The Urology Trade Association (UTA) has this week called on ministers to reconsider a decision not to review implementation of NHS England’s continence guidance, after a parliamentary question tabled on behalf of the PCF in December revealed that the Department of Health has not audited the effect of the NHS’s Excellence in Continence Care guidance. The UTA, which represents the manufacturers of urological devices, cited a fall in the number of referrals to specialist urology services as evidence that patients could be seeing non-specialist district and practice staff, rather than specialist urology services.
Elsewhere, NHS Improvement has published provider sector figures indicating that NHS trusts have accrued a deficit of £886 million for the first nine months of 2016/17. The regulator predicts that this could be reduced to between £750 million and £850 million by the end of the financial year. The provider sector had aimed to keep its deficit below £580 million following a £2.45 billion deficit last year, but the chief executive of NHS Providers, Chris Hopson, criticised the “wafer-thin” margin of error which this was predicated on.
Finally, the Department for Communities and Local Government (DCLG) has published the final local government finance settlement, confirming that that the Government will not provide any new funding for councils in 2017/18. The Local Government Association responded that councils, the NHS and care providers are in desperate need of new government funding for social care. It said that by “continuing to ignore these warnings, social care remains in crisis and councils and the NHS continue to be pushed to the financial brink.”
Trade association calls on Government to review implementation of NHS continence guidance
The Urology Trade Association (UTA), which represents the manufacturers of urological devices, has called on ministers to review the implementation of NHS England’s Excellence in Continence Care guidance, after a question tabled on behalf of the PCF last year revealed the Government has failed to assess the implementation of the guidance. Conservative MP Sir David Amess asked the Department of Health whether it had held discussions with NHS England on auditing the effect of the guidance on paediatric continence services. Health Minister David Mowat responded that “The department has had no formal discussions with NHS England on auditing the effect of its guidance Excellence in Continence Care on the quality of paediatric continence services.”
The UTA cited responses to Freedom of Information (FOI) requests from 113 acute NHS trusts in England to warn that patients could be struggling to access specialist urology support. The number of referrals to specialist urology services increased by eight per cent between the period 2013/14 and 2015/16. However, the figures also revealed a fall in referrals between 2013/14 and 2015/16. The UTA warned that this could mean patients are being seen by district and practice staff lacking specialist training, rather than specialist urology services.
Responding to the figures obtained by the UTA, Patricia McDermott, chair of the Association of Continence Advice and a consultant clinical nurse specialist in urology in Guernsey, said that “continence care requires a higher priority than it currently receives.” She said that poor continence care is both distressing for individuals and costly for the NHS, adding that “effective community-based continence services can save valuable NHS resources whilst restoring dignity to people and improving quality of life.”
House of Lords debates nursing workforce
The House of Lords debated the nursing workforce this week, after Labour Peer Lord Clark of Windermere asked what plans the Government have to eradicate the shortage of trained nurses in the NHS and care sector.
Citing reports that the NHS is short of 24,000 nurses and that nursing applications have undergone a 23% reduction, Lord Clark urged the Government to reinstate the bursary scheme at university for nurses, or at least promise nurses who qualify and spend several years working in the health service that they will have their tuition fees reimbursed. In response, Health Minister Lord O’Shaughnessy claimed that there are 6,500 more full-time equivalent nurses and health visitors than there were in 2010, and that there has been a 15% increase in the number of training places offered. He also said that the new nursing apprenticeship route could allow up to 1,000 additional nurses to join the NHS each year.
When Labour Peer Baroness Pitkeathley asked what progress is being made with training nurses who can work across health and community services, Lord O’Shaughnessy responded that the number of nurses with general qualifications who are capable of working across multiple specialties and different sectors has risen. He also denied that there has been a drop-off in the number of EU nationals joining the NHS workforce since the referendum, but said it was “clearly sensible” to reduce the UK’s reliance on overseas nurses each year. He said that the Government is working to do this through additional training places and through retention and return to work schemes.
NHS loses 6 per cent of school nurses in a year
The number of school nurses working in the NHS in England has dropped by 6% in a year, according to NHS workforce statistics. The number of school nurses dropped from 2,725 in October 2015 to 2,561 in October 2016. The data also reveals an 8.7% drop in the number of whole-time equivalent health visitors working in the NHS, which fell from 10,309 in October 2015 to 9,410 twelve months later.
Commenting on the figures, health publication Nursing Times pointed out that the decline in staffing levels took place in the twelve months after the commissioning of public health services fully transferred over to local authorities, in October 2015. It said the data confirms fears that ongoing cuts to council public health budgets are leading to a significant reduction in nurses working in children’s services.
Dr Cheryll Adams, Executive Director of the Institute of Health Visiting, warned that further reductions to the NHS health visiting workforce could lead to the same unsustainable staffing levels seen in the mid-2000s. She said that when the Government cut health visiting in 2005, many health visitors went off sick or looked for other jobs due to what they felt were large and unsafe caseloads. She said that this “will be starting to happen again when cuts are planned.”
King’s Fund calls for STPs to be developed into “credible plans”
The Sustainability and Transformation Plans (STPs) need to be strengthened and developed into “credible plans”, according to a report published this week by The King’s Fund. The STPs are the main vehicle for transforming health and care services in England in line with the NHS Five Year Forward View, but have attracted significant criticism due to a lack of funding, limited public consultation, and controversial decisions such as hospital closures or downgrades.
The King’s Fund defended the STPs, stating that they “offer the best hope for the NHS and its partners to sustain services and transform the delivery of health and care”. However, while the think-tank recognised that the 44 STPs submitted in October are wide-reaching – proposing changes in areas from prevention through to acute and specialised services – it said these must now be developed into coherent plans, with clarity about each STP footprint’s top priorities.
The report outlined several recommendations, including that:
- The NHS should improve engagement with staff, patients, local authorities and the third sector in discussing the proposals.
- The governance and leadership of STPs needs to be strengthened and more realistic timescales adopted for implementation.
- National bodies should work together to support the NHS and local authorities to implement the plans and send out consistent messages on what they now expect.
- Proposals to transform services provided in the community should be a high priority, and new care models being developed by vanguards need to be supported and spread to other areas.
- The Government should recognise the need for additional resources for the NHS and social care if the STPs are to deliver the proposed transformations in care, given the financial and operational pressures the NHS now faces.
- Changes to the law are needed to amend aspects of the Health and Social Care Act 2012 that are not aligned with the Five Year Forward View, particularly in relation to market regulation.
Commenting on the report, Royal College of Nursing Chief Executive Janet Davies expressed support for the ambitions of the STPs – preventing ill health, joining up services and delivering care closer to home – but said that a lack of “proper resourcing” risked undermining these aims. She said that the RCN have “ongoing concerns about the way STPs have been developed so far, behind closed doors”, adding that the involvement of nurses and other health and care staff in the STPs will be vital to their success.