Weekly political news round up – 6th August

August 14, 2018 in Uncategorized by Whitehouse

Paediatric Continence Forum
Political and Parliamentary Monitoring
Week Commencing 6th August 2018

The number of patients waiting over a year for non-urgent NHS surgery a hit a record high, new data has revealed, as the chair of the Royal College of GPs has urged the Government to address the “haemorrhaging” of staff and serious shortfall of doctors.

New figures indicate that 3,517 patients in June had been waiting over a year for non-urgent surgery, despite a pledge in 2014 by the then Health Secretary, Jeremy Hunt, to end “unacceptable” delays. The news that the waiting list has increased by another 400 patients since May comes as the health service is reeling from a ‘summer crisis’ brought on by the hot weather. NHS Providers, the trade association representing NHS acute, ambulance and community health services, has said some Trusts are experiencing unprecedented demand on A&E services.

The NHS target is to see 90 per cent of patients who need non-urgent operations within 18 weeks, but the new data shows that the number of patients seen within the target time was 87.8 per cent. Chris Hopson, Chief Executive of NHS Providers, has said the summer was providing “no respite” for NHS staff, with the service running at “boiling point” all year round. June’s figures also show that the waiting list for routine treatments continues to travel in the wrong direction. Performance by NHS Trusts against the 62 day wait cancer target, for example, shows the performance rate is at its lowest level since data collection began in 2009.

The news that the NHS is experiencing unprecedented strain comes in the same week that Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, has warned that waiting times for GP appointments were already at an “all time high”, and that the country needs the help of thousands of overseas doctors in order to plug the shortage of staff. An annual survey of more than 800,000 patient experiences of getting GP appointments has found that 20 per cent wait more than a week to be seen, whilst a further 11 per cent are unable to obtain an appointment at all. Ms Stokes-Lampard urged the Health Secretary to increase investment in general practice in order to ease pressure.

This news will interest PCF members, as urological assessments and treatments are usually considered non-urgent. We will continue to monitor waiting times, and any Government announcements regarding extra funding for the health service.

• Better training needs, Forum says
• NHS embraces technology
• New public toilet campaign launched

Better training needed to improve continence care
The Nursing Times, which held a roundtable event discussing continence care last month, has said that whilst awareness of continence issues is on the rise, better training was needed in order to improve levels of care. Colleagues from across the charity and health sectors celebrated the fact that the quality and number of products had improved vastly, but warned that funding pressures sometimes limited the ability of nurses to provide appropriate options.

Many members warned that cutting the budget for pads and other continence devices was a false economy, with costs incurred later as patients appear at GPs or hospitals at a later date with more complex needs that takes longer to assess, treat and prescribe for. Indeed, many panel members suggested that there weren’t enough ward nurses, with Juliana Tinhunu, a clinical nurse specialist for continence at Barts Health NHS Trust saying that “sometimes [nurses] think it’s easier to put pads on patients instead of doing continence assessments”.

Moving forward, many members at the roundtable event suggested that more work needed to be done to attract nurses in to the continence sector. Caroline Knott, Bladder and Bowel Specialist Nurse at Kent Community Health Foundation Trust, described how nurses have been “putting off” training because they don’t want to do continence procedures. Others described how staff can struggle to discuss continence issues openly, making it difficult for patients to be treated.

The views expressed at this conference will be of great interest to PCF members, who have expressed concern about the pressures on nurses and lack of trained staff specialising in continence care. Whilst many members will agree that the quality and variety of pads has continued to improve, the Forum will acknowledge the value of having trained staff on hand to support young people and others with continence issues.

Whitehouse will monitor any response to the Government to the round-table discussion, most notably regarding nursing staffing levels and the provision of continence services.

NHS embraces new technology in effort to tackle stress urinary incontinence
The NHS is moving to embrace new technology in an effort to tackle incontinence. This week, NHS Supply Chain announced it was making available an at-home biofeedback device for pelvic floor muscle training. With a retail price of £169, the ‘Elvie Trainer’, as the device is known, will help the 32% of women who have urinary incontinence. As it stands, the NHS spends over £230 million annually on treatments, devices and support for people with continence issues.

It is claimed the new technology could revolutionise continence care. The device is places inside the vagina and connects to an app in which the user can receive biofeedback to help improve continence techniques. The biofeedback device is thought to improve both compliance and success rates by 10% as well as reducing surgery rates by 50%. Hannah Rose Thornton, Head of Strategic Partnerships and Health at Elvie, said the availability of the Elvie Trainer “represents the opportunity to reduce the costs to the NHS and improve outcomes for patients”, adding that the company was “thrilled that the NHS is investing in tools to support conservative management of stress urinary incontinence”.

The product has been hailed as simple to use, whilst the App which provides user feedback has been lauded as “beautiful” and “simple” by health physiotherapists. The news that the new urinary continence device has been launched comes less than a month after the new Secretary of State, Matt Hancock, announced a £500 million investment in technology. Criticising the “binary” approach to care, Mr Hancock pledged that the money would be spent on reducing waiting times, digitsing the health service, and development new and effective treatments.

Whitehouse will continue to monitor technological advances, and will report on any new consultations linked to technological testing or development.

New campaign to increase the number of toilets available for use
Over the last month, we have reported on the news that some of the UK’s largest cities have no public toilets suitable for people with disabilities and continence needs, with some councils reducing all of their services. Now a new campaign has been launched to encourage private businesses to open up their toilets for general public use.

Over the past two decades the number of public toilets in the UK has slumped by nearly 40%, according to responses to freedom of information requests, as local councils continue to experience squeezed budgets. The total number of public toilets in the UK has fallen from 3,955 in 2000 to 2,414 this year, according to the British Toilet Association, with the average local authority in England operating just 15 toilets. This means that, on average, each public toilet in the country serves 12,500 people.

The news that there has been such a dramatic cut in the number of toilets comes just a month after Paula Sheriff MP raised the issues of Changing Places facilities in the House of Commons. This week it was revealed that disabled women and undergoing unnecessary surgery in order to avoid the embarrassment and discomfort of struggling to find or use a public toilet.

A new campaign, “Use our Loos”, launched by the British Toilet Association, is urging businesses to make their toilets available to non-customers. Each participating outlet will be encouraged to have a sticker on display so the public can easily spot a business happy for people to use its facilities. Many restaurants and cafes have easily-accessible facilities, which would benefit the 250,000 disabled people who currently struggle to find public toilets. Indeed, the British Toilet Association said this would be a great help to older people, families and people with medical conditions.

The PCF will monitor the launch and the success of the scheme, highlighting successes and reporting on concerns and feedback.

Weekly political news round up – 30th July

August 3, 2018 in Uncategorized by Whitehouse

Paediatric Continence Forum
Political and Parliamentary Monitoring
Week Commencing 30th July 2018

Niall Dickson, Co-Chair of the Brexit Health Alliance, has said that making good preparations for Brexit is the difference between “life and death” for many patients. In a week in which the Government has been forced to announce that it plans to stockpile medicines, and even fly-in some drugs, the Alliance, which brings together the NHS, medical research industry, and public health organisations, said the Government should be prepared to store up to six weeks’ worth of supplies.

It has now been announced that formal engagement between the pharmaceutical industry and the Government will begin in September, but the Department of Health and Social Care has not yet published detailed outlines. Some drug companies, including Sanofi and Novartis, are already increasing stocks by four weeks in case of disruption in the event of a ‘no deal’.

Senior figures in the pharmaceutical industry are said to be concerned that any stockpiling or short planning period could create “serious issues” and an increase the costs of drugs, as manufacturers cannot guarantee getting hold of the raw materials needed to create the extra stock required. It is not uncommon for pharmaceutical companies to schedule the manufacturing processes a year ahead to guarantee supply.

However, in a further twist, a it was revealed that unless the EU waives regulations regarding how market-ready drugs can be stored, then the UK’s ability to stockpile could be severely hampered. Mark Thompson, Chief Executive of the Association of the British Pharmaceutical Industry, added that the only way to ensure drugs got to patients in the long term was for the UK and the EU to come to an agreement on recognising each other’s medical safety standards. The EU has said that if the UK leaves the union without an agreement in place, there is a distinct possibility that medicines being exported and imported may have to be ‘batch tested’. However, others have highlighted that a ‘no deal’ scenario would simply mean the UK and EU’s relationship reverting to World Trade Organisation terms, with the ability to still import and export medication by agreement.

Whilst it is unclear whether the stockpiling measures would extend to pads or continence devices, there is a concern that some drugs used to treat continence issues could find themselves being stored for essential-only use if the UK and EU can find no common agreement.

• ‘Changing Places’ data released
• New report on improving nursing and continence care highlights need for specialised treatment
• NHS in the middle of ‘summer crisis’

New ‘Changing Places’ data released
New research by the Changes Places Consortium has revealed that just 12 railways stations, and 17 pubs, restaurants and cafes across the whole of the UK have official Changing Places toilets. This news comes just a month after we reported that Paula Sherriff, MP for Dewsbury and Shadow Minister for Mental Health, was putting forward the Changing Places Bill in order to ensure every large building has easily-accessible facilities.

The Consortium reports how disabled people regularly face the uncomfortable choice of not going out, not using trains, or lying down on dirty toilet floors in order to be changed. Fully accessible toilets are needed by more than a quarter of a million people across the UK, yet some of the country’s largest towns do not have any registered. Changing Places toilets are bigger than standards accessible ones, and are used by people with severe disabilities. They often have additional benches for adults to get changed, and some may even contain a harness or brace for assistance.

Having access to Changing Places toilets increases independence and improves quality of life. Without these facilities, disabled people can feel isolated, forcing some to turn to extreme measures. In one reported case, an individual underwent surgery to have a suprapubic catheter inserted, after experiencing difficulty and frustration finding toilet facilities.

Whilst it is unclear whether the Government in Westminster will support Paula Sherriff’s proposals for more Changing Places toilets in large buildings and public spaces, the Scottish Government has already gone one step further. Kevin Stewart MSP, Minister for Local Government and Housing, recently wrote to the charity PAMIS (Promoting A More Inclusive Society) to confirm that he intends to introduce Changing Places toilets as a compulsory element of Scottish building regulations. This will be of great interest to PCF members, many of whom meet young people and their families who struggle with day-to-day activities because they cannot gain access to the facilities they need.

Whitehouse will continue to monitor the Government’s plans for introducing Changing Places legislation, as well as any local plans to improve provision for people with disabilities.

New research published in to improving nurse engagement in continence care
An international study of nursing standards has identified as key the need to improve nurse engagement in continence care. Published in ‘Nursing: Research and Reviews’, the article outlines the environmental factors which prevent nurses from making positive interventions in care.

The report said that outdated attitudes and a lack of basic understanding of continence issues limits nurses’ engagement in continence care; whilst it was also found that
personal issues, including a lack of knowledge on the issue, as well as organizational concerns, including a failure to make continence issues a priority, mean there are often delays in ensuring those with continence complaints get the care they need. One way of improving care, according to the report, is by improving access to specialised nursing and services, ensuring there is a clear pathway of care and thus reducing the number of repeat referrals.

The news that additional specialist care is key to improving nurse engagement in continence care was reflected in the new Excellence in Continence Care guidance published at the end of July. The guidance outlines that good care includes ensuring “specialist diagnostics and evidence-based treatments” with ‘red warning flags’ in place to ensure that those with the most obvious and concerning symptoms of continence issues can undergo assessment.

This new report will interest PCF members as it further supports the themes of the NICE-accredited Pediatric Continence Commissioning Guide, which the PCF is encouraging all CCGs and Health Bards to adopt. By creating a single ‘under one roof’ service, young people are more likely to get the specialist treatment they need in a timely fashion.

Whitehouse will continue to monitor the implementation of the new Excellence in Continence Care guidance, and its uptake by local authorities.

NHS summer crisis to become the new norm
The increase in admissions because of recent hot weather, as well as reduction in staffing numbers and the concern over Brexit has led to a ‘summer crisis’ in the NHS, with claims the increased pressure could become the new norm as the population continues to age and recruitment levels remain stubbornly low.

It was recently reported that there had been an increase in admissions, primarily of the very young and old, related to the hot weather. It is not now uncommon to find hospitals almost constantly ‘borrowing’ resources from other departments in order to support A&E wards and, in some areas, the extra admissions are leading to delays for patients requiring planned operations.

More worryingly, the increased pressure is being felt at a time when morale amongst staff in the NHS is at record lows, with the number of vacancies in the health service continuing to rise, and fears of the impact of Brexit remaining unaddressed. Writing today, one doctor said that high burnout rates and low morale were having a direct – and often negative – impact on patient care. New Health & Social Care Secretary, Matt Hancock, has cited NHS workforce as one of his key priorities in the role and has said that he will seek to raise morale amongst NHS staff.

These challenges are compounded by Brexit concerns. Four in five doctors believe that the NHS is at risk of collapsing after Brexit, with a brain drain of European NHS staff deepening the recruitment crisis. The survey, commissioned by the London School of Hygiene and Tropical Medicine, found the areas of health care most vulnerable to a reduction in staff levels included cancer treatment.

The news that the NHS appears to be undergoing a ‘summer crisis’ may not shock or surprise some members of the PCF, however it will be of interest that the constant need to have doctors work in A&E rather than in their own departments is causing delays in diagnosis and treatment for other patients.

The PCF will continue to monitor which NHS Trusts have the longest delays, and whether the Government will make an official statement on the increased pressure.