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 Public Health
Finance Regulation
Foundation Trusts General
 Governance

Care

Publications/Guidance
Transforming urgent and emergency care services in England: Update on the Urgent and Emergency Care Review. This update sets out what the Review has been doing since NHS England last reported in November 2013. It reports on progress with NHS England’s work with local commissioners and the development of their five year strategic and two year operational plans as well as updates on planning to develop demonstrator sites to trial new models, including the new NHS 111 service specification.

Community nursing programme: professional pathway for community nurses. Guidance to help community nurses work more collaboratively with other key professionals and partners to deliver improved quality of life and health outcomes for both the carer and the people they care for. The pathway focuses on the district nurse and general practice nurse contribution; however, the principles are transferable to other professionals within community settings. Community nursing services cannot support carers in isolation, and this pathway aims to ensure community nurses can identify, assess and act on issues facing carers and work effectively with other agencies to improve support. It focuses on the health and wellbeing needs of carers; it outlines the challenges community nursing services face and opportunities for improvements in support that can be achieved through an integrated approach.

Consultations
Reimbursement of urgent and emergency care: options for reform. NHS England’s review of urgent and emergency care described a vision for a new way to deliver urgent and emergency care as a co-ordinated system. NHS England and Monitor consider that a consistent approach to payment for all providers in the system that recognises the ‘always-on’ nature of urgent and emergency care services (UEC), and where individual providers share in the financial effects of their actions on the system as a whole, would be a powerful spur for the system to provide better quality, co-ordinated care for patients within the budget available. This discussion paper sets out their current thinking on options for reforming the UEC payment approach. it looks at: the case for reforming the urgent and emergency care payment approach; a suggested payment approach, including the supporting evidence and analysis; preliminary options for implementing a new payment approach to support improved delivery of urgent and emergency care; and the next steps for Monitor and NHS England’s work. The closing date for comments is 9 September 2014.

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

 

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
Selected summaries of investigations by the Parliamentary and Health Service Ombudsman: Volume 1, report 1 (February and March 2014). The Parliamentary and Health Service Ombudsman has for the first time disclosed online details of failures by public services that have had major impacts on people's lives, including death and financial hardship. The report, the first in a series of quarterly digests, details 81 investigations completed by the Ombudsman.

Patient safety in private hospitals: the known and unknown risks. This report argues that patients undergoing operations in private hospitals may be put at risk from inadequate equipment, lack of intensive care beds, unsafe staffing arrangements, and poor medical record-keeping. It reveals that over 800 people have died unexpectedly in private hospitals in England during the last four years and calls for private hospital data to made publicly available.

Consultations
Reviewing how we deal with concerns about doctors: A public consultation on changes to our sanctions guidance and on the role of apologies and warnings. The GMC has issued a consultation on a wide range of proposals to update the guidance given to fitness to practise hearing panels run by the Medical Practitioners Tribunal Service (MPTS). These panels decide what action should be taken to deal with doctors who do not meet professional standards. The role of apologies and warnings in fitness to practise process is also being reviewed. The proposals include:
Imposing sanctions where doctors make serious clinical errors, even where they have successfully retrained and improved their practice, if they failed to heed concerns and take steps to protect patients sooner.
Whether panels should require a doctor to apologise where he or she has previously failed to do so.
Imposing more serious action in cases where doctors fail to raise concerns about a colleague’s fitness to practise or take prompt action where a patient’s basic care needs are not being met.
Improved public protection in cases where a doctor has bullied colleagues and put patients at risk or discriminated against others in their professional or personal life.
The consultation closes on 14 November 2014.

News
NHS Board fined £50,000 for serious safety breaches after patient suicide. NHS Ayrshire and Arran Health Board has been fined for serious safety breaches after a mental health patient was able to hang herself. A investigation by the Health and Safety Executive (HSE) found a number of failings led to the death, including a failure to remove window restrictors, which had been identified as a risk of being used as a ligature point. The NHS Board was fined £50,000 after pleading guilty to breaching the Health and Safety at Work etc Act 1974, s.3(1).

NHS Trust fined for putting workers at risk of asbestos exposure. West Hertfordshire Hospitals NHS Trust has been fined £55,000 and ordered to pay £34,078 in costs after it was found likely to have exposed workers to potentially fatal asbestos material for more than a decade at its three hospitals in Hertfordshire. The Health and Safety Executive (HSE) investigated and brought a prosecution for health and safety breaches, including a major failure to manage health risks to the Trust’s employees or to provide training in avoiding exposure.

The NHS LA has published a document called Checklist for Safety Improvement Plans.

Berwick one year on: NHS England’s advances in patient safety. Dr Mike Durkin, NHS England’s director of patient safety, has reported on progress since Don Berwick’s review of patient safety in the NHS, published this time last year.

The NHS LA has updated their Sign up to Safety document.

Keep Safe is the newsletter from the NHS Lone Worker Protection Service.

Bevan Brittan Updates
The New Fundamental Standards The fundamental standards set out in the draft Regulations will apply across the whole health and social care sector from April 2015. The need for new, fundamental, standards was one of the cornerstones of Sir Robert Francis QC's recommendations in the Mid Staffs Inquiry. Robert Francis' findings were that CQC's current Essential standards of quality and safety are unclear and overly bureaucratic. In their place, Robert Francis recommended the introduction of a new set of standards which should be both clear and properly enforced.

Bevan Brittan Events

CTG Masterclass (cardiotocograph interpretation) Medical Seminar Bristol office 18 September 2014 : 09:15 - 16:45 (registration opens at 08:30). The course covers the pathophysiology of CTG, NICE guidance, acid-base balance, the technology behind CTG and ST-Analyser (STAN) together with an overview of clinical cases and medico-legal learning points. The course will be led by experts in the field including Mr. Edwin Chandaharan and his research team from St George’s Hospital, London.

Improving Safety & Outcomes in the Delivery Suite – the Role of ‘Human Factors’ Medical Staff Training Bristol office. 10 October 2014 : 09:30 - 16:30 (registration opens at 08:45) This Birth 2 UK Training course will focus on the introduction of non-technical skills for proffessional members of acute maternity teams.

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

 

Commissioning

Publications/Guidance
More information sharing needed to improve controlled drugs management. Systems which enable the secure gathering, sharing and recording of intelligence about controlled drugs concerns can be improved, says the Care Quality Commission (CQC) in a report on the management of controlled drugs. The CQC has said it will contribute to the wider sharing of information by passing on concerns around medicines management found during inspections to NHS England and controlled drugs accountable officers (CDAOs). The report's recommendations to support the role of CDAOs include stronger links with clinical commissioning groups and the sharing of best practice.

Complying with Monitor’s integrated care requirements. Online guidance to assist providers and commissioners of healthcare services and health and wellbeing boards to comply with their integrated care obligations. It also explains the relationship between these obligations and the other rules that Monitor enforces.

Payments: NHS Commissioning Board to dental providers. Payments are made to dental providers under a General Dental Services (GDS) contract or Personal Dental Services (PDS) agreement. The amount of money is decided in line with the relevant Statement of Financial Entitlement (SFE). This page links to the GDS and PDS SFEs 2013.

The maternity pathway payment system: supplementary guidance. The maternity pathway payment system was introduced in April 2013 to reduce variance in the way organisations describe and record antenatal and postnatal care; encourage more proactive care, delivered closer to home; and encourage a more woman-focused approach to maternity care. This guidance outlines which services are included in the maternity pathway payment and explains how to implement the payment system.

Special measures – One year on. Most of the NHS Trusts put into special measures in July 2013 had shown significant improvement by the time of an inspection by the Care Quality Commission (CQC) eight to 10 months later, says a joint report from NHS regulator Monitor, the CQC and the NHS Trust Development Authority (NHS TDA). Some Trusts have been judged ready to exit special measures, while others need to make further progress to being 'good' within a reasonable timeframe. The report gives an update on progress made at 11 NHS Trusts and Foundation Trusts put into special measures.

CMA guidance on the review of NHS mergers: Summary of responses to consultation. A Competition and Markets Authority (CMA) publication sets out a summary of the key issues addressed in the responses received following the consultation on the CMA's draft guidance concerning its review of NHS mergers. The CMA also sets out its views on those responses and explains any amendments and additions to the final CMA NHS review guidance.

Supporting NHS providers considering transactions and mergers. Monitor has published a suite of resources for providers on how its new approach applies to joint ventures and major investments as well as mergers and acquisitions. It is urging NHS providers considering a merger to contact Monitor early in their planning to ensure proposals work well for patients. Monitor will then provide expert support at an early stage to help NHS foundation trusts understand whether a particular merger is the best way forward and makes sense from quality, operational, financial and (where relevant) choice and competition perspectives.

Getting it right for children & young people (including those transitioning into adult services):: a report on CQC’s new approach to inspection. CQC has published a report by Dr Sheila Shribman that looks at how CQC inspects hospital services for children and young people including stand-alone specialist children’s hospitals. The report finds that CQC’s new approach to inspection provides a real opportunity to drive up the standard of care for children and young people and reduce unacceptable variations and it sets out how CQC can begin to achieve this, focusing on what CQC can realistically be expected to deliver. The report makes 73 recommendations, a number of which formed the basis of two successful pilot inspections of specialist children’s hospitals (Sheffield and Alder Hey) that took place in May - June 2014. All the recommendations have now been considered and CQC accepts in whole or in part 70 of these recommendations. CQC has deferred making a decision on the remaining three.

Commissioning third sector counselling: valuing and enabling services. This report highlights the contribution the third sector can and does make to NHS service provision, while identifying the challenges the sector faces and support it needs to effectively survive the transition from grant funding to tendering. The report is relevant to third sector organisations, their local partners and commissioners in the NHS and local authorities.

Technical requirements for 2014/15 GMS contract changes. NHS Employers has published version four of the technical requirements for 2014/15 GMS contract changes. These set out the detailed technical requirements for area teams and practices that hold a GMS contract and for all practices offering enhanced services and vaccination programmes nationally, commissioned by NHS England. Version four includes additional information about the ‘avoiding unplanned admissions enhanced service’ as well as the technical detail supporting the ‘childhood seasonal influenza’ and ‘routine seasonal influenza and pneumococcal’ vaccination programmes, including Read codes.

National Health Service Commissioning Board: Annual Report and Accounts 2013 – 14. NHS England has published its first Annual Report and Accounts setting out its achievements in the last year and its aspiration for 2014/15. The report features key milestones since its inception in April 2013, the annual accounts and a Directors’ report.

Is access to surgery a postcode lottery? This Royal College of Surgeons’ report examines whether new commissioners are rationing essential clinical treatments. It compares CCGs’ commissioning policies against the clinical evidence base, including guidance from NICE, the RCS and surgical specialty associations, for a number of major surgical operations that account for more than 177,000 of the total number of procedures carried out on the NHS. It finds that CCGs are imposing arbitrary referral restrictions and denying access to vital surgical procedures, which can significantly improve the quality of life for patients. The paper highlights that rationing access to treatment can impact on the outcome of surgery. It says that referrals to treatment should be driven by need based on clinical assessment and must not be compromised by financial pressure. It recommends that the Government and NHS England need to review what further action is required to ensure the NHS is providing equitable access to high quality surgical care. 

Consultations
Reimbursement of urgent and emergency care: options for reform. Monitor and NHS England set out their current thinking on options for reforming the urgent and emergency care payment approach.

Bevan Brittan Updates
Developing your Better Care Fund. Bevan Brittan is working with a number of local authorities and CCGs in developing their Better Care Fund including section 75 agreements to support the pooled fund. Click here to view our guide to Delivering Better Care. We'd be pleased to come to meet you to discuss approaches being developed elsewhere and how we could support you in implementing your Better Care Fund arrangements.

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

 

Employment/HR

Publications/Guidance
Model process flowchart for raising concerns. NHS Employers has published a model process flowchart poster that helps in raising staff awareness about how to raise concerns and in creating an open and transparent culture. it can be adapted to include local raising concerns or whistleblowing policy and the organisation's own logo.

Staff Friends and Family Test – early experiences briefing and free workshop A new briefing document shares HR directors’ early experiences of the Staff Friends and Family Test. The resource was created following discussions with HR directors who shared their ideas and emerging lessons about the test, which has been in place since April 2014. A free workshop on 17 September will provide further opportunity for organisations to share experiences and develop ideas for implementation. Download the briefing and access online booking for the workshop on the resources page.

Everything you need to know about sickness absence. This online tool from NHS Employers is designed to help managers support staff. It includes a step-by-step guide for what to do when a staff member calls in sick, practical advice on some of the common reasons for sickness absence, as well as information on what to do if staff are frequently off sick.

Ethics in practice – Promoting ethical standards in public life. Lord Nolan in his First Report of the Committee on Standards in Public Life in 1995 was clear that an essential part of the necessary guidance and education on ethical standards was induction training. In this report the Committee revisits the subject of ethics in induction. It notes good practice, highlights areas where standards are at risk, and identifies where improvements could be made to embed ethical standards more effectively. It finds that induction is essential to ensure that public office holders are aware of the standards expected of them, and so ethical standards need to be included in the induction arrangements for all those public life.

A workforce fit for the future: Working together to improve the delivery of urgent and emergency care. This briefing brings together the learning from two workshops held by the NHS Confederation’s Hospitals and Urgent and Emergency Care Forums and hosted by PwC, which explored how to develop a more flexible, integrated workforce to deliver urgent and emergency care.

Guidance from the NHS LA on Taking a doctor to a capability hearing following a referral to the National Clinical Assessment Service (‘NCAS’). The High Court case of Chakrabarty v Ipswich Hospital NHS Trust gives NHS employers clear guidance on the circumstances in which they can proceed to a capability hearing.

The NHS pension scheme for England & Wales 2015: update on scheme reforms and contribution rates. This document updates scheme members and employers on NHS pension scheme reforms ahead of a formal regulatory consultation. It sets out the proposals for the detailed design of the NHS Pension Scheme for England and Wales 2015 and transitional arrangements for existing members.

A guide to eligibility for criminal record checks. Updated guidance on the types of jobs and roles that are eligible for a criminal records check, to support registered bodies' decision making when carrying out pre-recruitment checks following an offer of employment, including volunteering roles and applications for specific licences. The DBS has also published updated child and adult workforce guides that help identify the type of workforce that an applicant will be working in.

Whistleblowing. This report from the HC Public Accounts Committee finds that although whistleblowing is an important source of intelligence to help government identify wrongdoing and risks to public service delivery, many concerns go unreported and the intelligence that does exist is not routinely collected and shared. It states that it is essential that employees have trust in the system for handling whistleblowers, and confidence that they will be taken seriously, protected and supported by their organisations if they blow the whistle. However, far too often whistleblowers have been shockingly treated, and whistleblowers who have come forward have had to show remarkable bravery. Departments’ own attempts at changing whistleblowing policy and processes for the better have not been successful in modifying a bullying culture, or in combating unacceptable behaviour, such as harassment of whistleblowers, within their organisations. The lack of cross-government leadership on whistleblowing has resulted in an inconsistent approach across departments. The Committee welcomes the Secretary of State’s recent announcement that Sir Robert Francis QC will lead an independent policy review into whistleblowing and creating a culture of openness and honesty in the NHS.

An independent review into creating an open and honest reporting culture in the NHS. This review was announced on 24 June 2014 by the Secretary of State for Health and is led by Sir Robert Francis QC. Sir Robert wants to hear from as many people as possible who have experiences, both good and bad, of raising concerns in the NHS. It will gather information in a number of ways including an invitation to share experiences and ideas, seminars and research projects. A report containing the findings is planned for November 2014.

Consultations
Code of conduct for healthcare support workers – a consultation. Could the code of conduct for healthcare support workers and adult social care workers be applied to all patient-facing roles? Skills for Health has received anecdotal feedback to support this view, since the code was published in March 2013. If you have views on this that you would like to share, an online consultation is open until 31 October to gather your feedback. Find out more and input into the consultation.

Bevan Brittan Updates

Employment news round-up, July 2014. Our round-up of news items of interest to those working with employment law is reported this month by Alastair Currie and covers: disciplinary sanctions on appeal (no right to impose a harsher sanction); a summary of the government's latest whistleblowing plans; details of the top cases dealt with by Acas; the new flexible working form from BIS and an update on overtime and holiday payments. Plus we detail our forthcoming events.

Severe obesity as a disability . Does EU law protect obese employees from discrimination? Victoria McMeel reports on a recent Opinion provided by the Advocate General which confirms that the effects of severe obesity may mean that disability legislation comes into play.

Zeroing in on zero hours. Zero-hours contracts have attracted much media attention recently, with the latest development being Vince Cable's announcement last month that the government intends to legislate on this political 'hot potato', and will also provide new guidance. Julian Hoskins reports on the government's attempts to retain the flexibility that zero-hours contracts offer, whilst ensuring that these arrangements are not abused. 

If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge

 

Finance

Publications/Guidance
Help for NHS to recover costs of care from visitors and migrants. These documents published by the Department of Health include template letters, posters and guidance to help NHS trusts manage overseas visitors and migrant charging.

Publication of Monitor data. Monitor have made all foundation trusts’ finances available, having released over a million lines of financial data including staff costs, income, and private finance initiative payments. The data is available to download for free from the regulator’s website and under the Government Open Licence via data.gov.uk.

Centre for Health Economics (CHE) Testing the bed-blocking hypothesis: does higher supply of nursing and care homes reduce delayed hospital discharges? Hospital bed blocking occurs when hospital patients are ready to be discharged to a nursing home but no place is available, so that hospital care acts as a more costly substitute for long-term care. This paper investigates the extent to which higher supply of nursing home beds or lower prices can reduce hospital bed blocking. It uses new local authority level administrative data from England on hospital delayed discharges in 2010-13. The results suggest that delayed discharges do respond to the availability of care-home beds but the effect is modest: an increase in care-homes bed by 10% (250 additional beds per local authority) would reduce delayed discharges by about 4%-7%. It also finds strong evidence of spillover effects across local authorities: higher availability of care-homes or fewer patients aged over 65 in nearby local authorities are associated with fewer delayed discharges.

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

 

Foundation Trusts

Publications/Guidance
Publication of Monitor data. Monitor have made all foundation trusts’ finances available, having released over a million lines of financial data including staff costs, income, and private finance initiative payments. The data is available to download for free from the regulator’s website and under the Government Open Licence via data.gov.uk.

Model election rules. Revised rules 2014 for use in elections to Foundation Trust councils of governors

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

 

Governance

Publications/Guidance
DH and NHS BSA framework agreement. This document outlines out how the DH and the NHS Business Services Authority will work together, setting out roles, responsibilities, governance and accountability arrangements.

Consultations
Guidance for NHS bodies on the fit and proper person requirement for directors and the duty of candour. Consultation on whether proposed guidance clarifies what NHS bodies need to do to meet the fit and proper person requirement for directors and fulfil their duty of candour.


Guidance for all providers of health and adult social care services on meeting the fundamental standards, and on CQC’s enforcement powers. Guidance to help all services meet fundamental standards, including the fit and proper person requirement for directors and duty of candour, and on guidance about our enforcement powers.

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

 Information Sharing Publications/Guidance
Data sharing between public bodies. This Law Commission report looks at whether there are inappropriate legal or other hurdles to the transfer of information between public bodies and between public bodies and private bodies engaged in public service delivery. It also considers whether law reform would mitigate or resolve the problems identified. It concludes that there are problems with the form of the law relating to data sharing that could usefully be addressed. It recommends that a full law reform project be carried out by the Law Commission of England and Wales, together with the Scottish Law Commission and the Northern Ireland Law Commission, in order to create a principled and clear legal structure for data sharing, which will meet the needs of society. The scope of the review should extend beyond data sharing between public bodies to the disclosure of information between public bodies and other organisations carrying out public functions.

Multi agency working and information sharing project. This Home Office report sets out findings from a project about multi-agency information sharing models, such as the Multi-Agency Safeguarding Hub (MASH), that aim to improve the safeguarding response for children and vulnerable adults through better information sharing and safeguarding responses. It finds that multi agency working is key to early and effective identification of risk, improved information sharing, joint decision making and coordinated action. The document gives examples of how agencies are working together to stop abuse before it occurs and identifies key barriers to information sharing. It also concludes multi-agency approaches do not supersede a single agency’s duty to identify, protect and support a child or vulnerable person.

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

 

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
Special educational needs and disability – A guide for parents and carers. This guide explains how the system that supports children and young people with special educational needs and disabilities (SEND) works. It covers: the law and statutory guidance on which the system is based; places to go for help and further information; and details about changes to the system from 1 September 2014.

News
Analysis reveals mental health trust funding cuts. NHS mental health providers have slashed beds and staff levels as they cope with real term funding cuts and the soaring cost of sending patients hundreds of miles away for treatment.

Lasting powers of attorney will be easier and simpler for people to make, Justice Minister Simon Hughes announces. Following a public consultation, Transforming the services of the Office of the Public Guardian (OPG): Enabling Digital by Default, several improvements are being put into place: They include:
introducing LPA forms that are easier to complete and encourage people to say when they wish their LPA to come into effect. There will continue to be separate forms for health and welfare and property and finance issues;
extending the range of cases for which a reduced application fee applies to include applications which have to be made to the Court of Protection; and
continuing to put in place a new model for the supervision of court-appointed deputies that offers proportionate monitoring and support to different deputy types.

The mental health trusts with the biggest income cuts

The Autism Innovation Fund, national co-ordination of awareness and the champions network 2014/15. The DH is inviting local authorities, NHS, third sector, commercial and voluntary organisations to bid for a share of £1.2m of funding to improve local autism services and increase awareness. Funding will be awarded in two main areas: £1m for innovative projects to improve advice and support services and skills and employment services for those with autism, and £200,000 to help coordinate national work on awareness. The DH will issue information about capital funding to make local environments more autism friendly at a later date. The closing date for applications is 26 August 2014.

Care Act 2014: supporting people at risk of abuse or neglect. The DH has responded to the National Autistic Society's Careless campaign, in which the NAS raises concerns that the new system under the Care Act risks leaving many adults with autism unfed, unwashed and afraid to leave the house. The Government states that the draft guidance clarifies that where a local authority has started a safeguarding enquiry, and identifies a potential need for care and support, it should continue the needs assessment at the same time, and determine whether the person has eligible needs that it must meet. The Care Act and its associated regulations and statutory guidance have been developed with interested parties such as charities and local government. The Government welcomes the National Autistic Society’s comments, and these will be taken into account when the DH finalises the eligibility regulations and guidance.

Carstairs smoking ban upheld after hospital wins appeal. See also case judgment.

Bevan Brittan Events
Court of Protection Seminar
   Bristol 22 October 2014 : 10:00 - 13:00 (registration opens at 09:30) seminar will be followed by lunch.
  London 04 November 2014 : 10:00 - 13:30 (registration opens at 09:30) will be followed by networking lunch
  Birmingham 20 November 2014 : 10:00 - 13:30 (registration opens at 09:30) seminar will be followed by lunch. 
Bevan Brittan's Court of Protection Team will be running a legal update session, based in a practical context, on how to manage cases involving incapable patients. The session will discuss navigating a pathway through complex care-planning and legal proceedings; when to go to Court and preparation of evidence; managing the media and an update on recent caselaw, including the latest on deprivation of liberty. The session will include a practical workshop. 

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

 

Primary Care

Publications/Guidance
Primary care factors and unscheduled secondary care: a series of systematic reviews. This systematic review by the University of Bristol identifies studies that describe the influencing factors at primary care organisational level that impact on levels of emergency department attendance and emergency hospital admissions. It was undertaken in light of a recent King’s Fund report which suggested that emergency admissions among people with long-term conditions that could have been managed in primary care cost the NHS £1.42bn annually and that this could be reduced by 8–18 per cent through investment in primary and community-based services. It finds that patients who saw the same GP every time they attended their GP surgery were less likely to require emergency care. Other factors that affect admission and attendances at emergency departments are: how easy it is for patients to access GP surgeries and primary care providers; the distance the patients live away from the emergency department; and the number of confusing options patients had for accessing emergency care.

We are primary care. This cross-sector report urges the public and policy makers to look beyond general practice as the only alternative to hospital care. It highlights the political drive to address the extreme demand and fiscal pressure on the NHS by taking care out of hospital and into the community, but argues that this can only be successful if people have a clear understanding that GPs are not always the most appropriate first contact. It further argues that reducing demand is an imperative and that high street health specialists have a key role to play in tackling public health challenges like smoking and obesity.

Consultations
NHS performers list: changes to suspension regulations. Seeks views on proposed changes to how NHS England should respond when practitioners are suspended by an interim suspension order.

Consultation on indicative sanctions guidance, apologies and warnings. The GMC has issued a consultation on a wide range of proposals to update the guidance given to fitness to practise hearing panels run by the Medical Practitioners Tribunal Service (MPTS). These panels decide what action should be taken to deal with doctors who do not meet professional standards. The role of apologies and warnings in fitness to practise process is also being reviewed. The proposals include:
Imposing sanctions where doctors make serious clinical errors, even where they have successfully retrained and improved their practice, if they failed to heed concerns and take steps to protect patients sooner.
Whether panels should require a doctor to apologise where he or she has previously failed to do so.
Imposing more serious action in cases where doctors fail to raise concerns about a colleague’s fitness to practise or take prompt action where a patient’s basic care needs are not being met.
Improved public protection in cases where a doctor has bullied colleagues and put patients at risk or discriminated against others in their professional or personal life.
The consultation closes on 14 November 2014.

News
Public support wider access to GP record. A YouGov survey for EMIS Group finds that an overwhelming majority of the British public – 85% – want any healthcare professional treating them to have secure electronic access to key data from the GP record. The survey found that over half the population (58%) are unaware that hospital doctors are often unable to electronically access information from a patient’s GP medical record. Most A&E doctors either have to treat without it, or phone the GP to ask for information to be faxed through. It also found that almost two thirds of people (61%) are worried that failing to share vital information about their health with A&E doctors could result in treatment delays or potentially life-threatening medical errors.

Crisis hit GP surgeries forced to turn away millions of patients. Research by the Royal College of General Practitioners shows that GP surgeries are so overstretched because of the lack of investment in general practice, that in 2015 on more than 51.3m occasions patients in England will be unable to get an appointment to see a GP or nurse when they contact their local practice. It claims that the number of occasions during which patients have to wait more than a week to see their GP or practice nurse are set to go through the 50m barrier for the first time ever following successive rises in previous years: up from 41.9m occasions in 2013 and 46m occasions this year. If current trends continue, the College predicts that the total number of occasions when patients will have to wait more than a week to see a GP will rise to at least 58.2m in 2016.

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

 

Public Health

Publications/Guidance
Transfer of 0-5 children’s public health commissioning to local authorities. Planning and paying for public health services for 0-5 year olds will transfer from the NHS to local authorities in October 2015. This DH factsheet explains how and why the commissioning and associated funding are being transferred to local authorities.

Communicable disease outbreak management – Operational guidance. Public Health England has published a framework for the management of local and national outbreaks of communicable disease in England across the new public health structures in local authorities, NHS England and other relevant bodies. The guidance can also be used to support CCGs and NHS England Area Teams to make sure that commissioned services have robust plans for responding to an outbreak. Local Health Resilience Partnerships can also use it when putting together Emergency Preparedness Resilience and Response plans.

Amendments to the Human Medicines Regulations 2012 to allow the supply of salbutamol inhalers to schools – Consultation response. Sets out the Government's response to the May 2014 consultation on proposals to allow schools to hold stocks of asthma inhalers containing salbutamol for use in an emergency. It confirms that from 1 October 2014, schools can buy inhalers and spacers from a pharmaceutical supplier in small quantities, provided it is done on an occasional basis and is not for profit. The DH is also issuing revised non statutory guidance for the use of emergency salbutamol inhalers in schools.  

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

 

Regulation

Publications/Guidance
A fresh start for the regulation and inspection of primary care dental services. The Care Quality Commission (CQC) plans to carry out inspections of 10% of dental care services in England from Spring 2015, with a focus on services which are seen as 'cause for concern'. A CQC report on how the inspections will be carried out follows an increase in the number of complaints about dental professionals. The CQC is asking for comments and feedback from the public and healthcare groups to gain a better understanding of the risks within the primary care dental sector and, in particular, whether there is a link between the number of complaints and the actual risk to patient safety. There will be a formal consultation on the CQC's plans later in the year, which will include whether to provide ratings to dental practices after 2016.

Consultations
The performers lists and suspension. Seeks views on on what NHS England should do when a practitioner is subject to an interim suspension order. Doctors, dentists, optometrists and ophthalmic medical practitioners may not perform NHS primary care services in England unless they are included on a performers list. The regulator may issue an interim suspension order when there is a concern about a practitioner. At the moment, NHS England has to remove practitioners from a performers list if they have been suspended by their professional regulator under an interim order. The DH is consulting on two options for change: either NHS England may suspend practitioners from the performers list, or NHS England is required to automatically suspend practitioners from the performers list rather than remove them. The consultation closes on 25 September 2014.

The General Medical Council and Professional Standards Authority: Proposed changes to modernise and reform the adjudication of fitness to practise cases. The DH is seeking views on the draft General Medical Council (Fitness to Practise etc.) and the Professional Standards Authority for Health and Social Care (Referrals to Court) Order 2014 that changes the way the GMC and the PSA each carry out their regulatory functions, including: establishing the Medical Practitioners Tribunal Service as a statutory committee of the GMC; strengthening adjudication procedures; confirming the objectives of the GMC and its fitness to practise functions; and amending the grounds on which the PSA can refer fitness to practise panel decisions to the higher courts and introducing a new right of appeal for the GMC. The reforms are designed to increase the separation between the investigation of fitness to practise cases and adjudicating on what should happen in each case to enhance public and professional confidence in the system of medical regulation. The consultation closes on 25 September 2014.

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

 

General

Publications/Guidance
Who to screen for MRSA. Outlines a more focused, cost-effective approach to MRSA screening whilst concentrating on reducing infections and improving patient health.

Fears expressed over new type of doctor with less training. The Secretary of State for Health has announced that science graduates with two years' training, compared with the seven years it takes to become a doctor, are to qualify as a new class of medic known as "physician associates". They will carry out many of the same roles as junior doctors, including examining patients, ordering and interpreting tests, admitting and discharging to hospital and deciding on treatment.

NHS patient, visitor and staff car parking principles. These car parking principles provide clear and consistent ground rules that will help manage car parking provision in the NHS. They suggest the provision of concessions to groups that need them such as disabled people, frequent outpatient attendees or visitors with relatives who are gravely ill.

Help for NHS to recover costs of care from visitors and migrants. These documents published by the Department of Health include template letters, posters and guidance to help NHS trusts manage overseas visitors and migrant charging.

Assisted suicide – Commons Library Standard Note. A House of Commons Library Standard Note sets out the law surrounding assisted suicide, noting the case of Debbie Purdy, who in July 2009 obtained a House of Lords ruling ordering the Director of Public Prosecutions to formulate an offence-specific policy setting out the public interest factors the Crown Prosecution Service will consider when deciding whether to prosecute assisted suicide offences. It also notes the cases of Tony Nicklinson, Paul Lamb and AM and discusses the Assisted Dying Bill being considered by the House of Lords.

Keeping knowledgeable: how NHS chief executive officers mobilise knowledge and information in their daily work. This study aimed to investigate how chief executive officers of NHS trusts make decisions and mobilise particular knowledge and ‘evidence’ in the course of their day-to-day activities.

Initiatives to reduce length of stay in acute hospital settings: a rapid synthesis of evidence relating to enhanced recovery programmes. The National Institute of Health Research has published a study on the clinical effectiveness and cost-effectiveness of enhanced recovery programmes for patients undergoing elective surgery in acute hospital settings. The study sought to identify key success factors associated with enhanced recovery programmes in the UK. It concludes that there is consistent, albeit limited, evidence that enhanced recovery programmes may reduce length of patient hospital stay without increasing readmission rates.

Together for Health – A delivery plan for the critically ill: A delivery plan up to 2016 for NHS. This report, together with the Annual Report for the critically ill 2014 - setting the baseline, assesses the unmet need for critical care in Wales. The reports present an overview of NHS performance and identify other steps health boards need to take to improve care for patients. Both reports show the NHS must focus on reducing delayed transfers of care from critical care units in Wales and ensure all admissions are appropriate and in patients’ best interests to make best use of existing beds before investing in additional capacity. The assessment of unmet need for critical care report concludes that Wales may need another 73 critical care beds; however, both it and the annual report highlight the problem Wales currently experiences with delayed transfers from critical care units, which can result in the loss of up to 14 beds a year. The assessment report also says that until the rate of delayed transfers is reduced, creating additional capacity is unlikely to alleviate the problem. The annual report says it may be appropriate to concentrate critical care services in fewer hospitals than they are currently provided. This might mean bringing together intensive care services – level three care – but ensuring other hospitals maintain the facilities to resuscitate and stabilise critically ill patients before they can be transferred to an intensive care unit.

Focus on: A&E attendances. This report from the Nuffield Trust's QualityWatch programme, in partnership with the Health Foundation, looks at patterns of A&E activity, the nature of the increased demand and what has driven waiting times upwards. It uses de-identified person-level data to examine the influence of some of the most commonly proposed causes of pressure in A&E. The findings raise important questions about whether A&E has reached maximum capacity and what options the NHS has to address the situation.

Consultations
Refreshing the NHS Outcomes Framework 2015-2016. Seeks views on proposals and long term plans for the NHS outcomes framework that measures performance in the health and care system and presents a national-level narrative on how the NHS in England is working. The document asks specific questions on four main areas of the framework: Mental health; Children and young people; Health inequalities; and Patient experience/safety. The consultation closes on 12 September 2014.

Travelling to better health - Guidance for healthcare practitioners on working effectively with Gypsies and Travellers. Research shows Gypsies and Travellers suffer disproportionately when compared with the general population in relation to access to healthcare and health outcomes. Draft guidance from the Welsh Government, entitled 'Travelling to Better Health', aims to improve access to healthcare and health outcomes for Gypsies and Travellers and in so doing, help to improve the cultural competence of the healthcare practitioners working with them. A consultation on the guidance asks for comments by 30 October 2014.

Code of conduct for healthcare support workers – a consultation. Could the code of conduct for healthcare support workers and adult social care workers be applied to all patient-facing roles? Skills for Health has received anecdotal feedback to support this view, since the code was published in March 2013. If you have views on this that you would like to share, an online consultation is open until 31 October to gather your feedback. Find out more and input into the consultation.

Bevan Brittan Updates
Strategic Estates Partnerships – Maximising value from your NHS Estate. Strategic Estates Partnerships ("SEP") are emerging as a new model which aims to maximise value from the NHS estate and to align it more closely with clinical strategy. Bevan Brittan has advised on four out of the five SEPs that have recently been established and we are currently advising on all three SEPs in procurement.

The New Fit and Proper Person Test. The Government's latest proposals around the new 'fit and proper person' test seek to strengthen registration requirements, and increase accountability, at the level of the 'controlling mind' of health and social care providers: this will apply to NHS providers from October 2014, and will be extended to all CQC registered independent healthcare and adult social care providers from April 2015. The draft regulations published with the Consultation response simply relate to NHS providers; further regulations will need to be introduced to extend the test to independent healthcare and adult social care providers although it is anticipated that the nature of the test will be the same across the board. If you are considering embarking on a SEP or you are interested in finding out more about the model and the value it can add, we would be delighted to meet with you without obligation, to explore this further.

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