06/02/2017
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.
If someone forwarded you this email you can sign up for your own copy here.
Training Events
Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If you are a client and would like to come along and join our team at these sessions just ask Claire Bentley for the programme of talks. You can attend in our London, Bristol or Birmingham office. If you are unable to get to one of our offices you can also sign up to watch the training sessions remotely via our webinar facility.
Acute and emergency care
Publications/guidance
Extended hours in primary care linked to reductions in minor A&E attendances. This briefing summarises the findings of a study that found that practices that offered additional appointments showed a reduction in the number of their patients attending emergency departments for minor conditions but that there was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. These findings suggest additional appointments may help reduce minor A&E visits but may be more costly overall.
Hospital Accident and Emergency Activity, 2015-16. This is a report on Accident and Emergency (A&E) activity in English NHS hospitals and English NHS-commissioned activity in the independent sector. This annual publication covers the financial year ending March 2016. It contains final data and replaces the provisional data that are published each month.
NHS ambulance services. This NAO report finds that ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care, such as resolving calls over the phone by providing advice to callers, has helped but there are signs of stress, including worsening performance against response time targets. The report also found that each of the 10 ambulance trusts in England has developed its own operating framework, with differences in workforce mix, fleet mix and estate. These differences have contributed to variations and inefficiencies in performance. Ambulance services are finding it challenging to engage with the wider health sector due to the growing number of stakeholders that trusts are required to work with. In addition, the wider system does not always make good use of the ambulance services’ experience or recognise the impact that changes to other local services have on the ambulance services.
NHS performance statistics up to and including November 2016. This briefing provides an overview of the key findings from the latest set of NHS performance data and some points of comparison. It looks at A&E attendances, emergency admissions, trolley waits and delayed transfers of care.
Consultations
Safe, sustainable and productive staffing: an improvement resource for adult inpatient wards in acute hospitals. This draft guidance aims to help standardise staffing decisions in adult inpatient wards in acute hospitals. This resource is based on the National Quality Board’s expectations to ensure safe, effective, caring, responsive and well-led care, and that trusts will employ the right staff with the right skills in the right place and at the right time. The closing date for comments on the draft guidance is 3 February 2017.
News
Over £31m to improve health services for mothers and babies. Announces that over £25m will be spent on redeveloping neonatal and obstetric services at the University Hospital of Wales, plus >£6m will be invested to consolidate and redevelop neonatal and obstetric services at Prince Charles Hospital, Cwm Taf.
Man evicted from hospital for blocking bed for two years. A patient has been evicted from James Paget Hospital in Great Yarmouth, Norfolk after repeatedly refusing all offers of appropriate accommodation since his arrival in August 2014, despite being fit for discharge, at a cost to the hospital estimated at £300,000. The hospital was granted a court order to take possession of his bed on 1 December 2016 and he was evicted into community accommodation on 10 January 2017.
If you wish to discuss any queries you may have around acute and emergency care please contact Claire Bentley.
Children
Publications/guidance
These are our children – A review by Dame Christine Lenehan. Dame Christine Lenehan was asked to take a strategic overview and recommend what practical action can be taken to co-ordinate care, support and treatment for children and young people with complex needs (and behaviour that challenges) involving mental health problems and learning disabilities and/or autism. Her report makes 11 recommendations for government departments and partners at a national level on how to improve the system.
Children’s sports prostheses funding: how to apply. The DH is making available £750,000 to fund prostheses in England for children who have suffered limb loss or were born with a limb deficiency, to enable them to take part in physical activity and sports. The funding is available until the end of March 2018. This guidance sets out the eligibility criteria and how NHS limb centres in England can apply for funding for children’s activity and sports prostheses up to the value of £5,000 per limb (not per child), including all the associated costs of fitting the new limb, such as a new socket or liner.
State of Child Health report 2017. This report from the Royal College of Paediatrics and Child Health brings together data for the first time on a comprehensive list of 25 measures of the health of UK children, ranging from specific conditions such as asthma, diabetes and epilepsy, risk factors for poor health such as obesity and a low rate of breastfeeding, to child deaths. The data provide an "across the board" snapshot of child health and wellbeing in the UK. it shows that nearly one in five children in the UK is living in poverty and inequality is blighting their lives, with those from the most deprived backgrounds experiencing much worse health compared with the most affluent. Despite some improvements in the health of UK children over the last decades, there is clear disparity with Europe, and major cause for concern.
Childhood obesity plan case studies. These case studies describe the progress being made across the country to improve children’s nutrition, health and wellbeing.
Guidance for designated professionals safeguarding children and child protection-information sharing (CP-IS). This document recognises the Designated Professionals Safeguarding Children role in the CCG as strategic leaders and professional advisers across the system. This guidance has been produced to support their role in ensuring the addition of CP-IS in the NHS Contract 2017/19 is promoted and implemented.
News
Inquiry launched into child protection thresholds after girl's death. Anne Longfield, the Children's Commissioner, is to review the variable application of child protection thresholds in England after serious failings were found in how social services dealt with the case of Poppy Widdison, a four-year-old girl who had been force-fed drugs and who had died after being assaulted by either her mother or her boyfriend after months of cruelty and neglect.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah.
Clinical Risk/Patient Safety
Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If you are a client and would like to come along and join our team at these sessions just ask Claire Bentley for our programme of talks. You can attend in our London, Bristol or Birmingham office. If you are unable to get to one of our offices you can also sign up to watch the training sessions remotely via our webinar facility.
Publications/Guidance
Will the NHS never learn? Follow-up to PHSO report "Learning from Mistakes" on the NHS in England: Seventh Report of Session 2016-17. A Public Administration and Constitutional Affairs Committee reports concludes the Government must do more to coordinate its efforts to establish a culture of open-minded learning and investigation within the NHS in England. The Committee's inquiry followed a Parliamentary and Health Service Ombudsman report which highlighted systemic problems with clinical incident investigations, where a fear of blame inhibited open investigations and learning.
Confidentiality: good practice in handling patient information. Revised, expanded and reorganised guidance from the GMC on confidentiality for all doctors practising in the UK. It sets out the principles of confidentiality and respect for patients’ privacy that doctors are expected to understand and follow, together with the responsibilities of all doctors for managing and protecting patient information. It outlines the framework for considering when to disclose patients’ personal information and then applies that framework to: a disclosures to support the direct care of an individual patient; disclosures for the protection of patients and others; and disclosures for all other purposes. The revised guidance comes into effect on 25 April 2017.
New bedside vision check tool to help prevent hospital inpatient falls. The Royal College of Physicians has published a new tool that enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital. It is being made available to trusts and local health boards in England and Wales.
Falls in older people This quality standard has been updated to set out the best practice for health and social professionals to support them in preventing falls. The guidance has been updated to highlight the importance of routine appointments with family doctors, at hospital, or during home visits by social care workers, as they can help to prevent falls, disability and loss of independence. It also calls for people aged 65 and over to be regularly asked questions about whether they have fallen over in the last year or feel unsteady on their feet.
Support overdue: women’s experiences of maternity services. This report, produced in partnership with the Women's Institute, is based on the NCT's second survey of women’s experiences of their maternity care. The findings aim to provide a benchmark for patient experiences, particularly as changes to maternity care are implemented following the National Maternity Review report. The report finds that many women have a positive experience of maternity care but the findings also highlight concerns around patient safety and staffing levels. The survey of 2,500 women found that half of the respondents had experienced 'red flag events', which NICE define as an indicator of dangerously low staffing levels.
Cases
Nile Joseph Welds (A child by his mother & litigation friend Delsena Walrond) v (1) Yorkshire Ambulance NHS Trust (2) Sheffield Teaching Hospitals NHS Foundation Trust [2016] EWHC 3325. There had not been a culpable delay on the part of a team of midwives and an ambulance crew dealing with a woman who was 33 weeks' pregnant and suffering from a major antepartum haemorrhage caused by a placental abruption.
Baynham (a child and protected party by her litigation friend, Sarah Jane Baynham) v Royal Wolverhampton Hospitals NHS Trust [2016] EWCA Civ 1249. The Court of Appeal dismissed the claimant's appeal against the finding that the NHS Trust was not liable for injuries caused during her birth. The judge had had to deal with complex issues in dispute between the parties' expert witnesses and the findings he had made had been open to him to make on the evidence before him.
Amanda McGuinn v Lewisham & Greenwich NHS Trust [2017] EWHC 88 (QB) The claimant established that those responsible for her medical care during her pregnancy had breached their duty of care in failing to appreciate that her daughter who was born severely disabled was at risk of suffering from microcephaly.
Lamarieo Manna (A Child & Protected Party by his Father & Litigation Friend Samuel Manna) v Central Manchester University Hospitals NHS Foundation Trust [2017] EWCA Civ 12. In a claim for damages the court declined to amend the multiplier adopted in a Roberts v Johnstone [1989] QB 878 calculation for the purchase of an additional home where the claimant could spend time with his father. The trust had failed to raise at trial whether the multiplier should be based on the father's life expectancy rather than the claimant's, and it was too late to raise such an argument on appeal.
Consultations
Fixed recoverable costs for clinical negligence claims. This consultation seeks views on proposal for a mandatory system of fixed recoverable costs for lower value clinical negligence claims in England and Wales. The proposal aims to improve the efficiency and cost-effectiveness of claims by supporting quicker and more cost effective resolutions; greater opportunities for early learning of lessons from harmful incidents; access to justice for claimants who bring low-value claims of a complex nature; and patients' access to justice by streamlining the system. The deadline for responses to the consultation is 1 May 2017.
News
Plans for fixed cap on legal costs for medical negligence cases. Legal firms will face a new cap on the amount of costs they can recover in negligence cases.
If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Catherine Radford or Penelope Radcliffe.
Commissioning
Publications/Guidance
Focus on the draft MCP contract. The BMA has published guidance on the Government's new Multi-speciality Community Providers care model and contract framework that summarises the main elements pertaining to the MCP contract and GPC’s key concerns. Whilst supporting the principles of integrated care, the GPC remains concerned by the apparent longer-term movement away from the national GMS contract and continues to believe that the key aims of the MCP contract can be met within the existing framework and protections of the national GMS contract.
Specialist substance misuse services for young people. Sets out four core commissioning principles that have been developed, based on the findings, research and evidence based guidelines, for the commissioning and provision of specialist substance misuse provision for young people. The document is designed to provide prompts around some core principles for consideration when local authorities are commissioning specialist substance misuse provision, but is not intended to be a comprehensive commissioning guide.
National tariff payment system 2017/18 and 2018/19. NHS Improvement has published published the 2017/19 National Tariff which aims to help NHS providers and commissioners deliver sustainable, high quality care. It contains a range of new features including: a two-year tariff; a move to the HRG4+ phase 3 currency design for national prices; two new mandatory best practice tariffs; and new mandatory payment approaches for mental health. The 2017/19 National Tariff Payment System will come into effect from 1 April 2017.
Bite-size guides to patient insight. NHS England has launched two further bite-size guides to patient insight to help CCGs and providers make better use of national surveys and feedback data and to plan their own local insight work to inform service reviews and redesigns.
Faulty by design: The state of public service commissioning. The think tank Reform has set out what it sees as the flaws in commissioning in the public sector. It includes insights from experts from government, providers and third-parties, alongside a literature review and evaluation of the publicly available data. The report focuses on complex human services, in which there is a purchaser-provider split - in health and social care, criminal justice, housing and homelessness, and employment services. It concludes that the current commissioning model is failing to achieve the Government’s aims of commissioning integrated, locally tailored services that meet the outcomes of service users, to the detriment of service users and taxpayers alike. Recognising this is the first step to designing a new commissioning framework capable of delivering services that meet the complex needs of users, wherever they may live.
Commissioning medicines optimisation services from community pharmacy: Guidance for commissioners. The University of Manchester, along with Primary Care Commissioning (PCC), has launched a toolkit to support commissioners to strategically plan, design and evaluate services provided by community pharmacies for patients requiring medicines. it contains guidance, resources and tips to improve the outcomes of services that involve medicines as part of the patient pathway.
Service standards for commissioning Female Genital Mutilation (FGM) care. This guidance describes service standards expected to be commissioned for the confirmation of FGM in children under the age of 18. Formerly known as "Provision for confirming suspected FGM in children", the guidance has been updated to follow the wording used by NHS England.
Delegated commissioning case studies. NHS England has produced a series of case studies to show how CCGs are using delegated commissioning to drive improvements for their local populations. The case studies include practical advice on how to maximise the benefits of full delegation.
Defining and measuring unmet need to guide healthcare funding: identifying and filling the gaps Budget allocations to CCGs include adjustments for meeting unmet health care needs and tackling health inequalities. This literature review aims to identify and understand the available evidence regarding unmet health need. The study found that while there was evidence to support identifying unmet health need, there was a gap in the evidence on how budget allocations are best used to reduce it.
Support after a suicide: a guide to providing local services. This practical guidance helps commissioners understand why and how they can deliver support after suicide (also known as postvention support) in their local areas.
If you wish to discuss the issue of commissioning please contact David Owens.
Employment/HR
Publications/Guidance
Regional review of medical education and training in the south west of England: 2016 This report outlines the findings of a review of medical education and training in the south west of England. Overall, it found that medical students and doctors in training are learning in positive and supportive environments, but training time becomes squeezed when doctors’ workloads increase.
Department of Health equality information and equality analysis 2017: the department as an employer This report contains a breakdown of the department’s workforce on all equality strands. This includes data on ethnicity, gender, disability, age, working patterns, sexual orientation and religious belief.
News
Drop in EU nurses coming to UK since Brexit vote
Bevan Brittan Updates
Workforce law – what to expect in 2017 and beyond. Sarah Maddock summarises forthcoming employment law changes and action points for employers.
Trouble ahead? Expired warnings lawfully taken into account where the employer expected future misconduct issues.
Employment law news in brief for January 2017. Julian Hoskins with this month's employment law news in brief, including the Supreme Court's decision on the Brexit process, public sector gender pay gap reporting and developments on 'gig' working, diabetes and disability discrimination.
If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.
Finance
Publications and Guidance
Tackling wasteful spending on health. This report finds that across OECD countries a significant number of health care system spending and activities are wasteful at best, and, at worst, harm our health. It estimates that one in ten patients in OECD countries is unnecessarily harmed at the point of care. It also finds that more than 10 per cent of hospital expenditure is spent on correcting preventable medical mistakes or infections that people catch in hospitals.
£40 million Budget boost for the Welsh NHS estate. The Welsh Government has announced additional capital funding of £40m to improve Wales’ health estate and accelerate transformation. The funding will be particularly targeted at the development of a new generation of integrated health and social services centres across Wales, which will improve local access and care closer to home. It will help Local Health Boards bring forward plans for facilities in primary and community settings more quickly in the future.
Outperforming trusts could get 'preferential access' to capital. NHS Improvement discussing potential scheme with the Department of Health comes after regulators confirmed trusts able to meet or better their control total will receive “bonus” payment Trusts have previously been warned over the scarcity of capital funding in coming years Regulators are seeking to give “preferential access” to capital funding to NHS trusts able to better their financial targets in 2016-17.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
Information sharing/data protection
Publications/guidance
Memorandum of understanding between the Home Office, NHS Digital and the Department of Health. This memorandum of understanding formalises existing arrangements for the Home Office to make disclosure requests to NHS Digital for the purpose of tracing immigration offenders and vulnerable people who may be at risk.
ABI principles for requesting and obtaining medical information electronically from General Practitioners. New guiding principles on electronic paperless requests for medical information have been published by the Association of British Insurers (ABI). Among other things, the guidance was created to ensure greater security of information than the current paper-based system.
Personal health records: Learning from voices of experience. Patient Information Forum have launched a new guide sharing the experiences of people who have first-hand experience of developing or using Personal Health Records (PHRs). These are a digital space for people to record and engage with their health and care information. With issues such as digital health, self-care and supported self-management dominating current health policy, PIF’s guide shares real life examples of how PHRs could impact people’s health and wellbeing, and change health services.
News
London NHS hospital trust hit by cyber-attack. Barts health NHS trust warns staff and takes ‘a number of drives offline’ as it urgently investigates phishing ambush.
If you wish to discuss any issues raised in this section please contact Jane Bennett.
Mental Health
Would you like to access the Bevan Brittan Mental Health Extranet? - It is a secure online resource containing a discussion forum, knowledge bank and information about training events. If you would like access please contact Claire Bentley.
Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If you are a client and would like to come along and join our team at these sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office. If you are unable to get to one of our offices you can also sign up to watch the training sessions remotely via our webinar facility.
Publications/Guidance
Five Year Forward View for Mental Health: government response. The government’s response to the work of the Mental Health Taskforce and the Five Year Forward View for Mental Health report.
Seeing through the fog: how mental health problems affect financial capability. This report seeks to identify and catalogue the needs people with mental health problems may have, and to map how products and services could be adapted to ensure everyone has fair access.
Mental Health in General Hospitals: Treat as One (2017) This NCEPOD report highlights the quality of mental health and physical health care for patients aged 18 years or older with a significant mental disorder who are admitted to a general hospital. The report takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and the organisational care of these patients.
The Mental Capacity Act and Deprivation of Liberty Safeguards. A free resource for healthcare professionals. Produced by Medical Protection in partnership with Cambridgeshire County Council and NHS England. This two and a half hour course is divided into nine modules of interactive content. It features interviews with leading experts working with the Mental Capacity Act.
Memorandum of Understanding – The Police Use of Restraint in Mental Health & Learning Disability Settings. This Memorandum of Understanding (MoU) provides clarity on the role of the police service in responding to incidents within mental health and learning disability settings.
Mental health conditions packs. These packs contain data across a range of mental health and dementia services. The packs are split into stages along a mental health pathway and enable local health economies to compare their performance with their ten most similar CCGs. Each stage also includes a combination of case studies, tools and guidance from around the country, helping to disseminate best practice to support CCGs wishing to introduce new and improved ways of working.
These are our children – A review by Dame Christine Lenehan. Dame Christine Lenehan was asked to take a strategic overview and recommend what practical action can be taken to co-ordinate care, support and treatment for children and young people with complex needs (and behaviour that challenges) involving mental health problems and learning disabilities and/or autism. Her report makes 11 recommendations for government departments and partners at a national level on how to improve the system.
Developing an outcomes-based payment approach for Improving Access to Psychological Therapies (IAPT) services: detailed guidance. This guidance, produced jointly with NHS England, provides details on the new outcomes-based payment approach for IAPT services. This new approach will balance the need to pay for activity, taking into account case complexity and severity as a driver of cost, with the need to incentivise good outcomes. It builds on the IAPT model and the data that all providers of IAPT services are required to collect and submit to the national IAPT minimum dataset.
Supporting carers: mental health carers’ assessments in policy and practice. The Care Act 2014 introduced a duty on local authorities to offer carers an assessment of their needs, in order to identify potential support needs. This briefing outlines the challenges that mental health carers face in accessing carers’ assessments, taking into account the legal context and how the assessments work in practice.
Mental health problems: statistics on prevalence and services. This briefing addresses the following questions: how common are mental health problems? How long do people wait to access talking therapies? How much is spent on mental health services?
Building the right home. New housing guidance from the Transforming Care Programme supports NHS and local authority commissioners to work with housing providers to expand the housing options available for people with a learning disability, autism or both, who display behaviour that challenges.
Support after a suicide: a guide to providing local services. This practical guidance helps commissioners understand why and how they can deliver support after suicide (also known as postvention support) in their local areas.
Preventing suicide in England: third progress report of the cross-government outcomes strategy to save lives. This progress report details the activity that has taken place across England to reduce deaths by suicide in the year ending March 2016. The updates contained in this report will help to meet the recommendations of the NHS five year forward view for mental health that are relevant to suicide prevention: to reduce suicides by 10 per cent by March 2021 and for every local area to have a multi-agency suicide prevention plan in place by the end of 2017.
Mental Health: Written statement - HCWS397. In a written statement, the Secretary of State for Health details his intention to proceed with plans to further improve mental health provision including: accepting the recommendations of a taskforce which will see mental health spend increase by £1 billion a year; a green paper on children's mental health to be published before the end 2017; enabling secondary schools to train someone in mental health; a new partnership with employers to support mental health in the workplace; an expansion of digital mental health provision; and an updated suicide prevention strategy.
The Mental Capacity Act and Deprivation of Liberty. A free resource for healthcare professionals Produced by Medical Protection in partnership with Cambridgeshire County Council and NHS England. This course will help healthcare professionals understand:
. What the MCA is
. What they need to know
. How it affects them
. How it affects their patients
. How to apply this to their practice.
Consultations
Child and Adolescent Mental Health Services consultation. NHS England has launched a consultation on five service specifications for Children and Adolescent Mental Health Service (CAMHs) Tier 4. The consultation closes on 28 February 2017.
Draft national dementia strategy. The Welsh Government is seeking views on developing and implementing a national dementia strategy, Together for a Dementia Friendly Wales 2017 – 2022. It discusses: the key themes and actions to be included in the strategy; services available for people living with dementia; and evidence of existing good practice. The consultation closes on 3 April 2017.
Cases
Briggs v Briggs (by his litigation friend, the Official Solicitor) [2016] EWCOP 53. The Court of Protection rejected the argument that s.4(5) of the Mental Capacity Act 2005 precluded it from relying on an argument based on the wishes and feelings of the first respondent, who was in a minimally conscious state, and what he would have wanted and would have decided, based on his wife's opinion. The first respondent would not have consented to further clinically assisted nutrition and hydration, and his best interests were therefore best promoted by not giving consent on his behalf.
Cheshire & Wirral Partnership NHS Foundation Trust v Z [2016] EWCOP 56 The best option for a woman with extremely severe anorexia nervosa was treatment on a voluntary basis. That option would respect her autonomy and was preferable to forced feeding and feeding under sedation.
R (LF) v HM Senior Coroner for Inner South London; King's College Hospital NHS Foundation Trust (Interested Party) & (1) Intensive Care Society & The Faculty of Intensive Care Medicine (2) Secretary of State for Health & Secretary of State for Justice (Interveners) [2017] EWCA Civ 31 CA. A death in the intensive care unit of a hospital was not a death in "state detention" for the purposes of the Coroners and Justice Act 2009 s.7 and s.48(2). Urgent medical treatment for physical illness did not constitute the deprivation of a person's liberty. A coroner was therefore not under an obligation to hold an inquest with a jury if a patient died in intensive care. See Bevan Brittan Update by Stuart Marchant below.
Re MM (A patient) sub nom Kirk v (1) Devon CC (2) MM (By his litigation friend, The Official Solicitor) [2017] EWCA Civ 34. The court approved a consent order setting aside an order compelling the appellant to authorise the return to the UK of an elderly man who lacked capacity and was living in a care home in Portugal.
AP (By his litigation friend, BA) v Tameside Metropolitan Borough Council [2017] EWHC 65 (QB).There was no presumption under the Human Rights Act 1998 s.7(5) in favour of an extension of time to bring proceedings for claimants who lacked capacity and therefore had to depend on others in order to make a claim.
News
Care home charges residents for DoLS authorisations. A care home’s decision to charge residents £250 if they require a Deprivation of Liberty Safeguards authorisation has caused controversy, with a leading expert in the field lodging a complaint with the CQC over the move.
NHS England launches new measures to help GPs and patients access the care they need. A world-first nationally funded service to support GPs and GP trainees suffering mental ill-health and addiction goes live next week while 11 areas have been chosen to pilot new ways of retaining GPs who are considering leaving the profession so their skills can continue benefitting patients.
Bevan Brittan Updates
Treatment in an intensive care unit does not constitute deprivation of liberty. The case of Ferreira v HM Senior Coroner for Inner South London in the Court of Appeal.
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
Guidance note: GP practices serving atypical populations. NHS England has produced new guidance for commissioners of atypical practices. These are practices that are demographically different, with workload challenges that are not always recognised in the practice’s existing contracts or its funding allocation. The guidance outlines challenges faced by providers and offers examples that may help articulate and/or address these pressures.
Improving patient access to general practice This NAO report examines the structures and mechanisms that exist to improve patient access to general practice. It concludes that the Department of Health and NHS England have a high-level vision for improving access to general practice and have increased the funding available, but are seeking to extend access despite failing to provide consistent value for money from existing services.
PSNC Briefing 076/16: How GPs and pharmacies can work together on EPS business continuity. This PSNC Briefing provides community pharmacy contractors and LPCs with suggestions to support joint working between GP practice teams and pharmacy teams in the event of an outage with the Electronic Prescription Service Release 2.
Extended hours in primary care linked to reductions in minor A&E attendances. This briefing summarises the findings of a study that found that practices that offered additional appointments showed a reduction in the number of their patients attending emergency departments for minor conditions but that there was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. These findings suggest additional appointments may help reduce minor A&E visits but may be more costly overall.
FGM safeguarding and risk assessment: quick guide for health professionals. Guide to to help health professionals identify and assess the risk of female genital mutilation (FGM) for patients in their care and to support the discussion with patients and family members.
Female genital mutilation early intervention model: evaluation. An evaluation of the Mayor’s Office for Policing and Crime (MOPAC) FGM early intervention model that looked at ways to prevent new cases of FGM among women and girls, while supporting those affected by FGM. The pilot was delivered across three local authority areas within London (the Tri-Borough, Tower Hamlets, and Waltham Forest) and its work included establishing FGM clinics located within hospital midwifery services and staffed by specialist FGM social workers, therapists, community and health advocates drawn from community organisations, and specialist FGM midwives.
News
Extended hours in primary care linked to reductions in minor A&E attendances. Practices which offered additional appointments showed a reduction in the number of their patients attending emergency departments (also known as A&E) for minor conditions. There was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. The study did not evaluate whether or not this is cost saving to the health service as a whole nor if health outcomes were improved.
If you wish to discuss any queries you may have around primary care please contact David Owens.
Procurement
Publications
NHS terms and conditions for procuring goods and services. Updated terms and conditions for the NHS when procuring goods and services from commercial organisations.
If you wish to discuss any queries you may have around procurement please contact Emily Heard.
Providers
Publications
National tariff payment system 2017/18 and 2018/19. NHS Improvement has published published the 2017/19 National Tariff which aims to help NHS providers and commissioners deliver sustainable, high quality care. It contains a range of new features including: a two-year tariff; a move to the HRG4+ phase 3 currency design for national prices; two new mandatory best practice tariffs; and new mandatory payment approaches for mental health. The 2017/19 National Tariff Payment System will come into effect from 1 April 2017.
Bite-size guides to patient insight. NHS England has launched two further bite-size guides to patient insight to help CCGs and providers make better use of national surveys and feedback data and to plan their own local insight work to inform service reviews and redesigns.
Focus on the draft MCP contract. The BMA has published guidance on the Government's new Multi-speciality Community Providers care model and contract framework that summarises the main elements pertaining to the MCP contract and GPC’s key concerns. Whilst supporting the principles of integrated care, the GPC remains concerned by the apparent longer-term movement away from the national GMS contract and continues to believe that the key aims of the MCP contract can be met within the existing framework and protections of the national GMS contract.
If you wish to discuss any queries you may have around providers please contact Vincent Buscemi. .
Public Health
Publications/Guidance
Rebalancing act. A resource for Directors of Public Health, Police and Crime Commissioners and other health and justice commissioners, service providers and users to support collaborative work to improve health, reduce offending and health inequalities among people in contact with the criminal justice system. The document sets out the case for investment, but also for making better use of existing resources, whether through joint or co-commissioning, pooled budgets, or simply more effective collaboration.
Support after a suicide: a guide to providing local services. This practical guidance helps commissioners understand why and how they can deliver support after suicide (also known as postvention support) in their local areas.
Specialist substance misuse services for young people. Sets out four core commissioning principles that have been developed, based on the findings, research and evidence based guidelines, for the commissioning and provision of specialist substance misuse provision for young people. The document is designed to provide prompts around some core principles for consideration when local authorities are commissioning specialist substance misuse provision, but is not intended to be a comprehensive commissioning guide.
State of Child Health report 2017. This report from the Royal College of Paediatrics and Child Health brings together data for the first time on a comprehensive list of 25 measures of the health of UK children, ranging from specific conditions such as asthma, diabetes and epilepsy, risk factors for poor health such as obesity and a low rate of breastfeeding, to child deaths. The data provide an "across the board" snapshot of child health and wellbeing in the UK. it shows that nearly one in five children in the UK is living in poverty and inequality is blighting their lives, with those from the most deprived backgrounds experiencing much worse health compared with the most affluent. Despite some improvements in the health of UK children over the last decades, there is clear disparity with Europe, and major cause for concern.
An evidence review of the outcomes that can be expected of drug misuse treatment in England. This review gives policy makers and local areas an objective assessment of what drug treatment outcomes are achievable, and compares outcomes in England to the evidence and to other drug treatment systems. It reviews the impact of housing problems, unemployment and social deprivation on treatment engagement and outcomes. The review also considers how drug treatment will need to be configured to meet future need and recommends an appropriate set of measures or indicator for treatment evaluation.
Antimicrobial stewardship: changing risk-related behaviours in the general population. This NICE guideline covers making people aware of how to correctly use antimicrobial medicines (including antibiotics) and the dangers associated with their overuse and misuse. It also includes measures to prevent and control infection that can stop people needing antimicrobials or spreading infection to others. It aims to change people’s behaviour to reduce antimicrobial resistance and the spread of resistant microbes.
Childhood obesity plan case studies. These case studies describe the progress being made across the country to improve children’s nutrition, health and wellbeing.
Obesity and the public purse: weighing up the true cost to the taxpayer This report analyses the cost of obesity to public services and estimates that the net cost is less than £2.5 billion a year or 0.3 per cent of government spending. The report argues that the economic burden of obesity has been exaggerated and that the health care costs of an ageing population should be the focus for public service efficiency savings.
Health matters: combating high blood pressure. This professional resource outlines how providers and commissioners can reduce the population average blood pressure through improved prevention, detection and management.
Tackling tuberculosis in under-served populations. Guidance for TB Control Boards and partners outlines ways to design and deliver programmes to reduce TB in under-served populations (USPs).
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/Guidance
Taking revalidation forward: improving the process of relicensing for doctors: Sir Keith Pearson's review of medical revalidation This report details the findings of a review of the medical revalidation process so far. The review gathered feedback from a wide range of individuals and finds that revalidation has delivered benefits in terms of clinical governance and driving changes in doctors' practice. The review highlights concerns around the added workload of revalidation and makes recommendations for better ways to support doctors who are undergoing the revalidation process. The GMC have responded to the recommendations in the review in their formal response document.
Standards of proficiency: social workers in England This is the revised set of professional standards, which sets out what social workers in England should know, understand and be able to do when they complete their social work training in order to register with HCPC. The revisions to the standards come after a public consultation, and the changes state that social workers must be able to identify and apply strategies to build professional resilience; understand information governance; and understand leadership and its application to practice.
Registration for vanguards and other new care models. Update for providers who offer care under new models, such as those described in the NHS England vanguard programme. It explains their duties in relation to registering with CQC and it also describes how CQC is developing its registration function to adapt to new models of care.
Government response to the review of the Surveillance Camera Code of Practice. The Minister for Policing and Fire Services, Brandon Lewis, has written to the Surveillance Camera Commissioner confirming that he does not intend to expand the list of relevant authorities who must have regard to Code's requirements to include NHS Trusts. However, he is still exploring the possibilities of increasing voluntary compliance with the Code, and has written to the LGA and the DH encouraging them to work with the Commissioner to explore the benefits of voluntary adoption of the code within the NHS.
Consultations
Changes to DH accounting guidance for NHS bodies: 2017 to 2018. Seeks views on the 2017-2018 Department of Health Group Accounting Manual, which is based on the 2017 to 2018 Treasury Financial Reporting Manual, adapted for the NHS. It includes mandatory accounting guidance for all DH group and NHS bodies on completing their statutory annual report and accounts. The GAM is applicable to all organisations within the DH group for the purpose of preparing annual accounts. However, for annual reporting purposes only, NHS foundation trusts will follow the separate Annual Reporting Manual published by NHS Improvement. The consultation closes on 24 February 2017.
News
Wokingham council criticised after woman left severely malnourished during stay in care home. The LGO has issued a report criticising a council after a vulnerable dementia patient lost a third of her body weight while living in the care home it contracted to look after her. The investigation recommends that, to remedy the injustice caused by poor care planning and delivery, the council pay a total of £4,000 to the patient's family. It also recommends that the council includes specific spot checks around nutrition, falls and care plans for activities.
Care provider prosecuted by CQC after burns incident at care home. A care provider that failed in its duty to provide safe care and treatment has been ordered to pay £24,600 in fines and costs by Highbury Magistrates’ Court.
CQC announces new partnerships with charities and patient groups
Bevan Brittan Updates.
CQC Consultation - Next Phase of Regulation – NHS trusts. CQC Consultation briefing Part 4.
CQC Consultation - "Registering Services for People with Learning Disabilities." CQC Consultation briefing Part 3.
CQC Consultation - The New Assessment Framework. CQC Consultation briefing Part 2.
CQC Consultation on "Regulating New Models of Care and Complex Providers." CQC Consultation Briefing Part 1
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
Social Care
Publications/guidance
Combating loneliness – A guide for local authorities. The LGA, with Age UK and the Campaign to End Loneliness, has produced a guide that sets out a range of actions for effectively combating loneliness, building on the latest evidence. These practical steps are illustrated by case studies drawn from around the country.
Oral health in care homes and hospitals: NICE quality standard This draft quality standard, out for consultation, advises care home staff to assess the oral health needs of their residents on admission and record these in personal care plans. It also advises that care home residents should be supported to clean their teeth or dentures on a regular basis to maintain oral health and enhance dignity and self-esteem. The consultation on this quality standard closes on 3 February 2017.
Care home charter for swallowing and medicines. This charter identifies key pledges that both patients and health and care professionals will abide by while in care settings, focusing on patients who experience swallowing difficulties.
Preventing falls in older people through conversation. NICE has advised health and care professionals to talk to older people about falls.NICE says routine appointments with family doctors, at hospital, or during home visits by social care workers, can prevent falls, disability and loss of independence.
Guidance for designated professionals safeguarding children and child protection-information sharing (CP-IS). This document recognises the Designated Professionals Safeguarding Children role in the CCG as strategic leaders and professional advisers across the system. This guidance has been produced to support their role in ensuring the addition of CP-IS in the NHS Contract 2017/19 is promoted and implemented.
Standards of proficiency - Social workers in England. The Health Care Professions Council has published the revised Standards of Proficiency (SoPs) for social workers in England. The standards set out what social workers in England should know, understand and be able to do when they complete their social work training in order to register with the HCPC. They also set out clear expectations of a social workers’ knowledge and ability whilst practising.
Falls and fracture consensus statement: supporting commissioning for prevention The National Falls Prevention Coordination Group, made up of organisations involved in the prevention of falls, care for falls-related injuries and the promotion of healthy ageing, was formed with the aim of co-ordinating and supporting falls prevention activity in England. This guidance is aimed at local commissioning and strategic leads in England with a remit for falls, bone health and healthy ageing. It outlines approaches to the interventions and activities helping prevent falls and fractures to improve health outcomes for older people.
News
PM must act on health and social care funding, say Select Committees. Three House of Commons Select Committees are urging Prime Minister Theresa May to reach a cross-party agreement very soon on the future of health and social care funding. The Chairs of the Health Committee, Public Accounts Committee and Communities and Local Government Committee have written to the PM, stressing that a consensus should be reached quickly so an agreed approach can be reflected in the next round of government spending.
If you wish to discuss any queries you may have around social care please contact Stuart Marchant.
General
Publications/guidance
NHS treatment for overseas patients: Thirty-seventh Report of Session 2016-17. A Public Accounts Committee report calls on the Department of Health to take urgent action to recover more money from NHS patients visiting from overseas, and ensure that the system is fair to taxpayers and to patients who are entitled to free care. It states that if the NHS does not recover the costs, then there is less money available to treat other people and "even more pressure on NHS finances".
Burning injustice: reducing tobacco-driven harm and inequality The APPGSH launched this inquiry to review current action on tobacco control in response to concerns that funding is being reduced or not used effectively for work on tobacco control. The report provides evidence-based recommendations to the government, local authorities and the NHS for effective action to further reduce smoking prevalence at a time of austerity.
NHS identity guidelines. Updated guidelines and identity Policy that set out how the NHS brand should be applied by NHS organisations and providers of NHS services across a range of different materials. The new NHS Identity Policy is mandatory for NHS organisations and providers commissioned under the NHS Standard Contract. It sets the framework to achieve the consistent application of the NHS Identity that patients and the public want and expect to see from the NHS as a single, national, unified health service. It also protects the NHS trade mark against misuse.
Building on the industrial strategy: Briefing for the NHS. The Government published its long-awaited Industrial Strategy green paper on 23 January 2017, setting out the Government's vision for a modern industrial strategy and some early actions it has committed to take. The paper aims to start a genuinely open and collaborative conversation about the skills, research, infrastructure and the other things needed to get right to drive long term growth in productivity. This briefing focuses on the implications and opportunities for NHS organisations arising from the industrial strategy.
Department of Health assures its engagement with Brexit negotiations. The Department of Health's approach to securing health objectives in the context of Brexit negotiations has been outlined in a letter sent by the Secretary of State for Health, Jeremy Hunt, to the Chair of the Commons Health Committee. The response asserts that DH is committed to playing its part in securing the best outcome from exiting the EU.
NHS efficiency map. The HFMA and NHS Improvement have worked in partnership to update and revise the NHS efficiency map. The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency.
Important Public Services Regulations 2017 – guidance on the regulations. Section 226(2B) of the Trade Union and Labour Relations (Consolidation) Act 1992 (inserted by the Trade Union Act 2016) requires ballots for industrial action, where the majority of union members who are entitled to vote are normally engaged in "important public services", to have the support of at least 40% of members before they are valid, unless the union reasonably believes this not to be the case. This guidance accompanies the several Important Public Services Regulations 2017 (currently in draft) that specify the important public services captured by this 40% threshold. It provides advice for unions on applying the 40% threshold in practice, and also suggests examples of workers who will be covered in each sector in the regulations - these include emergency service and health service workers.
Sustainable Development Management Plan (SDMP) guidance for health and social care organisations. Practical guidance developed by the Sustainable Development Unit to assist organisations to write their own Sustainable Development Management Plan (SDMP). Having a board approved SDMP is one of the cornerstones of the Sustainable Development Strategy and it is also an indicator in the Public Health Outcomes Framework. Along with regular annual reporting on sustainability, an SDMP is expected by the NHS Standard Contract (Service Condition 18). Annual Sustainability Reporting is furthermore required from arm's length bodies, through the Greening Government Commitments, encouraged from CCGs and Trusts through the Department of Health Group Accounting Manual and suggested by the Foundation Trust Annual Reporting Manual.
Allied Health Professions into action: Using Allied Health Professionals to transform health, care and wellbeing. This document brings together the views of the third largest workforce in the health and care system, which includes chiropodists, dieticians, orthoptists, paramedics, physiotherapists, art therapists and speech and language therapists. It sets out how the 12 Allied Health Professional (AHP) groups across England can be at the forefront of innovative changes to patient care and shape future health policy by having a full involvement in transformation plans being developed across the country. The new guidance aims to provide a blueprint for Clinical Commissioning Groups, provider organisations, health leaders and local authorities to fully utilise and involve AHPs in transformation programmes and the delivery of NHS England’s Five Year Forward View.
Consultations
Asthma management. NICE has issued draft guidance on the management of asthma that calls for a change to how the medicines are offered to enable the NHS to make savings of potentially £3m per year. The draft guideline also describes how health professionals should help people self-manage. It recommends they offer people a written plan with details of their triggers, how to adjust medicines and when to seek help. The consultation closes on 16 February 2017.
Cases
Spire Healthcare Ltd v Royal & Sun Alliance Insurance Plc [2016] EWHC 3278. A medical negligence clause in an insurance policy operated so as to aggregate linked claims and subject them to a lower liability limit than would otherwise apply if each claim were counted separately. However, there was no express wording to aggregate the excess or contribution payable by the insured, so that the latter had to make a separate contribution in respect of each linked claim.
Bevan Brittan Updates
New joint guidance on housing demand. Issued by NHS England, the Local Government Association and ADASS, arising from the Transforming Care Programme
If you wish to discuss any issues raised in this section please contact Claire Bentley.
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