There has been much talk in the national press this week about Brexit and arrangements for a Customs Union, with splits in the Cabinet reportedly forming and Government aide, Andrea Jenkyns, leaving her role to ‘fight for Brexit’. Theresa May is also set to ask the EU for a second Brexit transition period to run until 2023 to avoid a hard border in Ireland. The proposal would mean that the whole of the UK will stay aligned with EU regulations and customs procedures until 2023, with the concept predictably being as praised by remainers as roundly criticised by Brexiteers.
Earlier this week, the Government responded to the Health and Select Committee’s report on Brexit: medicines, medical devices and substances of human origin. The Government had been criticised by the committee over what it sees as a lack of contingency planning in the event of a ‘no deal’ scenario. While the Government claims such an event is “highly unlikely”, it provided little new information on the prospects for the pharmaceutical and medical devices sectors post-Brexit, saying, “it would not be appropriate to publish anything that would risk undermining our negotiating position.”
Prime Minister tipped to approve large NHS funding increase
Theresa May is reportedly set to approve a substantial rise in funding for the NHS, as she and Health & Social Care Secretary, Jeremy Hunt, prepare to unveil a new long-term plan and financial settlement for the service. As celebrations for the 70th birthday of the NHS draw near, the Prime Minister appears to have favoured the Hunt’s call for a significant increase, over the more conservative plan put forward by Chancellor, Phillip Hammond.
The Spectator’s report notes that a yearly increase of 3% would ensure an additional £350 million per week for the NHS budget against current levels, thereby meeting the financial pledge made by Vote Leave during the EU referendum campaign in 2016. Hunt, NHS England Chief Executive, Simon Stevens, and a number of independent health policy officials are calling for a rise closer to 4%, or around £5.2 billion per year, in order for the service to meet anticipated demand increases over the course of this parliament.
A report released by the Institute for Fiscal Studies (IFS) and Health Foundation said this necessary funding increase will have to come from tax rises, which could cost British households an extra £2,000 per year. IFS Director, Paul Johnson, said the public now faces a clear choice between “higher taxes and a health and social care system which meets our expectations and improves over time, or taxes at current levels and a more constrained health service delivering less than we have become accustomed to.” Chair of the Health Committee, Sarah Wollaston, said that anything below a 4% increase “would be disastrous”, while claiming that the public would be willing to pay more for an improved service.
If the Spectator report proves to be true, Theresa May will be shortly presenting a popular birthday present to the NHS in the form of the most significant increase in funding since the Coalition Government came to power in 2010. Jeremy Hunt refused to confirm or deny the reports at an Institute for Government event later in the week, but it appears almost certain that the Government will give the NHS additional money well over and above that provided by recent limited top-ups.
The devil will be in the detail: in keeping with Sarah Wollaston’s warning, stakeholders across the sector will be unlikely to ease the pressure on the Government if it presents a figure below that called for by the likes of the King’s Fund, IFS, and Office for National Statistics. However, a 3% year-on-year increase would indeed take funding beyond the £350 million extra-per-week demanded by prominent Brexiteers in 2016 and would represent a considerable victory for the likes of Boris Johnson and Michael Gove in their efforts to present a ‘better Britain’ post-Brexit.
NMC launches new nursing standards
The Nursing and Midwifery Council has launched a new set of standards to ensure the “next generation of nurses will learn… to deliver world class care.” The regulator has also introduced standards for a “more modern and innovative approach” to the training of nurses and midwives by practice partners and universities across the UK. The introduction of these new standards follows a decision taken in March that all future nurses are trained under the same set of procedures, and to provide the same set of communication skills regardless of their particular fields of practice.
Key features of the new standards include: changes to mentoring, to support students better in both practice and academic settings; adoption of the Royal Pharmaceutical Society competency framework for prescribers; and removal medical management standards, which will be replaced by “consistent guidance” applying to all health and social care staff. Chief Executive of the NMC, Jackie Smith, said the new standards “represent a huge leap forward”, and “raise the bar for the next generation of nurses”. The NMC added that nurses will have greater understanding across all four fields of practice, in particular mental health, while also emphasising teamwork and leadership.
Scotland reveals safe health and care staffing standards
The Scottish Government has published a Bill to enforce safe staffing standards across the Scottish health and care system. If passed, the Health and Care (Staffing) (Scotland) Bill will legally require NHS boards and care services to have appropriate numbers of trained staff in place. It would also require the use of the country’s existing workload planning tools to determine what safe staffing levels are.
Scottish First Minister, Nicola Sturgeon, first made the promise for safe staffing legislation in 2016, after Wales became the first UK country to introduce similar legislation. Unlike the draft Bill in Scotland however, Welsh legislation is currently only applies to adult acute medical and surgical inpatient wards.
Scottish Health Minister, Shona Robinson, said the Government was fully aware, stating: “there is a clear link between effective and sustainable staffing levels and high-quality care”, adding that it is “vital we have the right staff in the right place, with the right skills, long into the future.” Peter Bennie, Chair of the British Medical Association in Scotland, said “it has never been more important to have the right mechanisms in place” but argued that “there must also be an acceptance that this bill does nothing to tackle the core issues of recruitment and retention that are such a problem for NHS boards.”
While the safe staffing legislation in Scotland appears almost certain to pass, there have been no serious suggestions at this stage that similar legislation will be enacted in England. Equally, Northern Ireland has not approached the issue in detail, though is of course incumbered from passing any meaningful legislation before a return to power-sharing takes place. A poll of 1,600 UK adults carried out for the RCN in May found that 74% were concerned about nursing staffing levels in the NHS.
GP representation declining as role of CCGs questioned
The GP magazine, Pulse, has obtained figures showing that GP representation on CCG boards continues to decline. The report states that 39% of all board positions are filled by general practitioners, a fall from 49% in 2012 when the Health and Social Care Act set up CCGs, and from 43% in 2014. The statistics, obtained through freedom of information requests, also show that GP representation is significantly higher in London CCGs than in the North, and that only 29% of GPs on the boards are female, despite women making up more than half of the overall GP workforce.
BMA GP Committee Chair, Richard Vautrey, said it had been clear from the beginning that the 2012 changes would fail to make an impact and argued “the idea of it being clinical-led commissioning is clearly not the case”. A spokesperson for NHS England said it was the responsibility of CCG’s to maintain the composition of board members. Meanwhile this week, the Institute for Government and the King’s Fund have published a report on The Lansley Reforms and the role of NHS England in English healthcare five years since the Health and Social Care Act. The report’s author, prominent health journalist, Nick Timmins, argued in a piece for HSJ that the reforms have failed to deliver all three main objectives.
The story about board underrepresentation is significant in so far as it adds to growing frustration with the Lansley reforms, at a point in time where the Government is allegedly considering scrapping parts of the 2012 Health and Social Care Act. Part of the rationale behind forming CCGs was to ensure clinician-led commissioning decisions, with a focus on input from family doctors. However, this has not worked in practice in many ways, as CCGs have faced strict budgetary frameworks, and increased oversight from NHS England and new regional health structures, such as integrated care systems and STPs.