This week, Public Health England (PHE) has published its service specification for local authorities commissioning health visitors and school nurses, for public health services for children aged 0-19. The specification contains four commissioning guides to support the commissioning of the Healthy Child Programme 0-19, to take advantage of the “new opportunities for bringing together a robust approach for improving outcomes for children and young people across both health and local authority led services”.

As continence is considered a clinical need rather than a public health need by PHE, the second document states that “commissioning clinical support for children with additional health needs or long-term conditions and disabilities, clinical support for enuresis or incontinence lies with NHS England and [CCGs], to ensure co-ordinated support across the life course.” However, the document also suggests that to achieve the outcome of “More children and young people develop and achieve their potential, through improved rates of school attendance”, there should be “Identification of continence issues and referral to appropriate services.”

The NHS’s funding challenges also continued to feature in the media, with HSJ reporting the Government’s sustainability and transformation process could see thousands fewer nurses and other staff employed in years ahead and an East London Trust announcing a 20% reduction in its community nursing team. In an article penned for the Guardian, former head of the civil service Bob Kerslake said that the pressures on the NHS are real and serious, and praised senior and frontline staff for their “extraordinary efforts” to keep essential services running. He said it is not surprising that the Government is standing firm on the funding agreed in the Five Year Forward View, but that NHS Chief Executive Simon Stevens was both right and courageous to challenge the Prime Minister’s stance last week; to stick to current funding arrangements would be a “profound mistake”.

Wider headlines were dominated by the Prime Minister’s speech outlining her strategy for Brexit and confirming speculation that she will not pursue maintaining membership of the Single Market. In the speech, May said she seeks a “fairer, more secure, united and outward looking” UK that will remain a “good friend and neighbour” to the EU, but highlighted that maintaining Single Market membership and gaining greater control of immigration are incompatible aims. Her statements were underpinned by a 12-point Brexit plan, which focused on strengthening the Union between the four nations of the UK, controlling immigration, protecting workers’ rights, and establishing the UK as a “great, global, trading nation” based on ambitious Free Trade Agreements with the EU and other countries. She also confirmed that the final Brexit deal will be put to a legally-binding vote in both Houses of Parliament. However, she did not indicate what kind of immigration system she would envisage for the post-Brexit era, an omission that will continue to cause uncertainty for the NHS.

MPs debate toilet facilities for the disabled

This week, MPs held an adjournment debate on community toilet facilities for people with disabilities, after Stalybridge and Hyde MP Jonathan Reynolds raised the issue on behalf of his constituent Brian Dean. Mr Reynolds related how Mr Dean – who suffers from Parkinson’s and has continence issues – had experienced difficulties finding a suitable toilet when returning from a trip to Blackpool, leading him to wet himself. Mr Dean had been left demoralised, he said, but had turned his anger into action and launched an appeal for a nationwide solution, calling for as many businesses as possible to provide an accessible toilet.

Mr Reynolds asked the Minister to evaluate current public sector accessible toilet provision across the nation, and how Parliament can work with local authorities to prevent further toilet closures. He also asked him to assess how many community toilet schemes are currently operating in the UK, and how we can ensure universal coverage of these, putting forward the suggestion of a national scheme. He furthermore called on him to lend his support to the Changing Places toilets scheme to ensure greater numbers of larger, better-equipped toilets exist for those who need them.

Responding on behalf of the Government, Housing and Planning Minister Gavin Barwell thanked Mr Reynolds for raising the issue, stating that “Part M” of local building regulations sets out minimum standards for accessible toilets in buildings when they are built or undergo major refurbishment. The Minister recognised that people’s needs and expectations change over time and that the Government must adopt its approach in response. He said that the Government has commissioned researchers to check that the current requirements in Part M remain fit for purpose, including the design and provision of accessible toilets, and that they would report later in the year.

Mr Barwell also said that local authorities have an important role to play in identifying how accessible toilet provision can be supported, and can provide accessible toilets directly, but are under no obligation to do so. He said the Local Government Finance Bill will allow councils the flexibility to use their existing discretionary relief powers to support publicly owned public toilets from 1 April 2018, adding to the powers they already have in relation to privately run toilets. Finally, Mr Barwell said there is a clear precedent for community, business and public sector leadership delivering improvements in accessible toilet provision through the success of the Changing Places campaign, and that the Government will continue to enhance provision through this scheme.

Written question tabled on school nurses

The Parliamentary Under Secretary of State for Public Health and Innovation, Nicola Blackwood MP, has responded to a written question tabled on school nurses in the House of Commons. Huddersfield MP Barry Sheerman had asked what steps the Department of Health (DH) is taking to support school nurses and the services they provide to disabled children in schools, referring to the report Disability Matters in Britain 2016.

Ms Blackwood responded that the DH and Public Health England (PHE) have produced guidance to support both commissioners and local providers, including the 0-19 commissioning guidance, and said that the DH and PHE are working with the Local Government Association and locally through PHE Centres to share evidence and guidance. She added that school nurses are not generally commissioned to deliver clinical support for children with disabilities – and that this function would be commissioned by CCGs, and may be provided by community children’s nurses or specialist school nursing services.

House of Commons to debate nursing pay

The House of Commons is set to debate nursing pay on 30th January, after a petition urging the Government to scrap an NHS pay cap of 1% reached 100,000 signatures. Initiated by community nurse Danielle Tiplady, the petition argues that Agenda for Change staff including nurses, midwives, healthcare assistants and associated healthcare professionals have experienced a pay restraint since 2010 and lost more than 14% of their pay in real terms.

The Department of Health has already been forced to respond in writing to the petition, after it passed an interim goal of 10,000 signatures last year. The statement which the department released in the autumn read: “there is a trade-off between pay and jobs in many public services, and pay restraint is one of the many difficult choices the Government has had to make.” It added that while pay restraint is challenging, overall earnings for nurses and other non-medical staff have increased 0.8-4% per year since 2010/11, due to low levels of inflation.

Royal College of Nursing (RCN) Chief Executive Janet Harding described the petition’s success as an “incredible achievement” and a “monumental step” in campaigning for better pay. “Nursing staff are going above and beyond every single day, yet they have endured the public sector pay cap since 2010”, she said, adding that more and more members are telling the RCN they are reaching breaking point. “We will continue to fight until all nursing staff receive the pay they truly deserve”, she said.

STPs forecast NHS will employ thousands fewer nurses

The NHS will deal with extreme funding pressure by employing thousands fewer nurses and other staff, according to unpublished proposals seen by HSJ this week. The findings are based on the finance, workforce and efficiency components of the sustainability and transformation plan process. 44 Sustainability and Transformation Plans (STPs) were submitted to the Department of Health last year, setting out how each NHS area or ‘footprint’ across England will implement the recommendations of the Five Year Forward View. The overarching STPs were published last autumn, but many of the more detailed annexes have been kept private, and it is some of these which HSJ has seen on the condition of anonymity.

11 of these STPs are reported to forecast a 1.6% reduction in whole time equivalent staff between 2016-17 and 2020-21, including a 2.3% reduction in registered nursing posts. Extrapolated across England, this projects reductions of 17,300 staff overall and 7,300 in the nursing, midwifery and health visitor group, which is dominated by nursing. NHS England’s chief executive Simon Stevens has distanced himself from the STP figures, stating last week: “It is certain that we are going to need more qualified nurses in the National Health Service in five years’ time than now.”

It could be that most of these cuts to nursing occur in hospitals and mental health, however, as the STPs also show that community and primary care are projected to see the fastest increases in funding, at the expense of slow growth in general acute and mental health spending. Total planned CCG spending across the 11 areas analysed shows a 25.9% increase in community health services spending; a 22% increase in core general practice and other primary care; and a 20.4% rise in spending on specialised services. This is represented in a wider theme across many of the STPs of moving care from acute to primary and community settings as a means of preventative demand reduction and saving money. By contrast, general acute services will receive a funding increase of just 2.4% and mental health an increase of 12.3%. NHS England’s response to the findings indicated that cuts in nursing could be mitigated by more registered nurses working in GP practices, but this detail is not included in the STPs.

School nurses launch online teen advice

School nurses from Hertfordshire Community Trust are to help run two new health websites for children and young people across the UK. The Health for Teens and Health for Kids websites feature content that promotes a “healthy body and mind”, and include information on both continence and local school nursing services. While the original concept and design of the websites are the work of Leicestershire Partnership NHS Trust – with which Hertford Community Trust is working in partnership – responsibility for updating the content will fall to Hertfordshire Community Trust’s nursing team.

Commenting on the new websites, Andrea Harrington, Hertfordshire Community Trust’s strategic lead and operational manager for school nursing, said: “These sites not only give children and young people helpful health and wellbeing guidance, but can be accessed by parents, carers and teachers to utilise the variety of resources available such as interactive games, signpost to other local health services or download relevant information materials”. She added that “people can also search for contact details of their child’s school nursing team”. Helen Thompson, Leicestershire Partnership’s director for family, young people and children’s services, said: “We are confident that, just as we have seen in Leicestershire, the websites will facilitate access to the expertise and support of Hertfordshire’s school nursing teams, to make a difference to children, young people and families locally”.