Although she promised to resign upon her Brexit deal being voted through, Prime Minister, Theresa May, kicked the notion into the long grass when the Brexit deadline was extended until the 31^st October. This week, senior Conservatives ruled out changing their rules to allow for an early challenge to Theresa May’s leadership, but have asked the Prime Minister for more clarity about exactly how long she plans to remain in office.

Under current rules, MPs cannot hold a new confidence vote in her leadership until December – 12 months on from last year’s vote, which she won. The 1922 Committee rejected bringing forward this deadline at a meeting, but Chair, Graham Brady, said MPs need a “clear roadmap” about her future.

Meanwhile, Scotland’s First Minister, Nicola Sturgeon, said she wants to hold a second referendum on Scottish independence by 2021 if the country is taken out of the EU. She told Holyrood that she would introduce legislation soon to set the rules for another vote, but indicated that she would need the agreement of the UK Government before doing so. Downing Street have said previously that it will not grant a new Section 30 order, which underpinned the 2014 referendum, so Ms. Sturgeon now faces the challenge of making ‘IndyRef2’ a reality.

Elsewhere, The Brexit Party and Change UK: The Independent Party launched their European Election campaigns with a flurry of candidate announcements. Reports of unsavoury tweets, racism and misogynistic slurs quickly came to light – but not from where you might expect. Change UK, self-proclaimed progressives standing up for EU citizens, landed themselves in hot water after one of their key MEP candidates was discovered to have said derogatory remarks about Romanian nationals just two years ago. Although different from their usual candidates, perhaps not the change they were looking for.

Ann Widdecombe also joined the line-up of EU election candidates, cancelling her decades of faithful Tory membership to stand as a candidate for The Brexit Party. With no sign of a Brexit deal being agreed anytime soon, it looks like the UK is heading full-throttle towards electing a new batch of MEPs.

Pre-school children with chronic constipation ‘often picky eaters’

According to US researchers, care of children with chronic constipation should include consideration of sensory issues and possible referral to occupational therapy – claiming their findings are “revolutionary”.

They have found that pre-school children who are developing normally with chronic constipation have underlying sensory issues that contribute to difficulties with toileting behaviours.

These children were found to often be picky eaters who might be overly sensitive to food textures, tastes, or odours, according to the authors of the study. In addition to this, such children might also have an exaggerated response to noises, bright lights, or other senses that can be stimulated.

In the new study by the Journal of Paediatrics, they assessed the differences in sensory processing patterns between 66 children, aged three to five years of age, with chronic constipation and a matched group of 66 controls. They also examined if and how the children’s sensory profiles correlated to the typical toileting behaviours of children.

Senior author, Dr. Mark Fishbein, from Northwestern University, said: “Our study is revolutionary, revealing that chronic constipation in young children accompanies heightened sensory sensitivity.

“In many cases, chronic constipation might be the first hint that the child also has some sensory issues and could benefit from occupational therapy. Feeding problems due to sensory sensitivities are especially common in these children and they are best addressed when kids are under five, before maladaptive behaviours become more entrenched.”

This news will interest PCF, given that knowledge of the link between chronic constipation and sensory sensitivity could transform clinical practice and provide further help for children with bladder and bowel continence issues.

NHS sees productivity grow twice as fast as economy

Productivity in NHS England has grown at twice the rate of the wider economy, despite reports that the Government is using ‘inefficiencies’ to justify further cuts.

Improvements in numbers of patients treated in the NHS each year have vastly outpaced investment in staff and budgets, a report by the Centre for Health Economics at York University found. For every £1 spent, the NHS delivered 16.5 per cent more care in 2016/17 than it did in in 2004/05. This compares to productivity growth of just 6.7 per cent for the wider economy.

With budget increases held to just 1 per cent a year as part of the Conservative Government’s drive to increase efficiency, staff have reportedly been left to work longer hours and more days.

“This is a huge tribute to the work of NHS staff, and the intrinsic efficiency of this country’s health service,” NHS England Chief Executive, Simon Stevens, said.

“This independent research confirms that NHS productivity has been growing at more than double of what was achieved by the rest of the UK economy, including the private sector.”

From April, the NHS is due to receive the first instalments of the £20.5bn additional funding promised by Theresa May. However, the investment is less than NHS England said was needed to overturn austerity measures imposed by the Government. Despite this, the Prime Minister has said it was only available on the basis that it “tackles waste, reduces bureaucracy and eliminates unacceptable variation”.

A spokesperson from the Department of Health and Social Care said: “The NHS Long Term Plan sets out a plan to make every penny of taxpayers’ money count and ensure the health service works hard to provide the best possible services and outcomes for patients in the most cost-effective ways.”

PCF will welcome this news, given that it demonstrates the NHS is making progress, despite ongoing budget cuts, to boost productivity and meet increased demand. Children with continence issues may find that they are seen quicker and more frequently as a result.

Councils place ‘unlawful hurdles’ in way of parents seeking SEND support

Councils with stretched budgets are allegedly putting hurdles in the way of parents seeking support for children with special educational needs and disability (SEND) by setting “unlawful” criteria to receive a needs assessment, The Commons Education Select Committee heard this week.

MPs were told that the recommendations of SEND experts were regularly being overridden by “somebody who is controlling a budget”. The Committee was hearing evidence as part of its ongoing inquiry into SEND.

One of the topics covered during the session was the high number of successful appeals against council decisions relating to education, health and care plans (EHCPs).

Alison Fiddy, the Chief Executive of the Independent Parental Special Education Advice, which offers independent legal advice on SEND, said: “If local authorities complied with the law and were able to justify their decisions not to carry out an assessment of a child’s needs when a request is made, that would also result in fewer appeals.”

Ms. Fiddy said that councils were engaging in “gatekeeping” when it came to SEND support. Her comments were backed up by Michael King, the Local Government and Social Care Ombudsman. “What we’re seeing is some local authorities introducing requirements that parents must meet before they will accept their duty to carry out a needs assessment.” he said.

The news that recommendations by specialist nurses are being overridden by somebody who is controlling a budget will be of great concern to PCF, given that the need for continence care provision will be overlooked on a financial basis and not one of necessity.

Representatives from the PCF attended the Urology Trade Association’s (UTA) annual Parliamentary Reception last Thursday. The event, hosted by the UTA and sponsored by the Chair of the All-Party Parliamentary Group on Continence Care, Rosie Cooper MP, brought together urology device manufacturers, suppliers, charities, forums and Parliamentarians.

Speaking at the event, Ms. Cooper highlighted the need to protect patient choice and access to urology devices post-Brexit, as well as the need to ensure that any new government regulation on single-use plastics doesn’t negatively impact the availability and range of devices manufactured.   Guests also heard from former Minister of State for Health, The Rt. Hon. Philip Dunne MP, who spoke about the need to secure the right products for patients with continence issues.

Dr Penny Dobson MBE, Chair of the PCF, attended with Vice Chair Nick Madden and the PCF’s clinical representatives. Members of the PCF engaged with manufacturers about the needs of young people, and the growing challenges faced by the paediatric continence sector. Most recently, this has included reductions to local government and public health funding, and the rise in demand for assistance and guidance from young people and families to charity members PCF.

Speaking about the event, Dr Dobson said: “It was a great pleasure to meet with members and companies of the UTA at its annual Parliamentary Reception. It is paramount that there is the range of devices available to help young people with bladder and bowel issues and to ensure that patients and clinicians have a full range of choices at their disposal to address continence issues. The PCF will continue to work with interested companies, supporters and clinicians to promote innovation across the urology sector, and disseminate information about bladder and bowel issues.”

—

Note to readers:

• The Urology Trade Association (UTA) represents 95 per cent of urology device manufacturers and suppliers, and is one of the largest trade associations in the health sector.
• The PCF continues to promote engagement with company members. More information can be found by contacting the PCF’s Secretariat, The Whitehouse Consultancy, at paediatriccontinenceforum@whitehouseconsulting.co.uk

Political and Parliamentary Monitoring
Week Commencing 31^st December 2018

The new year has provided many news outlets, think tanks, and analytical platforms with the opportunity to reflect on 2018, in doing so highlighting the main health news which grabbed the nation’s attention and reviewing and assessing how much has changed in terms of health policy. The Digital Health publication focused its attention on the growing technological challenges facing the NHS. In November, the Health & Social Care Secretary, Matt Hancock, confirmed that 500 NHS Digital staff would be made redundant as part of the organisation’s restructure, with the announcement coming just months after the Department of Health & Social Care committed to investing nearly half a billion pounds in to new technology.

The theme of restructuring was also prominent in the Health Service Journal’s review of 2018. The outlet’s most read stories included the plans from NHS England and NHS Improvement to create seven new “single integrated regional teams” to improve co-working, and calls for NHS Directors to stand down after an investigation by the NHS Counter Fraud Authority.

The year ahead will undoubtedly be dominated by the NHS spending review. The 10-Year Forward Plan outlining the health service’s priorities for the next decade was meant to be published at the end of 2018, but has since been delayed. It has already been announced that the Plan will include a new cancer strategy, but there is speculation that the Government is angling for a commitment from leaders at the Department of Health and Social Care that the extra money will also help reduce waiting-times, which have risen in recent years.

As ever, in the short term the new year will pose challenges for hospital admissions, with the number of emergency calls expected to rise in the event of a cold weather snap. Should demand on NHS services rise, and staff are diverted to work on the frontline, this will inevitably have an effect on day-to-day and planned services. The Secretariat will continue to monitor any developments.

The Secretariat wishes the PCF a prosperous 2019.

Overview

• NHS will still be short of nurses in five years
• First ever drop in teaching assistant numbers “concerning”
• Act now to reduce health inequalities

New funding pledged to support children with SEND

The Education Secretary, Damian Hinds, has announced that an additional £350 million is to be allocated to supporting children with complex needs and disabilities. In an announcement published during the Christmas recess by the Department for Education, the Education Secretary announced that local councils will receive an additional £250 million over the next two years to provide “much needed support for children and young people with complex SEND.” This is in addition to £6 billion which the Department has already allocated for SEND support over the same time period.

The Secretary of State also announced that families will benefit from more choice over their child’s education through an extra £100 million investment to create more specialist places in mainstream schools, colleges and special schools. Additionally, more special free school meals will get the green light, as the Education Secretary confirmed that he will approve all high-quality bids in the current round of special and alternative provision free schools.

Speaking about the announcement, Mr Hinds said that “every school or college should be one for a young person with special educational needs.” The announcement comes just two months after a petition against special needs funding cuts was delivered to the Prime Minister by head teachers. Indeed, there remains speculation that despite the pledged extra funding, many local authorities and schools face growing deficits this year which require difficult funding decisions and the reduction in some services.

There is evidence that, in some cases, paediatric continence issues can be linked to physical, psychological or emotional development in children. With this in mind, any new money for children with SEND will impact on the work of paediatric continence experts, nurses, and those who assist in managing continence conditions.

Extra funding for social care makes NHS better prepared for winter crisis

The National Health Service has said it is “better equipped” to deal with the surge in demand for health services during the winter thanks to a multi-million-pound funding boost. Some £240 million of extra funding made available to local authorities over the last year means that older patients have been able to be discharged from hospitals at a quicker rate, thus freeing up hospital beds.

Councils in England also plan to deliver an additional 30,000 packages of care to older people over the next few months, meaning those at risk of being hospitalised can receive high-quality care in the safety and comfort of their own home.

The Department of Health and Social Care will be eager to avoid a situation like last year, when official figures showed ambulance queues and bed shortages hit their worst levels on record. Ambulance Trusts across England were provided with an additional £36 million in 2018 for 250 new ambulance vehicles. 100 had been delivered by Christmas Eve, with the expectation that more will be made available by Winter.

The news regarding extra funding to avert a winter crisis will be welcomed by PCF. Whilst it is unclear where the funds are coming from, and whether they are being diverted from other NHS services, the additional money is likely to ensure that staff who work in outpatient and non-A&E services will not be diverted, subsequently reducing the possibility of delays for patients needing treatment.

Children ‘second class citizens’ as staff redeployed

Seriously ill children are being treated like “second class citizens” by the NHS as scarce paediatric staff are pulled from emergency rooms to cope with winter pressures in adult service. Around 850 paediatric consultants are needed across the NHS to provide safe and sustainable care, according to the Royal College of Paediatrics and Child Health.

However, many nurses and consultants are now being diverted to other duties in adult services, meaning that entire wards are being closed because there are not the staff numbers in place to run them safely. Dr Simon Clark, workforce officer at the Royal College of Paediatrics and Child Health said that “if we do not have the beds, we cannot treat the patients and that means children are missing out on important care.”

The shortage of paediatric consultants is compounded by the staff recruitment crisis in the sector. There has been a 58 per cent drop in the number of European doctors applying to paediatric training in the last year, whilst those consultants working in paediatrics on average only work around 77 per cent of full-time hours. Professor Russel Viner, President of the Royal College of Paediatrics and Child Health, has said the NHS “urgently needs hundreds more” doctors.

The Paediatric Continence Forum will be concerned about this news. Given the growing demand for paediatric continence care services, as well as the delays in accessing care at ‘early’ stages from a GP or school nurse, further disruption to planned treatment could result in the quality of life of young people with continence issues falling.

Political and Parliamentary Monitoring
Week Commencing 17^th December 2018

This week, the Government revealed its eagerly anticipated immigration white paper, setting out how the UK’s border system will operate post-Brexit. The white paper, aspects of which will continue to be consulted on over the coming months, will prove influential as the National Health Service plans its services moving forward. The incoming Chief Executive of the King’s Fund, Richard Murray, called on the Government to “grasp the nettle of migration policy and allow in [to the country] many more health and social care staff from abroad.”

It is unclear whether the white paper lives up to Mr Murray’s demands, with many concerned that a £30,000 minimum wage cap, which sets the threshold for what is defined as a ‘skilled migrant’, could prove detrimental to the social care sector. Those earning under the £30,000 cap may find it difficult to secure long-term visas.  Although the Cabinet is still divided over what the exact cap should be, and further consultation is likely, the £30,000-figure has been touted as the preferred cap by the Home Office based on recommendations by the Migration Advisory Committee.

Given the average salary of a care worker is in the region of £20,000, and the starting salary of a nurse is in the region of £22,000, it is unsurprising that many in the health sector have raised their concerns over whether desperately needed staff from abroad will be able to gain access in to the UK. The Cavendish Council of health and care organisations said it was “extremely concerned” that visa proposals would prevent the health service and businesses accessing the number of care staff needed to sustain services.

For those health workers earning more than £30,000 (predominantly doctors, consultants and other specialists) the removal of the cap on number in the existing tier 2 visa route made the sponsorship system less bureaucratic for employers. This has since benefitted non-EU doctors attempting to gain entry in to the UK.

This is the last monitoring document of 2018. Monitoring will resume on Friday 4^th January 2019. The Secretariat wishes the PCF a Merry Christmas, and a prosperous and peaceful New Year.

Overview

• NHS will still be short of nurses in five years
• First ever drop in teaching assistant numbers “concerning”
• Act now to reduce health inequalities

NHS will still be short of nurses in five years

Ian Dalton, Chief Executive of NHS Improvement, has said it will be more than five years before the number of nurses the NHS needs are available. Speaking ahead of an anticipated long term plan on workforce strategy, Mr Dalton said that the shortfall in nurses was proving hard to solve and that he expected reaching breakeven would take at least five years.

Recent figures from NHS Improvement show that the number of vacant posts in the health service has risen by almost 10 per cent in the first quarter of the year, with more than 42,000 nursing posts being advertised across England and Wales. Mr Dalton, along with Simon Stevens, the Chief Executive of NHS England, have previously indicated that increases in staffing will be closely linked with additional resources provided to the NHS. Dame Donna Kinnair, the Acting Chief Executive of the Royal College of Nursing, said that “swift action” was required to avoid a recruitment crisis.

NHS Improvement has said that it will be working with those Trusts with the lowest retention rates to improve the training and opportunities available to staff. At the same time, NHS England said that it hoped that the recent recruitment campaign for the NHS would continue to be funded as part of the NHS’s long-term plan.

The news regarding the number of nursing vacancies will be of concern to the PCF. Delays in treatment can negatively affect the standard of living for those with bladder and bowel complaints, and can often create the ‘stop-go’ style of care which damages trusts in clinicians. The Secretariat  will continue to monitor recruitment and retention figures.

NHS’s long-term plan delayed until January

The HSJ has learnt that the NHS’s long-term plan has been delayed until at least January, with the political fallout over Brexit preventing the document from getting approval from all cabinet ministers. The plan commissioned by the Prime Minister when she announced the NHS’s £20 billion funding settlement in the summer – was initially expected to be published in November. Simon Stevens, the Chief Executive of NHS England, then said the plan would be delayed until early December. It is now understood that the document will not be revealed until 2019.

The plan is expected to set out the priorities for the NHS over the next five years – which are covered by the £20 billion funding settlement – and some targets for improvements over the next decade. A planning timetable sent to NHS Chief Executives suggests that the financial documents associated with the long-term plan will continue to take place over 2019. Responding to the news about the delay, Jonathan Ashworth, the Shadow Secretary of State for Health, said that patients “deserved better”.

Niall Dickson, Chief Executive of the NHS Confederation, which represents organisations across the healthcare sector, said the new plan must be “radical” but needed to avoid being “unrealistic”, adding that the current situation facing the NHS was “very serious”, with overstretched services. NHS England declined to comment on the delay, except to say that it was important to get the long-term plan right.

The Secretariat is prepared for the launch of the report early in 2019, and will inform the PCF of the exact date when it is released. The Secretariat will also provide expert insight and analysis in the announcement and the possible implications for paediatric continence care.

‘Catastrophic’ funding gap could pause district nurse supply for a year

The supply of district nurses coming into the NHS could drop to zero in 2021 unless the government provides additional funding, it has emerged. Health Education England’s national funding for the one-year postgraduate course is due to finish in 2019-20, with the government planning for the apprenticeship levy to provide funding for a part-time two-year course from 2020-21. However, nurses training through the apprenticeship route would only qualify in 2022, meaning no new recruits in 2021.

The Chief Executive of Queens Nursing Institute, Crystal Oldman, has said that this would be “catastrophic”, whilst NHS Providers said this would have a “severe” impact on the nursing workforce. As the PCF will be aware, district and community nursing is essential for supporting vulnerable people, including children and young people with bladder and bowel issues which may effect mobility or their ability to access treatments. At the same time, district and community nurses play a crucial role for those remote communities who may have little or no direct contact with major centres of healthcare.

In response to the news, a Department of Health and Social Care spokeswomen said, “we are working with HEE on funding for the specialist qualification for district nursing”, whilst earlier this year the Care Minister, Caroline Dinenage, said that the Government would offer “golden hellos” worth £10,000 to new post-graduates who wish to train as a district nurse.

The Paediatric Continence Forum will be concerned about this news. Given the growing demand for paediatric continence care services, the prospect of no district nurses entering the Health Service in 2021 risks exacerbating the challenges the Service faces in recruiting new staff.

Political and Parliamentary Monitoring
Week Commencing 10^th 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.

Political and Parliamentary Monitoring
Week Commencing 3^rd 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.

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.

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 sector, in 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. 

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.