Paediatric Continence Forum
Political and Parliamentary Monitoring – Week commencing 16th July 2018

NHS England Chief Executive, Simon Stevens, has identified five major priorities for the 10-year NHS plan due to be unveiled in the Autumn. The 10-year plan, a pre-requisite laid down by Theresa May, will now pave the way for the sign-off on the additional £20 billion of funding earmarked for the NHS.

The major priorities identified by Stevens include action on mental health, the potential need for “core crisis care”, and on cancer, Stevens outlined the need to improve screening services to make them more risk stratified. Other priorities will include a focus on cardiovascular disease, including strokes and heart attacks, as well as a renewed focus on children’s services, and a new effort to reduce health inequalities.

As well as demanding the NHS produce a 10-year plan, Theresa May also announced a review of NHS waiting times. There is currently speculation as to whether any review could lead to NHS England targets being reduced. When asked about the 18-week cancer target, Mr Stevens simply replied that it was important to ensure that patients were treated on the basis of clinical need.

Mr Stevens’s announcement comes as the new Secretary of State for Health & Social Care, Matt Hancock, has been discussing his priorities for the department. An article by Mr Hancock talked of mending the fractured relationship between Government and NHS staff, and directly referenced the way in which many workers feel undervalued by managers and leaders. His article comes in the same week the GMC has raised concerns about workplace pressures, with one third of junior doctors reportedly feeling exhausted before they even start a shift.

Senior GP hits out at state of public health
Former Chair of the NHS Alliance, Dr Michael Dixon, has said that the current structure for public health is simply “not working”, and has become too disconnected from front-line clinicians. Responsibility for public health shifted to local authorities from the NHS as part of a package of health service reforms that took effect in 2013.

Dr Dixon complained that the problem with public health is that decision-making power and influence is handed over to consultants and “people who aren’t working at the front line of medicine”. Dixon added that, given the growing disconnect between policy-makers and the frontline, upon reflection, public health should never have been devolved to local councils. He also said that there should be a greater role for volunteers to run sporting exercise, and offer health advice. Plenty of retired health workers, Dixon suggested, could still offer services and their expertise to the NHS on a smaller scale.

The news that there is growing concern about public health amongst the clinical community indicates a shared concern growing across the medical profession. As reported at the last PCF meeting, cuts in public health funding are having a strong impact on frontline services, including school nursing. Like-for-like spending on public health by local authorities in 2018 is likely to fall by 5 per cent in real terms, whilst demand on services continue to rise.

Whitehouse is co-ordinating a response from the PCF to Simon Stevens to highlight our concerns about the current state of continence services. This will include a reference to the lack of school nurses and public health resources currently available.

Virtual GP service rated outstanding
A report in to one of Britain’s first virtual GP services has been rated outstanding by the Care Quality Commission. West Health Medical Centre, which operates a telephone and video consultation service available seven days a week to patients from practices that are part of Birmingham’s Healthcare Federation, was rated overall outstanding.

Inspectors found that services reduced workloads for GPs across the Federation, improving access to appointments and generating significant savings on medicines waste. At the time of the CQC inspection, there were nine GPs, an advanced nurse practitioner, seven pharmacists, two managers and a number of administrative staff employed across the virtual consultation service.

The inspectors were also given data by the Federation suggesting that scores of patients who may otherwise have needed hospital attention were now able to be seen from the comfort of their own homes. The ability to avoid A&E will be welcome news to many, especially given the news that the review of NHS waiting times targets may produce longer delays at hospitals.

However, the news that more Trusts are looking in to the viability of virtual GP services, may represent a cause for concern for many PCF members. It is unclear whether, away from the GP, how many other staff have specialist continence training. There is also the concern that, given the virtual nature of assessments, whether using phones, tablets or laptops is optimal enough for young people with continence issues.

Whitehouse will continue to monitor the development of virtual services, and enquire with Birmingham Health Federation as to whether those providing clinical advice have continence care training.

Patients ‘beg’ for treatment
There has been a sharp rise in the number of patients blocked from accessing hip or knee operations by NHS Rationing panels, despite their GP thinking surgery is necessary, an investigation has found. Thousands of patients, a report by the British Medical Journal found, were forced to jump through hoops in order to receive “clinically and cost effective” procedures.

Between 2016-17 and 2017-18 there was a 45 per cent increase in the number of patients rejected after their GPs recommended them for surgery in this way. The increased in rejected requests mirrors an increase in the number of GPs being forced to use exceptional funding applications to ensure patients get the treatments they deserve. The process of exceptional funding applications was introduced in 2000 for GPs to refer patients for procedures that could be considered costly. It is, therefore, concerning to see that funds intended to be used in the rarest of cases are now being earmarked for common treatments.

PCF members will find this particularly frustrating given that many young people with continence issues are already finding it difficult to access the services they need and require. At the All-Party Parliamentary Group on Continence meeting this week, one member indicated that an NHS Trust was no longer intending to pay for pads, and instead said it would encourage patients to buy them commercially.

The PCF will continue to monitor decisions made by NHS Trusts regarding prescription pads, as well as the delays in treatment for patients.