Paediatric Continence Forum 

Political and Parliamentary Monitoring
Week Commencing 22nd October 2018 


The budget will take place next Tuesday, 29th October, and details are emerging of what key decisions Mr Hammond will have to face. With the final Brexit deal still unknown, it is unclear how much money will be put aside for contingency planning. At the same time, the Prime Minister has already announced an additional £20 billion of investment for the NHS by 2023/24, applying extra pressure on The Treasury, especially given that a new report today by experts at the Institute for Fiscal Studies calculates that most of this will be spent on keeping spending on health services in line with inflation.  


On the opposition side, Labour has been preparing its ‘alternative budget’, highlighting its own priorities and calling for the Prime Minister to “end austerity”. In an event in London, the Shadow Chancellor, John McDonnell MP, said an additional £108 billion would be required to end austerity and reverse cuts to social security and social care funding. Speaking to business and trade union representatives, McDonnell said that Labour would prioritise the NHS, adult social care, and schools as the three areas in need of urgent investment. 


The annual budget speculation comes as Audit Scotland, the public spending watchdog for the country, announced this week that Scotland’s  NHS faces a huge funding crisis. The organisation said, “the scale of the challenges means decisive action is required”, after finding real-terms funding of health services fell 0.2 per cent last year. Whilst the Scottish Parliament has oversight of health matters, given the UK Government at Westminster provides Scotland with a bloc grant of financial support each year, it is likely that Chancellor will be pressured to provide more funds to the devolved authorities. 


Speculation before the annual budget is nothing new, however pressures seems to be mounting on all sides of Mr Hammond, and especially so in the health sector. The devolved nature of health services; across the NHS, local authorities, and the devolved Parliaments, mean that the Chancellor will be pushed to provide additional funding for councils and the nations and regions, as well as central government health projects. Whitehouse will provide budgetary insight and analysis on the day. 



  • Territorial injustice likely to increase 
  • School toilet policies breach child rights 
  • Charities fear over children’s centres cuts 


Leaders express fears over Brexit impact on care 

The National Care Forum (NCF), which represented care providers associations from across the UK, have expressed serious concerns about the impact of Brexit on the sector. In a statement, the NCF highlighted concerns over post-Brexit availability of staff and equipment, stressing that “the social care sector is heavily reliant on a workforce from across the EU”. The categorisation of social care staff as ‘low skilled workers’ by the Migration Advisory Committee risks preventing workers essential to the operation of the health service from entering the country. 


The NCF also stressed their concern over the supply of continence devices and drugs, saying that “the Government must recognise the interdependencies between the UK social care sector in ensuring continued access to the skilled workforce and the resources required to deliver quality care.” The NCF added that they were calling for a Brexit which ensured continuity of care across the UK. The news comes as a vacancy crisis emerged in the Health Service, with the number of EU students coming to Britain falling, and the number of domestic students applying to study nursing also falling. 


Last week, the Secretary of State of Health issued another letter to medicine and device manufacturers describing what measures they should put in place to protect supply chains and ensure patients still received the prescriptions and supplies they required. Officially, the Government is still confident of a deal being forged, and is recommending that all patients, including paediatric continence, do not begin to personally stockpile, in the confidence that there will be enough supplies. 


Recent research report by the BMJ and the House of Commons Library has shown that hospitals in London and South East are especially reliant on EU staff, who represent 11 per cent of the whole workforce. In comparison, just two per cent of the whole NHS workforce in North East England comes from the EU. 


Whilst the PCF will welcome reassurances from the Secretary of State regarding Brexit preparations, it will share many of the concerns raised by the NCF. Ensuring minimal disruption to continence devices must be a priority for the health service, as the provide continence support can lead to those with bladder and bowel issues presenting at their local GP or hospital. 



Student nurses should be warned about nursing job challenges 

Prospective student nurses should be warned about the challenges and demands of the job before choosing to pursue the career, according to a new report by Health Education England, which is attempting to gain a greater understanding of the reasons why healthcare students fail to complete their course or quit the profession within two years of registration. In the academic yeas 2013-14 and 2014-15, the overall attrition rate, referring to the percentage of nurses who did not complete their course on time, continued to rise, the top reasons being finances and academic concerns. 


Now, Health Education England has released a series of recommendations to lower the attrition rate, including making clinical staff more involved in the recruitment of student so they can convey the true demands of the course and subsequent career. The report also recommended that hardship funds be made available to encourage more people, particularly those who are older, to embark on a career in nursing, midwifery or therapeutic radiography. More work should be done between universities and healthcare providers to map out detailed clinic placement plans for students, so those studying understand in greater detail what they will be doing, and the costs involved. 


Last week, Whitehouse reported that a study by BPP University had found that healthcare assistants were now taking over many of the jobs previously undertaken by nurses. Whilst providing better financial support to trainee and student nurses could increase the take-up, explaining in greater clarity the challenges of the job may risk turning some prospective nurses away from choosing the profession. Nonetheless, Professor John Clark, Regional Chief Nurse who led on the Health Education England report, and the project associated with it, said that “attrition is everyone’s business”. By providing a toolkit for universities and healthcare providers aimed at better supporting students, it is hoped that many students currently struggling from financial worries and stress will have the resources available to alleviate hardship. 


The PCF welcomes any attempt to increase the number of nurses working in the NHS. One priority must be ensuring that all aspects of nursing receive the spotlight, investment and focus they deserve. With reductions in council funding threatening school and public health nursing positions, it is prudent for the health service to highlight the rewards associated with the school nursing sectorin order to retain current levels of provision. 


Bury continence service award 

Bury’s Young People’s Continence services have won a CARES Award for supporting children with bladder and bowel complaints and who experience daytime and night-time wetting, constipation and soiling – issues which affect more than 900,000 children in the UK each year. Selected ahead of 65 other nominees, Bury was successful due to the high standards and levels of provision, and the trans-anal irrigation training provided to children and their families at home.  


The training, previously carried out in hospital, involves emptying the bowels using water, thus preventing constipation and providing young people with more regular bowel movements. By training children and adults to do the procedure at home, the nurses are both decreasing the pressure on hospital services, and giving young people greater dignity and freedom. Claire Bilsborrow, Continence Care Advisor, said that “through support, we can give children more control, improving their social experience, self-esteem and giving them a happier life overall.” 


Dignity was central to the ‘Getting It Right For Every Child’ (GIRFEC) approach developed in Scotland, and reported by the PCF last month. The approach, which aims to empower and inform young people and their families, aims to provide care in a familiar and comfortable environment, in the knowledge that this provides better emotional support for the child, and saves the NHS money in the long term. NICE approved the use of an irrigation device for treating constipation earlier this year. When NICE came to that decision, Brenda Cheer, Paediatric Specialist Continence Nurse said “no child should have to suffer from ongoing faecal soiling; if laxatives and regular, effective toileting do not prevent it then thy should be offered a rectal intervention.” 


The PCF congratulates the Bury paediatric service for their outstanding achievements. In the longer term, the GIRFEC approach to treating children may be suitable for wider rollout across the UK. Once the GIRFEC approach has been more firmly established, the PCF will contact NHS England outlining its value.