Weekly political news round up – 23rd July

July 27, 2018 in Uncategorized by Whitehouse

Paediatric Continence Forum
Political and Parliamentary Monitoring
Week commencing 23rd July 2018

This week, the Government announced a pay rise for doctors, although the increase is below the recommended two per cent made by the NHS pay review body. The Health & Social Care Secretary, Matt Hancock, said that he had taken note of the low morale amongst staff, but the offer was quickly dismissed by the British Medical Association, who attacked the Government, saying this would “make a bad situation much worse”.

From October 2018 Junior Doctors could see their pay increase by a minimum of £532 per annum, whilst consultants will see a boost of £1,150. However, the 1.5 per cent rise announced is less than the rate of inflation and comes after years of real terms pay cuts for health professionals. The offer is also lower than the two per cent recommended for salaried doctors by the independent pay review body. The Government said this pay award took into account the three-year contract reform of the Agenda for Change contract, the long-term funding settlement and contract reform for GPs. A third of the increase will come from a new system of performance-related pay.

The news that doctors are set for an increase in pay comes in the same week that the nursing sector has been hit with confusion about their own pay awards. The head of the Royal College of Nursing has apologised after nurses in England complained of being “misled” over a new pay deal. The union had said they would receive a 3 per cent increase in pay as part of a three-year pay deal. However, some nurses have complained of receiving significantly less – in some cases just a few pence extra each month.

It transpires that only those at the top of their pay band will get the 3% immediate rise, whilst others will get on average 1.5% until their incremental pay-rise date is reached, at which point staff will be eligible for a further increase. For many, however, any incremental increase could be many months away.

This latest debacle over pay and conditions will fuel concerns over NHS management. There are currently over 35,000 nursing vacancies in England, and anger amongst their profession is unlikely to draw new members in to their ranks.

Overview
• Cautious welcome for government response to ‘The Nursing Workforce’
• Hancock says public health funding not the responsibility of the Department for Health
• New technology key for success in the NHS

Government responds to report on ‘The Nursing Workforce’
The Government has responded to the Health and Social Care Select Committee report ‘The Nursing Workforce’, outlining measures that will be taken to address the acute shortage or nursing staff, and to increase morale amongst the profession. The report suggested that the NHS should assist those nurses who want to move between departments or train in specialist areas, whilst it also calls for reversal in the cuts to nurses’ professional development budgets.

Responding to the report, the Secretary of State, Matt Hancock, said that he wanted to ensure that nurses “feel valued at work”. He announced that NHS England and NHS Improvement are collaborating on a programme to develop, test and implement a “place based” model, to test new approaches which should make it easier for staff to move around the health service.

However, there was no dramatic shift in government policy on bursaries for student nurses. Hancock’s response said that “The Government has been clear that the bursary funding system was not working for patients, for students, or for the universities that train them.” Hancock defended the Government’s current position, indicating that eligible healthcare students have access to additional provision for travel to clinical placements and an “exceptional” support fund. He also lauded the repayment plan on graduate loans.

The Government’s response to the Select Committee’s report was welcomed cautiously by many in the health service and will be of interest to the PCF. The prospect of making it easier for nursing staff to enter the paediatric nursing sector will be welcomed by many, although the news that the funding support for student nurses is unlikely to change will cause alarm given the number of nursing vacancies hit a record high at the beginning of the year.

Whitehouse will continue to monitor the Government’s plans for the nursing workforce and any consultations that arise from it.

Hancock fails to support public health funding
The Health & Social Care Secretary, Matt Hancock, has come under pressure for signaling that it is not the role of the Department for Health to fund public health spending. Appearing before the Commons’ Health and Social Care Select Committee on Wednesday, Mr Hancock was questioned about the planned 4 per cent reduction in public health grants to councils up to 2020-2021.

In response, Mr Hancock said that, whilst he agreed with taking preventative measures as it decreases higher costs later, he insisted primary care was as important as prevention in improving public health. He then went further and insisted he did not think it was “ever intended that the Department of Health & Social Care should be the biggest funder” of public health.

. Since public health responsibilities were transferred to local authority control, funding has been slashed year-on-year. Indeed, as central government grants to local authorities have been reduced by up to 40 per cent, public health funding has often been the first victim of service reductions and some may question as to whether the Department of Health & Social Care should have more concern over public health given that, whilst it is now under the jurisdiction of local government, the effects of poor public health provision and prevention services can impact upon the NHS, as ailments exacerbate due to lack of effective treatments

The news that there is little appetite from the Department of Health and Social Care to help plug the public health funding gap will concern many PCF members. Since school nurses, many of which oversee paediatric continence care, were transferred to local authority control, their numbers have dropped. Any further reduction in the grant could mean a further reduced service, and an increase in the postcode lottery which already affects thousands of children and young people.

Whitehouse will continue to monitor local authority public health funding, and track where any changes coincide and link with the data collected under the FOI audit of councils which was undertaken last year.

Technology key to solving NHS crisis
The new Health & Social Care Secretary has said that technology and the use of apps is the key to solving the NHS crisis. In an interview with the BBC, the former Secretary of State for Digital, Culture, Media & Sport, said there was “loads to do on that [technological] area”, and declared his job was to make government more tech savvy and digital.

The Secretary of State added that technology could make the NHS more convenient for patients, but could also improve the working lives of doctors and nurses. Hancock is familiar with developing apps, having developed his own ‘Matt Hancock App’ to provide residents in his West Suffolk constituency with an update on his parliamentary engagements.

The news that the Secretary of State is interested in developing technology further comes in the same month that it was announced a new NHS app would be launched by December which would end the 8 a.m. scramble for GP appointments by allowing patients to communicate directly with clinical staff over their phone. In a fresh development, Thomas Cook said that it would use similar technology to offer tourists who have taken travel insurance out with the company an opportunity to have video consultation, and have treatment prescribed electronically.

Whilst the prospect of new technology may be received with a cautious welcome by many PCF members, especially as it has the prospect of reducing the time it takes for children and young people to access treatment, it cannot replace the benefits of face-to-face diagnosis, and ensuring that those children who need medical treatment can be referred in a timely fashion.

The PCF will continue to monitor which NHS Trusts are utilising new technology, how it is being implemented, and how successful it is.

Weekly political news round up – 16th July

July 23, 2018 in Uncategorized by Whitehouse

Paediatric Continence Forum
Political and Parliamentary Monitoring – Week commencing 16th July 2018

NHS England Chief Executive, Simon Stevens, has identified five major priorities for the 10-year NHS plan due to be unveiled in the Autumn. The 10-year plan, a pre-requisite laid down by Theresa May, will now pave the way for the sign-off on the additional £20 billion of funding earmarked for the NHS.

The major priorities identified by Stevens include action on mental health, the potential need for “core crisis care”, and on cancer, Stevens outlined the need to improve screening services to make them more risk stratified. Other priorities will include a focus on cardiovascular disease, including strokes and heart attacks, as well as a renewed focus on children’s services, and a new effort to reduce health inequalities.

As well as demanding the NHS produce a 10-year plan, Theresa May also announced a review of NHS waiting times. There is currently speculation as to whether any review could lead to NHS England targets being reduced. When asked about the 18-week cancer target, Mr Stevens simply replied that it was important to ensure that patients were treated on the basis of clinical need.

Mr Stevens’s announcement comes as the new Secretary of State for Health & Social Care, Matt Hancock, has been discussing his priorities for the department. An article by Mr Hancock talked of mending the fractured relationship between Government and NHS staff, and directly referenced the way in which many workers feel undervalued by managers and leaders. His article comes in the same week the GMC has raised concerns about workplace pressures, with one third of junior doctors reportedly feeling exhausted before they even start a shift.

Senior GP hits out at state of public health
Former Chair of the NHS Alliance, Dr Michael Dixon, has said that the current structure for public health is simply “not working”, and has become too disconnected from front-line clinicians. Responsibility for public health shifted to local authorities from the NHS as part of a package of health service reforms that took effect in 2013.

Dr Dixon complained that the problem with public health is that decision-making power and influence is handed over to consultants and “people who aren’t working at the front line of medicine”. Dixon added that, given the growing disconnect between policy-makers and the frontline, upon reflection, public health should never have been devolved to local councils. He also said that there should be a greater role for volunteers to run sporting exercise, and offer health advice. Plenty of retired health workers, Dixon suggested, could still offer services and their expertise to the NHS on a smaller scale.

The news that there is growing concern about public health amongst the clinical community indicates a shared concern growing across the medical profession. As reported at the last PCF meeting, cuts in public health funding are having a strong impact on frontline services, including school nursing. Like-for-like spending on public health by local authorities in 2018 is likely to fall by 5 per cent in real terms, whilst demand on services continue to rise.

Whitehouse is co-ordinating a response from the PCF to Simon Stevens to highlight our concerns about the current state of continence services. This will include a reference to the lack of school nurses and public health resources currently available.

Virtual GP service rated outstanding
A report in to one of Britain’s first virtual GP services has been rated outstanding by the Care Quality Commission. West Health Medical Centre, which operates a telephone and video consultation service available seven days a week to patients from practices that are part of Birmingham’s Healthcare Federation, was rated overall outstanding.

Inspectors found that services reduced workloads for GPs across the Federation, improving access to appointments and generating significant savings on medicines waste. At the time of the CQC inspection, there were nine GPs, an advanced nurse practitioner, seven pharmacists, two managers and a number of administrative staff employed across the virtual consultation service.

The inspectors were also given data by the Federation suggesting that scores of patients who may otherwise have needed hospital attention were now able to be seen from the comfort of their own homes. The ability to avoid A&E will be welcome news to many, especially given the news that the review of NHS waiting times targets may produce longer delays at hospitals.

However, the news that more Trusts are looking in to the viability of virtual GP services, may represent a cause for concern for many PCF members. It is unclear whether, away from the GP, how many other staff have specialist continence training. There is also the concern that, given the virtual nature of assessments, whether using phones, tablets or laptops is optimal enough for young people with continence issues.

Whitehouse will continue to monitor the development of virtual services, and enquire with Birmingham Health Federation as to whether those providing clinical advice have continence care training.

Patients ‘beg’ for treatment
There has been a sharp rise in the number of patients blocked from accessing hip or knee operations by NHS Rationing panels, despite their GP thinking surgery is necessary, an investigation has found. Thousands of patients, a report by the British Medical Journal found, were forced to jump through hoops in order to receive “clinically and cost effective” procedures.

Between 2016-17 and 2017-18 there was a 45 per cent increase in the number of patients rejected after their GPs recommended them for surgery in this way. The increased in rejected requests mirrors an increase in the number of GPs being forced to use exceptional funding applications to ensure patients get the treatments they deserve. The process of exceptional funding applications was introduced in 2000 for GPs to refer patients for procedures that could be considered costly. It is, therefore, concerning to see that funds intended to be used in the rarest of cases are now being earmarked for common treatments.

PCF members will find this particularly frustrating given that many young people with continence issues are already finding it difficult to access the services they need and require. At the All-Party Parliamentary Group on Continence meeting this week, one member indicated that an NHS Trust was no longer intending to pay for pads, and instead said it would encourage patients to buy them commercially.

The PCF will continue to monitor decisions made by NHS Trusts regarding prescription pads, as well as the delays in treatment for patients.

Weekly political news round up – 6th July

July 6, 2018 in News by Whitehouse

Overview

The National Health Service is carrying out planning for a “no deal” Brexit scenario, according to NHS England Chief Executive, Simon Stevens, as Civil Servants have warned of shortages of food, fuel and medicine within weeks if the UK leaves the European Union without a customs arrangement in place.

The UK imports 37 million patient packs per year from the EU, and products are developed in large-scale supply chains which span the continent. The duplication time for the manufacture and quality control testing of drugs and resources should the UK leave the EU without a deal has been estimated at over 42 months and would inevitably cause serious delays to patients in need of urgent treatment. Simon Stevens’ openness that the NHS is now preparing for all scenarios will be news to many in the health industry, after he told MPs last October that the NHS had not been asked to prepare any contingency plans for a no-deal Brexit.

Earlier this year the Health and Social Care select committee raised concerns about implications for the future of medical research and development should Britain leave the EU without any customs arrangement in place.

Baroness Warnock strikes out at “contradictory” Ofsted

Baroness Warnock, a prominent peer who chaired the 1978 inquiry into the education of handicapped children and young people, which paved the way for statementing, has attacked Ofsted for its lack of focus on the needs of SEND children.

Speaking to the Lamb Inquiry in to children with special needs, Warnock slated the education regulator for failing to acknowledge the roles schools play in supporting SEND children. Warnock told the inquiry that “Schools are described as failing or needing improvement, when actually they are doing very well by those children. So I think Ofsted needs to take a look at itself, to see what is being inspected”. Ofsted, she added, was becoming too obsessed with academic rigour and not with the overall inclusiveness and support offered to pupils.

Warnock’s 1978 report created a vision for schools whereby they would adapt to the requirements of children with special needs, integrating them in to learning. The law was amended in 1981 and included the first duty to include pupils with SEND in mainstream schools. Warnock now claims that the intention of the report has been betrayed, with underfunded local authorities seen as the enemies of parents.

Warnock has called for smaller secondary schools in order to create more personable environments for pupils, as well as improved teacher training to ensure that SEND priorities are at the centre of teachers’ minds. Whilst Baroness Warnock’s comments were received positively by the charity sector, Stephen Kingdom, Campaign Manager at the Disabled Children’s Partnership, said that schools shouldn’t be incentivised to “lower expectations of a pupil because they have special education needs”.

NHS turns 70

There were widespread celebrations yesterday across the country to mark the 70th birthday of the National Health Service. To mark the occasion, NHS England has launched its largest ever marketing campaign, ‘We are the NHS’, to highlight the amazing work the organisation does and recruit more staff. As it stands, there are over 30,000 nursing vacancies in the NHS in England.

Theresa May announced last month that the NHS would receive an additional £20 billion in funding to coincide with its landmark birthday. Chief Executive of NHS England, Simon Stevens, has outlined to MPs that the money will be focused on meeting the goals set out in the ‘Five Years Forward’ review. This includes the option of shared budgets combining health and social care, as well as allowing different local health communities to choose from amongst a small number of new radical care delivery options.

To mark the birthday a series of events are taking place in hospitals across the country, and the BBC has a series of programmes going behind the scenes at some of Britain’s biggest NHS institutions.

NHS England stops providing more treatments

NHS England is considering proposals to stop offering or reduce the amount they offer 17 “ineffective or risky” routine treatments. If the proposals go ahead, treatments such as tonsils removal, breast reductions and snoring surgery will only be offered if evidence of need is “compelling” and there are no alternatives, in a plan that is estimated to save the NHS £200m. NHS England said that for most of the treatments under consideration, there are alternative more efficient treatments available and the money can be better spent elsewhere. Patient leaders have warned that this could result in patients being wrongly denied treatment by overzealous staff.

This is part of NHS England’s aim to make cost savings and builds on its decision last year to stop offering prescriptions for infrequent and non-serious ailments, of which laxatives were included. As you’ll remember, the PCF responded to the consultation on the matter highlighting the detrimental impact this would have on children. The guidance that subsequently came out is ambiguous but states that children should not have laxatives unless prescribed by a GP.

The PCF will look to engage with GPs to raise awareness of this and ensure that they continue to prescribe laxatives to children when appropriate.