Weekly political news round up – 4th July 2014

July 4, 2014 in News by Whitehouse

Around the sector

The Department of Health has published six short documents to support local authorities and other stakeholders through the transfer of responsibility for commissioning children’s public health services, including visitors, from NHS England to local authorities from 1st October 2015. One of the documents focuses on the two year old review (integrated review), where health visitors carry out a full assessment of a child’s development at the age of 2 to 2 and a half. The document outlines what it is, why it is required and how it will be measured.

The Commons Public Accounts Committee has published a report which has criticised Monitor, the regulator for foundation trusts, for only employing seven people from a clinical background out of a total staff of 337. Labour MP Margaret Hodge, chair of the Public Accounts Committee, said that Monitor’s effectiveness is “undermined by a lack of frontline NHS experience”.

Ofsted has published a letter to schools from Sir Michael Wilshaw, Ofsted’s chief inspector, informing them that school-based nurseries and reception classes will now receive separate graded judgements on their effectiveness. The changes follow a consultation by Ofsted in which they asked whether early years and post-16 education should have their own separate assessments. The formal outcome of the consultation, however, is yet to be published.

The Guardian has reported that the Local Government Association (LGA) has criticised the proposed £200 million worth of cuts by the Department for Education’s to the education services grant, a fund paid to councils to cover school improvement and other education functions. The LGA said that the reductions will harm the school improvement sections of councils, many of which have already suffered deep cuts in recent years but still face pressure from Ofsted inspectors and parents to reform schools.

Health Select Committee publishes report on managing the care of people with long-term conditions

The Health Select Committee has published a report on their inquiry into the management of long term conditions (LTC) by the NHS and social care system in England. The inquiry looked at the strategic direction of services, clinical care for people with LTCs, and how the system can best deliver care for people with LTCs.

The report emphasised the financial impact of LTCs, highlighting that 70% of the total expenditure on health and care in England was associated with the treatment of just 30% of the population with one LTC or more. It stressed that the situation was only likely to worsen, with the number of people with LTC set to increase from 15 million to 18 million by 2025 – a cost increase of £5 billion to the system between 2011 and 2018.

Continence was not discussed explicitly by the committee, but a number of their findings are of more general interest.

Strategic direction of services

In assessing the strategic direction of services for LTC, the Committee found that four of the nine progress indicators used to measure four objectives for the management of LTCs could not be measured, as there was little reliable data available to do so (health-related quality of life for people with LTC, the health-related quality of life for carers, the proportion of people feeling supported to manage their condition, and the effectiveness of post-diagnosis care in sustaining independence and improving quality of life). The Committee subsequently called for greater clarity in the setting of baseline indicators and greater transparency and rigour in the measurement of progress against these indicators.

It also found that NHS England had not taken forward a national approach to strategic planning for LTCs, despite taking over the responsibility for developing work on a cross-government strategy for LTCs from the Department of Health in 2013. As such, the Committee concluded that the strategic response from the Government and NHS England to the pressures arising from increased incidence of LTCs was “unclear and lacks urgency”.

Clinical care for people with long-term conditions

The Committee identified several areas of concern in clinical care for people with LTCs. In particular, the Committee claimed that the current definition of LTCs used by the Department of Health had resulted in the condition being treated rather than the person as a whole. For people with multiple LTCs, it meant that their care was unstructured, uncoordinated and problematic.

Consequently, the Committee found that care pathways needed to be rebalanced to provide greater integration of treatment across all care settings, as well as support for patients to manage their own conditions. It was subsequently recommended that individual care planning models centred on the needs of patients should be adopted.

The report said the Committee believed that there had been a systematic and cultural shift towards greater personalisation of health and care services, and greater involvement of service users in constructive discussions about how their LTCs are treated. It identified that there was scope to increase the choice patients have over the ways their conditions are treated, and highlighted that the challenge for commissioners was now how they should evaluate and measure the effectiveness of treatment where patients feel it is likely to be effective.

Discussing staffing, the Committee found if more treatment of LTCs is to take place in primary and community care, then the recruitment and workforce planning required must take place as a matter of urgency, in particular to address a work force shortfall in primary care already identified by the Centre for Workforce Intelligence.

Managing the system to deliver better long-term conditions care

The Committee discussed the level of practical support given to commissioners to support the design of services which promote community-based care and provide for the integration of health and social care in the management of long-term conditions. In their findings, they highlighted that while for some long-term conditions, such as diabetes and epilepsy, there was a wealth of third-party guidance and support for commissioners, support for commissioners in the form of surveys and engagement with patients did “not presently exist on any significant scale”.

Despite identifying the Government’s aim of reducing the number of unplanned acute admissions for conditions which could be better treated in primary or community care, the Committee found that they were “not convinced” that focusing on measures to reduce admissions to the acute sector will effectively address the underlying issues in management of LTCs which seem to drive patients with chronic conditions into acute care.

They found that despite widespread understanding that patients with LTCs can be better and more effectively treated in primary and community care, they have not found any conclusive evidence that a large-scale shift in services will provide clinical or economic benefits, though a change in service mix may well be beneficial overall in supporting those with LTCs. As such, they recommended that long-term studies should be commissioned looking at the effectiveness and economic benefit from integrated services for the management of LTCs.

The Committee said that reducing the activity of acute hospitals on LTCs, and their income from such activity, is bound to have a consequential impact on services. The Committee said that the likely impact of service redesign on the acute sector in particular must be explicitly recognised and openly debated, in order to secure broad public understanding of, and agreement to, proposals for change.

Health Education England launches consultation on reorganisation of internal structure

Health Education England (HEE) has launched a consultation on proposals for the reorganisation of its internal structure. Although these changes will not impact on the role and function of HEE, which is to provide leadership and coordination for the education and training for health care workers, they do mean changes in responsibilities in senior management.

HEE highlighted that these changes were prompted by an annual budget reduction of 20%, as well the shift in organisation type from a Special Health Authority (SpHA) to a Non-Departmental Public Body as part of the Care Act 2014. HEE also stated it wished to create a “One HEE programme”, which addressed complaints that HEE felt more like fourteen organisations rather than one, resulting in a duplication of functions.

The consultation document emphasises that the thirteen Local Education and Training Boards (LETBs) will continue to remain the local footprint of HEE. The role and functions of LETBs will remain the same on 1st April 2015; the only changes proposed are ones related to staffing and senior management structure.

The most pertinent proposal is the introduction of an LETB Director. The LETB Director will replace the role of Managing Director, and also assume some of the functions of Director of Education and Quality. It will report directly the appropriate National Director (based on geography) rather than HEE’s Chief Executive.

It is also proposed that each LETB Director will be responsible for appointing a Post Graduate Dean, who will work across the spectrum of health so to ensure that the provision of education reflects changing service models and delivers the integrated workforce. The document states that this will provide significant clinical leadership to the work on developing educational frameworks and assessments, based on care pathways and patient flows.

In order to enhance the alignment between the local and the national, HEE will appoint four new National Directors (by geography). The National Directors will act as a bridge between local LETBs and the Executive Team.

Included in the proposals are plans to appoint a provider chief executive to be a member of a new national advisory body called the Provider HEE Advisory Group (HEEAG). The purpose of this group will be to supplement HEE’s current national structure through the addition of a new advisory group to strengthen the voice of local providers at a national level.

The consultation consists of four questions:

What is the most appropriate geography for the National Directors with local oversight?

  1. Should a clinical qualification be a requirement for the LETB Director role?
  2. How should LETBs be represented on the Provider HEE Advisory Group (HEEAG)?
  3. What should the reporting and accountability arrangements be for the new posts of Head of Finance and Director of Education and Quality?

Welsh Affairs Select Committee announces inquiry into cross-border health arrangements

The Welsh Affairs Select Committee has announced an inquiry into cross-border health arrangements between England and Wales and the experience of patients who rely on services on each side of the border. The inquiry comes over a year after NHS Wales and NHS England agreed a Protocol for Cross-border Healthcare Services to ensure smooth and efficient interaction between the NHS on either side of the England-Wales border. However, assessments have not been carried out on how well this has been functioning so far.

The Committee is seeking written evidence on the following relevant issues:

The impact of policy divergence in the health systems of England Wales on cross-border healthcare services

  • The experience of patients in England and Wales who are reliant on the use of healthcare services on the other side of the border
  • The case for sharing of resources and facilities
  • The impact of the Protocol for Cross-border Healthcare Services
  • Any lessons that can be learned from other cross border health arrangements