Health and Social Care update

Legal intelligence for professionals in health and social care

Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

Care	Mental Health
Clinical Risk/Health and Safety	Primary Care
Commissioning	Procurement
Employment/HR	Public Health
Finance	Regulation
Foundation Trusts	General
Information sharing

Care

Publications/Guidance
Transforming urgent and emergency care services in England: Urgent and Emergency Care Review – End of Phase 1 Report. Sir Bruce Keogh has published a report on the first stage of his review of urgent and emergency care in England, in which he proposes a fundamental shift in provision of urgent care, with more extensive services outside hospital and patients with more serious or life threatening conditions receiving treatment in centres with the best clinical teams, expertise and equipment. His report proposes a new blueprint for local services across the country that aims to make care more responsive and personal for patients, as well as deliver even better clinical outcomes and enhanced safety.

Winterbourne Review: transforming care one year on. This report summarises the changes to improve the quality of care for vulnerable people - specifically, for people with learning disabilities or autism who also have mental health conditions or behavioural problems.

Transitions to palliative care for older people in acute hospitals: a mixed-methods study. This study finds that patients with palliative care needs represent a significant proportion of the hospital inpatient population and that there is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.

Hard truths--The journey to putting patients first. Patients will have a greater say in their treatment at NHS hospitals so care can be improved, according to a report drafted by the Department of Health. The report, which has written in response to the inquiry on the Mid Staffordshire NHS Trust, seeks to improve the transparency and training standards of NHS professionals in order to provide a higher standard of patient care.

If you wish to discuss any queries you may have around care please contact Stuart Marchant.

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Clinical Risk/Health and Safety

Publications/Guidance
Maternity services survey 2013. This CQC survey looks at the experiences of people receiving maternity services. The focus of this report is the collation and interpretation of some of the basic numbers that tell the story of the state of maternity services. It looks at the rising birth rate in England and also the complexity of the midwifery workload due to factors such as the continuing growth of births to older women. See also the RCOG statement on CQC survey on Maternity Services.

Midwifery supervision and regulation: recommendations for change. This report follows the completion of three investigations into complaints from three families, all of which related to local midwifery supervision and regulation. It finds that the midwifery supervision and regulatory arrangements at the local level failed to identify poor midwifery practice at Morecambe Bay NHS Foundation Trust. It concludes that the current arrangements do not always allow information about poor care to be escalated effectively into hospital clinical governance or the regulatory system.

Never Events data. NHS England has published more detailed data than ever before about “never events” – the serious errors in care that put patients at risk of harm and that should not happen if full preventative procedures are in place. For the first time, provisional quarterly data on the number of never events happening at each hospital trust in England will be published, for patients, healthcare professionals, managers, stakeholders and the public to see and understand. Until now, data has been published only annually, and only at national, aggregated level. The data is available on the NHS England website, and will be updated in three months’ time. From April 2014, the data will be updated every month.

Meeting needs and reducing distress: Guidance for the prevention and management of clinically related challenging behaviour in NHS settings. Guidance from NHS Protect on how to prevent and manage challenging behaviour related to a patient's clinical condition, for the use of clinical and non-clinical NHS staff and managers. The guidance helps staff prevent and manage clinically related challenging behaviour by minimising a patient's distress, meeting their needs and delivering high quality personalised care, in an environment that is safe for staff, patients and visitors. It underscores the importance of staff employing good communication skills and being compassionate to build trust with patients and service users and better understand what leads to distress. This will ensure that appropriate care can be designed to prevent challenging behaviour.

Doctor Foster Hospital Guide 2013. Dr Foster has published a report looking at four areas:-
How austerity is affecting hospitals,
The impact of drug and alcohol problems on patients and hospitals
The quality of care at weekends
Measuring hospital mortality

NHS whistleblowing procedures in England. This note sets out the current rights and procedures for NHS staff to raise concerns about safety, malpractice or wrongdoing at work, and guidance on where wider disclosure of concerns may be appropriate, including raising concerns with the Care Quality Commission.

Managing the flow: a review of the care received by patients who were diagnosed with an aneurysmal subarachnoid haemorrhage. This report highlights the process of care for patients who are admitted with with aneurysmal subarachnoid haemorrhage, looking both at patients that underwent an interventional procedure and those managed conservatively. It takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and the organisational care of these patients.

Polypharmacy and medicines optimisation: making it safe and sound. Polypharmacy – the concurrent use of multiple medications by one individual – is an increasingly common phenomenon that demands attention at clinical policy and practice level. Driven by the growth of an ageing population and the rising prevalence of multi-morbidity, polypharmacy has previously been considered something to avoid. It is now recognised as having both positive and negative potential, depending on how medicines and care are managed. This report offers the terms ‘appropriate’ and ‘problematic’ polypharmacy to help define when polypharmacy can be beneficial. It traces the occurrence of polypharmacy in primary and secondary care, and in care homes. It also explores systems for managing polypharmacy and considers it in the context of multi-morbidity and older people, offering recommendations for improving care in both cases.

Smoking cessation - acute, maternity and mental health services: guidance. This guidance aims to support smoking cessation, temporary abstinence from smoking and smoke-free policies in all secondary care settings.

The NHS atlas of variation in diagnostic services. This publication features 69 different maps of England and identifies local variations for a wide range of diagnostic services covering imaging, endoscopy, physiological diagnostics, pathology, and genetics. It shows that patients in certain areas are hundreds of times less likely to be offered some tests than in other parts of the country.

Consultations
Patient safety and quality of care - Actions at EU level. In order to assist the European Commission's reflection on future EU action on patient safety and quality of care, views are sought on the provisions and implementation of the 2009 EU Recommendation on patient safety. In particular comments are sought on whether the Recommendation is contributing to patient safety and what further should be done at EU level to improve it. The consultation will close on 28 February 2014.

Procedures for the approval of independent sector places for the termination of pregnancy. The Department of Health is seeking views on proposed updates to the procedures independent sector places must follow in order to be approved to carry out abortions. The updated procedures are designed to ensure independent sector places comply with all legal requirements and provide the best quality of care for patients. Those wishing to comment on the proposed updates should do so by 3 February 2014.

The draft NICE quality standard for Infection control consultation period ended Tuesday 17 December 2013. The relevant documents are available here.

News
NHS England promises new and far reaching drive to improve patient safety. NHS England has highlighted the significant work it is leading to improve the safety of patients as part of a co-ordinated response to the Francis Report.

MMR vaccine families sue over 'lawyer negligence'. The Times, 23 November 2013, reports that families involved in a class action over the safety of the MMR vaccine are lodging claims of negligence against the solicitors that handled the case. The action was dropped in 2003 after it emerged that research into the vaccine was flawed and concerns raised by a doctor, Andrew Wakefield, were groundless. Firms involved include Freeth Cartwright, Hodge Jones &Allen and Irwin Mitchell. All strongly deny the claims.

Poll: no increase in use of single joint experts post-Jackson. Only 14 per cent of experts surveyed by Bond Solon said that the number of instructions to act as a single joint expert had gone up, while 21 per cent said it had reduced. The survey indicates that there is little sign of the Jackson reforms achieving an increase in single joint experts being instructed. Two thirds of the respondents said that the Jackson reforms would not increase access to justice.

NHS staff found guilty of patient neglect could face up to five years in jail under plans announced by Health Secretary, Jeremy Hunt. A new offence of 'wilful neglect or mistreatment' will be created for doctors, nurses and NHS managers in cases where standards of care fall short in the most extreme cases. 

PIP implant scandal: German firm ordered to pay damages. A French court has ordered a German company to pay compensation to hundreds of women who were fitted with defective breast implants.

Bevan Brittan Events
Clinical Risk Claims and Complaints Forum 06 February 2014 : Timings TBC. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. This regular seminar addresses a variety of clinical risk and complaints related issues. Further information about the exact topics that will be discussed in this session will be provided closer to the date of the seminar.

If you wish to discuss any clinical risk or health and safety issues please contact Joanna Lloyd or Stuart Marchant .

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Commissioning

Publications/Guidance
Community pharmacy – helping with winter pressures. NHS England has published suggestions on how local commissioners (CCGs and NHS England Area Teams) can make better use of community pharmacy services to support healthcare provision during the winter months. The accompanying appendix has detailed proposals for three services (flu vaccination, emergency supplies of medicines and provision of self-care support for winter ailments) that commissioners could consider locally.

Clinical commissioning and direct commissioning assurance. These frameworks set out how NHS England will assure that CCGs' and NHS England’s own direct commissioning functions – which include primary care, specialised services, health screening and immunisation services, services for members of the armed forces and health and justice services – are operating effectively to commission safe, high quality and sustainable services within their resources. Both assurance processes will be carried out through quarterly discussions based on six identical domains, which enable a broad assessment of delivery, capability and organisational health. The domains focus on whether patients are actively engaged, are receiving clinically commissioned, high quality care, whether CCGs are working collaboratively, delivering better outcomes for patients and whether they have robust leadership and governance in place.

Interim commissioning policies for non-specialised services. NHS England has published 37 nationally consistent commissioning policies as part of its role as a direct commissioner for some non-specialised services. The policies, which are interim at this stage, are of particular benefit to the armed forces and health and justice populations as members of these communities, particularly serving armed forces personnel and their families, are subject to changes in location which may disrupt the provision of their healthcare. They have been selected from a much longer list of policies, as being those of most relevance to these communities, and are based on existing policies used by the former PCTs and the newly formed CCGs. All of the policies will be subject to further review by NHS England’s Clinical Reference Groups, and will be subject to full public consultation next year.

Make, share or buy commissioning support services – a tool kit for CCGs. NHS England has responded to CCGs' request for support in the decision making process around whether to make, Share or Buy their commissioning support services with a Make, Share, Buy toolkit to enable CCGs to make informed decisions around what and from whom they access Commissioning Support. Through this it aims to support CCGs in securing high calibre services that represent the best value for money. Use of the toolkit is entirely voluntary however where CCGs wish to make changes to their commissioning support arrangements it is critical that the rationale behind these decisions is properly documented. The toolkit will enable CCGs to make the ‘right’ decisions, whilst enabling them to clearly demonstrate that the impact on the local health economy has been taken into account.

Role of the voluntary sector in providing commissioning support. This report from the Nuffield Trust looks at what role the voluntary sector can play in providing commissioning support to commissioners and commissioning support units, and what the challenges are. It explores: what support CCGs and CSUs want and need from the voluntary sector and what the ‘value-add’ is; what commissioning support services the voluntary sector can offer; how a partnership between the voluntary sector and commissioners can uniquely help to resolve challenging scenarios commissioners encounter; and the necessary steps to ensure strong collaboration between commissioners, commissioning partners and the voluntary sector.

Assurance frameworks for CCGs and direct commissioners. These frameworks set out how NHS England will assure that CCGs and NHS England’s own direct commissioning functions – which include primary care, specialised services, health screening and immunisation services, services for members of the armed forces and health and justice services – are operating effectively to commission safe, high quality and sustainable services within their resources.

Briefing for commissioners on the NHS provider licence. All providers of health care services for the NHS including independent providers, will require a Monitor licence from 1 April 2014, unless they are exempt. This document outlines the action commissioners now need to take to be ready for 1 April 2014. 

Consultations
Framework of excellence in clinical commissioning. NHS England is seeking feedback on its draft Framework of Excellence that aims to set out what excellent practice looks like in CCG clinical commissioning. It has been developed in collaboration with CCGs with nearly 90% of CCGs taking the opportunity to review and contribute to its development. The closing date for comments is 31 January 2014.

Bevan Brittan Updates
Integration Transformation Fund (ITF) for CCGs. As CCGs will be aware from the letter from NHS England and the Local Government Association about the Integration Transformation Fund (ITF) this is now a matter needing prompt action to get the initial building blocks in place to support the preliminary year arrangements for 2014/15. The letter makes it clear that NHS England is expecting local agreements on a five year strategy and a two year operational plan in order to implement the fund at a local level.

Bevan Brittan Events
Mergers, Acquisitions and Service Change in the NHS: Competition Law Aspects. 27 February 2014 : 10:00-12:30 (registration opens at 09:30) The seminar will be followed by lunch. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct,London, EC4M 7RF. Bevan Brittan together with Oxera have joined their professional expertise in order to deliver the ' Mergers, Acquisitions and Service Change in the NHS: Competition Law Aspects' seminar. The seminar aims to examine the legal and commercial issues involved in mergers, acquisitions and service change in the NHS, and the lessons that can be learnt from recent successful and unsuccessful mergers, including the case of the Royal Bournemouth and Christchurch Hospitals and Poole Hospitals Trust.

Social impact bonds. 07 May 2014 : Timings TBC. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. This seminar will provide an overview of the key legal issues associated with social investment projects, including social impact bonds (SIBs), for commissioners and providers including the alternative legal structures, use of corporate vehicles, investor issues and the payment by outcomes contract.

If you wish to discuss the issue of commissioning please contact David Owens.

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Employment/HR

Publications/Guidance
NHS whistleblowing procedures in England. This note sets out the current rights and procedures for NHS staff to raise concerns about safety, malpractice or wrongdoing at work, and guidance on where wider disclosure of concerns may be appropriate, including raising concerns with the Care Quality Commission.

GMC welcomes new rules on the movement of doctors across Europe. According to the General Medical Council (GMC), new rules agreed by EU ministers on the movement of health professionals across Europe are a major improvement in patient safety. The GMC will be able to check a doctor's language skills before allowing them to practice in the UK, and a new alert system will be introduced, requiring health regulators across Europe to warn each other when a doctor or other health professional has been removed from its register, or has had his or her practice restricted.

Seven day consultant present care: implementation considerations. This report argues that most patients in hospital over a bank holiday or a weekend would benefit from a daily review of their care led by a consultant. It also argues that for seven day care proposals to succeed, strong links between hospitals and community care need to be in place, particularly for frail, elderly and vulnerable patients.

NHS culture. These discussion papers are part of a series which will be examining the reasons why a negative culture has developed in parts of the NHS and how it can be turned around. The first two papers look at professionalism and supporting doctors in raising concerns.

Medical revalidation at Public Health England. Prof Anthony Kessel, Responsible Officer, and Dr Imogen Stephens, deputy Responsible Officer, give a brief overview of the revalidation process.

A guide to support providers and commissioners in making the right decisions about nursing, midwifery and care staffing capacity and capability. The National Quality Board, sponsored by Jane Cummings, Chief Nursing Officer in England, has published new guidance to support providers and commissioners to make the right decisions about nursing, midwifery and care staffing capacity and capability.

Updated guidelines on the prevention and management of sickness absence. These updated guidelines outline the key principles that NHS organisations should follow to prevent and manage sickness absence.

Consultations
Amendments to NHS pension scheme regulations. This consultation seeks views on amendments to extend scheme access to independent providers of NHS clinical services, and increase member contribution rates. The consultation will close on 10th February 2014.

Bevan Brittan Updates
TUPE and SPCs exception. An important exception from the TUPE Regulations applies to short term contracts but we have, until recently, had very little guidance on how this should be applied. Victoria McMeel looks at a case which sheds some light on this issue and outlines how the exception now works in practice.

Reasonable adjustments - Q&A Bevan Brittan's employment team regularly advises on a range of issues relating to equalities, and we have been dealing with several cases recently in respect of the duty to make reasonable adjustments for disabled employees. James Gutteridge answers some of the tricky and common questions which arise in relation to this thorny issue.

Employment news round-up. Julian Hoskins provides a summary of the key workforce aspects of the government's response to the Francis Inquiry, and also sets out the latest employment law news stories for this month, including: new Acas guidance on redundancies, new guidance on preventing illegal working, the latest on the game-changing 'Woolworths' redundancy case and an update on two Judicial Review applications: on employment tribunal fees and the new 12 months' earnings limit on unfair dismissal awards.

If you wish to discuss any employment issues or any of the items raised in this sectin please contact Julian Hoskins or James Gutteridge.

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Finance

Publications/Guidance
Transforming healthcare: the role for the finance teamThis briefing looks at how NHS finance practitioners can contribute to the transformation agenda.

Direct payments and personal budgets for social care. This note gives a brief overview of the rules governing the provision and use of direct payments for social care and provides information on the development of personal budgets for care.

Guidance on the consolidation of NHS charities. This draft guidance for comment aims to assist NHS organisations as they work through whether their NHS charities would need to be consolidated under IAS 27 and the steps which need to be taken to prepare consolidated accounts.

Energy and water bills in the NHS. This research note analyses water and energy costs for NHS trusts in England and highlights where money could potentially be saved.

What Personal Independence Payment means for the health sector. This updated publication contains guidance on the timetable, process and the impact that PIP will have on people working in the health sector and their role in supporting disabled people. It includes what they will need to do to help support a PIP claim.

The cost of our health: the role of charging in healthcare. This report examines the funding of health and care and the role of user charging in healthcare. It argues that new charges could raise nearly £3 billion per year to fund NHS services.

If you require further information about any of the items raised in this section please contact David Owens.

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Foundation Trusts

Publications/Guidance
Performance of the foundation trust sector - six months ended 30 September 2013. This quarterly report finds that NHS foundation trusts are generally delivering the quality of services patients expect, despite the challenges of a tough economic climate. It also shows the sector’s A&E performance improved over the summer period and the number of target breaches was more in line with historical levels.

NHS Foundation Trust Annual Reporting Manual 2013/14.The NHS Foundation Trust Annual Reporting Manual 2013/2014 provides guidance to foundation trusts on producing their annual reports and accounts. 

Review by Monitor of the provision of walk-in centre services in England.This is their preliminary report into the provision of walk-in centre servcies in England.

Monitor update: December 2013

Bevan Brittan Events
Mergers, Acquisitions and Service Change in the NHS: Competition Law Aspects. 27 February 2014 : 10:00-12:30 (registration opens at 09:30) The seminar will be followed by lunch. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct,London, EC4M 7RF. Bevan Brittan together with Oxera have joined their professional expertise in order to deliver the ' Mergers, Acquisitions and Service Change in the NHS: Competition Law Aspects' seminar. The seminar aims to examine the legal and commercial issues involved in mergers, acquisitions and service change in the NHS, and the lessons that can be learnt from recent successful and unsuccessful mergers, including the case of the Royal Bournemouth and Christchurch Hospitals and Poole Hospitals Trust.

If you wish to discuss any issues relating to foundation trusts please contact Vincent Buscemi.

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Information Sharing

Publications/guidance
Temporary workers still require adequate data protection training. Employers have been warned by the Information Commissioner's Office (ICO) to train temporary workers in data protection procedures. The warning has been issued after data breaches were committed by temporary workers at the Great Ormond Street Hospital for Children NHS Trust Foundation. As a result, the ICO has stressed to employers that employing temporary workers does not absolve their data protection duties.

News
GP surgery manager prosecuted for illegally accessing patients’ medical records. Maidstone Magistrates' Court has fined a former manager who oversaw the finances of a GP’s practice in Maidstone a total of £996 for unlawfully accessing the medical records of approximately 1,940 patients registered with the surgery. Steven Tennison accessed patients’ records on 2,023 occasions over 14 months. The offences were uncovered in October 2010 when the Practice Manager at the GP surgery was asked to review Tennison’s attendance file including a review of Tennison’s use of the patient records program. The majority of the records viewed related to women in their 20s and 30s. The practice confirmed that Tennison only needed to access patients’ records on three occasions during this period. Tennison pleaded guilty to charges of unlawfully obtaining personal data under s.55 of the Data Protection Act 1998 and was fined a total of £996 and ordered to pay a £99 victim surcharge and £250 prosecution costs.

If you wish to discuss the issue of information sharing generally please contact Jane Bennett.

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Mental Health

Bevan Brittan Mental Health Extranet. - This is a free resource for Bevan Brittan NHS clients. Bevan Brittan has a wealth of mental health knowledge it would like to share with NHS clients. We have therefore developed an online searchable extranet designed to bring various sources of mental health information and guidance into one place.

If you would like information about how to access the Bevan Brittan Mental Health Extranet please email Claire Bentley.

Current topics being discussed are:-
 Court of Protection - serious medical treatment
 X v Finland
 Discussion of case M.H. v. The United Kingdom

Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.

Publications/Guidance
Winterbourne Review: transforming care one year on. This report summarises the changes to improve the quality of care for vulnerable people - specifically, for people with learning disabilities or autism who also have mental health conditions or behavioural problems.

Mental health and community services. This briefing explores the opportunities and good practice currently developing in 'combined’ or ‘integrated’ trusts, as well as the challenges. It considers whether this growing trend is good for mental health and community services and what the consequences might be.

Mental wellbeing of older people in care homes. This care standard was created to help care homes tackle loneliness, depression and low self-esteem in older people by configuring services to ensure that the right care and support is given. It also addresses a problem that sometimes exists in older people gaining access to NHS services. It recommends that older people have the symptoms and signs of mental health conditions and physical problems recognised and recorded as part of their care plan, and that they have access to the full range of healthcare services when they need them

MiNDbank. This database presents a range of information about mental health, substance abuse, disability, human rights and the different policies, strategies, laws and service standards being implemented in different countries. Users can review policies, laws and strategies and search for best practices and success stories in the field of mental health.

Mental health dashboard. The first annual mental health dashboard gathers the best information available to show progress against the objectives set out in the ‘No health without mental health’ strategy. The dashboard provides a clear, concise picture of mental health outcomes. It includes information on: mental health services, the physical wellbeing of people with mental health problems, experiences of stigma and discrimination. The dashboard is for reference and use by anyone working in the care and support system.

Dementia: A state of the nation report on dementia care and support in England. This report sets out what is known about dementia care, support and research. It highlights where improvements are being made and where progress can be seen – it also shows where improvements are needed, including where better data is necessary. The report supports an interactive map where people can see data about dementia care in their area and across the country.

Meeting needs and reducing distress. Guidance on the prevention and management of clinically related challenging behaviour in NHS settings. This guidance is for the use of clinical and non-clinical NHS staff and managers and may also be of interest to patients and service users, carers and families. It aims to help staff prevent and manage clinically related challenging behaviour by minimising a patient’s distress, meeting their needs and delivering high quality personalised care, in an environment that is safe for staff, patients and visitors.

Overlooked and forgotten. This review looks at how well children and young people's mental health is prioritised in the current commissioning landscape and offers support and recommendations to health and wellbeing boards on how they can prioritise and address children and young people’s mental health.

Welfare advice for people who use mental health services: developing the business case. This report calls for every mental health service to secure specialist welfare advice to help to support recovery and to intervene early when difficulties emerge. It recommends that health and social care commissioners should ensure that their plans include welfare advice provision and that the government should consider including welfare advice in its outcomes frameworks for the NHS, social care and public health.

A place for parity: health and wellbeing boards and mental health. This report is the result of a study which reviewed 100 strategies and found that nine did not include mental health in their priorities at all. It looks at how much focus the boards have given to mental health in their strategies, which areas of mental health they focus on and what factors helped or hindered the agenda of mental health during the development of the strategies.

A fresh start for the regulation and inspection of mental health services. A new approach to inspecting specialist mental health services with a greater emphasis on inspecting care which people with mental health problems receive in the community has been set out in a report by the Care Quality Commission (CQC). The new approach includes plans to implement new ways of engaging with people who use community mental health services, their families and carers, during inspections and also at other times.

Deprivation of Liberty Safeguards: putting them into practice. This resource describes good practice in the management and implementation of the Deprivation of Liberty Safeguards (DoLS; the Safeguards). It includes the roles of clinical commissioning groups (CCGs) and wider local authority governance.

Hazards with the use of court-approved Deprivation of Liberty Safeguards (DoLS) and legal aid. This paper has been prepared for the information of legal practitioners by the Law Society's Mental Health and Disability Committee. It sets out concerns as to the impact of the Civil Legal Aid (Financial Resources and Payment for Services) Regulations 2013 on the entitlement to non-means tested legal aid in DoLs cases where there is court challenge to a DoLS authorisation.

Learning disabilities good practice project report. The report gives people who commission, design and deliver services a better understanding of how to improve the lives of people with learning disabilities.

We still need to talk: a report on access to talking therapies. This report finds that 12% of people with mental health problems are stuck on waiting lists for over a year before receiving talking treatments and 54% wait over three months. The survey of over 1,600 people who have tried to access talking therapies such as counselling and cognitive behaviour therapy on the NHS in England over the last two years also shows how some people are paying for private therapy to get the help they desperately need. One in ten said that they had faced costs for private treatment because the therapy they needed was not available on the NHS.

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England. Findings from a major programme of research in support of the National Suicide Prevention Strategy have been published by the National Institute for Health Research (NIHR). Researchers at Manchester, Oxford and Bristol aimed to examine outcomes in relation to current models of service provision, develop new interventions for suicidal behaviour, examine the impact of public health and prescribing interventions on suicidal behaviour, and give an insight into how we might best interpret recent trends in suicide.

Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. A study led by Dr Jayne Cooper reported that hospital management of patients who self-harm has barely changed in the past 10 years despite the introduction of clinical guidelines. The investigation of 32 hospitals in England found that only 58% of people received a psychosocial assessment following self-harm, varying from 22-88% between hospitals.

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Patient suicide: the impact of service changes. This report argues that mental health service providers looking after patients at risk of suicide need to reduce absconding on in-patient wards and boost specialist community services like crisis resolution to reduce deaths.

Statements and reports in mental health cases. New practice direction came into effect on 28 October 2013.

News
NHS England rolls out new personal health budget sites. Seven new sites have been set up to look at rolling out personal health budgets to people who use mental health services.

CQC launches national review of dementia care. The Care Quality Commission (CQC) is investigating the care of dementia sufferers at 150 care homes and hospitals across the country. The aim of the review is to analyse care offered to people suffering with dementia so it can identify areas of future improvement.

If you wish to discuss any of the items raised in the above section please contact Simon Lindsay or Stuart Marchant.

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Primary Care

Publications/Guidance
A fresh start for the regulation and inspection of GP practices and GP out-of-hours services. This report sets out a new approach to inspecting and regulating all GPs and out-of-hours services, due to start in April 2014.

GMS contract changes 2014/15. PCC has developed a short summary on the changes to the GP contract for 2014/15. Major changes to the GP contract from next April include cuts to QOF payments, new incentives for reducing emergency admissions, named GPs for the over 75s and removal of practice boundaries.

General practice contract changes 2014-2015. The BMA GPs committee has produced a series of FAQs to help GPs looking for further detail about the changes that were announced last week in England. The guide seeks to answer GPs’ questions about issues such as seniority payments, the publication of earnings and a named GP for patients over the age of 75, along with other details.

News
Patient care compromised as funding for general practice slumps across the UK. New figures published by the Royal College of General Practitioners (RCGP) and the National Association for Patient Participation (NAAP) show funding for general practice has slumped across Great Britain over the last nine years to the lowest percentage on record. In 2004-2005, 10.33% of the British NHS budget was spent on general practice. By 2011-2012, this figure had declined by almost two percentage points to 8.4% - even lower than previously thought. When Northern Ireland is factored in, the percentage share of the NHS budget spent on general practice across the UK has fallen as low as 8.39%. GPs say the slump in funding is compromising the standard of care they can offer patients, leading to longer waiting times, and increasing pressure on hospitals.

If you wish to discuss any queries you may have around primary care please contact David Owens.

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Procurement

Publications/Guidance
Policy and guidance to help the NHS achieve excellence, value for money, and improvement in procurement. These publications and resources support the ‘Better Procurement, Better Value, Better Care Procurement Development Programme for the NHS’ and general NHS procurement. The programme aims to help the NHS save £1.5bn by 2015 to 2016.

The power of partnership: how to seize the potential - a practical guide to forming and maintaining cross-sector partnerships in healthcare. This report explores the case for partnership working, helps define partnership and highlights the things to consider when navigating the procurement process. It looks at three phases of the partnership process: getting started, procurement and delivery.

Bevan Brittan Events
The Integration Transformation Fund opportunity: planning and delivering integrated health and social care (London). 08 January 2014 : 10:00am - 12:45pm (registration from 09:30am) Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. This conference will consider the issues raised by procuring clinical services on an outcome basis. This will include CCG decision making and consultation issues, the options for the procurement process, contractual aspects and transitional issues.

The Integration Transformation Funding opportunity: planning and delivering integrated health and social care (Birmingham). 14 January 2014 : 10:00am - 12:45pm (registration from 09:30) Location: Bevan Brittan, Interchange Place, Edmund Street, Birmingham, B3 2TA. This conference will consider the issues raised by procuring clinical services on an outcome basis. This will include CCG decision making and consultation issues, the options for the procurement process, contractual aspects and transitional issues.

If you wish to discuss any queries you may have around procurement please contact Matthew Mo.

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Public Health

Publications/Guidance
NHS winter planning. A collection of information and plans for winter, including announcements about A&E winter pressure, the cold weather plan and flu immunisation.

Improving the public's health: a resource for local authorities. This report brings together a wide range of evidence-based interventions about 'what works' in improving public health and reducing health inequalities. It presents the business case for different interventions and signposts the reader to further resources and case studies.

Healthy dialogues: embedding public health in local governmentThis research finds that councillors are preparing to transform the way public health services are delivered, but many of them are likely to be frustrated by inflexible ring-fenced budgets and locked-in contracts with the private sector. It also found that the wider determinants of public health and increasingly being considered as priorities for public health but this is not reflected in spending decisions.

Public health commissioning in the NHS 2014 to 2015. This agreement sets out outcomes to be achieved and funding provided for NHS England to commission public health services.

Consultations
Topics for new NICE quality standards and guidance to improve the quality of public health. In order to develop the longer term public health quality standards work programme, NICE wants to hear from stakeholders to help decide on potential further topics for quality standard development to help improve the quality of public health. Where there are no existing relevant guidelines, this topic list will inform the development of future guidelines. As a result, the scheduling and publication dates of the quality standards will be affected by the availability of appropriate guidance. NICE are hoping to collect views on an initial proposed list and any other areas that it is felt feel need to be included. The consultation will be open from the 27 September until the 20 December.

If you wish to discuss any queries you may have around public health please contact Olwen Dutton.

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Regulation Publications/Guidance
Hospital inspections reports. These reports detail the findings from the CQC's new way of inspecting hospitals in England. The inspections looked at eight key services areas: accident and emergency; medical care (including frail elderly); surgery; intensive/critical care; maternity; paediatrics/children’s care; end of life care; and outpatients.

If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.

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General

Publications/Guidance
Focus on Accident & Emergency - December 2013. This publication provides a compilation of Accident and Emergency (A&E) data in England, to give a broad picture of the patient journey through A&E. the report shows striking consistencies in patterns of A&E activity over several years. In particular, it shows that in 2012-13 A&E departments dealt with 21.7m attendances overall, or 60,000 a day. This is an 11% growth on four years ago (2008-09) and compares to a 3.2 per cent growth in the England population during the same period.

Prolonged disorders of consciousness: national clinical guidelines. The Royal College of Physicians has launched new guidelines on the diagnosis and management of people with prolonged disorders of consciousness (PDOC). They should help healthcare staff, families, carers, friends and others understand the clinical, ethical and legal issues surrounding the care of these patients.

NHS services open seven days a week: Every day counts. This publication offers case studies and examples of how hospitals, community health and social care services across the country are working together to deliver routine services seven days a week. Recent listening events have shown that patients and the public want us to act now to make seven day services a reality in the NHS.

Volunteering in acute trusts in England: understanding the scale and impact. This research aims to help local providers and system leaders understand the contribution of volunteering and provide organisations with benchmarking information, including possible returns on investment in volunteering.

The state of health care and adult social care in England 2012/13. This year’s State of Care report looks at the pressures on A&E services due to an increase of admissions for ‘avoidable’ conditions. It also brings together the findings of more than 35,000 inspections to try and give a picture of the quality of health and social care services in 2012/13.

Reducing violence and aggression in A&E: through a better experience. This report provides evidence that accident & emergency departments could improve patient experience, increase staff wellbeing and save money by implementing a new, proven design solution created by studio PearsonLloyd. The two-pronged solution called ‘A Better A&E’ incorporates a ‘Guidance Solution’ - signage to guide and reassure patients, and a ‘People Solution’ - a programme to support staff in their interactions with frustrated, aggressive and sometimes violent patients through communications training and reflective practices.

Government Response to the House of Commons Science and Technology Committee Inquiry into Clinical Trials. This response from the Department of Health sets out actions the government is taking to make it easier for clinical trials to be carried out in the UK and to increase registration of trials and publication of results.

Immune response: adult immunisation in the UK. This report sets out an argument for adult immunisation in the UK as a preventative public health intervention within broader healthy ageing strategies as a cost-effective measure. It highlights a number of policy recommendations that include: JSNAs taking a life-course approach to immunisation; health and wellbeing boards ensuring that that life-course vaccination is adequately considered as part of health planning and commissioning; and that commissioning arrangements for immunisation should support the uptake of adult vaccination.

NHS England, the National Offender Management Service (NOMS) and Public Health England. This agreement sets out the shared strategic intent and joint commitment for the National Offender Management Service (NOMS) and NHS England (formerly the NHS Commissioning Board (NHS CB)) to work together for the purposes of co-commissioning and delivering healthcare services, supported by Public Health England (PHE) in adult prisons in England.

Healthcare behind bars. The OHRN have made a short video clip that is a mini-documentary to explain why they do prison health research and how they have been working alongside ex-offenders to improve healthcare in prisons.

Framework agreement between the Department of Health and Public Health England. This document defines how the Department of Health and PHE will work together to serve the public and the taxpayer, and how they will discharge their accountability responsibilities. 

News
Man in vegetative state should not be resuscitated. The Court of Protection has ruled that a 78-year-old man in a vegetative state or - at best - minimally conscious state since May 2013, should not be resuscitated if his condition deteriorates. Despite his advanced ill health, his family said that in the event of a heart attack, they would prefer him to be kept alive. Mr Justice Mostyn said it was "perfectly clear to me that it would not be in SM's best interests" to undergo resuscitation.

High Court judge orders life-saving bone marrow transplant to go ahead for three-year-old boy against father's will. The Independent reports that following an emergency High Court ruling, a three-year-old boy whose father tried to prevent him receiving life-saving treatment will have a bone marrow transport on 5 December 2013. AA, who was born in an Arab country, has had his immune system "effectively deleted" in preparation for the transplant. His father had originally consented to the operation, but at the last minute withdrew permission, insisting his son instead be flown home.

Bevan Brittan Updates
Changes to defamation law from 1 January 2014 . The Defamation Act 2013 is due to come fully into force on 1 January 2014. This note highlights the provisions that are most relevant to entities that provide public services or perform public functions who are seeking to protect their own reputation or that of their officers and employees, and also to those organisations who find themselves on the receiving end of a defamation claim.

Bevan Brittan Events
Health and social care seminar (London). 04 February 2014 : Timings TBC. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. This high level session will deal with some of the current issues local councils are dealing with given their new responsibilities about health; and will look at their duties and responsibilities; governance issues around health and wellbeing boards; the integration agenda and developing effective partnerships; health commissioning and NHS contracts.

Health and social care seminar (Birmingham). 05 February 2014 : Timings TBC. Location: Bevan Brittan, Interchange Place, Edmund Street, Birmingham, B3 2TA. This high level session will deal with some of the current issues local councils are dealing with given their new responsibilities about health; and will look at their duties and responsibilities; governance issues around health and wellbeing boards; the integration agenda and developing effective partnerships; health commissioning and NHS contracts.

Health and social care (Bristol). 06 February 2014 : Timings TBC. Location: Bevan Brittan, Kings Orchard, 1 Queen Street, Bristol, BS2 0HQ. This high level session will deal with some of the current issues local councils are dealing with given their new responsibilities about health; and will look at their duties and responsibilities; governance issues around health and wellbeing boards; the integration agenda and developing effective partnerships; health commissioning and NHS contracts.

If you wish to discuss any of the items raised in this section please contact Claire Bentley.

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