Weekly political news round up – 18th March 2016

March 18, 2016 in News by Whitehouse

Around the sector

NHS England has announced 44 areas in which local NHS providers, clinical commissioning groups (CCGs), local authorities and other health and care services have come together to develop sustainability and transformation plans (STPs) to help deliver the Five Year Forward View. These “STP footprints” take into account factors including geography, the scale in which change will be delivered, existing footprints of change, the financial sustainability of organisations in an area, and leadership capacity and capability to support change.

Two research papers published in BMJ Quality and Safety have found that “pushy” patients are more likely to be misdiagnosed by doctors. The study found that doctors who felt under pressure from aggressive patients, or those questioning their competence, were more like to expend energy on the problematic behaviour and therefore have less capacity to focus on the medical issue.

Public Health England has published ‘child health profiles’ for each local authority and CCG in England, which provides a snapshot of child health using key health indicators, enabling for comparison locally, regionally and nationally. Each profile contains comparative data on mortality, those achieving a good level of development at the end of reception, rates of obesity and hospital admissions for injuries, mental health, as well as other health indicators.

The Public Accounts Committee has published a report on the sustainability and financial performance of acute hospital trusts, which found that the financial health of these trusts has “significantly worsened in the last three financial years” and that their “finances look set to deteriorate further”. The Committee found that the target for trusts to make 4% efficient savings across the board is “unrealistic” and that “better data is needed for more informed savings and efficiency targets”. It identified that “there is much to do to produce the convincing plan necessary for the NHS to get itself back into financial balance”.

The Royal College of Physicians (RCP) has criticised plans to introduce seven day services in the NHS in England, with RCP president Professor Jane Dacre commenting that “if we have neither enough trainees nor consultants to run the service now, how are we going to implement a safe seven-day service?” Research by the RCP last year showed that four in 10 vacant posts for consultant physicians went unfilled, whilst one in five consultants reported gaps in their junior doctor rotas.

The Royal College of Paediatrics and Child Health (RCPCH) has announced that it will be holding a workshop on Thursday 14th April to discuss the planned implementation of the SNOMED CT clinical coding system in hospital and GP settings across in England, as required by NHS England. The RCPCH argued that the introduction of SNOMED CT will help clinicians obtain timely information about patients to help better understand care outcomes and enable comparisons.

David Pannell, chief executive of Suffolk GP Federation – the largest GP federation in England, has criticised NHS England and CCGs for not taking sufficient action to develop general practice. Pannell said that there had been “lots of talk but no action” on encouraging GP federations and networks through contract changes, noting that “lots of us have really struggled because we’re all dressed up and [have] nowhere to go”.

Forthcoming events

The House of Lords will rise for Easter recess on 23rd March and the House of Commons will rise on 24th March – both will return on 11th April.

NICE launches consultation on a draft quality standard for promoting health, social and emotional wellbeing in children under five

NICE has launched a consultation on a draft quality standard for promoting health, social and emotional wellbeing in children under five. The draft quality standard focuses on aspects of health and social care that are commissioned locally, with a scope to cover home visiting, childcare, early intervention services in children’s social care, and early education. It does not cover vulnerable children who may need additional support, nor does it cover clinical treatment or the role of child protection services.

The draft quality standard contains three quality statements:

  • Statement 1. Parents and carers of children under 5 are offered a discussion during each of the five key visits about factors that may pose a risk to their child’s social and emotional wellbeing.
  • Statement 2. Children under five with identified risks to their social and emotional wellbeing, and their families, receive tailored support.
  • Statement 3. Children are offered an assessment of their speech and language skills at their 2–2 ½ years integrated review

The PCF submitted a response to the topic engagement exercise for this quality standard, arguing that toilet training should be provided through health visiting services to help prevent continence produces from occurring later in childhood.

Continence is now referenced under quality statement 2, where it is outlined that children under five with identified risks to their social and emotional wellbeing should be offered specialist support services, such as mental health, continence and special educational needs services and speech and language therapy.

NICE’s accompanying briefing paper on the development draft quality standard indicated that continence was added as a direct result of the PCF’s response. The briefing paper listed the Paediatric Continence Commissioning guide as a “key development source” and quoting recommendation 1.7 directly, with continence being listed as a “specific area for quality improvement”.

In the context of statement 2, the consultation asks what are the potential risks that should be acted upon and what support should be provided.

Welsh Government publishes National Urology Implementation Plan

The Welsh Government has published the National Urology Implementation Plan (NUIP) for urology services in the Welsh NHS. This document aims to improve patient experience and deliver sustainable services by requiring Welsh health boards to better understand and measure demand, capacity and activity in urology and establish a patient experience measure for urology services in Wales. A subsidiary aim is to prevent unnecessary referrals to secondary care through advocating better use of community based services.

The NUIP covers all urology services, including continence services, but also those for kidney, bladder and prostate disease, impotence, infertility, cancer and reconstruction of the genito-urinary tract. There are no references to catheters within this document.

There are three primary drivers for service change:

  • Clinical value prioritisation – making sure that only the right patients are managed in secondary care
  • Integrated care – establishing collaborative care groups and empowering patients to manage their health
  • Best in class – measuring value for money and benchmarking against top performing organisations

As part of clinical value prioritisation, the NUIP recommends that health boards maximise the use of community continence services to include effective management of continence resources, including staff and products (it is not clear whether this refers to catheters and/or containment pads). It notes that health boards should establish processes to prevent referral into secondary care of patients who will gain little benefit from the referral.

The NUIP also outlines that health boards should take a holistic approach to care, which includes targeting risk factors for urological disorders. In particular, it outlines that obesity is a risk factor for incontinence, and recommends that health boards ensure that there are a suitable range of weight reduction support services available to local communities.

As part of the drive towards integrated care, each health board will be required to establish “collaborative care groups” to manage the flow of patients between primary and secondary care. These will include local professionals, patients and service managers, and will oversee patient streams and referral thresholds, and where necessary triage referrals before submission to secondary care, and establish services to improve patient activation and decision making.

Welsh Assembly votes against Public Health (Wales) Bill

The Public Health (Wales) Bill has been rejected by the Welsh Assembly on the final day of proceedings before the May elections, and will not become law. The vote had been tied, with the presiding officer casting the deciding vote against the legislation.

The Bill would have required local authorities to improve their local toilet provision through developing a local toilets strategy. The Bill would have also introduced pharmaceutical needs assessments (PNAs) to Wales. The PCF submitted written evidence to the Welsh Health and Social Care Committee shortly after the Bill was announced, which stressed the importance of consulting with stakeholders when developing local toilet strategies and when creating and reviewing PNAs.

The Bill had been expected to pass, but was derailed at the last minute by Plaid Cymru to teach Labour a “lesson”, following controversy of perceived disrespectful comments by Labour about Plaid Cymru. There were also objections over the anti-smoking provisions by the Liberal Democrats and Conservatives. Both the British Medical Association and the Royal College of Nursing, amongst others, have described the news as “disappointing” and called on the next assembly to “put aside game playing” and develop a long-term public health strategy.

Department for Education and Department of Health publish guidance on the SEND code of practice

The Department for Education and Department of Health has published guidance for CCGs, local authorities (LAs) and health professionals on their statutory duties as outlined the Children and Families Act 2014 and the SEND code of practice.

The guidance outlines that these organisations have a responsibility to coordinate the most appropriate support for those with SEN, including the necessary equipment, strategies and interventions to “support the child’s progress and build self-esteem and confidence”. It also specifies that CCGs and local authorities should include procedures in education, health and care plans to resolve disputes over care between their organisations, and details the advice that must be given to parents, carers or children and young people on how to coordinate care and request personal budgets.

Budget 2016

Chancellor George Osborne  delivered his Budget 2016 speech to Parliament this week, stressing the themes of “acting now to avoid paying later” and “doing the right thing for the next generation”. The Budget document itself is available here.

This year’s Budget contained few notable measures, but rather reaffirmed that the Government will maintain its current course: reiterating and in some cases expanding on known priorities. Largely this is because of trepidation surrounding the forthcoming referendum on Britain’s European Union membership.

There were no announcements that will directly affect the PCF, with very few health related announcements in general. Below is a summary of announcements of interest:

The Government will now require all schools to become academies by 2020, or to have an academy order in place to convert by 2020.  Osborne announced in his speech that Education Secretary Nicky Morgan will launch a white paper tomorrow setting out the further improvements that the Government will make to the quality of education.

Children’s hospitals in Manchester, Sheffield, Birmingham and Southampton will also receive funds raised from banking fines to pay for projects on eye care, emergency trauma and MRI scanners. The only other health announcements related to the extension of the defibrillator grant scheme, child prosthetics, and a duty on hand-rolling tobacco by an additional 3% above the current escalator.

Other announcements

Discussing the UK’s economic situation, Osborne outlined that the Office for Budget Responsibility (OBR) downgraded its GDP growth predictions for the UK amid challenging global economic circumstances. The UK’s GDP is now estimated to grow by 2.0% in 2016, 2.2% in 2017 and 2.1% in each year until 2020, with inflation predicted at 0.7% in 2016 and 1.6% in 2017. Osborne was keen to emphasise that despite slightly downgraded economic predictions, the UK is still predicted to grow faster than any other well developed industrialised nation.

The OBR also predicted that borrowing will fall from £55.5 billion in 2017/18 to £21.4 billion 2018/19, before reaching a budget surplus of £10.4 billion in 2019/2020.

Osborne emphasised that the OBR’s growth forecasts were predicated on Britain remaining in the EU, outlining the OBR assessment that a vote to leave the EU will “usher in an uncertain period” which could have negative implications on business and consumer confidence, with greater volatility in financial and other asset.

We will monitor for any post-Budget developments that may be of relevance for the PCF.

Below is a summary of other policy announcements of interest in the Chancellor’s speech:

Childhood obesity: the introduction of a sugar levy on the soft drinks industry in two years’ time, subject to public consultation. This levy will raise £520 million, to be spent on doubling the amount of sport in primary school and funding longer school days in secondary school to facilitate extra sport. The devolved nations will receive equivalent funding, as health and education are devolved matters.

Business tax reform: loopholes will be closed, with overall reductions in business rates to attract multinational corporations and ensure that they pay taxes in the UK – measures which will raise an additional £9 billion in revenue. The rate of corporation tax will be reduced from 20% to 17% by April 2020. There will also be changes to small business rate relief worth £7 billion, with half of small businesses seeing their rates reduced or withdrawn all together.

Tax avoidance: more work will be undertaken to shut down various loopholes, with public sector organisations now required to ensure that their employees pay the tax that they should. Tax avoidance measures are estimated result in an additional £12 billion of revenue by 2020.

Devolution: negotiations are underway for devolution deals for Edinburgh and Swansea, with Manchester set to receive additional powers in relation to criminal justice. The Greater London Authority will move towards a full retention of business rates from April 2017 – three years earlier than planned.