Health and Social Care Update - March 2014

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.

18/03/2014

Claire Bentley

Claire Bentley

Associate

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

Publications/Guidance
Community services: how they can transform care. This paper looks at the changes needed to realise the full potential of community services for transforming care. It finds that while the emphasis on moving care closer to home has resulted in some reductions in length of hospital stay, it is now time to focus on the bigger issue of how services need to change to fundamentally transform care.

Is excessive paperwork in care homes undermining care for older people? This study found that care homes have to regularly complete more than 100 separate items of paperwork, often duplicating the same information. It recommends that the sector rethinks its priorities and makes changes to the way it deals with administration so older people can be given more compassionate, personalised care.

News
New hospital leads the way in providing dedicated emergency services. NHS Medical Director Sir Bruce Keogh has given his seal of approval to Northumbria Specialist Emergency Care Hospital, which will be the first hospital in the country dedicated to providing emergency care every day of the week.

If you wish to discuss any of the items above or the issue of care more generally please contact Stuart Marchant .

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Clinical Risk/Health and Safety

Publications/Guidance
Commissioning the conditions for safer surgery. This report makes a series of recommendations for new standards and systems to further improve the safety of surgery in English hospitals. The main recommendations of the report cover three themes: standardise, educate and harmonise. In response, NHS England has committed to identifying practical ways to take forward the report’s recommendations to eradicate never events from surgical procedures.

Government response to the review of the regulation of cosmetic interventions. This publication sets out the government's response to the independent review of the regulation of cosmetic interventions. The government accepts the principles of the Keogh Review and the majority of its recommendations for protecting people who choose cosmetic procedures.

MPS highlights prescribing as one of the top risks in general practice. Prescribing continues to be one of the top five risks in general practice based on Clinical Risk Self Assessments (CRSAs) conducted by the Medical Protection Society (MPS) at more than 150 practices across the UK and Ireland in 2013.

Emergency admissions to hospital. A strategy to address the chronic shortage of A&E consultants should be developed and implemented with urgency, according to a report published by the Public Accounts Committee on emergency admissions to hospital and the shortage of consultants. The report also recommends there needs to be more information about the implementation of 24/7 consultant cover in A&E departments.

Ripping off the sticking plaster: whole-system solutions for urgent and emergency care. Mounting pressures on England’s urgent and emergency care services have been well documented in local and national media over recent months. This report from the NHS Confederation acts as a roadmap to the fundamental changes required to create a sustainable and high-quality urgent and emergency care system that can meet the needs of patients now and in the future.

Independent midwives: insurance options outlined. The DH has announced its decision that funding Independent Midwives UK members’ insurance will not give patients protection. This follows independent advice that the business model proposed by Independent Midwives UK was unlikely to be successful in providing long-term protection for patients, regardless of the amount of funding provided.

Building a culture of Candour. Following the Government's response to the Mid Staffordshire Public Inquiry, Professor Norman Williams, President of the College, and Sir David Dalton Chief Executive of Salford Royal Hospital, were asked by the Secretary of State for Health to lead a review on two proposals to enhance candour in the NHS. These include whether the threshold for the new statutory duty of candour should be set at the level of death and serious injury, or death, serious duty, and moderate harm and how the NHS Litigation Authority might incentivise candour by seeking reimbursements from trusts in cases where they had not been candid with a patient or family.

A review of support available for loss in early and late pregnancy. This report:
Scopes what support currently exists for women and families across England who experience loss at less than 24 weeks gestation
Scopes what support exists for women and families across England who experience loss at greater than 24 weeks gestation
Scopes what support exists for stillbirth, pre and post-delivery, identifies the key charities involved in this and determines what they offer
Identifies areas of good practice, soft intelligence and stories from women with experience of loss.

Shine: Improving the value of local healthcare services. This report from the Health Foundation summarises the key lessons, successes and challenges from the first two rounds of the its Shine programme, where 32 projects developed innovative approaches to improve or maintain healthcare quality while reducing costs. The report shows what can be done at a local level to improve quality and reduce costs with a relatively small amount of money and within a short timescale of just over a year. It demonstrates the effectiveness of clinically-led improvement projects to improve services.

Consultations
New offence of ill-treatment or wilful neglect. Seeks views on developing a new criminal offence of ill-treatment or wilful neglect of patients and service users. The proposal arises as part of the response to the Francis Report and follows a recommendation of the National Advisory Group on the Safety of Patients in England. The proposed new statutory offence would apply where an individual or organisation wilfully neglects or ill-treats someone in a way that causes serious harm or death. "Wilfully" connotes acting deliberately or recklessly. Penalties for the offence would be equivalent to those under s.44 of the Mental Capacity Act 2005. The consultation closes on 31 March 2014.

News
CA to decide whether heavy drinking in pregnancy is crime. A landmark damages claim on behalf of a child who was harmed by her mother's heavy drinking during pregnancy is to go before the Court of Appeal. Permission has been given for the court to hear allegations that the mother ignored warnings from social workers and medical staff that her heavy alcohol consumption risked harming her unborn child. The lawsuit is being filed by a local authority in north-west England against the Criminal Injuries Compensation Authority. It maintains the mother's action constituted the crime of poisoning under s.23 of the Offences Against the Person Act 1861.

Events
Anatomy of clinical negligence claims: Medico-legal issues for the maternity team. 20 March 2014 : 09:20- 16:30 (registration opens at 08:50). Location: Bevan Brittan LLP, Kings Orchard, i Queen Street, Bristol BS2 0HQ. ThisBirth 2 UK Maternity Training course examines the anatomy of clinical negligene claims in a gynecology and obstetrics setting. The NHS Litigation Authority report ‘Ten Years of Maternity Claims’ has highlighted the lessons we may learn from these claims. Key themes to emerge from the report include the importance of providing effective supervision and support for staff in terms of training and development, the benefits of good multi-disciplinary working, and the need to ensure that national guidance is reflected within local guidelines and followed. This exciting and innovative one-day course will provide an overview of clinical negligence claims and the law that applies to them and how this relates to our everyday practice as busy professionals.

Post Francis Seminar - Birmingham. 27 March 2014 : 14:00 - 17:00 (registration opens at 13:30) reception will follow. Location: Bevan Brittan, Interchange Place, Edmund Street, Birmingham B3 2TA
Post Francis Seminar - Bristol. 01 April 2014 : 14:00 - 17:00 (registration opens at 13:30) seminar will be followed by reception. Location: Bevan Brittan, Kings Orchard, 1 Queen Street, Bristol BS2 0HQ.
Post Francis Seminar - London. 02 April 2014 : 14:00 - 17:00 (registration opens at 13:30) reception will follow. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF
As the Recommendations (from Robert Francis) and Responses (from Government and regulators) begin to find form in legislation, this seminar reviews the state of the new regulatory landscape and its implications for providers. The main topics that will be discussed are:
 The new requirements (Fundamental Standards; duty of candour; fit and proper person test for directors; and the offence of False and Misleading Information)
 The new CQC inspection and ratings regime
 Whistle blowing (the legal framework) and raising concerns in practice.

Clinical risk claims and complaints forum. 17 April 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.

Predict to Prevent Health Seminar. 30 April 2014 : 09:10 - 16:30 (registration opes at 08:45). Location: Bevan Brittan LLP, Kings Orchard, 1 Queen Street, Bristol Bs2 0HQ. Over 90% of premature babies now survive the immediate postpartum period, but the resultant morbidity can be significant and takes a high toll on families. This exciting new one day course will be of interest to all clinical staff with an interest in the prediction and prevention of preterm labour together with the management of small babies using the best evidence (where available) in order to guide clinicians in relation to diagnosis, investigation and management.

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
CCG allocation growth projections 2016/17 to 2018/19. This guidance is intended to support commissioners who are currently developing their five years strategic plans. It sets out some high level planning assumptions that CCGs can use when considering how to project growth in allocations in years three to five of the planning period.

Commissioning and funding general practice: Making the case for family care networks. This King's Fund report describes examples of innovative models of primary care provision that are already being used, with four case studies in different areas of England. It also highlights how the existing system is imperfectly understood, particularly regarding contracts. Building on ideas articulated in previous work, the report argues for a new approach that brings together funding for general practice with funding for many other services. It would entail new forms of commissioning, with GPs innovating in how care is delivered. Over time, the report foresees ‘family care networks’ emerging that provide forms of care well beyond what is currently available in general practices. 

Clinical commissioning groups: Their key responsibilities, accountability and how VCS groups can work with CCGs. This briefing from Regional Voices' network in the North East, VONNE, outlines CCGs' key responsibilities, describes how they will be held to account for their activity, and provides examples of how community and voluntary groups can work with CCGs.

Commissioning primary care: transforming healthcare in the community. This publication explores the challenges to local reforms in primary care commissioning as well as offering clear and practical solutions. It also looks at examples of good, working partnerships and explains why integrated services must always start with a ‘whole system’ strategy if they are to bring the best care to patients and local communities.  

Report of the working group into joined up clinical pathways for obesity. This report recommends greater clarity around how obesity care in England is commissioned. It aims to support more equitable access to obesity and weight management services, including obesity surgery, across the country.

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

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Employment/HR

Publications/Guidance
Review Body on Doctors' and Dentists' Remuneration 42nd report: 2014 The DDRB provides independent advice on the pay of doctors and dentists in the NHS. This report sets out the DDRB analysis of evidence given by relevant organisations and makes proposals on doctors and dentists’ pay from April 2014.

NHS Pay Review Body (NHSPRB) 28th report: 2014. This report sets out the NHSPRB analysis of evidence given by relevant organisations and makes proposals NHS staff paid under Agenda for Change from April 2014.

Medical revalidation: from compliance to commitment. This paper, commissioned by the NHS Revalidation Support Team, presents the findings from focus group discussions with doctors and interviews with wider staff. It provides analysis from interviewees’ perspectives and offers commentary on how leaders at all levels can use revalidation to help create a culture of excellence in patient care.

2013 NHS staff survey in England. This briefing note provides an overview of results from the eleventh annual national survey of NHS staff. The results are primarily intended for use by NHS organisations to help them review and improve staff experience so that staff can provide better patient care. The 2013 survey was structured around four of the pledges in the staff NHS Constitution, with the additional themes “equality and diversity” and “raising concerns”.

Frontline First: more than just a number This report reveals that there are 3,994 fewer full time equivalent nursing staff working in senior positions than in April 2010. Staff working at this level include ward sisters, community matrons, clinical nurse specialists and advanced nurse practitioners. It warns that with almost 4,000 fewer senior nursing posts than 2010, the NHS is being drained of valuable leadership, experience and specialist knowledge from the health service.

Nurse migration from the EU: what are the key challenges? The nursing workforce is facing significant change, it is ageing and there is more demand for part-time working. More of its traditional entrants are choosing alternative careers. Facing these recruitment and retention issues while simultaneously trying to improve productivity and the quality of care is proving to be a challenge. Traditionally popular solutions that involve recruiting nurses from the international marketplace can help but they bring their own human resources management challenges. This Policy+ focuses on nurse migration into the UK from other European Union countries.

NHS Staff Friends and Family Test: Guidance for implementing, submitting and publishing the Friends and Family Test for NHS Staff. From April 2014, NHS England is introducing the "staff friends and family test" in all NHS trusts providing acute, community, ambulance and mental health services in England. NHS England says all staff should have the opportunity to feed back their views on their organisation at least once a year. It claims the staff test will help to promote a big cultural shift in the NHS, increasing the confidence of staff to have their say. This guidance aims to support those who will be administering the Staff FFT and outlines the requirements for implementation, data submission and data publication.

Fair Deal for Staff Pensions: staff transfers from Central Government. It provides further clarity to contracting authorities, bidders and providers in relation to the application of the new Fair Deal policy where the relevant public service pension scheme is NHSPS. Stage 1 of the Guidance deals with first generation transfers; stage 2 provides additional guidance on retenders.

Social media toolkit for the NHS launched. This free toolkit aims to provide a framework to help decide if using social media is right for your NHS organisation. It gives a selection of social media template policies and processes, to save time writing and updating your own showcases and some ‘thoughts on’ key areas of social media practice.

Events
Post Francis Seminar - Birmingham. 27 March 2014 : 14:00 - 17:00 (registration opens at 13:30) reception will follow. Location: Bevan Brittan, Interchange Place, Edmund Street, Birmingham B3 2TA
Post Francis Seminar - Bristol. 01 April 2014 : 14:00 - 17:00 (registration opens at 13:30) seminar will be followed by reception. Location: Bevan Brittan, Kings Orchard, 1 Queen Street, Bristol BS2 0HQ.
Post Francis Seminar - London. 02 April 2014 : 14:00 - 17:00 (registration opens at 13:30) reception will follow. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF
As the Recommendations (from Robert Francis) and Responses (from Government and regulators) begin to find form in legislation, this seminar reviews the state of the new regulatory landscape and its implications for providers. The main topics that will be discussed are:
The new requirements (Fundamental Standards; duty of candour; fit and proper person test for directors; and the offence of False and Misleading Information)
The new CQC inspection and ratings regime
Whistle blowing (the legal framework) and raising concerns in practice.

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

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Estates and Facilities

Publications/Guidance
Release of NHS owned land for development. The DH has published a spreadsheet with details of the land currently owned by NHS organisations in England that could be used for development. 

Events
Property Law Seminar Birmingham. 25 March 2014 : 10:30 - 13:00 (registration opens at 10:00) Lunch will follow. Location: Bevan Brittan, Interchange Place, Edmund Street, Birmingham B3 2TA. For every organisation operating in the public services arena, there is an ever-increasing need to be more efficient and innovative regarding the way in which land is managed and used. This varied but focused seminar will cover the key recent developments in the law of property and will enable attendees to find out the answers to those questions which they need to know but have been too afraid to ask! 

If you wish to discuss any issues relating to estates and facilities please contact Rob Harrison. 

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Finance

Publications/Guidance

NHS payment reform: lessons from the past and directions for the future. This policy response from the Nuffield Trust reviews different approaches to payment for health services in the English NHS. It explores the evidence on whether recent payment initiatives have met their goals. It looks at options for development of the payment reform system in England. It recommends that any changes are targeted on where they are likely to have the greatest impact, and aligned with wider system changes. The authors also call for any changes to be transparent and evidence-based, as well as predictable and credible.
This report is published alongside a research report, The NHS payment system: evolving policy and emerging evidence, which looks at the evidence on whether recent payment initiatives have met their goals.  

Public expenditure on health and social care. The Commons Health Committee has published its fourth annual review of the implications on the Government’s spending plans for health and care services, looking at the financial situation of the health and care system with commentary on how best to utilise resources to meet demand. It finds that while the straightforward savings have been achieved, there has not been the transformation of care on the scale which is needed to meet demand and improve care quality. The successful integration of high-quality health and care services represents a substantial and growing challenge, which is not helped by the current fragmented commissioning structures. As Health and Wellbeing Boards have been established to allow commissioners to look across a whole local health and care economy, their role should be developed to allow them to become effective commissioners of joined-up health and care services. It also recommends that the current level of real terms funding for social care should be ring-fenced. The committee warns that without stronger commissioners and ring-fenced health and care funding, there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead. It also considers competition, pay restraint, and trusts and foundation trusts.

The NHS payment system: evolving policy and emerging evidence. This research report reviews different approaches to payment for health services in the English NHS. It explores the evidence on whether recent payment initiatives have met their goals.

NHS charges from April 2014. Announces that NHS prescription charge in England will increase by 20 pence from £7.85 to £8.05 for each quantity of a drug or appliance from 1 April 2014.

If you wish to discuss any of the items in this section or the issue of finance in healthcare please contact David Owens.

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Foundation Trusts

Publications/Guidance
NHS foundation trusts: review of nine months to 31st December 2013. This report summarises key trends drawn from foundation trusts’ individual reports. It looks at operational performance, financial performance and regulatory performance.

Monitor: regulating NHS foundation trusts. According to this report, Monitor has achieved value for money in regulating NHS foundation trusts, and has generally been effective in helping trusts in difficulty to improve. It highlights Monitor's processes and standards, which it has adapted and strengthened, for assessing NHS trusts applying for foundation trust status. 
 

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

Back to topInformation Sharing Publications/Guidance
Information Commissioner calls for jail terms for those who obtain information illegally. The Information Commissioner, Christopher Graham, has called for jail terms for those who obtain private information, such as medical records, illegally. More than a third of the 14 cases brought by the Information Commissioner's Office of unlawful accessing of personal information involved medical data. Mr Graham notes prosecutions tend to result in a "relatively menial fine". He argues that greater penalties would reassure patients about the introduction of a central database for medical records.

NHS England acts in response to concerns about information sharing – statement from Tim Kelsey, National Director for Patients and Information. NHS England has responded to concerns from patients, many GPs, their professional organisations and groups like Healthwatch about the care.data information sharing programme. It states that, in view of these concerns, it will put back the start date for collecting data from GP surgeries to the Autumn, instead of April, to allow more time to build understanding of the benefits of using the information, what safeguards are in place, and how people can opt out if they choose to. It will also work with patients and professional groups to develop additional practical steps to promote awareness with patients and the public, and ensure information is accessible and reaches all sections of the community, including people with disabilities, and look into further measures that could be taken to build public confidence, in particular steps relating to scrutiny of ways in which the information will be used to benefit NHS patients. In the meantime it will work with a small number of GP practices to test the quality of the data.

Patient data plan postponed. A plan to share patient data has been put on hold for the next six months. The delay follows concerns about the new scheme from doctors and patients' groups, as well as fears that many people did not understand the plans or how to go about opting out.

If you wish to discuss any issues around information sharing please contact Jane Bennett.

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Mental Health

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
The sixth year of the Independent Mental Capacity Advocacy (IMCA) Service: 2012/2013. This report provides an overview of the 6 years that the IMCA service has been active. It is particularly relevant to local authority commissioners, mental capacity leads and safeguarding leads.

Mental Health Act: exercise of approval instructions 2014. These instructions lay out the function of approving registered medical practitioners and of approving individuals to act as approved clinicians under the 1983 Mental Health Act.

Deprivation of liberty – guidance for providers of children's homes and residential special schools. Guidance jointly issued by the President of the Court of Protection and Ofsted sets out advice for providers of children's homes and residential special schools regarding deprivation of liberty under the Mental Capacity Act 2005.

Mental health and crisis care. The DH has published the Mental Health Crisis Care Concordat, a commitment from national organisations, as signatories to the document, to work together to support local systems to achieve systematic and continuous improvements in crisis care for people with mental health problems across England. This briefing provides a summary of the key principles and commitments in the Concordat and highlights how stronger local partnerships can work together to deliver improved crisis care.
See also Crisis care concordat brings mental health closer to parity of esteem: Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, explains why it is so crucial to get emergency mental health care right.

The maternal mental health of migrant women. This briefing examines why there is low take-up of maternal mental related services by migrant women in the UK. It considers how maternal mental health care providers can develop services which meet the needs of migrant women.

Supporting recovering in mental health services: quality and outcomes. This publication aims to help organisations in the mental health sector develop clear, empirically-informed statements about what constitutes high-quality services, and how these will lead to key recovery outcomes for service users. It also includes a series of recommendations for health and social care providers and commissioners, and for NHS England and the government, that aim to support development of an evidence-based approach to commissioning mental health services.

Mental Capacity Act 2005: post-legislative scrutiny. This report finds that vulnerable adults are being failed by the Act designed to protect and empower them. It finds that social workers, healthcare professionals and others involved in the care of vulnerable adults are not aware of the Mental Capacity Act, and are failing to implement it.

Statistics on children admitted to adult mental health wards released. The report details the recorded number of under-18s who were inpatients on adult mental health wards in the year2, number of admissions during the year for people aged under 18 and the number of days spent by under-18s on such wards during the year. The report also compares the MHMDS statistics with the number of notifications made by hospitals to the Care Quality Commissions of instances where under-18s spend 48 hours or more on an adult mental health ward.

News
Court of Protection backs amputation refusal. The Court of Protection has ruled that an NHS trust must respect the wishes of a patient with schizophrenia who refused a potentially life-saving operation. The court denied permission for doctors at the Heart of England NHS Trust to amputate the gangrenous foot of patient "JB" without her consent, ruling that her mental illness had not robbed her of the power to make rational decisions. The judgment is at Heart of England NHS Foundation Trust v JB [2014] EWHC 342 (COP).

Mental health and community health providers to be inspected from April. The CQC has announced the second group of mental health and community health providers that will be inspected as part of its "new approach to inspecting specialist mental health services". The providers cover a broad range of sizes, specialisms and regions across England.

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
Commissioning and funding general practice: Making the case for family care networks. This King's Fund report describes examples of innovative models of primary care provision that are already being used, with four case studies in different areas of England. It also highlights how the existing system is imperfectly understood, particularly regarding contracts. Building on ideas articulated in previous work, the report argues for a new approach that brings together funding for general practice with funding for many other services. It would entail new forms of commissioning, with GPs innovating in how care is delivered. Over time, the report foresees ‘family care networks’ emerging that provide forms of care well beyond what is currently available in general practices.

Commissioning primary care: transforming healthcare in the community. This publication explores the challenges to local reforms in primary care commissioning as well as offering clear and practical solutions. It also looks at examples of good, working partnerships and explains why integrated services must always start with a ‘whole system’ strategy if they are to bring the best care to patients and local communities.  

Important information for GP practices - Quality and Outcomes Framework (QOF) 2013/14. The Health and Social Care Information Centre has published guidance on the QOF for the financial year 2013/14. The guidance includes important information on participating in QOF 2013/14, the General Practice Extraction Service (GPES) and Calculating Quality and Reporting Service (CQRS), and enhanced services on CQRS. It also explains the contingences that the HSCIC has in place to ensure aspiration payments are protected for GP practices. A step-by-step detailed guide on what practices need to do for QOF will be issued in March.

GP practice checklist for QOF 2013/14 year-end. HSCIC has provided a step-by-step detailed checklist advising GP practices what they need to do, and when, for the Quality Outcomes Framework (QOF) 2013/14 year-end. The information is split into sections detailing what actions GP practices should take now, after they are participating in QOF on CQRS, and after QOF 2013/14 achievement data are available (from 1 April). Updates will be made to the checklist on the CQRS website on a weekly basis.

Improving general practice: a call to action - phase 1 report This report contains a future strategy for commissioning general practice services. It focuses on the central role NHS England wants general practice to play in wider systems of primary care, and it describes NHS England's ambition for greater collaboration with clinical commissioning groups in the commissioning of general practice services.

News
How can CCGs support GPs in their role as 'Accountable GP'? NHS England has announced that from 1 April 2014, GP practices will be offered the opportunity to take part in an enhanced service which is designed to reduce avoidable unplanned admissions by improving services for the most vulnerable patients and those with complex physical or mental health needs. This enhanced service is created as a result of a reduction in QOF that will allow GP practices a greater opportunity to understand the needs of the patients who most need their support to stay well in the community and avoid unplanned hospital admissions. The funding can be used, for example, for new services based in general practice or for new or additional community services, such as rapid response community nursing, additional support from mental health service providers, designated district nursing, additional discharge coordinator services or targeted social care services, or additional services from third and voluntary sector providers.

34m patients will fail to get appointment with a GP in 2014. The RCGP reports that >34m patients in England will this year fail to get an appointment with their GP, when seeking treatment, because of the slump in the funding of general practice over the last decade, and rapidly growing demand.

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

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Procurement

Publications/Guidance
NHS terms and conditions for procuring goods and services. The DH has published framework agreements to be used by the NHS when procuring goods and non-clinical services from commercial organisations (not from other NHS bodies or independent sector providers). There is also updated guidance.

NHS standards of procurement: Peer review guidance. Last year the DH published standards for NHS healthcare provider organisations to assess and benchmark procurement performance and identify areas for improvement. There is also an evidence tool that provides suggested evidence that should be reviewed as part of an assessment of a trust against the standards. This peer review guidance provides NHS organisations with an objective review process.

News
NHS England launches procurement process to accredit the best commissioning support suppliers. Announces that NHS England has started the process to create a unique framework agreement for commissioning support services. The lead provider framework will allow Clinical Commissioning Groups (CCG’s), NHS England and others to buy some or all of their commissioning support needs, ranging from non-frontline support services to bespoke services that support local and large scale service design change projects. NHS England is inviting bids from any organisation or group of organisations that can deliver the services in scope, including NHS bodies, local authorities, private sector and voluntary sector suppliers. 

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

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Public Health

Publications/Guidance
Public expenditure on health and social care: seventh report of session 2013-14. This report concludes that the health and care system needs fundamental change so that services are joined up and focussed on the needs of patients. It recommends that the current level of real terms funding for social care should be ring-fenced. It also recommends that the role of health and wellbeing boards should be developed to allow them to become effective commissioners of joined-up health and care services. It also considers other issues such as competition, pay restraint and trusts and foundation trusts.

Directors of Public Health in England. This document contains a list of all directors of public health in England, listed by region and local authority.

Public Health England. The Commons Health Select Committee has published the findings of inquiry into how Public Health England (PHE) has set about establishing its policy priorities and programme of work. The Committee concludes that Parliament created PHE as an independent voice within Government to champion the policies that will make the greatest difference to the nation’s health but the organisation has not yet developed a clear set of priorities: "Tackling alcohol misuse, smoking and the crisis of obesity are fundamental to improving the nation’s health, but PHE has yet to strike the right tone when addressing these issues. Its public comments have often been faltering and uncertain when they should have been clear and unequivocal." The Committee is concerned that there is insufficient separation between PHE and the DH, and there is an urgent need for this relationship to be clarified and for PHE to demonstrate that it is genuinely able to ‘speak truth unto power’. It notes, however, that the transition from the old public health arrangements and the creation of PHE was undertaken successfully.

Public health services non mandatory contract. The DH has published an updated version of the Public Health Services Contract and guidance for 2014/15 that may be used by local authorities when commissioning services to deliver their new public health functions. There is also updated guidance on the 2014/15 contract.

Encouraging people to have NHS Health Checks and supporting them to reduce risk factors. This briefing summarises NICE's recommendations for local authorities and partner organisations that could be used to encourage people to have NHS Health Checks and support them to change their behaviour after the NHS Health Check and reduce their risk factors. It is particularly relevant to health and wellbeing boards.

Sources of social statistics: health services and public health. This note is intended as a guide to the key sources in health services and public health statistics. It represents a self-help guide, providing a starting point for those interested in obtaining statistics for themselves.

Hidden needs: identifying key vulnerable groups in data collections: vulnerable migrants, gypsies and travellers, homeless people, and sex workers. This report argues that the health care needs of the most vulnerable groups in society not being met because of gaps in health information and data gaps. It is aimed at data providers, healthcare professionals, commissioners and others working to improve the health of the vulnerable groups and signposts the way to good data.

Smokefree and smiling: Helping patients to quit tobacco. Updated guidance from PHE for dental teams, commissioners and educators on how they can contribute to reducing rates of tobacco use. It highlights resources available to support them. The guidance explains how dentists can offer very brief advice, using a ‘30 second approach’, to tobacco users and signpost them to local stop smoking services, by following three simple steps - Ask, Advise, Act.

Local authorities' public health responsibilities (England) - Commons Library Standard Note. A House of Commons Library Standard Note sets out the main statutory duties for public health that were conferred on local authorities by the Health and Social Care Act 2012. The note includes information on public health funding; how local authorities have been spending their ring-fenced public health grants; and on accountability arrangements.

News
Tackling health inequalities. Public Health England is launching a "national conversation" about health inequalities to better understand the English public’s perception and experience. The project will involve speaking with public health professionals and community leaders and holding a series of workshops with members of the public to gain valuable insight into how people are living now. The workshops will explore local solutions that may help to mitigate inequalities and this knowledge will be collated for dissemination via a number of means both locally and nationally.

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

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Regulation

Publications/Guidance
Government response to the review of the regulation of cosmetic interventions. This publication sets out the government's response to the independent review of the regulation of cosmetic interventions. The government accepts the principles of the Keogh Review and the majority of its recommendations for protecting people who choose cosmetic procedures. 

Monitor: Regulating NHS foundation trusts. Monitor has achieved value for money in regulating NHS foundation trusts, and has generally been effective in helping trusts in difficulty to improve.

Framework agreement between the Department of Health and the Care Quality Commission (CQC). This document defines the key elements of the relationship between the Department of Health and CQC. It outlines the roles and responsibilities; lines of accountability; and governance arrangements.

Events
Post Francis Seminar - Birmingham. 27 March 2014 : 14:00 - 17:00 (registration opens at 13:30) reception will follow. Location: Bevan Brittan, Interchange Place, Edmund Street, Birmingham B3 2TA
Post Francis Seminar - Bristol. 01 April 2014 : 14:00 - 17:00 (registration opens at 13:30) seminar will be followed by reception. Location: Bevan Brittan, Kings Orchard, 1 Queen Street, Bristol BS2 0HQ.
Post Francis Seminar - London. 02 April 2014 : 14:00 - 17:00 (registration opens at 13:30) reception will follow. Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF
As the Recommendations (from Robert Francis) and Responses (from Government and regulators) begin to find form in legislation, this seminar reviews the state of the new regulatory landscape and its implications for providers. The main topics that will be discussed are:
The new requirements (Fundamental Standards; duty of candour; fit and proper person test for directors; and the offence of False and Misleading Information)
The new CQC inspection and ratings regime
Whistle blowing (the legal framework) and raising concerns in practice.

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: Distance from home to emergency care. This report from the Health Foundation's QualityWatch programme, produced in partnership with the Nuffield Trust, examines changes over the last decade in the distance travelled from home to receive emergency care. It examines over a decade’s worth of data to assess whether the distance that patients travel to receive emergency care in England has changed. The study finds that, despite the total number of emergency admissions rising by over a third in ten years, the average distance from home to hospital has only increased by 0.2 miles. In most cases these distances are not large: in 70% of cases, emergency admissions happened within 6.2 miles (10km) of a patient’s home, and only 3% of people were admitted to a hospital more than 18.6 miles (30km) from home. But the research did show that people in some rural areas have to travel over ten times as far as those in urban areas. It also reveals that changes in services can significantly change distances to emergency care.

Patient experience in adult NHS services. Evidence updates highlight new evidence relating to published accredited guidance. In particular, they highlight key points from the new evidence and provide a commentary describing its strengths and weaknesses. This evidence update contains a summary of selected new evidence relevant to the NICE clinical guideline: ‘Patient experience in adult NHS services: improving the experience of care for people using adult NHS services’ 

Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. This guidance aims to help identify, prevent and reduce domestic violence and abuse. Violence and abuse perpetrated on children by adults ('child abuse') is not dealt with in this guidance, but it does include support for children who are affected by domestic violence and abuse.

Framework agreement between the Department of Health and NHS England. This document sets out how DH and NHS England will work together, setting out roles, responsibilities, governance and accountability arrangements.

Ensuring human rights in the provision of contraceptive information and services: guidance and recommendations. This guidance aims to help countries ensure human rights are respected in providing more girls, women, and couples with the information and services they need to avoid unwanted pregnancies. The guidance recommends that everyone who wants contraception should be able to obtain detailed and accurate information, and a variety of services, such as counselling as well as contraceptive products.

NICE and Department of Health framework agreement. Describes the important elements of the working relationship between the DH and the National Institute of Health and Care Excellence (NICE). It outlines out how the DH and NICE will work together, setting out roles, responsibilities, governance and accountability arrangements.

News
Foreign doctors to face new language test. Doctors coming to practise in Britain from other European countries will have to take rigorous English-language tests from June 2014 under plans announced by the General Medical Council (GMC). The GMC will require a score of at least 7.5 out of 9 in the International English Language Testing System. If doctors fail, they could be struck off.

Sir Stuart Rose to advise on NHS leadership. Sir Stuart Rose, former chairman of Marks & Spencer, is to advise how the NHS can attract and retain the very best leaders to help transform the culture in under-performing hospitals. He will look in particular at the problems faced by the 14 trusts currently in “special measures”, the programme to turn-around failing hospitals introduced last year, where strong leadership was identified as key to improvement. His review will run alongside a separate review into how the NHS can make better use of its best existing leaders, so-called “superheads”, who could spread the highest standards for patients across the system by taking on struggling organisations or establishing national networks of NHS hospitals and services.

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

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