This week, capacity concerns and the fate of the medical workforce have dominated news surrounding the health service, against the backdrop of MPs debating the latest iteration of the EU Withdrawal Bill.

New data from NHS England revealed that more than a quarter of patients are not being seen by a consultant within 14 hours of admittance to hospital: a key requirement within the Government’s pledge to provide a full “seven-day service” across England. The 14-hour wait was one of four central standards introduced by NHS England in 2013, as the national commissioning body sought to redress a “significant variation in outcomes” for patients admitted at weekends, compared to those seen during the week.

Despite this claim, the difference in performance against the standard on weekdays and at weekends is minimal, with the proportion of patients being seen by a consultant within the 14-hour window at 73%, and 70%, respectively. NHS England and NHS Improvement did not comment on their expectations for the 14-hour standard, while a recent study from the University of Manchester argued there is “no association” between access to consultants and weekend death rates.

Meanwhile, the British Medical Association published a survey which found that 45% of doctors from the European Economic Area are considering leaving the UK medical workforce. The report, which polled 1,720 doctors from the EEA, also found that almost one in five medics (18%) had already made plans to leave, while over three-quarters (77%) of respondents would be encouraged to leave if there is a negative outcome to Brexit negotiations on EU citizens’ rights.

Nursing conditions criticised by Francis, profession leaders

The author of an influential report on patient safety has this week joined senior nursing figures in criticising NHS leaders on their approach to workforce shortages. Sir Robert Francis, who led on the Mid Staffordshire NHS Foundation Trust Public Inquiry earlier this decade (“the Francis report”), claimed that senior NHS officials have regrettably “shied away” from using staff/patient ratios as an effective measure of “acceptably safe care”.

In his submission to the Health Committee’s inquiry on the nursing workforce, Francis also warned against incremental cuts to nursing numbers by trusts under pressure to make savings, noting that these measures were a key contributor to the Mid Staffs scandal resulting in a number of avoidable hospital deaths.

The Health Committee met once again this week to discuss the shortage of nurses employed in the NHS, and were told by leaders of the profession that cuts to continuing professional development have been particularly damaging to retention rates. Council of Deans Chair Professor Brian Webster- Henderson – representing UK university nursing departments – labelled Health Education England’s cuts to CPD “a nonsense” at a time when the profession is introducing new standards. He was supported by the chief executive of the Nursing and Midwifery Council, Jackie Smith, who argued that such cuts contributed to the feeling that “the nursing profession does not feel valued.”

HEE reduced its CPD fund for nurses, midwives and allied Health Professionals from £205 million in 2015 to £83 million in 2017, which NHS Employers chief executive Danny Mortimer labelled the “biggest single factor now in terms of poor rates of retention in the NHS”.

Children with special educational needs face school exclusion

The Children’s Commissioner for Wales, Sally Holland, has expressed concern over the increasing number of children being taken out of school to be taught at home. Some 1,906 pupils were removed from Welsh schools in 2016-17, a dramatic increase from the 864 students taken out of formal education in 2013-14. The National Autistic Society Cymru said, “a lot of parents are finding themselves in positions where they have no options”, while Sally Holland suggested “some parents… have been encouraged to home educate because their child might be affecting the school or local authority’s performance data.”

The most recent report by the Special Education Needs Tribunal for Wales showed an increase in appeals against inadequate support for children with most special educational needs in recent years. The comments from Sally Holland come in a week where the Children’s Commissioner for England, Anne Longfield, expressed her own fear in parliament that pupils in England with behavioural problems were being at times unnecessarily excluded, and subject to poorly managed disciplinary initiatives.

Daily Mail highlights incontinence concerns

Two academics from the University of Leeds have publicised the effect of incontinence in the Daily Mail, particularly highlighting the stigma attached to the condition and the anticipated impact on an ageing population. Dani J Burton and Pete Culmer note, “the profound personal and socio-economic consequences” of incontinence in their article, discussing the severe impact managing the condition has on everyday life, “bringing worries about where the nearest public toilet will be and making even short outings stressful”.

The academics explain the differences in continence care and management between wealthier countries and the third world, but note that even where supply chains, infrastructure and policies are
clearly in place in countries like Britain, “affordability and a reluctance to seek medical help can result in many suffering quietly”. Burton and Colmer argue the solution to better tackling incontinence is in improving awareness and understanding, “through education, public discussion, media coverage (and) better recognition in healthcare.”