Health and Social Care Update September 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	Foundation Trusts
Children/young people	Information Sharing
Clinical Risk/Health and Safety	Mental Health
Commissioning	Primary Care
Emergency Care	Public Health
Employment/HR	Regulation
Finance	General

Care

Publications
Mental Capacity Act 2005, Deprivation of Liberty Safeguards (England), Annual Report 2014-15. This official statistics report provides the findings from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1 April 2014 to 31 March 2015. Also see Care Management Matters news report.

Care and support: What's changing? Updated information on what the changes to the Care and Support Act mean for carers and the cared for.

Ambitions for palliative and end of life care: A national framework for local action 2015-2020. The National Palliative and End of Life Care Partnership, made up of statutory bodies including NHS England, the Association of Adult Social Services, charities and groups representing patients and professionals has developed a framework for action in making palliative and end of life care a priority at local level. It builds on the DH’s 2008 Strategy for End of Life Care and responds to an increased emphasis on local decision making in the delivery of palliative and end of life care services since the introduction of the Health and Social Care Act 2012.

Counting the cost of care – The council’s role in informing public choices about care homes. This LGO focus report examines whether families across England are paying more than they need to because they have not been given comprehensive information about the costs of care available in their area. It provides guidance for councils to make sure their procedures do not put people at risk of paying too much and offers questions for councillors to help scrutinise their authorities’ policies and procedures. The report includes examples of cases where councils provide confusing or incorrect advice, do not offer potential residents a genuine choice of affordable care home or have any affordable homes available.

An analysis of social care activity in prisons and approved premises. The Care Act 2014 "clarified" local authority responsibilities for people living in prisons and approved premises. This ADASS report describes what happened in the first three months from when the legislation was implemented in April 2015. it sets out the findings of a survey of all local authorities in England with either a prison or approved premises.

Home care: delivering personal care and practical support to older people living in their own homes. This NICE guideline covers the planning and delivery of person-centred care for older people living in their own homes (home care or domiciliary care). It aims to promote older people's independence and to ensure safe and consistently high quality home care services. It recommends that services support the aspirations, goals and priorities of each person, and that they and their carers are treated with empathy, courtesy and respect. Home care visits shorter than half an hour should only be made if the home care worker is known to the person and the visit is part of a wider package of support and the purpose of the visit can be properly undertaken in that time. The guideline also highlights the importance of prioritising continuity of care by ensuring the person has the same home care worker or workers so that they can become familiar and build a relationship.

A charge on caring? This report from the Carers Trust analyses the use and impact of charges by councils providing support to unpaid carers. Following concerns that a number of local authorities had started to introduce charges to unpaid carers for the support they provide to help them in their caring role, contrary to the Care Act statutory guidance, the Trust sent an FOI request to all social services councils in England to establish how many councils are using charges, how are they are being applied, and the impact they are having on carers.

Moving care closer to home. Monitor has published resources that provide support for providers and commissioners to make evidence-based appraisals of how the benefits compare with the costs of various approaches to move care closer to home.

Revised Prevent duty guidance. Updated guidance under the Counter-Terrorism and Security Act 2015 to authorities (including health organisations) on the duty to have due regard to the need to prevent people from being drawn into terrorism – the "Prevent duty".

News
Nice criticises ‘flying home care visits’ as short as five minutes. Government advisers want care workers to spend at least half an hour with vulnerable people but admits council budget cuts are an obstacle.

Journal Articles
Stuart Marchant and Emma Timmons have published an article in Care Management Matters called Deprivation of Liberty - your chance to change the law.

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

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Children/young people

Consultations
Continuing care for children and young people with complex needs. The DH is seeking views on the revised National Framework for Children and Young People’s Continuing Care, including a tool to ensure all relevant needs are assessed and support decisions about care. The framework helps CCGs and other professionals to assess the care required for children and young people with health needs that are not met by existing or specialised services. The 2010 framework has been revised to take account of changes to commissioning and the new arrangements for children with special educational needs and disability. The consultation closes on 23 October 2015.

Jointly commissioning palliative care for children and young people. Children’s palliative care charity Together for Short Lives has published a guide to support CCGs and local authorities in England to commission palliative care for children and young people aged 0–25 effectively. It also supports health and wellbeing boards to understand their role in the commissioning process.

If you wish to discuss any issues relating to foundation trusts please contact Claire Bentley.  

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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/
The National Safety Standards for Invasive Procedures (NatSSIPs) aim to reduce the number of patient safety incidents related to invasive procedures in which surgical Never Events could occur. These new standards set out broad principles of safe practice and advise healthcare professionals on how they can implement best practice, such as through a series of standardised safety checks and education and training. The standards also support NHS providers to work with staff to develop and maintain their own, more detailed, local standards and encourage the sharing of best practice between organisations.

Complaints about acute trusts 2014-15. This report outlines how many unresolved complaints the Parliamentary and Health Service Ombudsman (PHSO) investigated for every acute trust in England and the final decision made. It reveals that, similar to last year, the top three reasons for hospital complaints investigated by the PHSO in the last financial year were poor communication, errors in diagnosis and poor treatment. Non-medical aspects of patient care are cited as a factor in almost half of all complaints investigated, while poor communication, including quality and accuracy of information, was a factor in one third of all complaints. Other reasons for complaints in this period included staff attitude and behaviour, which were factors in two out of 10 complaints. See also BBC news

NHS whistleblowing procedures in England. This Commons Library research briefing sets out the current rights and procedures for NHS staff to raise concerns about safety, malpractice or wrongdoing at work ("whistleblowing").

Consultations
Independent Patient Safety Investigation Service Expert Advisory Group – Call for evidence. The new Independent Patient Safety Investigations Service (IPSIS), which will operate from April 2016, will offer support and guidance to NHS organisations on investigations into serious patient safety incidents, and carry out certain investigations itself. An Expert Advisory Group has been set up to make recommendations on how the new investigation service should work, and is seeking views from a wide range of stakeholders. The closing date for comments is 31 October 2015.
See also an article by Dr Mike Durkin, Director of Patient Safety, NHS England, in which he discusses the plans for IPSIS.

NHS maternity review. The NHS maternity review is currently underway to make recommendations for the improvement of services for women and their families. It is open to women, fathers, partners, their families and advocates, professionals, commissioners and people from representative organisations. The closing date for comments is 31 October 2015.

Independent Patient Safety Investigation Service (IPSIS) expert advisory group: call for evidence. The Independent Patient Safety Investigations Service, which will operate from April 2016, will offer support and guidance to NHS organisations on investigations into serious patient safety incidents, and carry out certain investigations itself. An expert advisory group has been set up to make recommendations on how the new investigation service should work, and is seeking views from a wide range of stakeholder. It wants views on 5 related themes: independence, governance and accountability; engagement and transparency; what IPSIS should investigate; supporting improvement and learning; and people, skills, operation. The deadline for responses to this consultation is 31 October 2015.

News
Silicone implants withdrawn due to contamination fears. Implants used in thousands of operations have been withdrawn in Britain by the Medicines and Healthcare products Regulatory Agency (MHRA) following the suspension of the CE certificate of conformity for all devices made by Brazilian manufacturer Silimed. An inspection of the manufacturing plant found that some devices were contaminated with particles. The implants have been used in procedures including breast implants, calf implants and gastric band surgery. A medical device cannot be marketed in Europe without carrying a CE mark. The MHRA said an urgent investigation is being carried out to discover what the particles are and whether they would pose a threat to safety.

Cutting reliance on paper will make patients safer, says NHS England. The NHS will urge health and social care leaders to end the unnecessary reliance on paper in the treatment of patients and make services safer, more effective and efficient.

EMA begins medical literature monitoring service. The European Medicines Agency (EMA) has started its full medical literature monitoring service which it expects will improve the safety monitoring of medicines. It is intended to benefit around 4,000 pharmaceutical companies, with a total of 400 active substance groups will now be monitored under the new programme.

Clinical negligence lawyers warn of "rushed" pre-Christmas consultation on fixed fees. The Department of Health is planning a "rushed" pre-Christmas consultation on fixed fees, according to medical negligence lawyers including Rosamund Rhodes-Kemp, vice-chair of the Society of Clinical Injury Lawyers, who said she was concerned the consultation would be run for only six weeks between mid-November and the end of the year.

Insurer invokes ‘fundamental dishonesty’ to see off claims. Insurer Axa has forced two claimants to revoke GBP 25,000 personal injury claims after invoking the fundamental dishonesty defence introduced under the Criminal Justice and Courts Act 2015. It is believed to be one of the first-known occasions that an insurer has used powers under the Act to have a claim thrown out in total if it is proven the claimant was fundamentally dishonest.

NHS Maternity Review. NHS England is seeking views on improving maternity services. Responses will feed into the Maternity Review that will assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies. The consultation closes on 31 October 2015.

NHS warns nurse immigration rules 'harm patient safety'.

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
Investigation into NEW Devon CCG’s commissioning of community services for adults with complex care needs in eastern Devon: final report. Monitor has published the findings of its investigation into how Northern, Eastern and Western Devon CCG (NEW Devon) selected Royal Devon and Exeter NHS Foundation Trust as its preferred provider of community services for adults with complex care needs in east Devon. Monitor opened its investigation after receiving a complaint from Northern Devon Healthcare NHS Trust, the current contract holder, which claimed that NEW Devon had undertaken an inadequate and unfair process in awarding a contract for these services. Monitor found that NEW Devon's commissioning of community services did not breach NHS commissioning regulations; however, the CCG will be doing further work in the next phase of its process as a result of the investigation. The commissioner took into account patient needs and the service improvements required and designed a process to select a provider from a number of proposals. However, the CCG now needs to do more work to ensure that it will get value for money before awarding the contract.

Transforming healthcare in England’s core cities. NHS Clinical Commissioners has launched a new publication showing how CCGs in England’s Core Cities are taking up the challenge set out in the Five Year Forward View and transforming the way in which healthcare is delivered to the benefit of their local population. The report's key themes are: developing new partnerships; ensuring equity of care across diverse populations; improving wellbeing; and finding better ways to provide healthcare services.

CCG involvement and the NHS Commissioning Assembly. NHS England and NHS Clinical Commissioners have released a joint note detailing how NHS England will engage with CCGs going forward. This follows NHS England's announcement last month that the Commissioning Assembly had been disbanded.

Managing conflicts of interest in NHS clinical commissioning groups. The National Audit Office has published its findings following an investigation into managing conflicts of interest in NHS clinical commissioning groups (CCGs). Among the key findings is that, across different CCGs, the adequacy of controls for managing risks of conflicts of interest varies.

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

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Emergency Care

Publications/Guidance
A&E delays: why did patients wait longer last winter? In quarter three 2014/15, the performance of A&E departments against the four hour standard reached its lowest in ten years. This report shows that the target four hour emergency care indicator is a measure of the performance of the whole health and care system, not just emergency care departments; the findings show that across England the rest of the hospital struggled to cope with the increase in admissions because of very high occupancy rates.

Investigating the impact of out-of-hours GP services on A&E attendance rates: multilevel regression analysis. This paper sets out how the NAO used an analytical technique called multilevel regression modelling to investigate the factors affecting levels of attendance at accident and emergency (A&E) departments by patients registered at a GP practice. 

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

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Employment/HR

Publications and Guidance
Nursing agency rules. This guidance outlines the new rules on nursing agency spend from Monitor and the NHS Trust Development Authority for NHS foundation trusts and NHS trusts. The rules come into effect on 1 September 2015 and apply to agency spend on registered nursing, midwifery and health visiting staff only. They include:
 an annual ceiling for total agency spend for each trust between 2015/16 and 2018/19;
 trusts are being sent individual ceilings today and will have the opportunity to apply for exceptions if there are specific local needs;
 mandatory use of frameworks for procuring agency staff; and
 limits on the amount individual agency staff can be paid per shift, which will be implemented later in the year after further work by the two organisations.

NHS whistleblowing procedures in England. This Commons Library research briefing sets out the current rights and procedures for NHS staff to raise concerns about safety, malpractice or wrongdoing at work ("whistleblowing"). 

Junior and consultant contract negotiations. In July the Review Body on Doctors' and Dentists' Remuneration (DDRB) published its recommendations and observations on the proposals put forward by the parties for reforming contracts for both doctors and dentists in training and consultants. This document contains a detailed analysis by the BMA on what the proposals mean for junior doctors.

Contracts and conditions in the NHS. This Commons Library briefing paper contains press coverage, parliamentary material, reports and Library briefings relevant to the Westminster Hall debate on Contracts and conditions in the NHS, that was scheduled for 14 September 2015. The debate was triggered by an e-petition which called for Parliament "To debate a vote of no confidence in Health Secretary the Right Hon Jeremy Hunt". 

Seven day services: an evidence base of enablers for transformation. NHS Improving Quality Seven Day Services team have been leading a service improvement programme across England designed to support the transformational change required to deliver access to high quality health and social care every day of the week. They interviewed key representatives of health and social care communities, from across the country, to determine what have been the key enablers and barriers in delivering change. The initial findings can be found in this report.

News
Simon Stevens announces major drive to improve health in NHS workplace. The NHS England Chief Executive Simon Stevens has launched a major drive to improve the health and wellbeing of 1.3m health service staff, in a bid to benefit both staff and taxpayers. Speaking at the NHS Innovation Expo conference, Mr Stevens set out how NHS organisations will be supported to help their staff to stay well, including serving healthier food, promoting physical activity, reducing stress, and providing health checks covering mental health and musculoskeletal problems – the two biggest causes of sickness absence across the NHS.

Hospitals warned by CQC over staff shortages. Three in four NHS hospitals have been warned by the Care Quality Commission (CQC) about potentially dangerous staff shortages in key areas, including critical care. However, a crackdown on health spending is putting hospitals under intense pressure to cut staffing costs to avoid going into debt.

A National Guardian for the NHS - Have your say. The CQC is seeking views on the new role of National Guardian, created to support whistleblowers in the NHS and improve reporting culture. The paper sets out its plans for how the National Guardian will operate, its scope and the specific functions it will cover. The consultation closes on 9 December 2015.

NHS warns nurse immigration rules 'harm patient safety'.

Bevan Brittan Articles
Travel time included in "working time" In an important decision for any organisation whose workers are based at home but travel to carry out their work – such as community nurses who drive from their homes to see patients, or maintenance staff who travel to various sites to carry out repairs – the European Court of Justice (ECJ) has today handed down its full judgment in the case of Federación de Servicios Privados del Sindicato Comisiones Obreras v Tyco Integrated Security SL.

Travel to work can be 'work'. Sarah Lamont follows up on our recent Alert on Tyco Integrated Services, and resolves some of the potential confusion over the practical and cost implications of the decision that travel time can count as 'work' for mobile workers.

Substantial influence by HR can lead to unfair dismissal James Gutteridge explains recent and important guidance on the scope of HR's role in disciplinary investigations.

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

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Finance

Publications/guidance
The health of health finances. This CIPFA paper considers whether the Government has adequate plans to deal with the financial pressures on the health service. It looks at recent financial results and forecasts and the pressures they indicate, making comparisons with trends in spending levels and analysing the specific pressures likely in future years. Current plans are based on the NHS’s Five Year Forward View’s assessment that £30bn of pressures are faced over the five years to 2021, and that £8bn of that will be offset by additional funding. CIPFA concludes that the key figures of £30bn pressures and £22bn savings are both optimistic, and – ahead of the forthcoming Comprehensive Spending Review – makes recommendations for how the Government can improve the realism of the plans, and what actions it should take to make any plan a more deliverable reality.

The financial cost of healthcare fraud report 2015. This report contains an in depth section on the UK's NHS showing what the NHS's own figures indicate the cost of fraud to be in each main area of expenditure – payroll, procurement, GP, dental, optical, and pharmaceutical services, as well as losses to income from patient charges. There are also examples of types of fraud.

Spending Review submission: health and social care funding – The short, medium and long-term outlook. The King's Fund's submission to the Government for the November 2015 Spending review argues that the period covered by this Spending Review will be the most challenging in the recent history of the health and social care system. Both services must simultaneously respond to growing pressures on services and put in place large-scale changes to ensure their future sustainability. Failure to do so will mean patients having to wait longer for diagnosis and treatment, the quality of health and social care declining, and fewer people receiving publicly funded social care. It concludes that it is not credible to maintain that current standards of care can be sustained (let alone improved) without the funding needed to deliver this. The Government should therefore spell out the consequences for patients and users of publicly funded social care of not providing the additional funding we argue for. This means being honest about the fact that access to care will deteriorate further and quality of care will be compromised because of the choices made about public spending and taxation during this Parliament.

2015 Comprehensive Spending Review: Representation to HM Treasury. The Nuffield Trust’s representation looks at the pressures on NHS funding up to 2020, the scope for savings and efficiencies, and the difficult choices on funding facing policymakers. Its briefing looks at the £8bn in extra funding promised to the NHS by 2020. It concludes that while it is a generous settlement in the context of wider spending cuts, it will be outpaced by constantly rising health care costs and patient numbers, with a real struggle to maintain standards. It expresses concern that other budgets held by the Department of Health may not be ring-fenced. Giving the NHS more money by cutting services it relies on, like training and public health, would be counterproductive; equally, the funding squeeze on social care could put progress on prevention and co-ordinated care at risk.

News
King's Fund Toolkit - Pilot sites announced!! The King's Fund has announced the 24 pilot sites that will test a “close partnering” toolkit which promises to improve relationships between clinical staff and finance teams. Nurses and midwives in the pilot sites are encouraged to actively engage and test the toolkit.  

NHS approves hospital chains. The NHS has approved the creation of chains of hospitals for the first time in its history in the hope of alleviating deep financial problems and allowing more patients to receive care from leading doctors in their fields.

If you wish to discuss any issues relating to foundation trusts please contact Claire Bentley.    

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Foundation Trusts

Publications/guidance
Foundation trust and NHS trust mergers. Mergers of trusts in the NHS are often instigated by national bodies so that NHS trusts can gain foundation trust status or failing providers can be rescued from financial difficulties. This report looks at 20 mergers between 2010 and mid-2015 and finds that significant sums of money are being spent on such mergers (£2 billion on just 12 mergers over this period), often based on faulty argumentation and a lack of evidence that mergers offer lasting solutions. It concludes that the Department of Health, Monitor and the Trust Development Authority should support service improvement and transformation where possible, rather than instigate merger. If a merger is contemplated, there needs to be a more realistic assessment of the costs and benefits.

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

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Information Sharing

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
Accessing and sharing health records and patient confidentiality. This House of Commons Library briefing note sets out current arrangements for accessing patient records and sharing confidential patient information. it describes how patients may request access to their records and the circumstances in which access to the records of others may be allowed and outlines safeguarding arrangements for confidential patient information. It also describes statutory and public interest disclosures of patient information, information sharing rules for people who lack mental capacity and access to information on hereditary conditions for relatives.

News
HIV clinic reveals patients' identities in data breach. An enquiry is to be launched after an HIV clinic in London, the 56 Dean Street clinic, sent out a newsletter which disclosed names and email addresses of 780 people, many of whom are HIV patients. Health Secretary Jeremy Hunt has ordered the inquiry into how the NHS handles confidential medical information.

Researchers warn that health apps could be privacy risk. Researchers from Imperial College London and the Imperial and Ecole Polytechnique CNRS France have warned that NHS-accredited health apps, which send unencrypted personal and health information over the internet, could be putting users' privacy at risk.  

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
Mental Capacity Act 2005, Deprivation of Liberty Safeguards (England), Annual Report 2014-15. This official statistics report provides the findings from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1 April 2014 to 31 March 2015. Also see Care Management Matters news report.

The five year forward view mental health taskforce: public engagement findings. This report summarises the views of more than 20,000 people on the top priorities for reshaping mental health services, as part of a drive to develop a five year national NHS strategy for people of all ages. Better access to high quality services, a wider choice of treatments, more focus on prevention, more funding and less stigma were the top five calls for change by 2020.

Horizon scanning: The legislative landscape in mental health. Mental health care and services are delivered within a complex legislative framework. There have been changes to this framework in the last 12 months with more revisions proposed. This briefing aims to provide members with an overview of the current legislative landscape, highlight how the current legislation is working in practice and explore the potential impact of proposed changes.

Inquiry: mental health and wellbeing of looked after children. Building on the Health Committee’s recent report on children's and adolescents' mental health and CAMHS, the Education Committee has announced an inquiry into the mental health and wellbeing of looked after children. The deadline for receipt of written submissions is 29 October 2015.

You are not alone: Help is at Hand for anyone bereaved by suicide. A guide for people affected by suicide and written by those directly affected has been published by Public Health England (PHE) and the National Suicide Prevention Alliance (NSPA).

Peer support for people with dementia – A social return on investment (SROI) study. This report from the Health Innovation Network finds that peer support groups, or having the opportunity to meet others regularly, can help people with dementia feel less lonely and less isolated and are a valuable intervention. Dementia peer support groups also offer carers respite by providing some time for themselves, and the opportunity to meet other carers. It provides benchmark evidence for those looking to commission, invest or set up dementia peer support groups and will be useful for organisations and groups providing peer support services when applying for funding.

Identifying and responding to suicide clusters and contagion: a practice resource. This toolkit, based on research of suicide clusters, is part of PHE's support for the government’s suicide prevention strategy. It is aimed at people with responsibility for suicide prevention in local authorities and their partner agencies. The steps required at local level to prepare for a suicide cluster are described alongside suggested responses to possible suicide clusters. Finally, best practice is provided on how to evaluate responses to a cluster, and on using the experience to improve further suicide prevention measures.

Section 49 reports – the thorny issues. This is a cross-post to the Court of Protection Handbook site, where Alex Ruck- Keene has just written about the very recent decision in Re RS on s.49 reports.

Journal Articles
Stuart Marchant and Emma Timmons have published an article in Care Management Matters called Deprivation of Liberty - your chance to change the law.

News
DoLS applications increase tenfold in a year. The Health and Social Care Information Centre (HSCIC) has published its statistics report on the findings from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1st April 2014 to 31st March 2015. It includes any application that was received and/or completed during the reporting year.

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
Clinical pharmacists in general practice pilot FAQs. NHS England is asking CCGs to share further guidance on the application process for the clinical pharmacists in general practice pilot. GP practices must submit their application for the scheme by 17 September 2015. Applicants should read these guidelines on how to register for access to the SharePoint website and to view further supporting information.

News
More than one in 10 GP roles in England vacant. A survey by the RCGP has found that more than one in 10 family doctor roles in England are vacant, with many practices increasingly having to rely on locum doctors to deliver patient care. The survey of 549 practices in England found that 10.2% of full time equivalent positions are vacant, with 61% of these currently filled by locum or agency staff. Of the practices surveyed, 64% reported that finding enough locum doctors to meet growing patient demand was either difficult or very difficult; just 8% reported that this was easy. The findings also cast doubt on the feasibility of government plans to introduce a seven-day working week in general practice, which would involve stretching current resources even further.

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
Reviewing the indicators in the Public Health Outcome Framework. The Public Health Outcomes Framework sets out a high-level overview of public health outcomes, at national and local level, supported by a broad set of indicators. The indicators cover the full spectrum of what is understood as public health and what can be measured at the moment. This consultation seeks views on whether government should remove, replace or revise the existing indicators in the framework. The closing date for comments is 2 October 2015.

Identifying and responding to suicide clusters and contagion: a practice resource. Guidance for people with responsibility for suicide prevention in local authorities and their partner agencies. It sets out the steps required at local level to prepare for a suicide cluster, alongside suggested responses to possible suicide clusters. It provides best practice on how to evaluate responses to a cluster, and on using the experience to improve further suicide prevention measures.

Consultations
Smoking in prisons. The Welsh Government is seeking views on draft Smoke-free Premises, etc (Wales) (Amendment) Regulations 2016 that would exempt designated prison cells in Wales from the smoking ban for a time-limited period. The consultation closes on 12 November 2015.

News
E-cigarettes: an emerging public health consensus. Public Health England and other UK public health organisations have issued a joint statement on e-cigarettes. It sets out how the public health opportunity is in helping smokers to quit, so while it may encourage smokers to try vaping, it certainly encourages vapers to stop smoking tobacco completely.

Health matters: smoking and quitting in England. Public Health England has published a new resource for public health professionals that is designed to support commissioning and delivering services across local areas. It provides information on the prevalence of smoking and evidence for what works to promote cessation at local and national level.

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

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Regulation

Publications/Guidance
Improving patient flow: evidence to help local decision-makers. Guidance from Monitor to help local NHS decision-makers evaluate options for improving patient flows through local health and care systems.

Consultations
Our approach to regulating: Independent doctor services. CQC is seeking views on on the regulation of independent doctor services, such as include private GP services, private specialists, remote consultation and provision of treatment, travel vaccination clinics, slimming clinics, but not in vitro fertilisation or termination of pregnancy services. It asks whether – and how – CQC should regulate this sector and whether these services should be rated, and also how to identify and share notable practice. The consultation closes on 19 October 2015.

Bevan Brittan Articles
Rating the CQC - emerging themes in meeting the Duty of Candour and Fit and Proper Person requirements . The fundamental standards have been in place since 1 April 2015 and we are starting to see CQC flexing its muscle.

Monitor's role in the new models of care. Monitor and the Competition and Markets Authority have jointly issued new guidance on the procedural approach to be taken at least by Foundation Trusts in relation to involvement in schemes under the Five Year Forward View for new models of care. 

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

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General

Publications/Guidance
Adult hearing services guidance. The National Community Hearing Association has published a series of easy-to-use guides to help the NHS increase access, quality and choice in adult hearing services. They advise how to deliver the goals in the Five Year Forward View – including putting patients first, improving access and follow-up, delivering more care out-of-hospital and making better use of limited resources. There are separate guides for CCGs, providers, Healthwatch and health & wellbeing boards, as well as checklists, price guides and an outcomes dataset. 

The Assisted Dying (No.2) Bill 2015: Briefing Paper. A House of Commons Library Briefing Paper provides a background to the key cases in the area of assisted suicide and the guidance provided by the Director of Public Prosecutions, an overview of the provisions of the Assisted Dying (No.2) Bill 2015 and a summary of the progress through the House of Lords of the Assisted Dying Bill 2014. 

Public hospital spending in England: evidence from National Health Service administrative records. This paper describes how costs vary across the lifecycle, and the concentration of spending among people and over time. It finds that costs per person start to increase after age 50 and escalate after age 70. Spending is highly concentrated in a small section of the population: with 32 per cent of all hospital spending accounted for by 1 per cent of the general population, and 18 per cent of spending by 1 per cent of all patients. There is persistence in spending over time with patients with high spending more likely to have spending in subsequent years, and those with zero expenditures more likely to remain out of hospital.

Improving length of stay: what can hospitals do? This report on length of stay by the Nuffield Trust is part of a larger project undertaken by Monitor which aims to find the best ways to improve quality of care across the health system in light of recent pressures on urgent and emergency care. It explores what approaches to reducing length of stay have been (and could be) effective, providing a set of measures for improving length of stay that are within the control of the hospital itself.

Consultations
How should we think about value in health and care? Nesta has launched this discussion paper as part of its wider Realising the Value programme that aims to demonstrate the value of people and communities in their own health and care. It asks about the elements of value in health and social care, what people most value, and whether we have adequate ways to describe the value that people and communities create through their contributions to building and managing wellbeing. The ideas set out in this paper will develop throughout the programme to underpin future activities and outputs of the programme. 

News
NHS sees 1,026 new FGM cases in three months as recording FGM attendance becomes mandatory. The Health and Social Care Information Centre has reported that since it began to record female genital mutilation (FGM) data in September 2014, there have been 4,989 cases reported nationally, and 1,026 cases between April and June 2015 including nine girls under the age of 18. Recording FGM attendance became mandatory for acute trusts on 1 June 2015, and becomes mandatory for GP practices and mental health trusts from 1 October 2015.

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

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