This week, the Royal College of Paediatrics and Child Health (RCPCH) warned that a majority of STPs fail to consider health and wellbeing needs among children and young people. Published on Tuesday, the RCPCH report – Sustainability and Transformation Partnerships, part of a short series of reports on child health – has reviewed the 44 published STP plans and exposes severe shortcomings in their approach to children’s and young people’s health. In response, the RCPCH proposes several recommendations moving forward, including ensuring that all STPs “develop, implement and evaluate a strategic plan which meets the needs of infants, children and young people within their respective geographical footprints.”

In other news, the Early Intervention Foundation (EIF), which works to promote research on early intervention for children and young people, has named Dr Jo Casebourne as its new chief executive. Dr Casebourne will replace Carey Oppenheim in August 2017, and joins the EIF from the Institute of Government, where she has led the institute’s work on development and public services.

General election: sector reactions & manifesto speculation

Party leaders address Royal College of Nursing annual conference

The Liberal Democrats have pledged in an address to the RCN’s annual conference – made prior to their manifesto publication – that they would lift the 1% cap on public sector pay and thus end pay restraint for nurses if elected into power on 8th June. The party’s election pledge comes shortly after the Royal College of Nursing (RCN) threatened to consider striking unless the next Government removes the pay cap.

According to the Liberal Democrats’ own estimates, lifting the pay cap and up-rating wages in line with inflation would result in an average salary increase of £527 a year for nurses by 2021. The party’s own analysis also indicates that a newly hired nurse will be £530 a year worse off by 2021 if the cap remains in place, due to rising inflation.

In addition to promising a nursing pay rise, Tim Farron told the RCN’s conference that his party will reinstate student nurse’s bursaries and invest more funds in the NHS. Commenting on the current government’s policy towards the NHS, Mr Farron said he has had enough of the “Conservative Government treating nurses like dirt.” Commenting on the policy, the Liberal Democrats’ financial spokesman Vince Cable said that public sector workers were facing “pitiful increases to pay combined with a Brexit squeeze caused by soaring inflation”.

Despite an invitation, the RCN’s conference was not addressed by a representative from the Conservatives, which the college’s chief executive Janet Davies said left delegates “disappointed, saddened and disrespected”. The RCN subsequently wrote to Theresa May’s office to express their disappointment that she did not address the conference, stating that the nurses present “were keen to hear from the Prime Minister personally” about her plans for the nursing workforce.

Labour’s manifesto launched

Labour formally launched its general election manifesto in Bradford on Tuesday, following a leak of the draft manifesto last week. The party’s spending commitments, detailed in a separate document, total £48.6 billion, which would be funded through a range of additional taxation measures including raising corporation tax to 26% by 2022. Building on the party’s commitment to rule out rises in income tax for those earning below £80,000, the manifesto confirms that Labour would lower the threshold for the 45p additional rate to £80,000 and reintroduce the 50p tax rate for those earning above £123,000, which it predicts would raise £6.4 billion per year.

The health and education policy commitments in the manifesto largely replicate the contents of last week’s draft, although there is one additional commitment to scrap hospital car parking charges. Labour stated that if elected to government, it would:

  • Focus resources on providing care closer to home, including working towards a new model of community care and increasing funding for GP services “to ensure patients can access the care they need”.
  • Offer guarantees for the rights of EU workers in the health and social care sector.
  • Boost capital funding for the NHS, as part of a £30bn commitment in extra funding over the next parliament, “to ensure that patients are cared for in buildings and using equipment that are fit for the 21st century”.
  • Introduce an Office for Budget Responsibility for Health, to scrutinise spending of the health budget, and a new “safety and excellence regulators”
  • Halt and review the STP progress, with local stakeholders included in a re-draft. The party does not pledge to scrap the plans entirely.
  • Create a new index of child health to measure the wellbeing of UK children against international standards – this will include measures of obesity and dental health, alongside mental health and the general health of under-fives. This policy would be supported by £250 million of additional funding, which would also look to increase the number of school nurses and health visitors.
  • Spend an additional £6.3 billion on schools per year by 2021/22. This will encompass a general increase in funding, protection for schools against losses from the new funding formula, free school meals and an arts pupil premium. With the exception of free school meals, this will be paid for through a rise in corporation tax.
  • Implement a “SEND strategy based on inclusivity, and embed SEND more substantially into initial teacher training so that staff, children and their parents are properly supported.”

The healthcare policy commitments are costed at £5 billion per year, including free hospital car parking but excluding higher pay for NHS staff and capital expenditure, while schools’ spending would cost £6.3 billion.

Liberal Democrat manifesto launched

The Liberal Democrat manifesto was also published on Wednesday. As expected, the manifesto set out the Lib Dems as the pro-EU alternative to the Conservatives or Labour, promising to hold a second referendum on the Brexit terms agreed at the end of the Government’s negotiation timetable, with the alternative being to remain in the EU. Beyond a decision to increase all bands of income tax by 1p in the pound to fund health and social care – which would raising approximately £6 billion – and reversing cuts to Corporation Tax and Capital Gains Tax, the manifesto does not look to increase taxation or change income tax bands.

The Lib Dems’ pronouncements on health policy were more detailed than Labour’s, and suggested a greater degree of engagement with stakeholders’ proposals than that seen in Labour’s manifesto. The party pledged that it would:

  • Increase all bands of income tax by 1p in the pound, with the £6 billion generated ringfenced to spend on health and social care. This would eventually be replaced by a dedicated health and care tax, calculated following consultation and potentially from reforming National Insurance contributions.
  • Direct additional investment to “social care, primary care (and other out-of-hospital care), mental health and public health”, as this would be most efficient and effective.
  • Integrate NHS and social care into one service, with the aim of “pooling budgets in every area by 2020 and developing integrated care organisations”. Without referencing the STP process, the manifesto highlights the need to allow local areas to decide how to allocate funds and provide care in their community.
  • Create a cross-party health and social care convention – as the party was campaigning for, along with notable health figures such as Sarah Wollaston, before the election – which would review the long-term sustainability of health and social care finances and workforce.
  • Introduce a statutory independent budget monitoring agency for health and social care, similar to that recommended by the House of Lords’ report on the long-term sustainability of the NHS and echoed in Labour’s manifesto.
  • On education, the Lib Dems would increase spending on schools by almost £7 billion over the next five years to protect per-pupil funding in real terms, and ensure that no school loses out under the national funding formula.
  • Endeavour to identify and support special educational needs and disabilities as soon as possible, accompanied by assessing all new policies for how they impact pupils with SEND.
  • The party would delegate responsibility to local authorities for “local school places planning and repeal the rule that all new state-funded schools must be free schools or academies”.

Conservative manifesto launched

The Conservatives have launched their general election manifesto at an event in Halifax, after trailing several of its key policies in the media overnight. The manifesto sets out “five giant challenges” for government in the long-term: the need for a strong economy; Brexit and a changing world; enduring social divisions; an ageing society; and fast-changing technology.

The most reported announcement from the manifesto was a policy requiring elderly people with assets of more than £100,000, including their home, to pay for their social care. The charge will be enforced regardless of whether people receive care in their home or in a nursing home, which is a change from existing policy which only includes people’s homes as an asset if they are in residential care, and increases the threshold of assets for anyone paying for their care from £23,250. The policy looks to address growing pressures in the social care sector which have had indirect impacts on the NHS – but Sir Andrew Dilnot, who carried out the coalition’s review of social care funding which proposed a cap on care costs, has criticised the policy as removing choice from people in how they pay for their care. The Conservatives made the following policy pledges:

  • A pledge to increase NHS spending by a minimum of £8 billion in real terms by 2022 – however, it should be noted that this does not allocate substantially more funding than that agreed at the 2015 Comprehensive Spending Review. The funding agreement for the NHS remains essentially the same, with the period that it covers extended, and with marginally more fundingan additional £230 million allocated to the revenue budget for 2018/19 to ensure that funding is still increased during that financial year.
  • Supporting the implementation of Sustainability and Transformation Plans, “providing they are clinically led and locally supported”, but acquiescing on the need for legislation if existing legislation is “either slowing implementation or preventing clear national or local accountability”. This effectively commits the Conservatives to legislation reversing many of the provisions of the Health and Social Care Act 2012.
  • Prioritising healthcare professionals from the EU during Brexit negotiations, but increasing the number of UK students in medical training with the intent of reducing this reliance over time.
  • A commitment to extend seven-day GP access across England by 2019, and expanding the use of phone and online consultations.
  • The document reiterates a previous commitment to publishing a green paper on young people’s mental health before the end of the year, and all primary and secondary school teachers will be able to access mental health first aid training by the end of the next parliament.

Responding to criticism of the new schools funding formula, the Conservatives would increase the overall schools budget by £4 billion by 2022 to ensure that no school experiences cuts under the new formula. This will be funded through removing eligibility for free school lunches for all children in the first three years of school, replacing it with a pledge for all primary school children to receive free school breakfasts.

Public Health (Wales) Bill passed through Welsh Assembly

The Public Health (Wales) Bill this week passed through Stage 4 of the legislative process in the Welsh Assembly. The Bill has now entered a four-week intimation period, during which the Counsel General or Attorney General could challenge its legality – however as this almost never happens, the bill is likely to be given royal assent and become law after this four-week period.

The Bill requires local authorities to put in place local toilet strategies across Wales, with each local authority required to prepare and publish a local toilets strategy within one year of when this section of the Bill comes into force. The strategy must include an assessment of the need for toilets in the local authority’s area to be available for use by the public; a statement setting out the steps which the local authority proposes to take to meet that need; and any other information which the local authority considers appropriate.

Local authorities will also have to consult any person it considers is likely to be interested in the provision of toilets in its area that are available for use by the public before it publishes its local toilets strategy.

RCN report highlights decline of school nurse and health visitor numbers

The Royal College of Nursing (RCN) has published a new report – The Best Start: The Future of Children’s Health – which warns that dropping numbers of health visitors and school nurses, together with cuts to public health funding, are “putting children’s health at risk”.

Amongst its key findings, the report records that there has been a decrease of over 1,000 health visitors since 2015, alongside a 16% drop in the number of full-time school nurses between 2010 and 2017. The report depicts a complex picture of workforce changes regionally, resulting from the recommissioning of services by local authorities to a range of providers, and skill mix changes. As some services have moved to providers outside of the NHS, the authors suggest that it has become more difficult to track workforce developments, which in turn hampers effective planning.

The report also suggests that planned reductions in public health funding for 2016-17 fell most heavily on services aimed at improving children and young people’s health, representing 14% of total cuts. There are also variations across England on whether families have access to the mandated universal health visiting service, with children in London the least likely to receive the required number of health visits. The document expresses concern about the increasing workloads for health visitors – with 72% of those responding to in an Institute for Health Visiting survey being concerned about providing inadequate safeguarding and child protection support. Statistics also suggest that school nurses are overstretched, with 29% of respondents to a National Children’s Bureau survey stating they worked across 13 or more schools.

Commenting on the RCN report, the RCN Chief Executive & General Secretary, Janet Davies, said: “There’s a wealth of evidence that ill health in childhood can have a detrimental impact in adulthood. If these cuts continue, we’re heading for more health problems, more inequality and even more pressure on our public services down the line.”

RCN poll shows appetite for pay action

According to a recent poll conducted by Royal College of Nurses (RCN), a majority (78%) of RCN members are prepared to go on strike, and 91% say they will support industrial action short of a strike unless the next government scraps a 1% pay-rise cap. The news came shortly after the RCN argued that the NHS in England lacks as many as 40,000 nurses to fill currently vacant posts. In addition, the union said that the 1% cap on pay rises has meant a real-term pay cut since 2010 of 14%.

The Chair of the RCN Council, Michael Brown, said that “Getting 52,000 NHS members taking part shows the strength of feeling about pay restraint – and the percentage in favour of taking action cannot be ignored.” Mr Brown continued by proposing an emergency resolution calling for a summer of planned protest activity, followed by an industrial action ballot, if the next Government fails to lift the policy of an NHS pay cap.

Chief executive of The King’s Fund warns NHS should embrace STP changes

The chief executive of The King’s Fund, Chris Ham, has urged politicians to back changes to local NHS provision proposed in Sustainability and Transformation Plans (STPs) in order to make health services better and more efficient. Mr Ham’s statement comes in the wake of both individual MPs and political parties promising to halt local A&E unit closures in order to secure votes on 8th June, with Labour going as far as promising to halt and review plans if elected.

In an interview with the Guardian, Mr Ham emphasised that politicians on all sides of the political spectrum should back STPs, particularly those elements looking to centralise urgent and specialist care. Speaking out on the issue, Mr Ham said: “With services like A&E and maternity care, we do not have enough doctors and nurses to be able to offer everything everywhere. This may mean some A&E departments becoming minor injury units and some maternity units needing to be staffed by midwives rather than doctors.”

Every Welsh child to have access to recognised nurse throughout their school education

The Welsh Health Secretary Vaughan Gething AM has announced that every child in Wales will have access to an “identified school nurse and associated health team with a variety of skills”, as part of the new School Nursing Framework being implemented across the country. The school nurses will have responsibility for a secondary school and their cluster primaries, and will be accessible to children outside term time following concerns that some schools only employed nurses during term time.

The nurses will be able to advise students on a number of issues, including physical health; promotion of emotional wellbeing; delivery of national screening and immunisation programmes; safeguarding; early identification and assessment of pupils’ needs; and additional support or signposting to local services for children and young people identified as having additional needs.

The Education Secretary Kirsty Williams AM commented on the announcement, stating that “We want to ensure pupils are aware of what school nurses can do for them and how to find them, to make it easier for children to use the school nursing service and get good advice on their health.”