Weekly political news round up – 16th October 2015

October 16, 2015 in News by Whitehouse

Around the sector

NICE chairman Professor David Haslam told delegates at the NICE annual conference in Liverpool on Tuesday that although NICE guidance represents the ‘gold standard’ of treatment and that health care professionals should take it ‘very seriously’, it ‘may not be appropriate for every patient’. He said that guidance is not intended to ‘replace a doctor’s clinical judgement’ or the joint decisions that they make with their patients about their specific needs. He added that NICE’s role is to ensure clinicians and social care professionals are supported to give the best care to people.

Professor Haslam also gave an interview to GPonline during the NICE annual conference in which he revealed that NICE will invite GPs to establish a specialist advisory group to communicate the biggest problems with the NICE guidance system. The group will also explore how to make guidelines more accessible, how to allow GPs to contribute more to guidelines and if NICE should establish a GP ‘jury’ to help finalise guidelines.  Haslam said that a list of potential GP members – who are independent of NICE – have already been identified and will be invited to join the group shortly.

The Department for Education has published the early years foundation stage profile (EYFSP) results for the 2014 to 2015 academic year, showing that 66.3% of children achieved a good level of development – an increase of 5.9% on 2014. The statistics also showed that a record 91.2% of all children have achieved the early learning goal for health and self-care, which includes a requirement for children to manage their own basic hygiene and personal needs successfully, including dressing and going to the toilet independently

Ofsted has revealed a correlation between early years inspection outcomes and the proportion of staff within each setting who are qualified to level three (the equivalent of an A Level). The study found that settings with 75% or more staff qualified to level or three or above tended to perform better in Ofsted inspections than those with 75% that do not have the same qualifications. 14% of providers receiving an ‘outstanding’ rating had 75% or more staff at level three or above, compared to 8% for the other group. The difference was significantly smaller for providers with a ‘good’ rating – 71% compared to 69%.

Written parliamentary questions on continence care and commissioning

Conservative MP Henry Smith has received answers to three written questions to the Health Secretary on continence care and commissioning.

  • The first asked what discussions he has had with NHS England regarding (a) commissioning of continence services and (b) guidelines for continence services

Public Health Minister Jane Ellison responded that the Health Secretary meets with representatives from NHS England regularly to discuss a wide range of issues, including the commissioning of local NHS services.

  • The second asked how many catheter associated urinary tract infection related deaths there were in the last three years

Ellison responded that the information is not available in the format requested.

  • The third asked how many people were admitted to hospital as an emergency case with acute retention of urine due to a blocked Foley catheter in the last three years.

Ellison responded that this information is not available centrally as Hospital Episode Statistics cannot identify blocked catheters or the type of catheter used.

Ofsted and Care Quality Commission launches consultation on SEND inspections

Ofsted and the Care Quality Commission (CQC) have announced that local public services are to be assessed on how well they fulfil their responsibilities to children with special educational needs and disabilities (SEND). The new form of inspection will begin in May 2016. For the first time, inspectors from Ofsted and the CQC will evaluate how local authorities, nurseries, schools, further education establishments, and health services identify children and young people with SEND. They will also evaluate how well they provide services to meet these needs in nurseries, schools and further education colleges, and through specialist services, such as speech and language therapy, physiotherapy and mental health services. Local areas will not receive an overall graded judgement, but reports will include recommendations and priority areas for improvement. The inspection reports will also highlight particular strengths and good practice in local areas, to encourage other areas to model similar practices.

In relation to this announcement, a consultation has been jointly launched by Ofsted and the Care Quality Commission. It sets out the principles under which the two inspectorates propose to undertake these joint inspections, and seeks views on a number of suggested approaches. The consultation asks for responses to the following proposals for the following inspection methodologies:

  • Proposal 1 Inspectors will evaluate how effectively the local area identifies disabled children and young people and those who have SEN. This will take into account factors such as the timeliness of assessment and identification, information provided from an assessment in helping to understand a child’s needs, how well the child and parent/carers were involved in the assessment, and how whether educational professionals worked well together during their assessments.
  • Proposal 2 – Inspectors will evaluate how effectively the local area meets the needs and improves the outcomes of disabled children and young people and those with SEN. This evaluation will include children and young people’s progress towards their next stage of education or employment, independent living, participating in society and being as healthy as possible. It will take into account how satisfied children and parents/carers are that their needs are being met.
  • Proposal 3 – A wide range of information will be used to evaluate the effectiveness of local area arrangements: this will include the views of children and young people, parents and carers, recent inspection reports and visits to a number of local education and health service providers
  • Proposal 4 – A wide range of approaches will be used during the inspection to obtain the views of disabled children and young people, and their parents and carers, including meetings, online questionnaires and social media

Ofsted and the CQC are seeking the views from all those with an interest in SEND. The consultation will close on 4 January 2016. The outcome of the consultation will be published in early 2016.

NHS England chief executive Simon Stevens address Kings Fund’s Integrating Care conference

NHS England chief executive Simon Stevens addressed the Kings Fund’s Integrating Care conference on Tuesday, in which he discussed the November Spending Review as well as the latest NHS foundation and non-foundation trust quarterly finance reports which showed large deficits.

Stevens said that any money made available to the NHS in the November Spending Review will only be available to organisations that plan collaboratively on population health-orientated geographically-based partnerships, making four-year plans with delivery milestones from 2016 to 2020. He added that the Spending Review announcement will be an opportunity to “move away from transactional payment approaches”, and get organisations to plan in health economics to 2020.

Stevens also said that “if we lose control of our finances, we lose control of our destiny”. He said that provider overspends are caused by increased workforce costs, rather than unexpected emergency demand.

Dr Arvind Madan appointed as NHS England’s director of primary care

NHS England chief executive Simon Stevens has announced the appointment of Dr Arvind Madan as NHS England’s new director of primary care. Dr Madan is currently a practising GP at the Hurley Group, a large multi-site general practice and urgent care provider. In his new role, he will also serve as a deputy national medical director to Sir Bruce Keogh.

Stevens also announced that Cally Palmer has been appointed as NHS England’s national cancer director, and that Dr Jonathan Fielden has been appointed as NHS England’s new director of specialised commissioning.

Stevens commented that these appointments will help “turbo-charge” the implementation of the Five Year Forward View.

Shadow Health Secretary Heidi Alexander asks urgent question on NHS financial performance

Shadow Health Secretary Heidi Alexander asked an urgent question to the Health Secretary on Monday, on whether he would make a statement on the financial performance of the NHS in light of the publication of the first quarterly financial results of NHS foundation trusts and other NHS trusts which showed an increase in the overall level of spending deficit.

Care Quality Minister Ben Gummer responded that the financial position of the NHS is “undoubtedly challenging”, but noted that the Government has promised an extra £8 billion for the NHS by 2020 in order to help address the £30 billion resource gap identified in the Five Year Forward View. He said that efficiency savings must also be made, specifically with agency staffing and mandatory central agreements.

Alexander quizzed Gummer whether it is possible to deliver safe patient care whilst also making savings. She also asked how the Government will fund seven day services.

Gummer responded that there are numerous NHS trusts which have balanced their books whilst also providing good patient care. He also rejected claims that the Government is not providing the NHS with enough funding, stating that the Government provided the NHS with an extra £2 billion in the autumn statement last year – £300 million more than was requested.

Conservative MP Helen Whately, who is also a member of the Health Select Committee, commented that the NHS could and should make better use of its resources through better procurement, the use of technology and the employment of permanent staff. She asked what steps the Government is taking to drive the pace and scale of the changes.

Gummer responded that it would be a “dereliction of duty” to “pour money” into an unreformed system. He said that the Government needs to move at pace to bring in the changes necessary to transform the health system.

Other MPs raised questions covering areas like mental health, social care, GDP spending on healthcare compared with other countries, regulation by the Professional Standards Authority, A&E waiting lists, training places for local nurses and doctors, PFI contracts, and local issues. Gummer did not directly answer a question by Health Select Committee chair Dr Sarah Wollaston on whether the £8 billion of extra funding would be front loaded.

Care Quality Commission publishes annual State of Care report on the health services it inspects

Healthcare regulator the Care Quality Commission (CQC) has published its annual report on the state of the health and social care services that it inspects, which highlighted the adverse impact of increasing budgetary pressures on the quality of care but stressed the importance of strong leadership. The report did not explicitly reference continence, but did reference high-level issues of relevance such as patient safety and primary medical services.

The CQC identified safety as its greatest concern, and was critical of the 6% of primary medical services which were rated as inadequate for safety. The report highlighted that there are a substantial number of services that have been rated as requiring improvement for safety, because there is more they could do to ensure a better safety culture.

The report expressed concern about the high number of services that have been rated inadequate, totalling 7% of all inspections across primary care, secondary care and mental health. It also identified large differences in the quality of care they receive – both between different services from the same provide rand between different providers.

An assessment of primary medical services found that there is a need for GP practices to review access to medical advice and treatment to ensure that they are in line with patient’s needs. The report also noted that GP practices deliver a better quality of care when they share learning and provide joined up care through multi-professional networks.

The report stressed that improvements can be made, emphasising that re-inspections after six months have found improvements in the quality of care, and that surveys of providers stated that they found that CQC reports to be useful. The report also stated that care be provided despite financial limitations, provided there is excellent leadership.

2015 NICE Shared Learning Award given for work on the management of urinary incontinence in women

Royal Cornwall Hospitals NHS Trust has won the 2015 NICE Shared Learning Award for its work on improving the management of urinary incontinence in women.

NICE said that the trust had conducted an audit of care which found that its provision of treatment had been “irregular and inconsistent”, did not follow NICE guidance, and had an overly complex referral pathway. The trust subsequently developed an ‘easy step guide’ for referral to simplify the pathway, also arranging teaching sessions with GPs every six months, and introduced a rolling annual audit on compliance with NICE guidance. A multidisciplinary team was also set up to ensure reviews of surgery or invasive treatment, in accordance with NICE advice.

The increased compliance led to less unnecessary urodynamic testing before conservative management, and in turn less physical and emotional stress for patients.

Report criticises ‘fragmented’ SEND system

A new report, written by the education think-tank LKMco and commissioned by the Driver Youth Trust, has warned that provisions for young people with SEND are becoming fragmented – despite reforms which aimed to provide a “simpler and more joined up” system.

The reports, The Joining the Dots, outlines a number of changes since 2010 that have affected children with SEND and their families, including the Academies Act 2010, which enabled more schools in England to become academies, free from local authority control, as well as changes in 2012 aimed at ending disparities in school funding. Additionally, in September 2014, a new SEND code of practice came into force in England, with the stated aim of putting pupils at the centre of their education planning. “The dominant rhetoric behind reform has been that of “autonomy”,” says the report. “Autonomy allows new players to work with schools and some provision has improved substantially as a result. Yet an autonomous environment is also a risky one: in relation to SEND we find that while some schools have thrived, others are struggling to provide high-quality teaching and additional support for their learners.”

The report was particularly critical of many Local Offers – which are supposed to provide comprehensive information on local provision for pupils with SEND – and accuses a number of local authorities of publishing inadequate information on provision for children with SEND. Analysis found that a quarter of councils’ published Local Offers were “unfinished or incomplete”.

The report makes 22 recommendations, which include:

  • Changes to initial teacher training to ensure newly qualified teachers can support SEND pupils
  • Regional School Commissioners monitoring SEND information reports and identifying schools that need support
  • School leaders making it clear that SEND pupils’ achievement is a whole school priority rather than just the domain of specialist staff
  • The National Audit Office commissioning a full evaluation of Local Offer policy and practice
  • The Department for Education introducing an annual SEND award with a prize to celebrate schools that make effective use of SEND funding.

The paper also recommends that Ofsted should have further powers to check on how schools are helping pupils with SEND. The Ofsted framework now explicitly states that inspectors will consider the progress of SEND pupils in schools, but the Driver Youth Trust wants inspectors to be able to commission a review of how SEND funding is spent in an individual school if necessary, in the same way that they can commission a review of pupil premium funding in a school to find improved approaches. In order to do this, the report recommends that all inspectors receive training on identifying SEND good practice or use specialists as part of inspection teams.