06/10/2016
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. Bevan Brittan ranks as Top Tier Firm in 8 practice areas in The Legal 500.
If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.
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Care
Publications/guidance
The framework for enhanced health in care homes. This framework document lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of in reach services. It sets out seven key components and 18 sub-components which define the care homes model, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.
Who knows best? Older people’s contribution to understanding and preventing avoidable hospital admissions. The authors of this report interviewed 104 older people, exploring their experiences of emergency admissions. The research focused on whether the older people felt it was appropriate to be admitted to hospital and whether they thought anything could have prevented their admission. The findings of this study confirm the belief that older people have an important role to play in helping understand the nature of emergency admissions and to devise appropriate responses to their rising numbers. The report concludes that ignoring this expertise could be detrimental to ensuring older people get the appropriate care they need.
Understanding quality in district nursing services: learning from patients, carers and staff. This report investigates what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff and puts forward a framework for understanding the components involved. It also looks at the growing demand-capacity gap in district nursing and the worrying impact that this is having on services, the workforce and the quality and safety of patient care. The report makes recommendations to policy-makers, regulators, commissioners and provider organisations as to how to start to address these pressures.
PIP assessment guide. DWP guidance for providers carrying out assessments for Personal Independence Payment (PIP). It is intended to supplement the contract documents agreed with providers as part of the commercial process, providing guidance for health professionals carrying out assessment activity and for those responsible for putting in place and delivering processes to ensure the quality of assessments.
Care and support statutory guidance. The DH has issued revised statutory guidance to support implementation of Part 1 of the Care Act 2014 by local authorities. It supersedes the version issued in October 2014. It takes account of regulatory changes, feedback from stakeholders and the care sector, and developments following the postponement of social care funding reforms to 2020. There is also a List of changes made to the Care Act guidance.
Social care for older people: home truths. This report, published jointly with the Nuffield Trust, looks at the current state of social care services for older people in England, through a combination of national data and interviews with local authorities, NHS and private providers, Healthwatch and other groups. It considers the impact of cuts in local authority spending on social care providers and on older people, their families and carers. Alongside this work, we were commissioned by the Richmond Group of Charities to interview older people about their experiences of social care. The picture that emerges is of social care providers under pressure, struggling to retain staff, maintain quality and stay in business; local authorities making unenviable choices about where to make reductions; a complex set of causes of delays in discharging older people from hospital; and the voluntary sector keeping services going even when funding was curtailed.
A cohort approach to social care funding. This paper from the Government Actuary's department suggests that the problem of social care funding is approached by tailoring the solutions to each generation. It refers to this as a "cohort approach" to social care funding. It argues that considering each generational group separately and developing solutions for the group, will help a robust, practical and workable set of solutions to be developed for the longer term. The paper briefly explores the issues and how such a cohort approach might be developed.
Spreading change: A guide to enabling the spread of person- and community-centred approaches for health and wellbeing. Nesta has published an action-focused guide outlines how behavioural science can help spread the take-up of person- and community-centred approaches to health and wellbeing. It is aimed at people who champion these approaches in health and social care, in other statutory bodies and in community-based organisations. It is supplemented by a second guide Supporting self-management which outlines how the science of behaviour can help people to self-manage their health and wellbeing.
Pressure points: Carers and the NHS. This report by Carers UK examines the role of carers in reducing emergency admissions and delayed transfers of care from hospital. The research looked at carers’ experiences of using emergency services like 999 or going to A&E and their reasons for turning to hospital rather than to a community health service. It also asked carers about what could have made a difference to preventing an emergency care admission or supporting them to care effectively at home without damaging their own health in the process.
Guidance: Needs assessments on hospital discharge. The CQC has issued guidance following some concerns that care home providers will not readmit people after periods in hospital without conducting full, in person assessments of need. It clarifies the legal requirements around this and offers some best practice guidance.
Moving from the margins: the challenges of building integrated local services. Collaborate and Turning Point have produced a discussion paper that presents seven key insights for building integrated public services. Its overriding message is that local integrated services should be at the heart of strategies for social renewal and public service reform. The report’s seven insights range from the need to shift the narrative from austerity to one of social challenges in a place, to the value of building system infrastructure that enables collaboration. The combination of the current political, economic, and social context coupled with the presentation of credible model of community-led integrated care, makes a compelling argument for these to be taken seriously.
Growing older in the UK: A series of expert-authored briefing papers on ageing and health. This series of briefing papers explores a range of topics relevant to supporting and improving people’s health and wellbeing as they grow older in the UK. They highlight the increasing demand and inadequate resources facing the UK’s health and social care system.
Consultations
Brexit and health and social care inquiry. The Commons Health Committee is inviting written submissions on the priorities for health and social care in the negotiations on the UK’s withdrawal from the EU. The evidence submitted to the Committee's pre-referendum inquiry into the impact of EU membership on health and social care has demonstrated the wide range of areas in which EU membership affects this policy area. The Committee is now seeking views on what the most important issues are to which attention will need to be paid in the withdrawal negotiations and what outcomes should be sought from them. It also invites views on what risks and opportunities for health and social care arise from the UK's withdrawal from the EU, and how the Government should seek to mitigate the risks, and take advantage of the opportunities. The closing date for submissions is 28 October 2016.
News
Plan to reduce health and care red tape burden. The Minister for Health Lord Prior is setting up the Burden Reduction Challenge Panel in partnership with NHS Providers, NHS Confederation and Care England. The panel will look at evidence of both the burdens and benefits of current NHS and social care regulatory activity and will then challenge their use and necessity. Regulatory activity judged to be unnecessary by the panel and relevant officials will be amended or removed. The organisations will engage health professionals to provide evidence that will feed into the panel. The panel’s first session will focus on data and information requests, at both national and local level.
If you wish to discuss any queries you may have around care please contact Stuart Marchant.
Children
Publications/guidance
Reporting and acting on child abuse and neglect. This consultation seeks views on the possible introduction of mandatory and also seeks views in relation to the extension of such duties to vulnerable adults.
Transforming community health services for children and young people who are ill: a quasi-experimental evaluation. Children’s community nursing (CCN) services support children with acute, chronic, complex and end-of-life care needs in the community. This research examined the impact of introducing and expanding CCN services on quality, acute care and costs. The research found that large, generic CCN teams that integrate acute admission avoidance for all children with support for children with complex conditions and highly targeted teams for children with complex conditions offer the possibility of supporting children more appropriately at home while also making some difference to acute activity.
Prevention of harm caused by alcohol exposure in pregnancy: rapid review and case studies from member states. This report gives an overview of the literature on interventions to prevent alcohol exposure during pregnancy that targets both pregnant and non-pregnant women. It reviews the literature on preventing alcohol exposure in pregnancy from studies published in the last decade and it also presents case studies from eight European countries
Lightning review: school nurses - children's access to school nurses to improve wellbeing and protect them from harm. This report finds that school nurses spend twice as much time on paperwork than on direct work with children in schools which potentially reduces their capacity to identify children at risk of neglect or abuse. The research also identified evidence that time pressures meant that the school nurse role in supporting and promoting child health and wellbeing, mental health, healthy relationships and sex education was being compromised.
Government response to the House of Commons Health Select Committee report on childhood obesity - brave and bold action, first report of session 2015-16. This paper sets out the government's response to the conclusions and recommendation in the Health Select Committee's report on child obesity. The response outlines the way that the government child obesity plan for action will aim to reduce levels of childhood obesity and improve the health and wellbeing of children.
Mental health and wellbeing of looked-after children: Government response to the Committee’s fourth report of session 2015 to 2016. This paper addresses the Education Committee’s recommendations and conclusions. It sets out the Government's plans to improve mental health services for all children and young people, with £1.4bn invested up to 2002 to drive that improvement. Specifically, this includes £1.4m in 2016/17 followed by £2.8m annually, for the following three years, targeted at improved mental health support for the most vulnerable looked-after children and young people, those who are looked-after in secure children’s homes.
More young people using mental health services. New figures from the Scottish government show a 30% rise in two years in the number of children and young people being seen by mental health services. Statistics also show the number of psychologists working in child and adolescent mental health services has more than doubled in the same period, which the Scottish government attributes to greater awareness of mental health than before, and more children being identified.
FGM: video resources for healthcare professionals. Videos to help healthcare professionals understand, safeguard and care for women and girls affected by female genital mutilation (FGM).
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah.
Clinical Risk/Patient Safety
Bevan Brittan Training - If you are a client and 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
Follow-up to PHSO report on unsafe discharge from hospital. The Commons Public Administration and Constitutional Affairs Committee has published a report looking at the work already carried out by the PHSO (Parliamentary and Health Service Ombudsman) which highlighted harrowing cases that illustrated the human costs of poor discharge, causing suffering and distress for patients, and anguish for their carers and relatives. The Committee found that the discharge failures identified by the PHSO report are not isolated incidents but rather examples of problems that patients, relatives and carers are experiencing more widely. Despite increased attention to the issue, it remains a persistent problem. It concludes that the incidence of unsafe discharge from NHS hospitals is unacceptably high as a result of political maladministration.
Joint whistleblowing guidance. HEE and the BMA have issued joint guidance on the new whistleblowing protection announced for doctors in training. This follows HEE’s recent letter to employers with the detailed Terms of Agreement that provides junior doctors in England with legal protection if they are subjected to detrimental treatment by HEE as a result of whistleblowing.
National neonatal audit programme: 2016 annual report on 2015 data. This report outlines the result of a national audit of neonatal services and finds an improvement in rates of two year follow-up for premature babies but that there was an increase in risk of illness and that some units were still failing to record timely consultation with parents. The report urges neonatal units to form partnerships with neighbouring hospitals in order to reduce variation and drive up standards of care for very sick babies.
NHS Injury Costs Recovery scheme: April 2016 to March 2017. The amounts collected by the Compensation Recovery Unit and paid to the NHS.
Understanding safe caseloads in the district nursing service. This discussion paper summarises the challenges in managing safe caseloads in district nursing and points to specific actions needed to improve and safeguard the future quality of services. The report provides a thematic overview of the issues that should be taken into account when determining a safe caseload including: skill mix, capacity of other health and care services, use of technology and housing.
Multimorbidity: clinical assessment and management. NICE has issued this new guideline that calls for a tailored approach to care when treating someone who has two or more long-term health conditions. It covers optimising care for adults with multimorbidity (multiple long-term conditions) by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care. It aims to improve quality of life by promoting shared decisions based on what is important to each person in terms of treatments, health priorities, lifestyle and goals. The guideline sets out which people are most likely to benefit from an approach to care that takes account of multimorbidity, how they can be identified and what the care involves.
Countess of Chester NHS Foundation Trust cervical screening programme quality assurance visit report. This summary report sets out observations and recommendations from a quality assurance visit to the Countess of Chester NHS Foundation Trust.
The Hillsborough Law. Lawyers for the families of the 96 Hillsborough victims have published a draft Public Authorities Accountability Bill that aims to ensure that public authorities and public servants tell the truth and act with candour, especially with respect to court proceedings, inquiries and investigations. The draft Bill seeks to place a further onus on those in public office to cooperate positively with investigations, and would make it illegal for those in public service to give misleading information, with penalties and fines for those who are wilfully non-compliant. The draft Hillsborough Law will be considered by Bishop James' Review, which was commissioned by the then Home Secretary Theresa May following the jurors' conclusions on 26 April, to consider what lessons could be learned from the disaster.
Patient safety: closing the implementation gap. Dr Suzette Woodward, National Campaign Director for NHS England’s Sign up to Safety campaign, reflects on the challenges of putting theory into practice when it comes to improving patient safety.
Trust-level 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: companion report. This report, co-authored by PHE's National Cancer Registration and Analysis Service and Cancer Research UK, is the first major report using systemic anticancer treatment data. This data gives trust-level insights about real-world chemotherapy treatment of patients in the NHS in England which was previously only available from clinical trials. The report shows that age, general wellbeing and other factors can affect 30-day mortality following chemotherapy for breast and lung cancer. This report is a companion to an open-access study paper published in The Lancet Oncology.
Legislation
Civil Procedure (Amendment No 3) Rules 2016. SI 2016/788: The Civil Procedure Rules 1998 (CPR), which apply to civil proceedings in the Civil Division of the Court of Appeal, the High Court and the County Court, are amended. The amendments chiefly concern the procedure for appeals to the Court of Appeal and the exercise, by court officers, of functions of the Court of Appeal. These changes become effective on 3 October 2016.
Health and Social Care (Safety and Quality) Act 2015 (Commencement No 2) Regulations 2016. SI 2016/906: Certain provisions of the Health and Social Care (Safety and Quality) Act 2015 (HSC(SQ)A 2015) relating to the regulation of health and social care professionals come into force on 26 September 2016. HSC(SQ)A 2015 makes provision about, among other things, the safety of health and social care services in England, the integration of information relating to users of health and social care services in England and the sharing of information relating to an individual for the purposes of providing that individual with health or social care services in England.
News
Statement on statins. A statement from Medicines and Healthcare products Regulatory Agency (MHRA) on the risks and benefits of statins says the benefits of statins are considered to outweigh the risk of side-effects in the majority of patients.
Patient safety in general practice could be ‘at risk’ – unless chronic shortage of GPs is turned around, with nearly 600 practices at risk of closure. The Royal College of General Practitioners says that patient safety in general practice across the UK could be 'at risk', if nothing is done to turn around the current chronic shortage of GPs, with 594 practices across the UK at risk of closure by 2020 if more family doctors are not recruited. The RCGP has launched a new video and guide which aim to help recruit thousands of additional foundation doctors, medical students and sixth form students into a career in general practice.
NHSLA tests in-house working to cut £120m defence costs. As part of efforts to make further savings in its budget, the NHS Litigation Authority (NHSLA), which spent £120.1 million on external legal costs in 2015/16, has set up an in-house litigation team to run as a 12-month pilot to enable analysis of the costs savings and effectiveness of the service. It is understood there are no immediate plans to reduce the existing panel of law firms that are contracted to work on the NHSLA's behalf.
Nurse views ‘underused’ as indicator of patient safety.
Whistleblowing protection detail. Health Education England has now formally written to employers with the specific terms of agreement for enhanced protection on whistleblowing for doctors in training.
NICE emphasises the importance of urgent referral in suspected melanoma. GPs should refer people with suspected malignant melanoma for an appointment within 2 weeks.
Bevan Brittan Events
Dealing with Complaints - This practical training day will focus on best practice and guidance for front-line staff of the NHS and healthcare organisations to investigate and manage claims, complex complaints and adverse incidents.
London - Tuesday 18 October 2016, 09:30
Bristol - Wednesday 19 October 2016, 09:30
Birmingham - Tuesday 01 November 2016, 09:30
Bevan Brittan Training - If you are a client and 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.
If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Catherine Radford or Penelope Radcliffe.
Follow us! Bevan Brittan's patient safety team is regularly tweeting the latest patient safety news @BBPatientSafety.
Commissioning
Publications/Guidance
Integrated primary and acute care systems (PACS) – Describing the care model and the business model. This framework document uses the learning from the nine PACS vanguards to support local health and care systems planning to implement a PACS model. It outlines the next steps required to set up the model, including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.
See also NHS England's news item Two local vanguard leaders explain what it means to be an integrated primary and acute care system (PACS), in which two members of the South Somerset Symphony Programme vanguard (Paul Mears, Chief Executive of Yeovil Hospital, and Dr Berge Balian, GP and Symphony Programme Board Chair) take a look at what the proposals could mean.
Making difficult decisions: Commissioning healthcare in changing times. NHS Clinical Commissioners has launched a new publication to support CCGs in making difficult decisions about prioritisation of resources and changes to local services. It sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes, drawing on both academic research and practical insight from commissioners, patient groups and NHS England.
NHS Operational Planning and Contracting Guidance 2017 – 2019. NHS England and NHS Improvement have published this year’s operational and contracting planning guidance three months earlier than normal to help local organisations plan more strategically. For the first time, the planning guidance covers two financial years, to provide greater stability and support transformation. This is underpinned by a two-year tariff and two-year NHS Standard Contract. It provides local NHS organisations with an update on the national priorities for 2017/18 and 2018/19, as well as updating on longer term financial challenges for local systems.
Commissioning for better health outcomes. Commissioners are vital in the process of making the most of collective resources to improve health outcomes for local citizens. The role of commissioning is no longer about identifying and procuring services for individuals but bringing people together to enable citizens to live a fulfilling and independent life for as long as possible. The LGA has developed this guide with commissioners from councils and partner organisations, building on existing learning and resources and sharing new and innovative practice developed by those working to improve public health. The guide includes eight case study examples which were chosen to illustrate positive approaches to commissioning being taken across the country to address a wide range of public health challenges.
The Long Term Conditions Year of Care Commissioning Programme implementation handbook. This programme worked to change the way services are both commissioned and provided to offer meaningfully person-centred coordinated care. It was based on three key drivers: the identification of patients with long term conditions; the provision of holistic, person-centred, integrated health and social care services by an integrated care team; and the engagement of patients in managing their care. A major focus for the programme was to transform how integrated care could be commissioned and particularly how care providers could be incentivised to work together by funding care for these patients using a capitated budget. This handbook describes the experiences of five care economies as they work towards developing capitated budgets for some patients and services. It provides practical advice and guidance on capitated budgets, population segmentation, leadership, co-production, planning for service change, and evaluation.
Consultations
2017/18 NHS standard contract. Seeks views on the draft NHS Standard Contract (in both full-length and shorter-form versions) for 2017/18 and 2018/19, along with associated Technical Guidance. The closing date for comments is 21 October 2016.
If you wish to discuss the issue of commissioning please contact David Owens.
Employment/HR
News
HEE statement on non-contractual support for doctors in training. Health Education England has announced a wide range of initiatives to tackle the non-contractual concerns that have been highlighted by junior doctors.
Whistleblowing protection detail. Health Education England has now formally written to employers with the specific terms of agreement for enhanced protection on whistleblowing for doctors in training.
Allegations against nurses and midwives charged with misconduct or incompetence will no longer be made available for public scrutiny. Allegations made against nurses and midwives charged with misconduct or incompetence will no longer made available for public scrutiny prior to a hearing, the Nursing and Midwifery Council (NMC) has announced.
NMC statement on the outcome of nurse Pauline Cafferkey’s fitness to practise hearing. Independent panel finds Ms Cafferkey's actions did not amount to misconduct.
New midwifery supervision model Equip pilot sites. NHS England is seeking to work with a small number of maternity providers who will test the new approach to midwifery supervision that will be put in place when statutory supervision is removed, alongside the current statutory model of supervision. It aims to have pilot sites in place by October 2016 and expects them to run for up to five months, with on-going evaluation designed to facilitate rapid learning to enable national launch of the final new approach in April 2017 (subject to the law change). Maternity organisations wishing to become a pilot site should send their expressions of interest using the application form by Friday 30 September 2016.
GMC outlines the possible impact of withdrawing from the European Union.
Bevan Brittan Updates
Raising the bar on raising concerns. The raising concerns agenda is in the limelight again and its scope is expanding.
Is ring-fencing pay a 'reasonable adjustment'? The EAT has considered whether long-term pay protection is capable of amounting to a 'reasonable adjustment' for a disabled employee.
Employment news round-up, September 2016. Employment law news in brief for September 2016
If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.
Finance
Publications and Guidance
Improving efficiency and resource allocation in future cancer care. This report, written in partnership with the Institute for Health Economics in Sweden, evaluates the current burden of cancer and identifies opportunities for increased efficiency in cancer care. The evidence focuses specifically on the health and cancer care landscape in nine European countries, including the UK. The report found that significant opportunity for improved efficiency exists in prevention activities and early diagnosis, for example targeting unhealthy behaviours such as high alcohol consumption and smoking, and the implementation of quality screening programmes. The report also highlights the potential to achieve greater efficiencies in the way new treatments are evaluated and how to enhance their uptake.
A false economy: Cuts to Continuing Professional Development funding for nursing, midwifery and the Allied Health Professions. This report from the Council of Deans of Health highlights the risk posed to the NHS by the funding cuts and calls for the DH to lead a discussion to address the disconnect between the funding decisions and national strategic priorities.
News
Department of Health and NHS finances. The Commons Health Committee has announced that it will hold two oral evidence sessions when the House returns in October to examine the state of NHS finances. The decision comes following the publication of reports by the Comptroller and Auditor General on the Department of Health, NHS England and NHS Consolidated Foundation Trust accounts for 2015–16, and the receipt by the Committee of a letter from NHS Providers on NHS funding.
NHS boss says NHS has hard four years ahead. The head of the NHS has warned of four hard years ahead for the health service – dismissing ministers’ claims that it has been given all the money it needs. Simon Stevens warned that much of a promised extra £10bn each year has been “back-ended to 2020”, which means promised improvements would be delayed and tough choices inevitable in the interim. Speaking to an inquiry by MPs – days after hospital bosses broke cover to argue the NHS will reach breaking point without more money – Mr Stevens admitted to the looming funding shortfall.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
Health and Safety
Bevan Brittan Events
Health & Safety Update. A number of recent developments mean that the potential impact of health and safety breaches is greater than ever before. Bevan Brittan is at the forefront of advising organisations in the UK to minimise your exposure from a financial, commercial and reputational perspective. This seminar provides a fantastic opportunity to ensure you are up to date with the law, to receive practical tips to help you achieve compliance, an interesting selection of break-out sessions to opt-in to, and a chance to share experiences with other colleagues
Bristol - Wednesday 02 November 2016, 09:15
London - Tuesday 15 November 2016, 09:15
Birmingham - Wednesday 16 November 2016, 09:15
If you wish to discuss any issues raised in this section please contact Adam Kendall.
Information Sharing
Publications/Guidance
Code of Practice on confidential personal information. The CQC has published an updated code that explains how CQC makes decisions relating to people’s confidential personal information. This includes how it decides whether it needs to look at medical or care records during an inspection, and whether it needs to share personal information that it holds. The revised Code of Practice recognises the most recent changes in legislation and ensures that its policy aligns with CoPs on confidential information from NHS Digital and the DH. It explains more clearly than before why the use of confidential personal information is vital to the CQC's role and gives specific examples that show how the code will translate into action.
Legislation
Health and Social Care (Safety and Quality) Act 2015 (Commencement No 2) Regulations 2016. SI 2016/906: Certain provisions of the Health and Social Care (Safety and Quality) Act 2015 (HSC(SQ)A 2015) relating to the regulation of health and social care professionals come into force on 26 September 2016. HSC(SQ)A 2015 makes provision about, among other things, the safety of health and social care services in England, the integration of information relating to users of health and social care services in England and the sharing of information relating to an individual for the purposes of providing that individual with health or social care services in England.
News
Hospitals must help provide better information for private patients. From 1 September 2016 hospitals that treat patients privately, both independent hospitals and NHS private units, must provide data to enable the Private Healthcare Information Network, an independent public website set up in 2014 by the Competition and Markets Authority following a private healthcare review, to publish performance information on certain measures such as mortality and infection rates, and eventually fees, to help inform patients' choices.
If you wish to discuss any of the items raised in the above section please contact Jane Bennett.
Mental Health
Bevan Brittan Training - If you are a client and 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 2015-16. 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 2015 to 31 March 2016. It includes any application that was active during the reporting year. The Deprivation of Liberty Safeguards (DoLS) are a legal framework that exist to ensure that individuals who lack the mental capacity to consent to the arrangements for their care, where such care may (because of restrictions imposed on an individual’s freedom of choice or movement) amount to a “deprivation of liberty”, have the arrangements independently assessed to ensure they are in the best interests of the individual concerned .A key element of the safeguards is that health and care providers must formally apply to their local Council with Adult Social Services Responsibilities (CASSR, council or local authority) and satisfy six different assessment criteria.
Women in mind: FOI response briefing. This document outlines the findings of Agenda's investigation into the provision of mental health services for women in England. The results of the FOI requests lodged found that only one out of 35 respondents had a women's mental health strategy and half had no policy on 'routine enquiry' (the practice of routinely asking female patients about experience of abuse) which is contrary to NICE guidance.
Improving access to mental health services. In a new report, the Commons Public Accounts Committee notes that one in four adults is diagnosed with a mental illness at some point in their lives, but only around a quarter of people estimated to need mental health services have access to them. It finds that the DH and NHS England have a laudable ambition to improve mental health services but, given the current pressures on the NHS budget, the Committee is sceptical about whether this is affordable, or achievable without compromising other services. It concludes that achieving 'parity of esteem' between mental and physical health is a task for the whole of government. The challenge is to build joined-up, well-configured services within the health system and across other parts of government that provide people in all areas of the country with access to the services they need, near to where they live. Achieving parity of esteem will also depend on the health system having the right staff, with the right skills in the right places. Staff costs represent the largest part of the cost of services, but the workforce needed to achieve parity of esteem, and the consequential cost, is poorly understood. Better information is also needed to assess the gap between current mental health services and need so that this can be used to inform planning and decision making.
Making a difference in dementia, nursing vision and strategy. This strategy sets out how nurses can provide high quality compassionate care and support for people with dementia, so they can live well with dementia within all care settings, including a person’s own home. It aims to support all nurses to be responsive to the needs of people with dementia, continue to develop their skills and expertise, and achieve the best outcomes for people with dementia, their carers and families. It builds on the original strategy, published in March 2013
Support from the start: commissioning early intervention services for mental ill health. This report showcases projects that promote early intervention in mental health and draws out tips from commissioners and practitioners involved in their development and delivery. The report highlights four projects where CCGs and their partners are tackling the challenge of early intervention and it aims to share the learning and good practice from these projects.
Mental health and wellbeing of looked-after children: Government response to the Committee’s fourth report of session 2015 to 2016. This paper addresses the Education Committee’s recommendations and conclusions. It sets out the Government's plans to improve mental health services for all children and young people, with £1.4bn invested up to 2002 to drive that improvement. Specifically, this includes £1.4m in 2016/17 followed by £2.8m annually, for the following three years, targeted at improved mental health support for the most vulnerable looked-after children and young people, those who are looked-after in secure children’s homes.
More young people using mental health services. New figures from the Scottish government show a 30% rise in two years in the number of children and young people being seen by mental health services. Statistics also show the number of psychologists working in child and adolescent mental health services has more than doubled in the same period, which the Scottish government attributes to greater awareness of mental health than before, and more children being identified.
News
Outstanding: First top ratings for NHS mental health trusts. Northumberland, Tyne and Wear NHS Foundation Trust and East London NHS Foundation Trust have become the first two NHS mental health trusts in England to be awarded overall ratings of outstanding, as detailed in inspection reports published on 1 September 2016.
The Priory clinic to pay compensation after patient death following 'gross failures' of care The High Court has approved a confidential settlement from mental health clinic The Priory to the widow and daughter of a patient who took his own life by jumping in front of a train. The Coroner at the 2013 inquest said there had been gross failures in the patient's care, including a failure to perform basic observations, inadequate members of staff with an inappropriate skill mix, a lack of staff discipline and a deliberate falsification of the nursing record.
NHS England prepare to invest in three new units for mums with mental ill health. NHS England is preparing to invest in three new inpatient units for mums with serious mental ill health to help them to stay with their babies
Keeping mental health in mind. When a survey revealed a rise in work-related stress among staff at Birmingham Children’s Hospital, the NHS trust tackled the problem head-on.
Transfer of prisoners to mental health hospitals on the increase. Following a freedom of information request, the Ministry of Justice has revealed that the number of prisoners being transferred to hospital under the Mental Health Act 1983 grew by more than 20% between 2011 and 2014 in England and Wales. The greatest increase was seen among men aged 21-39. Concern has, however, been raised over the 26.5% decline in hospital orders, which allow defendants to be sent for medical care instead of prison.
New £816 million investment in health research. Research into mental health, dementia and antimicrobial resistance among the projects funded by £816 million investment in NHS research.
Help for people with learning disabilities to live independently. The DH is inviting local authorities to apply for share of a £25m Housing and Technology Fund to enable the creation of a range of housing and technology options for people with learning disabilities. The closing date for applications is 28 October 2016.
Funding for children and young people’s mental health. Claire Murdoch, National Mental Health Director, NHS England, has written to CCG Clinical Leaders and Accountable Officers advising of an additional £25m in funding for children and young people's mental health services which has been made available for CCGs in 2016/17. This is additional to the £149m already allocated to CCGs for these services in the same period.
Increase in the number of people dying with dementia. PHE reports that the proportion of people dying with a recorded dementia diagnosis has more than doubled since 2001. It has launched a range of products which examine the deaths of people recorded with dementia between 2012 and 2014. The reports draw on national data to see if there have been changes in dementia deaths over time, who the people dying with dementia are, where they die and the cause of their death. The findings suggest that people who live in more deprived areas die with dementia at a younger age than those who live in more affluent areas. There are also considerable differences between the place of death for people who have dementia and the general population: people with dementia are considerably more likely to die in hospitals and care homes and less likely to die at home or in end of life care settings such as hospices.
Bevan Brittan Updates
Case Summary: South Staffordshire NHS FT and others v St George's Hospital NHS Trust and AU [2016] EWHC 1196 (Admin). How the Hospital Managers review regime can and should operate
Bevan Brittan Events
Court of Protection Seminar - This session will focus on practical issues that practitioners, commissioners and providers encounter in matters engaging the Court of Protection; covering relevant legislation, guidance and case law and their impact on managing incapable patients.
Bristol - Wednesday 23 November 2016, 09:30
Birmingham - Thursday 24 November 2016, 09:30
London - Tuesday 29 November 2016, 09:30
Leeds - Tuesday 29 November 2016, 09:30
If you wish to discuss any of the items raised in the above section please contact Simon Lindsay or Stuart Marchant.
Primary Care
Publications/guidance
NHS payments to General Practice, England, 2015/16. Key facts and statistics on NHS payments to individual providers of general practice services in England. Figures are given for the main payment categories which include Global Sum, the Minimum Practice Income Guarantee (MPIG), Balance of PMS expenditure, Quality Outcomes Framework (QOF) and Enhanced Services.
Dental working hours, 2014/15 and 2015/16. Provides information on the dental working patterns of self-employed primary care dentists who provided some NHS/Health Service treatment in England & Wales, Northern Ireland and Scotland during one or both of these financial years. Time-series comparisons are also provided from 2006/07 for England & Wales and from 2008/09 for Northern Ireland and Scotland. Safe working in general practice. This BMA offers one evidence-based method for measuring safe working levels, arguing that a GP-led locality hub model could be commissioned in areas where demand outstrips capacity. It demonstrates this concept within the context of current service pressures and policy priorities through a number of examples where a hub model is already being trialled. it includes proposals for GP appointments to be lengthened to 15 minutes and consultations to be limited to a target of 25 a day.
Extended access to general practice: A guide to completing the extended access survey. Provides GP practice staff with information to assist them in submitting data to NHS England about their practice’s offer to patients of enhanced access to appointments.
What if people had to pay £10 to see a GP? This King's Fund essay considers whether charging people to visit a GP would raise funds for the NHS or add to the care burden by having a negative impact on people's health.
News
Patient safety in general practice could be ‘at risk’ – unless chronic shortage of GPs is turned around, with nearly 600 practices at risk of closure. The Royal College of General Practitioners says that patient safety in general practice across the UK could be 'at risk', if nothing is done to turn around the current chronic shortage of GPs, with 594 practices across the UK at risk of closure by 2020 if more family doctors are not recruited. The RCGP has launched a new video and guide which aim to help recruit thousands of additional foundation doctors, medical students and sixth form students into a career in general practice.
GP practice closed after CQC inspection. Media, GP and GP out-of-hours services. A south London GP practice has had its registration cancelled after the Care Quality Commission published findings after an inspection in July. It was rated as Inadequate overall.
If you wish to discuss any queries you may have around primary care please contact David Owens.
Procurement
Guidance
Procurement policy note 8/16: Standard Selection Questionnaire (SQ) template. The CCS has issued a revised standard Selection Questionnaire (SQ) template and guidance. It replaces the current standard Pre-Qualification Questionnaire (PQQ). This PPN supersedes the guidance on supplier selection and PQQs in PPN 03/15. This PPN applies to all contracting authorities in England, and contracting authorities in Wales and Northern Ireland that exercise wholly or mainly reserved functions for procurements above the thresholds laid down in the Public Contracts Regulations 2015 (PCR 2015).
Bevan Brittan Updates
Procurement Alert - New standard Selection Questionnaire and statutory guidance. The Crown Commercial Service has updated its Selection Questionnaire.
Procurement Byte: Contract change provisions. A recent judgment of the European Court of Justice (ECJ), Finn Frogne (C-549/14), serves as a reminder of the usefulness and importance of clear and robust change provisions in contracts and careful planning at the outset of a procurement process. This is particularly the case for long term or complex contracts where adaptation, changes and amendments are highly likely during the life of the contract and may result in a material change to the scope or value of the contract.
Bevan Brittan Events
Procurement Update - Our Procurement team will cover legislative and policy developments as well as looking at recent EU and UK court cases and how these affect procurement in practice.
Birmingham - 7 November 13:00
Leeds - 8 November 09:30
London - 9 November 09:00
London - 9 November 13:00
Bristol - 10 November 09:00
If you wish to discuss any queries you may have around procurement please contact Emily Heard
Providers
Publications/guidance
Integrated primary and acute care systems (PACS) – Describing the care model and the business model. This framework document uses the learning from the nine PACS vanguards to support local health and care systems planning to implement a PACS model. It outlines the next steps required to set up the model, including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.
See also NHS England's news item Two local vanguard leaders explain what it means to be an integrated primary and acute care system (PACS), in which two members of the South Somerset Symphony Programme vanguard (Paul Mears, Chief Executive of Yeovil Hospital, and Dr Berge Balian, GP and Symphony Programme Board Chair) take a look at what the proposals could mean.
Single Oversight Framework for NHS providers. NHS Improvement has published its single oversight framework setting out the rules FTs and trusts will be assessed under. It plans to introduce the framework from 1 October 2016, at which point the Monitor 'Risk Assessment Framework' and NHS Trust Development Authority's 'Accountability Framework' will no longer apply. Providers will placed into one of four bands and rated as an organisation with: no concerns; some support needs; significant concerns; or major or complex concerns. To determine which band a provider is placed in NHS Improvement will judge them against criteria covering: quality of care; operational performance; leadership; strategic change, which includes their contribution to sustainability and transformation plans; and finance.
News
Plan to reduce health and care red tape burden. The Minister for Health Lord Prior is setting up the Burden Reduction Challenge Panel in partnership with NHS Providers, NHS Confederation and Care England. The panel will look at evidence of both the burdens and benefits of current NHS and social care regulatory activity and will then challenge their use and necessity. Regulatory activity judged to be unnecessary by the panel and relevant officials will be amended or removed. The organisations will engage health professionals to provide evidence that will feed into the panel. The panel’s first session will focus on data and information requests, at both national and local level.
If you wish to discuss any of the items raised in the above section please contact Vincent Buscemi.
Public Health
Publications/Guidance
GP practice closed after CQC inspection. Media, GP and GP out-of-hours services. A south London GP practice has had its registration cancelled after the Care Quality Commission published findings after an inspection in July. It was rated as Inadequate overall.
Public health post-2013. This report is the result of a short inquiry on the impact of the Health and Social Care Act reforms on the public health landscape. It warns of risks of widening health inequalities and a false economy due to cuts in local authority and public health budgets. It calls for a Cabinet Office minister to be given specific responsibility for embedding health across all areas of government policy at a national level and for greater and bolder action to tackle public health issues such as childhood obesity.
Lightning Review: School nurses - Children's access to school nurses to improve wellbeing and protect them from harm. Research by the Children's Commissioner finds that school nurses face significant barriers in working directly with children and young people, with paperwork getting in the way. The support they offer needs to be better promoted and new ways to enhance their engagement with children explored.
Understanding and preventing drug-related deaths: The report of a national expert working group to investigate drug-related deaths in England. PHE has published the report of a national expert group's inquiry into the causes of recent rises in drug-related deaths and the prevention of future premature deaths. The report highlights a number of principles for action by local authorities, drug treatment providers and others.
Improving eye health through community optical practice: a briefing for councils. LGA, Optical Confederation and Local Optical Committee Support Unit (LOCSU) briefing for councillors, senior council officers and commissioners of services, which describes the essential role that community optics can play in helping to improve eye health specifically, as well as general health and wellbeing.
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/guidance
Code of Practice on confidential personal information. The CQC has published an updated code that explains how CQC makes decisions relating to people’s confidential personal information. This includes how it decides whether it needs to look at medical or care records during an inspection, and whether it needs to share personal information that it holds. The revised Code of Practice recognises the most recent changes in legislation and ensures that its policy aligns with CoPs on confidential information from NHS Digital and the DH. It explains more clearly than before why the use of confidential personal information is vital to the CQC's role and gives specific examples that show how the code will translate into action.
Consultations
Reforming misconduct in public office. In January, the Law Commission published a background paper that set out the current law of misconduct in public office and highlighted problems that arise through areas of uncertainty, as well as gaps and overlaps with alternative offences. It is now seeking views on options for reform of the law of misconduct in public office, looking at whether the existing offence of misconduct in public office should be abolished, retained, restated or amended. The responses to the background paper clearly showed that it would be undesirable either to retain the existing offence or to attempt to codify it in statute so all the options in this consultation assume that the common law offence will be abolished. The consultation closes on 28 November 2016.
Consultation on revised standards of education and training and supporting guidance. The Health & Care Professions Council is seeking on proposed changes to the standards of education and training that describe the policies, processes and arrangements that each education and training programme must have in place in order to gain HCPC approval, together with supporting guidance. The consultation closes on 25 November 2016.
Consultation on revised guidance on returning to practice. The Health & Care Professions Council is seeking views on draft revised guidance professionals who are considering returning to practice. The requirements help to ensure that registrants who have been out of practice for more than two years, and wish to return, update their knowledge and skills in order to resume safe and effective practice. The consultation closes on 7 October 2016.
Legislation
Health and Social Care (Safety and Quality) Act 2015 (Commencement No. 2) Regulations 2016 (SI 2016/906 (C.63)). These regulations bring s.5 of, and the Schedule to, the 2015 Act into force on 26 September 2016. Section 5 amends the National Health Service Reform and Health Care Professions Act 2002 regarding the over-arching objective of the Professional Standards Authority for Health and Social Care. The Schedule to the Act provides about the objectives of certain regulators of health and social care professionals in respect of which the Authority exercises functions, and about when committees or panels of those regulators should have regard to those objectives.
General Dental Council (Fitness to Practise) (Amendment) Rules Order of Council 2016 (SI 2016/902)). This Order, which comes into force on 1 November 2016, amends and updates the Fitness to Practise Rules 2006, which are set out in the Schedule to SI 2006/1663.
News
GP practice closed after CQC inspection. Media, GP and GP out-of-hours services. A south London GP practice has had its registration cancelled after the Care Quality Commission published findings after an inspection in July. It was rated as Inadequate overall.
Plan to reduce health and care red tape burden. The Minister for Health Lord Prior is setting up the Burden Reduction Challenge Panel in partnership with NHS Providers, NHS Confederation and Care England. The panel will look at evidence of both the burdens and benefits of current NHS and social care regulatory activity and will then challenge their use and necessity. Regulatory activity judged to be unnecessary by the panel and relevant officials will be amended or removed. The organisations will engage health professionals to provide evidence that will feed into the panel. The panel’s first session will focus on data and information requests, at both national and local level.
Bevan Brittan Updates
Court Challenge to CQC Factual Accuracy Process. The process of seeking Factual Accuracy corrections to CQC's draft inspection reports can be cumbersome and extremely frustrating for care providers.
If you wish to discuss any queries you may have around primary care please contact Stuart Marchant
General
Publications/Guidance
Transformation of seven day clinical pharmacy services in acute hospitals. Considers how hospital pharmacy services could operate more efficiently and safely, with 13 key recommendations on how clinical pharmacy services in hospitals could be strengthened, particularly at weekends, to benefit patients. It calls for patients admitted through urgent and emergency routes, high risk individuals and those requiring a discharge on weekends, to receive prompt medication reviews through targeted clinical pharmacy services in line with the seven day services clinical standards. To avoid variations in hospital services, the optimal use of medicines, technology, workforce and collaboration within and across staff and primary care organisations needs to be activated. In addition new professional guidance for pharmacists should be introduced and solutions provided for delivering pharmacy services outside of normal working hours.
The value of community pharmacy. This study by PwC, which was commissioned by PSNC following the Government’s proposals to reduce community pharmacy funding, analyses the value to the NHS, public sector organisations, patients and wider society of 12 services across public health, self-care support and medicines support. The report demonstrates the value of community pharmacy at a crucial time and PwC concludes that it is important to robustly assess the significance of any proposed changes to the support and delivery of these services.
See also: Pharmacy Minister announces delay to community pharmacy reforms. Reports that the Pharmacy Minister David Mowat has announced in a speech at the Royal Pharmaceutical Society’s Annual Conference that the Government’s planned implementation of the 6% cut to community pharmacy funding in October would be delayed to "make sure that we are making the correct decision and that what we do is going to be right for you, right for the NHS and right for the public".
Traditional health and care services need to change - but how? Healthwatch asked a cross-section of the public to find out what they want from the health care reforms currently taking place in Manchester. This report, conducted in conjunction with ten local Healthwatch organisations in Greater Manchester, examines public and patient opinion on how health and care needs should be met in future. The research focuses on ways that services can work better together and ways that healthy communities can be encouraged and fostered in local areas.
Chief Coroner's annual report: 2015 to 2016. The annual report of the Chief Coroner outlines: progress made during 2015 to 2016 and throughout his term in office from 2012 to 2016 in promoting consistency in coroner practices across England and Wales; the guidance and training the coroner has facilitated during that time; and further positive developments that have taken place as well as issues of concern and recommendations on how to improve coroner services further.
Brexit - impact across policy areas. This updated Commons Library briefing paper looks at the current situation in a range of policy areas and considers what impact Brexit might have. This will depend, among other things, on the Brexit negotiations, whether the UK stays in the European Economic Area and how the Government fills any policy gaps left by withdrawal. The policy areas covered include health, employment and education.
Engaging local people – a guide for local areas developing sustainability and transformation plans. This document is for teams developing STPs in each of the 44 footprint areas, and the statutory organisations which form part of them. It is intended to clarify the expectations on stakeholder involvement, in particular patient and public participation. It also covers legal duties around engagement and consultation and will be of particular interest to communication and engagement leads for STPs and footprint leaders.
Private healthcare remittal: summary of final report. In April 2012, the CMA started a market investigation in private health care and the final report of the investigation concluded that certain features of the markets for privately-funded health services were leading to adverse effects on competition. This report summarises the adverse effect on competition in the central London market and whether any action should be taken to remedy this.
FGM: video resources for healthcare professionals. Videos to help healthcare professionals understand, safeguard and care for women and girls affected by female genital mutilation (FGM).
Female genital mutilation: abuse unchecked. There have been no successful prosecutions for Female Genital Mutilation (FGM) in the 30 years since it became illegal, according to a Home Affairs Committee report. It suggests clinicians are failing to record data on FGM incidence and cross-departmental efforts to tackle the problem are disjointed. The Committee is recommending the government engage directly with affected women and girls to learn the motivations behind FGM.
Post-chemotherapy deaths examined using SACT data. Public Health England (PHE) has lauded new data, published by Lancet Oncology, which provides insights about the real-world chemotherapy treatment of patients in the NHS in England. The report is thought to be the first of its kind to use world-first systemic anticancer treatment (SACT) data. Notably, in most of the hospitals studied, there were no curative intent deaths.
How is the NHS performing? Relentless demand for services is driving up waiting times and exacerbating financial pressures in the NHS according to our latest Quarterly Monitoring Report. The report found that more than one million patients were admitted to hospital from A&E in the first quarter of 2016/17, with the number of patients attending A&E departments also soaring to nearly six million. This means that for each month in the first quarter of the year, there were an additional 54,000 attendances at A&E departments and 14,200 emergency hospital admissions compared to the same time last year. It also found that increased demand for services is placing the health system under huge strain with more than 90 per cent of beds occupied by patients, well above the threshold that is considered safe. This is fuelling deteriorating performance against a number of key measures.
Making IT work: harnessing the power of health information technology to improve care in England. The National Advisory Group on Health Information Technology in England has advised the Department of Health and NHS England about making the secondary care system more digital. The report details the group’s overall findings and principles and gives ten implementation recommendations.
Fairer decisions, better health for all: Health equity and cost-effectiveness analysis. The Centre for Health Economics at the University of York has published a report providing a non-technical introduction to practical methods for using cost-effectiveness analysis to address health equity concerns. These methods can provide information about the likely impacts of alternative health policy decisions on inequalities in health, financial risk protection and other health-related outcomes that may be considered unfair, allowing for the distribution of costs as well as benefits.
Motor Neurone Disease resource. The RCN has launched a new online resource to improve knowledge and provide support for nurses treating people living with Motor Neurone Disease.
MHRA issues new guidance on emergency contraceptive. New guidance from the Medicines and Healthcare Products Regulatory Agency (MHRA) recommends that women needing the emergency contraceptive pill containing levonorgestrel should inform their healthcare professional if they are currently taking certain medicines which may reduce the effectiveness of the emergency contraceptive.
Consultations
Managing conflicts of interest in the NHS: A consultation. NHS England is seeking views on proposed changes to the way in which conflicts of interest in health are managed. The proposals cover gifts, hospitality, employment, sponsorship and other interests. It aims primarily to support staff to manage interests appropriately, encouraging the right behaviours whilst also enabling staff and organisations to identify and manage inappropriate behaviour, making clear what is and is not acceptable. The consultation closes on 31 October 2016.
News
Smartphone diagnosis to be enrolled for NHS. All NHS patients will be offered diagnosis by smartphone in a bid to modernise the offer to the public, and lift pressures on ailing services.
HEE statement on non-contractual support for doctors in training. Health Education England has announced a wide range of initiatives to tackle the non-contractual concerns that have been highlighted by junior doctors.
Hospitals must help provide better information for private patients. From 1 September 2016 hospitals that treat patients privately, both independent hospitals and NHS private units, must provide data to enable the Private Healthcare Information Network, an independent public website set up in 2014 by the Competition and Markets Authority following a private healthcare review, to publish performance information on certain measures such as mortality and infection rates, and eventually fees, to help inform patients' choices.
The economics of housing and health: the role of housing associations. This report, based on work commissioned by the National Housing Federation from The King’s Fund and the New NHS Alliance, looks at the economic case for closer working between the housing and health sectors. The authors demonstrate how housing associations provide a wide range of services that produce health benefits, which can both reduce demand on the NHS and create social value. The report concludes that there is no one piece of economic analysis that will persuade health providers or commissioners to work with or commission housing associations. However, the case studies in the report illustrate the economic benefits that housing association can provide.
Bevan Brittan Updates
Bevan Brittan ranks as Top Tier Firm in 8 practice areas in The Legal 500. The Legal 500 has listed Bevan Brittan as a top-tier firm in eight practice areas and named four of our team as Leading Lawyers
Medical Devices and Brexit. The dust has barely settled on the Brexit referendum and the future planning yet to begin.
mHealth: the Latest App-date from the MHRA. The use of technology in the provision of health and social care is slowly gathering pace but appears to be lagging way behind the current technological world. The MHRA has issued new guidance to assist in checking whether or not an app is a medical device and what to look for to make sure the app is safe and effective.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
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