Weekly political news round up – w/c 10th December

January 8, 2019 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 10th December 2018

 

In a tumultuous week in Westminster, Theresa May has won the backing of her party to stay on as Prime Minister. At nine o’clock on Wednesday evening, Sir Graham Brady, Chair of the 1922 Committee of backbench MPs, announced the result. In a blow to pro-Brexit Conservative MPs who had hoped to remove the Prime Minister, the result – 200 votes in her favour, 117 against – means she cannot be challenged in a similar vein for another year.

 

Emerging from 10 Downing Street late on Wednesday evening, the Prime Minister said she and her party had a “renewed mission” to deliver Brexit and unite the country. May flew to Brussels on Thursday to appeal to her fellow EU leaders to offer Britain a legally binding commitment that the backstop on the island of Ireland, which would be introduced in the event of a no-deal scenario in which new trade arrangements have not been completed, would be legally binding.

 

In private, it is believed that May confirmed to colleagues that although she would like to fight the next general election, she would step down before 2022. James Cleverly MP, a loyalist to the Prime Minister, said that May “recognises a lot of people are not comfortable with her leading us into a future general election.” In response to the vote, the Leader of the Labour Party, Jeremy Corbyn, urged the Prime Minister to “bring her dismal deal back to the House of Commons.”

 

Plus ça change, plus c’est la même chose. The more things change, the more they stay the same. At the end of a week of politicking, the Prime Minister remains secure in her position, and a vote in Parliament on a Brexit deal remains some weeks off.

 

Overview

  • NHS waiting lists for lung and bowel treatments double in eight years
  • Scottish GP workforce increases
  • Act now to reduce health inequalities

 

NHS waiting lists for lung and bowel treatments double in eight years

NHS waiting lists for patients in “excruciating pain” or with life-threatening conditions including lung cancers and bowel diseases have doubled since 2010, and the overall waiting list now stands at more than 4 million. Specialist treatments have been worse-affected by the ‘double whammy’ of tighter controls on health spending and the increase in the number of NHS staff vacancies.

 

Despite the commitment to another £20.5 billion of funding for the NHS from 2019, the investment rate is still just a quarter of the amount the Health Service relied on for decades. Rachel Power, Chief Executive of the Patients’ Association, said that the mixture of budget cuts and loss of staff meant “we risk returning to the days of unacceptably long wait for elective surgery”, adding that for some “those days are clearly here again already”.

 

Since its inception the NHS relied on average annual growth of around four per cent, but since 2010 spending on the Health Service has risen by just one per cent a year. Waiting lists fell to a low of 2.4 million in 2009-10, but have since climbed. Jonathan Ashworth, the Shadow Health and Social Care Secretary, said that the “staggering increases in waiting lists” had resulted in “patients waiting longer and longer in pain, distress and anxiety”.

 

In response to the news, a Department of Health and Social Care spokesperson said that “nearly 15,000 fewer people are waiting over a year for non-urgent operation compared to eight years ago.”

 

This news will be of great concern to the PCF. Without the expert staff and investment, many patients with bladder and bowel issues can go for long periods without the offer for suitable treatment. This can impact quality of life, and in the meantime may mean that some are not using the devices or short-term treatments best suited for them.

 

Scottish GP workforce increases for first time in a decade

Figures published by the Scottish Information Services Division show that there were 4,994 GPs working in Scotland at the end of September 2018 compared to 4,919 in 2017, representing a small but significant increase in the number of GPs working in the country. This is the first real increase in GP number Scotland has seen for a decade, and is part of a wider trend which has seen some surgeries close and ‘super surgeries’ expand.

 

Chair of the General Practitioners Council of Scotland, Dr Andrew Buist, welcomed the figures, but added that in the short-term it is “essential that we do everything possible to retain the GPs currently working”. A new GP contract introduced by the Scottish Government, has aimed to increase the retention rate by addressing working conditions.

 

The increase in Scotland has not been mirrored in other parts of the country. In England, GP numbers have only just stabilised after months of rapid decline, November figures show. At the time, Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, said that “the trajectory is on the up” and recommitted the organisation to work with the NHS to increase numbers.

 

As the PCF will be aware, having well-trained doctors available to diagnose and treat young people and children is essential for good care. With this in mind, the organisation will welcome the rise in the number of GPs, and the Secretariat will continue to monitor whether the increased number of staff will have an impact on delays to treatment.

 

Act now to reduce health inequalities, public health experts said

A group of thirty senior public health experts from England have written an open letter highlighting their concerns over the cuts to central government public health grants. Quoting the Northern Health Science Alliance’s Health for Wealth report, the experts, which include the Chief Executive Officers of multiple NHS Trusts, warn that more must be done if the country is to avoid exacerbating a postcode lottery of services.

 

The letter says “the government has future opportunities to halt the widening gap between rich and poor in the country”, adding that health inequalities can be tackled by “using next year’s spending review to reverse cuts to public health grants.” The letter comes in the same week that local authorities in Sunderland, Shropshire, South Shields and Durham have all announced that they are slashing the public health budgets for their areas.

 

The Paediatric Continence Forum will be concerned about this news. Given that school nurses are now funded by local authorities, to see that central government grants are continuing to fall in this area could negatively affect services.

Weekly political news round up – w/c 3rd December

January 8, 2019 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 3rd December 2018

 

The number of people accepted onto nursing courses in England continued to fall in 2018, despite the fact UK-wide acceptance rates hit a record high, the latest university application figures show. A new report by the Universities and College Admissions Service (UCAS) shows that number of applicants from England being accepted on nursing courses fell by 1.4% over the last year. This is the first time ever that acceptance rates have fallen two years in a row.

 

At the same time, the number of applicants to nursing courses across the UK declined for the second year running, with a 7.6 per cent decrease in 2018 on the back of 17.6 per cent drop the year before. Despite this fall in the overall number of applicants, places on nursing courses continued to be over-subscribed. In contrast to England, the number of acceptances in Scotland and Wales, two countries which unlike the Department of Health & Social Care in England, decided to retain bursaries for nursing students.

 

The Council of Deans of Health, which represents universities providing nursing, midwifery and allied health professional courses, said it was concerned about the decline, with its Executive Director, Katerina Kolyva, saying it showed the need for “urgent” steps to boost student numbers. Last month, Health Minister, Stephen Hammond MP, indicated that the Government may be wiling to consider reintroducing bursaries or a new system of grants in England.

 

Overview

  • NHS funding hike must bring permanent end to GP crisis, says Chair
  • Cuts to public-health short-sighted, according to BMJ study
  • Secretary of State to consider safe staffing law in England

 

Secretary of State to consider safe staffing law in England

Matt Hancock, the Health and Social Care Secretary, has said he will look at the possibility of introducing safe nurse staffing legislation, it has been revealed. It is believed the first time a minister in England has openly said they are willing to look into the idea of enshrining safe staffing in law, with the Government have previously opposed such a move. The comments by the Secretary of State also come after a similar was introduced in Wales.

 

Speaking to members of the Royal College of Nursing (RCN), Mr Hancock said he would be “very happy” to look at proposals to introduce safe staffing laws. The admission comes after the RCN ran a high-profile campaign to call for legal minimum safeguards in the face of rising demand for services, falling numbers of staff, and rising vacancies. The law, as envisioned by the RCN, would make it mandatory for healthcare providers to have sufficient nurses on shift or available on projects to ensure patient safety.

 

Dame Donna Kinnair, acting Chief Executive and General Secretary of the RCN, welcomed the comments from Mr Hancock, saying that Mr Hancock was “right to make the workforce a top priority for a sustainable NHS”. Mr Hancock had attended the RCN summit to launch a new Government strategy to reduce violence against NHS workers.

 

Whilst the Secretary of State’s comments will be welcomed by the PCF, it raises several questions. It is unclear about whether it would apply to all nurses, or just those in A&E, and how the NHS would operate should it fail to meet the ‘safe standard’. As more details are released, the Secretariat will engage with inform the PCF of developments.

 

NHS spending on public health creating a postcode lottery of support

A new report published in the BMJ has highlighted that cuts to preventive health budget have affected some local authority activities more than others. Looking at the history of public health spending, the report examines the impact of reductions in spending by the Heath Service centrally, as well as local authorities, comparing spending in the decade 2000-2010 with 2010-2018.

 

Less emphasis is being put on public health now than at any point since Derek Wanless released his report in 2002, which placed the spotlight firmly on changing behaviours and improving public health with the aim averting more costly interventions at a later date. Since then, public health spending by central government has been scaled back greatly, with local authorities having bigger control over public health measures.

 

This, the BMJ article notes, has resulted in a postcode lottery with some councils allocating more funding to public health than others, and with the Local Government Association (LGA), which represents local authorities to central government, warning that some authorities are “salami slicing” services or digging into case reserves to make ends meet. “Some local authorities [are] showing they can cope better with austerity [than others]” the LGA says, adding that changing demographics and rising demand for services is increasing costs.

 

This report by the BMJ will further support the PCF’s calls for a review of how public health funding is allocated. Local authorities oversee school nurse funding, a health sector which has seen reductions in funding and provision over the last eight years.

 

Ofsted condemns ‘disjointed’ disability provision

Ofsted, the schools’ watchdog, has delivered a damning indictment of the education of children with special educational needs and disabilities. In her second annual report, the Chief Inspector of England’s schools, Amanda Spielman, warned that provision for pupils with SEND was often “disjointed and inconsistent”, with thousands missing out on vital support.

 

Her report, which captures the state of education in England, criticised the fact it took too long for many young people with special educational needs diagnoses, thus preventing them and their families accessing vital support. Her report highlights concerns around the step rise in the number of Education and Health Care Plans being delayed or refused. In 2017, there were 14,600 refusals by local authorities to carry out assessments, a third more than two years earlier.

 

The report also flagged the growing postcode lottery and disparity in the amount of provision and care offered by different local authorities, with a widening gap in performance and outcomes between the best and the worst local areas. Of the 68 inspections of SEND sites, there were serious failings in 30. Addressing an audience of education professional and policy experts in Westminster at the launch of her report, Spielman said that “there are still children who lag behind. Children for whom it seems the die is cast, even before entering nursery, and who never catch up in 12 years of schooling.”

 

Commenting on the report, a spokesperson for the Department for Education, said that the report also recognised that England has a “robust education system” where “parents can feel assured that the vast majority of schools, early years providers, children’s homes and local authorities provide a high level of education and care for young people, regardless of their circumstances.”

 

The Paediatric Continence Forum will be concerned about the findings of Ofsted’s annual report. Children with bladder and bowel issues and recognised disabilities linked to urology and continence issues are evidently not getting the support needed. If the PCF agrees, the Secretariat will engage with the schools’ regulator about the need to provide adequate support and facilities for those with disabilities.

Weekly political news round up – 29th October

November 6, 2018 in Uncategorized

Paediatric Continence Forum 

Political and Parliamentary Monitoring
Week Commencing 29th October 2018 

 

The Chancellor presented The Budget to Parliament this week. In it, he announced additional funding for disability facilities and schools, as well as extra investment in health funding and Air Ambulances. In the last Budget before the United Kingdom leaves the European Union, Mr Hammond set aside additional funds for contingency planning, and vowed to do “whatever is necessary” to support the country. 

 

Whilst this was one of the biggest ‘giveaway’ budgets ever, this was almost entirely because of the extra £20 billion allocated to the National Health Service. Whilst the announcement about additional funding was originally made in the Summer, the Chancellor did provide a little extra insight in to where the extra cash was headed. New mental health crisis services are to be established across the UK, along with a 24/7 support hotline for those vulnerable people with mental health challenges who need immediate support. 

 

Nonetheless, many other aspects of The Budget were underwhelming. Whilst there was an announcement of more funding for social care, there was no mention of the need to address the increased demand in the NHS, or of improving the integration between health and social care by providing extra money for local government. A consensus is emerging amongst experts from trade and national press that, despite the positive impact the extra £20 billion of investment will have in the NHS, away from Health, “per-capita spending cuts are due to continue in the coming years”. 

 

Away from Health, the Chancellor also announced an additional £400 million investment for school “cosmetic” changes, equating to £10,000 for each Primary school and £50,000 for each Secondary school. The Chancellor said the extra funding was for “little extras”, and wouldn’t be repeated next year. In response, the Shadow Chancellor John McDonnell, said that some parents and teachers had been “really angered” by the remark.  

 

Whitehouse has provided expert analysis of The Budget, which it will circulate with this monitoring to the Paediatric Continence Fpri, 

 

 

 

Overview  

  • Territorial injustice likely to increase 
  • School toilet policies breach child rights 
  • Charities fear over children’s centres cuts 

 

Continued fall in health visitors, school and learning disabilities nurses 

The numbers of health visitors, school nurses and learning disability nurses in England have continued to fall over the last year, analysis from the National Health Service, has shown. Whilst the overall nursing numbers have increased, they have yet to make up for the decline in some specific areas the of the Health Service. The monthly figures show that, as of July 2018, there were 3,199 full-time equivalent learning disability nurses working in hospitals and the community, 124 fewer than in the year before. 

 

The latest drop continues a steady decline in numbers, with more than 2,000 fewer learning disability nurses working in the profession that there were eight years ago. Similarly, there are fewer health visitors working the NHS, with numbers falling from a peak of 10,300 in October 2015 to just 7,852 in July this year. School nurses – who are included in the community nursing stats – saw full-time numbers drop from 2,422 in July 2017 to 2,213 in July 2018. Again, this is part of a steady downward trend, with a peak of more than 3,000 school nurses having been employed in 2010. 

 

Whilst the figures alone are cause for concern, they also reveal a growing postcode lottery o are. Whilst North West London saw full-time equivalent nursing numbers increase by over four per cent, there was a steep drop n the West Midlands. This evidence will reiterate the conclusions of the PCF’s 2017 FOI audit, which found under-resourced service in many of the UK’s major towns and cities. 

 

The news that the number of community, school and public health nurses continue to fall will be of concern to the PCF, which has long campaigned to increase awareness of the value of the school nurses. As Whitehouse prepares to run a new campaign with the Paediatric Continence Forum, we will highlight where necessary the current staffing issues. 

 

 

Doubling the number of medical students ‘not affordable’ 

Doubling the number of medical students is “not affordable” and could results in “too many”, the Chief Executive of Health Education England has said. Speaking at the Westminster Health Forum this week, Ian Cumming said that Health Education England was now trying work out how many more medical students were needed, adding that “I think doubling the number of people we need to be doctors in this country is not affordable on the current funding model”. Health Education England, the education and training body, is now devising a workforce strategy. Mr Cumming added that this strategy would factor in the number part-time workers currently trained to work in the NHS. HEE is also currently exploring giving doctors more flexibility during training, by extending in to seven years rather than five, so trainees can spend time working in other areas. 

 

Mr Cummng reiterated comments made earlier in the year regarding predictions about the demand for clinical workforce in the NHS rising by between three and five per cent a year over the next decade. However, he stressed that a five per cent increase in the workforce year-on-year over the next decade would be unaffordable, and has instructed the workforce strategy to examine ways to keep the figure as low as possible. One particular aspect of NHS workforce which will come under great scrutiny, which Mr Cumming said was facing a “demographic timebomb” as the number of people retiring increases and the average age of those leaving the profession continued to creep down.  

 

The announcement by HEE comes in the same week that it was revealed the organisation will be made more accountable to NHS Improvement, in an effort to create “a ore coherent approach to workforce development”. In a statement, HEE and NHS Improvement said they would “work more closely together to ensure the national workforce system is well aligned”.  

 

The PCF welcomes any attempt to increase the number of staff working in the NHS, including this strategy. One priority must be ensuring that all aspects of the health service get the resources they need to respond to rising demand. This includes making sure there are enough school, community and paediatric nurses to support young people and their families.  

 

 

Tax on Toilets are abolished 

 

The Chancellor announced additional, much-needed, investment in local authorities in his budget this week.  An extra £650 million will be made available for social care funding, as well as a £45 million grant for disabled facilities and the abolition of business rate tax on toilets made available for public use. This news will be welcomed by many in the wider continence care sector who have been campaigning for better investment in public facilities. Whitehouse has reported on the efforts of Paula Sherriff MP, who has campaigned for more Changing Places facilities in the UK’s towns and cities. 

 

The All-Party Parliamentary Group on Continence Care, which The Whitehouse Consultancy attends, has made improving toilet facilities and Changing Places provision a priority, and the announcements made by the Chancellor today indicates a recognition of the importance of urology care. As such, this announcement will be considered a major victory for those who have campaigned for a more accessible net work of public toilets, including the Paediatric Continence Forum. The Whitehouse reached out in support of Paula Sherriff MP in the summer, and the Forum will welcome today’s announcement. 

 

The PCF will welcome the news, after supporting the APPG’s concerns that the lack of resources was a breach of the human rights of disabled people and those with bladder and bowel issues. Whitehouse will continue to monitor the implementation of this policy.

Weekly political news round up – 22nd October

November 6, 2018 in Uncategorized

Paediatric Continence Forum 

Political and Parliamentary Monitoring
Week Commencing 22nd October 2018 

 

The budget will take place next Tuesday, 29th October, and details are emerging of what key decisions Mr Hammond will have to face. With the final Brexit deal still unknown, it is unclear how much money will be put aside for contingency planning. At the same time, the Prime Minister has already announced an additional £20 billion of investment for the NHS by 2023/24, applying extra pressure on The Treasury, especially given that a new report today by experts at the Institute for Fiscal Studies calculates that most of this will be spent on keeping spending on health services in line with inflation.  

 

On the opposition side, Labour has been preparing its ‘alternative budget’, highlighting its own priorities and calling for the Prime Minister to “end austerity”. In an event in London, the Shadow Chancellor, John McDonnell MP, said an additional £108 billion would be required to end austerity and reverse cuts to social security and social care funding. Speaking to business and trade union representatives, McDonnell said that Labour would prioritise the NHS, adult social care, and schools as the three areas in need of urgent investment. 

 

The annual budget speculation comes as Audit Scotland, the public spending watchdog for the country, announced this week that Scotland’s  NHS faces a huge funding crisis. The organisation said, “the scale of the challenges means decisive action is required”, after finding real-terms funding of health services fell 0.2 per cent last year. Whilst the Scottish Parliament has oversight of health matters, given the UK Government at Westminster provides Scotland with a bloc grant of financial support each year, it is likely that Chancellor will be pressured to provide more funds to the devolved authorities. 

 

Speculation before the annual budget is nothing new, however pressures seems to be mounting on all sides of Mr Hammond, and especially so in the health sector. The devolved nature of health services; across the NHS, local authorities, and the devolved Parliaments, mean that the Chancellor will be pushed to provide additional funding for councils and the nations and regions, as well as central government health projects. Whitehouse will provide budgetary insight and analysis on the day. 

 

Overview  

  • Territorial injustice likely to increase 
  • School toilet policies breach child rights 
  • Charities fear over children’s centres cuts 

 

Leaders express fears over Brexit impact on care 

The National Care Forum (NCF), which represented care providers associations from across the UK, have expressed serious concerns about the impact of Brexit on the sector. In a statement, the NCF highlighted concerns over post-Brexit availability of staff and equipment, stressing that “the social care sector is heavily reliant on a workforce from across the EU”. The categorisation of social care staff as ‘low skilled workers’ by the Migration Advisory Committee risks preventing workers essential to the operation of the health service from entering the country. 

 

The NCF also stressed their concern over the supply of continence devices and drugs, saying that “the Government must recognise the interdependencies between the UK social care sector in ensuring continued access to the skilled workforce and the resources required to deliver quality care.” The NCF added that they were calling for a Brexit which ensured continuity of care across the UK. The news comes as a vacancy crisis emerged in the Health Service, with the number of EU students coming to Britain falling, and the number of domestic students applying to study nursing also falling. 

 

Last week, the Secretary of State of Health issued another letter to medicine and device manufacturers describing what measures they should put in place to protect supply chains and ensure patients still received the prescriptions and supplies they required. Officially, the Government is still confident of a deal being forged, and is recommending that all patients, including paediatric continence, do not begin to personally stockpile, in the confidence that there will be enough supplies. 

 

Recent research report by the BMJ and the House of Commons Library has shown that hospitals in London and South East are especially reliant on EU staff, who represent 11 per cent of the whole workforce. In comparison, just two per cent of the whole NHS workforce in North East England comes from the EU. 

 

Whilst the PCF will welcome reassurances from the Secretary of State regarding Brexit preparations, it will share many of the concerns raised by the NCF. Ensuring minimal disruption to continence devices must be a priority for the health service, as the provide continence support can lead to those with bladder and bowel issues presenting at their local GP or hospital. 

 

 

Student nurses should be warned about nursing job challenges 

Prospective student nurses should be warned about the challenges and demands of the job before choosing to pursue the career, according to a new report by Health Education England, which is attempting to gain a greater understanding of the reasons why healthcare students fail to complete their course or quit the profession within two years of registration. In the academic yeas 2013-14 and 2014-15, the overall attrition rate, referring to the percentage of nurses who did not complete their course on time, continued to rise, the top reasons being finances and academic concerns. 

 

Now, Health Education England has released a series of recommendations to lower the attrition rate, including making clinical staff more involved in the recruitment of student so they can convey the true demands of the course and subsequent career. The report also recommended that hardship funds be made available to encourage more people, particularly those who are older, to embark on a career in nursing, midwifery or therapeutic radiography. More work should be done between universities and healthcare providers to map out detailed clinic placement plans for students, so those studying understand in greater detail what they will be doing, and the costs involved. 

 

Last week, Whitehouse reported that a study by BPP University had found that healthcare assistants were now taking over many of the jobs previously undertaken by nurses. Whilst providing better financial support to trainee and student nurses could increase the take-up, explaining in greater clarity the challenges of the job may risk turning some prospective nurses away from choosing the profession. Nonetheless, Professor John Clark, Regional Chief Nurse who led on the Health Education England report, and the project associated with it, said that “attrition is everyone’s business”. By providing a toolkit for universities and healthcare providers aimed at better supporting students, it is hoped that many students currently struggling from financial worries and stress will have the resources available to alleviate hardship. 

 

The PCF welcomes any attempt to increase the number of nurses working in the NHS. One priority must be ensuring that all aspects of nursing receive the spotlight, investment and focus they deserve. With reductions in council funding threatening school and public health nursing positions, it is prudent for the health service to highlight the rewards associated with the school nursing sectorin order to retain current levels of provision. 

 

Bury continence service award 

Bury’s Young People’s Continence services have won a CARES Award for supporting children with bladder and bowel complaints and who experience daytime and night-time wetting, constipation and soiling – issues which affect more than 900,000 children in the UK each year. Selected ahead of 65 other nominees, Bury was successful due to the high standards and levels of provision, and the trans-anal irrigation training provided to children and their families at home.  

 

The training, previously carried out in hospital, involves emptying the bowels using water, thus preventing constipation and providing young people with more regular bowel movements. By training children and adults to do the procedure at home, the nurses are both decreasing the pressure on hospital services, and giving young people greater dignity and freedom. Claire Bilsborrow, Continence Care Advisor, said that “through support, we can give children more control, improving their social experience, self-esteem and giving them a happier life overall.” 

 

Dignity was central to the ‘Getting It Right For Every Child’ (GIRFEC) approach developed in Scotland, and reported by the PCF last month. The approach, which aims to empower and inform young people and their families, aims to provide care in a familiar and comfortable environment, in the knowledge that this provides better emotional support for the child, and saves the NHS money in the long term. NICE approved the use of an irrigation device for treating constipation earlier this year. When NICE came to that decision, Brenda Cheer, Paediatric Specialist Continence Nurse said “no child should have to suffer from ongoing faecal soiling; if laxatives and regular, effective toileting do not prevent it then thy should be offered a rectal intervention.” 

 

The PCF congratulates the Bury paediatric service for their outstanding achievements. In the longer term, the GIRFEC approach to treating children may be suitable for wider rollout across the UK. Once the GIRFEC approach has been more firmly established, the PCF will contact NHS England outlining its value. 

Weekly political news round up – 15th October

November 6, 2018 in Uncategorized

Paediatric Continence Forum 

Political and Parliamentary Monitoring
Week Commencing 15th October 2018 

 

The Chancellor, Philip Hammond, has announced that this year’s Budget will be held on October 29th, as speculation rises that tax increases are in the pipeline   to provide extra funding for the increase in NHS spending. Theresa May announced at the Conservative Party Conference that, by in large, austerity was over, and that Government spending would now begin to increase at a faster rate than the public had experienced over the last eight years.  

 

Theresa May’s announcement, coupled with the Government’s plans for an additional £20 billion in funding for the NHS by 2021/22, will put additional strain on The Treasury, which has also committed itself to ‘fiscal restraint’. Now, Mr Hammond has said that “people will have to contribute a little extra in the future to pay for our ageing population”, adding “that will mean a little more tax to pay for the service”.  

 

These comments have caused division in the Conservative Party, with Brexit Secretary, Dominic Raab, saying that he would much rather focus on cutting waste than increasing taxes. Pro-remain MPs, such as Anna Soubry, have also pounced on comments, questioning why the additional funding for the NHS is coming from taxation rather than dividend that the Leave campaign claimed could be injected in to the National Health Service. 

 

At the same time, a group of health faculties and royal colleges have urged the Chancellor to use the Budget to invest long-term in adult social care and health services, or “risk the NHS failing to meet demands”. The letter, jointly signed by 11 institutions, including the Royal College of Physicians and the Royal College of Surgeons, reminds Mr Hammond that a healthier population is key to the long-term sustainability of public services. 

 

The PCF will welcome any additional funding for the NHS, with the understanding the early diagnosis and treatment has the potential to save money in the longer term.  

 

 

 

Overview  

  • Territorial injustice likely to increase 
  • School toilet policies breach child rights 
  • Charities fear over children’s centres cuts 

 

GP trainee recruitment target surpassed for the first time 

Secretary of State for Health & Social Care, Matt Hancock MP, has announced that nearly 3,500 GP trainees were recruited this year, above the 3,250 target set for 2017/18 and a rise of ten per cent on last year. Speaking to the Best Practice conference, Mr Hancock announced that “we have a record number of GPs in training”, adding that NHS England is on track to see an increase in the number of other staff working in general practice rising by 5,000 by 2020. 

 

Celebrating the news, Mr Hancock said that working in General Practice should have the same prestige as being a consultant or a surgeon, because of their role as “the bedrock of the NHS”. Mr Hancock also announced that the NHS needed to explore new business modes, including mutuals, whereby clients own part of the business. Reacting to the news about GP numbers, Dr Krishna Kasaraneni, a British Medical Association GP Committee Executive Workforce Lead, said that, whilst he welcomed the news, we must not forget that new GPs take ten years to train and that, without urgent action and investment, more doctors will leave the profession. 

 

Mr Kasaraneni added that “whilst the Health Secretary again promises an extra 5,000 GPs in the workforce, the Government continues to push the deadline for achieving this back as overall numbers dwindle”, adding that “while the news on recruitment is very welcome, there is still more work to be done on retention.” Additional GPs are required in the Health Service if it is to meet the rising demand. At the same time, this winter is set be the busiest on record, with multiple hospitals warning of staff and funding shortages.  

 

The PCF  will welcome the news that additional GPs are now undergoing training compared with a year ago, especially given the long delays in diagnosis, referral and treatment which many young people experience in the Health Service.  

 

 

NHS Trusts turning to healthcare assistants to ‘plug nursing shortfall’ 

Healthcare assistant now account for almost three in 10 of all nursing team roles in NHS Trusts in England, a new study has shown, and their numbers are increasing at nearly four times the rate of registered nurses. Analysis by BPP University’s School of Nursing used data obtained through Freedom of Information requests to show that 29 per cent of nursing and support roles are now filled by healthcare assistants. Healthcare assistants are meant to help trained nurses, carrying out basic tasks such as feeding patients, answering call bells and helping them to the toilets. However, there is an increasing concern that they are now being used to perform tasks for which they are not trained, such as administration of medicines, or being left in charge of multiple patients. 

 

The study by BPP says that the increase in the number of nursing vacancies over period has creating an “alarming picture”, with hospitals now reliant on healthcare assistants and agency staff. In the north west of England, nursing vacancies rose by 48 per cent between December 2015 and December 2017. Across all England NHS Health Trusts, the nursing and midwifery vacancy rate rose from 28,713 in December 2015 to 34,62 in December 2017 – a rise of 21 per cent. Overall, while the number of nurses rose by 0.5 per cent between December 2015 and December 2017, the number of healthcare assistants rose by 6.5 per cent, the analysis shows. 

 

Joyce Robins, of the patient representation group, Patient Concern, said the trends were “frightening”, adding that “we are seeing far too much reliance on staff who just aren’t trained for the tasks they are doing.” Dr Anne Corrin, Head of Professional Learning Development at the Royal College of Nursing said that while healthcare assistants provided “vital support to registered nurses and other clinical staff”, it was a “very different role” to nursing and could not be considered a substitute. 

 

This news will cause concern for the PCF. Trained nurses are essential for good continence care, and should not be replaced, or see their duties transferred, to the Healthcare Assistants. The PCF will contact the Department of Health to raise our concerns over this issue. 

 

English councils brace for the biggest cuts since 2010 

Councils in England are facing the biggest cuts to their budgets since 2010, despite unprecedented pressures on demand. The Revenue Support Grant, the main source of local government funding and which is transferred from central to local government authorities, will be cut by 36 per cent next year, the largest annual deduction in almost a decade and at a time when demand for health and social care services continues to rise. 

An analysis by the Local Government Association reveals that, overall, councils will have suffered a 77 per cent decrease in the government funding for local councils between 2015/16 and 2018/19, dropping from £9 billion to £2 billion. Councils will instead receive grater control over business rates and local taxes, which they will now receive directly, and which will no longer be redistributed by the Ministry of Housing, Communities and Local Government. Once concern over the change is that those areas with a low proportion of businesses, or where business rates and land value is low, could be disproportionately hit by the new system, thus threatening local services. 

There is continued speculation that public health spending could be squeezed further, as council prioritise social care and education. Andrew Gwynne MP, Shadow Minister for Communities and Local Government, said “The Government can no longer ignore this crisis”, adding that without additional investment into local services “councils will be in an impossible position” and many will face bankruptcy. In a statement, a Government spokesperson said that Council “are responsible for their own funding decisions”, adding that “ We are giving them the power to retain the growth in business rates income”. 

This news will interest the PCF. Since the transfer of school nurses to local authority oversight, there has been growing concern about the future of local authority funding. The PCF reiterates in all meetings and events the need to ensure universal provision and protect funding.

Weekly political news round up – 8th October

November 6, 2018 in Uncategorized

 

Political and Parliamentary Monitoring
Week Commencing 8th October 2018

 

Healthcare leaders in the UK must have a voice in the Brexit negotiations due to the expected impact on workforce, an expert on global nursing policy has warned. Howard Catton, Director of Nursing, Policy and Programmes at the International Council of Nurses, intervened in the Brexit debate due to the tremendous impact the negotiations were having on nurse recruitment. Speaking to the Nursing Times, Mr Catton said “the impact of Brexit on the health workforce could be really significant and I don’t know how close health is to these Brexit negotiations.”

 

Mr Catton’s call comes just a day after the Care Quality Commission published its ‘State of Care’ document, which outlined that the EU referendum outcomes had added “to the uncertainty in health and care in the challenge to recruit and retain staff.” The report shows the number of EU nurses and midwives registering to work in the UK fell from 9,389 in the year to March 2016 to just 805. The decline was only “slightly offset” by a rise in the new nurse and midwives from countries outside the EU, the report added.

 

Speaking to the Nursing Times, Mr Catton said employers must be mindful of the state of health services and workforce in a country when deciding where to recruit nurses from, adding that “If you are recruiting in a country the impact on a country already short on nurses could mean services close or waiting times increase”. He urged for those negotiating a Brexit deal to listen to the concerns of nursing leads about a broad range of issues, including language testing and identifying qualifications.

 

The PCF will welcome the calls by Mr Catton and agree that, in order to ensure that there are enough nurses in the UK (including the paediatric continence sector), the Government needs to have a clear policy in place on skilled migration in to the UK.

 

 

Overview

  • Territorial injustice likely to increase
  • School toilet policies breach child rights
  • Charities fear over children’s centres cuts

 

Territorial injustice may rise in England

Disproportionately harsh spending cuts to local public services in England’s poorest areas are likely to intensify perceived “territorial injustice” between deprived and wealthy parts of the country,  study has shown. Research from the University of Cambridge has shown that Post-industrial cities in the north of England, together with some inner-city London Boroughs, have been hit by the deepest cuts to local government spending. Mia Gray, an economic and social geographer at Cambridge who co-authored the study, said that “the idea that austerity has hit all areas equally is nonsense”.

 

More than 30 council areas in England have experienced cuts in spending of over 30 per cent between 2010 and 2017, with seven councils, Westminster, Salford, South Tyneside, Slough, Wigan, Oldham and Gateshead having budgets cuts of more than 40 per cent. The smallest reductions in budget have been in East Riding of Yorkshire, Hampshire, Surrey and Somerset. The cuts in England, on average, have been twice as deep as in Scotland and Wales. Ms Gray waned that the government needed to decide whether it was prepared to see more local authorities go bust in the manner of Northamptonshire County Council, which took the unusual step of declaring insolvency this year after being unable to balance its budget.

 

A spokesperson for the Ministry of Housing, Communities and Local Government said the funding its gave councils was based on the relative needs of different areas, adding that “the average spending power per dwelling for the 10 per cent most deprived authorities is around 23 per cent more than for the least deprived 10 per cent in 2018-19”. Soon, local authorities will also have full-control over business rates tax receipts, thus increasing inequality between areas with high-value business outlets, and low-value areas.

 

The PCF will be concerned that any future decrease in local government spending could negatively affect school nurses, who now fall under the oversight of local councils, and thus efforts to treat bladder and bowel issues in young people.

 

 

School toilet policies breach child rights

School pupils’ rights to leave a classroom to use the toilet has hit the headlines recently. In one case, reported in The Independent this week, a girl was left to bleed through her clothes after being refused permission to go to the toilet while she was menstruating, whilst parents have reported that children who need to use the toilet are having their requests refused because it could lead to disruption in the classroom.

 

The National Education Union’s own guidance raises the concerns of reducing bladder capacity, saying that the practice of only letting pupils go to the toilet at a certain time can cause ‘I’ll just go in case practices’ whereby the bladder does get used o holding on until it’s full. Over time the bladder capacity can reduce, increasing the need to visit the toilet more frequently. Another impact of this practice is that a child may consciously or unconsciously ration their fluid intake, or avoid drinking altogether, or they fear not being able to go to the toilet when they need to.

 

A recent American study concluded that young people with continence problems often require unrestricted access to private and adequate toilet facilities during the school day. It added that there is a need for inclusive toilet access policies and improved toilet standards in schools, and notes that children with continence issues are at greater risk of not achieving their full academic potential. The Department for Education has said that, in order to reduce disruption, and to prevent poor behaviour, teachers are able to limit toilet breaks where they deem necessary.

 

This news will cause concern for the PCF. Without the freedom to use toilets when necessary, young people risk exacerbating bladder and bowel issues. As in the case of the young girl mentioned above, it can cause embarrassment for pupils, and can indicate a deep lack of understanding on the part of teachers to the needs of those with continence issues.

 

Charities fear over children’s centres cuts

Planned spending on children’s Sure Start centres has fallen by more than a third since 2014, Government figures reveal, from nearly £1 billion four years ago to less than £650 million today. Imran Hussain, Director of Policy and Campaigns at the charity Action for Children, said “we known from our own work that without the safety net of well-funded early help services like children’s centres, thousands of children at risk of abuse, neglect or domestic violence are being left to fend for themselves until problems spiral out of control.” Sure Start and children’s centres act as a main gateway for advice for new parents, or those parents and carers who do not have traditional sources of support in order to seek advice. This incudes paediatric and continence care advice.

 

Peter Lampl, founder of the Sutton Trust, echoed Mr Hussain’s calls, adding that “high quality early years provision is crucial to the development of children from the poorest homes”, whilst the Government indicated that spending by both the Department for Education and Department of Health and Social Care continues to rise. This news comes just a month after the Local Government Association warned of a real-terms cut to school spending and the need for the Government to introduce “greater certainty over future funding by introducing three-year budgets, and ensure that the overall level [of spending] is sufficient”.

 

This news will interest the PCF, given its campaign for increased paediatric continence provision. Reduction in school nursing positions by local authorities, coupled with a lack of investment in Sure Start and children’s centres, risks resulting in a situation whereby parents and carers are forced to turn to their GP for advice, which is often a long process. Alternatively, continence issues are left untreated.

 

 

Weekly political news round up – 1st October

November 6, 2018 in Uncategorized

Paediatric Continence Forum 

Political and Parliamentary Monitoring
Week Commencing 1st October 2018 

Major health announcements were made at the Conservative Party conference this week, including an increase in emergency funds for social care and extra resources for hospitals this winter. Recently, we have reported on the concern many trusts have over rising patient demand and increase in the number of patients presenting themselves at A&E. This summer has been likened to a ‘summer crisis’, with the hot weather causing a spike in admissions. 

Now, the Health Secretary, Matt Hancock, has announced an emergency injection of £240 million in to the care system in an attempt to ease pressure on the NHS this winter. In a speech on Tuesday, Mr. Hancock told the Conservative conference that the extra funding will prevent unnecessary admissions and mean that delays to routine operations experienced when staff are diverted to the frontline would now be avoided. “I want to help the NHS through this winter, too”, Mr. Hancock added. 

The move comes after managers in the social care sector declared hat it needed at least £1 billion to adequately relieve the intensifying pressure faced in the care system. The Shadow Social Care Minister, Barbara Keeley, said the amount earmarked by Hancock was a “drop in the ocean” and called urgently called for further investment. 

The PCF will welcome the news that the Secretary of State is investing more money in social care in order to alleviate demand in A&E and routine surgery. In the last year, continence care specialists either providing treatment or diagnosis have been diverted to emergency care, thus delaying the care that many young people with bladder and bowel issues urgently need. An extra investment is therefore useful in avoiding another ‘winter crisis’. 

 

 

Overview  

  • Essity report update 
  • Minister highlights needs to promote community nursing  
  • SEND cuts ‘breaking’ nurseries  

 

Essity report  

Essity have reached out to Whitehouse to inform the PCF about the progress which has been made on their School Hygiene Essentials initiative. The PCF provided a quote for the Initiative in May this year, and the organisation has now provided details of the next phase of development.  

The next phase will include a survey that has been set up in partnership with the National Association of Primary Education to survey teachers from across the UK about what resources would be most helpful for Essity to create. The survey has now gone live and the results will soon be analysed and shared with the PCF via Whitehouse.  

Whitehouse will distribute the results of the Essity Report, as well as the resources it plans to develop, when the report is finalised and distributed 

 

Minister highlights need to promote work of community nurses 

The Care Minister, Carol Dinenage, has promised to fight to get the voice of community nurses heard in Government. In a speech to the Queen’s Nursing Institute Conference, Ms. Dinenage told the audience that “much of what you do goes unnoticed and that simply must change”. Ms. Dinenage’s brief includes community services, for which she said she was “passionate” about improving. The theme of the event was Healthcare in the Community: From Silence to Voice, and looked at the challenges facing community health. 

Ms. Dinenage set out three particular areas of focus for the Government, including: the workforce, improving data collection and analysis and joining up structures. The Minister announced the introduction of a ‘Golden Hello’ of up to £10,000 for new graduates entering district nursing roles, and confirmed that “big progress” was being made on the community services dataset, which would improve data collection on staff and patients and in turn create a more efficient health service. The dataset will also allow Commissioners to compare data from different areas, and, therefore, better understand where to focus resources. 

In a post-speech question and answer session, one delegate was applauded for challenging Ms. Dinenage, saying that “ you can’t develop an already diminished and stretched workforce”, and asked her to bring back the student nurse bursary. The Minister insisted that “she heard” and understood the concerns of the sector, but added that such matters were “beyond my paygrade”. In all, she emphasised the Department of Health & Social Care wanted to learn about what nurses were doing, and encouraged delegates to use the TalkHealthandCare digital platform to record best practice and highlight concerns. 

This PCF will  welcome the news that the Government wants to prioritise community healthcareWhilst Ms. Dinenage does not have oversight of all public health nurses, as these are now funded and administered via local authorities, the emphasis on good community care suggests a subtle change in Government policy which has, thus far, involved slashing funding streams for district nurses. Whitehouse will engage with Ms. Dinenage, and invite her to meet with us to discuss concerns over staffing levels, the importance of early intervention, and paediatric issues more broadly. 

 

SEND cuts ‘breaking’ nursery schools 

Funding to support some of the most vulnerable children in the education system is being cut, according to research released by Early Education, a profession association for early years nursery schools, has shown. Figures indicate that one in six maintained nursery schools got no extra funding for children with special education needs or disabilities despite having children eligible for SEND support and additional funding via education, health and care plans. 

More than a third of the 128 schools surveyed reported that less funding had been available since April 2017 or that they had pupils whose increased funding did not match their increased hours. One nursery reported that they were at “breaking point”. Beatrice Merrick, Chief Executive Early Education, said that “schools are having to meet the needs of children with SEND with less funding than they used to be able to access”. Maintained nursey schools are widely seen as a canary in the coal mine for the education service, because of the high concentration of children with SEND. Whereas schools for older pupils have a notion SEND budget, which is used to pay for up to £6,000 of support per child, but early years providers do not – meaning that they must use their core budget and request a top-op from their authority. 

The figures come just weeks after the National Association of Head Teachers warned that 94 per cent of headteachers were funding it more difficult to resource SEND provision than they had done two years ago. Anntoinette Bramble, Chair of the Local Government Association’s Children and Young People Board, said: “We have been clear all along that the Government needs to provide significant, ongoing and sustainable funding to help council manage their rising demand in support from pupils”. In response, the Department for Education highlighted that a record high of £6 billion was being spend on high-needs funding for children with SEND. 

This news will interest the PCF. Identifying bladder and bowel issues at an early age  is crucial to early intervention. Mapping childhood development and identifying areas of concern help address continence issues in young people. By reducing the funding and resources for nurseries, there is the risk young people may ‘slip through the net’ in terms of support and care.

Weekly political news round up – 24th September

October 1, 2018 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 24th September 2018

 

Labour has attacked the Government’s cuts to public health budgets, as the Party held its annual conference in Liverpool. Shadow Secretary of State for Health, Jonathan Ashworth, told delegates that 85% of local authorities in the country had been forced to slice their public health services due to diminishing allowances from the Department of Health. Union leaders representing nurses, health visitors and midwives slammed the cuts and expressed their concern about the impact on their members. In total, over £800 million is being taken away from public health in the six years to 2020-21, according to the Opposition.

A total of 88 councils are slicing their spending on the NHS health check programme, whilst the national child measurement programme is also losing over £1 million of funding. Mr Ashworth said that “these swingeing cuts to public health budgets are short sighted, cynical and wrong.” Clare Livingstone, professional policy advisor at the Royal College of Midwives, said the budget cuts were “not logical”.

Mr Ashworth continued to attack the previous Conservative Government for the expense incurred during the previous reorganisation of the NHS, and vowed to resist cuts in Parliament. In response, a Department of Health and Social Care spokesperson said “there is always more to be done, which is exactly why we are giving £16 billion to local council to fund public health services over the current spending period.”

This news will interest the PCF greatly. It is essential to have accessible bladder and bowel issues checked in school. Without school nurses, it will take longer to receive an official diagnosis, as parents and young people are forced to access services through their GP or manage the condition independently.  Whitehouse will continue to monitor policy developments as they happen across all major party conferences.

Overview

  • NHS workforce continues to tumble
  • Local areas face tough NHS funding choices
  • RCN council forced to quit

 

NHS learning disability nursing workforce hits records low

Statistics released from the National Health Service have shown a sharp decline in the number learning disability nurses working in hospital and community health services in England. A total of 3,192 learning disability nurses were employed in England in June 2018, the lowest since records began in September 2009 when 5,553 were employed. The number of health visitors has also fallen significantly, to 7,910, the lowest level since October 2012.

The news comes as the NHS’s enters the second phase of its nursing recruitment drive. Over 250,000 people have visited the recruitment website since the campaign was launched three months to go to learn more about a career in nursing. The new phase will specifically target students starting their final year of A-levels or those taking a year out before university. The national campaign aims to increase the total number of applications into the NHS by 90,000 as well as to double the number of nurses returning to practice and improve retention of staff in all sectors.

Responding to news that the number of learning disability nurses and health visitors had fallen, Professor Bob Gates, a leading learning disabilities expert, said that it was a “sad reflection on the NHS that they are not able to provide the senior leadership necessary to resolve this situation, and also a poor reflection on the value placed on one of the most marginalised groups in our society – especially when we know wo much about health inequality.” We reported earlier this year that the Royal College of Nursing was warning that crisis in the number of staff vacancies risked forcing the health service to a return to the Victorian era.

This news will interest the PCF given we have reported by the increased vacancies over the last few months, as well as concerns about pay and working conditions. The PCF will welcome the news that the NHS’s recruitment drive is successful, although Whitehouse will continue to highlight current demand, especially for those children and young people currently under the care of the health service.

 

Local areas face ‘tough choices’ health service bosses warn

Health economies which are struggling financially will have to make “difficult choices” as national NHS chiefs seek to deliver a breakeven position in 2018-19. Finance bosses at NHS Improvement and NHS England say they are looking to reduce the planned deficit for the provider sector by almost £300 million, as well as cutting planned commissioning spending by more than £260 million. The national bodies have also this week announced plans to deliver a balanced budget for the overall health service in 2018-19.

A joint finance paper said that NHS England was “committed to achieving a balanced budget ” and had agreed with NHS Improvement to a join programme of actions designed to eliminate the £519 million deficit recently reported by the organisations. The commissioning sector, which organises the procurement of new services and treatments, is expected to provide an underspend this year to offset a high deficit reported amongst service providers and NHS Trusts.

The news comes just weeks after NHS trusts forecasted a combined deficit of more than £500 million, despite an earlier commitment to break-even. Many Trusts have released plans outlining where they will make considerable savings, although in previous years many have fallen short of ambitions. Sally Gainsbury, senior policy analyst at the Nuffield Trust, said that the figures “are a reminder that [despite pledges to increase health funding] we are starting underwater”, adding that the health service’s first priority must be “simply getting back to a firm footing.”

This news will interest PCF members, given Trusts are a main provider of care for young people with bladder and bowel issues. The news that they continue to overspend, and will therefore need to reduce expenditure, will cause concern given that it can take many months to access procedures and appointments, which are usually delayed.

 

RCN council must stand down after no-confidence vote

It has been announced this afternoon that the whole council of the Royal College of Nurses must stand down after losing a vote of no confidence. At a special Emergency General Meeting held in Birmingham today, following uproar over the organisation’s failure to properly negotiate a pay increase, 78 per cent of respondents voted in favour of the motion to remove the current leadership.

The EGM was organised in response to a petition signed by more than 1,000 members. In total, 11,156 people voted in favour of the resolution which stated, “we have no confidence in the current leadership of the RCN, and call on council to stand down.” A further 3,124 people voted against the motion and 1,112 abstained.

There has been much uproar amongst the nursing union since the leadership bodged a pay increase negotiation which saw the organisation promise staff substantial pay increases and back pay, but which ultimately led to nurses receiving only an additional few pence each month through the actual terms and conditions associated with the deal. We have reported over the last few months about new data which suggests that pay in the sector has dropped by more than ten per cent in real terms in the last eight years.

This is breaking news, but will be welcomed by many Forum members who have seen their pay and conditions eroded over the last eight years. Whitehouse will continue to update the PCF as and when more information is published.

Weekly political news round up – 17th September

September 24, 2018 in Uncategorized

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

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.