Weekly political news round up – 1st December 2017

February 20, 2018 in News by Whitehouse

This week, NHS England has published its initial thoughts on the consultation on items which should not be routinely prescribed in primary care, which could implement restrictions on over the counter medications for constipation. The Health Select Committee has resumed its inquiry into STPs, and leaders from the Royal College of Nursing have been criticised for having a positive reaction to the Budget. NHS England has also published a planning paper discussing waiting time standards and prescriptions.

NHS England board paper proposes restrictions to OTC medications for constipation

An NHS England board paper has confirmed that following the consultation on items which should not be routinely prescribed in primary care, a number of items will be removed from prescriptions to save £141 million per year. The paper also said a consultation will be launched on restrictions to prescriptions for some over the counter (OTC) products, either where they are products used to treat minor conditions; products used to treat both minor and non-minor conditions; and products used to treat non-minor conditions. The restrictions on products for minor conditions could save approximately £190 million per year.

‘Simple constipation’ is given as an example of a condition caused by a “lack of fibre in the diet [which] can be considered minor and treated with an OTC product” – although it acknowledges that constipation can sometimes be a side effect of other drugs or conditions, such as terminally ill patients using morphine. The paper concludes that “We therefore expect around 20% of OTC prescribing for drugs in this category to be for minor conditions. We do not propose restrictions on OTC prescribing for non-minor conditions.”

The paper stated that NHS England will publish draft guidance in January 2018 to consult with CCGs, patients, clinicians, professional and other stakeholder bodies. The outcome of this will be “a consistent, national framework, in the context of which local CCGs will be able to decide whether and how to implement the national clinical commissioning guidance, with due regard to both local circumstances and their own impact assessments.”

Health Select Committee resumes STPs inquiry

The Health Select Committee has resumed its inquiry into STPs which was launched earlier this year but cut short by the general election. The Committee specifies that it will be taking a national view of the STP process rather than commenting on individual plans, and will look at areas including:

  • How effective have STPs been in joining up health and social care across their footprints, and in engaging parts of the system outside the acute healthcare sector, for example primary care, local authorities, public health, mental health and voluntary sector partners? How effectively are they engaging local communities and their representatives?
  • Looking across all STPs, are there any major areas where the content of the plans needs to be tested for credibility and realism? Are there any major gaps? For example, are proposals in some plans to reduce bed capacity credible? Are the NHS efficiency estimates in STPs robust? Is the workforce available to enable the implementation of STPs? Is the timescale for the changes proposed in STPs realistic?
  • What public engagement will be necessary to enable STPs/ACSs to succeed, and how should that engagement be undertaken?

RCN leaders criticised for “positive” Budget response

Regional leaders from the Royal College of Nursing have criticised both the Chancellor for not going far enough to increase nurses’ pay in the Budget, and national RCN leaders for delivering an “underwhelming” response to the Budget. The regional leaders said in an open letter that the national RCN leaders should not have welcomed the Chancellor’s pledge to provide additional funding for a pay increase for NHS staff if it is agreed with pay review bodies, as the pay increase has not been finalised yet.

Health unions also warned that the Government risked a similar situation to the junior doctors’ contract dispute if the Health Secretary’s suggestion – that overall pay could be increased to the detriment of additional pay for weekend and overnight working – materialises. Jeremy Hunt made the suggestions during an interview with HSJ this week, which he said would introduce “modern professional pay structures” for the NHS. The head of health at Unison, Sara Gorton, said “If the government is expecting staff to pay for their own wage rise, it’ll be a very short set of talks indeed.”

NHS England planning paper discusses waiting time standards and prescriptions

NHS England has published a planning paper in response to the Budget, discussing the possibility of waiting time standards not being met as a result of the NHS’s funding settlement. The paper warned that difficulties in achieving enough efficiency savings to work with the funding available will mean that “the NHS will likely not be able to do everything being expected of it”. Building on previous statements that elective care waiting time standards are unlikely to be met next year, the paper says that while there will be “some difficult judgements about priorities” needed, NHS England leaders are not prepared for mental health, cancer and primary care services to be used as a “balancing item” to fund other services.

Weekly political news round up – 24th November 2017

February 20, 2018 in News by Whitehouse

This week, the Government’s Autumn Budget allocated £2.8 billion in funding to the NHS over the next three years, but neglected to address pressures on education or social care budgets. MSPs has debated a motion on incontinence in the Scottish Parliament, and MPs have discussed the need for more Changing Places toilets in Westminster.

Autumn Budget update

The Chancellor has presented his first Budget to the House of Commons since the main budget moved to the Autumn. He presented figures on economic growth from the Office of Budget Responsibility (OBR), indicating that forecasts for GDP growth have been revised down from those presented earlier this year – GDP is predicted to grow by 1.5% in 2017 (revised down from 2% in March), 1.4% in 2018, 1.3% in 2019 and 2020, 1.5% in 2021 and 1.6% in 2022.

The outcome of the general election, and the impact that constricted public spending had on the Conservatives’ performance, meant that this Budget was viewed as a crucial opportunity by the Government to focus on the domestic policy agenda and bring back voters lost to Labour in June. However, one of the Chancellor’s key announcements was the allocation of an additional £3 billion fund for Brexit preparations during this financial year, followed by £1.5 billion in both 2018/19 and 2019/20, alongside £700 million previously announced.

The key announcements for the PCF included a pledge of an additional £2.8 billion to meet NHS revenue pressures over the next three years, including an immediate injection of £350 million to help with winter pressures. This was a reaction to the calls from health service leaders for additional funding, but did not go as far as meeting the additional £4 billion which Simon Stevens said the NHS needs to meet rising service demands. The NHS was also allocated £3.5 billion in capital funding, to act on the recommendations of the Naylor Review of NHS property and estates. The Budget document stipulates this funding will “allow the NHS to increase the proceeds from selling surplus NHS land and buildings to at least £3.3 billion”, and will be accompanied by other private sector investment in the healthcare estate.

There was also a decision announced to launch a call for evidence in 2018 on how “the tax system or charges could reduce the amount of single-use plastics waste, building on the success of the existing plastic carrier bag charge.” There are no further details on this at present, including on whether it would affect products such as catheters. Finally, there was confirmation of the decision to delegate the decisions on public sector pay increases to Pay Review Bodies in 2018/19, alongside a commitment from the Chancellor to fund a pay increase for NHS staff with new funding if that is the decision taken.

Responses from the health sector suggested that while the NHS received more funding than expected, this is not enough to meet the needs of the health service over the coming years. The outgoing national medical director at NHS England, Sir Bruce Keogh, tweeted that his personal opinion was that the Budget “plugs some but [definitely] not all of [the] NHS funding gap. [It will] force a debate about what the public can and can’t expect from the NHS. Worrying that longer waits seem likely/unavoidable.” The director of policy for The King’s Fund, Richard Murray, warned that “Even with this additional funding, the service will struggle to meet key targets and provide the investment needed in services such as general practice and mental health.”

Moreover, responding to the Chancellor’s assurance that the Government would fund a pay rise for NHS staff outside of its existing budget, the Royal College of Nursing called for the Government to make this a “meaningful” pay rise not linked to productivity improvements. The College said, “with more talk of reform and productivity, Hammond runs the risk of insulting nurses who regularly stay at work unpaid after 12-hour shifts.”

Scottish Parliament debates incontinence motion

Members of the Scottish Parliament have debated the motion on incontinence tabled by Alex Cole-Hamilton MSP several weeks ago, calling for a national incontinence strategy. Cole-Hamilton recognised from the outset of the debate that “women and men of all ages suffer [with continence issues] in silence”, but did not address the issues facing children with bladder and bowel problems at any point. He highlighted the costs associated with incontinence, ranging from product provision, medication, surgery and treatment of mental health conditions associated with the difficulties. Based on a study in Australia in 2010, he estimated that continence problems could cost approximately £5,000 per person each year.

The Conservative MSP Annie Wells also suggested that, according to the Scottish intercollegiate guidelines network’s 2004 clinical guideline on the management of urinary incontinence, “Urinary incontinence is not a condition in itself but is a symptom resulting from one or more underlying conditions.” She therefore argued that “the effective treatment of urinary incontinence depends wholly on thorough assessment and diagnosis.” Meanwhile the Labour MSP Monica Lennon raised the importance in access to public toilets.

Responding on behalf of the Scottish Government, the Health Secretary Shona Robison said that her ambition for Scottish continence services is “that patients should see the right person at the right time, and certainly early enough, to provide them with support and advice on how to manage their condition.” She concluded by saying “I am happy to ask the chief medical officer and the chief nursing officer to write jointly to NHS boards to reinforce the importance of a continence service that is person centred and tailored to people’s needs, including prevention and early intervention.”

MPs discuss Changing Places toilets

The Conservative MP for Eastleigh, Mims Davies, has questioned the Government on its work to “ensure that changing facilities are available in toilets for people with disabilities”, during a session of Oral Questions on Women and Equalities. In response to her question, the Communities and Local Government Minister Jake Berry highlighted the Government’s collaboration with the Changing Places campaign and Mencap, and the funds provided for a “searchable application to enable people to find their nearest Changing Places lavatories.”

The SNP MP Dr Lisa Cameron MP, who is also a member of the Health Select Committee and Chair of the APPG for Disability, also asked the Government whether they would consider putting Changing Places toilet on a statutory footing, due to “repeated distressing stories about disabled children being changed on toilet floors owing to lack of provision.” Berry implied in his answer that an ongoing review of building regulations may take action to increase the number of Changing Places toilets across the country, but suggested this would require changes to existing regulations.