Weekly political news round up – 19th September 2014

September 19, 2014 in News by Whitehouse

Around the sector

The Department for Education has published statistics on the characteristics of childcare and early years provision, including the number of staff with formal qualifications. The statistics showed an increase in the number of paid staff in full day care settings with level 3 qualifications (which enables them to supervise other staff and work unsupervised with children) or above, from 75% in 2008 to 84% in 2011 and 87% in 2013. The number of paid staff in full day care settings with level 6 qualifications (the equivalent of a BA degree) also increased, from 11% in 2011 to 13% in 2013.

National Institute for Health and Care Excellence publishes nocturnal enuresis quality standard

Alongside the formal launch of the Paediatric Continence Commissioning Guide on Thursday 18th September, the National Institute for Health and Care Excellence (NICE) has published quality standard 70, which covers the assessment and management of nocturnal enuresis (bedwetting) in children and young people aged 18 years or younger.

This quality standard was introduced to help improve the quality of life and psychological wellbeing of children, young people and their families and carers.

NICE launched a consultation on a draft version of the quality standard on 25th April 2014. The draft quality standard contained three quality statements, which stated that:

  1. Children and young people (aged 5-18 years) who are bedwetting have an initial assessment that includes their bedwetting pattern, daytime symptoms, fluid intake, toileting pattern and any physical, social, emotional or developmental issues.
  2. Children and young people (aged 5-18 years) and their parents and carers if appropriate, have a discussion about initial treatment with an alarm or desmopressin when bedwetting has not improved after changing their daily routine.
  3. Children and young people (aged 5-18 years) whose bedwetting has not responded to treatment with an alarm or desmopressin or both are referred for a specialist paediatric continence review.

The final quality standard contains five quality statements, which state that:

  1. Children and young people who are bedwetting have a comprehensive initial assessment.
  2. Children and young people have an agreed review date if they, or their parents or carers, are given advice about changing their daily routine to help with bedwetting.
  3. Children and young people and their parents or carers if appropriate, have a discussion about initial treatment if bedwetting has not improved after changing their daily routine.
  4. Children and young people who are bedwetting receive the treatment agreed in their initial treatment plan.
  5. Children and young people whose bedwetting has not responded to courses of initial treatments are referred for specialist review.

Following the consultation process, quality statements two and four were added, whilst all three draft quality statements received slight modifications.

The consultation period ran until 27th May 2014. During this period, the PCF submitted a response which made the following key points:

  • ‘Healthcare professionals’ is not properly defined in the statement; it does not say who should deliver frontline services (e.g. GPs, school nurses, community nurses, etc.). This should be amended.
  • Sometimes there are problems with the availability of products, such as alarms, which negatively impact treatment outcomes. This should be highlighted in the quality statement.
  • In the definition of terms for quality statement 3, the definition of terms states that paediatric continence services “may be a dedicated paediatric service or integrated with adult continence services”. This should be amended to state that paediatric continence services should be led by a paediatric continence nurse specialist and comprised of a multi-disciplinary team.
  • For quality statement 3, an amendment should be made that provides a timescale for non-response to treatment following a referral to a paediatric continence service.

Following the consultation, NICE have subsequently made the following amendments:

  • Healthcare professionals are now clarified as being GPs, school nurses and community nurses.
  • Quality statement 4 (access to treatment) was added. In particular, it states that “any delay in their agreed treatment being available, for example as a result of local waiting lists or treatment policy, may put families under unnecessary pressure and have a negative impact on the outcomes for children and young people”.
  • Quality statement 5 (non-response to treatment) was amended to remove references to adult continence services, and it was added that an example of a paediatric continence service would be one that is delivered by a multidisciplinary team trained in managing continence problems in children and young people..
  • Quality statement 5 (non-response to treatment) was also amended to provide greater detail on what should happen if there is no response to treatment. It now states that: “bedwetting has not responded to treatment if the child has not achieved 14 consecutive dry nights or a 90% improvement in the number of wet nights per week”. Furthermore, a sentence has been added which states that desmopressin should be withdrawn for 1 week after 3 months of treatment to check if dryness has been achieved.

Scotland votes ’No’ in independence referendum

Scotland has voted against becoming an independent country, following a referendum held on Thursday. With over 3.6 million votes cast – a turnout of 84.6% – the ‘No’ campaign prevailed by a double-digit margin of 55.3% to 44.7%. The margin of victory was much higher than expected, especially given the surge towards ‘Yes’ in opinion polls in the run up to the referendum.

Prime Minister David Cameron made a statement shortly after the outcome was declared, in which he announced that plans were to be drawn up for a greater devolution of powers to all four nations in the UK.

As promised by the three main parties prior to the referendum, Cameron announced Scotland will receive greater devolution powers with regards to tax, spending and welfare. Lord Smith of Kelvin will oversee the process, with the detail of the proposals set to be agreed by November, with draft legislation being published by January 2015.

Cameron added that similar proposals will be developed for England, Wales and Northern Ireland, within the same timeframe. Although there are many details still to be decided, this is likely to mean that Scottish MPs will be barred from voting on issues that only affect England, with the intention for this to eventually apply to Welsh and Northern Irish MPs.

To work towards these new arrangements, Cameron announced that William Hague, Leader of the House of Commons, has been assigned to set up a cross-party Cabinet Committee to draw up the proposals. He added that he hoped that these proposals would be agreed by November, with draft legislation being published by January 2015.

Little specific information was revealed about plans for Wales and Northern Ireland, with Cameron stating that more power will be given to the Welsh Government and Welsh Assembly, and that work needed to be done in Northern Ireland to ensure that devolved institutions function effectively.

Government publishes response to Health Select Committee report on Long Term Conditions

The Government has published its response to the House of Commons Health Select Committee’s report into long-term conditions, which was published in July 2014. The response welcomes the findings of the report, largely reiterating areas where the Government has made progress in developing a framework for addressing long term conditions.

The response argued that clear objectives to address long term conditions had been set out in the Mandate to NHS England, and that these were measured against the NHS England Annual Report and the Department of Health’s annual assessment. It also highlighted that NHS England’s effectiveness in dealing with long-term conditions, amongst other conditions, is measured against indicators in the NHS Outcomes Framework. Further detail on NHS England’s strategic approach, such as the implementation of the House of Care – a model of person-centred coordinated care, was also laid out in NHS England’s Business plan, Putting Patients First 2014-16 – 2015-16, published in March 2014.

Discussing the Committee’s assessment that it recognised the benefits to the patient of a health and care system that offered “robust support” for self-management of long-term conditions, the response highlighted that it was “committed to embedding self-care and support for self-management approaches throughout the NHS”. The response said that NHS England planned to publish a supported self-management guide for people with complex care needs and frailty later in 2014.

In response to the Committee’s concern about the “apparent downgrading of the role of, and reductions in the numbers of, clinical nurse specialists”, the Government said that although it recognised the role of clinical nurse specialists in proving expert care, support and advice to patients, it was for local commissioners and providers to be “content that they are providing specialist skills and expertise in the most appropriate and sensitive way for their local populations”.

Labour releases pre-manifesto document

The Labour Party have released their pre-manifesto document, which will serve as the basis for the final general election manifesto and will be discussed during the Labour Party conference next week. A high-level document, it includes a dedicated section on health and social care with a strong focus on “whole person care”.

Although the pre-manifesto makes no explicit reference to continence, the key policies laid out are as follows:

Health and Care

The next Labour Government will:

  • repeal the Health and Social Care Act to ensure that the NHS is free at the point of contact, and does not prioritise private patients
  • end Monitor’s role as economic competition regulation and scrap Section 75 regulations that force services to be put out to tender
  • ensure all outsourced contracts for services, including under the Health and Social Care Act 2012, are properly managed to ensure they are meeting clinical and financial standards
  • ensure that existing and future procurement projects for public infrastructure and services are scrutinised and action taken to ensure they deliver best value for money for the taxpayer and the NHS
  • guarantee a single named contact for the co-ordination of an individual’s care needs.

Role of providers

Labour want to reduce the purchaser provider split across the NHS to enable local providers to determine how services should be delivered. As a result:

  • all Trusts – Foundation, NHS and Community – will need to be accountable to the public and operate within a collaborative and integrated system not a “free market free for all”
  • the mixed economy of Trusts and Foundation Trusts will need to be reviewed so that all service providers are fully integrated to deliver the whole-person care agenda in a collaborative, not competitive, way, which is fully accountable to the public

Health and Wellbeing boards

Labour want health and wellbeing boards to play a more important role in commissioning:

  • “Health and Wellbeing Boards will have a central role in the commissioning process for people with long-term conditions, disability and frailty – people whose care is often most fragmented and who are heavy users of health and care services.”
  • “The Health and Wellbeing Board would be responsible for creating a local collective commissioning plan for this group of people [those with long-term conditions, disability and frailty] – within a nationally defined outcome framework for the development of whole-person care – with a duty on CCGs and Local Authorities to enact the collective commissioning plan.”

Integration

Labour want to “break down the organisational and cultural barriers between those involved in providing, commissioning and planning care.” At the same time, they support a system where physical health, mental health and social care are joined up into a single service, coordinating all of a person’s needs. They state this can be achieved in a number of ways:

  • By providing incentives for joint working through a single budget to fund services through a ‘year of care’ tariff
  • They plan to develop new funding mechanisms for health and social care providers based on “delivering quality, equitable and integrated services and incentivising health promotion and preventative care.”
  • A Labour Government will abolish the system of “any qualified provider” and create a national entitlement, written into the NHS Constitution, to ensure that patients get legal rights to access the services they need.

Service reconfigurations

“Labour acknowledges that there will be occasions where there is a strong clinical case for changes to hospital services that will improve care. What matters is that service reconfigurations, and changes to the way that health services are provided, are evidence-based and clinically led, not purely financially driven, and that the local community is consulted early and frequently.”

Changes Labour support:

  • the culture of the NHS – ensure communities are given a real say in shaping the future of their local services, including hospital reconfigurations
  • “reverse the introduction in the Care Act of sweeping powers to force changes to services across an entire region without proper public consultation” – this implies Labour will repeal clause 119 of the Act if they get elected
  • extend Freedom of Information legislation to cover all organisations delivering public service contracts, including the private sector
  • will consider ways of strengthening the role of members within Foundation Trusts and work to better engage and involve NHS staff in Trust membership.

Institute for Public Policy Research (IPPR) publishes report on the self-management of long-term conditions

Left-leaning think-tank the Institute for Public Policy Research (IPPR) have published a report which found that more needs to be done to recognise and support the huge amount of self-management done by people with long-term conditions and their carers, and to enable people to work in partnership with healthcare providers to agree the services that fit their needs. The report was based  on a survey of over 2,500 people with long-term conditions, which asked them about their attitudes towards and experience of the management of their conditions.

The report found that patients with long-term conditions had great expertise in managing their conditions, but that this was not currently being recognised by the healthcare system. It said that more needed to be done to acknowledge patients’ expertise on the effects of their condition(s) on their lives, and to marry it with expert medical advice, so that patients have more of a say over the services they receive.

 

Issues were raised in the report about the lack of information and support. The survey found that just over a third (37%) of respondents were not satisfied with the day to day management of their condition(s), and of these, a relatively high proportion had not been given information and support when they were diagnosed. Moreover, over three-quarters (77 per cent) of respondents believed that more of their healthcare could and should be managed independently at home – but they said that a lack of support and information was holding them back from doing so.

In terms of recent government developments to help those with long term conditions, notably personal health budgets, around a third of respondents (35%) thought that they would be useful. According to the survey, some respondents said that they had not heard of them or did not know what they were.

The report concluded that the current system was not designed and delivered in a way which prioritised patient empowerment, and in some cases hindered it. It found that there was little systematic evidence of patient empowerment being embedded – of it driving service design, and shaping strategies and service delivery across the board.

Below is a list of relevant recommendations:

  • It should be guaranteed that everyone diagnosed with a long-term condition – at the point of diagnosis and regular thereafter – is offered information, advice and coaching about how best to self-manage their condition. NICE should also develop patient-friendly equivalents of each clinical guidance note relating to long-term conditions.
  • Everyone diagnosed with a long term condition should be able to access peer-to-peer support. Organisations operating in each local health economy – including voluntary sector organisations – should work together to enable the provision of peer-to-peer support mechanisms in communities.
  • Everyone with a diagnosed long-term condition should be guaranteed a healthcare plan covering their physical health, mental health and social care needs, into which they have substantial input and which they develop in partnership – and jointly agree – with their healthcare professional or care coordinator.

The King’s Fund publishes priorities for next government

Influential health think-tank the King’s Fund has published its priorities for the next government, which include: meeting the financial challenge of the health care system; transforming services for patients; improving quality of care; and reforming the NHS.

Financial challenges

According to the document, the next government will enter office with the NHS facing “financial meltdown”. Although it states that “good progress” had been made in delivering £20 billion in productivity improvements, it also highlights most of the savings have been found by limiting staff salary increases, reducing prices paid to hospitals for treatments, and cutting management costs. The document argues that there is no more scope for further cuts in these areas. As such, it argues that savings should come through changes to clinical practice and more sophisticated approaches to incentivising NHS organisations to improve efficiency.

It also recommends that the next government should establish a ring-fenced health and social care transformation fund to be used to develop new community-based services and to cover double-running costs during the transition between old and new models of care. In line with the recommendations made in the King’s Fund health and social care commission report, published in September 2014, the King’s Fund also recommends radical tax reforms, including limiting some universal benefits for older people, to pay for the costs required.

Transforming services for patients

The report highlights that in order to meet the needs of an ageing population and the growing number of people with long-term conditions, barriers between primary and secondary care, physical and mental health, health and social care need to be overcome in order to provide integrated care. It states that these ambitions need both financial and political backing – arguing that the government and local politicians must be “much braver” in supporting changes to services where there is a clear case for change.

Improving quality of care

The King’s Fund states that a shift is need to involve patients more closely in decisions about their care. It states that patients must be fully informed about their options, and that personal budgets to deliver personalised care could be used more widely.

NHS reform

It is stated that a “fundamental shift” is needed in NHS reform, which learns from what has worked here and around the world. The current approach identified by the King’s Fund, which involves top-down structural reorganisation and frequent changes in direction have “got in the way” of the long-term commitment need to deliver transformational change. Instead, it suggests that ministers should focus on general policy direction, with local leaders focusing on improving the quality of services and developing new models of care. Reform, it argues, should involve engagement with frontline staff.