This week, the Health, Social Care and Sport Committee published the transcript of an evidence session on the Public Health (Wales) Bill, in which Committee members questioned a Crohn’s and Colitis UK representative on the Bill’s provisions for public toilets. Andy McGuinness, Crohn’s and Colitis UK’s social policy and public affairs officer, said that the provisions requiring local authorities to the local toilets strategies would help address the lack of public toilets provision in Wales, but that the absence of a statutory obligation on local authorities to ensure access to toilets means there will always be some council that under-deliver.
In another development stemming from the Public Health (Wales) Bill, the Welsh Finance Committee published its report on the financial implications of the Bill’s provisions. This states that the Committee “has concerns as to whether the production of strategies alone would lead to improved public access to toilets, and therefore whether the investment would represent value for money.”
The British Medical Association have featured prominently in broader headlines: firstly, for declaring that NHS organisations will need £9.5bn of capital funding to create the infrastructure necessary to successfully deliver; and secondly, for that NHS organisations will need £9.5bn of capital funding to create the infrastructure necessary to successfully deliver; and secondly, for warning that Brexit-induced uncertainty is creating “serious instability” for the NHS and calling for staff from the EU to be given the right to remain.
Elsewhere, NHS England has confirmed that the NHS RightCare programme has been working alongside Sustainability and Transformation Plan (STP) footprints to encourage planning and change; and a petition on the parliament website to ‘save’ the children’s nursing degree has gained over 13,000 signatures, just a week after it was launched.
HSCS Committee takes evidence on Public Health (Wales) Bill
The Welsh Health, Social Care and Sport Committee has published the transcript of an evidence session on the Public Health (Wales) Bill, which took place in January. Among the items on the agenda were the Bill’s provisions requiring local authorities to produce strategies for the provision of public toilets. The Committee took evidence on this issue from Andy McGuinness, the social policy and public affairs officer of Crohn’s and Colitis UK.
UKIP AM for South Wales West Caroline Jones initiated the Committee’s questioning of Mr McGuiness by asking for his views on access to information about public toilets. Mr McGuiness answered that the level of information available to people on local authority websites is a “mixed bag”, with some councils providing little to no information on their websites. He noted that the Bill contains provisions for local authorities to improve access to information, but said that the Government “should provide access through a united one-Wales approach”, as there is “no point in having 22 different local solutions”. He said the Bill should require Government to work with local authorities to collect information on public toilets, which could then be published online. This information could also be used to analyse the gaps in current service provision, he said.
When Ms Jones asked how the needs of toilet provision can be effectively met at a time when local authorities face significant financial pressures, Mr McGuinness responded that the lack of public toilets is a real issue in Wales – particularly for people with continence issues – and that the Welsh Government’s figure of 950 public toilets needs to be doubled. He said that the local toilets strategies will go some way to addressing this issue, but noted that the lack of a statutory obligation on local authorities to ensure access to toilets means there will always be some that under-deliver. He suggested that it would be “naïve” to introduce a statutory duty on local authorities to provide public toilets directly given the lack of available funding, but said the Government must “think a bit more intelligently for us to come up with intelligible solutions”.
In response to a further question from Ms Jones about how the Bill can ensure third party organisations provide access to toilet facilities, Mr McGuiness said he has called for the introduction of a duty to co-operate with local authorities to ensure that third parties do provide access. This issue was taken up by Labour AM for Merthyr Tydfil and Rhymney Dawn Boden, who asked Mr McGuinness how the allocation of the public facilities grant scheme has changed since being introduced in 2009, and what the impact of these changes has been. Mr McGuinness said the public facilities grant had been ring-fenced, making £200,000 available for local authorities to give to local businesses, with £500 for businesses to open their local toilets. He said that this was then un-ringfenced in 2012/13, meaning that many local authorities have used the funding for other priorities. When Ms Boden asked whether he thought £500 was sufficient incentive, he suggested that it was not.
The final question of the session came from Plaid Cymru AM for Ynys Môn, Rhun ap Iorwerth, who suggested that allowing local authorities to charge for the use of toilets as a way of overcoming limited funding, and asked Mr McGuiness about concerns he had expressed about this. Mr McGuiness responded that about 50 per cent of the stakeholders Crohn’s and Colitis UK had spoken with would be happy to pay a small fee, because then at least those toilets would be available, but said it is a question of dignity. He said that people with Crohn’s and colitis can need access to a toilet up to 10 or 20 times a day and that charging these people creates a real barrier for access.
Finance Committee report on Public Health (Wales) Bill published
This week, the Welsh Finance Committee published its report on the Public Health (Wales) Bill. While the HSCS Committee scrutinised the provisions of the Bill as a whole, the Finance Committee focused only on the Bill’s financial implications. Key points from their analysis of the provisions requiring local authorities to produce strategies for the provision of public toilets are provided below.
The Committee’s report notes that while Bill requires local authorities to produce a strategy for the provision of public toilets, it does not include a statutory obligation on local authorities to provide public toilet facilities, due to concern about the costs of capital investment and maintenance of increased provision. Citing the Welsh Government Regulatory Impact Assessment (RIA), it states that the Bill would nevertheless result in additional costs of just over £451,900, of which £442,900 would fall upon local authorities.
A number of local authorities expressed concern that the proposal to develop strategies would not achieve the policy aims on its own. The Finance Committee’s report echoes this point, stating that the Committee “has concerns as to whether the production of strategies alone would lead to improved public access to toilets, and therefore whether the investment would represent value for money.” It recommended that the Welsh Government review the effectiveness of the provisions relating to public toilets in improving access to facilities and the value for money they represent.
STPs using NHS RightCare approach
NHS England papers from the board meeting last week confirm that the NHS RightCare programme has been working alongside Sustainability and Transformation Plan (STP) footprints to encourage planning and change, and will continue to do so in 2017. CCGs, STPs and their stakeholders have been drawing on the NHS RightCare approach to identify key pathway and system priorities, plan and deliver change, according to the papers.
The NHS RightCare approach is designed to support local health economies in understanding where opportunities exist for improvement, and is based on three core principles: intelligence, or using data to highlight variation and identify areas of opportunity; innovation, or working in partnership with organisations, patient groups and other programmes to test new concepts and influence policy; and implementation, or supporting health economies to embed sustainable change that improves population health.
The papers from last week’s board meeting state that early adopters of the RightCare approach proved that it delivers improvements more efficiently. This paved the way for an accelerated roll-out national level in 2016, with 65 local health economies having received support since February and the remaining 144 economies joining the programme in November.
BMA advocates greater funding for delivery of STPs
NHS organisations will need £9.5bn of capital funding to create the infrastructure necessary to successfully deliver the STPs, according to analysis published by the British Medical Association (BMA) this week. The analysis, which is based on responses to FOI requests from 37 of the 44 footprint areas, found that over half of the footprints have told NHS England they will need more than £100m of up front funding, and a handful have quoted capital needs
of more than £500m.
The BMA said that with budgets under significant pressure, NHS leaders are unlikely to have the capital required to deliver the STP projects. It warned that the annual capital allocation of £4.8bn awarded to the Department of Health from 2016/17 to 2020/21 in the latest spending review is being transferred to cover hospital deficits and will be taken up by other demands.
Commenting on the findings, Royal College of Nursing (RCN) Director of England Tom Sandford praised the aspirations of STPs, but said “the lack of any financial commitment from the Government is their Achilles heel.” He added that the RCN remains concerned that these plans “will be used to make savings, and short-term cuts to hospital beds and community services will be made without any plans for the long-term change envisaged by NHS England.”
Petition to protect children’s nursing passes 13,000 signatures
A petition on the parliament website to ‘save’ the children’s nursing degree has gained over 13,000 signatures, just a week after it was launched. Orla McAlinden, a children and young people’s nursing educator, set up the petition on 9th February in the hope of protecting children’s nursing from moves towards a more ‘generic’ model for nurse education.
The petition comes after a 2015 review of nursing education – the Shape of Caring review – recommended that students receive two years of general training, before specialising in a specific area such as children’s nursing in the third year of their degree. This pathway stands in contrast to the current model, in which students can specialise in children’s nursing from the beginning.
Ms McAlinden called on people to sign the petition, stating that “moves are afoot to make nursing a generic pathway – getting rid of children’s nursing, despite clear evidence of its worth.” She added that “our children need and deserve appropriately skilled/educated children’s nurses, not generic nurses (adult) with some limited experience and knowledge.”
As the petition has passed the 10,000 signatures mark, ministers must now publish a written response on the parliament website. If the petition goes on to gain 100,000 names, MPs may then also hold a debate on the subject, as happened recently as result of a petition on nursing pay.