NHS Trusts in England have reported a combined £960 million deficit over the past financial year, nearly twice the figure anticipated by NHS bosses. Prominent health think-tank the Nuffield Trust said the figures are much worse than they appear on paper, given the deficit takes into account the additional financial support provided by the Government in the Budget last November. Chris Hopson, Chief Executive of the Hospital Trust association, NHS Providers, said a 5% annual increase in funding is needed to match European levels of care, noting that, “everywhere you look you get a sense of the NHS under real pressure.” The rise in demand for hospital services is a major contributor to the burgeoning deficit, with another report finding this week that the number of emergency readmissions have risen by a fifth over the past seven years.
Meanwhile, Jeremy Hunt becomes the UK’s longest-serving Health Secretary of all time this weekend, beating Norman Fowler’s previous record of 5 years and 272 days in the role. Hunt’s milestone has been complemented by news that the he has been spared sanction by the Parliamentary Standards Commissioner for the late reporting of his pecuniary interest in the property company Mare Pond. The Health Secretary apologised for his non-disclosure after it came to light, with the Commissioner, Kathryn Stone, declaring this week that Hunt’s infraction was “at the less serious end of the spectrum”.
Studies warn of poor toilet training, genetic link to bedwetting
A study carried out by Swedish health and hygiene company and PCF company member, Essity has found that school children risk contracting bladder infections and potential bowel and continence problems as a result of poor toilet training, and poor school toilet hygiene. The report – based on interviews carried out by YouGov with more than 400 primary school teachers and 500 parents and children – found that 44% of children avoid using the toilet at school at some point every week, while 4.7 million children actively avoid defecating at school. One in 10 primary school teachers said they have seen children abstaining from eating or drinking in efforts to avoid using school toilets, while more than half of teachers are concerned about the impact accidents on other children in class.
The Director of the NAHT Edge teachers’ union, James Bowen, said “we are concerned about the increasing number of school leaders who are telling us that children are arriving in school unable to use the toilet independently.” He said that “this appears to be a growing problem”, adding, “with school budgets under enormous pressure, the reality is that most (schools) are finding it increasingly difficult to repair and upgrade such essential facilities.”
Another study released this week has suggested that bed wetting can be caused by a child’s genetic make-up. The research carried out by academics at Aarhus University Hospital in Denmark discovered a genetic combination which makes some young people 40% more likely to wet the bed, contradicting the notion that the issue is purely caused by psychological activity. A spokesperson for ERIC said that while bed wetting at night “isn’t caused directly by psychological issues”, stress can play a part.
Trusts lean on bank nurses to curb agency spending
NHS Improvement is reporting that spending on agency nurses fell by 20% in the last financial year, as trusts have increased their use of ‘bank’ nursing staff within hospitals. The Department of Health and Social Care arms-length body, which regulates all NHS trusts, said a £93 million reduction in spending on agency staff across all NHS roles was “partly caused by moving agency workers and shifts into bank and substantive roles, which represent greater value for money than the equivalent posts”.
NHSI proclaimed the reduction as “a huge achievement in view of the record levels of demand and the extreme pressure on the acute sector”, with new Chair, Ian Dalton, saying the results are testament to “NHS staff up and down the country (displaying) incredible resilience” in the face of “epic challenges”. The regulator has prioritised a reduction in the use of agency staff, including nurses, in NHS hospitals due to rising concerns over its impact on NHS finances over the past few years. Last year, then Chief Executive, Jim Mackey, wrote a letter to all trusts telling them to “redouble” their efforts and “go further” to cut agency employment costs.
While the reduction in agency spend has been cited as a success for the NHS, HSJ is reporting a related overspend on bank staff by almost £1 billion across the NHS provider sector. Royal College of Nursing Chief Executive, Janet Davies, said the figures reveal “a cash-starved NHS forced to run without enough staff to treat people safely.” She argued that, “as long as hospitals remain £1bn in the red, patients will pay a heavy price.”
Bank staff benefit from more flexible working arrangements than nurses in substantive or permanent posts, but do not earn the high rates of remuneration given to agency workers or agency firms. Bank workers also enjoy substantially less employment protection and contractual rights than NHS staff working full-time under Agenda for Change terms, so NHS Improvement’s reaction to the shift towards greater utilisation of bank workers is particularly telling.
NHS trusts have consistently found it difficult to recruit appropriate numbers of staff in order to avoid a heavy use of temporary workers, and the employment of bank staff is, for the most part, simply a means of doing the same thing for less money. With 10% of nursing posts currently unfilled and a decreasing supply of EU-trained staff to rely on, Ian Dalton’s comments point to a new Chief Executive who is either overly eager to present good news, or critics and may result in criticism from those who feel that he is out of touch with some of the concerns of the NHS workforce and NHS organisations facing ongoing staffing issues.
“NHS Assembly” set to help create 10-year plan
NHS England and NHS Improvement have outlined their intention to set up a new “NHS assembly” to broaden stakeholder input into the Government’s forthcoming long-term plan for healthcare services in England. According to a board paper presented at a joint meeting between the two arms-length bodies last week, the Assembly will act as “the forum where stakeholders discuss and oversee progress on the Five Year Forward View and help codesign the proposed upcoming NHS 10 year plan”.
Assembly members will include national clinical, patient and workforce organisations; representatives from the voluntary, community and social enterprise sector; arms-length bodies; integrated care system and STP leads, as well as representatives from trusts, CCGs and local authorities. The concept was introduced by Simon Stevens last year, when he said that NHSE and NHSI were considering creating “some form of NHS council or assembly that brings together, on a regular basis, frontline organisations and national bodies”. Similar proposals have been made in the past, including through the NHS Modernisation Board in 2001 which was set up to advise then Health Secretary, Alan Milburn, on the implementation of the “NHS Plan”.
The Government will be eager to show that the new long-term plan for the NHS has been sufficiently scrutinised by key health and social care stakeholders. Whilst the range of stakeholders outlined for assembly membership is incredibly wide-reaching, the finer detail revealing those involved will be critical. Key tests will include the extent to which GPs are included (as ICS and STP leads tend to come from trust management), and the type of “patient and staff organisations” involved.
DHSC also risks further accusations of creating a forum for purely tokenistic consultation if it follows the model set through the current process for creating Accountable Care Organisations, where a lack of public engagement in the early stages has contributed to the current challenge being heard in the High Court. It is not clear to what extent the NHS Assembly will consider the future of social care, though it is notable that local authority stakeholders will be invited to join the forum.