Weekly political news round up – 17th September

September 24, 2018 in Uncategorized by Whitehouse

Political and Parliamentary Monitoring
Week Commencing 17th September 2018

Former Chair of the Royal College of General Practitioners, Professor Clare Gerada, has said that general practice is a “complete and utter and total mess” in a speech to the Westminster Health Forum this week. The Former Chair said that over 1,500 GPs had received help from a specialist mental health and addiction service, as stress levels amongst health professionals skyrocket and morale continues to fall.

Professor Gerada said that general practice now resembled something out of the 1970s, when the health service was in crisis, with doctors forced to take on too much, too often. The 1970s crisis was solved by the creation of a GP Charter which outlined the duties and responsibilities that GPs should reasonably take-up. Professor Gerada is now calling for a 21st century GP Charter to be commissioned.

Her other recommendations included reviewing staff contracts, which she said were “far too rigid”. Many contracts for general practice outline how many patients should be seen in a particular time-frame, thus preventing doctors from spending more time on those patients which need additional care or have complex medical needs. At the same time, such a rigid view of seeing patients has resulted in a lack of reflection in the profession, with little opportunity for doctors to review recommendations and the decisions they had made.

This news will interest the PCF greatly. It is essential to have well-trained and accessible GPs with the ability to diagnose bladder and bowel issues. Without enough GPs, whether because of stress or other factors, this will impact on the time it takes to receive an official diagnosis. At the same time, it is crucial that GPs have the time and resources to adequately diagnose patients. Any delays can cause further funding stresses on the NHS at a later date.

 

Overview

  • Standardising support for children with nocturnal enuresis
  • Early findings revealed from RCN pay debacle probe
  • NHS suffering worst ever staff crisis

 

A&E appointments system proposed in NHS shakeup

Under a proposed shakeup of NHS targets, patients could have to start booking appointments in A&E units, and those with only minor ailments may be forced to wait many hours before being seen, it has been revealed. NHS England chiefs are examining whether to relax the longstanding obligation to see 95% of A&E patients within four hours.

NHS England is reviewing its core service and longstanding targets to see 95% of A&E patients within four hours as part of its forthcoming 10-year plan, which will outline how the organisation will spend the extra £20 billion it is due to receive by 2023. Senior leaders have been looking at case studies and best practice from around Europe, including the Denmark model in which only the most ill patients are expected to ring to make at an appointment in A&E. If adopted in England, it could force many of the 22 million visitors to A&E every year to pre-book before arriving.

The Denmark model, which was adopted in 2014, led to complaints that patients faced long delays getting through to phonelines and that some serious injuries and illnesses were misdiagnosed because the assessor had no contact with the patient. Professor Keith Willett, NHS England’s Director of Acute Care, supports a move to this system but many A&E staff say it is unclear who would triage and assess patients ringing in. Dr Taj Hassan, President of the Royal College of Emergency Medicine, said he would “very surprised if this worked in the NHS”.

Senior NHS leaders have voiced their concerns over the last few months that understaffing, combined with financial problems, meant that many hospitals could no longer meet the four-hour A&E target. Other ideas being put forward include watering down the 18-week target for planned surgery. Chris Hopson, Chief Executive of NHS Providers, which represents NHS trusts, said many hospitals had already downgraded the 18-week target because that was best approach based on medical need.

This will interest the PCF because it indicates that the Department of Health and Social Care is thinking boldly about where to invest new funding as part of its forthcoming 10-year plan. Whitehouse has already made representation to the NHS about ensuring bladder and bowel issues are at the core of any funding plans.

 

Early years workforce facing ticking timebomb

The Education Policy Institute has found that the Early Years and nursing sector is facing a “ticking timebomb” with staff shortages and a falling number of professionals taking new qualification crippling the industry. In a set of predictions for the Nursery sector, the EPI found that four-fifth of Early Years staff will not be working towards a higher qualification level.

Sara Bonetti, the author of the report, said that one in five staff qualified at Level 6 or higher are aged over 50 and will be approaching retirement within the next ten to fifteen years. If this trend continues, by 2023 over 80 per cent of the group-based staff will not be working towards a higher qualification level. At the same time, by 2023 the number of unpaid staff will have risen to 13 per cent of the workforce.

This study comes at a time when the Government is under pressure to put in place plans to grow the graduate workforce. Highly-qualified staff are key to raising childcare quality and giving children the best start in life. In response to the study, the Government said that it was investing a record amount in childcare, with an estimated £6 billion to be spent each year by 2020. The Social Mobility Action Plan, announced at the beginning of the year, will also mean an additional £20 million will be spent supporting quality improvement in pre-reception nursery settings.

This news will interest PCF members, as any fall in the number of qualified teaching staff will no doubt impact on the detection rates for bladder and bowel issues, especially given that nursery staff play a key role in tracking the stages of childhood development.

 

‘Worst yet to come’ for local authorities

Cash-strapped local authorities face further cuts of almost £1 billion next year, local authority leaders have warned. Residents in area run by some of England’s largest councils will face another round of “unpalatable” cuts, according to the County Councils Network, representing some of England’s largest local authorities. Cuts of at least £685 million will have to be announced in February 2019, followed by an additional £233 million unplanned cuts across the year. Over a quarter of cuts have not yet been earmarked, forcing many residents and campaigners to worry about where the axe will fall next.

From April the Government’s “adult social care precept” will end for 13 county authorities, and ministers have chosen not to renew the grant system, which has provided councils with last-minute funding over the past two years. Instead, local authorities will now have to face the choice of either cutting adult social care provision or maintaining funding by diverting resources from other projects, scheme and departments.

The County Councils Network is now calling for an immediate injection of new resources, saying ending the grants systems would put “additional strain” and “intense financial pressure” on local budgets. In a separate, subsequent survey, it was revealed 44 per cent of local authorities were planning to reduce public health expenditure. Councillor Nick Rushton, Leader of Leicestershire County Council, warned that authorities were in a “seriously and extremely challenging” financial position.

In response, a Government spokesperson said that the funding settlement had given a real-term increase in resources for local government in 2018-19, with local councils being provided £90.7 billion over the next two years to help them meet the needs of residents. The spokesperson added that Government was developing a funding system for the future “based on the needs of different areas.”

This news will be of tremendous interest to the PCF. Further cuts to public health may impact on school nurses, who are no longer represented or funded by the NHS. We will highlight the planned cuts to local authority budgets in any relevant correspondence with local MPs.

 

 

Weekly political news round up – 27th August

September 4, 2018 in Uncategorized by Whitehouse

Paediatric Continence Forum
Political and Parliamentary Monitoring
Week Commencing 27th August 2018

The number of GP partners in England fell sharply by 308 from March to June 2018, new figures have revealed. GP partner numbers have fallen by 10% since September 2015, whilst the total GP workforce as a whole has shrunk by 4%. In September 2015, former Health Secretary Jeremy Hunt said it was his aim to have an additional 5,000 GPs employed nationwide within the lifetime of the Parliament, yet since then there has been a drop of over 1,400 GPs. 500 GPs left the profession in the March-June period alone.

Chair of the General Practitioners Council, part of the BMA, Dr. Richard Vautrey, warned that “GP recruitment [is in] crisis” adding that “the situation is in fact getting worse”. The continued decline in the number of GPs across the country is placing extreme pressure on practices and on GPs who are already working above and beyond to meet growing patient demand. A combination of rising workload and falling pay has led to a marked decline in the number of GPs choosing partnership roles.

The decline in the number of GPs will be of concern for the PCF. With the decline in the number of school nurses, many families will turn to their local GP for advice. The news that their numbers are also depleting will therefore be of great concern, especially as patients may be forced to turn to A&E and other emergency services.

Whitehouse will continue to monitor health employment statistics.

Overview
• RCN admits error on pay deal
• NHS bosses turn to private firms
• Number of new nurses not enough

Royal College of Nursing admits communications error
The Royal College of Nursing has pledged to make “lasting change” in the wake of the recent pay debacle which saw its Chief Executive, Janet Davies, announce she was stepping down. Ms Davies had previously made a public apology. Whitehouse reported over a month ago that errors in communication and negotiation had meant that many nurses were offered minimal pay increases despite being guaranteed much more. An external review is underway into the governance processes which hampered “understanding and communication”.

RCN activities launched a petition in July calling on Royal College leaders to stand down. Over 1000 members signed the petition, which has also triggered an emergency General Meeting which is to take place in Birmingham next month. The anger and frustration stems from a guarantee the RCN gave member of a three per cent pay rise backdated. This turned out not to be the case, with only half of staff getting the rise straight away.

Dame Donna Kinnair, the RCN’s Acting Chief Executive and General Secretary, said that “whatever the conclusions of the review, we already know that the RCN’s processes around the pay deal and its communication were not up to the standards” expected. The RCN has already released early details of meeting over its handling of the pay deal for nurses, which suggested that the RCN had not been clear in the way it had explained the proposed pay deal.

Whitehouse will report on any news of a replacement for Ms. Davies, as well as the result of the investigation.

NHS bosses urge hospitals to send patients to private firms
NHS bosses have urged hospitals to send patients to be treated by private healthcare firms in a bid to reduce the increasing number of patients waiting for planned operations. Whilst the move has sparked claims that it will waste scarce NHS funding by directing money in to the private sector, it is hoped the end result will be shorter and more manageable waiting times. The total number of patients in England on the waiting list in June was the highest figure for ten years.

In response to news that many hospitals are finding it impossible to treat 92% of patients within the supposed 18-week maximum waiting time, which is one of the NHS’s key performance targets, NHS England’s National Director, Matthew Swindell, said that: “Where trusts determine that they will no longer be able to meet their activity and performance commitments in their board approved plan you should work with your trusts to determine how these gaps will be closed through use of capacity in other trusts and/or the independent sector.” The letter also instructed local commissioners to reduce the number of those waiting over 52 weeks by at least 50 per cent.

In response, NHS Providers Chief Executive Chris Hopson, agreed that the “current elective performance is concerning”, but warned that a significant private sector drive could “destabilise” cash-strapped trusts and would simply mean “taxpayers paying a premium” for private clinics to take on NHS work. Mr Hopson added that many hospitals had been prioritising A&E and cancer care in light the NHS England Five Year Forward View, which gave what he considered “a clear signal” about where resources should be directed.

Whitehouse will monitor waiting times, and where necessary combine this data with the results of the PCF’s FOI audit.

Number of new nurses “will not tackle currency vacancy levels”
The number of nurses and midwives employed in Scotland is set to rise by less than 20 full-time posts this coming year, which is nowhere near enough to address widespread shortages, unions have warned. Scottish Government figures released this week show that the number of nursing staff is projected to rise by 0.01% in 2018-19, the equivalent to just an additional 20 roles. Nursing and midwifery numbers are expected to drop in many areas, with only a few locations seeing any notable positive impact. Overall, the number of nurses will remain at just under 60,000 whole-time equivalents.

NHS Ayrshire and Arran reported that a 4.2 per cent decrease in nursing and midwifery staff, which the Health Board claimed was a result of the closure of unfunded emergency care beds. NHS Glasgow and Clyde has also seen a drop in the number of nurses, meaning that Scotland’s largest city is going to be serviced by fewer healthcare professionals.

Whilst the PCF will find the reduction in nurses concerning, NHS 24 is investing heavily in country, with additional nurses set to be available via the telehealth and telecare organisations. This news is undoubtedly welcomed, but it is questionable whether NHS 24 will be able to take over the full capabilities nurses provide, such as face-to-face support and advice.

In response to the news, the Royal College of Nursing said that “Scotland needs more nurses” adding that “The projections set out today will not tackle the current levels of vacancies in the NHS boards, let alone take into account the continued increased in demand for health and care services across Scotland”.

Whitehouse will continue to monitor staffing levels.