Health and Social Care Update - August 2015

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
Emergency Care	Public Health
Employment/HR	Regulation
Finance	General

Care

Publications/guidance
Social care: paying for care home places and domiciliary care (England). This Commons research briefing sets out the means test that applies to care home residents and those in other settings (such as care at home) in need of social care, and provides information on personal budgets.

One chance to get it right: one year on report. This report shows the progress organisations have made on specific commitments in the One Chance To Get It Right report, which set out actions to improve care in the last days and hours of life. It sets out progress made on: the new Care Quality Commission inspection regime for end of life care; new NICE guidance; actions to improve education, training and research; professional regulation; and the implementation of the priorities for care. 

PIP Assessment Guide: A DWP guidance document for providers carrying out assessments for Personal Independence Payment. Personal Independence Payment (PIP) is a benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these. It is paid to make a contribution to the extra costs that disabled people may face, to help them lead full, active and independent lives. This updated guidance supplements the contract documents agreed with providers as part of the commercial process. It provides guidance for health professionals carrying out PIP assessment activity and for those responsible for the quality of assessments.

Delay in the implementation of the cap on care costs. Letter from Care and Support Minister Alastair Burt announcing that, in response to concerns expressed by the Local Government Association and many other stakeholders about the timetable for implementing the cap on care costs in April 2016, the Government has decided to delay its implementation until 2020. The delay will allow time to be taken to ensure that everyone is ready to introduce the new system and to look at what more can be done to support people with the costs of care.

Viewpoint: Reconsidering accountability in an age of integrated care. In this paper authored for the Nuffield Trust, Ben Jupp, Visiting Senior Fellow and former director of public service reform at the Cabinet Office, examines the future of governance and accountability in the NHS and social care amid the rise of new provider models, a growing focus on integration and deep cuts in council funding. He argues that the purchaser-provider split, after 25 years, will lose its position as the cornerstone of NHS structure and accountability under these developments. If the health service is to remain fit for purpose, the paper stresses the need for these new providers to be held to account in new ways.

New Care Models: update and initial support. The NHS Five Year Forward View partners have published a support package for the new models of care vanguards which were launched in March 2015. The 29 vanguards were selected following a rigorous process involving patients, clinicians and peer review, and will initially improve the care provided to more than 5m people. Building on the best practice already being displayed, the support package is designed to be led by vanguard leaders alongside national experts, and aims to help the vanguards be as successful as possible in making the changes they are planning. It is also intended to maximise sharing of learning and practice across the 29 vanguards and, importantly, with the wider NHS and care system – a key element of the vanguards’ work.

Consultations
Care of the dying adult: draft guideline consultation. NICE has launched a consultation on a draft guideline to support the NHS in providing high quality and compassionate care for people who are dying, to help doctors and nurses identify when someone is entering their final few days of life. It also provides guidance about the management of some common symptoms that may be experienced at the end of life, and places the individual and their loved ones at the heart of decisions about their care. The draft NICE guideline follows the abolition of the Liverpool Care Pathway. The closing date for comments is 9 September 2015.

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

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Clinical Risk/Health and Safety

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 on selected summaries of investigations by the Parliamentary and Health Service Ombudsman: December 2014 and January 2015. This report contains 121 summaries of complaints which are a snapshot of those investigated between December 2014 and January 2015 about the NHS in England and UK government departments and their agencies. It illustrates the impact public service failures and poor complaint handling in the NHS in England and UK government departments can have on the public.

Safely home: What happens when people leave hospital and care settings? This report from Healthwatch sets out the findings from its inquiry into people's experiences of the issues surrounding discharge and the impact it has on them when it goes wrong, focusing on older people, homeless people, and people with mental health conditions. Many people said that, although they may have been deemed medically safe to leave hospital, they did not feel safe or adequately supported to do so. Others told the inquiry about experiences of delays to their discharge and the significant consequences of being kept in care too long. The report found that there are five core reasons people feel their departure was not handled properly. It highlights how, when discharge goes wrong, it comes at significant cost, both to individuals and to the health and social care system.

'Learning not blaming': What NHS boards need to know. Learning not blaming, the Government’s response to three reports on patient safety, contains several new requirements, structures and arrangements for NHS boards to be aware of and act on. They are summarised below and should be considered alongside announcements made by the health secretary on 16 July to 'profoundly change the culture of the NHS'. The report details the Department of Health’s response to the Freedom to Speak Up Review consultation, the Public Administration Select Committee’s report Investigating clinical incidents in the NHS and Dr Bill Kirkup’s report on failings in care at Morecambe Bay. It also provides an update on progress against report recommendations and next steps.

Powerful people: reinforcing the power of citizens and communities in health and care. This report argues for giving citizens greater control over their own h ealth and care, so that services are redesigned around their needs and aspirations, to improve health outcomes, and to save money by supporting people better to manage their conditions themselves.

Code of practice on the prevention and control of infections and related guidance. The previous code of practice the prevention and control of infections, and related guidance, has been updated by the Department of Health to reflect the structural changes which took effect in the NHS from 1 April 2013. The changes relate to the role of infection prevention (including cleanliness) in optimising antimicrobial use and reducing antimicrobial resistance.

NHS Litigation Authority Annual Report and Accounts 2014/15. ​​In its latest annual report published today, the NHS Litigation Authority (NHS LA) examines the drivers of the costs of clinical negligence claims and outlines initiatives to support its members in their work to improve safety. Figures for the past year show that the NHS paid out more than £1.1bn to patients and their legal representatives, and estimates that figure will rise to £1.4bn over the coming year reflecting the significant increase in claims that were reported a few years ago. Provisions for future payments relating to incidents occurring prior to 31 March 2015 are £28.6bn, an increase of £2.5bn in the year. Approximately one third of the total sum paid out last year went to the legal profession, most of which was paid to claimants’ lawyers. The NHS LA has stated its support for a move to a position where legal costs are more proportionate to damages whilst ensuring that those with valid claims have a place to go for skilled and experienced support.

How the NHS in England compares to other countries in publishing selected transparency metrics. This analysis looks into how the NHS in England compares to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States in publishing information on quality of care, patient experience and outcomes.

Older people’s experiences of dignity and nutrition during hospital stays: secondary data analysis using the adult inpatient survey. According to this report, an estimated one million people in later life are affected by poor or inconsistent standards of dignity or help with eating in hospitals. It calls for action to improve standards and ensure dignity in care.

7-day NHS services: a factsheet. Hospitals and community services are already working together to create a better service 7 days a week. This fact sheet sets out how the Government wants to go further and faster to deliver safer care in this Parliament. 

News
Review to look at the care of new born babies that need extra support. The CQC is to carry out a thematic review of about 20 services in England that will look at how well staff in foetal medicine, obstetrics, neonatal and community services work together to care for new born babies with declining health problems, particularly those with hypertension (high blood pressure) and tracheostomies. It will to use this review to look at variation in the care management and how one service hands over to another service so the care is continuous. The review may also lead to the development of clinical guidelines where required, so there is consistency in care across England. 

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

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Commissioning

Publications/Guidance
A patient approach: Putting the consumer at the heart of UK healthcare. This paper from the Institute of Economic Affairs concludes that the UK has nothing to fear from adopting market based reforms in healthcare. It finds that universal and equitable access to healthcare would not be at risk if the Government’s role were limited to purely guaranteeing access to health provision. Offering patients the freedom to choose between public or private providers, as well as building upon the market reforms of the mid-2000s, would not only be compatible with public opinion but would substantially improve health outcomes in the UK. The author Dr Kristian Niemietz argues that supporters of moving the NHS to a competitive system that incorporates a combination of public and private providers, should capitalise on the growing appetite for reform amongst the general public. Going 'the whole hog' would not require a revolution.

CCG Assurance Framework 2015/16: Operating manual. This operating manual has been developed to complement the CCG Assurance Framework for 2015/16. It sets out for CCGs and for staff in NHS England’s regional teams the details of how the assurance process will operate throughout the year. It should be used in conjunction with the CCG Delivery Dashboard technical appendix and other resources provided on NHS England's CCG Assurance web page.

A fresh start for registration: Improving how we register providers of all health and adult social care services. CQC has published information that sets out the improvements along with its vision for the future of registration as part of its approach to regulation within a new five-year strategy from 2016. This document informs people and their families what they deserve to expect when using health and social care services registered with CQC. It also explains how CQC's registration system is there to protect people from poor care by determining who is able to enter the regulated health and social care market, or by cancelling or placing conditions on a provider's registration when required.

Study on the use of contractual mechanisms in commissioning: final report. This report from a three-year project funded by the DH's Policy Research Programme, aimed to investigate how commissioners negotiated, specified, monitored and managed contractual mechanisms to improve services and allocate financial risk in their local health economies, looking at both acute services and community health care. It found that current contracting arrangements are not working and that quality incentive schemes cost more to run than they deliver.

How do I reach a decision about treatment for my patient? A guide for clinicians on decision making in specialised commissioning at NHS England. NHS England has published refreshed guidance and advice for clinicians on accessing treatments in clinically critically urgent situations.

Commissioning for Quality and Innovation (CQUIN) Guidance 2015/16 templates. NHS England has published revised CQUIN templates. Requirements for the community services element of the CQUIN indicator have been clarified for dementia and delirium. For improving physical healthcare, in a revision of the initial guidance, the community early intervention psychosis element of the CQUIN now requires that providers demonstrate progress towards the aims of the CQUIN in community settings through a locally led exercise, with reporting of findings to be assured by locally agreed governance arrangements.

Frequently asked questions and guidance for writing business cases. Following publication of initial guidance on 2 June 2015, Monitor, NHS England and the NHS TDA have provided FAQs on consultancy spending controls/approvals and further guidance to assist trusts and clinical commissioning groups (CCGs) in writing their business cases. The guidance is in two parts: What to cover in a business case and How to ensure your case is as well presented as possible.

Procurement Policy Note 12/15: Availability of procurement procedures (decision tree). This PPN note contains a new Decision Tree and guidance on the choice of procurement procedure resulting from the Public Contracts Regulations 2015. It also sets out the general policy expectations on procurement that continue to apply.

Procurement Policy Note 13/15: Increasing the transparency of contract information. Provides guidance on how to implement the transparency principles published in March 2015. It aims to increase the type and accessibility of contract and procurement data to the public. It applies to all central government departments including their executive agencies and NDPBs. it applies to contracts advertised on or after 1 September 2015.

Commissioning and statutory funding arrangements for hospices in England: Survey results 2015. Sets out the findings of a survey by charities Hospice UK and Together for Short Lives of local hospices' experiences of the commissioning and statutory funding environment. It concludes that statutory funding for adult and children’s hospices in England is fragile, unfair and unsustainable. There are early signs that the lack of fair and sustainable funding is already having an adverse effect on hospice services. This could lead to more pressure on already overstretched NHS services if hospices are forced to reduce the level of care they provide. Hospice UK and Together for Short Lives are calling on the Government to set out how it will bring about fair and sustainable statutory funding for hospice and palliative care. 

Consultations
Fair and transparent pricing for NHS services: A consultation on proposals for revising the objection mechanism to the pricing method. To develop a national tariff, Monitor and NHS England engage with commissioners and providers of NHS services and other interested parties. The Health and Social Care Act 2012 specified an objection procedure, which allows commissioners and providers to object to the chosen method for calculating national prices, rather than the price itself. If the percentage of objections meets thresholds set by the Secretary of State, Monitor cannot adopt and publish the national tariff and must either reconsider the proposed method and publish a revised tariff for consideration or refer the method and objections to the Competition and Markets Authority. This paper seeks views on proposals to revise the objection process for setting a pricing system for NHS services in England. The consultation closes on 11 September 2015.

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

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Emergency Care

Publications/Guidance
PFI and the NHS in London: Dealing with the growing pressure of the Private Finance Initiative on our hospitals in the capital. This paper from lobbying group NHS Support Federation examines the scale of PFI debt in London and the extent to which it influences the financial position of the capital’s NHS trusts. It looks at some of the impacts on planning and services and how this affects patients. It explores the options for reducing the burden of PFI debt in an attempt to move policy makers to taking action that can help to secure the future of the NHS.

Making payment work better to support new models of urgent and emergency care: an introduction. This document is for all organisations involved in the commissioning or delivery of urgent and emergency care services, including NHS 111, community pharmacy, community care urgent response and social care urgent response services, in-hours urgent primary care, GP out-of-hours, 999, ambulance, walk-in centres, urgent care centres, emergency department attendances and emergency admissions. It is intended for chief executives, clinicians and others who require a broad understanding of a potential new payment approach being developed by Monitor and NHS England to support the service reform, but who do not need to access detailed guidance on payment design and implementation.

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

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Employment/HR

Publications and Guidance
Contract reform for consultants and doctors and dentists in training – supporting healthcare services seven days a week. This report provides the recommendations and observations of the Review Body on Doctors' and Dentists' Remuneration on the proposals put forward by the parties for reforming contracts for both doctors and dentists in training and consultants, to help deliver the aim of providing healthcare services seven day a week. 

Medical students: professional values and fitness to practice - consultation. The General Medical Council and Medical Schools Council have launched a joint consultation on guidelines to help medical students develop into competent and compassionate doctors that meet the expectations of patients and the public. Two pieces of guidance have been produced which replace the current guidance and aim to help medical students understand the professional values they need to meet while they are at university and also medical schools and universities to deal with concerns about students’ professional conduct and health. The deadline for responses to this consultation is 11 November 2015.

12-hour shifts: prevalence, views and impact. Reports from employers in the NHS appear to suggest that the 12-hour shift system is increasing and may now be the dominant shift system in the NHS. In this document, Steven Weeks, policy manager at NHS Employers summarises the key findings of a major new study that examines the impact 12-hour shifts have on quality of care and patient experience, alongside nurse opinion on the growth of this shift system.  

The Royal College of Nursing response to the Nursing and Midwifery Council (NMC) evaluation of the revalidation pilots. The Nursing and Midwifery Council is requiring all nurses and midwives to undergo revalidation every three years, in order to renew their registration. This paper outlines the RCN position on the NMC revalidation pilot. The RCN believes that the right model of NMC revalidation, which is effective and proportionate, can help to protect the public and also to create and sustain a strong culture of professionalism amongst nurses. Their response sets out a number of areas on which the NMC must urgently provide clarity, in order to instil confidence in the nursing workforce and indeed the wider healthcare system that current proposals will be effective, including third party confirmation and the NMC’s emphasis on the use of appraisal as the vehicle for revalidation.

7-day NHS services: a factsheet. Hospitals and community services are already working together to create a better service 7 days a week. This fact sheet sets out how the Government wants to go further and faster to deliver safer care in this Parliament.

Mind the gap - exploring the needs of early career nurses and midwives. This report from Birmingham and Solihull Local Education and Training Council explores staff retention among newly qualified health professionals. It draws conclusions relating to generational differences evident amongst healthcare professionals, and suggests employers need to accommodate generational needs in order to ensure that newly qualified staff of all ages are supported and retained. 

Promoting excellence: standards for medical education and training. This new single set of standards cover both undergraduate and postgraduate medical education and are designed to put patient safety, quality of care, and fairness at the heart of the training received by both medical students and doctors. It also makes the roles and responsibilities of organisations delivering medical education clearer as well as the requirements for teaching, supervision and support. This standard replaces current GMC standards set out in Tomorrow's Doctors (aimed at medical students) and The Trainee Doctor (aimed at postgraduate doctors in training) and comes into effect on 1st January 2016.

GMC launches new app for doctors. The General Medical Council (GMC) has launched a new app to help doctors manage their professional development. The 'GMC My CPD' app enables doctors to record their ongoing learning activities. The GMC believes it will be a useful aid to frontline doctors. 

All public sector employees who work directly with the public to have fluent English. The Cabinet Office has announced that the Government is to introduce new legislation requiring every public sector worker employed in a public-facing role to speak fluent English. Public sector bodies will have to ensure that staff will have at least ‘level 2’ English, depending on the nature of the role and profession. The legislation and a new code of practice will apply to existing and new employees working in public-facing roles, including police officers, social workers, teaching staff and assistants and local government employees. 

Bevan Brittan Updates
Meters out of reach; legal changes within reach. In a decision which will have a significant impact on UK equalities law, the European Court of Justice has answered the question of whether 'associative' discrimination can apply to indirect discrimination, as well as direct discrimination. Sarah Maddock reports.

Unpacking Holiday Entitlements. Now that the holiday season is in full swing, we thought it would be timely to provide an update on where we are with holiday entitlements, including the recent decision on holiday pay and long term sick leave.

Employment news round-up - July 2015. This month's news round-up features: trade union reforms, the 'living wage', gender pay reporting, nurse revalidation, tribunal fees, the 'fit for work' service, tax-free childcare, Freedom of Information and details of our forthcoming events. Julian Hoskins reports.

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

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Finance

Publications and Guidance
Making change possible: a Transformation Fund for the NHS. Joint report from the Health Foundation and The King’s Fund on the key aspects of a Transformation Fund for the NHS in England. The report draws on analysis conducted by the two organisations, in particular six case studies of funding transformation, in the health sector and beyond, along with examples of local NHS initiatives. They find that the Transformation Fund requires £1.5–2.1bn a year in dedicated funding between now and 2020/21. While bringing together the existing strands will go some way towards this, more resources will be needed above the £8bn increase in NHS funding already announced by the Government. The introduction of the Fund would involve two phases: the first phase (2016/17–2020/21) would be split into two strands: an Efficiency Strand, which would look to achieve higher rates of efficiency growth across all services, and a Development Strand to invest in new models of care. The second phase (2021/22 and beyond) would focus on widespread roll-out of the successful new models of care. This would include double-running costs associated with these new models. 

Quarterly monitoring report: issue 16. According to this report, more than 60 per cent of NHS trust finance directors think controls on agency spending announced in June will not significantly reduce the amount spent on agency staff. The regular survey carried out for the report also found that three-quarters of trusts intend to recruit more permanent nurses in the next six months, suggesting that the NHS is continuing to prioritise quality of patient care despite rising financial pressures.  

Consultations
Public Sector Efficiency Challenge: Chancellor and Chief Secretary's letter to public sector workers. The Chancellor George Osborne and Chief Secretary to the Treasury Greg Hands have written to public sector workers asking for their ideas on how the Government can do more for less through the Public Sector Efficiency Challenge. The letter invites them to take part in an online survey to share their ideas for doing more while saving public money, ahead of this year’s Spending Review. This follows a similar exercise in 2010 in which people who were working on the front line were asked to suggest ways to improve the public services they provide, using their expertise and knowledge of how those services are actually delivered. The closing date for suggestions is 4 September 2015. 

News
NHS trusts told financial plans 'unaffordable'. The BBC reports that the Chief Executive of Monitor, David Bennett, has written to the 46 foundation trusts with the biggest deficits "challenging" their financial plans. He has asked all providers ‘to look at what more can be done’ to reduce the sector’s deficit. The letter urges FTs to take money-saving measures such as leaving non-essential vacancies unfilled, and to follow guidelines on safe staffing in a way which was "proportionate and appropriate". 

If you wish to discuss any finance issues please contact Claire Bentley.   

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Information Sharing

Publications/Guidance
Legacy records management: services provided by the Department of Health Records Office. These documents relate to services provided by the Department of Health Records Office. They are for the attention of managers, financial departments and any other colleagues with records management responsibilities within organisations that have inherited legacy records from former PCTs and SHAs.

Information management policy: retention and destruction. This document details the general disposal decisions that the Department of Health applies to information and helps ensure disposal is carried out at the correct time. It is used as a basis for deciding how and when information in all formats is disposed.

Privacy of health records: Europeans' preferences on electronic health data storage and sharing. This briefing summaries the evidence from one of the largest-ever surveys of citizens' views across Europe on security, surveillance and privacy issues in the storage of health records.

If you wish to discuss any of the items raised in the above section please contact Jane Bennett.

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Mental Health

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

Publications/Guidance
Statutory disclosure guidance. Criminal disclosure guidance updated to include mental health. The Home Office has published updated statutory guidance on disclosing police information within the criminal records process. The first edition of the guidance was effective from September 2012, with the updated guidance coming into effect on 10 August 2015. Amid concerns about the damaging long-term effects on such individuals, the updated guidance now includes health information, crucially on when it is relevant and proportionate to disclose mental health information.

Care and Treatment Reviews: policy and guidance. Care and Treatment Reviews (CTRs) were developed as part of NHS England’s commitment to improving the care of people with learning disabilities or autism. They bring those responsible for the care of those who are in, or at risk of being admitted to, specialist hospitals around the table with the individual themselves and their families, as well as independent clinicians and experts by experience, to ensure that the care needs of that individual are being met. This guidance has been produced by building on the learning from the reviews which have taken place so far, including extensive engagement with people with learning disabilities, their representatives and their families. It will help CCGs and NHS England commissioners implement the recommendation from this learning that CTRs should become ‘business as usual’.

Reasons why people with dementia are admitted to a general hospital in an emergency This study finds the proportion of people with dementia being admitted to hospital in an emergency increased by 48 per cent between 2008/09 and 2012/13. It focuses on the reasons why people with dementia are admitted to a general hospital in an emergency and considers ways in which some of these could be prevented. It recommends that although strategies to improve care for people with dementia have progressed and there is greater awareness of the symptoms, there is room for improvement.

Mental healthcare: a capitated approach to payment with outcomes and risk share components. This document is intended for all organisations involved in commissioning or delivering new care models. It is aimed at providers and commissioners who are interested in more information on outcomes-based payment models and how they could work in practice. It will be of particular interest to finance, contracting and commissioning staff seeking detailed guidance on developing new financial mechanisms to support service reform.

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The report highlights areas of healthcare where safety should be strengthened.
Key messages include:
•The rise in suicide among male mental health patients appears to be greater than in the general population - suicide prevention in middle aged males should be seen as a suicide prevention priority.
•It is in the safety of crisis resolution/home treatment that current bed pressures are being felt – the safe use of these services should be monitored; providers and commissioners (England) should review their acute care services.
•Opiates are now the most common substance used in overdose – clinicians should be aware of the potential risks from opiate-containing painkillers and patients’ access to these drugs.
•Families and carers are a vital but under-used resource in mental health care – with the agreement of service users, closer working with families would have safety benefits.
•Good physical health care may help reduce risk in mental health patients – patients’ physical and mental health care needs should be addressed by mental health teams together with patients’ GPs.
•Sudden death among younger in-patients continues to occur, with no fall – these deaths should always be investigated; physical health should be assessed on admission and polypharmacy avoided.

Supporting people with a learning disability and / or autism who have a mental health condition or display behaviour that challenges. NHS England, the LGA and ADASS have published a new draft national framework designed to improve the care of people with learning disabilities, shifting services away from hospital care and towards community-based settings. The new draft service model is the latest piece of work to emerge from the Transforming Care for People with Learning Disabilities programme.

Dementia: Statistics on prevalence and improving diagnosis, care and research. This Commons research note outlines Government, NHS and other statutory bodies’ work to improve dementia diagnosis, care and support and research. It also includes statistics, tables and maps on age-adjusted dementia prevalence across the UK, including for each English Parliamentary constituency.

Dementia friendly communities – Guidance for councils. Discusses the important role of councils in supporting people with dementia by creating local dementia friendly communities. It includes case studies that demonstrate how many councils are already working in partnership with their local communities to develop innovative ways to enable people with dementia to take part in everyday activities and retain their independence for as long as they are able.

Finding a path for the cure for dementia: an independent report into an integrated approach to dementia research. This report by Raj Long, Senior Regulatory Officer at the Bill & Melinda Gates Foundation, sets out what and where hurdles exist in the development of treatments for dementia. The report forms part of the ambition to help drive towards the G8 dementia summit’s goal of a cure or disease modifying therapy for dementia by 2025.

Consultations
Supporting people with a learning disability and/or autism who have a mental health condition or display behaviour that challenges. NHS England, the LGA and the Association of Directors of Adult Social Services have published a new draft national framework designed to improve the care of people with learning disabilities, shifting services away from hospital care and towards community-based settings. The draft Service Model sets out nine overarching principles which define what 'good' services for people with learning disabilities and/or autism whose behaviour challenges should look like. The closing date for comments is 4 September 2015.

Cases
Re MOD and others (Deprivation of Liberty) [2015] EWCOP 47. The Court of Protection considered several cases before it in the light of guidance from the Supreme Court and Court of Appeal on the subject of deprivation of liberty in the context of Sch.1A to the Mental Capacity Act 2005 which contained a scheme whereby a managing authority of a hospital or care home was allowed to deprive a patient or resident of his or her liberty. See case summary by Hannah Taylor on the mental health extranet.

Bevan Brittan Updates
Mental Capacity and Deprivation of Liberty. On 7 July 2015 the Law Commission published its Consultation Paper on Mental Capacity and Deprivation of Liberty. In this alert we explain the key proposals put forward.

Bevan Brittan Events
At the beginning of November, Bevan Brittan's Court of Protection team is hosting a practical update session which will cover relevant legislation, guidance and case law and their impact on managing cases involving incapable patients. If you would like to register your interest in any of these sessions please click on any of the links below:- 
Court of Protection - Birmingham
Court of Protection - Bristol
Court of Protection - London

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

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Primary Care

Publications/Guidance
Primary care in the NHS: Busting the myths. The NHS Confederation is publishing a series of myth busters, which challenge common misconceptions and enrich debate on topical, sometimes controversial, issues regarding our health and care. This one, the third in the series, dispels myths about primary care in the NHS. Previous myth busters covered Competition in the NHS and NHS managers.

Primary care co-commissioning submission and approval process. NHS England has set out the key dates and the application process for CCGs who wish to apply in 2015/16 to take on new delegated and joint commissioning arrangements for the majority of GP services. CCGs are encouraged to work closely with their regional directors of commissioning operations and teams as soon as possible in advance of making applications. For delegated commissioning arrangements, CCGs should submit their proposal by the extended deadline of noon on 6 November 2015 to england.co-commissioning@nhs.net and their local NHS England team. CCGs who meet the criteria will take on delegated arrangements from 1 April 2016. For joint commissioning arrangements, CCGs are able to go live on the first day of each quarter, before which submissions should be made and shared with local NHS England teams. The next implementation date for joint commissioning is 1 October 2015. 

The future of primary care: Creating teams for tomorrow. The independent Primary Care Workforce Commission, chaired by Martin Roland CBE, was commissioned by the DH and Health Education England to identify and highlight innovative models of primary care that will meet the future needs of patients and the NHS. Its report calls for greater collaboration across organisations and a broader range of staff involved in the delivery of healthcare.

Improving acute inpatient psychiatric care for adults in England: interim report. The Commission on Acute Adult Psychiatric Care was set up by the Royal College of Psychiatrists in response to widespread concerns about the provision of acute inpatient psychiatric beds and alternatives to admission available for patients. This interim report is based on the Commission’s initial observations about acute inpatient psychiatric services for adults in England and its discussions with patients, carers, advocates, health and social care professionals and policy makers. It finds that the so-called bed or admission crisis in adult mental health is very significantly a problem of discharges and alternatives to admission that can only be addressed through changes in services and management of the whole service.

Examples of outstanding practice. The CQC has been inspecting general practices under a new inspection model since October 2014, and has now published approximately 1,200 GP practice inspection reports. This online tool brings together a collection of some of the most innovative and effective examples of outstanding practice that CQC inspectors have found since implementing the new methodology. 

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

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Public Health

Publications/Guidance
E-cigarettes: an evidence update. PHE has published a review that explains the relative risks and benefits of e-cigarettes, in terms of harm reduction when compared with cigarettes and as an aid to quitting. The review concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.

Doing, supporting and using public health research: the Public Health England strategy for research, translation and innovation This document sets out PHE’s commitment to research, translation and innovation; the steps that PHE will take, alone or with partners, to do research, to support research and to use evidence from research.

Inequalities in life expectancy: Changes over time and implications for policy. This report from the King's Fund explores how the relationship between income deprivation and life expectancy (the "Marmot curve") has changed over time and looks at the impact of other variables such as employment, housing deprivation, binge drinking and diet. It assesses what that tells us about the success or otherwise of government policy on inequalities in health over the period 1999–2003 to 2006–10.

Smoking in vehicles. The DH has issued an update on the new law on smoking in cars and other vehicles with someone under 18, that comes into effect on 1 October 2015.

Who we are and what we do: Annual Plan 2015/16. PHE has published its latest Annual Plan that sets out its core functions and outlines the key steps and actions for the year ahead.

Review of the Public Health Skills and Knowledge Framework (PHSKF). This report presents the outcomes of the first stage of the review of the UK PHSKF that sets out the skills and knowledge that the public health workforce need for their current and future practice.

NHS public health functions agreement: Variation to the 2014-15 agreement on public health functions to be exercised by NHS England. Provides for variations to the NHS public health functions agreement that sets out the arrangements under which the Secretary of State delegates responsibility to NHS England for certain public health services (known as Section 7A services).

Royal Society for Public Health: Rethinking the public health workforce. This report outlines plans for a range of different occupations to support efforts to improve the public’s health. It identifies a number of occupations, who have already started to support public health work, many of which already have regular contact with the public, such as the fire service, allied health professionals and pharmacists. With only 40,000 people estimated to be part of the core public health workforce, and in light of the crisis in lifestyle health issues, the report calls for anyone who has "the opportunity or ability to positively impact health and wellbeing through their work" to join the wider public health workforce.  

Consultations
Consultation guide: National procurement for the provision of behavioural interventions for people with non-diabetic hyperglycaemia. NHS England, Public Health England and Diabetes UK are asking CCGs to register their interest in becoming first wave sites for the NHS diabetes prevention programme in 2016. The programme will focus on improving diet, weight and exercise to reduce the incidence of type 2 diabetes. Service providers will also be invited to contribute to the programme. The deadline for responses is 7 September 2015. The feedback will be used to help NHS England develop an Invitation to Tender (ITT) later this year.

Community engagement: approaches to improve health and reduce health inequalities. NICE has issued a draft public health guideline on approaches to community engagement to help communities improve their health and wellbeing and reduce health inequalities. The closing date for comments is 24 September 2015.  

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

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 Regulation 

Publications/Guidance
Capacity and capability to regulate the quality and safety of health and adult social care. This report finds that the Care Quality Commission has made substantial progress as it seeks to address public concerns about its regulatory approach, but argues that significant challenges lie ahead if it is to demonstrate effectiveness and value for money.

Rethinking regulation. According to a report from the Professional Standards Authority (PSA), the healthcare regulatory framework in the UK is out of date, over-complicated and too expensive. In the report ‘Rethinking regulation’ the PSA concluded the nine organisations which regulate health professionals and social workers in the UK are largely ineffective and are becoming unfit to meet future challenges.

CQC annual report 2014/15. Reflects on how CQC has progressed from designing, testing and evaluating its new, rigorous and expert-led way of monitoring, inspecting and regulating health and adult social care services across England, to implementing it. it includes details of its achievements in 2014/15.

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

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General

Publications/Guidance
The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance. This revised version of the CoP replaces the edition published in 2010 and applies to NHS bodies and providers of independent healthcare and adult social care in England, including primary dental care, independent sector ambulance providers and primary medical care providers. The code now reflects the changes required to meet the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the role of infection prevention (including cleanliness) in optimising antimicrobial use and reducing antimicrobial resistance. The law states that the code must be taken into account by the CQC when it makes decisions about registration and that providers must have regard to the code when deciding how they will meet the regulations. However, the code is not mandatory, so registered providers do not by law have to comply with the code. A registered provider may be able to demonstrate that it meets the regulations in a different way (equivalent or better) from that described in this document.

Complete list of NHS estates related guidance. The DH has published a spreadsheet that is a definitive list of all estates related guidance past and present. It identifies the current status of each document, including whether it has been superseded and whether it is available for download. It includes health building notes (HBN), health technical memorandum (HTM) and choice framework for local policies and procedures (CFPP).

Report of the Chief Coroner to the Lord Chancellor – Second Annual Report 2014 to 2015. This is the Chief Coroner's second annual summary of the operation of coroner services under s.36 of the Coroners and Justice Act 2009, following the implementation of the Act’s reforms in July 2013. The report summarises his work to promote consistency in the resourcing of and practices in coroner offices across England and Wales. It highlights how the Chief Coroner is working towards a greater consistency in all areas of the coroner domain and is encouraging bringing coroner services together under one roof.

Better leadership for tomorrow: NHS leadership review. The Secretary of State for Health asked Lord Rose to conduct a review into leadership in the NHS. The review asked what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS. It also asked how strong leadership in hospital trusts might help transform the way things get done and how best to equip CCGs to deliver the NHS five year forward view. It makes 19 recommendations covering training, performance management, bureaucracy and management support.

News
'Common sense' plea over ambulance speeding fines. The BBC reports that ambulance trusts spent hundreds of hours having to appeal against speeding fines issued to emergency vehicles by police forces. Health bosses have called for the automatic exemption on emergency vehicles to be better enforced. Some trust staff are spending 40 hours a month appealing against the fines. The web page includes statistics on penalty charge notices issued to ambulance trusts.