Health and Social Care Update - April 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.

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
Managing medicines in care homes. This guideline considers all aspects of managing medicines in care homes and recommends that all care home providers have a care home medicines policy. It considers prescribing, handling and administering medicines to residents living in care homes and the provision of care or services relating to medicines in care homes.

Focus on: social care for older people. This report from the Nuffield Trust's and Health Foundation's QualityWatch programme examines the scale and scope of cuts to social services for older people in England from 2009/10 to 2012/13. It reveals that most local authorities are tightly rationing social care for the over-65s in response to cuts, resulting in significant drops in the number of people receiving services like home-delivered meals and day care. The study seeks to assess the impact of social care cuts on the health and well being of older people and their carers, but finds that, due to a lack of available data, it is not possible to quantify this. It warns that the NHS and Government are 'flying blind' in planning services for vulnerable older people because there is no comprehensive way to quantify the impact that social care cuts are having on their health and wellbeing.

A commitment to care. The Health Minister Norman Lamb has pledged his and the DH’s full support for the Social Care Commitment, which is a sector led initiative that focuses on improving workforce quality, instilling shared values, and driving the highest standards of professional, compassionate behaviour across adult social care. He encourages every employer and every employee working in adult social care to go online and make the Social Care Commitment.

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

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
Patient safety alert: improving incident reporting and learning. NHS England and the Medicines and Healthcare products Regulatory Agency have jointly issued two patient safety alerts to help healthcare providers increase incident reporting for medication errors and medical devices. The alerts instruct providers to take specific steps that will improve data report quality; and will see the establishment of national networks to maximise learning and provide guidance on minimising harm relating to these two incident types.

Managing medicines in care homes. This guideline considers all aspects of managing medicines in care homes and recommends that all care home providers have a care home medicines policy. It considers prescribing, handling and administering medicines to residents living in care homes and the provision of care or services relating to medicines in care homes.

Raising concerns at work: whistleblowing guidance for workers and employers in health and social care. This guidance contains a number of recommendations, aiming to help make whistleblowing an important part of improving the quality of service user support and patient safety.

Consultations
Medical Innovation Bill: Will it encourage responsible innovation and help prevent what's irresponsible? Seeks views on whether doctors are being held back from using pioneering treatments because of the fear of being sued if something goes wrong. It asks if a proposed Medical Innovation Bill would both encourage doctors to innovate in medical practice and bolster patient safeguards. The consultation closes on 25 April 2014.

Introducing the statutory duty of candour. The DH is seeking views on proposals for a duty of candour that will require all health and adult social care providers registered with CQC to be open with people when things go wrong. The draft Health and Social Care Act 2008 (Duty of Candour) Regulations 2014 would impose a specific and detailed duty of candour on all providers where any harm to a service user from their care or treatment is above a certain harm threshold. It will mean providers must notify the patient about incidents where ‘significant harm’ has occurred and provide an apology. This will be a legal requirement and CQC will be able to take enforcement action when it finds breaches. The proposals are open for consultation until 25 April 2014.

News
Survey suggests hospital experiences improving. The results of the CQC's national survey of hospital patients suggest that people are generally having a better experience in hospital compared to a year ago. However, the findings also show there’s room for improvement, with some variation in the quality of people’s stay.

Halving avoidable harm and saving up to 6,000 lives. A new ambition to reduce avoidable harm in the NHS by half over the next three years, cut costs and save up to 6,000 lives has been outlined by the Health Secretary Jeremy Hunt. Each NHS organisation will be invited to ‘Sign up to Safety’ and set out publicly their ambitious plans for reducing avoidable harm, such as medication errors, blood clots and bed sores over the next three years. The NHS Litigation Authority, which indemnifies trusts against law suits, has agreed to review the plans and, when approved, reduce the premiums paid by all hospitals successfully implementing them. Every year the NHS spends as much as £1.3bn on litigation claims.

Events
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.

Bevan Brittan Articles
The Francis Effect - Duty of Candour and Fit and Proper Person Test Consultations It is now more than a year since Robert Francis QC's report into the Mid Staffordshire Inquiry. However, the recommendations he made to the increase: clarity in healthcare standards; openness, transparency and candour; and accountability of senior managers across the health and social care sector are now crystallising as legislation with increasing pace.

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
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.

Clinical commissioning groups one year on. The King’s Fund and Nuffield Trust have published a slideshow summarising results of a survey of six CCG areas, which polled the views of GPs about progress of CCGs in their first year. Less than half of the GPs surveyed felt that decisions made by CCGs reflected their views, but the research also suggests that three times as many GPs think they can influence the work of their CCG than could influence their predecessor PCTs.

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

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Employment/HR

Publications/Guidance
The "snowy white peaks" of the NHS. This study finds that the black and minority ethnic (BME) population is largely excluded from senior positions both as NHS managers and as NHS trust board members. It finds that the pattern extends to all national NHS bodies, and appears to be particularly serious in London. It also considers the extent of the gap between the diversity within the workforce and the local population, and that visible among trust leaderships and senior management. That gap is then considered in the light of growing evidence about the impact of staff and board diversity on the effectiveness of healthcare provision and the patient experience.

Running on empty: NHS staff stretched to the limit. This survey of almost 3,000 nurses from across the UK highlights the pressures staffing levels in the NHS. The survey reveals that 65% of staff said that they did not have enough time with patients and 55% reporting that as a result care was left undone. The report also highlights research that demonstrates the clear link between appropriate patient staff ratios and patient mortality.

The implementation of the Working Time Directive, and its impact on the NHS and health professionals. This report finds that the implementation of the European Working Time Directive (EWTD) in the NHS has had an adverse impact on the training in certain medical specialities, including surgeons and doctors working in acute medicine. The report was commissioned by the government in response to concerns it had about the impact of the directive on patient care and doctors’ learning. The taskforce found that although some groups of doctors are able to receive the training they need within the 48-hour week, this is very challenging for others.

Unnecessary jobs in the NHS. This briefing is the result of Freedom of Information requests submitted to NHS organisations regarding non-clinical NHS staff roles.

How to ensure the right people, with the right skills, are in the right place at the right time: a guide to nursing, midwifery and care staffing capacity and capability. This guidance has been jointly issued by NHS England and the Care Quality Commission in order to help deliver on the commitments associated with publishing staffing data regarding nursing, midwifery and care staff levels.

Fair Deal for staff pensions: staff transfers from Central Government: DH guidance for the NHS Pension Scheme. Fair Deal is a non-statutory policy setting out how pension issues are to be dealt with when staff are compulsorily transferred from the public sector to independent sector providers of public services. Under the new Fair Deal, these staff will be entitled to retain membership or eligibility for the public service pension scheme they were in or eligible to join immediately before the transfer. This guidance gives information to contracting authorities, bidders and providers about the application of the new Fair Deal policy where the relevant public service pension scheme is the NHS Pension Scheme. It identifies areas that Treasury guidance had highlighted and outlines the department’s recommended position for the NHSPS.
See also Procurement Policy Note PPN 05/14: Fair Deal for staff pensions – Staff transfers from Central Government, which explains how the policy affects pensions when staff transfer from Central Government to independent contractors delivering public services. It states that contracting authorities planning to award a contract which will involve the compulsory transfer of staff should make clear to potential bidders as early as possible, and ideally at the pre-procurement stage of the process, that the new guidance will apply. It is directly applicable to Central Government Departments, Executive Agencies, the NHS, maintained schools (including academies but excluding those covered by other arrangements for local government) and any other parts of the public sector under the control of Government ministers where staff are eligible to be members of a public service pension scheme.

Frontline First: More than just a number. This briefing from the Royal College of Nursing (RCN) on reduction in nursing posts reveals that there are 3,994 fewer full time equivalent (FTE) nursing staff working in senior positions (bands 7 and 8) than in April 2010. Staff working at these bands include ward sisters, community matrons, clinical nurse specialists and advanced nurse practitioners. It warns that the health service has been treating staff with years of experience as ‘disposable’ and a quick way to save money, which means specialist clinical knowledge and leadership is being lost just as it is needed more than ever. Another tactic is ‘downbanding’, or forcing senior staff into lower pay grades. This short-term measure permanently devalues the role and sends a message that experience and leadership is not valued in the NHS. While the RCN recognises that the NHS is experiencing unprecedented financial pressure, it does not believe that financial savings should be made at the expense of these more senior and experienced nursing staff.

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.

Bevan Brittan Articles
Employment news round-up March 2014. Anne Palmer takes a look at this month's key employment law news stories, including a raft of changes coming into force next week; family-friendly and surrogacy developments; zero-hours contracts and, finally, reports on the dramatic drop-off in employment tribunal claims and its possible implications.

Pregnancy and maternity discrimination - update and summary guide. Although many cases of maternity discrimination may be fairly clear cut, the picture can be more complex when issues of discrimination arise in relation to maternity related illness, particularly when it occurs after the 'protected period'. Alastair Currie looks a case which clarifies the correct approach to take when an employee is dismissed because of post-natal depression which occurs after maternity leave has ended – and provides a useful summary of this somewhat complex area.

Sharing and caring: your guide to shared parental leave & pay. In what may turn out to be an epoch-making moment in relation to gender equality in the workplace, this October will see new regulations coming into force which will enable parents to choose which of them will take leave to look after their baby during its first year of life. This month, the government has published draft regulations setting out the detail of how they intend the scheme to work in practice. Given that the new arrangements will apply to babies born from next April onwards, it would be sensible to start preparing for the new arrangements now. The operation of shared parental leave is complex but Sarah Maddock provides a useful guide to the new scheme's key features.

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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Finance

Publications/Guidance
Government response to the House of Commons Health Select Committee report into public expenditure on health and social care. This paper sets out the Government’s response to the 18 conclusions and recommendations made in the House of Commons Health Select Committee report. It agrees with the Committee on the very real financial challenge facing health and care services, and recognise that maintaining both financial control and delivering efficiency savings are of paramount importance to ensuring the sustainability of the health and care system. It believe that the reforms it has introduced, the steps it is taking to promote integration and its commitment to protecting the health budget in real terms, go some way towards creating this sustainable service. However, there is more that needs to be done, which is why the Government is continuing to focus on finance and efficiency through better procurement, productivity improvements and transformational changes to services.

Combating inflation - guidanceThis guidance has been produced in order to enable the NHS to take a consistent approach to resisting inflationary pressures as part of a wider programme of initiatives to stabilise non-pay spend.

Solving the NHS care and cash crisis. This report, authored by the former Minister for Health Reform Lord Warner, argues that NHS funding from general taxation should rise only with inflation and proposes a NHS membership scheme for UK residents. It also argues that the creation of a national health and care service is central to tackling the care crisis and integration of health and social care.

Solving the NHS care and cash crisis: Routes to health and care renewal. This report from Reform sets out proposals for a new “National Health and Care Service” (NHCS), based on a new partnership between State and citizen, with integrated health and social care available locally in the community and consolidation of hospital specialist services on fewer sites of higher quality. The authors argue that NHS funding from general taxation should rise only with inflation to avoid starving the rest of the public sector of resources. Higher “sin” taxes on alcohol, tobacco and sugary foods, means-testing of NHS Continuing Care, plus a £10pm NHS membership charge and other patient contributions are needed for the NHS to survive the next five years of austerity. It proposes an NHS Membership scheme for all UK residents, including an annual health MOT to set new responsibilities each year for both the NHS and the individual.

NHS foundation trusts: financial accounting guidance. Guidance for NHS foundation trust finance staff on financial accounting updates, including year-end accounts, the NHS foundation trust consolidation (FTC) process and the agreement of balances process. This version has been updated to include an update on year end information to be provided by Monitor.

Funding transfer from the NHS to social care 2014: directions. The Government has published Directions and an explanatory note about the transfer of £1.1bn in the financial year 2014 to 2015 from the NHS to local authorities for social care. This funding consists of £900m to support adult social care which has a health benefit and an additional £200m for preparing for implementation of mandatory pooled budgets between local authorities and clinical commissioning groups in financial year 2015 to 2016 (the Better Care Fund). The local authority and clinical commissioning groups must agree together how to use the money. They should be read together with the conditions relating to payments between NHS bodies and local authorities.

News
NHS fraud and error 'costing the UK £7bn a year'. Fraud is costing the NHS £5bn a year, with a further £2bn lost to financial errors, the former head of its anti-fraud section says.

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 Trust Annual Reporting Manual 2013/14. All NHS foundation trusts must publish annual reports and accounts to allow scrutiny of the year’s operations and outcomes. This updated guidance outlines the process foundation trusts should follow when producing and submitting these documents. The revisions include changes relating to: the Foundation Trust Code of Governance; severance payments; off-payroll arrangements; and Companies Act changes. They also correct some errors.

NHS foundation trusts: financial accounting guidance. Guidance for NHS foundation trust finance staff on financial accounting updates, including year-end accounts, the NHS foundation trust consolidation (FTC) process and the agreement of balances process. This version has been updated to include an update on year end information to be provided by Monitor.

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

Back to topInformation Sharing Publications/Guidance
Good practice – Audit outcomes analysis: Health – August 2012 to January 2014. This report from the Information Commissioner’s Office (ICO) gives a snapshot of organisations providing secondary health care and how they are complying with the Data Protection Act. The report summarises key findings from 19 audits carried out primarily with NHS Trusts by the ICO. The audits looked at how personal data is handled by the organisation, and fit alongside NHS information governance guidelines. The organisations voluntarily agreed to work with the ICO to identify good practice and, where necessary, improve procedures relating to the handling of personal data.

Good practice: audit outcomes analysis. This report aims to give a snapshot of organisations providing secondary health care and how they are complying with the Data Protection Act. The report summarises key findings from 19 audits carried out primarily with NHS Trusts by the ICO. The audits looked at how personal data is handled by the organisation, and fit alongside NHS information governance guidelines.

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
Investing in recovery. This report shows how money could potentially be saved when proven interventions for people with schizophrenia and psychosis are made available. It makes the case for early intervention services which this report estimates could create savings of £15 for every £1 spent.

Think autism: fulfilling and rewarding lives, the strategy for adults with autism in England: an update. This document aims to set out a clear programme that the Department of Health and other government departments will be taking to improve the lives of people with autism, primarily through taking actions that will support local authorities, the NHS, other public services and their partners with their local implementation work. It has a new focus on building communities that are more aware of and accessible to the needs of people with autism.

Note on deprivation of liberty safeguards (DoLS) judgments of the Supreme Court. This note sets out how health and social care organisations can continue to act within the law following the revised test about the meaning of a deprivation of liberty which has now been supplied by the Supreme Court.

The CQC have published a briefing for providers on the Deprivation of Liberty Safeguards.

Positive and proactive care: reducing the need for restrictive interventions. This document provides a framework for adult health and social care services to develop a culture where restrictive interventions are only ever used as a last resort. It identifies actions that will improve people’s quality of life which should then reduce the need for restrictive interventions. It sets out ways to know who is responsible for making these improvements, including effective governance, transparency and monitoring.

Mental health payment mechanism survey report. This report presents the results from the 2014 survey of 43 mental health organisations in relation to the implementation of the payment mechanism for mental health and adult learning disability services. The survey sought to find out how the payment mechanism is currently working in reality; how far the supplementary guidance has been used for contracting purposes and how the payment mechanism and guidance might be developed in future years

Think Autism: fulfilling and rewarding lives, the strategy for adults with autism in England: an update. This is the Government’s update to the 2010 adult autism strategy Fulfilling and Rewarding Lives. Think Autism sets out the DH's programme to improve the lives of people with autism, primarily through taking actions that will support local authorities, the NHS, other public services and their partners with their local implementation work. Think Autism has a new focus on building communities that are more aware of and accessible to the needs of people with autism. It also looks at promoting innovative local ideas, services or projects that can help people in their communities and how advice and information on services can be better joined up. There is a package of funding of £4.5m which DH will be using to take forward themes in the strategy update.

MHN2014: the future of mental health. This paper discusses what challenges mental health services face and what these challenges might mean for the future of the nation's mental health.

Personal Health Budgets: including people with learning disabilities. This report commissioned by Think Local Act Personal (TLAP) focuses on personal health budgets for people with learning disabilities and autism. It shows that when people and their families get the chance to write their own individual plan and have control over the money available for their support, it can lead to better support for individuals who may otherwise end up in high cost, poor quality residential services. The report contains examples from around England of NHS CHC teams and people from specialist learning disability services working together to better integrate health and care support for individuals. There are also case studies of people experiencing the benefits of receiving a personal health budget or joint health and social care budget.

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.

Supporting recovering in mental health services: quality and outcomes. 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 – International aspects. Solicitors are increasingly finding themselves faced with cases in which a client who has moved overseas, or owns assets abroad, loses mental capacity. Often, the solicitor's practice does not routinely deal with international issues. A new Law Society practice note gives some initial practical assistance on Lasting Powers of Attorney for Property and Financial Affairs (LPAs) and Enduring Powers of Attorney (EPAs), as well as some aspects of deputyship.

Consultations
Quality Premium: development of additional mental health indicators. The quality premium rewards CCGs for improving the quality of services they commission and for associated improvements in health outcomes and reducing inequalities. NHS England is seeking suggestions on possible future mental health measures. These could be directly about mental health outcomes or could cover wider issues where it is known that people with mental health needs have poorer outcomes, such as physical health needs or employment,

Review of the operation of sections 135 and 136 of the Mental Health Act 1983 in England and Wales. The operation of ss.35 and 136 of the Mental Health Act 1983, which give the police powers to temporarily remove people who appear to be suffering from a mental disorder, and who need urgent care to a 'place of safety' so a mental health assessment can be carried out and appropriate arrangements made for their care, is being reviewed by the Government in a new consultation exercise. Responses should be received by 3 June 2014.

News
The Court of Protection has made it clear that social workers are among those who can submit evidence of assessments of people’s mental capacity under the Mental Capacity Act 2005. The change is reflected in the revised version of the COP3 form, which states, for the first time, that the court will accept evidence of social workers.

Mental health teams in police stations and courts scheme goes live. A trial scheme testing a new model of Liaison and Diversion (L&D) is launched this week in ten locations across England. The scheme will fund mental health professionals in police stations and courts, to ensure people with mental health conditions and learning disabilities are recognised and get the right treatment promptly.

Bevan Brittan Articles
Deprivation of liberty – What does the landmark judgment in Cheshire West mean? The Supreme Court handed down its landmark judgment in the cases of P v Cheshire West and Chester Council; P & Q (aka MIG and MEG) v Surrey CC [2014] UKSC 19 on 19 March 2014. The court found that P, MIG and MEG were all deprived of their liberty and that in considering the concrete situation of a person who may be deprived of his liberty attention should focus in particular on whether the person concerned is under continuous supervision and control and is free to leave.

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
Transforming primary care: safe, proactive, personalised care for those who need it the most. This guidance sets out plans for more proactive, personalised and joined up care, including the Proactive Care Programme, providing the 800,000 patients with the most complex health and care needs with a personal care and support plan; a named accountable GP; a professional to coordinate their care; and same-day telephone consultations. The plan builds on the role of primary care in keeping patients well and independent. It explains how professionals across the healthcare system can work together to transform care to become more proactive and tailored to patients’ individual need.

Primary medical care functions delegated to clinical commissioning groups: Guidance. NHS England has the power to direct a CCG to exercise any of its functions relating to the provision of primary medical care services. This guidance sets out the arrangements for CCGs to commission out-of-hours primary medical services for their area.

Prime Minister’s Challenge Fund. NHS England has announced that 20 GP collaborations have been awarded funds to run pilots for one year, to transform primary services in their areas and improve the patient experience, funded by the £50m Prime Minister’s Challenge Fund.. A wide variety of innovative ideas are being trialled, including: opening 8am-8pm on weekdays and weekends; better use of telecare and health apps; more ways for patients to book appointments including e-mail and Skype; and new services like care coordinators, to manage care for patients with complex needs.

Your health, your way: Your NHS guide to long-term conditions and self care. NHS Choices guide with advice and practical information for those living with a long-term condition. It includes a simple self-assessment tool.
Contract changes 2014/15. NHS Employers, NHS England and the General Practitioners Committee of the BMA, have published documents to support GP practices and NHS England area teams to implement the 2014/15 contract changes. They include the amended statement of financial entitlement, 2014/15 GMS contract guidance and audit requirements (including core contractual requirements and enhanced services) and the 2014 DES and APMS directions. There is also a letter about implementing the 2014/15 GP contract.

Dental contract uplift and efficiencies 2014/15. This information sets out the Secretary of State’s determination on dental contracts and agreements for 2014/15 and the associated NHS England dental quality and productivity measures.

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
GP boundary pilot fails to attract patients. The BMA reports that a pilot exercise allowing patients to register with GPs outside of their areas has failed to allay BMA concerns. Around a quarter of surgeries in the choice of GP practice scheme did not receive any patient registrations during the 12-month government pilot. The BMA GPs' committee said the results showed there was very low patient interest in the scheme and failed to ease fears that the move could fragment patient care.

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

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Procurement

Publications/Guidance
Procurement transparency. The DH has issued guidance to all NHS provider organisations on the requirement in the 2014/15 NHS Standard Contract that ‘the Provider must comply with Transparency guidance if and when applicable’. It advises on the actions to be taken to increase openness and clarity about NHS procurement, covering: opening up public procurement; being transparent about expenditure; and sharing expenditure data.

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.

Actions on procurement transparency for NHS provider organisations from April 2014. This document provides guidance to all NHS Foundation and Non-Foundation trusts on the actions to be taken to increase openness and clarity about NHS procurement. Although this document is not applicable to independent sector providers of NHS healthcare, such providers may wish to consider the benefits of adopting the guidance in this document.

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

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Public Health

Publications/Guidance
Annual Report of the Chief Medical Officer: Surveillance Volume, 2012: On the state of the public’s health. In her latest annual report, the Chief Medical Officer, Prof Dame Sally Davies, looks at some of the big issues she identified in her last surveillance report. She has invited experts to examine these issues in detail and explore them further. As well as presenting data and evidence, the CMO also comments on overarching trends. This year, she highlights concerns that being overweight is becoming normal as the majority of the adult population is overweight or obese. Her concern is based on data showing that, taking into account average height and weight, the average man and woman in England is overweight. This brings with it an increased risk of diabetes, strokes and other health problems. The report highlights studies that show some people who are overweight believe they are ‘about the right weight’. Other key areas of concern are: deafness and blindness and dementia; alcohol; and walking and cycling.

School nursing: Public health services. The DH has published guidance to support effective commissioning of school nursing services to provide public health for school aged children. It also explains how local school nursing services can be used and improved to meet local needs.

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.

Contraceptive services with a focus on young people up to the age of 25. This guidance recommends that doctors, nurses and pharmacists provide information about the full range of contraceptives available, including emergency contraception and long-acting reversible contraception, and the benefits and side effects for young people up to the age of 25. It also states that all young people in England should be given access to contraception and advice at convenient locations so no-one is denied services because of where they live.

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 accountability arrangements.

News
Raiding the public health budget. The BMJ claims that an investigation reveals that local authorities across England are diverting ringfenced funds for public health to wider council services to plug gaps caused by government budget cuts, and that public health staffing in some parts of the country is being scaled back to save money. But the BBC reports that the LGA has said that the report was "scaremongering".

New system leaders share progress and learning ahead of one-year anniversary. The NHS Confederation has published practical new resources distilling lessons learned during Health and Wellbeing Boards’ first full year of operation. The slide packs and videos share valuable learning and insight from HWBs across England on their development as system leaders, and explore three key themes: facilitating shared ownership; working across boundaries; and the future of system leadership. The videos also capture HWB members’ reflections on progress made in developing shared leadership within their board, working with other HWBs, and what boards could consider doing next as they develop.

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

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Regulation

Publications/Guidance
Regulation of health and social care professionals - Summary of responses. The need for a new legal framework introducing a clear and consistent way of enabling regulators to uphold their duty to protect the public has been recommended by the Law Commission in its new draft Bill for the Regulation of Health and Social Care Professionals. The draft Bill also seeks to reform the role of the government in professional development, and recommends the government is given default powers to intervene in cases of regulatory failure.

Regulation of health care professionals and regulation of social care professionals in England. This project is a review of UK law relating to the regulation of health care professionals, and in England only, the regulation of social workers.

Provision for fees. This document outlines the registration fees that health and social care services will be charged by CQC from 1st April 2014. As the regulation of services is undergoing changes this year, there will only be minimal changes to fees this year.

2013 accountability hearing with the General Medical Council: Tenth Report of Session 2013-14: Report, together with formal minutes relating to the report. A Health Committee report on the General Medical Council (GMC) concludes that the GMC must: seek to better understand what has driven the rise in complaints that it has received and the detail behind them; and formally assess whether revalidation for all licensed doctors is making a significant contribution to the improved practice of doctors.

2013 accountability hearing with Monitor. The model of care provided by the NHS is not changing quickly enough, leading to pressures which threaten the financial stability of individual providers and the quality of care provided, says a report of the Commons Health Committee's annual inquiry into the work of NHS regulator Monitor. The report concludes that, under the current funding regime, the NHS will only be able to deliver the care required from it by significant innovation in the provision of health care, but insufficient change has yet been made

Evaluating the Care Quality Commission’s acute hospital regulatory model: emerging findings. The CQC commissioned The King's Fund and Manchester Business School to explore whether the new approach to inspections provides a better analysis of the performance of an acute hospital. The full report is due to be published in May 2014.

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.

Review of the regulation and governance of NHS charities: Government response to consultation. Summarises the responses received to the November 2012 consultation on proposals to revise the governance of NHS charities. As the majority of respondents supported the principle of the proposals for the transition of NHS charities to independent Charity status, the DH believes that it is appropriate to allow those who wish to follow this course to proceed subject to the appropriate safeguards and process being followed. Among other things this will mean they can, if they choose, appoint a dedicated board of trustees with the expertise to develop the charity. At the same time DH will assure that those organisations that wish to retain the status of an NHS Charity may do so. A layer of central bureaucracy is also being removed because in future where NHS charities decide to follow this path neither the DH nor ministers will be involved in appointments to the charities and fund transfers.

Risk assessment framework for independent sector providers of NHS services. This document describes how Monitor carry out their role to ensure the continued delivery of essential healthcare services at independent providers of commissioner requested services. 

Consultations
Introducing the statutory duty of candour. The DH is seeking views on proposals for a duty of candour that will require all health and adult social care providers registered with CQC to be open with people when things go wrong. The draft Health and Social Care Act 2008 (Duty of Candour) Regulations 2014 would impose a specific and detailed duty of candour on all providers where any harm to a service user from their care or treatment is above a certain harm threshold. It will mean providers must notify the patient about incidents where ‘significant harm’ has occurred and provide an apology. This will be a legal requirement and CQC will be able to take enforcement action when it finds breaches. The proposals are open for consultation until 25 April 2014.

Strengthening corporate accountability in health and social care: Consultation on the fit and proper person regulations. Seeks views on proposals to introduce a new registration requirement that all directors of providers registered with the CQC must meet a new fit and proper person test. The CQC will be able to insist on the removal of directors that fail this test. It follows a previous consultation on proposals to hold providers to account where there are serious failures in care. The consultation closes on 25 April 2014.

How the CQC inspect, rate and regulate health and social care services - a consultation. The CQC are asking people who use and run health and adult social care services as well as the public to gather opinion on their plans for regulating, inspecting and rating care services. The consultation will be open until 4th June 2014.

Bevan Brittan Articles
Competition Law - new rules for mergers. The NHS has been trying to get to grips with a new set of regulators and rules in particular in connection with mergers of NHS organisations and the way in which the rules can apply not merely to full mergers but also to transfers of individual services.

Competition Law news round-up A brief overview of competition law news, brought to you by Laura Brealey and Robyn Sandilands. Here we cover the OFT's final decision in its investigation into the supply of healthcare products and the final report by the CMA on the Private Healthcare Market.

Recent activity of Monitor's Cooperation and Competition Directorate. Monitor's Cooperation and Competition Directorate has now been up and running for a year having taken over from the NHS Cooperation and Competition Panel in April 2013. We take a look back at some of the Directorate's activity over the past year.

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

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General

Publications/Guidance
NHS 2014 to 2015 Choice framework. This framework brings together information about patients’ rights to choice about their health care, where to get more information to help make a choice, and how they can complain if they have not been offered choice. The 2014 to 2015 version reflects changes to expansions of patients’ rights to choice in the areas of: general practice; mental health; and personal health budgets. The NHS Choice Framework will be updated annually, as choice rights expand to new services and patient groups.

How is the NHS performing? This is the eleventh in a series of quarterly monitoring reports which aims to provide a regular update on how the NHS is coping as it grapples with the evolving reform agenda and the more significant challenge of making radical improvements in productivity. It highlights that the NHS has had no real rise in spending between 2010/11 and 2013/14, yet despite this, in broad terms the NHS has continued to provide services to a growing population and to maintain the quality of those services. However, our survey finds that there is deepening pessimism about the ability of the NHS to make ends meet financially, particularly in 2015/16.

Helping health and care services manage difficult patient behaviour. This document provides guidance for adult health and social care staff to develop a culture where restrictive interventions are only ever used as a last resort.

Survey suggests hospital experiences improving. The results of the national survey of hospital patients, published by the CQC, suggest that people are generally having a better experience in hospital compared to a year ago.

An alternative guide to the urgent and emergency care system in England. A&E is often seen as a service in crisis and is the focus of much media and political interest. But A&E is just the tip of the iceberg – the whole urgent and emergency care system is complex, and surrounded by myth and confusion. This animation gives a whistle-stop tour of how the system fits together and busts some myths about what’s really going on – explaining that the underlying causes go much deeper than just A&E and demand a joined-up response across all services.

NHS and social care: public perceptions 2013. The Department of Health commissions a ‘tracker’ survey to explore public attitudes towards, and perceptions of, the NHS and social care services. These reports present the findings from the spring and winter 2013 surveys. The spring 2013 wave brought in new questions on whether people are treated with compassion when they use NHS and social care services and whether it is easy to give feedback on NHS services.

A call to action: transformative ideas for the future NHS. Monitor, NHS England and the Trust Development Authority have published this document in a bid to encourage debate about the about how the NHS can change its models of care to provide better services in the future. It states that the NHS needs to change and it needs to do it now if we are to meet the quality and efficiency challenges it faces. This report outlines just the sort of potentially transformative options that local health economies may wish to consider.

NHS TDA and DH framework agreement. The Department of Health and the NHS Trust Development Authority have jointly signed a framework agreement that sets out the relationship between the two organisations. The agreement covers roles and responsibilities and lines of accountability, and describes how the DH and the Authority will work together:

Telehealth and telecare. The UK’s elderly population is growing and with it the number of people with long-term health problems. This is putting pressure on the health and social care systems. Increased use of technology such as telehealth and telecare may help to improve quality of care and reduce costs. This note describes current UK telehealth and telecare initiatives and the role they may play in delivering future care.

News
Cutting-edge drugs to be fast-tracked to patients. Severely ill patients with life-threatening and seriously debilitating conditions will be offered the chance to try ground-breaking new medicines years before they would previously have reached them according to an announcement made by the DH. The Early Access Medicines scheme will allow doctors to make innovative and promising drugs available to patients as soon as the Medicines and Healthcare Products Regulatory Agency has said the benefits outweigh the risks following an initial scientific assessment.

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

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