Weekly political news round up – 17th November 2017

November 23, 2017 in News by Whitehouse

Overview

This week, capacity concerns and the fate of the medical workforce have dominated news surrounding the health service, against the backdrop of MPs debating the latest iteration of the EU Withdrawal Bill.

New data from NHS England revealed that more than a quarter of patients are not being seen by a consultant within 14 hours of admittance to hospital: a key requirement within the Government’s pledge to provide a full “seven-day service” across England. The 14-hour wait was one of four central standards introduced by NHS England in 2013, as the national commissioning body sought to redress a “significant variation in outcomes” for patients admitted at weekends, compared to those seen during the week.

Despite this claim, the difference in performance against the standard on weekdays and at weekends is minimal, with the proportion of patients being seen by a consultant within the 14-hour window at 73%, and 70%, respectively. NHS England and NHS Improvement did not comment on their expectations for the 14-hour standard, while a recent study from the University of Manchester argued there is “no association” between access to consultants and weekend death rates.

Meanwhile, the British Medical Association published a survey which found that 45% of doctors from the European Economic Area are considering leaving the UK medical workforce. The report, which polled 1,720 doctors from the EEA, also found that almost one in five medics (18%) had already made plans to leave, while over three-quarters (77%) of respondents would be encouraged to leave if there is a negative outcome to Brexit negotiations on EU citizens’ rights.

Nursing conditions criticised by Francis, profession leaders

The author of an influential report on patient safety has this week joined senior nursing figures in criticising NHS leaders on their approach to workforce shortages. Sir Robert Francis, who led on the Mid Staffordshire NHS Foundation Trust Public Inquiry earlier this decade (“the Francis report”), claimed that senior NHS officials have regrettably “shied away” from using staff/patient ratios as an effective measure of “acceptably safe care”.

In his submission to the Health Committee’s inquiry on the nursing workforce, Francis also warned against incremental cuts to nursing numbers by trusts under pressure to make savings, noting that these measures were a key contributor to the Mid Staffs scandal resulting in a number of avoidable hospital deaths.

The Health Committee met once again this week to discuss the shortage of nurses employed in the NHS, and were told by leaders of the profession that cuts to continuing professional development have been particularly damaging to retention rates. Council of Deans Chair Professor Brian Webster- Henderson – representing UK university nursing departments – labelled Health Education England’s cuts to CPD “a nonsense” at a time when the profession is introducing new standards. He was supported by the chief executive of the Nursing and Midwifery Council, Jackie Smith, who argued that such cuts contributed to the feeling that “the nursing profession does not feel valued.”

HEE reduced its CPD fund for nurses, midwives and allied Health Professionals from £205 million in 2015 to £83 million in 2017, which NHS Employers chief executive Danny Mortimer labelled the “biggest single factor now in terms of poor rates of retention in the NHS”.

Children with special educational needs face school exclusion

The Children’s Commissioner for Wales, Sally Holland, has expressed concern over the increasing number of children being taken out of school to be taught at home. Some 1,906 pupils were removed from Welsh schools in 2016-17, a dramatic increase from the 864 students taken out of formal education in 2013-14. The National Autistic Society Cymru said, “a lot of parents are finding themselves in positions where they have no options”, while Sally Holland suggested “some parents… have been encouraged to home educate because their child might be affecting the school or local authority’s performance data.”

The most recent report by the Special Education Needs Tribunal for Wales showed an increase in appeals against inadequate support for children with most special educational needs in recent years. The comments from Sally Holland come in a week where the Children’s Commissioner for England, Anne Longfield, expressed her own fear in parliament that pupils in England with behavioural problems were being at times unnecessarily excluded, and subject to poorly managed disciplinary initiatives.

Daily Mail highlights incontinence concerns

Two academics from the University of Leeds have publicised the effect of incontinence in the Daily Mail, particularly highlighting the stigma attached to the condition and the anticipated impact on an ageing population. Dani J Burton and Pete Culmer note, “the profound personal and socio-economic consequences” of incontinence in their article, discussing the severe impact managing the condition has on everyday life, “bringing worries about where the nearest public toilet will be and making even short outings stressful”.

The academics explain the differences in continence care and management between wealthier countries and the third world, but note that even where supply chains, infrastructure and policies are
clearly in place in countries like Britain, “affordability and a reluctance to seek medical help can result in many suffering quietly”. Burton and Colmer argue the solution to better tackling incontinence is in improving awareness and understanding, “through education, public discussion, media coverage (and) better recognition in healthcare.”

Weekly political news round up – 10th November 2017

November 23, 2017 in News by Whitehouse

Overview

This week, NHS England has appointed a new medical director to replace Sir Bruce Keogh following the announcement of his departure in April. Professor Steve Powis, who is currently medical director at the Royal Free Foundation Trust, was described by Sir Bruce as “a standard bearer for clinical excellence, professionalism and patient centred care.” It is not yet clear when Professor Powis will take up the role.

Elsewhere, the think tank Reform has published a report on the devolution of public-services commissioning, which calls for devolution in England to be “drastically accelerated” and to cover healthcare, employment services and offender management services under one devolved budget. The report calls for NHS England to be scrapped and 95% of its budget, equating to more than £100 billion, to be devolved to 38 “super councils”. It stipulates that: “The centre must take a light-touch approach by setting high-level outcomes, for local commissioners to tailor to their areas. International moves to a more devolved state suggest this can be completed in 15 years, with the right support.”

Parliamentary written questions tabled on prescribing in primary care

The Labour MP Steve McCabe has tabled several written parliamentary questions on NHS England’s recent consultation on ‘items which should not routinely be prescribed in primary care’. McCabe’s question focused on the impact of the proposals on: patients with inflammatory bowel disease and other long-term conditions; the management of urgent care services and hospital admissions; and access to medications for children, older people and other vulnerable people. He also asked what the implications would be for patients with a long-term condition who have already purchased prescription prepayment certificates; and for the “medicine-taking behaviour of patients who rely on regular and multiple medications to prevent symptoms of long-term conditions.”

Primary Care Minister Steve Brine responded that the consultation sought to “ensure that the NHS is able to secure best value from its use of medicines and therefore focuses on areas of prescribing that have been found to be ineffective or where there are more cost effective alternatives.” He also said that NHS England will carefully consider the responses submitted to the consultation, “both to ensure that particular groups of people are not disproportionately affected and that principles of bets practice on clinical prescribing are adhered to.”

WellChild warns of growing pressures on children’s nursing

WellChild, the charity for seriously ill children, has published its annual impact report which warns that demand for specialist children’s nursing services is putting growing pressure on its network. The charity warns that there has been nearly a 40% growth in demand for its network of paediatric nurses over the last year, as well as a 37% increase in a nurse’s average caseload and an 82% increase to its ‘Helping Hands’ scheme over the same period.

The report calls for investment in the children’s community nurse workforce and in access to support services such as short break respite care. The charity’s Chief Executive, Colin Dyer, suggested that there is not adequate attention given to children and young people “living with serious and exceptional health needs”, despite a similar focus on adult social care.

Simon Stevens calls for additional NHS funding

The chief executive of NHS England, Simon Stevens, has made a call for additional funding to be allocated to the NHS in the upcoming Budget. Stevens also suggested that “trust in democratic politics” will be compromised if the Vote Leave’s pledge of an additional £350 million a week for the NHS after Brexit is not delivered.

He made the call for more funding at the NHS Providers annual conference in a speech that was not briefed to the Health Secretary beforehand, and argued that planned improvements to cancer and mental health care will not materialise without further funding. He also controversially suggested that performance targets will have to be abolished under current funding arrangements, as waiting lists will soar without investment and achievement against targets will go back “a decade” if nothing is done.

In his own speech to the conference, Jeremy Hunt agreed that the NHS needs more money, but indicated that the Chancellor does not think the same, saying he has repeatedly made and “must win” the argument for more funding. Hunt simultaneously emphasised the need for the NHS to find further efficiency savings to earn additional funds Hunt said that more funding overall – and increases to NHS staff pay – will depend on the overall economic situation and long-term productivity gains from the service.

Responding to the statements, the shadow health secretary Jonathan Ashworth said that Stevens was right to “set out in the clearest terms the stark implications of failing to give the NHS the funding it needs.”

Three health charities call for £4 billion more NHS funding

The Health Foundation, the King’s Fund and the Nuffield Trust have come together to call for £4 billion more funding for the NHS, as “current spending plans fall well short of what the NHS needs based on an assessment of Office of Budget Responsibility projections and historic rates of funding growth.” In a joint briefing, the health charities warn that the current NHS funding settlement will lead to funding per person falling by 0.3% in 2018/19, despite a pledge from the Government to increase NHS spending in real terms during every year of this parliament. The analysis also warns that there could be a funding gap of at least £20 billion by 2022/23, despite the Five Year Forward View intending to eliminate any funding gap through efficiencies and funding increases by 2020/21.

Commenting on the briefing, the Chief Executive of the Nuffield Trust Nigel Edwards said that NHS funding issues will not be addressed with “one-off bungs or bailouts”, and called on the Government to “face facts and commit to sustainable increases over the lifetime of this parliament.” The Chief Executive of the Health Foundation Jennifer Dixon also warned that the NHS risked falling below European standards without additional funding, and said that “An extra £4 billion in 2018/19 would simply be a return to the average increases of the first 63 years of the NHS’s history. The additional funding required is not exceptional, it is the last 7 years of austerity that are the exception.”

Seven CCGs to merge into two new bodies

NHS England has approved the merger of seven CCGs into two new CCGs, Berkshire West CCG and East Berkshire CC. The CCGs forming Berkshire West CCG will be Newbury & District CCG, North & West Reading CCG, South Reading CCG and Wokingham CCG, and the CCGs forming Berkshire East CCG will be Bracknell & Ascot CCG, Slough CCG, Windsor, Ascot & Maidenhead CCG. The former have already signed a memorandum of understanding to create the Berkshire West accountable care system (ACS), while the latter are all part of the Frimley Health STP and ACS.

Weekly political news round up – 3rd November 2017

November 23, 2017 in News by Whitehouse

Overview

This week, a written parliamentary question and an Early Day Motion have been tabled on incontinence. The Government has also launched a consultation on the regulation of healthcare professionals across the UK, and the Professional Records Standards Body has published a report on what information it believes should be available in digital child health records. The new Carter Review of community and mental health services has also identified £200 million in savings which could be found from corporate services.

Parliamentary developments on incontinence

Two parliamentary developments on incontinence have taken place this week. The first is a written parliamentary question tabled by Mark Hendrick MP in response to his previous written question on how the Department collects statistics on prescriptions for catheters, out-patient appointments, surgical interventions and costs of pads and other incontinence products. His question this week asked if the Department would make it its policy to collect that information centrally; the Government responded that it had no intention to do so.

The second development was the tabling of an Early Day Motion (EDM) by the Liberal Democrat MP Christine Jardine, highlighting the need for an incontinence strategy. This motion included recognition that “only about 30 per cent of men and women with incontinence problems seek help”, and “urges research into the current costs to the UK public purse caused by incontinence, including managing the secondary effects, loss of earnings, burden of disease and cost of treatment.” Any MP can support an EDM as a means of expressing their support for a topic, although Ms Jardine’s EDM has yet to attract any further signatories.

Government launches consultation on regulation of healthcare professionals

The Government has launched a consultation on reforming the regulation of healthcare professionals, with the possibility of merging the existing nine regulatory bodies into three or four being proposed. The proposals affect all four nations of the UK, and were initially put forward by David Cameron in 2013 before being included in the Conservative manifesto for this year’s election. Two of the key changes proposed are on whether regulators should be given a “full range of powers for resolving fitness to practise cases” and “greater flexibility to set their own operating procedures”, as is the case for the General Medical Council which regulates doctors.

In a ministerial statement, the Health Minister Lord O’Shaughnessy said that the Government’s primary objectives in pushing reform are to:

  • Improve the protection of the public from the risk of harm from poor professional practice;
  • Support the development of a flexible workforce that is better able to meet the challenges of delivering healthcare in the future;
  • Deal with concerns about the performance of professionals in a more proportionate and responsive fashion;
  • Provide greater support to regulated professionals in delivering high quality care; and
  • Increase the efficiency of the system.

The consultation document states that the existing system has been criticised as being “slow, expensive, complicated, reactive, overly adversarial and confusing for patients, professionals and employers”, which compromises its efficacy. For the Nursing and Midwifery Council, it was estimated that fitness to practice cases cost each registrant £84 per year during 2015/16. Responding to the launch of the consultation, the NMC called it “a welcome step in the right direction, but government must ensure that they press ahead with the changes that are so desperately needed to ensure that we have legislation which will enable us to properly protect the public in the years to come.”

PRSB publishes report on standardised information on child health

The Professional Records Standards Body (PRSB), which defines the standards for good care records in health and social care, has published a report on what information should be included in all digital child health records. The standards have been agreed to support the Healthy Child Programme, and list the information on screening tests, immunisations and developmental milestones that “should be accessible to ensure that children receive appropriate care.” The PRSB also intends for parents to have access to their child’s digital health records, and has worked with NHS England, NHS Improvement, the RCPCH, the RCGP and the RCP on the project.

One of the pieces of information which the PRSB says should be recorded is whether a child has achieved certain developmental skills, which would indicate that they are ready to start school. These include being toilet trained, having listening and communication skills, and the ability to dress/undress and follow instructions. The clinical lead for the project from the RCPCH, Dr Andy Spencer, said “When these new standards are implemented, parents will have the same access to their child’s personal health record as health and care professionals, and they will always know who the records are being shared with and why.”

New Carter Review identifies £200 million in savings

The new Carter Review of community and mental health services, which is currently being carried out, has identified a potential £200 million in savings in trusts’ corporate services. However, the NHS Improvement director who has been working on the review, Luke Edwards, has criticised the lack of data available in community and mental health trusts, which has made it difficult to identify areas of variation – and thereby savings – across trusts.

The review is examining how savings can be achieved across staffing and care hours, medicines and pharmacy optimisation, procurement, and how community and mental health services are commissioned. Mr Edwards said “We think there is scope to drive more savings in corporate services through collaboration and basically becoming a bigger entity”, as evidence indicates that smaller services have higher running costs. Lord Carter has previously expressed his opinion that there should be a “wrecking ball” approach to closing small community hospitals with these high costs.

Weekly political news round up – 27th October 2017

November 23, 2017 in News by Whitehouse

Overview

This week, the Labour MP Mark Hendrick has received an answer to a written question on faecal incontinence. The Royal College of Nursing has called for an above inflation pay rise for nurses based on minimum income measures; and a campaign group has launched a legal case against a contract for Accountable Care Organisations published by NHS England in the summer.

Response to written question on faecal incontinence

Public Health and Primary Care Minister, Steve Brine, has responded to a question from Labour MP for Preston, Mark Hendrick, on what steps have been taken by CCGs in Greater Preston, Blackburn with Darwin and West Lancashire to monitor the number of people who are referred for appropriate specialised management after receiving initial management for faecal incontinence.

Hendrick also asked how many people were offered referral for appropriate treatment after receiving initial management for faecal incontinence by each CCG in each quarter between 1 March 2014 and 30 September 2017. Steve Brine responded saying that this information is not collected centrally.

RCN calls for above inflation pay rise for nurses

A report from NatCen has led the RCN to call for an above inflation pay rise for nurses, after it found that 41% of nurses do not meet the minimum income measure used by the Joseph Roundtree Foundation, a 50% rise over seven years, and a greater proportion of the workforce than police officers or teachers.

The minimum income standard is based on research into what members of the public think households need in order to meet a minimum socially acceptable standard of living, and varies according to the type of household.

RCN Chief Executive Janet Davies commented that “This is a timely pre-Budget reminder that the Government has driven down living standards with year after year of real-terms pay cuts, leaving more nursing staff falling behind the acceptable income standard than other public-sector workers”.

Legal case launched against accountable care contract

The campaign group ‘999 Call for the NHS’ has launched a legal challenge against a national contract published by NHS England in the summer, which will allow for the creation of Accountable Care Organisations (ACOs). The contract would allow the awarding of contracts which pay a fixed price for one provider to deliver NHS services to a whole population, but the group claims this will contradict the requirement in the Health and Social Care Act for payment to be linked to the patients treated and/or the complexity of their treatments.

Commenting on the legal challenge, the group said, “A fixed capitated budget would fail to ensure that there would be enough money to meet the cost of delivering NHS services to the required quality standard.”

NHS England criticised the challenge and said it would “resist this mistaken campaign to frustrate the move to more integrated care between hospitals, mental health and community services.”

Weekly political news round up – 20th October 2017

November 23, 2017 in News by Whitehouse

Overview

This week, a Scottish Lib Dem MSP has called for a national incontinence strategy in a motion tabled in the Scottish Parliament. Labour has warned of the significant variation in access to child health checks from health visitors across England; and several NHS procurement contracts are expected to be awarded to their incumbent providers by the Department of Health. The European Council has decided not to progress to the next stage of Brexit negotiations for now; the release of the 2016 NHS England staff survey has shown concerns from its employees about decision-making; and the chief executive of NHS Providers has set out three NHS challenges which need to be addressed in the Budget.

Scottish Lib Dems call for national incontinence strategy

A Scottish Liberal Democrat MSP, Alex Cole-Hamilton, has tabled a motion calling for a national incontinence strategy in the Scottish Parliament. While discussing incontinence which can occur in women after childbirth, the motion recognises that “incontinence has the potential to affect everyone at some point”, and “acknowledges the taboo around the subject which, [the Scottish Parliament] believes, suppresses an open discussion about it and often prevents people experiencing the condition from seeking help”. He calls for a national incontinence for health and wellbeing benefits as well as cost savings, citing an estimate that incontinence has associated costs of approximately £25 billion a year in Australia.

Speaking about the motion, Cole-Hamilton said, “There’s a view that it’s only linked with old age or infirmity, but it has the potential to affect all age groups and demographics.” In the Scottish Parliament, motions are submitted to “initiate debate or propose a course of action”, and this motion is classed as having achieved cross party support, as it has been supported by six other MSPs.

Labour warns of “huge” variation in health visitor checks

Labour has warned that statistics from NHS Digital show the “huge” variation in the proportion of children receiving required health checks across England. The statistics demonstrated that there were 8,588 health visitors working in the NHS in June, a 9.5% decline from the previous year, and which follows a pledge from the Conservatives while in coalition to increase the health visitor workforce by 50%. The shadow health secretary Jonathan Ashworth commented on the statistics at the Community Practitioners and Health Visitors Association’s conference in Cardiff, labelling them “a damning indictment of the Government’s commitment to tackling child ill health.”

Regionally, only about half of children in London are seen by a health visitor around the time they turn one – and this is as little as 3% in Greenwich. About 61% of children in London receive the two-and-a-half-year check, compared with 90% in the North East and 71% in the South West.

NHS procurement contracts awarded to incumbent providers

It has been reported that the Department of Health is intending to award several significant NHS procurement contracts to their incumbent providers. Ten contracts were tendered to run category towers – which will manage the procurement of certain categories of products once the NHS Future Operating Model is introduced by autumn 2018, replacing the current NHS Supply Chain. These category towers will manage the procurement of items from medical equipment and capital equipment to NHS food and hotel services. Sources have told HSJ that the incumbents NHS Collaborative Procurement Partnership and DHL – which is thought to have partnered with the Oxford Academic Health Science Network and an American health analytics company – will likely be given three contracts each, worth £112 million in total. DHL currently runs the NHS Supply Chain, which covers 40% of the NHS’s expenditure on equipment.

The procurement was intended to increase the proportion of the products procured in secondary care by the category towers to 80%, from the current figure of 40% for NHS Supply Chain, and is hoped to save £600 million overall. A DH spokesperson said that the successful bidders would be announced in due course.

Other health and industry developments

Brexit: European Council delays trade negotiations

The European Council met this week to debate the circumstances under which Brexit negotiations could move on from divorce talks to working out the future trading relationship. It was evident before the meeting that the Council did not believe sufficient progress had been made to move onto the second phase of talks, but the remaining member states confirmed that they will start to discuss the future trading relationship with the UK without its involvement for the time being. Theresa May said that she is feeling “ambitious and positive” about the talks, and German Chancellor, Angela Merkel, said that they were making progress in the negotiations, “step by step”. This tone in negotiations is thought to be derived from a concern among EU leaders that any criticisms of May could further weaken her position in the UK and disrupt talks.

2016 NHS England staff survey shows concerns over decision-making

The results of NHS England’s 2016 staff survey have been made public following a Freedom of Information disagreement between Simon Stevens and the Information Commissioner’s Office. The survey found that only 41% of NHS England staff believe its leaders made decisions in line with the organisation’s values, and 46% said they felt safe challenging how things were done at NHS England. At the time, 35% of staff did not intend to still be working at NHS England in 12 months, and only 47% could do their job without working excessive hours.

NHS Providers sets out three NHS challenges

The chief executive of NHS Providers, Chris Hopson, has outlined the challenges for the NHS which need to be addressed in the upcoming Autumn Budget in an article for HSJ. Hopson says that the Government needs to make available capital funding to reduce the NHS’s backlog maintenance bill, estimated to be £5.5 billion, and to give capital to STPs to help them achieve their transformation goals. He also argued that any pay rise for NHS staff must be funded by the Government, and potentially targeted at specific workforce groups with particularly acute recruitment issues.

Finally, Hopson said that the NHS is in a trap of “There isn’t enough funding to cope with rising demand and meet performance targets but it’s yet to be widely accepted that the targets are undeliverable without the extra funding.” He warns that the NHS shouldn’t promise to deliver further efficiencies in exchange for more funding, as he says this is not realistic.

Weekly political news round up – 13th October 2017

November 23, 2017 in News by Whitehouse

Overview

This week, the Department of Health has announced a consultation on the regulation of medical associates, covering physician associates, physicians’ assistants (anesthesia), surgical care practitioners and advanced critical care practitioners. The consultation wants to seek views on the introduction of statutory regulation for these professions and how proportionate these would be, in light of the Government’s ambition for 1,000 physicians’ associates to work within general practice by 2020.

Parliamentary questions on Excellence in Continence Care guidance answered

Labour MP Mark Hendrick received answers to two written questions on the Excellence in Continence Care Guidance from Public Health Minister Steve Brine. Hendrick asked what progress the Department of Health had made, on measuring reductions in inappropriate or unnecessary catheterisation and catheter associated UTIs, and what statistics there were to demonstrate this; what progress has been made in reducing the number of prescriptions for catheters, out-patient appointments, surgical interventions, and costs relating to pads and other incontinence products. Answering both questions, Brine said that the information is not collected centrally, and did not provide any further information.

Conflicting messages on NHS pay rises

During the first session of Health Questions since the conference recess, the Health Secretary Jeremy Hunt seemed to announce an end to the public sector pay cap. Following protracted campaigning from health unions and the abandonment of the cap for police and prison officers, Hunt had confirmed it would be removed for NHS staff too. However, Hunt then said that “the latitude that the Chancellor has given me with respect to the negotiation of future pay rises is partly linked to productivity improvements that we will negotiate at the same time.”

However, Simon Stevens of NHS England and Jim Mackey of NHS Improvement then told the Health Select Committee that an end to the pay cap could not be funded from further NHS efficiencies. Stevens commented that “We have said from the get go that over time it will be necessary for NHS staff to get rates of pay that are consistent with the rest of the economy. That does need to be funded.” Stevens also said during the evidence session that the decisions taken on NHS funding in the Budget “will determine the shape of the NHS next year and the year after”, indicating that he may have advocated for further funding to ease the funding constraints predicted for 2018/19 and 2019/20.

King’s Fund publishes analysis of nursing workforce statistics

The King’s Fund has published analysis of nursing workforce statistics published by NHS Digital, and has warned that the number of nurses working in the NHS has fallen over the last three months, even when accounting for seasonal fluctuations. The analysis looked back at previous levels of recruitment to the nursing workforce, which averaged 2.3% between 2000 and 2010, before declining between 2011 and 2013 and then increasing again in the wake of the Mid Staffs scandal.

Despite this trend, the number of nurses has fallen over the last three months. The author – the King’s Fund’s director of policy, Richard Murray – argues that a correlation can be drawn between the recent decline and the outcome of the EU referendum, saying “the UK is no longer quite so attractive a destination for clinical staff for obvious reasons.” The chief executive of the Royal College of Nursing, Janet Davies, called for “a new law that makes ministers and others accountable for proper workforce planning and safe and effective staffing levels.”

“Too late” for NHS winter cash injection

The chief executive of the NHS Confederation, Niall Dickson, has written in the Times that a sudden cash injection is unlikely to solve the forthcoming winter pressures on the NHS, and has called on the Government to “revisit the penciled-in figures for 2018/19 and 2019/20” to avoid future crises. Senior NHS figures have repeatedly raised concerns that the potential for a winter flu epidemic is worrying hospitals, and Dickson says that to prevent this from putting pressure on hospitals there needs to be “effective planning and good co-operation across the entire health and social care system, but there is only so much that can be done.” His piece is accompanied by figures suggesting that 92% of healthcare leaders polled by NHS Confederation are concerned about their ability to handle winter pressure.

Brexit negotiations reach “disturbing” deadlock

The UK and EU negotiating teams have held their monthly press conference updating on the state of Brexit negotiations, with the EU’s chief negotiator Michel Barnier concluding that there has been insufficient progress on the first stage of talks to progress to the next stage. The European Council is due to meet next week and was set to decide whether to move on to discussions on the future trading relationship between the UK and the EU, but without this proposition from Barnier, the decision will be delayed until a future meeting.

Barnier made clear that an impasse has been reached because the UK has not made a firm offer on how much it would pay to the EU, stating “On this question we have reached a state of deadlock which is very disturbing for thousands of project promoters in Europe and it’s disturbing also for taxpayers.” However, it was subsequently reported that the remaining member states are set to discuss the future trade relationship without involving the UK. The EU did recognise progress on the Northern Ireland border, while the Brexit Secretary David Davis pointed to developments on citizens’ rights, by clarifying that processes for EU citizens to register with UK authorities will be streamlined.

It is little surprise to those in Brussels that Barnier does not want to progress to the next stage of negotiations. The Government has also had to postpone the next stage of debate on the European Union (Withdrawal) Bill which had been due to take place next week due to the number of amendments tabled. 300 amendments have reportedly been tabled, and Labour claims that at least a dozen of these could be supported by rebellious Conservatives. Such a degree of hostility would make the debate difficult for the Government, given the previous statements from Remain-supporting Conservatives that they were passing the Bill at second reading only if the Government accepted concessions at a later stage.

Weekly political news round up – 6th October 2017

November 23, 2017 in News by Whitehouse

Overview

This week, the Conservative Party conference has seen an announcement from the Health Secretary of an additional 5,000 nurse training places next year, and a troubled speech from the Prime Minister which has reignited calls for her to resign. The Welsh Government has also published its draft budget for 2018/19; and a contract for children’s services in Devon with Virgin Care has been extended.

Health Secretary pledges 25% increase in nurse training places

The Health Secretary has revealed plans to increase the number of training places for student nurses by 5,000, or 25%, in 2018/19 at the Conservative Party conference. The places would be on top of the 10,000 extra places which the Government committed to by the end of 2020/21, which would equate to an additional 15,500 training places between 2018 and 2021. It is expected that £35 million of new government funding which will be confirmed in the Autumn Budget. The announcement came as an investigation by the Nursing Times found that universities have not been able to make additional nursing training available places this year because the funding to do so was only made available in August.

The Government’s accompanying press release highlighted that 5,000 additional nursing associates will also be trained through apprenticeships in 2018 and 7,500 in 2019, who can then work towards being a fully qualified nurse. Jeremy Hunt said that the increase would represent “the biggest increase in nurse training places in the history of the NHS”, and announced additional policies to improve NHS staff retention including “new flexible working arrangements to be made available to all NHS staff, and a new right of first refusal for affordable housing built on NHS property.”

Conservative Party conference: May’s leadership threatened

The Prime Minister’s authority has been threatened following her speech at the Conservative Party conference this week, which was beset by a prank and difficulties with her voice. While May announced a review of mental health legislation and additional funding for 25,000 council houses over five years, the problems with the speech overshadowed these, and some accused her of pursuing a “Labour-lite” agenda and lacking policy ideas. The difficulties have resulted in renewed calls for her to resign, yet several members of the Cabinet, including Amber Rudd and Michael Gove have defended her leadership.

It has emerged that the group of backbenchers reported to be preparing to call for May to resign has been led by the former party chairman Grant Shapps. Shapps claims that 30 MPs have agreed they would push for her to quit, but this falls short of the 48 MPs needed to trigger a leadership challenge. There are concerns that another leadership contest would disrupt Brexit negotiations and jeopardise their progress onto trade talks in the coming month – and a YouGov poll has indicated that voters do not overwhelmingly support the Prime Minister standing down now, with 39% thinking she should remain and 38% thinking she should go.

Welsh Government publishes draft budget

The Welsh Government has published its draft budget for 2018/19, which includes a £450 million increase for the NHS. Cabinet Secretary for Finance and Local Government, Mark Drakeford, said this was not a “generous settlement”, but that it couldn’t be increased because of the UK government’s “flawed and foolish policies of austerity”. The additional funding will be split into £230 million in 2018/19 and £220 million in 2019/20, but this will only represent a 1% increase when accounting for inflation.

The Welsh Local Government Association responded to the budget by stating that councils will need to increase council tax by 5% to fund the budgets commitments. The Health Foundation praised the funding allocation while highlighting that savings of 1% per year will need to be maintained “to allow for maximum funding for long term transformation and sustainability.” It also pointed to the pressure to lift the NHS pay cap in Wales, stating that this it will “substantially increase the pressure on existing budgets” unless the UK government provides additional funding.

Virgin Care given extension of Devon children’s services contract

Virgin Care’s contract to provide children’s services in Devon has been extended by the local CCGs and Devon County Council .The contract was due to finish in March 2018, but has been extended by a year to allow procurement of a new service for up to ten years. The contract provides services for mental health, school nursing, health visitors and care for disabled children and young people, and has been subject to a consultation which took views from 800 service users, parents and professionals.

The extension to the contract is worth £35 million, indicating that if a new contract is awarded for up to ten years as suggested, it could be worth hundreds of millions of pounds. The new service could be provided for more than five days a week; offer a “locality based “integrated front door”” to a range of services; and provide a rapid triage process for referrals by a coordinator supported by professional expertise.

Weekly political news round up – 29th September 2017

November 23, 2017 in News by Whitehouse

Overview

This week, NICE has published updated guidelines on urinary tract infections (UTIs) in children and young people. The first, guidance on urinary tract infection in under 16s: diagnosis and management, has had its named changed from ‘urinary tract infection in children: diagnosis, treatment and long-term management’, and includes changes to some recommendations on urine testing strategies for infants and children under 3 years. The second, a quality standard on urinary tract infection in children and young people, has been updated to ensure it is in line with the guidance on UTIs in under 16s and describes what high-quality care should look like in priority areas for improvement.

Elsewhere, the Department for Education has appointed Sir Theodore Agnew to be Academies Minister to replace Lord Nash. The shadow health and education secretaries have given keynote speeches at the Labour Party conference; and the GMB union has criticised the Government’s delay in lifting the public sector pay cap.

New Education Minister appointed

The Government has appointed a new minister to replace the Academies Minister Lord Nash, who is leaving government following his drive to implement the academies system since January 2013. The new minister will be Sir Theodore Agnew – who will be given a peerage to assume the role – who has previously sponsored the Inspiration Trust academy chain and chaired the academies board at the Department for Education. Sir Theodore has also previously worked with Michael Gove at both the Department for Education and the Ministry of Justice, and was a “leading candidate” for the chairmanship of Ofsted in 2014.

Lord Nash’s departure has been viewed by some as concerning for the further development of the academies programme, with one unnamed stakeholder commenting that he was “among the last of the old school of Gove-era ministerial education reformers.” Sir Theodore’s appointment has, however, been interpreted as an additional move away from the creation of new grammar schools, given that he has previously stated that he doesn’t believe in grammar schools, as failing the 11-plus exam made him that “I’m a second class citizen from this day.” He has also previously funded research by the centre-right think tank Policy Exchange which argued for the pupil premium for disadvantaged students.

Shadow health and education secretaries speak at Labour Party conference

The shadow health and education secretaries, Jonathan Ashworth and Angela Rayner, have given speeches to the Labour Party conference building on their party’s manifesto commitments. Ashworth reiterated the party’s commitment to an additional £45 billion in funding for health and social care, and used his speech to call for a £500 million winter fund for the NHS to assist with pressures on A&E departments. On child health, Ashworth said that Labour would “recruit more health visitors for our communities […] And we’ll end the disgraceful cuts to child and adolescent mental health budgets, end the scandal of children being treated on adult wards, and finally deliver true parity of esteem.”

Angela Rayner, who has been tipped as a future Labour leader, elaborated on the party’s manifesto commitment to a National Education Service; pledged to allocate £500 million a year to Sure Start centres; and “provide the full £13 billion needed for the existing school estate.” Jeremy Corbyn’s speech was set against a more united backdrop within the party than the previous year’s, and called for the Prime Minister to “make another impetuous decision” in calling another election.

Union criticises delay in lifting public sector pay cap

The trade union GMB has called on the Government to lift the public sector pay cap before the Autumn Budget on 22nd November. The recent announcement by the Government that police and prison officers would receive a pay increase was branded a “token gesture” by the union – given the speculation beforehand that the cap would be lifted for all public sector workers. GMB’s national secretary for public services, Rehana Azam, said that the Government “claims the pay freeze has been broken. Well, do not believe a word of it.”

Azam also highlighted that “over half of public sector workers are not even covered by independent pay review bodies”, meaning that the announcement would not apply to them. The comments came in the same week that the Royal College of Nursing warned that it would ballot its members on strike action if the pay cap is not lifted in the Budget, and said it would be looking to discuss the issue with Conservative MPs at next week’s party conference.

Nurses say NHS staff shortages causing patients to die alone

A Royal College of Nurses survey has revealed deep concerns among nurses about the impact of staff shortages in the NHS on seriously ill and vulnerable patients. This week the RCN canvassed 30,000 members – including midwives and health care support workers – with the survey revealing a range of issues for patients caused by a lack of time NHS staff were able to dedicate to individuals’ care.

The RCN described some of the stories it received through the survey as “desperately sad”, but “sadly all too familiar”. According to the BBC, there were reports of situations where patients had died alone, as their nurses and carers did not have time to cover all of their responsibilities. RCN general secretary Janet Davies said, “when this many professionals blow the whistle, they cannot be overlooked.” A spokeswoman for the Department of Health said that the numbers of nurses in training is increasing, and said there would be another 10,000 in the workforce by 2020. A report by the union earlier in the year found that one in nine existing posts are vacant, with the steep decline in the number of EU trained nurses applying to work in the UK since the EU referendum last year exacerbating the shortages.

King’s Fund warns that hospital bed closures go too far

The number of NHS hospital beds has been cut in half over the past 30 years, and a new report from the influential think-tank, the King’s Fund, has warned that proposed closures outlined through Sustainability and Transformation Plans are “neither desirable nor achievable”. The report shows that the number of hospitals beds per head of population in England is lower than that of any other EU country, at 2.3 per 1,000 people, as compared with the European average of 3.7 per 1,000.

The report’s author – Helen McKenna – said that while many historic bed cuts had been related to advancements in healthcare services, current proposals to reduce beds are so extreme that they may jeopardise patient safety, and seriously impact the quality of care within “hospitals already stretched to breaking point” as the NHS prepares for what is anticipated to be a difficult winter. An NHS England spokesman said that “work is underway to free up 3,000 more (beds) by improving the availability of community health and social care”, while saying that the national commissioner has “introduced an explicit test to prevent inappropriate bed closures.”

NICE updates guidance on urine testing for children

NICE has issued an update to its clinical guidance on urine testing, in the review of its guidelines for Urinary tract infection in under 16s: diagnosis and management. The Committee, which approved the changes to the existing guidelines first developed in 2007, changed the specific guidance for urine testing to recommend dipstick testing in infants and children aged 3 months or older but younger than 3 years. It also recommended referral to specialist paediatric care for all children under the age of 3 months, given concerns about sepsis in infants. The full explanation for the revisions to this guidance can be found here.

Weekly political news round up – 22nd September 2017

November 23, 2017 in News by Whitehouse

Overview

This week, concerns have been raised by the RCN’s London regional director that the Sustainability and Transformation Partnerships (STPs) planned for London do not have sufficient resources or appropriate workforce plans to produce change. Statistics have shown that nearly 10,000 NHS staff from the EU left the health service in the year after the Brexit vote, while the Health Select Committee has launched an inquiry into medicines and medical devices after Brexit. The Prime Minister is also set to announce her proposals for a two-year transitional Brexit deal at a speech in Florence.

Concerns raised about London STP resources and joint working

The RCN’s London regional director, Bernell Bussue, has warned in a blog post that Sustainability and Transformation Partnerships (STPs) planned for the city have not been allocated appropriate funding or staff to facilitate the changes they outline. While Mr Bussue endorsed the plans’ ambitions to move care into the community and close the NHS funding gap, he said, “there are huge questions still to be asked of the plans themselves, particularly when it comes to protecting patient care and the nursing workforce.” The proposals in some of the plans to reduce the number of nurses were highlighted as an area of concern, with Mr Bussue stating that “We need more nurses, not less.”

Meanwhile, a separate survey by the Chartered Institute of Public Finance and Accountancy and iMPOWER has found that very few STPs are or will be able to deliver full joint working between health services and local authorities, despite this being a key ambition of the plans. Fifty-five of the 56 organisations that answered the survey held this opinion; while only 15% of respondents anticipated being able to access funding to facilitate prevention even though this was considered essential or important by 95% of organisations.

Nearly 10,000 EU staff quit NHS since Brexit vote

Statistics from NHS Digital have shown that nearly 10,000 EU nationals working in the NHS have quit since the vote to leave the EU, prompting a renewed call for EU citizens to have their right to live in the UK guaranteed. Between June 2016 and June 2017 9,832 doctors, nurses and other health professionals from the EU had left the NHS, rising by 22% on the previous year and 42% on the year before that. Nearly 40% of those who left were nurses and 18% were doctors – a lower figure than predicted in a survey by the British Medical Association, which said that its research indicated that 40% of EU doctors were considering leaving since the referendum.

The data produced a call from the BMA to “end the uncertainty and grant EEA [European Economic Area] doctors working in the NHS permanent residence, rather than using them as political pawns in negotiations.” The leader of the Liberal Democrats, Sir Vince Cable, also called for the Prime Minister to “make a bold offer to the EU to ringfence negotiations on citizens’ rights and come to a rapid agreement.”

Health Committee launches inquiry into medicines and medical devices after Brexit

The Health Select Committee has announced it will be examining the regulatory arrangements required around medicines, medical devices and substances of human origin to “guarantee safe and effective supply” of these products after Brexit. The Committee wants to explore what the implications of Brexit for the life science industry, and medical research and development, will be. The terms of reference poses questions including:

  • What are the key considerations that arise for companies, healthcare services and regulatory bodies in the UK as a result of the UK’s withdrawal from the EU? Focussing on patients and the public, what needs to be done to ensure that any adverse impact is minimised or eliminated, and that opportunities to enhance services are maximised?
  • Following the UK’s withdrawal from the EU, what alternative arrangements for the regulation of medicines, medical devices, medical products and substances of human origin could be introduced? What are the respective opportunities, risks and trade-offs involved?
  • What are the implications for medical research and development, including for the timely patient access to new medicines, technologies and other relevant medical innovations developed within or outside the UK? How can any adverse consequences be avoided or mitigated and any potential opportunities be enhanced?

May to announce two-year transitional Brexit deal

The Prime Minister is set to announce her intention to seek a transitional deal to leave the EU, with the possibility of different sectors of the economy leaving the EU at different times to mitigate fears of a “cliff-edge Brexit.” The proposed two-year deal would be in place from March 2019. It is thought that this will be accompanied by continuing with the UK’s budget contributions to the EU for a defined period of time, and while these have not yet been set out there is speculation it will meet the UK’s existing contributions of around £20 billion.

The proposed deal was subject to extensive consultation with the Cabinet this week, and is being pushed in an attempt to make further progress on exit negotiations – with the EU having stated that future trade talks will not begin until the UK has settled issues including the Brexit bill. Mrs May had faced difficulties earlier this week with the Foreign Secretary Boris Johnson, following the publication of an article by him raising his concerns about the possibility of a “soft Brexit” and subsequent speculation that he would resign from the Cabinet over the issue. The pursuit of a flexible exit with a transition deal marks a victory for the Chancellor Phillip Hammond, while the EU’s chief Brexit negotiator Michel Barnier called for the UK to “settle the accounts – no more, no less”.

Weekly political news round up – 15th September 2017

November 23, 2017 in News by Whitehouse

Overview

This week, the Government won a vote on the second reading of the European Union (Withdrawal) Bill, in what was seen as one of the first key parliamentary tests for the Government in passing the legislation through the House of Commons. No Conservative MPs opposed the Bill, and seven Labour MPs voted with the Government against the instruction of their party to vote against the Bill. Further consideration of the Bill at third reading stage is likely to provoke further debate on key issues such as restrictions on immigration from the EU and what powers will be transferred from the EU to Westminster.

Health Committee launches inquiry into shortage of nurses

The newly re-formed Health Committee has launched its first inquiry, looking at the shortage of nurses in England. The committee highlights statistics published by the Nursing and Midwifery Council in July 2017 which found that more nurses are now leaving its register than joining; it also pointed out that there have been frequent reports of increasing vacancy rates and a lack of incentives to join the profession. The terms of reference request evidence on “the current and future scale of the shortfall of nursing staff and whether the Government, arms-length bodies, NHS, community and specialist providers and other partners have effective plans in place to recruit, train and retain this vital workforce.”

The inquiry will also look at the impact of new routes into nursing, including student funding reforms, the Apprenticeship Levy, Nurse First and nursing associates. The committee would like to “receive suggestions for how policymakers could optimise the potential of new routes into nursing, as well as how they might retain and deploy existing staff more effectively.” The effects of Brexit and language testing will also be explored.

RCN publishes response to NMC consultation on pre-registration nurse education standards

The RCN has published its response to the Nursing and Midwifery Council’s consultation on pre-registration nurse education standards. The RCN surveyed 7,380 members online and invited more than 600 to participate in 18 workshops. The response focused on the broader standards rather than specific elements of practice, and supported the NMC’s ambition for all nurses to be able to complete full assessments of patients regardless of their field of practice. It also praised the consultation’s attempts to reduce “unwarranted variation” in the pre-registration of nurses across the four fields.

Contributions to the response noted areas for improvement in the standards, with the RCN’s Children and Young People forum highlighting that training on “elimination: normal, assisted, urostomy, stoma care” was missing from the standards. The response called for continuing professional development to continually update skills and knowledge among the workforce. The RCN’s Head of Professional Learning and Development, Dr Anne Corrin, said that the College’s response noted “the importance of investing in the current nursing workforce to ensure these new standards can be fully implemented in practice” in addition to ensure that nursing can respond to future needs.

Health unions demand 3.9% pay rise for NHS staff

14 health unions have called on the Government to give NHS staff a 3.9% pay rise and an £800 bonus, at a cost of £2.5 billion, on the back of the lifting of the 1% pay cap for police officers and prison workers. In a statement on Tuesday, the Government announced that these groups of workers would receive at least a 1.7% pay rise, but did not comment on other public sector workers. While it is anticipated that the Autumn Budget will address this to some degree, the letter calls for the Government to take action to address recruitment and retention problems.

The letter was signed by unions including the Royal College of Nursing and Royal College of Midwives, but not by the British Medical Association, which represents doctors. Sara Gorton, head of health at Union, said “NHS staff and their families need a pay award that stops the rot and starts to restore some of the earnings that they have been missing out on.” The chief executive of the NHS Confederation, Niall Dickson, warned that any pay increases should be funded through additional money for the NHS rather than from existing budgets – as was the case for a recent increase in schools funding, taken from elsewhere in the Department for Education’s budget.