Weekly political news round up – 20th November 2015

November 20, 2015 in News by Whitehouse

Around the sector

NHS England has revealed that it may reduce the number of national clinical directors. There are currently 23 national clinical directors, with some understood to have “much busier briefs than others”. It is expected that a reorganisation will result in a new “slimmer” setup and more focus on “big ticket areas” such as cancer and other long-term conditions. No final decisions have yet been taken, but changes are expected to be implemented when secondment agreements for most national clinical directors end on 31st March 2016.

A major study on bullying in secondary schools, conducted and published by the Department for Education, has found that 30,000 fewer year 10 children in England are subject to bullying compared to 2005 – a percentage reduction from 41% to 36%. For children in the year 9, the percentage reduction was 43% to 36%. The study also found that a higher proportion of children with SEN encountered bullying compared to those without SEN – 46% to 36%. It also found that 11% of children have been cyberbullied since the DfE started recording data on this in 2014.

The Department of Health has published its reference costs for 2014-15, setting out where over £61.2 billion has been spent by NHS providers in 2014-15, as well as the average unit cost to the NHS of providing defined services to NHS patients in England.  The document shows an increase in expenditure recorded in this manner from £58.3 billion in 2013-14 – the equivalent of 4.9% and representing 55.4% of the £110.6 billion total NHS revenue expenditure. It shows increases in the costs of day case treatments (£698 to £721), outpatient attendances (£111 to £114), A&E attendances (£124 to £132), as well as elective and non-elective inpatient and excess bed day costs.

NHS England’s latest financial report, covering the six months to the end of September, forecasts a £44 million underspend on “primary care and secondary dental” services – a contrast to the previous report covering four months to July, showing a full spend in 2015-16. Richard Murray, director of policy at influential health think-tank the King’s Fund, commented that, as in recent years, NHS England will be “relying on underspending in primary care to manage overspending in specialised commissioning and acute services”.

Jim Mackey, the chief executive of newly created healthcare regulator NHS Improvement (a merger of Monitor and the NHS Trust Development Authority), has described the £22 billion of efficiency targets as “unachievable and…stupid”. Mackey also said that forthcoming figures on NHS finances – said to show a £1.5 billion deficit rising to £2 billion by the end of the financial year – were “awful”.

NHS England publishes Excellence in Continence Care commissioning framework

NHS England has published the Excellence in Continence Care commissioning framework – providing guidance for commissioners, providers and health professionals on how best to guide people to manage continence problems. It was produced following recognition by NHS England of the necessity for nationwide improvements for people with continence problems.

This guidance, which is advisory, will “help support best practice in continence care, promoting equal access to services and treatment for all”. The purpose is to promote consistent practice, improve the experiences of people with continence needs, drive advances in clinical outcomes and reduce health inequalities. NHS England engaged with CCG and NHS trust officials, as well as bodies like the Royal College of General Practitioners and the Association for Continence Advice, to produce the document.

The framework notes that containment products such as absorbent pads are “costly, can affect a person’s dignity and do not offer a long-term solution”, and “should not be offered in the long term”. It also warns that indwelling urinary catheters are associated with infection that can “lead to illness, hospital admission and even death”. It suggests that the continence service teaches patients how to self-catheterise intermittently. The framework does not make reference the Drug Tariff.

The framework outlines a pathway including assessment, diagnosis and treatment to recovery where possible. It identifies the groups who are at most risk of continence problems and outlines what a good continence service should deliver for standards and outcomes.

It highlights the importance of providing access to information, advice and treatment, as well as the ability of the workforce to work in a person centred way. It outlines minimum standards for the workforce involved in continence care, along with the specific roles and responsibilities of continence team members, including the patient, family and carers.

It recommends outcome measurements to determine the effectiveness of actions taken. It provides information to members of the public who may need guidance on accessing services for themselves, or for their families. It outlines the benefits of improving continence care, such as a better quality of life, less reliance on pads and products, a reduction in admissions to hospitals and care homes, fewer complications like UTIs, and a reduction in costs.

Eight steps have been set to implement this guidance:

  • Ensure commissioning intentions focus on continence needs for people of all ages and includes both bladder and bowel.
  • Ensure that commissioners and providers have a full understanding of local need relating to continence care through effective engagement with the public, service users, patients, carers and families.
  • Implement a baseline assessment of local continence care provision considering best practice.
  • Develop continence care pathways that meet local need.
  • Ensure outcome measures are in the contracting, quality assurance and performance monitoring of commissioned services.
  • Monitor and evaluate the outcomes of commissioning intentions for continence care.
  • Deliver continuous improvements in continence care via an improvement trajectory.
  • Ensure the commissioning process provides community based integrated services.

Healthcare Financial Management Association publishes survey of NHS financial officers showing a lack of confidence in addressing the £30 billion resource gap

The Healthcare Financial Management Association (HFMA) has published the results of a survey of chief finance officers (CFOs) from provider trusts and clinical commissioning groups, which found a continued deterioration of financial performance across the NHS in England. Analysing perspectives on the £30 billion resource gap identified in the Five Year Forward View, it found most CFOs want the £8 billion of extra funding by 2020 to be frontloaded; it also highlighted a lack of confidence in the NHS’s ability to achieve £22 billion of efficiency savings.

The survey found that 50% of CCG CFOs do not believe the £5 billion of savings outlined in Lord Carter’s interim report on NHS productivity are achievable, with 49% unsure and 1% believing they are achievable. Meanwhile, 49% of CCG CFOs believe the new models of care in the Five Year Forward View will not meet the remaining £17 billion funding gap, with 49% unsure, and 2% confident.

The survey found little confidence amongst CFOs that the NHS can deliver the same quality of care as it is currently doing within the £8 billion of promised funding. 67% of CCG CFOs believe that this could be achieved if the £8 billion is frontloaded, with 0% believing so if it is not frontloaded.

88% of CCG CFOs and 93% of trust finance directors do not think there are effective financial arrangements in place to manage financial risk across their local health economies. Finance directors overwhelmingly agree that the organisations in their area do not have sufficient baseline financial resources for them to implement the Five Year Forward View or other long-term financial plans without additional support.

Despite pessimism about the financial position of the NHS, 88% of finance directors do not expect the quality of patient services to reduce in 2015/16 – 72% believe it will stay the same, 16% believe quality will improve, 9% think quality will deteriorate and 3% do not know. However, they are more pessimistic about 2016/17 – 68% of respondents do not expect quality to deteriorate, 28% believe quality will reduce, and 4% are unclear how quality will change.

To address the financial challenges ahead, 80% of CFOs plan to introduce integrated/redesigned pathways across community, mental health and acute services, with 75% investing in community services to avoid hospital admissions, and 71% investing in primary care. For trusts, 79% of finance directors said they would reduce pay costs from agency staff, 70% would make cost savings across procurement, and 68% would reduce unnecessary clinical variation.

CCG CFOs and trust finance directors both identified risks in achieving their 2016/17 financial plans. CCGs identified increasing demand (74%), prescribing costs (67%), and increases in emergency care (67%) as the three main risks to achieving their financial plans. Finance directors from all sectors felt that waiting times (74%) and access to services (63%) were the most vulnerable areas due to the current financial challenges.

Report warns of mental health consequences of bullying

The Anti-Bullying Alliance has reported that a new survey it has conducted indicates that more than a quarter of young people bullied at school say it impacted on their mental health. Over a third of the 16-25 year olds surveyed said that being bullied made them feel angry or withdrawn and more than a quarter of young people said they experienced body image anxieties. A fifth simply avoided school or college as a way of coping with bullying. Many of the 1,500 young people polled said the effects of bullying have continued to cast a shadow over their lives after leaving school. Almost 40 per cent said it had had a negative effect on their ability to form personal relationships.

Over 40 per cent of young people said access to a supportive teachers trained in dealing with bullying would have made a difference. However, 70 per cent of the 170 teachers surveyed said there was inadequate support for schools working with children with mental health issues and over half would value better training.