This week the controversial EU (Withdrawal) Bill, which aims to transfer EU law into UK law once the UK leaves the EU, has been adopted by the UK Parliament. The Bill entered the so-called “ping pong” phase, where amendments to a Bill move back and forth between the House of Commons and the House of Lords. After Peers had retabled an amendment giving Parliament a “meaningful vote” if the Government fails to reach a Brexit deal, MPs rejected it by 319 to 303.

The Government fought off a rebellion within own party ranks by promising that an official ministerial statement would be issued making clear it is ultimately for the House of Commons Speaker to decide whether MPs get a “meaningful vote”. While the concession was accepted by pro-EU Conservative Dominic Grieve, who drafted the amendment, six other Conservative rebels still voted in favour. On the Labour side, four MPs defied their whips and sided with Government.

Both sides have claimed victory with pro-EU MPs saying that the Parliament will have a say on what happens if negotiators fail to get a deal.  International Trade Secretary Liam Fox, meanwhile, said nothing had really changed and the option of a no-deal Brexit was still on the table.  The Bill now waits for the final stage of Royal Assent when it will become law.

May announces major NHS funding boost

The Prime Minister, Theresa May, has announced that she will increase NHS funding by 3.4 per cent, the equivalent of £20bn over four years, as part of plans to implement a long-term NHS funding package to coincide with the NHS’s 70th birthday celebrations. The announcement comes after eight consecutive years of one per cent annual funding increases, the longest period of constrained funding growth in the history of the health service. During this period, conditions in the NHS are widely considered to have deteriorated, with increases in demand outpacing additional funding. May has said that, in return for the extra money, the NHS must create and deliver a 10-year plan with improvements in services, particularly focusing on A&E waiting times, cancer survival rates and mental health provision. She said that the additional funding cannot be “wasted… on bureaucracy.”

This 3.4 per cent increase remains below the 3.7 percent average annual increase in NHS funding since its creation in 1948 and has come amid intense pressure from key figures in the sector who have argued the NHS needs at least a 4 per cent annual increase in order to maintain its current levels of service delivery. Support for the 4 per cent increase comes from NHS England Chief Executive, Simon Stevens, and prominent health think tanks – the King’s Fund, Nuffield Trust, and the Health Foundation – among others.

Jeremy Hunt’s recent calls for increased NHS spending have been supported by a handful of Cabinet allies and other influential non-party organisations, including the Institute for Fiscal Studies and the Office for Budgetary Responsibility. Major stakeholders have welcomed the announcement admitting it is more than they had anticipated. The King’s Fund Chief Executive, Chris Ham, responded saying, “ While we welcome the Prime Minister’s assurance that future decisions about social care spending will not add to pressures on the NHS, this hardly suggests an ambitious statement of intent.”

This is a bold move by the Prime Minister considering the pressure currently being placed on her and her Chancellor, Philip Hammond for increased funding from several other government departments. The Treasury is eager to keep costs down in the wider context of a low value for the pound, and uninspiring economic growth. Where the increased funding will come from has been subject to debate (as detailed below) but the increase is widely expected to be sourced through a combination of increased taxes (with a specific ‘hypothecated’ NHS tax unlikely to be used), increased government borrowing and a “Brexit dividend.”

Critics have highlighted the lack of costings for the plan as the source of £11bn of the £20bn package has yet to be determined. Health and Social Care Secretary, Jeremy Hunt, suggested that “exact details” of how the increase would be funded “will be announced in the budget” in November, while hinting that the pot will be funded via a combination of additional government borrowing and tax rises.

It is believed that borrowing could account for £8-10bn, while the Times is reporting that initiatives such as a freeze of personal allowance and national insurance thresholds at the end of parliament could generate £4bn, although increasing taxes or debt may be met with strong resistance from within the Conservative Party whose core base support has traditionally supported low tax models. It is also rumoured that the Government will cancel planned reductions to corporation tax, despite these being strongly supported by Chancellor Philip Hammond.

Theresa May has referred to a “Brexit Dividend” as one source of funding. This refers to the Vote Leave campaign’s controversial claim that leaving the EU could free up £350 million a week for additional investment in the NHS. Critics roundly dismissed this claim, but the total funding announced exceeds the pledge by committing £394 million a week between now and 2023. Critics have noted that the money saved from not being in the EU will not be available within the relevant time period, given the UK has provisionally agreed to a transition period until 2021 and will probably be making substantial contributions towards the EU Budget long after that. Health Select Committee Chair and Conservative MP, Dr Sarah Wollaston, called the reference to a Brexit dividend “tosh”, whilst Labour’s Shadow Chancellor, John McDonnell, described it as “not credible”.

The Prime Minister also reiterated her commitment for a tangible new 10-year plan for the NHS, promising ‘more doctors’ and ‘more nurses’, but reports from the Institute for Policy Research said that whilst the proposed increase in NHS funding was ‘very welcome’, it ‘must be accompanied by a serious plan for reform’, with a ‘shift from diagnose and treat to predict and prevent’.

This comes after polling by the NHS Confederation found that 77 per cent of people support a four per cent increase in health spending over the next 15 years, and 82 per cent supported a 3.9 per cent increase in social care funding. This would increase the NHS budget from its current £128bn to £234bn by 2033.

This announcement presents an opportunity for the PCF as it can help the Department for Health and Social Care (DHSC) achieve its policy aims of providing healthcare that is longer-sighted and more preventative than it has not been as empowered to pursue until now. The PCF’s asks fit well within the demands placed on the NHS; we will look to engage with policymakers to ensure that its voice is heard.

This announcement suggests that the Government, weakened by divisions on Brexit, is backing down on positions it once firmly– keeping taxes low and tackling immigration – in order to gain credibility on its management of the NHS, something Prime Minister, Theresa May, has acknowledged as a weakness for the Conservative Party. The fiscally conservative nature of Chancellor, Philip Hammond, has manifested in his assertion that the break with policies of austerity in DHSC will not mean other departments will receive an increase in funding to fill their budget shortfalls.

The Prime Minister’s reference to a “Brexit dividend” was seen by some as a calculated ploy to gain leverage with Brexiteers ahead of her requests for a series of compromises on the EU Withdrawal Bill and Brexit negotiations. However, the announcement signifies a tangible break with years of Conservative Party commitment to austerity, while offering a clear indication that the Prime Minister has overruled her Chancellor, Philip Hammond, who had suggested a more modest increase in NHS spending.

The 3.4 per cent funding rise will not please everyone, with respected figures across the health service claiming between 4 and 5 per cent is needed. Additionally, a verdict on this pledge may not be reached until the budget announcement in November, when the precise source of the funding has been revealed: a reduction in personal allowance will entice the Labour opposition to criticise May for punishing the working poor, while any revision to corporation tax cuts will infuriate the right of the Conservative Party and many grassroots activists. 

In the short-medium term, May’s nod to the Leave Vote pledge and significant cash boost for the NHS should ease some of the internal and external pressure on the Prime Minister’s position. She will also be applauded by less-partisan figures in the NHS who will look forward to the most significant funding boost for the best part of a decade.

World Continence week marked across the world

This week marked World Continence Week which saw stakeholders including the PCF and its constituent members getting involved. The Association for Continence Advice (ACA) has published posters to help raise awareness for the occasion. The PCF invited people to visit its website this World Continence Week, promoted by ERIC, and Essity and Coloplast promoted their recent reports relating to paediatric continence issues.

The International Continence Society (ICS) outlined the history of World Continence Week, which started in Cairo in 2008 and its aims to break the “taboo” around continence issues which it estimates results in over 60 per cent of people with continence issues refraining from getting help. The ICS advertised related events including a Toilet Training Including Children with Additional Needs in July and ERIC’s Paediatric Continence Care Conference in October.

The ICS outlines the vision of World Continence Week being:

  • Globally facilitate continence awareness and promotion to improve health, wellness and quality of life.
  • Provide a reputable forum for those seeking information on Continence Promotion and therapies.
  • Create a worldwide network of events and organisations that will be recognised as leading authorities of Continence and Bladder and Bowel Health information.
  • Further establish Continence Awareness and promote a multi-disciplinary approach to treatment.

The World Federation of Incontinence Patients (WFIP) tweeted regularly in the run up to World Continence Week, supported by Medtronic UK and Ireland who have published an infographic on adult continence issues, their prevalence and what can be done to help. How to Potty Train has shared its potty-training expertise for the occasion.

The PCF will continue to engage with World Continence Week and collaborate with stakeholders to raise awareness of paediatric continence among the public and policymakers.

Australia uses toilet humour to tackle continence issues

Australian Health Minister Ken Wyatt, who launched World Continence Week in Australia, has publicly encouraged the one in four Australians who are affected by continence issues to seek help so that they can “laugh without leaking” and “live life to the full.” The Australian Government has provided over 14 million Australian Dollars since 2016 to “ensure all Australians have access to the information and support they ned to get help for continence problems.”

Chief Executive of the Continence Foundation in Australia, Rowan Cockerell, said that only 30 per cent of people with a problem seek help because of the stigma attached to the condition. He highlighted that “even children” are affected by this. Australia which is leading the way in terms of many continence provisions, had over 200 events related to World Continence Week.