Bevan Brittan Health and Social Care Update - December 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	Information Sharing
Clinical Risk/Health and Safety	Mental Health
Commissioning	Personalisation
Emergency Care	Primary Care
Employment/HR	Providers
Finance	Public Health
Foundation Trusts	Regulation
Governance	General

Care

Publications/Guidance
Going home alone: Counting the cost to older people and the NHS. The Royal Voluntary Service and the King’s Fund have published a report which looks at the discharge from hospital and re-admission of those aged over 75. It explores the possible financial impact of appropriate and effective Home from Hospital services. It finds that if Home from Hospital services could alter the underlying causes of inappropriate admissions and were targeted appropriately with full coverage across England, they might reduce costs of re-admissions by around £40.4m per year. The evidence suggests Home from Hospital schemes are a valuable service well regarded by those who use them. Given that many older people who are re-admitted to hospital feel they were discharged too early or did not receive enough support, they are likely to play a valuable role. Modelling suggests they could lead to significant cost savings through reductions of re-admissions, but their prime purpose is to improve health and wellbeing. The report argues for more effective collaboration by charities, health professionals, older people and their families to reduce re-admission rates.

Managing quality in community health care services. This King's Fund report presents findings from a small-scale study into how quality is managed in community services. It explores how community care providers define and measure quality and recommends important next steps to support better measurement and management of quality.

The bigger picture – Understanding disability and care in England’s older population. This project, sponsored by the Strategic Society Centre and Independent Age, explores disability and care at a national, regional and local authority level in England. It brings together data from Census 2011, DWP and HSCIC ‘administrative data’, as well as from Wave 6 of the English Longitudinal Study of Ageing, to look at the prevalence of disability, need and care of different types, and to ‘paint a picture’ of the lives of different groups.
The Centre has also published a policy discussion paper that uses the findings of the research to evaluate public policy in relation to the reach of publicly funded support, unmet need, consistency v variation, as well as to explore issues around the implementation of the Care Act in light of findings from the research.

I’m still me: A narrative for coordinated support for older people. This report from National Voices sets out how coordinated (or integrated) care and support looks and feels to older people, and is written from their point of view. The publication, developed by older people working with National Voices, UCL Partners and Age UK, challenges health and care services to work together and improve the outcomes older people say are most important to them – things like independence, social interaction and relational support. I’m Still Me outlines five themes that older people say are key to coordinated support: independence; community interactions; decision making; care and support; and terminology. It also sets out a series of "I statements" that summarise what older people have said that they want their support to look like.  

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
The NHSLA have updated their Duty of Candour slides. They cover:- • NHS LA Duty of Candour Guidance • What is an apology • Saying sorry • Do's and Don'ts on candour. The NHS LA have also published a briefing note on the Duty of Candour. This covers:- • What is candour • When might it arise • What triggers the statutory duty of candour • What does candour look like • What is an apology • Do's and don'ts on candour

Safer staffing: a guide to care contact time. This guide is for providers and commissioners as part of the drive to deliver safe and effective care. It gives providers a suite of toolkits to support them in making decisions to secure safe staffing care for their patients and service users and recommends that organisations review the contact time staff spend with their patients. It also supports commissioners working with providers to assure themselves that there is sufficient nurse, midwifery and care staff capacity and capability to meet appropriate outcomes and quality standards and to use commissioning and contractual levers to help secure improvements.

Intrapartum care: care of healthy women and their babies during childbirth. This guideline offers evidence-based advice on the care of women and their babies during labour and immediately after the birth. It covers healthy women with uncomplicated pregnancies entering labour at low risk of developing intrapartum complications. New recommendations have been added in a number of areas, including choosing place of birth, care during the latent first stage of labour, transfer of care, fetal assessment and monitoring during labour and management of the third stage of labour.

The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study. The performance of maternity services is seen as a touchstone of whether or not NHS care is high quality. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK. The objective of this research was to understand the relationship between organisational factors, maternity workforce staffing and skill mix, cost and indicators of safe and high-quality care.

Guidance for NHS bodies on the Fit and Proper Persons requirement for directors and Duty of Candour. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (SI 2014/ 2936) setting out fundamental standards of care will come into force for all care providers on 1 April 2015; however, two standards – the Duty of Candour and the Fit and Proper Persons requirement for directors – have been brought into force earlier, on 27 November 2014.
The Duty of Candour explains what providers should do to make sure they are open and honest with people when something goes wrong with their care and treatment.
The Fit and Proper Persons requirement outlines what providers should do to make clear that directors are responsible for the overall quality and safety of care. All NHS board members will be required to undergo the Test before they are appointed. This will include an assessment of their character and a robust consideration of whether the person has the right qualifications, skills and experience for the role. The CQC will check during their inspections that providers have strong systems in place to carry out these checks before an appointment is made.
CQC has issued this interim guidance for providers on how to comply with these requirements.

Briefing: The fit and proper person test. This briefing provides an update on the requirements placed on NHS provider organisations as of 27 November 2014 to ensure director level appointments meet the ‘fit and proper persons test’ which has been recently integrated into CQC’s registration requirements, and falls within the purview of their regulatory and inspection approach. Produced by the NHS Confederation, NHS Employers organisation and NHS Providers, the briefing provides a summary of the regulations themselves, as well as a practical toolkit to support provider boards in assuring themselves that they have followed a robust and due process with regards to the fit and proper persons test.

Openness and honesty when things go wrong: the professional duty of candour. This report came out of a recent Public Policy Projects conference on the duty of candour. The report comments that the draft guidance "clarifies what the regulators expect from doctors, nurses and midwives, wherever they work. It makes clear there is a responsibility to put right where possible, to learn and to restore trust. It focuses on: • Telling patients and families when something has gone wrong • What to consider when apologising to patients or their families • Providing a full explanation of what happened and the likely effects • Promoting a culture of learning where errors and near misses are reported so that future patients can be protected".

Patient Safety Collaboratives: Plan on a page. NHS Improving Quality and NHS England are working nationally with the Academic Health Science Networks to provide support and opportunities for the Collaboratives to learn from each other, ensuring the most effective and successful solutions are rapidly spread and adopted across England. For the next five years, each Collaborative will support individuals, teams and organisations to build skills and knowledge about patient safety and quality improvement to create space and time to work on the challenges, and provide opportunities to learn from each other. This resource summarises the Patient Safety Collaboratives current priority plans.

State of Care 2013/2014. Basic safety and leadership are key issues for healthcare. A new inspection approach by the Care Quality Commission (CQC) to NHS Trusts, introduced in September 2013, has resulted in some findings of outstanding care, but also examples of care which requires improvement or is inadequate. The CQC's report, State of Care 2013/14, sets out the differences in quality between one Trust and another, from hospital to hospital within Trusts, and between different services within hospitals.

Selected summaries of investigations by the Parliamentary and Health Service Ombudsman: April to June 2014. This report presents a summary of 161 investigations carried out between April and June 2014. The cases investigated included several complaints about incorrect discharges from hospitals, failings in diagnosis of cancer and another complaint concerned poor case handling from the Child Support Agency.

Consultations
Openness and honesty when things go wrong: the professional duty of candour. The GMC and NMC are asking for views on draft guidance which is designed to support doctors, nurses and midwives in fulfilling their professional duty to be open and honest about mistakes. It also calls on clinical leaders and employers to support doctors, nurses and midwives by creating cultures in the workplace that are open, honest, and where people learn from mistakes so that future patients are protected from harm. The consultation closes on 5 January 2015.

News
Formal launch of MyNHS. Health Secretary Jeremy Hunt has formally launched MyNHS – a new site on NHS Choices where people can compare the performance of their local NHS hospital, their care services and their local authority with up-to-date information. people will also be able to search consultant outcome data on NHS Choices.

Bevan Brittan Articles
CQC 'Fit and Proper Person' Requirement The first pieces in the new framework of CQC standards – the 'Fit and Proper Person Requirement' ("FPPR") and the statutory Duty of Candour – go live for NHS bodies on 27 November 2014. (For independent healthcare and adult social care providers these requirements will not take effect until April 2015). Ahead of this launch, the Regulations (the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014) have been finalised and CQC has issued its Guidance for NHS bodies on how to comply with FPPR and Duty of Candour.

Statutory Duty of Candour For NHS providers (NHS trusts and FTs) the statutory duty of candour goes live on 27 November 2014 (for independent healthcare and adult social care providers the duty will not take effect until April 2015). CQC have now issued guidance for NHS bodies on how to comply with the statutory duty. The guidance does not differ dramatically from the draft Guidance consulted upon but does provide some further clarification of how CQC expect the duty to be implemented:

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

Commissioning

Publications/Guidance
Next steps towards primary care co-commissioning. NHS England has published guidance for CCGs setting out co-commissioning options, and providing CCGs and area teams with the information and tools they need to implement the right form of co-commissioning for their local health economy. The guidance gives CCGs the opportunity to choose afresh the co-commissioning model they wish to assume, in line with changes set out in the NHS Five Year Forward View. The guidance looks at three possible models of primary care commissioning that CCGs could pursue: Greater involvement in primary care decision-making; Joint commissioning arrangements; and Delegated commissioning arrangements. . It clarifies the opportunities and parameters of each model, including associated functions; governance arrangements; resources; and any potential risks, with advice on how to mitigate these. The document then sets out the steps towards implementing co-commissioning arrangements, including the timeline and approvals process.
The document is accompanied by a suite of practical resources and tools which are appended to support local implementation of co-commissioning arrangements.

Commissioning and contracting for integrated care. This report from the King's Fund describes how CCGs in England are innovating with two broad models – the prime contract and alliance contract. It draws on experiences from five geographical areas, covering different population and disease groups (cancer, end-of-life care, musculoskeletal services, mental health rehabilitation, and older people’s services). It concludes by highlighting four lessons that CCGs, other commissioners and providers should keep in mind as they embark on new models of commissioning and contracting to support integrated care.
It has also published a summary of three contractual vehicles being used by commissioners to deliver integrated services: Prime contractor model; Prime provider model; and Alliance contract model.

A shared agenda – Creating an equal partnership with CCGs in health and wellbeing boards. This briefing from NHS Clinical Commissioners shares the views and thoughts of CCGs on the development and direction of health and wellbeing boards (HWBs), as well as their ambitions for future joint working. CCGs believe in the potential of HWBs as the place that can bring together the NHS, local government and other key players in the health and care system to find the right solutions for their patients and local populations. It also highlights that HWBs are still very much in development, and need time to grow and mature, but they are not commissioning bodies.

Leading local partnerships: How CCGs are driving integration for their patients and local populations. This report from NHS Clinical Commissioners profiles some of the clinical commissioning groups across England who, despite still being relatively new organisations, are already driving new and innovative models of care that put the patient at the heart of the system, and are improving the health and wellbeing of their local populations.

Driving local change for effective and efficient eye care services. The UK Vision Strategy Commissioning for Effectiveness and Efficiency has launched commissioning guidance to help commissioners, local government partners, Local Eye Health Networks (LEHNS) and partnerships to plan and deliver eye care and sight loss services that maximise the best possible outcomes for their local communities. There is also a set of support tools.

Consultations
A consultation on arrangements for the transfer of commissioning responsibility from NHS England to Clinical Commissioning Groups: Renal dialysis services and Morbid obesity surgery services. Seeks views on moving responsibility for renal dialysis services and morbid obesity surgery services from NHS England to CCGs. It asks what type of support CCGs will need from NHS England to be able to commission these two services safely and effectively. It also asks whether the transfer should happen from 1 April 2015, if the DH can put that support in place. The results will be analysed and used to inform decisions on when and how the transfer in commissioning responsibility should be made. The consultation closes on 9 January 2015.

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

Emergency Care

Publications/Guidance
Urgent and important: the future for urgent care in a 24/7 NHS. The Urgent Care Commission, supported by an unrestricted grant from Care UK, explores the provision of urgent and out of hours care in England and makes eight recommendations to improve standards and ensure the most efficient use of resources. It also highlights concerns from GPs that out of hours care is being hindered by a lack of integration with in-hours services and insufficient resources to consistently provide high quality care.

Accident and emergency survey 2014. The results of this annual patient survey finds that 80 per cent report a good A&E experience, but there are still problems with patient discharge and people waiting too long for pain relief. The findings demonstrate that departments are largely caring, however, more work needs to be done so that services are safer, are more effective and are more responsive to people’s needs.

News
National patient survey says 80% report a good A&E experience, but there are still problems with patient discharge and people waiting too long for pain relief. The CQC has published results from the fifth accident and emergency (A&E) survey which almost 40,000 people took part in. The survey shows some encouraging results with almost eight out of 10 respondents saying their overall experience was good, rating it seven or more out of ten and only 3 per cent of patients saying the doctor or nurse did not listen to what they had to say. The findings demonstrate that departments are largely caring, however, more work needs to be done so that services are safer, are more effective and are more responsive to people’s needs.

If you wish to discuss the issue of emergency care please contact Claire Bentley.

Employment/HR

Publications and Guidance
Guidance on prevention and management of stress at work. NHS Employers have published comprehensive guidance to help managers throughout the NHS reduce stress in the workplace and better support staff who experience it.

News
Nearly one in ten doctors in training experience bullying. A GMC survey of the 50,000 doctors in training has found that nearly one in ten report that they have been bullied, while nearly one in seven said they had witnessed bullying in the workplace. While the survey shows that systems are generally working well, it suggests there are still areas that need to be improved. The GMC argues that bullying and undermining can affect the safety of patients as it can make doctors in training more reluctant to report concerns.  

Bevan Brittan Articles
Employment news round-up, November 2014 November's employment law developments, distilled by John Moore and including: the latest developments on the recovery of public sector exit payments, the NHS 'five year forward' plan proposals for partnership with employers, an update on the mass zero-hours claims against Sports Direct, calls for curbs on Council's TU 'facility time' and, finally, details of our forthcoming events.

Holiday and overtime payments In a landmark decision, the Employment Appeal Tribunal decided earlier this month that holiday pay should include "non-guaranteed" overtime that is normally worked. This decision has attracted widespread interest, both in the mainstream media and amongst HR professionals. Now that the dust is settling on the EAT's decision, Sarah Lamont looks at the issues that are emerging, and considers the options available to employers.

Ill-health absences and disability In the recently decided case of General Dynamics Information Technology v Carranza the EAT considered a disabled employee's claims of failure to make reasonable adjustments in relation to a final written warning and unfair dismissal for sickness absence. Anne Palmer reports.

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

Finance

Publications/Guidance
Pressure Points – Postnatal care planning. The Royal College of Midwives publishes a report on the funding of maternity services.

The financial sustainability of NHS bodies. This report finds that the financial position of the NHS has worsened since 2012-13, with growing financial stress in NHS trusts and foundation trusts. It notes that financial risk is increasing in NHS trusts and foundation trusts, and those in severe financial difficulty continue to rely on in-year cash support from the Department of Health. In 2013-14, over £0.5bn extra money was issued to 21 NHS trusts and 10 foundation trusts to ensure that organisations in difficulty have the cash they need to pay staff and creditors.

The impact of hospital financing on the quality of inpatient care in England. This paper assesses the impact of Payment by Results (PbR) on hospital quality, using in-hospital mortality and 28-day emergency readmission targets. It examines the impact of PbR particularly across hip replacements, hernia repair and stroke care.

Reforming the payment system for NHS services: Supporting the Five Year Forward View. NHS England and Monitor have published plans describing radical changes to how healthcare is paid for, which will enable the NHS to introduce new models of care. This would enable the NHS to put into practice its long-standing commitment to better integrate hospital, community and mental health care, and provide a payment system to help introduce the examples of care models outlined in the Five Year Forward View launched in October 2014. The plans identify several payment approaches with potential to help realise the vision of the Forward View. The payment system is likely to comprise menus for locally determined payments, from which commissioners and providers could choose the most appropriate approaches for their local models of care and service contracts; a number of national prices for episodes of care delivered by centres of excellence and specialised services networks; and national guide prices for all other currencies. To develop the payment system so that it begins to support a rapid shift to new models of care by 2020, they now want to work in even closer partnership with local providers and commissioners of care, including those in social and primary care.

Reforming the payment system for NHS services: Supporting the Five Year Forward View. NHS England and Monitor have published plans describing radical changes to how healthcare is paid for, which will enable the NHS to introduce new models of care. This would enable the NHS to put into practice its long-standing commitment to better integrate hospital, community and mental health care, and provide a payment system to help introduce the examples of care models outlined in the Five Year Forward View launched in October 2014. The plans identify several payment approaches with potential to help realise the vision of the Forward View. The payment system is likely to comprise menus for locally determined payments, from which commissioners and providers could choose the most appropriate approaches for their local models of care and service contracts; a number of national prices for episodes of care delivered by centres of excellence and specialised services networks; and national guide prices for all other currencies. To develop the payment system so that it begins to support a rapid shift to new models of care by 2020, they now want to work in even closer partnership with local providers and commissioners of care, including those in social and primary care.

The efficient management of healthcare estates and facilities. This guidance is for NHS trusts, foundation trusts and other NHS organisations and contains advice on achieving efficiency savings and reducing costs in NHS estates. The building note is split into two parts: Part A outlines how efficiencies in the running of land and property can be achieved. Part B provides more detailed advice about the active management of land and buildings used for healthcare services.

Pressure Points – Postnatal care planning. The Royal College of Midwives publishes a report on the funding of maternity services.

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
Foundation trust annual planning for 2015/16. This note sets out the planning priorities and timetable jointly agreed by Monitor, NHS England and the NHS Trust Development Authority for the 2015/16 NHS planning process. It includes 2015/16 planning requirements and the jointly agreed planning timetable.

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

Governance

Publications/Guidance
Making an impact through good governance: a practical guide for health and wellbeing boards. Now that health and wellbeing boards are fully operational, their emphasis is on being as effective as possible in their statutory and influencing roles. This guide discusses how health and wellbeing boards can make an impact through their governance structures and procedures – delivering business within council constitutional requirements, as required by statute – while enabling all board members to participate as equal partners.

Bevan Brittan Updates
Better Care Fund: Implementing an Action Plan within the legal framework - Section 75 and Governance arrangement The Better Care Fund is coming soon – CCGs and local authorities need to be ready for the 1 April implementation of the pooled fund regime for the Better Care Funds, and this means you need to start work on your S75 Agreements now.

If you wish to discuss any issues relating to governance please contact Vincent Buscemi. Information Sharing Publications/Guidance
In the picture: A data protection code of practice for surveillance cameras and personal information. ICO have published updated code of practice on use of CCTV and other surveillance.

National Data Guardian appointed to safeguard patients' healthcare information. Dame Fiona Caldicott has been appointed to the new role of National Data Guardian for health and care. The National Data Guardian will become the patients' champion on security of personal medical information.

Interim guidance for Troubled Families Programme early starter areas – Sharing health information about patients and service users with troubled families. DCLG, DH, NHS England and Public Health England have developed a national health offer to support the expanded Troubled Families programme. This is an initiative to improve the lives of up to 400,000 families with multiple problems, including families with mental and physical health problems, affected by domestic violence and with vulnerable children. This data sharing protocol sets out how NHS and Adult Social Care organisations can work within the Information Governance Alliance’s five rules for information sharing to share information in the interests of families, in order to identify families who could benefit from the Troubled Families Programme. There is also includes guidance for health professionals and their partners on Leadership and on Health skills and training.  

Review of data releases by the NHS Information Centre: Summary of HSCIC progress against the review recommendations. Details the Health and Social Care Information Centre's progress with ensuring that patient data is always used safely and securely for the benefit of health and social care, while protecting patient privacy. Its non-executive board member Sir Nick Partridge led a review in June 2014 into how data was released by its predecessor, the NHS Information Centre. He made nine key recommendations to the HSCIC to guarantee greater openness and public confidence, stricter controls over data use and better clarity for data users. This report provides an update on the actions taken to implement the recommendations.

Consultations
Confidentiality and information sharing for direct care. Seeks views on draft guidance to help health care professionals make the right decisions about data sharing. There are also explanatory notes. The consultation closes on 31 January 2015.

News
National Data Guardian appointed to safeguard patients' healthcare information. Dame Fiona Caldicott has been appointed to the new role of National Data Guardian for health and care. The National Data Guardian will become the patients' champion on security of personal medical information.

NHS patient records will still be sold to insurers. The deputy chairman of the Health and Social Care Information Centre has said that the NHS will continue to sell medical data insurers and other third parties. Sir Nick Partridge's comments come despite an investigation revealing that tens of thousands of patient records were unlawfully passed on.

Social worker suspended for serious breach of confidentiality. A social worker has been suspended from the Health & Care Professions Council (HCPC) Register for 12 months for a serious breach of confidentiality when he was employed in the Adult Safeguarding Team at Portsmouth City Council. Geneva Sibanda accessed the confidential records of three service users who were not in his care and for no professional purpose.

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
Report calls for new charter of rights for people with learning disabilities. A report by NHS England calls for a new charter of rights for people with learning disabilities or autism, including a right to challenge decisions about where they are to live.

Chief Coroner's guidance on Deprivation of Liberty. The purpose of this guidance is to give coroners a steer on the application of DoLS in the context of coroner work.

Deprivation of liberty. A Practice Direction by the Courts and Tribunals Judiciary addresses: the procedure to be followed in applications to the court for orders under s.21A of the Mental Capacity Act 2005 relating to an authorisation to deprive a person of his or her liberty; and the procedure to be followed in applications under s.16(2)(a) of that Act to authorise deprivation of liberty under s.4A(3) and (4) pursuant to a streamlined procedure. See also Alex Ruck Keene's blog.

Winterbourne View – Time for change: Transforming the commissioning of services for people with learning disabilities and/or autism. Sir Stephen Bubb, chief executive of ACEVO, has published an independent report on the future of services for people with learning disabilities. The report makes a series of recommendations for the NHS, local government, regulators and the Government, that includes a robust NHS commissioning framework to support people with learning disabilities and autism move out of hospitals and into the community. He also sets out a roadmap for action.

Frontline First: Turning back the clock? RCN report on mental health services in the UK This special report seeks to highlight the issues facing the mental health nursing community and puts the case forward for greater investment in this vital service in conjunction with Rethink Mental Illness.

Intelligent monitoring - trusts that provide mental health services. These intelligent monitoring reports set out the analysis that will guide the Care Quality Commission's inspections of trusts that provide mental health services. Together with local information from partners and the public, the intelligent monitoring model helps to decide when, where and what to inspect. For trusts that provide mental health services, the model considers 59 different types of evidence, based on sources that include the NHS staff survey, bed occupancy rates, the national health outpatient survey and concerns raised by trust staff.

CQC publishes inspection information for mental health services. Information published by the Care Quality Commission (CQC) about every NHS Trust in England which provides mental health services, shows the majority appear to be of low concern. The CQC has published the information to show the public how it decides what to focus on and how it will inspect services according to risk.

Commissioning better mental health services for young people. The Mental Health Foundation has published a guide to commissioning mental health services for young people.

The Mental Capacity Act (MCA) and care planning. This report shows commissioners and providers of care how to embed the principles of the MCA into care and support planning across the board.

Acting as a litigation friend in the Court of Protection. The Guidance aims to demystify the Court of Protection generally and the role of litigation friend specifically so as to enable more people to consider taking up the role - thereby ensuring the better promotion and protection of the rights of those said to be lacking capacity to take their own decisions.

Children's and adolescents' mental health and CAMHS. The Health Select Committee has concluded in a report that there are serious and deeply ingrained problems with the commissioning and provision of children’s and adolescents’ mental health services (CAMHS). Such problems affect the whole system, from prevention and early intervention through to inpatient services for the most vulnerable young people. The Committee has made a number of recommendations to the Department of Health (DH), Department for Education and NHS England, including recommending that it be a priority for the DH/NHS England taskforce to obtain up-to-date data on CAMHS.

Consultations
Draft revised statutory guidance to implement the strategy for adults with autism in England. Seeks views on draft statutory guidance for local authorities and NHS organisations to support the implementation of Think Autism, the update to the 2010 adult autism strategy. The draft guidance covers areas including the training of staff who provide services to adults with autism. It also contains additional elements introduced by Think Autism focused on improving the way health and social care services identify the needs of adults with autism and ensuring identified needs are met more effectively to improve the health and well-being of adults with autism, such as the planning of services, preventative support and safeguarding and employment for adults with autism. The consultation closes on 19 December 2014.

Cases
Cases A and B (Court of Protection: Delay and Costs) [2014] EWCOP 48. In considering cost and delay in two cases, the Court of Protection expressed the view that the case management provisions in the Court of Protection Rules had proved inadequate on their own to secure the necessary changes in practice.

Re AB [2014] EWCOP 49. The Court of Protection considered an application by a health provider to withdraw artificial nutrition and hydration from AB, who had been unconscious since 2005 with no prospect of recovery. The court held that it was in AB's best interests for artificial nutrition and hydration to be withdrawn.

News
Deputy PM announces £150m investment to transform treatment for eating disorders. Nick Clegg has announced new investment to radically reform the treatment of children and young people with eating disorders and pave the way for new waiting time standards. The investment, which will be rolled out over 5 years, is part of an ongoing campaign by the Government to bring mental health services on a par with physical care. Money from expensive institutional care will be channelled to local provision and act as a base for the development of waiting time and access standards for eating disorders for 2016 by: supporting schemes to get young people with eating disorders and self-harm early access to services in their communities with properly trained teams, making hospital admission a last resort; and extending access to talking therapies so that children and young people have a choice of evidence-based therapies, a treatment plan agreed with their therapist and monitored and recorded outcomes.

More mental health teams to be based at police stations and courts. NHS England has announced that another 13 Liaison and Diversion trial schemes are to launch in April 2015 to place mental health professionals in police stations and courts. These schemes aim to ensure people who come into the criminal justice system with mental health conditions, learning disabilities and other vulnerabilities are recognised and are promptly referred into health and other services to get the treatment or support they need. These new schemes will join the existing ten areas that have been taking part in a two year trial that began in April 2014, to join up police and courts with mental health services. This will mean half of the English population will be covered by such schemes from April 2015. The model will be independently evaluated to inform a business case for services to cover all of the English population by 2017/18.

Mentally unwell teenager admitted to adult psychiatric ward after two days in cell. A 16-year-old who spent two days in a police cell due to no children’s mental health beds being available was eventually admitted to an adult psychiatric ward.

New National Forum on policy around mental capacity and Lasting Powers of Attorney. A National Forum, with an independent chair, will be established to raise awareness of the Mental Capacity Act 2005 (MCA 2005) and its introduction of Lasting Powers of Attorney (LPA), the Minister of State for Justice and Civil Liberties has said. Simon Hughes, speaking at the ‘Compassion in dying conference’, which explored support and information around end of life decisions, said that it is important to ensure that those people who lose or lack the ability to communicate autonomy over decisions, do not lose their rights to do so.
Mental health taskforce announced. The Deputy Prime Minister Nick Clegg has announced that he is to establish and chair a new Mental Health Taskforce that will urgently examine: how to improve mental health services for young people; welfare and employment issues and helping people back into work; and how to improve crisis care and prevent the large numbers of people with severe mental health problems ending up in police cells and prisons.

Fresh approach to school mental health support. The DfE has announced that it will be working with the PSHE Association to help schools know how to teach pupils about mental health and banish the stigma which can leave young people with mental health problems feeling isolated. In addition, it will set out a blueprint for schools to use when delivering their counselling services, which will be informed by young people and experts to make sure the advice will meet the needs of the people it is intended to support.

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

Personalisation

Publications/Guidance
Person-centred care made simple. The Health Foundation has issued a guide to person-centred care that offers a clear explanation of the principles of person-centred care, why it is important, how it has developed, and some examples to help those considering putting person-centred care in to practice. It is written for anyone interested in health and health care, including health care professionals and those who use the NHS.

If you wish to discuss any of the items above or the issue of personalisation more generally please contact David Owens or Deborah Jeremiah.

Primary Care

Publications/Guidance
An inquiry into patient centred care in the 21st century: implications for general practice and primary care This inquiry concluded that clinicians must work with patients in a different way, providing personalised care and empowering patients to play an active role in managing their health. The report also calls for a shift in the way that general practice is delivered, so that practices come together as federations or networks and work with a range of other services to deliver coordinated and proactive care in the community.

Choice of GP practice: Guidance on the new out of area patient registration arrangements. From 5 January 2015 GP practices may register patients who live outside their practice area without home visiting and other urgent care obligations when patient is at home and too ill to attend their registered practice. This guidance explains how the new registrations arrangements will work and associated issues to support implementation, including how NHS England will ensure such patients can continue to access care at or near home. It includes a commissioning framework to support area team decisions on putting in place urgent primary medical care services. This also provides a nationally priced enhanced service to be used when commissioning services from local GP practices where these feature in local strategies to deliver urgent care to out of area patients when at home.

Out-of-hours GP services in England. The Commons Public Accounts Committee has published a report on its inquiry into Out of Hours GP services. It finds that people turn to out-of-hours GP services when they are worried about their own health or that of family or friends, and want urgent advice or treatment. However, the urgent and emergency care system is complex and people struggle to know which is the right service to use. The Committee makes a number of recommendations, including that NHS England should adopt a proportionate oversight regime which provides it with assurance on the value for money of out-of-hours GP services and allows it to identify poorly performing services and make targeted interventions. NHS England should test whether its guidance on conflicts of interest is being followed and assess whether it offers enough safeguards. Where contracts for out-of-hours GP services have been awarded since 1 April 2013, it should seek documentary evidence that no one with an interest in the successful provider organisation was involved in the procurement process. Given the pressures on the NHS budget it is important that NHS England should expedite the redesign of urgent and emergency care services. NHS England, working with Monitor, should urgently identify solutions for paying for urgent and emergency care that address the current mis-aligned incentives and promote the treatment of patients in the most appropriate setting and the most effective use of NHS resources.

CQC publishes GP quality data. Almost eight out of ten general practices (GPs) in England appear to be of 'low concern' the Care Quality Commission (CQC) reported. Information on every GP in England has been analysed and published to help the CQC prioritise its inspections under the new regime, which was rolled out formally in October 2014. The CQC's analysis indicated the services which appear to be doing well, as well as areas where people may not be receiving high-quality care. GPs have been placed into bands based on this data, but the CQC emphasised it can only judge the quality of care within a service once it has carried out an inspection.

Report unveils plans for digital technology in healthcare. The quality of patient care and health outcomes can be improved through digital technology and innovation, according to a report from the National Information Board (NIB). Under the plans, all patients should have access to their GP records through apps and digital platforms by 2015, and to all of the health records – hospitals, community, mental health and social care services – by 2018.

Next steps towards primary care co-commissioning. NHS England has published guidance for CCGs setting out co-commissioning options, and providing CCGs and area teams with the information and tools they need to implement the right form of co-commissioning for their local health economy. The guidance gives CCGs the opportunity to choose afresh the co-commissioning model they wish to assume, in line with changes set out in the NHS Five Year Forward View. The guidance looks at three possible models of primary care commissioning that CCGs could pursue: Greater involvement in primary care decision-making; Joint commissioning arrangements; and Delegated commissioning arrangements. . It clarifies the opportunities and parameters of each model, including associated functions; governance arrangements; resources; and any potential risks, with advice on how to mitigate these. The document then sets out the steps towards implementing co-commissioning arrangements, including the timeline and approvals process.
The document is accompanied by a suite of practical resources and tools which are appended to support local implementation of co-commissioning arrangements.

Is general practice in crisis? This Nuffield Trust policy briefing provides an evidence-based overview of the current state of general practice in England, and offers policy-makers some potential solutions. It examines demand for GP services, the GP workforce, funding, and standards of access and patient care. It then presents four ideas to help solve the problems facing general practice and the wider NHS.

Not more of the same: Ensuring we have the right workforce for future models of care. The Royal College of General Practitioners has estimated that England needs more than 10,000 more GPs by 2022 to meet increased demand and warns of a GP workforce crisis with consequences such as practice closures and even longer waiting times for appointments. This paper from the NHS Confederation sets out some considerations for developing a primary care workforce that is fit for purpose now and in the future. It argues that workforce planning and modelling assumptions in primary care need to incorporate new, emerging and more sustainable models of primary care.

Patient online support and resources guide. This guide, developed by NHS England in partnership with the Royal College of General Practitioners, provides help for general practices to deliver patient services online. It contains practical tools on implementing a range of online services including booking appointments and ordering repeat prescriptions.

The right workforce for future models of care. The NHS Confederation has published a paper about the need to develop a primary care workforce.

RCGP launches 'common sense' guide to Ebola for GPs and their teams. The Royal College of General Practitioners (RCGP) has published a step-by-step guide to help GP practices prepare for and deal with the Ebola outbreak.

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

Providers

Publications/Guidance
Examining new options and opportunities for providers of NHS care: The Dalton Review. Sir David Dalton was asked by the Secretary of State for Health to lead a review into exploring ways to address the challenges faced by providers of NHS care. He has now pubished his independent report in which he looks at new options and opportunities to help the best leaders and organisations in the NHS to do more for patients. His report complements the Forward View [see below] and provides the organisational 'delivery vehicles' that can help translate its ideas into reality. He states that there are no 'right' or 'wrong' organisational forms – what matters is what works. This report does not champion one organisational model over any other but recognises that it is for our system leaders to pursue the models that will deliver the greatest benefits to the populations they serve. He identifies five important themes:
one size does not fit all
quicker transformational and transactional change is required
ambitious organisations with a proven track record should be encouraged to expand their reach and have greater impact
overall sustainability for the provider sector is a priority
a dedicated implementation programme is needed to make change happen.
Alongside his report are a number of supporting documents including details of the collaborative, contractual and consolidation models that he identifies.

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

Public Health

Publications/Guidance
A framework for personalised care and population health for nurses, midwives, health visitors and allied health professionals. This Framework has been developed as a resource to help nurses, midwives, health visitors and allied health professionals access best evidence and support them in delivery of their public health role. It is also a tool for clinical leaders, managers and commissioners to develop services which use the knowledge and skills of healthcare practitioners to deliver the best health outcomes for the populations they serve.

Automated external defibrillators (AEDs): a guide for maintained schools and academies. Guidance for schools on how they can buy, install and maintain an automated external defibrillator. The Government has announced that schools can now opt to buy defibrillators at a reduced price, after it struck a deal, initially for 500 machines, through a reverse auction process run by NHS Supply Chain. The Government intends to order additional batches of defibrillators, with quantities based on school demand, through further reverse auctions.

16 days of action toolkit. 16 Days of Action Against Domestic Violence is aimed at businesses to support them to take action against domestic abuse and violence. Employers have a legal obligation to assess dynamic risk and support the health and safety and wellness of their employees. Companies can do more to aid their employees who endure domestic violence, to train those who witness it, and to protect staff as a whole, with the goal of securing safety and mitigating financial loss. Spanning across 16 days from 25 November to 10 December 2014, a theme will be identified each day to explore the various forms of domestic violence. This toolkit is a step-by-step simple guide on how a company can tackle domestic violence within these 16 Days. It includes posters, podcasts and briefings.
In addition, the DH, PHE and the RCGP have highlighted the role that GPs can play in combating domestic violence has been highlighted, in support of International Day for the Elimination of Violence against Women.

Tackling poverty: Making more of the NHS in England. As well as setting out the NHS funding challenge, NHS England’s five year forward view discusses the health system’s role in promoting healthy lifestyle change. But beyond this, there is a bigger opportunity still. Despite all the pressures, the NHS remains, and will continue to remain, a massive economic and social entity. Are we making the most of this enormous power? This report from the King's Fund considers this question as part of the Joseph Rowntree Foundation's wide range of evidence reviews to inform its anti-poverty strategy. The report thinks more broadly about the role of the NHS and its contribution to the wider determinants of health, with a focus on poverty.

Ebola: top facts and mythbuster. These documents set out the important facts about Ebola virus disease and dispel some common myths. They are for organisations to use, if they wish, in their communications with their staff and stakeholders.

Healthwatch – On the board toolkit: Developing skills for effectiveness on health and wellbeing boards. Toolkit from the LGA that supports local Healthwatch representatives on their health and wellbeing board. It provides guidance on the skills the local Healthwatch representative needs to effectively represent the local Healthwatch on the HWB, along with tools that representatives can use for self-development of leadership capacity.

Health visiting programme and 0-5 commissioning of public health services. This factsheet provides information for health practitioners, providers and local authorities on the Healthy Child Programme and the Health Visiting Programme, the importance of health visiting, and the transfer of service commissioning for 0 to 5 to local authorities from 2015.

Scope of 0-5 public health services transition. Planning and paying for public health services for 0 to 5 year olds will transfer from the NHS to local authorities in October 2015. This paper sets out the scope of 0-5 children’s public health commissioning in greater detail, providing background information and further detail that capture existing commissioned services, where they belong currently and where their future destinations are planned.
There is also an updated Finance fact sheet on the timescales for NHS Area Teams and local authorities in the run-up to the commissioning.

Consultations
Introducing mandatory reporting for female genital mutilation. The Home Office has launched a consultation on how to introduce a mandatory reporting requirement on cases of FGM. It focuses on what and who should be covered by the mandatory reporting requirement: which agencies the requirement should be applied to; how the requirement will work in practice, and; also the sanctions that should be employed if professionals fail to report FGM. It also seeks views on how the multi-agency practice guidelines on FGM should be placed on a statutory footing most effectively. The consultation closes on 12 January 2015.
DCLG has also announced the successful 17 frontline community projects that will receive a share of £270,000 to help end FGM and ‘honour’ based violence by creating a network of community champions.

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

Regulation

Publications/Guidance

New care inspection regime for hospices. The Care Quality Commission (CQC) has set out how it intends to regulate and inspect England's hospices and hospice services in a new handbook. Specialist teams, including trained members of the public (Experts by Experience), will inspect all hospice services by carrying out unannounced visits. Services will be rated from 'outstanding' to 'inadequate'. The inspection regime takes effect in January 2015.

Exploring CQC’s well-led domain: how can boards ensure a positive organisational culture? Following the Francis Report into the failures of care at Mid Staffordshire NHS Foundation Trust, and the Government’s response to the report, the Care Quality Commission (CQC) has introduced a more rigorous and wide-ranging approach to inspecting health care providers. The main purpose of inspections is to assess the quality of care delivered to patients. In making this assessment, CQC now also analyses the leadership and organisational culture of providers. The CQC’s inspections focus on five key lines of enquiry as part of its ‘well-led’ domain. These lines of enquiry derive from research undertaken by staff at The King’s Fund and the Centre for Creative Leadership into leadership and culture and draw on a strong evidence base.

Inspecting together: Developing a new approach to regulating healthcare in prisons, young offender institutions and immigration removal centres. The CQC is seeking views on how healthcare in prisons, youth offending institutions and immigration removal centres is regulated. This signposting statement sets out its initial thoughts on a new regulatory model for this sector. In January 2015 there will be a formal 8-week consultation on new guidance for all providers on the joint inspection framework, including how to comply with the new regulations and CQC’s enforcement policy.

Reforming the payment system for NHS services: Supporting the Five Year Forward View. This paper from Monitor and NHS England describes how the NHS payment system could begin to look from 2020. It sets out several payment approaches that Monitor and NHS England want to develop further with NHS providers and commissioners, including those in social and primary care. The payment models aim to support the development of: integrated care approaches; urgent and emergency care networks; high quality elective care and specialised services; and parity of esteem for mental health services. The paper also sets out the improvements needed to the information building blocks underpinning the NHS payment system.

Capitation: a potential new payment model to enable integrated care. Monitor has published this document to support local service improvement and reconfiguration in 2015/16 and beyond, highlight examples of successful local payment arrangements in the NHS and enable evaluation of emerging potential payment models for use in the NHS. It should be read alongside Monitor and NHS England’s Guidance on locally determined prices for 2015/16.
See also Monitor's National tariff payment system 2015/16: a consultation notice that sets out the proposed price lists and payment rules for NHS services for 2015/16. The consultation closes on 25 December 2014. The web page also links to a number of supporting documents.

Bevan Brittan Articles
CQC proposed inspection approach for independent acute healthcare. CQC last week launched their long awaited consultation on their approach to regulating independent acute healthcare. The consultation runs until 23 January 2015. The document sets out a reasonable level of detail on the main features of CQC's approach to regulation of the sector. However, on other important points, the consultation is a 'blank canvas' simply inviting suggestions as to how the approach should be developed. Providers are strongly encouraged to review the consultation and participate as fully as possible in shaping the direction of regulation.

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

General

Publications/Guidance
National health screening. This report highlights concerns that the risks and benefits of participating in screening programmes, for conditions and diseases like cancer, are not consistently communicated by either the NHS or private health care providers.

91% of doctors want more guidance on patients recording consultations, MPS survey reveals. A survey by the Medical Protection Society (MPS) has revealed that one in five (19%) doctors have experience of patients recording their consultations. Of those, 40% were not made aware at the time that the patient was recording the consultation. The survey also revealed that 97% of respondents are not aware of any practice or trust policy on having consultations recorded, however almost three quarters (73%) believe they have a right to decline a patient’s request to record a consultation. In addition, 91% would like more guidance on what to do should a patient ask to record a consultation. The MPS has issued advice on dealing with consultations being recorded: Digital dilemmas - Patients recording consultations.  

Waiting times for hospital treatment - Commons Library Standard Note. A House of Commons Library Standard Note on waiting times for hospital treatment presents data, charts and maps on the number of people treated (for both admitted and non-admitted pathways), waiting times by NHS area team and NHS provider, and data on individual treatment specialisms.

Department of Health's agencies and partner organisations. An updated list of the DH's arm's length bodies. For each organisation, it gives contact details and information on the executive team.

Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care. This report by the Academy of Medical Royal Colleges provides a framework for a way in which doctors can think critically about waste from a clinical perspective and provides examples of doctors improving the value of health care by reducing waste. Estimates suggest that around 20% of mainstream clinical practice brings no benefit to the patient as there is widespread overuse of tests and interventions.

Consultations
Language controls for nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians. Seeks views on changes that will allow the Nursing and Midwifery Council, General Dental Council, General Pharmaceutical Council and Pharmaceutical Society of Northern Ireland to put in place systems for carrying out proportionate language controls on European applicants and for taking fitness to practise action where there are concerns about the English language skills of professionals who are already in practice. There is also a draft Health Care and Associated Professions (Knowledge of English) Order 2015 that will implement the changes, once finalised. The consultation closes on 15 December 2014.

Mandatory FGM reporting by healthcare professionals. Views are sought on how to introduce a mandatory reporting requirement in cases of female genital mutilation (FGM). The Home Office's consultation is specifically focused on the issues and professionals which should be covered by the mandatory reporting requirement--which agencies the requirement should be applied to, how it will work in practice, and sanctions to be employed for failure to report FGM. The consultation closes on 12 January 2015.

News
Hospital in bid to evict patients who are well enough to leave. The Royal Bournemouth Hospital is threatening to take legal action so it can evict recovered patients whose relatives refuse to take them home. The hospital's allegations relate mainly to elderly patients, who are to be given a week's notice if they are well enough to leave. Those still on the ward after the notice period ends could potentially face legal action.

Simon Stevens announces winners of £2.5m Regional Innovation Fund. NHS England has announced the 46 NHS Trusts that have received a share of the £2.5m Regional Innovation Fund to help change patients’ lives and improve care through innovation. The fund was launched in April to support and promote the adoption and spread of innovation across the NHS. It provides opportunities for clinicians to work in new ways driving innovation which can change patients’ lives. Organisations can apply for sums up to £50,000 for individual applications and up to £250,000 for those working collaboratively.

The King's Fund has set up an online Election Tracker. As the political debate about the NHS gathers pace, it will follow the key developments and provide commentary and analysis on what the parties are saying about health and social care.

Operating Department Practitioner struck off for misconduct and dishonesty. An operating practitioner who stole and took controlled drugs while working for University Hospitals of Leicester NHS Trust has been struck off the Health & Care Professions Council (HCPC) Register for misconduct and dishonesty. Ziyaad Lorgat forged five signatures on the Controlled Drugs Register, falsified hospital records logging the drugs issued to patients, fell asleep while on duty, left his post without permission, and stole and took controlled drugs.

Doctor summoned in first gender abortion prosecution. Dr Prabha Sivaraman has been summoned to appear in a criminal court accused of planning an abortion based on the gender of an unborn child. In the first case of its kind to come to court in the UK, Dr Sivaraman must appear before Manchester and Salford Magistrates' Court in December 2014 to face an allegation under the Offences Against the Person Act 1861. It is part of a rare private prosecution brought by a pro-life campaigner after the Crown Prosecution Service decided against charging Dr Sivaraman and another physician, Dr Palaniappan Rajmohan. A hearing will be held in January 2015 to decide whether a separate summons should be issued against Dr Rajmohan

New system to ensure a more timely and consistent approach for new and innovative medicines to be introduced in Wales. Announces a new system for so-called “orphan” and “ultra-orphan” medicines and treatments for patients with rare diseases. The Welsh Health and Social Care Minister has also announced that the Individual Patient Funding Request (IPFR) process, which gives some patients access to innovative medicines not routinely available on the NHS, is to be strengthened.