24th April 2015

Contents

• King's Fund quarterly report paints bleak outlook for NHS
• SNP manifesto promises to back increase in funding and fight to restore fully public NHS in England
• European Commission outlines possible harmonisation of medical devices regulation under TTIP
• Potential 2016 timetable for EWTD revision
• RCS launches professional guidance on duty of candour
• Special analysis: What happens if there's a hung parliament?

King’s Fund quarterly report paints bleak outlook for NHS

The King’s Fund this week published its latest quarterly monitoring report on the NHS, combining publicly available data on NHS performance measures with the views of NHS finance directors and clinical commissioning group (CCG) leads.

The report again highlights the pressing financial stresses on the NHS, with two-thirds of hospitals and 40% of CCGs saying they are concerned about their ability to stay within budget over the next 12 months. The findings also reveal that fewer than half (45%) of NHS trusts say they feel confident of achieving productivity targets while three-quarters believe there is a very high risk of failing to achieve the efficiency savings outlined in the NHS five year forward view. The report also highlights that 90% of trust financial directors and 85% of commissioners are concerned about the financial state of their local health economies.

The King’s Fund also state that key performance targets are continuing to deteriorate. For example, waiting times for A&E are at their worst level since 2003 with 8.2% of patients waiting longer than four hours in the last quarter of 2014/15. The number of delayed transfers of care is also up by more than 20% over the same period while the proportion of inpatients waiting longer than 18 weeks for treatment, at 13%, is at its highest level since the target was introduced. The report does find however that the number of people waiting longer than 18 weeks is falling, suggesting that the Government’s “managed breach” policy is having some effect.

Meanwhile, a survey of CCGs by the Health Service Journal has found around a third are considering restricting access to services including surgery in order to save money.

SNP manifesto promises to back increase in funding and fight to restore fully public NHS in England

The Scottish Nationalist Party published its election manifesto at the beginning of this week, promising extra funding to drive integrated care and a £2.5m boost for specialist nursing services for the devolved Scottish NHS. The party also announced that it would be deploying an extra £100m in Scotland over 3 years to combat delayed discharges.

With the latest polling suggesting that the party are set to all but oust Labour from Scotland it is looking increasingly likely that the SNP will command the third biggest representation of MPs at Westminster. This could have a significant impact on matters south of the border, with the SNP manifesto promising that the party would fight against any further privatisation of the NHS in England and would back moves to restore it to a fully public service. They also support increasing NHS funding by £9.5bn over inflation by 2020/21 and want to see the NHS fully excluded from the Transatlantic Trade and Investment Partnership (TTIP) negotiations. The manifesto also states the party’s desire to “lock the Tories out of Downing Street” and claims that SNP MPs would support a motion of no confidence against a Tory government.

The RCS has been commenting on the publication of the political manifestos including the SNP’s, and you can read our statements here.

European Commission outlines possible harmonisation of medical devices regulation under TTIP

The Transatlantic Trade and Investment Partnership (TTIP) is a proposed bi-lateral free trade agreement between the European Union and the United States. The proposal aims to improve regulatory coherence, establish common international standards, and generally facilitate international cooperation to drive economic growth on both sides of the Atlantic.

The European Commission recently published a paper outlining a number of “preliminary ideas” on how the deal could be applied to the regulation of medical devices. These ideas included converging the models for marketing submissions. For example, currently a manufacturer seeking marketing authorisation for a medical device would need to submit separate applications to both the EU and US regulators. TTIP however would aim to establish a common application process. The paper also describes how, by establishing a single EU/US identification system, the transatlantic traceability of medical devices already on the market could be significantly enhanced. The Commission also believes that TTIP would bring commonality to the auditing of quality management systems for high risk devices, bringing benefit to manufacturers of high risk devices who currently must have their systems rated separately in the EU and US.

Negotiations for TTIP are currently ongoing, with critics such as the Unite union arguing that the deal may open up the NHS to private American firms.

Potential 2016 timetable for EWTD revision

In a response to a question on the Working Time Directive, the European Commission has stated that the timetable for any proposed new amendments would be at some point in 2016.

The Commission is currently undertaking an impact assessment of the Directive with a view to potentially reviewing its provisions. 

RCS launches professional guidance on duty of candour

The College has this week published guidance on the steps an individual surgeon should take to ensure they are fully compliant with legislation on Duty of Candour, which came into force in 2014 and was amended in April this year.

The document gives guidance on the professional and the statutory duty of candour for surgeons and their employers and provides a step by step handbook to ensure that, where an error has occurred, the situation is dealt with in the most appropriate manner. Also included is an explanation of terms, for example definitions for moderate, severe, and prolonged psychological harm.

You can view the guidance here.

Special analysis: What happens if there’s a hung parliament?

Based on current projections it looks unlikely that any party will win the General Election with an outright majority. In this case, as with the 2010 General Election, the outcome will be a hung Parliament. In 2010 the Conservatives formed a formal coalition with the Liberal Democrats in order to secure a majority. A majority is crucial in order for the government to be able to pass legislation.

What happens in a hung Parliament?

This situation is complicated as the UK has no written constitution.

If no party has an overall majority after the election, the incumbent Prime Minister is entitled to remain in place until a new government is formed. Ministers who lose their seats at the election can also remain as ministers. The incumbent Government therefore have the first opportunity to attempt to form a government. In the event of the Prime Minister feeling that they are unable to govern under a supportive majority then they will resign and the leader of the largest opposition party will be invited to form a new government, either as a minority or in coalition with another party or parties. In 2010, the incumbent Prime Minister Gordon Brown resigned within a few days of the election when it became clear that Labour could not govern and that the Conservatives and Liberal Democrats could form a coalition.

If the party in power believe they can form a government they will have the first opportunity to do so by seeking approval for their programme in the Queen’s Speech debate.

In the event of a hung parliament, where the incumbent executive cannot rely on such a majority, the government may choose to govern with a minority of MPs or, alternatively, they can negotiate support from other parties under a coalition agreement. In the case of a minority government, the governing party would need to rely on support on a case-by-case basis. A minority government operated as recently as February 1997 when John Major’s majority was minus one.

It is also important to note that the largest party at an election does not always form a government. For example, in 1924 only the second largest party was able to form a government.

Forming a new government can take days, weeks or longer. In Belgium, political parties were unable to form a new government for 535 days until 2011.

How does the Fixed Term Parliament Act affect things?

One of the reforms of the last parliament was to introduce the Fixed Term Parliament Act, which set the date of parliament at 5 years and prohibited a government from calling a snap election when the conditions were more favourable for them. The Fixed Term Parliament Act allows for the early dissolution of Parliament, and therefore an early election, if 2 circumstances are met: if two-thirds of the House vote for a motion of no confidence and if that motion is passed and no alternative government is confirmed within 14 days. This would mean, for example, that under a coalition government that has disintegrated and is no longer functioning then there would only be an election following a successful vote of no confidence. The largest opposition would then have 2 weeks to form a government or there would be a General Election.