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 31st 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 1st 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 70th 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 4th 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.”