Weekly political news round up – 27th April 2018

April 27, 2018 in News by Whitehouse

Overview

Prime Minister, Theresa May, and Home Secretary, Amber Rudd, have been widely criticised for implementing policies which have seen many people who moved to the UK from the West Indies in 1948 as part of the ‘Windrush Generation’ deported after wrongly being identified as illegal immigrants. The policies were enacted during Mrs. May’s tenure as Home Secretary. when policy papers from her Department detailed “a really hostile environment” for illegal immigrants. During her tenure at the Home Office legislation was brought about which compelled public service providers, including NHS staff, to withhold services from people who could not prove their citizenship, despite the fact that the landing cards of Windrush immigrants had been destroyed. The policy has been criticised by some who felt it could have a negative impact upon community cohesion. Mrs Rudd had committed to increasing the number of deportees by 10 percent a year. The Government has since issued a formal apology, but the media storm continues.

King’s Fund reports on the rising cost of medicines

The King’s Fund has published a report entitled The rising cost of medicines to the NHS: what’s the story? in which it reviews how much the NHS spends on different kinds of medicines and the impact of the Pharmaceutical Price Regulation Scheme, as well as predicts likely medicine price controls policymakers are likely to implement in the future. It references NHS England’s OTC consultation and it highlights that “policymakers have recently sought to exert greater control over medicines expenditure” to handle the growing incompatibility between spending and budget.

The report finds that “NHS spending on medicines in England has grown from £13 billion in 2010-11 to £17.4 billion in 2016-17”, which averages a five per cent increase a year. This increase has disproportionately impacted the hospital sector, which has seen an average increase of 12 per cent. In primary care, the almost doubling of prescription items provided to patients in the decade to 2016 has been offset by a nearly 25 per cent reduction in the average cost of prescription. It concludes that “Without a new funding settlement for the NHS, policy-makers are likely to face increasingly difficult choices. There is a risk of returning to the position of the 1990s, when funding pressures led to widespread concern about patients’ access to medicines.”

This report by the influential King’s Fund raises questions about the effectiveness and sustainability of cost-saving measures such as prohibiting the prescribing of OTC medicines considering the scale of savings required.

RCPCH publishes report calling for more healthcare resources to keep children safe

The Royal College of Paediatrics and Child Health has published its Facing the Future: Standards for Acute General Paediatric Services. It says that more resources are needed for children’s health services to prevent doctors from “burning out” and services becoming “more unsafe”. It calls for an increase in paediatric consultant presence during peak hours, which are 8 a.m. and 10 p.m., to improve hospital care. It found that most wards could not guarantee a consultant would be present, even at busy times and called for between 84 and 110 extra consultants to be recruited in Scotland over the next five years, considering units were often unable to deliver consultant support and most units do not have a “linked consultant paediatritian” for GP practices.  The report calls for the Department of Health and Social Care to identify “the barriers to implementing guidelines and standards then create an action plan to overcome them”. It says that the Government must commit to developing a cross-departmental child health strategy for England by 2019”.

Dr Carol Ewing, RCPCH vice president for health policy, said: “It is down to the sheer dedication of our doctors that children are being treated as safely as they possibly can on paediatric wards in the UK but the risk of ‘burn-out’ is all too real.”

We will continue to monitor for the development of a cross-departmental child health strategy for England and seek ways in which to engage.

CCG risks NHSE intervention over deficit plan

HSJ has reported that Hambleton, Richmondshire and Whitby CCG held an extraordinary board meeting this week, as it realised that it will not meet its breakeven control total for 2018-2019. It faces a £4 million deficit, which might result in action by NHS England. The CCG had an allocation of £186m for 2017-18, which will rise to £188m this year, according to the latest NHSE figures. It had a forecast outturn deficit of £6.7 million for 2017-18, having ended the previous three years in surplus. The CCG’s breakeven control total means that it is not eligible for any commissioner sustainability funding.

A spokeswoman for the CCG said: “The governing body confirmed that the CCG will be submitting a deficit plan for 2018-19 of £4.05 million. The plan does not meet the requirement to breakeven and there will therefore need to be further discussion with NHS England on the next steps.”

This news further demonstrates the extent of the financial constraints some CCGs are findings themselves in. As they will continue to look for cost-saving measures, continence care remains under threat of cuts. It is important that the PCF continues its engagement in this area to highlight the long-term cost savings that treating continence issues early generates, and especially so when such services may have to compete for funding.

Weekly political news round up – 20th April 2018

April 20, 2018 in News by Whitehouse

Overview

The seventh Global Forum on Incontinence has been in the press this week, which is sponsored by many PCF members and will feature on the PCF website in the coming days. The event brought together more than 300 patients, carers, policy-makers, health and social care professionals and NGOs from around the world.

Pioneering new outcome measures could improve standards of incontinence care

The Nursing Times has reported on ‘Measuring Outcomes to Improve the Management of Continence Care,’ the “definitive” set of outcome measures and key performance indicators for toileting and containment strategies that were launched at the GFI this week, and credited Essity for leading the study. It listed the 14 recommended KPIs:
• Proportion of staff with the skills to perform a continence assessment and prescribe a toileting and containment strategy • Proportion of persons with incontinence in receipt of pads with a documented assessment and formulation of a toileting and containment strategy • Mean number of days from referral to assessment for persons with incontinence who require a toileting and containment strategy • Proportion of persons whose toileting and containment strategy is reviewed • Proportion of persons with incontinence who receive education on toileting and containment strategies • Proportion of persons with incontinence deemed eligible for a toileting and containment strategy who are offered a choice of product type following assessment of incontinence
• Proportion of persons with incontinence and incontinence associated dermatitis who receive a toileting and containment strategy • Proportion of persons with incontinence with an indwelling catheter to manage incontinence • Proportion of persons with incontinence managed with a toileting and containment strategy who report “good” or “acceptable” levels of access and support to toilet facilities in their daily life • Persons with incontinence managed with a toileting and containment strategy who report sustained or improved emotional wellbeing • Proportion of persons managing incontinence with a toileting and containment strategy who are either able to remain in work or take up work • Cost of hospital admissions and re-admissions related to poor management with toileting and containment strategies for incontinence
It quoted a number of people from the research panel, such as Professor Adrian Wagg, from the University of Alberta in Canada, who said: “This study has identified the type of outcomes upon which we should focus and has produced tangible KPIs which, if embedded in quality frameworks, will help to advance standards of care.” Mattias Abrahamsson, Vice President for Incontinence Care and Global Hygiene at Essity, said: “We hope the output from this study will make a tangible contribution to the improvement of care provision for people living with incontinence and be adopted by national health and social care systems.”
The Nursing Times has also published a review of the guidance, calling the diagnosis and treatment of continence issues using the continence assessment “a fundamental nursing skill”. In the article, it advocates consideration of the patient’s “complete medical, surgical, neurological, obstetric, mental health and social history” as well as environmental factors, the medications the patient takes, a review of their typical symptoms, quality of life and diet, as well as dipstick urinalysis, post-void residual urine volume, vaginal, rectal, abdominal, neurological examinations.
The article outlines the purpose of the continence assessment has being “to help identify the causes of, and factors contributing to, urinary and faecal symptoms” as well as to determine how long the problem has persisted, the symptoms and presentation of the condition, the effect on quality of life, and how it is currently managed. It also refers to the negative wider implications continence issues can have on a person, spanning their “physical, emotional and financial wellbeing,” including increasing the risk of urinary tract infections, falls and skin damage.
This is very positive press for a PCF member and we will promote it on the PCF website when we have sign-off on the pictures.

Education Select Committee launches inquiry into SEND provisions

The Education Select Committee has launched an inquiry into SEND provisions, particularly those transitioning into further and higher education, and the impact of reforms introduced by the Government in 2014. The Committee says, “The Government claimed these changes would give families greater choice in decisions.”
Education Committee chairperson, Rt Hon Robert Halfon MP, said: “It has been four years since major SEND reforms were introduced and it’s important we examine whether the Government’s stated ambitions for simpler, improved and consistent help for children and young people with SEND have been met. There are rising concerns about the quality and access to SEN provision which the Committee will want to explore in this inquiry. The Committee’s current inquiry into alternative provision has heard considerable evidence that children with special educational needs are disproportionately excluded from school and over-represented in alternative provision. During the course of our quality of apprenticeships and skills training inquiry we’ve also heard that with young people with SEN have faced significant barriers in accessing apprenticeships.”
The deadline for written submissions to the inquiry is 14th June. We will review whether it would be beneficial for the PCF to make a submission.

Labour pledges to increase mandatory healthcare for babies

Labour has pledged to provide £25 million to a mandated visit for every baby in England between three and four months old. The announcement cites “experts” highlighting the particular risks faced by mothers at that time. Shadow Health Secretary Jonathan Ashworth outlined analysis that demonstrated the extent to which healthcare for children had decreased, namely through the termination of the national Health Visitor Programme in 2015, since which time the number of health visitors has decreased by 20 per cent. The analysis also found that 17 per cent of babies have missed out on their six to eight-week review nationally, and a third of babies in London.
Labour also pledged to “work towards ensuring all maternity services achieve and maintain UNICEF’s UK Baby Friendly Initiative accreditation- as already occurs in Scotland and Northern Ireland, and is recommended by NICE as a minimum standard.”
Complementing the announcement that it would invest in more health visiting for children, Mr Ashworth has penned an article for The Times which he opened with the famous quote by Nelson Mandela: “There can be no keener revelation of a society’s soul than the way in which it treats its children.” Mr Ashworth highlighted mortality and obesity as some of the problems facing the UK’s children today, and the causes for the UK’s child health outcomes “stalling”.

Weekly political news round up – 13th April 2018

April 13, 2018 in News by Whitehouse

Overview

With Parliament in recess, Jeremy Hunt has come under fire for failing to disclose his purchase of several luxury flats in Southampton. The Health Secretary has been referred to the parliamentary standards commissioner, as he failed to follow House of Commons regulations which require all MPs to register any business holding higher than 15% within 28 days of purchase. Hunt has apologised, whilst the Cabinet Office insists he has not breached the ministerial code.

The Health Secretary’s difficulties come in a week in which the BBC revealed that A&E waiting times have reached their highest levels in England since records began in 2004. 88.4% of patients across the country were seen within the 4-hour target, below the 95% level set in the NHS constitution. The worst performing hospital against this metric was the Princess Alexandra hospital in Essex, where only 71% of patients were seen within the target time.

The 95% national standard was reached for the best part of a decade from 2005, but performance has dipped below this mark and declined exponentially since 2014/15. Phillippa Hentsch, from NHS Providers, said the figures “underlined the urgency of the problems facing the NHS”, while a Department of Health and Social Care spokesperson said the Prime Minister has committed to releasing a long-term funding settlement for the NHS later this year.

NMC launches consultation on standards for nursing associate

The Nursing & Midwifery Council has released proposals on how they will regulate the new nursing associate role. This role will ‘bridge the gap between healthcare assistants and registered nurses in England’. The NMC has highlighted that they expect ‘ambitious standards of proficiency’ to bring about ‘first class care’. Under the plans, nursing associates would also be subject to the same revalidation requirements as nurses and midwives when renewing their registration with the NMC, as well as the same fitness to practice processes should something go wrong. Full details on the consultation may be found here.

Continence is specifically mentioned in the Draft Standards of Proficiency for Nursing Associates, which states that ‘to provide support with bladder and bowel health’, the nursing associate must demonstrate the ability to: A.) Observe and monitor the level of urinary and bowel continence to determine the need for ongoing support and intervention, the level of independence and self management of care that an individual can manage. B.) Assist with toileting, maintaining dignity and privacy and use appropriate continence products including pads, sheaths and appliances. C.) Care for and manage catheters for all genders and help with self-catheterisation. D.) Recognise bladder and bowel patterns to identify incontinence, constipation, diarrhoea and urinary and faecal retention. E.) Undertake stoma care.

Majority of voters back tax rise in aid of the NHS

Most UK taxpayers would be willing to pay more to support the NHS, according to a British Social Attitudes Survey. The poll found a significant shift in attitude among Conservative voters, with 56% now supporting such a policy, up from 49% in 2016. In total, 61% of respondents supported the premise that they would either “pay more through the taxes I currently pay” or “pay more through a separate tax that would go directly to the NHS”, with the latter option proving slightly more popular.

Equally significant findings from the survey included the remarkably low number of respondents who said they would favour paying small amounts to visit their GP or local A&E department, or for nonmedical costs in hospitals. Three times as many people said they felt the NHS has got worse than those who feel it has improved: a gap not seen in the survey since the late 1990s. Commenting in The Times, King’s Fund Chief Executive, Chris Ham, said the results should act as “a wake up call”, adding that he had not seen “anything as dramatic as this over such a time period.”

The Treasury has reportedly ruled out using a dedicated NHS tax to fund spending increases, however it may seek to use national insurance rises instead. Director of the Health Foundation, Anita Charlesworth, said this option would raise about £11 billion “but it would take twice that to fill the gap of over £20 billion facing the NHS by the end of the current parliament”. Whilst Theresa May is set to release a new long-term funding settlement for the NHS later this year, The Times’ story quotes an unnamed government source who says “there are some in the cabinet who think (the NHS) shouldn’t get more”.

Whilst polls have frequently found Britons favouring higher taxes to fund greater investment in the NHS, this survey significantly reveals that a majority of taxpayers are personally willing to pay more to ensure a better service. Upon taking the reigns at Number 10, Theresa May was initially determined not to treat the Department of Health as a special case for funding and would’ve counted herself among the section of the population which feels the NHS needs to “live within its means” (15% still believe this is the right approach).

The Prime Minister’s approach has changed in recent months, underlined by the increased funding provided in the last budget for the NHS and the promise of a new long-term settlement. The cabinet ministers opposed to the Prime Minister’s new direction are out on their own on this issue, with the public clearly tiring of declining standards in the NHS, particularly over the past 3-4 years.

“Ghost wards” revelation causes anger amidst beds crisis

Hospitals across England have closed entire wards, despite the decreasing availability of hospital beds. In September 82 “ghost wards” were recorded around the country, containing almost 1500 empty beds, according to trust data obtained by the Guardian. This level of ward closure is significantly higher than that recorded four years ago, when 32 wards and 502 beds went unused, according to statistics the newspaper obtained from freedom of information requests.

The wards closures are most likely the result of staff shortages and a lack of supporting resources across the board. North Tees and Hartlepool NHS FT said a lack of doctors and nurses meant it had 270 beds empty in 2017. A spokeswoman for the trust said “the shortage of specialist medical staff to fill vacancies and our unwillingness to compromise on patient safety meant that we feel this was the right decision to make”.

Leading medical representatives and Labour party figures reacted with disdain to the news. Shadow Health Secretary, Jonathan Ashworth, called the revelation “a scandal” and the President of the Society for Acute Medicine, Dr Nick Scriven, said the situation is “amazing”, whilst adding the findings would “not surprise any clinical staff in the NHS”. BMA Chair of Council, Dr. Chaand Nagpaul, said “it is illogical for hospitals to have extra beds available but also unavailable.” The Department of Health and Social Care said The Guardian’s claim that hospital beds are being “mothballed” was misleading, adding that it is the responsibility of trusts to control the number of beds to meet demand from patients.

Primary Care staff “left behind” as patients wait for appointments

Health unions have warned that primary care staff are set to miss out on the benefits of the new NHS pay deal, provisionally agreed between workforce bodies and the Department of Health and Social Care in late March. DHSC confirmed that more than 80,000 staff across the sector in England will not receive pay rises of at least 6.5% over three years as they are employed directly by GP practices, and not on the Agenda for Change terms presented to staff officially employed by the NHS.

NHS Employers, which negotiates pay and conditions on behalf of DHSC, said that whilst GPs have the option of employing staff through equivalent contracts, the new national deal does not apply to these agreements. Marie-Therese Massey, Chair of the Royal College of Nurses General Practice Nurse Forum, said there is currently a “wide variation” in terms and conditions for GP nurses across the country, arguing that standardisation would be welcomed in order to bring primary care staff in line with colleagues working in other parts of the NHS. Massey said practice nurses feel “left behind”, particularly given that there is no evidence “that our employers will be reviewing GP nurse pay in light of the new pay award”.

The British Medical Association’s GP Committee Chair, Dr. Richard Vautrey, agreed there is a need to increase pay for primary care staff, arguing “if practices don’t do this it could further impact on recruitment and retention problems”. Vautrey, who represents GP partners responsible for setting staff pay within their practices, said it is “imperative” that the government provides the necessary additional funding for practices to pay all staff fairly.

Meanwhile, a Daily Mail/Populus survey released this week found that 42% of people over the age of 50 are waiting over a week to see a GP, with one in seven saying they’ve had to wait longer than a fortnight. These figures are consistent with previous findings: a Pulse survey with a smaller sample size last year revealed that 40% of patients of all ages were waiting over two weeks for routine appointments.

The Government and senior NHS officials have consistently insisted that primary care is a priority, with the Department of Health and Social Care pledging to have recruited 5,000 new GPs between 2014 and next year. It is increasingly clear that efforts in this challenging area are failing to make the desired impact, with GPs across the country struggling to cope with increased patient demand for appointments and a system-wide change supporting a shift of activity into primary care settings.

While the 5,000 new doctors target will be missed, the Department and RCN would both have helped this cause by more closely considering other primary care staff in negotiations over a new pay deal, particularly given the widespread acceptance of the need for more practices nurses.

Weekly political news round up – 6th April 2018

April 6, 2018 in News by Whitehouse

 

Overview

The Government’s Soft Drinks Industry Levy comes into effect today (Friday, 6th April) in efforts to reduce children’s consumption of sugar, in attempts to tackle the child obesity epidemic, a current priority for the Department of Health and Social Care. NHS Digital has published statistics that show NHS spending on obesity is soaring as hospital admissions because of obesity has increased 18 per cent on the year. Child obesity prevalence currently stands at 10 per cent in reception year of school, and 20 per cent at the end of primary school in year six. NHS Chief Executive Simon Stevens has called it “the new smoking” in terms of public health impact.

Parliament is currently in recess and returns on 16th April.

NHS crack down on prescriptions for “minor ailments” comes into effect

At the end of last week, NHS England published its guidance to stop prescribing treatment for “minor, short-term conditions” including constipation and diarrhoea. The guidance is limited to “self-limiting conditions” and those “suitable for self-care.” NHS England’s press release says that many of the conditions covered by the changes “will cure themselves or cause no long-term effect on health” and specifies that the changes do not apply to “longer term or more complex conditions” and those that are part of a wider health issue.

The move is outlined as a cost-saving exercise. NHS England says that it spends “£22.8 million on constipation” which is claims is “enough to fund around 900 community nurses” and £2.8 million on diarrhoea, which is “enough to fund 2912 cataract operations.”

NHS England Chief Executive, Simon Stevens, said: “Across the NHS our aim is to: ‘Think like a patient, act like a taxpayer’. The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further. Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.”

Dr Graham Jackson, co-chair of NHS Clinical Commissioners and Clinical Chair of Aylesbury Vale Clinical Commissioning Group, who also co-chaired the joint clinical working group for this work, said: “It is not good use of the NHS’s limited resources to issue prescriptions for products which are not clinically effective, or for conditions that will get better without treatment or whose symptoms can be managed with appropriate self-care.”

The Royal Pharmaceutical Society responded to the announcement, with its English Pharmacy Board Chair, Sandra Gidley, saying: “we remain concerned that the implementation might disadvantage patients on low incomes and people may be denied treatment because of their inability to pay.” National Voices, a coalition of charities campaigning for “people being in control of their health and care” also responded to the announcement calling for the financially vulnerable to be exempt from the ban.

This shows the context in which the PCF’s consultation response and Norgine’s press release, calling for constipation to be omitted from the list of conditions not needing prescription medicine will be received. It is not alone in calling for changes to the guidance and asking for exemptions. However, the financial constraints NHS England finds itself under means it is unlikely to review the guidance in the short-term. Therefore, the PCF’s representations will be most effective at the political level; we will engage with ministers on the matter.

It happens to me, too continues to get media attention

Champion, a local newspaper in Sefton and West Lancashire, has reported on the launch of It happens to me too in the Houses of Parliament last month. Rosie Cooper, the Chair of the All-Party Parliamentary Group on Continence Care, is the MP for the newspaper’s catchment area. It outlines the recommendations of the report, including promoting the implementation of the EICC.

The article quotes Ms Cooper saying “It is believed there are more than 21 million people in the UK who suffer with bladder and bowel control problems, 900,000 of whom are children and young people. There is often a stigma associated with bladder and bowel problems, which impacts on the ability of children and young people to interact socially and live as independently as possible in their local communities. They face further challenges in gaining access to practical advice that explains what they should expect from their local health and social care services.”

SEND pupils without school place soars

The BBC has reported on figures it obtained on the impact of shortages for special educational needs funding is resulting in “growing numbers of children being left without suitable school places.” The figures show that 4,050 special needs pupils did not have a school place in England in 2017, compared with 1,710 in 2016, a 137 per cent increase. The total number of pupils up to the age of 19 with SEND or education and healthcare plans (EHCPs) has increased from 233,431 to 279,582.

The BBC notes that the figures have come after 48 local authorities have asked to move money allocated to SEND pupils in mainstream schools to SEND-specific schools, 16 of which were granted permission, 12 were denied permission, and 20 withdrew their applications. While the number of pupils on ECHPs has been increasing, councils budgets have been “cash flat” which is a reduction in funding when accounting for inflation.

Results of a survey conducted by the Association of Directors of Children’s Services suggested that there was a £400 million shortfall in high needs funding last year and schools additionally have to provide 36,000 per pupil per year for children’s special needs plans.

Kevin Courtney, Joint General Secretary of the National Education Union, responded to the figures saying ““It is an absolute disgrace that the Government is starving local authorities of the resources needed for children with SEND.  Children are at home because local authorities don’t have enough money to provide suitable education.  Local authorities are being placed in an impossible position.”

These statistics shed a light on the extent to which SEND pupils are being failed by the education system, months after Ofsted’s annual report criticised schools for informally excluding underperforming, particularly SEND, pupils. This data will help inform the PCF’s parliamentary engagement going forward in enforcing its message that children with special needs, such as continence issues, fail to have their needs met.

School leaders flag increasing child poverty

The National Education Union (NEU) published the results of a survey of 900 teachers it conducted with the Child Poverty Action Group which suggest that 60 per cent of school support staff believe that child poverty has worsened since 2015 and 87 per cent of respondents believing that poverty has a significant impact on children’s learning. The results also showed that teachers and schools had to help families with school equipment, meals, and in some cases emergency loans.

Respondents in the survey reported on hungry children “filling their pockets” with food and looking malnourished. One head teacher said, “My children have grey skin, poor teeth, poor hair; they are thinner.”

Joint General Secretary of the NEU, Kevin Courtney, said: “The level of child poverty teachers and school staff are witnessing on a daily basis is having a dreadful effect on the life chances and education of far too many children and young people. It is shocking that in one of the richest countries in the world we have children without appropriate clothes or shoes, who go hungry every day, who cannot afford sanitary protection or who have no stationery to do their homework.”

Alison Garnham, Chief Executive of the Child Poverty Action Group, said: “Teachers see the heart-breaking reality of rising child poverty every day in their classrooms and dinner halls. We must listen to what they are telling us. With nine children in every classroom of 30 now falling below the official poverty line, it is time to ensure all families have enough to live on, and to rebuild the safety net for struggling parents. A vital first step is to lift the freeze on children’s benefits so that they keep up with the rising cost of living.