This week, Labour leader Jeremy Corbyn has set out his support for the UK remaining in a permanent customs union with the EU after Brexit. This would be different to being in the customs union which the UK is currently part of through the EU, and would enable the UK to not have any tariffs with Europe or a hard border between Northern Ireland and the Republic. Labour’s position could cause difficulties for the Government by tempting pro-Remain Conservative MPs to rebel against the Government during the negotiation process.

NICE publishes guidance on the use of the Peristeen transanal irrigation system

NICE has published its medical technologies guidance for the Peristeen transanal irrigation system for managing bowel dysfunction, following a consultation on the topic launched in August 2017. The guidance concludes that “The case for adopting Peristeen for transanal irrigation in people with bowel dysfunction is supported by the evidence”, while acknowledging that it may not be suitable for all people with bowel dysfunction, may take several weeks to get used to and is not necessarily more costeffective over a long period than other transanal irrigation systems.

The guidance reported evidence that there is a lower drop-out rate among children using Peristeen than adults using the system and that there are “highly positive comments from parents and carers, who stated that transanal irrigation had significantly improved their child’s quality of life.” It was noted that children with bowel dysfunction using the system could increase their participation in school and social events. The committee considering the guidance “acknowledged that Peristeen is successfully used in children in the NHS” and “may offer significant benefits for children with bowel dysfunction.”

Commenting on the publication of the guidance, PCF member and paediatric continence specialist June Rogers said: “This new NICE guidance means that these young patients will now have another form of treatment available from the NHS. Hopefully this will also reduce the need for them to undergo surgery.” Brenda Cheer, a paediatric specialist continence nurse from ERIC and also a PCF member, said the guidance will “add credibility to the prescription of Peristeen both for long term conditions and for those that require it temporarily to enable the bowel to rehabilitate. […] Transanal irrigation is well tolerated by children and young people; we should not shy away from its use.”

Government to act on prescription errors

The Health Secretary has said the Government will act to reduce errors in prescriptions, which new data estimates could be happening 237 million times a year in the UK and resulting in 700 deaths per annum. Jeremy Hunt said that this issue is “a far bigger problem than generally recognised, causing appalling levels of harm and death that are totally preventable.” He also said that the Government will continue to push the introduction of electronic prescription, as it is thought that this could reduce errors by up to 50%.

The Chief Executive of the Royal College of Nursing, Janet Davies, warned that the errors can be attributed to staffing and financial pressures, which creates “real problems in preserving patient safety.” A blog post on the RCPCH’s website by Dr Alice Roueché, a Consultant General Paediatrician and Meds IQ clinical lead, highlighted that children are three times more likely to be harmed by medication errors than adults. She highlighted that Meds IQ, a community created by the RCPCH, allows paediatricians to share ideas and resources including on reducing prescription errors.

NAO publishes report on reducing emergency admissions

The National Audit Office (NAO) has published a report on reducing emergency admissions, examining work by the Department of Health and Social care and NHS England to prevent these. The report states that some emergency admissions “could be avoided by providing alternative forms of urgent care, or by providing appropriate care and support earlier to prevent a person becoming unwell enough to require an emergency admission.” It notes that there was a 9.3% increase in emergency admissions between 2013/14 and 2016/16, and NHS England had deemed 24% of emergency admissions in 2016/17 as avoidable. It was also suggested that if admission thresholds had not been raised since 2010, the number of emergency admissions would have been nearly 12% higher in 2015.

The NAO highlights that NHS England and DHSC have introduced several programmes to attempt to reduce emergency admissions and their impact, including improving access to GP services, improving the performance of A&E departments and out of hospital care. However, it notes disagreement on whether these programmes have actually caused a slight decline in the growth of emergency admissions, saying there is “disagreement among clinicians, other practitioners and evaluators about the effectiveness of some of the interventions.” The report concluded that there is not enough capacity in community services to prevent emergency admissions, and that NHS England does not have good enough data on emergency admissions. The report’s recommendations include:

  • The Department of Heath & Social Care, NHS England and NHS Improvement should establish an evidence base for what works in reducing emergency admissions and use this to inform future national programmes.
  • NHS England and NHS Digital should link hospital activity data with primary, community health care and social care data.
  • DHSC and NHS England should set out how community services will support reductions in emergency admissions.

Satisfaction with GP services at record low

Data from the British Social Attitudes survey has shown that satisfaction with GP services has fallen to the lowest level since data started being collected in 1983. Satisfaction with GP services fell to 65% in 2017 from 72% in 2016, although people were more satisfied with the care given by their GPs than with GP waiting times. The Deputy Chief Executive of NHS Providers, Saffron Cordery, said the findings are “deeply worrying. The shift in public mood has been a long time coming.” Meanwhile, the Chief Executive of the RCN, Janet Davies, warned that “Ministers must act urgently on public concerns over NHS understaffing. The shortages are beginning to bite and that is reflected in this research.”

Chief Executive of the King’s Fund to step down

The Chief Executive of the King’s Fund, Professor Chris Ham, has announced he will step down by the end of this year. Professor Ham has been in the position since 2010, before which he worked for the Department of Health and World Health Organisation. The Chair of the Fund’s board of trustees, Sir Christopher Kelly, said “Under his leadership, the Fund has grown in influence and become a stronger organisation. He will leave it in very good health and will be greatly missed by his colleagues.”