Overview

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

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

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

Baroness Warnock strikes out at “contradictory” Ofsted

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

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

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

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

NHS turns 70

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

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

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

NHS England stops providing more treatments

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

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

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

Overview

NHS England’s Chief Executive, Simon Stevens, has said that the NHS has “an enormous responsibility” to be financially responsible following the Government’s announcement of a 3.4 per cent annual funding increase for the Health Service over the next five years, breaking with the Government’s eight-year programme of austerity. It is important that the PCF raises awareness of the long-term cost savings of implementing paediatric continence provisions throughout England where the funding applies.

Shadow Health Secretary, Jonathan Ashworth, has said that the funding announcement, which falls short of the health sector’s claim that it requires four per cent just to maintain current performance, is not enough to tackle the NHS crisis in the midst of increasing demand coming from an aging population.

MPs debate toilet provision and accessibility

Labour MP for Dewsbury and Shadow Minister for Mental Health, Paula Sherriff, has moved a Bill in the Commons Chamber on Toilets (Provisions and Accessibility), calling for certain buildings to have “Changing Places,” toilets which are accessible to “people with complex needs” such as a height-adjustable, adult-sized changing bench, a tracking hoist system or mobile hoist, and adequate space for a disabled person to have two carers, a centrally placed toilet with room either side, a screen or curtain for privacy, a wide tear-off paper roll to cover the bench, a large waste bin for disposable pads, and a non-slip floor. Changing Places are currently recommended for some buildings; this Bill would make them mandatory for “large new builds, complexes with public access, or sites where visitors can reasonably be expected to spend long periods of time.”

The UK’s 1,123 Changing Places are disproportionately concentrated in large cities and there are some areas which do not have such facilities within 100 miles. Sherriff asserted that over a quarter of a million people cannot use standard accessible toilets in the UK, including 30,000 people with cerebral palsy, as well as 40,000 people with profound and multiple disabilities, and 10s of thousands of people with other complex needs. She noted that “the number of people with complex disabilities is growing” as technology advances and saves people’s lives and people live longer and said the extent to which lack of facilities prohibits people from going out is “a sad reflection on our society’s priorities.” It can result in disabled people “facing the indignity of being changed on the dirty floors of public toilets,” people staying at home and social isolation.

This Bill will be read for a Second time on Friday 23^rd November.

We will reach out to Sherriff inviting her to meet with the PCF so we can introduce the Forum and its campaigns and invite her to support us going forward.

Driver Youth Trust launches SEND Governance Review Guide

The Department for Education has collaborated with literacy charity Driver Youth Trust and Whole School SEND, a consortium of SEND campaigners, to launch a SEND Governance Review Guide which sets out a framework for how to ensure that learners with SEND access high-quality provision. When publishing the Guide, Driver Youth Trusts Chief Executive, Chris Rossiter, highlighted in TES that SEND children have the poorest academic outcomes of any demographic, with only 18 per cent of Key Stage 2 children with SEND meeting the expected standards in the three Rs in 2017, compared with 70 per cent of non-SEND children. The Guide provides advice for mainstream and special schools on how to ensure they meet their obligations in a financially strained environment.

The Guide sets out the features of governance which provides a basis on which boards can effectively and confidently discharge their duties with regards to offering high quality SEND provisions: strategic leadership, accountability, compliance, structure and processes, people management, and evaluation. The Guide lists potential next steps following a review; boards could create an action plan in line with existing strategic plans to keep up to date; a review of policies to ensure they are compliant and sufficiently signposted; active engagement in peer reviews, and engaging the expertise of a National Leader of Governance.

NHS performance below that of international peers

The NHS at 70: How Good is the NHS? is one report in a series conducted by researchers from the Health Foundation, the Institute for Fiscal Studies, the King’s Fund, and the Nuffield Trust and commissioned by the BBC for the NHS’s 70^th birthday. It compares the NHS with its international peers in five key areas: the relative strengths and weaknesses of the health service, the state of social care, NHS funding, the public’s expectations of the NHS and the potential of technology to change things in future. The report is an analysis of OECD data across 18 similar developed countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Portugal, Spain, Sweden, and the USA. It pays particular attention was paid to the speed and accessibility of care, the efficiency of the system, and the outcomes delivered for patients.

The report found that the most notable strengths of the NHS included “unusually good financial protection to the public from the consequences of ill health.” The NHS had the lowest proportion of those countries examined of people skipping medicine due to cost; in 2016 2.3 per cent of patients did so compared with the average of 7.2 per cent. Despite media coverage, the NHS is relatively efficient, with the largest share of generic prescribing, at 84 per cent compared with the international average of 50 per cent. It spends less on administrative and managerial costs than most of the comparators, and it is particularly doing well at managing patients with long-term conditions out of hospital. A&E waiting times and waiting times for hip operations are average, again despite media criticism and deteriorating rates in recent years.

The NHS’s weaknesses, as identified by the report, include poor treatment of eight of the 12 most common causes of death, such as in the 30 days after a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, although it has started to improve in recent years. It is the third worst performer in managing amenable (i.e. preventable) mortality. It has an above average perinatal and neonatal mortality rate, standing at seven in 1,000 compared with the average of 5.5 in comparator countries.

Commentators have noted that the NHS performs this well despite having lower than average numbers of all types of staff besides midwives. It has one doctor for every 356 people, compared with the average of comparator countries of a doctor for every 277 people. The NHS has the lowest number of MRI and CT scanners per patient of all the systems considered.

Nigel Edwards, Chief Executive of the Nuffield Trust, referred to media coverage of NHS performance saying that “Discussion about the NHS is often marked by an unhelpful degree of exaggeration” while noting that the NHS is run “with very scarce resources” and achieves “poor outcomes in some vital areas like cancer survival.” Paul Johnson, Director of the Institute for Fiscal Studies, said that while “access is good and people are protected from high costs […] too many people in the UK die when good medical care could have saved their lives.” Dr Jennifer Dixon, Chief Executive of the Health Foundation said that “austerity has bitten hard, and the lag of investment shows.”

Overview

This week the controversial EU (Withdrawal) Bill, which aims to transfer EU law into UK law once the UK leaves the EU, has been adopted by the UK Parliament. The Bill entered the so-called “ping pong” phase, where amendments to a Bill move back and forth between the House of Commons and the House of Lords. After Peers had retabled an amendment giving Parliament a “meaningful vote” if the Government fails to reach a Brexit deal, MPs rejected it by 319 to 303.

The Government fought off a rebellion within own party ranks by promising that an official ministerial statement would be issued making clear it is ultimately for the House of Commons Speaker to decide whether MPs get a “meaningful vote”. While the concession was accepted by pro-EU Conservative Dominic Grieve, who drafted the amendment, six other Conservative rebels still voted in favour. On the Labour side, four MPs defied their whips and sided with Government.

Both sides have claimed victory with pro-EU MPs saying that the Parliament will have a say on what happens if negotiators fail to get a deal.  International Trade Secretary Liam Fox, meanwhile, said nothing had really changed and the option of a no-deal Brexit was still on the table.  The Bill now waits for the final stage of Royal Assent when it will become law.

May announces major NHS funding boost

The Prime Minister, Theresa May, has announced that she will increase NHS funding by 3.4 per cent, the equivalent of £20bn over four years, as part of plans to implement a long-term NHS funding package to coincide with the NHS’s 70^th birthday celebrations. The announcement comes after eight consecutive years of one per cent annual funding increases, the longest period of constrained funding growth in the history of the health service. During this period, conditions in the NHS are widely considered to have deteriorated, with increases in demand outpacing additional funding. May has said that, in return for the extra money, the NHS must create and deliver a 10-year plan with improvements in services, particularly focusing on A&E waiting times, cancer survival rates and mental health provision. She said that the additional funding cannot be “wasted… on bureaucracy.”

This 3.4 per cent increase remains below the 3.7 percent average annual increase in NHS funding since its creation in 1948 and has come amid intense pressure from key figures in the sector who have argued the NHS needs at least a 4 per cent annual increase in order to maintain its current levels of service delivery. Support for the 4 per cent increase comes from NHS England Chief Executive, Simon Stevens, and prominent health think tanks – the King’s Fund, Nuffield Trust, and the Health Foundation – among others.

Jeremy Hunt’s recent calls for increased NHS spending have been supported by a handful of Cabinet allies and other influential non-party organisations, including the Institute for Fiscal Studies and the Office for Budgetary Responsibility. Major stakeholders have welcomed the announcement admitting it is more than they had anticipated. The King’s Fund Chief Executive, Chris Ham, responded saying, “ While we welcome the Prime Minister’s assurance that future decisions about social care spending will not add to pressures on the NHS, this hardly suggests an ambitious statement of intent.”

This is a bold move by the Prime Minister considering the pressure currently being placed on her and her Chancellor, Philip Hammond for increased funding from several other government departments. The Treasury is eager to keep costs down in the wider context of a low value for the pound, and uninspiring economic growth. Where the increased funding will come from has been subject to debate (as detailed below) but the increase is widely expected to be sourced through a combination of increased taxes (with a specific ‘hypothecated’ NHS tax unlikely to be used), increased government borrowing and a “Brexit dividend.”

Critics have highlighted the lack of costings for the plan as the source of £11bn of the £20bn package has yet to be determined. Health and Social Care Secretary, Jeremy Hunt, suggested that “exact details” of how the increase would be funded “will be announced in the budget” in November, while hinting that the pot will be funded via a combination of additional government borrowing and tax rises.

It is believed that borrowing could account for £8-10bn, while the Times is reporting that initiatives such as a freeze of personal allowance and national insurance thresholds at the end of parliament could generate £4bn, although increasing taxes or debt may be met with strong resistance from within the Conservative Party whose core base support has traditionally supported low tax models. It is also rumoured that the Government will cancel planned reductions to corporation tax, despite these being strongly supported by Chancellor Philip Hammond.

Theresa May has referred to a “Brexit Dividend” as one source of funding. This refers to the Vote Leave campaign’s controversial claim that leaving the EU could free up £350 million a week for additional investment in the NHS. Critics roundly dismissed this claim, but the total funding announced exceeds the pledge by committing £394 million a week between now and 2023. Critics have noted that the money saved from not being in the EU will not be available within the relevant time period, given the UK has provisionally agreed to a transition period until 2021 and will probably be making substantial contributions towards the EU Budget long after that. Health Select Committee Chair and Conservative MP, Dr Sarah Wollaston, called the reference to a Brexit dividend “tosh”, whilst Labour’s Shadow Chancellor, John McDonnell, described it as “not credible”.

The Prime Minister also reiterated her commitment for a tangible new 10-year plan for the NHS, promising ‘more doctors’ and ‘more nurses’, but reports from the Institute for Policy Research said that whilst the proposed increase in NHS funding was ‘very welcome’, it ‘must be accompanied by a serious plan for reform’, with a ‘shift from diagnose and treat to predict and prevent’.

This comes after polling by the NHS Confederation found that 77 per cent of people support a four per cent increase in health spending over the next 15 years, and 82 per cent supported a 3.9 per cent increase in social care funding. This would increase the NHS budget from its current £128bn to £234bn by 2033.

This announcement presents an opportunity for the PCF as it can help the Department for Health and Social Care (DHSC) achieve its policy aims of providing healthcare that is longer-sighted and more preventative than it has not been as empowered to pursue until now. The PCF’s asks fit well within the demands placed on the NHS; we will look to engage with policymakers to ensure that its voice is heard.

This announcement suggests that the Government, weakened by divisions on Brexit, is backing down on positions it once firmly– keeping taxes low and tackling immigration – in order to gain credibility on its management of the NHS, something Prime Minister, Theresa May, has acknowledged as a weakness for the Conservative Party. The fiscally conservative nature of Chancellor, Philip Hammond, has manifested in his assertion that the break with policies of austerity in DHSC will not mean other departments will receive an increase in funding to fill their budget shortfalls.

The Prime Minister’s reference to a “Brexit dividend” was seen by some as a calculated ploy to gain leverage with Brexiteers ahead of her requests for a series of compromises on the EU Withdrawal Bill and Brexit negotiations. However, the announcement signifies a tangible break with years of Conservative Party commitment to austerity, while offering a clear indication that the Prime Minister has overruled her Chancellor, Philip Hammond, who had suggested a more modest increase in NHS spending.

The 3.4 per cent funding rise will not please everyone, with respected figures across the health service claiming between 4 and 5 per cent is needed. Additionally, a verdict on this pledge may not be reached until the budget announcement in November, when the precise source of the funding has been revealed: a reduction in personal allowance will entice the Labour opposition to criticise May for punishing the working poor, while any revision to corporation tax cuts will infuriate the right of the Conservative Party and many grassroots activists. 

In the short-medium term, May’s nod to the Leave Vote pledge and significant cash boost for the NHS should ease some of the internal and external pressure on the Prime Minister’s position. She will also be applauded by less-partisan figures in the NHS who will look forward to the most significant funding boost for the best part of a decade.

World Continence week marked across the world

This week marked World Continence Week which saw stakeholders including the PCF and its constituent members getting involved. The Association for Continence Advice (ACA) has published posters to help raise awareness for the occasion. The PCF invited people to visit its website this World Continence Week, promoted by ERIC, and Essity and Coloplast promoted their recent reports relating to paediatric continence issues.

The International Continence Society (ICS) outlined the history of World Continence Week, which started in Cairo in 2008 and its aims to break the “taboo” around continence issues which it estimates results in over 60 per cent of people with continence issues refraining from getting help. The ICS advertised related events including a Toilet Training Including Children with Additional Needs in July and ERIC’s Paediatric Continence Care Conference in October.

The ICS outlines the vision of World Continence Week being:

• Globally facilitate continence awareness and promotion to improve health, wellness and quality of life.
• Provide a reputable forum for those seeking information on Continence Promotion and therapies.
• Create a worldwide network of events and organisations that will be recognised as leading authorities of Continence and Bladder and Bowel Health information.
• Further establish Continence Awareness and promote a multi-disciplinary approach to treatment.

The World Federation of Incontinence Patients (WFIP) tweeted regularly in the run up to World Continence Week, supported by Medtronic UK and Ireland who have published an infographic on adult continence issues, their prevalence and what can be done to help. How to Potty Train has shared its potty-training expertise for the occasion.

The PCF will continue to engage with World Continence Week and collaborate with stakeholders to raise awareness of paediatric continence among the public and policymakers.

Australia uses toilet humour to tackle continence issues

Australian Health Minister Ken Wyatt, who launched World Continence Week in Australia, has publicly encouraged the one in four Australians who are affected by continence issues to seek help so that they can “laugh without leaking” and “live life to the full.” The Australian Government has provided over 14 million Australian Dollars since 2016 to “ensure all Australians have access to the information and support they ned to get help for continence problems.”

Chief Executive of the Continence Foundation in Australia, Rowan Cockerell, said that only 30 per cent of people with a problem seek help because of the stigma attached to the condition. He highlighted that “even children” are affected by this. Australia which is leading the way in terms of many continence provisions, had over 200 events related to World Continence Week.

Overview

PCF Chair Penny Dobson has been published in the Nursing Times (detailed below) in which she raises awareness of the children and young people with continence difficulties and the work the PCF does to address it.

This week, the EU (Withdrawal) Bill, the Government’s flagship piece of Brexit legislation, returned to the House of Commons from the House of Lords. In a relative success for the Government, the Commons rejected 14 of the 15 amendments that peers added to the Bill.

Theresa May will be relieved that the Commons rejected an amendment that would give MPs a “meaningful vote” on the final Brexit deal; however, to achieve this, the Prime Minister is reported to have promised backbench MPs plans that would give Parliament more power to block a no-deal Brexit. To assure the support of some 17 pro-remain Conservative MPs to reject the amendment after hours of negotiation, May, agreed to submit her own Government amendment to ensure that MPs are given greater powers to prevent a no-deal Brexit. In the end, all Conservative MPs with the exception of Ken Clarke and Anna Soubry voted with the Government.

PCF Chair published in Nursing Times

The Chair of the PCF, Dr Penny Dobson MBE, has written an article for the Nursing Times highlighting the plight of the 900,000 children and young people experiencing continence difficulties in the UK, and the work of the PCF in addressing it. The article outlines the findings from the PCF’ FOI audit carried out in 2017 compared with previous years, showing that only 41 percent of CCGs and health boards provided comprehensive and integrated community-based paediatric continence treatment services, and only 15 percent of local authorities provided a continence service following the transfer of school nurses and health visitors to local authority control.

Penny highlights that an unintended consequence of this poor provision is more children going to A&E and being admitted to hospital for advanced constipation and urinary tract infections, undermining the Government’s pledge to bring more healthcare into the community, which is cheaper for the NHS and less disruptive for the patient.

The article highlights the NICE-accredited Paediatric Continence Commissioning Guide which was published by the PCF in 2015 and is being updated this year, which provides advice for setting up “community-based, integrated and cost-efficient paediatric continence services.” It notes that it is encouraging that 64 percent of CCGs have heard of the Guide and 50 percent are using it. The article also brings the reader’s attention to NHS England’s Excellence in Continence Care guide, an updated version of which is due to be published soon.

This is an articulate and informative piece by Penny and is very positive and wide-reaching coverage promoting the PCF and its asks. Many health providers read the Nursing Times regularly and so will. The article includes contact details for anyone wanting more information; we will keep members updated with any interest expressed. Now that this has been published, we can also seek to published the results of the FOI audit on the PCF website and will continue to campaign to have them published on Public Health England’s Fingertips tool.

Welsh Government launches action plan for health and social care

The Welsh Government has published its action plan for “A Healthier Wales: health and social care” in which it outlines how the Welsh Government intends to promote healthy living and provide for those who need health and social care. It aims to support people to “stay well, not just treat them when they become ill;” improve the technology used in healthcare to improve the patient and staff experience; provide support to patients’ loved ones as part of a “person-centred” approach; and deliver more care in the community, supporting the NHS’s aims more broadly to take pressure of hospitals, save money and be less disruptive to the patient.

The plan outlines five main objectives: integrating health and social care services; shift services out of hospitals and into communities; improve how it measures “what really matters” such as early detection; making health and social care in Wales a “great place to work;” and encourage collaborative working. This will be funded in part by the UK government and the Welsh Government will consult on how to generate the extra revenue required. It outlines children and young people as a key demographic to improve provisions for.

This action plan is consistent with the policy aims of the NHS broadly. The PCF will engage with key stakeholders in the Welsh Assembly to highlight the extent to which continence services in the community save the NHS money and young people the distress of experiencing continence issues unsupported.

May poised to boost NHS budget by billions

Prime Minister Theresa May is expected to announce that she will increase NHS funding by between three and four percent, the equivalent of £20bn over four years, as part of plans to implement a long-term NHS funding plan and to coincide with the NHS’s 70^th birthday celebrations. This comes after eight years of a one percent annual funding increase limit, the longest period of constrained funding growth in its history. In that time conditions in the NHS have been deteriorating as increases in demand have been outpacing increases in funding.

Those working in the health space have mounted intense pressure on the Government to increase funding by four percent to keep the NHS going, including NHS England Chief Executive Simon Stevens, health think tanks the King’s Fund, Nuffield Trust, and the Health Foundation, economics bodies such as the Institute for Fiscal Studies and the Office for Budgetary Responsibility, and even Health and Social Care Secretary Jeremy Hunt and other Cabinet members.

This is a bold move by the Prime Minister considering the pressure mounting for increased funding from other departments while HM Treasury is trying to keep costs down in the wider context of a low value for the pound. The funding is expected to come from a combination of increased un-hypothecated tax, increased government borrowing and a “Brexit dividend,” going some way to meeting Vote Leave’s campaign pledge to increase NHS funding by £350 million a week with the money no longer being sent to the EU and NHS calls for a four percent increase against HM Treasury’s reluctance to increase funding above 2.5 percent.

This comes after polling by the NHS Confederation found that 77 percent of people support a four percent increase in health spending over the next 15 years, and 82 percent supported a 3.9 percent increase in social care funding. This would increase the NHS budget from its current £128bn to £234bn by 2033.

Overview

This has been a tense week for the UK’s Brexit team as they published a position paper on the customs backstop (detailed below). Brexit Secretary, David Davis, had previously said he would resign if an end date was not put on and transition agreement but Prime Minister, Theresa May, has refused to commit to one. Foreign Secretary, Boris Johnson, has accused the Prime Minister of lacking “guts” in a speech he claimed was under Chatham House rules, but which mysteriously managed to find its way into the public domain and criticised Chancellor, Philip Hammond, and the Treasury of being “the heart of Remain.” We have not seen any resignations so far, but it is certainly a very volatile and tense political climate at the moment.

Disabled toilets deemed inadequate for children

The Times has reported on a survey of 113 disabled people conducted by someone with cerebral palsy who uses a wheelchair. The survey found that parents and carers of people with profound disabilities suffer from insufficient toilet facilities with proper equipment to the extent that it often prevents disabled people going out. Some families carried padded mats and blankets for their disabled child to lie on when they needed the toilet. Respondents to the survey say that the lack of provisions are unhygienic, undignified, and unacceptable. It noted that some children with such disabilities needed incontinence pads or colostomy bags changed when on the move.

Charities across the UK are campaigning for what have been dubbed “changing places” which are lavatories with wheel chair access and enough space for two carers, a changing bench and a hoist in all city centres, stations and public buildings.

Nic Bungay, Director of Campaigns at Muscular Dystrophy UK, said: “There are a quarter of a million adults and children with severe disabilities such as muscular dystrophy who could benefit from a changing places toilet.” The Department of Housing, Communities and Local Government said: “There are now 1,109 [changing places] toilets across the UK, up from just 140 in 2007, and we have helped fund the development of a new website so people know where to find them.”

Whitehouse met with Muscular Dystrophy UK’s Changing Places Team and arranged for them to discuss their work with relevant PCF members, who would then report back to the Forum.

Major health charities join forces to call for more health funding

Three major health organisations – the Health Foundation, the Nuffield Trust, and the King’s Fund – have written a joint open letter to Prime Minister, Theresa May, calling for increased funding for the NHS. Jennifer Dixon, Chief Executive of the Health Foundation; Chris Ham, Chief Executive of the King’s Fund; and Nigel Edwards, Chief Executive of Nuffield Trust, signed the letter which welcomed May’s announcement on a new long-term funding plan and multi-year funding settlement for the NHS, as well as the “relative protection of the health budget since 2010.”

The letter argued, however, that “historically low funding increases and rising demand for services from a growing and aging population have left the NHS facing unprecedented pressures and struggling to maintain standards of care” as it supported calls for a four per cent a year increase in overall funding, as well as reform to ensure the NHS remains “sustainable.” It says that the NHS has met savings by reducing important activity in public health, capital investment and staff training which, it asserted, “is not a technical point, it has a material impact on patient care.” It calls for the ongoing reforms to be sufficiently funded. The letter focused on revitalising the NHS workforce which it says is in “crisis” and also needs a long-term strategy, and on the need to reform social care.

Health Secretary confirms NHS funding boost

Health and Social Care Secretary, Jeremy Hunt, has asserted that the NHS will get a “significant increase” in its budget as part of its 70^th birthday celebrations, The Guardian has revealed. Hunt claimed that Prime Minister, Theresa May, was motivated to increase funding in order to show that the Conservatives can be trusted with the NHS, and to tackle chronic understaffing coupled with the increased demand stemming from an ageing population. He also said that May would fulfil her promise of implementing a “long-term plan” for the NHS. Hunt called May “unbelievably committed” and asserted that “now the economy is back on its feet” the Government is able to review NHS spending.

However, whilst HM Treasury is under pressure from multiple departments to increase funding it is keen to keep costs down. While DHSC and the wider health community is calling for a minimum of a four per cent a year increase, The Treasury believes it cannot afford more than 2-2.5%. In expressing his support for a long-term funding strategy, Hunt noted the short-sightedness of the recent policy of small, ad hoc increases and emergency injections of cash, calling them “unviable.”

Hunt admitted that the Government was unlikely to meet the target he first made in 2015 to increase GP numbers by 5,000 by 2020 and acknowledged the impact of Brexit on staff shortages. He said, “We do need 5,000 more GPs” but “it has been harder than we thought.”

This looks promising for NHS funding however nothing will be confirmed until the Chancellor’s Autumn Budget in November and it is likely both DHSC and HM Treasury will have to compromise and the NHS will get a funding increase somewhere in between the Treasury’s preference of 2-2.5 percent and DHSC’s call for four per cent. It will be important to raise awareness of the needs of children and young people with continence issues as such services will be competing for limited funds with other health provisions.

Scottish Government consults on supporting Disabled Children, Young People, and their Families

The Scottish Government is consulting on its proposals for supporting disabled children, young people and their families. The proposals span across the inclusive communication of people’s rights to who needs to know, accessibility to support, and transitions to adult care. This is in response to a survey conducted by the Scottish Government which found that families wanted to have centralised resources that are signposted, and resources to span over the legal rights and support mechanisms available. The Scottish Government’s aim is, therefore, to develop “a central, inclusive source of information” available online and on a mobile app.

The deadline for submissions is the 5^th September. The consultation does not reference continence directly but this is a good opportunity to try to make the EICC more accessible to service users. Whitehouse will draft a response to the consultation from the PCF.

Overview

NHS Trusts in England have reported a combined £960 million deficit over the past financial year, nearly twice the figure anticipated by NHS bosses. Prominent health think-tank the Nuffield Trust said the figures are much worse than they appear on paper, given the deficit takes into account the additional financial support provided by the Government in the Budget last November. Chris Hopson, Chief Executive of the Hospital Trust association, NHS Providers, said a 5% annual increase in funding is needed to match European levels of care, noting that, “everywhere you look you get a sense of the NHS under real pressure.” The rise in demand for hospital services is a major contributor to the burgeoning deficit, with another report finding this week that the number of emergency readmissions have risen by a fifth over the past seven years.

Meanwhile, Jeremy Hunt becomes the UK’s longest-serving Health Secretary of all time this weekend, beating Norman Fowler’s previous record of 5 years and 272 days in the role. Hunt’s milestone has been complemented by news that the he has been spared sanction by the Parliamentary Standards Commissioner for the late reporting of his pecuniary interest in the property company Mare Pond. The Health Secretary apologised for his non-disclosure after it came to light, with the Commissioner, Kathryn Stone, declaring this week that Hunt’s infraction was “at the less serious end of the spectrum”.

Studies warn of poor toilet training, genetic link to bedwetting

A study carried out by Swedish health and hygiene company and PCF company member, Essity has found that school children risk contracting bladder infections and potential bowel and continence problems as a result of poor toilet training, and poor school toilet hygiene. The report – based on interviews carried out by YouGov with more than 400 primary school teachers and 500 parents and children – found that 44% of children avoid using the toilet at school at some point every week, while 4.7 million children actively avoid defecating at school. One in 10 primary school teachers said they have seen children abstaining from eating or drinking in efforts to avoid using school toilets, while more than half of teachers are concerned about the impact accidents on other children in class.

The Director of the NAHT Edge teachers’ union, James Bowen, said “we are concerned about the increasing number of school leaders who are telling us that children are arriving in school unable to use the toilet independently.” He said that “this appears to be a growing problem”, adding, “with school budgets under enormous pressure, the reality is that most (schools) are finding it increasingly difficult to repair and upgrade such essential facilities.”

Another study released this week has suggested that bed wetting can be caused by a child’s genetic make-up. The research carried out by academics at Aarhus University Hospital in Denmark discovered a genetic combination which makes some young people 40% more likely to wet the bed, contradicting the notion that the issue is purely caused by psychological activity. A spokesperson for ERIC said that while bed wetting at night “isn’t caused directly by psychological issues”, stress can play a part.

Trusts lean on bank nurses to curb agency spending

NHS Improvement is reporting that spending on agency nurses fell by 20% in the last financial year, as trusts have increased their use of ‘bank’ nursing staff within hospitals. The Department of Health and Social Care arms-length body, which regulates all NHS trusts, said a £93 million reduction in spending on agency staff across all NHS roles was “partly caused by moving agency workers and shifts into bank and substantive roles, which represent greater value for money than the equivalent posts”.

NHSI proclaimed the reduction as “a huge achievement in view of the record levels of demand and the extreme pressure on the acute sector”, with new Chair, Ian Dalton, saying the results are testament to “NHS staff up and down the country (displaying) incredible resilience” in the face of “epic challenges”. The regulator has prioritised a reduction in the use of agency staff, including nurses, in NHS hospitals due to rising concerns over its impact on NHS finances over the past few years. Last year, then Chief Executive, Jim Mackey, wrote a letter to all trusts telling them to “redouble” their efforts and “go further” to cut agency employment costs.

While the reduction in agency spend has been cited as a success for the NHS, HSJ is reporting a related overspend on bank staff by almost £1 billion across the NHS provider sector. Royal College of Nursing Chief Executive, Janet Davies, said the figures reveal “a cash-starved NHS forced to run without enough staff to treat people safely.” She argued that, “as long as hospitals remain £1bn in the red, patients will pay a heavy price.”

Bank staff benefit from more flexible working arrangements than nurses in substantive or permanent posts, but do not earn the high rates of remuneration given to agency workers or agency firms. Bank workers also enjoy substantially less employment protection and contractual rights than NHS staff working full-time under Agenda for Change terms, so NHS Improvement’s reaction to the shift towards greater utilisation of bank workers is particularly telling.

NHS trusts have consistently found it difficult to recruit appropriate numbers of staff in order to avoid a heavy use of temporary workers, and the employment of bank staff is, for the most part, simply a means of doing the same thing for less money. With 10% of nursing posts currently unfilled and a decreasing supply of EU-trained staff to rely on, Ian Dalton’s comments point to a new Chief Executive who is either overly eager to present good news, or critics and may result in criticism from those who feel that he is out of touch with some of the concerns of the NHS workforce and NHS organisations facing ongoing staffing issues.

“NHS Assembly” set to help create 10-year plan

NHS England and NHS Improvement have outlined their intention to set up a new “NHS assembly” to broaden stakeholder input into the Government’s forthcoming long-term plan for healthcare services in England. According to a board paper presented at a joint meeting between the two arms-length bodies last week, the Assembly will act as “the forum where stakeholders discuss and oversee progress on the Five Year Forward View and help codesign the proposed upcoming NHS 10 year plan”.

Assembly members will include national clinical, patient and workforce organisations; representatives from the voluntary, community and social enterprise sector; arms-length bodies; integrated care system and STP leads, as well as representatives from trusts, CCGs and local authorities. The concept was introduced by Simon Stevens last year, when he said that NHSE and NHSI were considering creating “some form of NHS council or assembly that brings together, on a regular basis, frontline organisations and national bodies”. Similar proposals have been made in the past, including through the NHS Modernisation Board in 2001 which was set up to advise then Health Secretary, Alan Milburn, on the implementation of the “NHS Plan”.

The Government will be eager to show that the new long-term plan for the NHS has been sufficiently scrutinised by key health and social care stakeholders. Whilst the range of stakeholders outlined for assembly membership is incredibly wide-reaching, the finer detail revealing those involved will be critical. Key tests will include the extent to which GPs are included (as ICS and STP leads tend to come from trust management), and the type of “patient and staff organisations” involved.

DHSC also risks further accusations of creating a forum for purely tokenistic consultation if it follows the model set through the current process for creating Accountable Care Organisations, where a lack of public engagement in the early stages has contributed to the current challenge being heard in the High Court. It is not clear to what extent the NHS Assembly will consider the future of social care, though it is notable that local authority stakeholders will be invited to join the forum.

Overview

There has been much talk in the national press this week about Brexit and arrangements for a Customs Union, with splits in the Cabinet reportedly forming and Government aide, Andrea Jenkyns, leaving her role to ‘fight for Brexit’. Theresa May is also set to ask the EU for a second Brexit transition period to run until 2023 to avoid a hard border in Ireland. The proposal would mean that the whole of the UK will stay aligned with EU regulations and customs procedures until 2023, with the concept predictably being as praised by remainers as roundly criticised by Brexiteers.

Earlier this week, the Government responded to the Health and Select Committee’s report on Brexit: medicines, medical devices and substances of human origin. The Government had been criticised by the committee over what it sees as a lack of contingency planning in the event of a ‘no deal’ scenario. While the Government claims such an event is “highly unlikely”, it provided little new information on the prospects for the pharmaceutical and medical devices sectors post-Brexit, saying, “it would not be appropriate to publish anything that would risk undermining our negotiating position.”

Prime Minister tipped to approve large NHS funding increase

Theresa May is reportedly set to approve a substantial rise in funding for the NHS, as she and Health & Social Care Secretary, Jeremy Hunt, prepare to unveil a new long-term plan and financial settlement for the service. As celebrations for the 70^th birthday of the NHS draw near, the Prime Minister appears to have favoured the Hunt’s call for a significant increase, over the more conservative plan put forward by Chancellor, Phillip Hammond.

The Spectator’s report notes that a yearly increase of 3% would ensure an additional £350 million per week for the NHS budget against current levels, thereby meeting the financial pledge made by Vote Leave during the EU referendum campaign in 2016. Hunt, NHS England Chief Executive, Simon Stevens, and a number of independent health policy officials are calling for a rise closer to 4%, or around £5.2 billion per year, in order for the service to meet anticipated demand increases over the course of this parliament.

A report released by the Institute for Fiscal Studies (IFS) and Health Foundation said this necessary funding increase will have to come from tax rises, which could cost British households an extra £2,000 per year. IFS Director, Paul Johnson, said the public now faces a clear choice between “higher taxes and a health and social care system which meets our expectations and improves over time, or taxes at current levels and a more constrained health service delivering less than we have become accustomed to.” Chair of the Health Committee, Sarah Wollaston, said that anything below a 4% increase “would be disastrous”, while claiming that the public would be willing to pay more for an improved service.

If the Spectator report proves to be true, Theresa May will be shortly presenting a popular birthday present to the NHS in the form of the most significant increase in funding since the Coalition Government came to power in 2010. Jeremy Hunt refused to confirm or deny the reports at an Institute for Government event later in the week, but it appears almost certain that the Government will give the NHS additional money well over and above that provided by recent limited top-ups.

The devil will be in the detail: in keeping with Sarah Wollaston’s warning, stakeholders across the sector will be unlikely to ease the pressure on the Government if it presents a figure below that called for by the likes of the King’s Fund, IFS, and Office for National Statistics. However, a 3% year-on-year increase would indeed take funding beyond the £350 million extra-per-week demanded by prominent Brexiteers in 2016 and would represent a considerable victory for the likes of Boris Johnson and Michael Gove in their efforts to present a ‘better Britain’ post-Brexit.

NMC launches new nursing standards

The Nursing and Midwifery Council has launched a new set of standards to ensure the “next generation of nurses will learn… to deliver world class care.” The regulator has also introduced standards for a “more modern and innovative approach” to the training of nurses and midwives by practice partners and universities across the UK. The introduction of these new standards follows a decision taken in March that all future nurses are trained under the same set of procedures, and to provide the same set of communication skills regardless of their particular fields of practice.

Key features of the new standards include: changes to mentoring, to support students better in both practice and academic settings; adoption of the Royal Pharmaceutical Society competency framework for prescribers; and removal medical management standards, which will be replaced by “consistent guidance” applying to all health and social care staff. Chief Executive of the NMC, Jackie Smith, said the new standards “represent a huge leap forward”, and “raise the bar for the next generation of nurses”. The NMC added that nurses will have greater understanding across all four fields of practice, in particular mental health, while also emphasising teamwork and leadership.

Scotland reveals safe health and care staffing standards

The Scottish Government has published a Bill to enforce safe staffing standards across the Scottish health and care system. If passed, the Health and Care (Staffing) (Scotland) Bill will legally require NHS boards and care services to have appropriate numbers of trained staff in place. It would also require the use of the country’s existing workload planning tools to determine what safe staffing levels are.

Scottish First Minister, Nicola Sturgeon, first made the promise for safe staffing legislation in 2016, after Wales became the first UK country to introduce similar legislation. Unlike the draft Bill in Scotland however, Welsh legislation is currently only applies to adult acute medical and surgical inpatient wards.

Scottish Health Minister, Shona Robinson, said the Government was fully aware, stating: “there is a clear link between effective and sustainable staffing levels and high-quality care”, adding that it is “vital we have the right staff in the right place, with the right skills, long into the future.” Peter Bennie, Chair of the British Medical Association in Scotland, said “it has never been more important to have the right mechanisms in place” but argued that “there must also be an acceptance that this bill does nothing to tackle the core issues of recruitment and retention that are such a problem for NHS boards.”

While the safe staffing legislation in Scotland appears almost certain to pass, there have been no serious suggestions at this stage that similar legislation will be enacted in England. Equally, Northern Ireland has not approached the issue in detail, though is of course incumbered from passing any meaningful legislation before a return to power-sharing takes place. A poll of 1,600 UK adults carried out for the RCN in May found that 74% were concerned about nursing staffing levels in the NHS.

GP representation declining as role of CCGs questioned

The GP magazine, Pulse, has obtained figures showing that GP representation on CCG boards continues to decline. The report states that 39% of all board positions are filled by general practitioners, a fall from 49% in 2012 when the Health and Social Care Act set up CCGs, and from 43% in 2014. The statistics, obtained through freedom of information requests, also show that GP representation is significantly higher in London CCGs than in the North, and that only 29% of GPs on the boards are female, despite women making up more than half of the overall GP workforce.

BMA GP Committee Chair, Richard Vautrey, said it had been clear from the beginning that the 2012 changes would fail to make an impact and argued “the idea of it being clinical-led commissioning is clearly not the case”. A spokesperson for NHS England said it was the responsibility of CCG’s to maintain the composition of board members. Meanwhile this week, the Institute for Government and the King’s Fund have published a report on The Lansley Reforms and the role of NHS England in English healthcare five years since the Health and Social Care Act. The report’s author, prominent health journalist, Nick Timmins, argued in a piece for HSJ that the reforms have failed to deliver all three main objectives.

The story about board underrepresentation is significant in so far as it adds to growing frustration with the Lansley reforms, at a point in time where the Government is allegedly considering scrapping parts of the 2012 Health and Social Care Act. Part of the rationale behind forming CCGs was to ensure clinician-led commissioning decisions, with a focus on input from family doctors. However, this has not worked in practice in many ways, as CCGs have faced strict budgetary frameworks, and increased oversight from NHS England and new regional health structures, such as integrated care systems and STPs.

Overview

The BBC has reported on the Professional Standards Authority publishing its review into the Nursing and Midwifery Council’s handling of allegations of malpractice by nurses on its register in what has been dubbed the Morecambe Bay maternity scandal. The report ruled that avoidable deaths occurred at the hospital while regulators took too long to act on concerns. 11 babies and one mother died in the nine years between 2004 and 2013. The NMC apologised and its Chief Executive, Jackie Smith, resigned ahead of the report’s publication. Having been in the position for six years, she will step down in July.

The Royal College of Nursing (RCN) had its annual congress this week in which it published a number of reports, including pertinent ones detailed below. The BBC reported on a poll of 1,600 adults in which 74 per cent of respondents are concerned about nurse staffing.

Consultation on UTI guidance launched

Public Health England has launched a consultation on the reference guide for diagnosis of urinary tract infections, and it includes a chapter and flow chart on “Infants or children under 16 years with suspected UTI.” The target audience of the guidance is doctors, nurses and pharmacists and “those giving first point of contact for urinary tract infections covering acute uncomplicated infections” in children and others. The aim is to provide “a simple, effective, economical and empirical approach” to diagnosis and treatment.

The guidance flow chart for children starts with a temperature check and lists other symptoms before determining the correct referral pathway and then details the outcome meaning of recommended tests. It outlines sampling options, how to interpret results, and other diagnostic tests.

The deadline for submissions is 30^th May. We are in the process of drafting a response on behalf of the PCF.

Nurses call for investment in specialist children’s nurses

The Royal College of Nursing (RCN) has published a report entitled The Best Start: The Future of Children’s Health – One Year On. Valuing School Nurses and Health Visitors in England, in which it called for more investment in specialist children’s nurses. Its findings show that there is a continued downward trend in health outcomes compared with other countries, further disinvestment in universal services and fragmentation in provision for children and young people.

The RCN highlights reduction in health visitors and school nurses is a particular problem and especially considering the Government’s drive to reduce pressures on acute health care services in favour of primary and community health care services. The report reveals that the health visiting workforce is experiencing significant reductions, with NHS posts falling from 10,309 in October 2015 to 8,275 by January 2018. 81 per cent of health visitors and 70 per cent of school nurses had reported working additional time in their last shift alone.

The RCN concludes that the Government must ensure there is sufficient data collected for necessary monitoring and analysis, that specific support is provided for early and school aged years, and inequalities are addressed “in order to improve child health and thereby, in the longer term, adult population health outcomes.”

Janet Davies, RCN Chief Executive & General Secretary, said: “Children’s health services are the frontline defence against childhood obesity and poor child mental health. This downward trend cannot continue. The Government risks turning back the clock on children’s health if it does not invest in the school nursing and health visitor workforce.”

Councils reallocate school funding for SEND provisions

The Independent has reported that councils across England are being compelled to reallocate funding for state schooling to pay for dedicated special educational needs provisions in order to compensate for yearly overspend elsewhere. Some Leaders of county councils have penned a letter to the Education Secretary, Damian Hinds, on the matter, following the County Councils Network publishing results of a survey which shows eight authorities have transferred £43 million of money allocated to schools to SEND provisions over the past four years. 21 county councils have overspent on their allocation of the £130 million high needs block government grant.

Angela Rayner MP, Labour’s Shadow Education Secretary, said that “Schools should not have to choose between funding extra support for children with special educational needs and providing the basics that every child deserves in the classroom, but that has been a result of this government’s cuts. The Education Secretary and the Chancellor promised every school a cash boost to their budget, but now they have abandoned their own guarantee. Schools have been left scrambling to fill the gaps in their budgets, with more cuts the inevitable consequence of their failure to give them the resources they need.”

A Department for Education (DfE) spokesperson said: “Thanks to our reforms and the hard work of teachers 1.9 million more pupils are in good or outstanding schools than in 2010. By 2020, core school funding will rise to a record £43.5 billion – its highest ever level and 50 per cent more per pupil in real terms than in 2000 – and the introduction of the National Funding Formula will address historic disparities in the system. The high needs budget for pupils with special educational needs is £6 billion this year – the highest on record. Thanks to the additional £1.3 billion funding announced last year, every local authority will see an increase in their high needs funding over the next two years.”

Nurses denied training because of “staffing and funding pressures”

The Royal College of Nurses (RCN) has published a report saying that nursing staff are missing out on training amid NHS cuts and attributes it to a combination of winter pressures, staff shortages and funding cuts. Workforce development funding in England has reduced by 60 per cent in two years by Health Education England, and stood at £83.49 million in 2017.

The Nursing Times has reported on an unpublished RCN survey which suggests that 14 per cent of nurses in England, along with 35 per cent in Wales, 27 per cent in Scotland and 24 per cent in Northern Ireland have been unable to complete mandatory training, ranging from hand hygiene to blood transfusion processes.

The report warned that this could result in staff falling behind with the latest clinical developments thereby putting patient safety at risk and potentially disqualifying nurses from the Nursing and Midwifery Council’s (NMC) register. The NMC’s revalidation requirements currently require nurses to complete 35 hours of continued professional development training every three years, on top of which the NMC is introducing new education standards for pre-registration students from January 2019.

The College is subsequently calling for additional ringfenced funding for nurse CPD, for all bodies working in healthcare education and development to publish data on total funding allocations for CPD and training, and for employers to be compelled to set aside time for it.

RCN Chief Executive and General Secretary, Janet Davies, said: “Nurses make up half the NHS workforce and, as a society, we cannot afford for their training to be an optional extra. These short-sighted cuts must be reversed. For the sake of patient safety, nurses must be allowed to keep up-to-date with developments and advance into tomorrow’s nurse leadership positions. Policymakers and employers must find a way to fund and guarantee this time. Nurses must not be allowed to fall foul of the regulator’s requirement,”

A Department of Health and Social Care spokesman said: “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to their skill and dedication. It’s essential that individual NHS employers – who remain responsible for funding this specific type of training – support staff to develop and grow their skills, so that they can meet the requirements of their role.”

Overview

The Daily Mail has reported on NHS England’s decision to prohibit the prescription of medicines that can be bought over the counter and treat infrequent and not serious ailments, highlighting that it comes into effect at the end of the month. The title highlights specifically that laxatives “will no longer be available on NHS prescription at the end of the month” and in the article references medicine for constipation as well. It makes no reference to child medicines.  The PCF responded to this consultation, which does contain the concession “laxatives are not recommended for children unless they are prescribed by GP”.

Health Minister answers questions on children’s continence care

The Labour MP for Bristol West and Opposition Whip, Thangam Debbonaire, has had her questions on children’s continence answered by Health Minister Steve Brine. Ms Debbonaire asked what assessment the Department for Health and Social Care “has made of the availability of Level 1 paediatric continence services for (a) school nurses, (b) health visitors and (c) GPs to provide preventative early treatment for (i) bladder and (ii) bowel problems in children.”

Mr Brine said: “Clinical commissioning groups (CCGs) are responsible for commissioning continence services and work with local partners to ensure the appropriate level of services are provided dependent upon local need. CCGs may choose to commission the health visiting and school nursing service to deliver continence services. Public Health England (PHE) has developed commissioning guidance to support local public health delivery; the guidance also clarifies the commissioning responsibilities for continence services. Further information is available here: https://www.gov.uk/government/publications/healthy-child-programme-0-to-19-health-visitor-and-school-nurse-commissioning Continence services are not included in the public health grant and PHE has not undertaken a national assessment of continence services.”

Ms Debbonaire asked what assessment the Department has made “of the effect on paediatric continence services of the transfer of public health commissioning responsibilities from NHS England to local authorities in 2015.” Mr Brine said that the Department had not made such an assessment.

Regarding continence care guidelines, Ms Debbonaire asked what steps the Department is taking “to monitor the implementation of NHS England’s Excellence in Continence Care guidelines.” Mr Brine said: “NHS England published the Excellence in Continence Care guidance in 2015 in order to help support best practice in continence care, and the Department would expect local commissioners to both draw on the guidance and monitor progress in improving continence care.”

Finally, Ms Debbonaire asked what assessment the Department has made of “of the effect of the Paediatric Continence Commissioning Guide published in 2014 and accredited by NICE.” Mr Brine said: “No national assessment of the effect of the guidance has been made. The Paediatric Continence Commissioning Guide sets out a clear set of specifications for commissioners to follow, including for paediatric incontinence services. The Department expects local commissioners to draw on the guide in commissioning services and to keep their incontinence services under review.”

Thangam Debbonaire tabled these parliamentary questions following engagement with PCF Chair, Dr Penny Dobson MBE. While these answers do not provide the PCF with any new information, they can be used to inform our engagement with parliamentarians and with the Department of Health and Social Care going forward.

MPs brand Govt’s plans for paediatric mental healthcare inadequate

The Education and Health and Social Care Select Committees have published their review of the Government’s Green Paper on Child and Adolescent Mental Health which they considers to be “failing a generation.” The report considers the plans to raise “the very real prospect of hundreds of thousands of children missing out on getting the help they so desperately need.” It notes that the proposals put “more pressure on the teaching workforce without sufficient resources.” It is estimated that 10 per cent of children and young people suffer from a mental health condition and although the number of children and young people seeking NHS care has significantly increased over the last 10 years, Public Health England have admitted that only a quarter of receive the help they need.

The Government’s proposals include encouraging every school and college to have a designated senior mental health lead; setting up mental health support teams to work in schools; and piloting a four-week waiting time for NHS mental health services. It pledged to offer every primary and secondary school in England mental health awareness training, and for mental health and wellbeing to be taught as part of PSHE. The Paper aims to result in one in four schools offering the provision by 2022. The Government pledged over £300m to achieving the proposals, including £95m for school to appoint and train the leads from 2019 and will be responsible for coordinating support between schools, specialist therapies and the NHS. £215m has been pledged to the support teams, which will work with the NHS to offer and support treatment in schools.

Dr Sarah Wollaston, Chair of the Health and Social Care Committee, called for services to be joined up “in a way which places children and young people at their heart and that improves services to all children rather than a minority”. Robert Halfon, Chair of the Education Committee, called for urgent action by Government “to address the mental health issues which children and young people face today.”

Mary Bousted, the Joint General Secretary of the National Education Union, agreed with the report, saying: “The crisis in child mental health provision will not be ‘transformed’ by the unambitious proposals in the government’s green paper. A government that’s complacent about child poverty and relaxed about excessive testing in schools can’t claim to care about young people’s mental health.”

This report further highlights the extent to which Government policy often leads to what has been dubbed a postcode lottery in health and education provisions, as the PCF has determined is the case with continence care through its FOI project. We will continue to make the case for this to be addressed in our engagement with Parliamentarians and civil servants.

Government announces support for children with additional needs

The Department for Education has launched new measures aimed to support children with special educational needs as part of “the government’s drive to give every child the tools to fulfil their potential” and the Early Years Workforce Strategy. This comes as the Government is migrating Statements for children and young people with Special Educational Needs (SEN) into Education, Health and Care (EHC) plans. The new measures include a £20 million contract with the Council for Disabled Children and Contact “to provide families and young people with SEND with impartial advice, support and information;” and a SEND school workforce contract with University College London.

Data published alongside the announcement show that over 98 per cent of SEN Statements  were assessed by the deadline of 31^st March. This means that 3,873 statements were not assessed by the deadline. Data from a month beforehand shows that decisions were made on 10,432 statements by Government in one month, because on 1^st March 14,305 statements were yet to be assessed. Ofsted has said that the quality of the plans vary widely between different geographical areas, and even plans completed on time often had “too much confusing terminology and jargon.”

Children’s Minister, Nadhim Zahawi, said “We want every child to have the support they need to unlock their potential, no matter what challenges they face. Today’s data shows that almost all of SEN statements were reviewed on time, which is testament to the hard work of councils their partners and families all over the country to give children and young people with Special Educational Needs and Disabilities (SEND) the support they deserve.”

This indicates that there is increasing collaboration between the Department for Education and the Department for Health and Social Care. The PCF will draft a letter to Mr Zahawi introducing the Forum and requesting a meeting.

Hammond and Hunt in battle over NHS funding boost

The Guardian has reported on a dispute between Health and Social Care Secretary Jeremy Hunt, and Chancellor of the Exchequer, Philip Hammond, over how much money the NHS should be allocated in the long-term funding deal currently being negotiated. Both Secretaries of State are competing for Prime Minister Theresa May’s support in negotiations after she voiced her support for giving the NHS 10-year funding cycle to help it better plan long-term. Hunt is calling a four per cent a year budget increase for the NHS, which is the equivalent of £5.2bn a year, with Hammond suggesting a more modest 2.5 per cent increase, the equivalent of £3.25bn a year. This is significantly more money than the Government has committed to date, which equates to a 0.7 per cent increase on the year of £800 million, increasing the budget from £126.4bn to £127.2bn a year.

Key health figures have supported Hunt in calling for a four per cent increase, including NHS Chief Executive, Simon Stevens, numerous royal medical colleges, the Office for Budget Responsibility and the Institute for Fiscal Studies, who believe that the additional investment will go a long way to solving the NHS’s crisis. Hunt is also supported by Defra Secretary, Michael Gove, and Foreign Secretary, Boris Johnson, who both supported the claim by Vote Leave that funding currently channelled to the EU could be diverted to the NHS after Brexit. May is expected to use the celebrations around the NHS’s 70^th birthday in July to announce an increase in funding.

Director of Policy at health think tank the Kings Fund, Richard Murray, said that anything less than a three per cent annual rise would hasten the NHS’s deterioration, adding: “Standards of care will fall and patients and their families will pay the price. We have to remember that we are in the longest funding squeeze in the NHS’s history and cracks are beginning to show across the service.”

Minister ‘misinformed’ over learning disability mortality report

HSJ has reported that Care Minister, Caroline Dinenage, has admitted that she misinformed MPs when answering an Urgent Question in the Commons this week. Dinenage had said that the Department for Health and Social Care had not known that the Learning and Disabilities Mortality Review Programme’s first annual review would be published on 4^th May when in fact the Department had been “informally notified” of its publication the day before it came out. The University of Bristol had been commissioned by NHS England to produce the report.

Labour MP for Worsley and Eccles South and Shadow Health Minister, Barbara Keeley, had asked why the review was published the day after the local council elections, during parliamentary recess and before the bank holiday, considering that gave “members little chance to scrutinise its findings.”  Labour MP for Heywood and Middleton and Shadow Foreign Minister, Liz McInnes, noted that the front page of the report stated “December 2017.”

In a letter acknowledging her mistake, Dinenage said: “Firstly, after the urgent question, I was informed NHS England had discussed the timing of the publication and agreed the date with the University of Bristol. Secondly, I have also learned that the Department was informally notified of the publication by NHS England on Thursday 3 May. It remains the case the Department was not officially notified about the timing of the publication of this report, and it did not have any say in the timing of its publication.” A spokesperson from the University of Bristol said that “Contrary to what the minister has said, the University of Bristol had no say on when the report was published.”

Keeley responded that, regardless of the apology, the Government and NHS England had tried to bury the findings of the report, which found that fewer than one in ten of the 1,311 deaths between July 2016 and November 2017 had been reviewed. She said: “The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties in order to complete a review. If there are issues around capacity and training we would like to know what NHS England is doing to rectify this.”

Overview

Local elections took place across the country this week. The top line analysis is that the three major parties benefitted from a significant collapse in the UKIP vote. UKIP lost 103 councillors, reducing the Party to just two councillors overall. Labour failed to win new councils in London and did not achieve the results some were expecting in the run-up to the local elections, fuelling comments that the peak of Jeremy Corbyn’s popularity has passed. Jeremy Corbyn said the Party had achieved a “solid set of results” highlighting that Labour has won 45 seats across England in places which it has never held before. Conservative Secretary of State for International Trade Liam Fox said the Tories’ results had been at the “higher end of expectations.”

The Tories performed well in areas with a substantial leave vote in the 2016 referendum, where they picked up a considerable number of votes from UKIP; while Labour performed well in places where the remain vote was stronger and with a higher proportion of younger voters. Labour failed to gain a single council in London, having targeted Wandsworth, Westminster, and Barnet, the latter of which is being attributed to anti-Semitism in the Party and the high number of Jewish voters in the area. Meanwhile outside of the capital, Labour lost control of Derby. Bedworth In Warwickshire and Nuneaton but did win back Plymouth and became the largest party in Trafford.

The Liberal Democrats had a positive night, regaining control of Richmond in London from the Tories and gaining seats elsewhere.  The Conservative vote is up by 13 points where more than 60% backed leave but down by one point in areas where less than 45% voted leave. The Conservative Party also struggled in places with where there were more graduates and people from an ethnic minority background.

Government publishes plans for Nursing Associates in England

The Government has published the outcome of its consultation on expanding the Nursing and Midwifery Council’s (NMC) governing legislation – the Nursing and Midwifery Order 2001 – to grant the NMC the legal power to regulate the nursing associate profession in England. The intention of this change is to ensure that associate nurses – a new role in healthcare – are held to the same standards and granted the same safeguards as nurses and midwives, “except where it is necessary to accommodate specific differences in the nursing associate profession.”

In announcing that it would implement the proposals, the Department of Health and Social Care said that it had “broad support” from industry. Going forward, the NMC will register, set standards, approve training programmes for, and carry out fitness-to-practice activities on associate nurses. Nursing associates training through a programme not approved by the NMC will be able to join the register up until July 2019, after which point they must be on an NMC-approved course. NMC inspections will be carried out by nurses until the associate nursing profession matures and there are enough qualified nursing associates in the role to manage it. Nursing associates will not be able to prescribe even on a temporary basis such as in times of national emergency.

In England, it will be an offence for someone to call themselves a nursing associate unless they are registered with the NMC and hold the requisite qualifications; while those with comparable qualifications from the devolved nations will be able to be put on the register. The Government noted that many of the respondents to the consultation called for this measure to be applied across the UK. The Government has not done this because nursing associates are not prevalent outside of England and such an offence comes under other crimes, such as fraud in Scotland.

State-Enrolled Nurses (SENs) will no longer be able to join the NMC register, although existing registrants will be able to remain on it. UK-trained SENS have been unable to register since the late 1990s and there are currently only 11,000 are currently on the SEN register, with “this number diminishing each year.” In future applicants from outside the UK will be directed to the associate nursing or sub-part 1 of the register.

NMC Chief Executive and Registrar Jackie Smith said: “Since our council agreed to become the regulator for nursing associates we’ve been working hard to make sure everything is ready to welcome the first nursing associates on to our register in January 2019. It’s clear that there’s widespread support for the proposed approach to regulation and while there’s still more work to be done, today is an important landmark. It’s critical that the government now push forward with these changes to enable us to open the nursing associate part of the register on time.”

The NMC is currently consulting on the standards to which they will hold nursing associates, as well as the content of training programmes. The PCF is compiling a response ahead of the submission deadline on 2^nd July.

Technical issues result in 450,000 women denied breast cancer screening

Health and Social Care Secretary Jeremy Hunt revealed this week that technical difficulties in the NHS had resulted in 450,000 women not being called to breast cancer checks, The Times reported. It has been estimated that this caused up to 270 premature deaths. The technical difficulties have gone undetected for nine years and were only identified in January of this year following a modernisation of the computer systems used. This is despite several separate concerns being raised previously. Public Health England and the NHS are blaming one another for the problem, as NHS England has responsibility for spending but does not run the 79 hospitals that provide breast cancer screening; while Public Health England has responsibility for preventative strategies but does not provide services. Both organisations manage the computer system.

Hitachi, which manages the computer system, attributed the concerns to a local issue that had been resolved when Public Health England’s regional teams investigated the concerns last year, which were raised by hospitals in London and the West Midlands, following women at the age of 70 not being invited to checks, despite that being policy.

Baroness Morgan of Drefelin, Chief Executive of the charity Breast Cancer Now, said: “We urgently need to understand why quality-assurance measures did not pick this up and what procedures will be put in place to ensure such a colossal mistake is never repeated.” Shadow Health Secretary Jonathan Ashworth said: “It seems extra-ordinary that while breast cancer screening rates were falling, serious questions were not being asked, especially as we are now hearing reports of GPs warning of missed tests.”

Ministers have also been urged to provide assurances that bowel and cervical cancer screenings were not affected, after former Conservative Health Secretary Andrew Lansley blamed health cuts for his own bowel cancer going undetected until it reached stage 4.

The Lancet finds child mortality rate one and a half times higher than Sweden

The Lancet has published a comparative study of child mortality rates in England and Sweden, to look into the extent to which “adverse birth characteristics and socioeconomic factors” determine the difference between child mortality in Sweden to that of England, where it is “almost twice as high.” It found that the difference is “largely explained” by England’s relatively “unfavourable distribution of birth characteristics” which could be countered most successfully by improving the health of women before and during pregnancy. Socioeconomic factors were found to have more of an impact after one month of age.

Dr Ronny Cheung from the Royal College of Paediatrics and Child Health (RCPCH) responded to the study saying, “At a time where public health budgets are being cut, the very services that are required to help improve these rates are being lost. We need a commitment from Government that health visiting services will be protected – helping professionals support mothers at risk of ill physical and mental health, in addition to providing stop smoking services, breastfeeding support and weight management advice to those at-risk groups.”