthew Cripps, the Chief Executive of NHS RightCare, is noted to have risen the most places on the list, going from 87th to 40th. The continued dominance of Simon Stevens and Jeremy Hunt at the very top of the list is linked to the current political climate, with the minority government and weakened Prime Minister increasing the influence of both. Other notable figures include the shadow health secretary Jonathan Ashworth (ranked 18th); the president of the RCN Janet Davies (ranked 19th); and the chief nursing officer at NHS England Jane Cummings (ranked 66th).

Nuffield Trust publishes analysis of primary care home model

The health charity the Nuffield Trust has published analysis of 13 rapid test sites for the primary care homes (PCH) model, a new model for primary care which encourages collaboration with other local community, hospital and social care organisations. While the model has now been extended to 180 sites across England, the initial rapid test sites were allocated £40,000 in funding from NHS England to assist with their start-up costs. The analysis concluded that the sites did not have the resources to fully evaluate their progress to date, and “lacked a clear explanation of how the planned interventions would deliver expected impacts.”

The sites were established in July 2016, making it too early in the process to evaluate patient outcomes. The analysis said that despite this, “Within six months the PCH approach had stimulated partnership working and developed or improved services for at least one patient subgroup across most sites.” Progress was said to be aided by “hard-working multi-organisation operational teams who were able to think creatively, shift staff around projects, and had the ears of their respective executives.” Many of the sites evaluated expressed their concerns about receiving longer-term funding to sustain their new ways of working, and the difficulties this posed for forward planning.

NHS England announces international GP recruitment programme

NHS England has announced an international GP recruitment programme to increase the pace of GP recruitment, with the aim of recruiting at least 2,000 GPs by 2020/21. The Government’s overall target is to recruit an additional 5,000 GPs in this time period, of which 500 doctors would have been recruited from abroad. The acceleration of this programme hopes to recruit 600 GPs in 2017/18 alone, supported by the creation of a GP International Recruitment Office.

The announcement comes shortly after more medical school training places were confirmed to increase the number of GPs trained in the UK. The Chair of the Royal College of GPs, Professor Helen Stokes-Lampard, said “We welcome any GP from the EU or further afield who wants to work in UK general practice – as long as they meet the rigorous standards set by the College, General Medical Council and others to ensure safe clinical practice.”

Weekly political news round up – 18th August 2017

August 25, 2017 in News by Whitehouse

Overview

This week, the Royal College of Nursing has analysed data which suggests that nine in ten of the largest NHS hospital trusts do not have enough registered nurses to provide safe and appropriate care. The Royal College of Paediatrics and Child Health (RCPCH) has published a report on the paediatric health workforce in Scotland, while Health Education England will allocate additional funding for clinical training places to universities and NHS trusts. The Government has also published two position papers on key Brexit issues in an attempt to accelerate progress in negotiations.

RCN analysis highlights hospitals’ nursing staff shortages

Analysis of data from NHS Choices, conducted by the Royal College of Nursing (RCN), has demonstrated that of the 50 largest NHS hospital trusts, nine in ten do not have enough registered nurses. As a result of these staff shortages, the RCN says that hospitals are placing healthcare assistants on wards in place of nurses, and in two thirds of the trusts analysed this happened particularly at night. The RCN has recently suggested there are 40,000 nursing vacancies across the NHS in England.

The Chief Executive of the Royal College of Nursing, Janet Davies, said that “In light of this, the Government must redouble its efforts to train and recruit more qualified nurses and stop haemorrhaging the experienced ones who are fed up, undervalued and burning out fast.” Davies also highlighted that where healthcare assistants are being used in place of nurses, they are being placed into situations that they might not have the expertise to handle.

RCPCH publishes report on paediatric workforce in Scotland

The Royal College of Paediatrics and Child Health (RCPCH) has published a report focusing on the paediatric workforce in Scotland, following its wider State of Child Health report published earlier this year. The report analyses date from nine of the 11 health boards providing child health services (81.8%), which include 14 paediatric inpatient units, 15 neonatal units and 17 paediatric outpatient services. 25% of the inpatient units which responded had to close to new admissions at some point during 2015/16 because of staff shortages, compared with 31.3% of inpatient units across the UK. These Scottish units also had to close less times on average than units across the UK, closing 0.8 times compared with 2.9 times.

However, 41.7% of neonatal units in Scotland had to close to new admissions during this period compared with 41.1% of neonatal units across the UK. The College is using the statistics to call on the Scottish Government to provide between 84 and 110 additional paediatric consultants to meet demand and workforce standards, which would meet the target for this area of the workforce to grow by 27-25%.

Universities given additional funding for clinical training places

Following the publication of A-Level results this week, Health Education England has told universities and NHS trusts that funding will be made available for an additional 1,500 clinical placements through the university clearing process. The announcement comes as part of a government drive to increase the number of training places for doctors and nurses, with the Department of Health allocating £16.4 million to increase the number of students training in the professions. This year’s allocation will be followed by funding for an additional 2,500 placements in 2018/19.

In addition to ongoing recruitment concerns, nursing professionals have argued that the replacement of the NHS bursary in favour of a student loan for nursing and midwifery students will adversely affect the number of nursing students. A letter from Health Education England stated that “All [Higher Education Institutions] running clinical undergraduate pre-registration which previously attracted bursary funding […] are eligible to have a 4.6 per cent uplift in the number of HEE funded clinical placements associated with those courses.” The number of places will have to be agreed between individual universities and trusts.

Brexit developments: Government publishes customs union and Ireland position papers

The Government has published position papers on future customs arrangements with the EU and the border between Northern Ireland and Ireland after Brexit. The papers were published in an attempt to make progress in the negotiations, with the EU having insisted that they wanted further clarity on the UK’s position on a number of key issues. The paper on future customs arrangements proposes an interim, time-limited customs agreement, which aims to avoid disruption for businesses and individuals and will take effect once the UK leaves the EU in March 2019. During this period, the Government intends to negotiate its own international trade deals, something it cannot do as a member of the EU’s Customs Union.

For a long-term customs arrangement, the Government proposed two approaches: a highly streamlined customs arrangement that would extend customs processes to all trade with EU Member States; or a new customs partnership with the EU which would see the UK align its customs regime with that of the EU. A spokesperson for the European Commission said that future customs arrangements will only be discussed once sufficient progress has been made on the terms of the withdrawal – namely on citizens’ rights, the financial settlement and the Irish border.

To address the issue of the Irish border, the Government’s second position paper stated that it would not create border posts along the Irish border. The paper argues that 80% of Northern Ireland firms which would be looking to trade across the border are small or medium sized engaging in local (rather than international) trade, and so should not be subjected to any additional checks after Brexit. There are suggestions that larger activities could have their activities monitored through CCTV systems rather than physical border checks and posts, which is seen as key to upholding good relations between the two sides.

Weekly political news round up – 11th August 2017

August 25, 2017 in News by Whitehouse

Overview

It has been reported this week that UK negotiators have expressed their willingness to pay a £36 billion Brexit ‘divorce bill’, provided that the EU is willing to negotiate the settlement as part of a wider deal on trade. The payment would seemingly be presented to the public as part of a deal to access the EU market during a three-year post-Brexit transition period, but has angered Eurosceptics as it would equate to roughly three years of contributions to the EU.

BBC coverage on appropriate toilets for people with physical disabilities

The BBC has aired a feature on a lack of appropriate toilets for people with physical disabilities on the Victoria Derbyshire show. The piece was led by the Paralympian Anne Wafula-Strike, who explored whether public toilets are meeting the needs of disabled people, including providing equipment such as hoists and plinths. The coverage argued that this isn’t the case, despite the recent Changing Places campaign for more accessible and suitably-equipped toilets to be made available across the UK – it is suggested that while 250,000 people in the UK need these toilets, only 1,000 are available.

The report described how one woman with spinal muscular atrophy, who does not have any continence issues but needs to use a hoist to use a toilet, chose to have a suprapubic catheter fitted as she could rarely find suitable toilets in public and so would avoid drinking. Lorna Fillingham, a mother of a seven-year-old with severe disabilities, also explained the health risks posed by a lack of appropriate toilets, including that if someone with a feeding tube or tracheostomy is changed on a toilet floor they could contract an infection.

Crohn’s and Colitis UK launches campaign to update disabled toilet signs

Crohn’s and Colitis UK has launched a campaign calling for disabled toilet signs to be updated to highlight that not all disabilities which require use of a disabled toilet are visible. The campaign is calling for travel hubs across the UK to make these changes, with Belfast Airport, Gatwick Airport and Moto Hospitality service stations already agreeing to introduce new signs to their disabled toilets. A similar campaign to adopt this accessible signage was led by Crohn’s and Colitis last year and resulted in Asda, Morrisons, Tesco and Waitrose installing “not every disability is visible” signage on accessible toilets.

The campaign was launched following a survey of people with Inflammatory Bowel Disease, which found that 72% of people with the condition found it limited their travel – primarily as they felt uncomfortable at the prospect of being confronted about using a disabled toilet. One respondent to this survey said “At times I’ve thought I’d rather have an accident in public than be confronted about using a disabled toilet.” Further information about Crohn’s and Colitis UK’s campaign can be found here.

Government allocates money for more medical and nursing students

The Government is attempting to mitigate the impact of leaving the EU on the NHS by providing additional funding for places at medical and nursing schools. The funding will be allocated to Health Education England to increase the number of places available, as part of a commitment to increase the number of doctors by 1,500 and the number of student nurses, midwives and allied health professionals by 10,000 by 2020. Approximately a quarter of doctors working in the NHS are from outside the UK, causing concerns that it will be unable to cope if more stringent immigration rules after Brexit increase  reliance on British doctors.

The additional funding for nursing places will be a minimum of £16 million, and has allayed fears that the Government was not going to provide additional funding for more places and leave the responsibility to universities. However, the chief executive of the Royal College of Nursing, Janet Davies, claimed that the increase would not be enough, stating that “10,000 training places is a drop in the ocean when there are 40,000 nursing vacancies in England alone.”

2018/19 will be “turning point” for vanguards

It has been predicted that NHS England’s vanguard sites will have saved more money than was invested in them by 2018/19, marking a “turning point” for the sites which are developing and trialling new ways of working. When investment was initially given to the sites they spent more than they saved – £41 million more in 2016/17. For 2017/18, to the sites are expected to produce net savings of £136 million compared with investment of £107 million, and by 2018/19 every vanguard site is expecting to be saving more than was invested.

However, the figures were accompanied by warnings that with national funding due to end in 2017/18, the sites will need £277 million in local funding between 2018 and 2021, echoing recent warnings from NHS Providers. Each vanguard focuses on a specific area of care, and the programme expected to return the greatest savings was the National Orthopaedic Alliance, which intends to create a national framework for orthopaedic care.

Weekly political news round up – 4th August 2017

August 25, 2017 in News by Whitehouse

Overview

This week, the Government announced a £1.3 billion plan to improve mental health services. The Health Secretary, Jeremy Hunt, said that 21,000 new posts would be created to facilitate more specialist nurses, therapists, psychiatrist, and peer support workers among other mental health professionals. The announcement received a mixed response from mental health campaigners and workforce bodies, with the British Medical Association welcoming the focus on psychiatric services and the Royal College of Nursing questioning the timeframe for training and saying the numbers “appear not to add up”.

Meanwhile, the Cabinet has continued to air its differing views on Brexit, with several ministers arguing for a soft transitional arrangement after March 2019 allowing for continued freedom of movement. Amber Rudd, Phillip Hammond and Jeremy Hunt have all publicly discussed the benefits of retaining ease of movement for EU citizens seeking to work in the UK over the past week, while the International Trade Secretary, Liam Fox, argued such arrangements would be a betrayal of the referendum result. A spokesperson for Number 10 sought to clarify the Government’s position by saying “it would be wrong to suggest (free movement and immigration) will continue as it is now.”

Concerns raised over Scottish nursing workforce

Audit Scotland, the auditing body for the public sector in Scotland, has warned that the Scottish Government has not made sufficient long-term planning arrangements for its nursing workforce. A report produced by Audit Scotland has suggested that if all Scottish nurses eligible to retire at 60 over the next five years do so, there will be a 9.6% shortfall in the number of nurses against the number of newly-qualified nurses coming into the sector. The report also highlights that the number of newly-qualified nurses fell by 15% in 2014/15 and 7% in 2015/16, skewing the proportion of nurses aged over
50.

This looming shortfall has been linked with rising workloads, with nine in ten Scottish nurses surveyed
by the Royal College of Nursing reporting that their workload has increased recently. The auditor
general for Scotland, Caroline Garnder, commended the Scottish Govenrment for recognisning the
problem, but said they “urgently need to improve their understanding of future demand, staff projections and associated costs, and set out in detail how they plan to create a workforce that can meet the longterm health needs of the population.” The Royal College of Nursing in Scotland said that the Scottish government had failed to “future proof” the Scottish NHS workforce.

Report highlights NHS waste and danger of “political” targets

An internal audit on clinical efficiency in the NHS has found large variations in the cost and quality of
care across England, highlighting the need for health organisations to significantly reduce waste in
general surgery. Professor Tim Briggs, the national director of clinical quality and efficiency at NHS
Improvement, led the audit as part of the Getting It Right First Time (GIRFT) programme, which seeks
to improve care in the NHS by reducing variations in service. The report outlines a number of clinical
procedures and treatments across the country where trusts are spending vastly different amounts for
products, and where substantially different results are being delivered for patients. For example, death
rates from bowel cancer surgery vary from zero to 14%, and some hospitals are paying 350 times more
than others for basic surgical equipment.

Professor Briggs says that the findings show there are “huge” efficiency and performance gains to be
made across the system, and argues that this should take priority over increasing funding for the NHS.
He told The Times that the NHS does not deserve more money, “until we put our house in order and
we actually make the changes that will improve quality of care.”

While not outlining a need for more money, the report criticised what its authors deemed to be
“politically derived measures” reducing the quality of care delivered to patients. Specifically, it
mentioned data collecting surgeon-specific mortality rates having the potential to create “clear perverse
incentives”, by disincentivising high-risk operations. The authors also highlighted cancer waiting times
targets as “not clinically driven or motivated”, suggesting that they “may even inadvertently result in
reducing the quality of care patients receive”. In a pre-prepared statement, Jeremy Hunt said that “by
reducing variation we can improve care and eliminate waste at the same time”, but the Department of
Health did not specifically respond to the issue of targets when approached by HSJ.

NHS procurement savings scheme falls behind schedule

It has been reported that the Nationally Contracted Products (NCP) programme, which is intended to agree prices on everyday products purchased by the NHS, is behind schedule on agreeing prices for some products, while being “broadly on track”. NHS Improvement, which is driving the programme, had intended for 12 product lines to have centrally-decided prices by the end of this year and is still aiming to decide prices for 14 categories in that time. However, the intention for this to cover more than 100 products does not seem to be progressing at pace, with only two products being made available to NHS providers.

The categories of product which will be covered by the programme include examination gloves, wipes, syringes and needles, with the hope that 25% savings could be made if all trusts across the country paid the same price for these products. NHS Improvement suggested during discussions with HSJ that procurement of other products had been delayed as “macroeconomic factors such as currency fluctuations can also determine the optimum time for a particular procurement”.

Brexit Healthcare Alliance publishes five priorities to safeguard UK health sector

The Brexit Healthcare Alliance, representing a range of organisations working to ensure specific healthcare issues are given prominence during Brexit negotiations, has published a list of five priorities needed to protect UK healthcare during the process. The Alliance differs from the Cavendish Coalition, which specifically focuses on Brexit-related workforce issues in health and social care, and intends to prioritise:

  • Ensuring maximum levels of research and innovation collaboration
  • Providing regulatory alignment for the benefit of patients and population health
  • Preservation of reciprocal healthcare arrangements
  • Robust coordination mechanisms on public health and wellbeing
  • Securing a strong funding commitment to the health and public health sectors

Organisations represented in the Alliance include the Academy of Medical Royal Colleges, the Association of British Healthcare Industries, the NHS Confederation and representatives from the devolved nations.