04/09/2017
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.
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If someone forwarded you this email you can sign up for your own free copy here delivered directly to your inbox.
Bevan Brittan Free Training Events
Court of Protection Seminars - SAVE THE DATE
In October and November, Bevan Brittan's specialist Court of Protection team is hosting practical update sessions in Bristol, Birmingham, London and Leeds. These sessions 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. They will offer guidance on the sort of problems that are faced by front-line practitioners and service planners. The sessions are aimed at all those working in organisations responsible for the care of vulnerable or incapable people both as care providers or commissioners. The sessions will run from 10:00 – 15.30. Registration for all sessions will open at 09:30 and lunch will be available.
- 31 October – Bristol
- 7 November – London
- 8 November – Birmingham
- 9 November – Leeds
If you would like to register your interest in one of the above seminars click on this link.
Clinical Risk Webinars
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. The lunchtime training sessions coming up are:-
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Developments in managing shoulder dystocia and Erb’s Palsy cases - 12 September 2017 (12.30pm - 2pm). If you would like to attend this free lunchtime webinar just ask Claire Bentley.
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Care claims after Reaney and other hot topics - 26 September 2017 (12.30pm - 2pm). If you would like to attend this free lunchtime webinar just ask Claire Bentley.
Bevan Brittan training packages
In addition to our free training programme, we also provide bespoke knowledge transfer sessions on a range of healthcare law topics. If you wish to discuss any queries you may have around training or webinars please contact Claire Bentley
Acute and emergency care
Publications/guidance
General surgery: GIRFT Programme National Specialty Report. This analysis by the Getting It Right First Time Programme (GIRFT) examines key aspects of the way general surgery - defined here as the management of patients presenting with elective or emergency abdominal disease - is delivered in NHS England. Drawing on a broad range of data from across the NHS, together with the learning from visiting many NHS provider trusts, it pinpoints areas of variation in general surgical practice, procurement and patient outcomes. It then analyses this variation to underpin a series of recommendations that offer opportunities to enhance patients’ experience of care, improve patient outcomes and reduce post-surgical complications, while delivering tangible savings to individual trusts and the NHS as a whole. These recommendations include suggestions that could reduce length of stay, cut readmissions and rapidly save millions of pounds on procuring clinical supplies.
Specialist major trauma networks and terrorist events: to care for many, care for one. Since its establishment in 2010, the London Trauma System has improved access to specialist trauma care, improved quality of care, and more than halved the mortality of severely injured patients. In this King's Fund article, trauma surgeon Karim Brohi reflects on the 2017 terror attacks and highlights the difference that the LTS has made.
Consultations
Emergency and acute medical care in over 16s: 1 service delivery and organisation. Draft NICE guideline on the organisation and delivery of emergency and acute medical care in the community and in hospital. It includes recommendations for practice and for research. The closing date for comments is 14 August 2017.
News
£50m to further improve NHS waiting times in Wales. Announces funding that will be targeted at making improvements to waiting times in elective surgery, diagnostics and therapies over and above those already planned.
If you wish to discuss any queries you may have around acute and emergency care please contact Claire Bentley.
Children
Publications/guidance
Supporting mental health in schools and colleges. The DfE has published key findings from research into mental health provision in schools and colleges. The research included a national survey of provision, and case studies exploring decision-making, models of delivery and experiences of different approaches to mental health provision followed by a workshop to consolidate learning from the research.
An RCN toolkit for school nurses This toolkit provides school nurses with information, examples of good practice, templates and useful websites to support and develop professional practice. It considers varying policy and practice which applies across the UK and the range of settings in which school nurses work.
Personal health budgets: Refreshed programme of support. NHS England provides an ongoing programme of support for professionals who are involved in the delivery of personal health budgets. This programme of support aims to support the further roll-out of personal health budgets, in order to achieve the Government’s Mandate expectations of 50,000 -100,000 personal health budgets by 2020/21, as well as supporting CCGs in line with their responsibilities regarding the legal right to have a personal health budget for people who are eligible for NHS Continuing Healthcare and continuing care for children.
Criminal exploitation of children and vulnerable adults: county lines. Guidance for frontline professionals on dealing with county lines, part of the Government’s approach to ending gang violence and exploitation.
Position statement on children and young peoples' mental health. This intercollegiate statement, produced in conjunction with the Royal College of Paediatrics and Child Health and the Royal College of Psychiatrists, outlines five principles to improve the care and support of children and young people (CYP) with mental health problems. The guidance highlights the need for a shared vision for CYP mental health across all professions and agencies.
News
Record rise in babies born with brain damage sees NHS compensation bill soar. The cost of meeting the "complex life-long care needs" of babies born with brain damage could soon exceed £20m per child.
Re X (A Child) (No.4) [2017] EWHC 2084 (Fam). The President of the Family Division commented upon the lack of availability of mental health placements for children and young people in England and Wales. The fact that a bed had finally been found for a 17-year old girl the subject of care proceedings, whose need was overwhelming and desperately urgent, was not a matter for congratulation, but a further cause for concern. Securing the right clinical support for those who needed it could not be dependent on a senior judge publicly showcasing his outrage and frustration.
No secure care place available for 'dangerous' teenager, UK judge told .
NHS accused of "cheating" over mentally ill children placements. The British Medical Association has criticised the way child mental health treatment placements are recorded, where in 2015 the definition of referrals being "out of area" was changed to only if the postcode of the place they were treated was outside "the footprint of the specialised commissioning hub covering where the patient resides", which can result in children being sent up to 200 miles from home for treatment.
£500,000 to improve eating disorder services for young people in Wales. The Welsh Health Secretary has announced that an additional £500,000 p.a. will be invested by the Welsh Government to improve the care that young people with eating disorders receive when they turn 18.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah.
Clinical Risk/Patient Safety
Publications/Guidance
Reporting claims to NHS Resolution
Encouraging speaking up through trust wide engagement. This case study outlines how York Teaching Hospital NHS Foundation Trust improved their levels of staff engagement across multiple sites and promoted awareness about raising concerns and the role of the Freedom to Speak Up guardian.
Improving the working environment for safe surgical care. This discussion paper outlines a number of critical recommendations to government to greatly improve safety in the delivery of surgical treatment and patient care. The report notes factors adversely affecting morale, including a lack of team structure, poor communication, high stress levels, and limited training opportunities. The report also records how staff, at times, feel diverted away from the patient-centred care they strive to deliver because of administrative and IT issues, and believe that being more innovative and efficient with existing resources could make a positive difference.
General surgery: GIRFT programme national specialty report. This report argues that the NHS could see a significant reduction in the amount of people unnecessarily admitted for emergency general surgery if more acute hospitals introduced consultant-led surgical assessments at their ‘front door’. The analysis estimates that this change could lead to up to 30 per cent fewer general surgery emergency admissions a year where no operation is delivered, and could cut the NHS’s annual cost for this from £361 million to £253 million.
National Maternity and Perinatal Audit Organisational report 2017. A new report from the RCOG finds large increase in midwife-led units co-located with obstetric units, increasing birthplace choice for pregnant women - but also describes variation in availability of staff, facilities and services
Falls and fractures: consensus statement and resources pack. These documents outline approaches to interventions and activities helping prevent falls and fractures to improve health outcomes for older people.
Cases
Mitchell v Gilling-Smith [2017] EWHC B18. A £10,000 premium incurred in a clinical negligence case was reasonable and proportional. This case emphasises the importance of a paying party bringing actual evidence to court if they wish to dispute the reasonableness and proportionality of a premium.
(1) Jonathan Mott (2) Helen Mott v (1) Wayne Long (2) Syreeta Long (2017) The defendants, whose solicitors had filed their costs budget 10 days late, were entitled to relief from sanctions.
SH (By her mther & litigation friend, CD) v Department of Health (Formerly South West Strategic Health Authority) (2017) The claimant, a 29-year-old woman, received a lump sum of £2,180,600 plus periodical payments of £107,500 per annum from December 2017, for the significant neurological injuries sustained following surgery in January 1988. An additional amount of £1,244,928 was paid as the claim settled following changes to the discount rate and no judicial review was brought within the "relevant period" of the order.
Wilkins v Barking Havering & Redbridge University Hospitals NHS Trust (2017) QBD (Spencer J). It was not appropriate to grant a wasted costs order against a medical negligence claimant's solicitors after a quantum trial had to be adjourned. The claimant had not kept her solicitors up-to-date about when surgery which ultimately delayed the trial would take place. The solicitors had informed the defendant as soon as they realised the surgery's consequences. That conduct had not been designed to harass the defendant and was not vexatious or unreasonable.
R v Ian Paterson sub nom Attorney General's Reference (2017). A total sentence of 15 years' imprisonment for 17 counts of wounding with intent and three counts of unlawful wounding was unduly lenient where a consultant general surgeon had misrepresented test results, exaggerated the risk of cancer and carried out unnecessary biopsies and mastectomies on 10 patients. The sentencing guidelines assumed one offence, and where there were a number of victims a sentence outside the range was inevitable. In the instant case, involving a gross breach of trust and physical and psychological harm to victims over a long period of time, a total sentence of 20 years' imprisonment was appropriate.
R (SB) v NHS England [2017] EWHC 2000 (Admin). The court has quashed NHS England's decision not to fund the drug Kuvan (sapropterin dihydrochloride) for an autistic child who suffered from phenylketonuria. The court held that the the Individual Funding Request (IFR) Panel's conclusion that the clinical effectiveness of Kuvan had not been demonstrated was irrational. The IFR Panel had either misinterpreted the phrase "clinical effectiveness" in the Ethical Framework or they had misunderstood or materially mischaracterised the evidence on that topic. If "clinical effectiveness" was properly interpreted, the evidence that Kuvan was clinically effective was overwhelming.
R v Rose [2017] EWCA Crim 1168. The Court of Appeal has allowed an optometrist's appeal against conviction for the gross negligence manslaughter of a young boy where she had breached her statutory duty of care to examine the internal structure of his eyes as part of a routine eye examination and consequently failed to identify an abnormality on the optic nerve which ultimately led to his death. The court held that in assessing reasonable foreseeability of serious and obvious risk of death in cases of gross negligence manslaughter, it was not appropriate to take into account what the defendant would have known but for his or her breach of duty, otherwise this would fundamentally undermine the established legal test of foreseeability in gross negligence manslaughter which required proof of a "serious and obvious risk of death" at the time of breach. The implications for medical and other professions would be serious because people would be guilty of gross negligence manslaughter by reason of negligent omissions to carry out routine eye, blood and other tests which in fact would have revealed fatal conditions notwithstanding that the circumstances were such that it was not reasonably foreseeable that failure to carry out such tests would carry an obvious and serious risk of death. R's negligent examination of the boy and failure to identify the defect which ultimately led to his death was a serious breach of duty; however, that was a matter for her regulator. It did not constitute the crime of gross negligence manslaughter.
George Thorburn v South Warwickshire NHS Foundation Trust [2017] EWHC 1791 (QB). In a claim for clinical negligence in the performance of knee replacement surgery, and the consequent need for two-stage revision surgery to the knee, the court awarded the claimant damages for pain, suffering and loss of amenity and consequential losses. It rejected his claim for loss of a chance in respect of a business he was developing.
Marsh v Ministry of Justice [2017] EWHC 1040 (QB). A claimant who had succeeded in his personal injury claim against the Ministry of Justice was awarded his costs of the trial. Part of the costs were awarded on the indemnity basis and additional awards under CPR r.36.17 were made where the claimant had done better than a Part 36 offer by a significant amount and the Ministry of Justice had refused to engage in mediation.
News
Portsmouth Hospital Trust warned waiting list failings may have put 12,000 patients at risk. An acute hospital trust has launched a review of its patient records after external advisers warned thousands of people may have been put at risk of clinical harm due to missed follow-up appointments.
NHS reveals record rise in newborn babies with brain injury. Official figures reveal that the number of claims against maternity units for cases which ended in life-long disability has risen by 29% in one year, where parents made 232 such claims against the NHS in 2016-17, amid criticisms on a campaign for births without medical intervention. Health service officials have stated that future payouts could exceed £20 million per child.
Private hospital firm takes NHS to court over rogue surgeon. An NHS trust that employed breast surgeon Ian Paterson is being taken to court by a private provider, which claims the health service has a legal responsibility to compensate private patients.
RCSEd Publishes Plan for Safer Working Environment. The Royal College of Surgeons of Edinburgh (RCSEd) has published a number of critical recommendations to government to greatly improve safety in the delivery of surgical treatment and patient care, with seven recommendations for best practice.
It’s too late for my son, but the end of the campaign for ‘normal birth’ is welcome. James Titcombe
Webinars
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. The lunchtime training sessions coming up are:-
-
Developments in managing shoulder dystocia and Erb’s Palsy cases - 12 September 2017 (12.30pm - 2pm). If you would like to attend this free lunchtime webinar just ask Claire Bentley.
-
Care claims after Reaney and other hot topics - 26 September 2017 (12.30pm - 2pm). If you would like to attend this free lunchtime webinar just ask Claire Bentley.
If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Catherine Radford or Penelope Radcliffe.
Commissioning
Publications/Guidance
Clinical commissioning group guidance on senior appointments, including accountable officers. NHS England has published revised CCG guidance on senior appointments, including accountable officers, and a new appointment pro forma.
Accountable Care Organisation (ACO) contract. NHS England has published a model Accountable Care Organisation Contract and supporting documents for use by local commissioners to inform the early stages of their procurement processes. The contract can be used for accountable care models generally, including MCP and integrated primary and acute care system (PACS) models. It has also published supporting documents to the contract and a template Alliance Agreement for use with the virtual model.
CCG improvement and assessment framework 2016/17. This new Improvement and Assessment Framework for CCGs replaces both the existing CCG Assurance Framework and separate CCG performance dashboard. In the Government’s Mandate to NHS England, this new framework takes an enhanced and more central place in the overall arrangements for public accountability of the NHS.
CCG Annual Assessment 2016/17. This document lists the overall rating for each of the 209 CCGs as part of their annual assessment under the CCG Improvement and Assessment Framework (CCG IAF).
NHS standard contract: guidance on the variations process (full-length and shorter-form contracts) This document contains guidance on the process to effect variations to a commissioning contract in the form of the NHS standard contract (full length or shorter-form) and is relevant to all commissioners and providers who are parties to an NHS standard contract.
Guidance on the Variations Process: full-length and shorter-form contracts. NHS England have issued guidance on the process to effect variations to NHS Standard Contracts (full-length and shorter form). It applies both to variations initiated by a party to the Contract and to variations mandated by NHS England (National Variations). There is also a template Variation Agreement for use with full-length or shorter-form contract.
Commissioning policy: Reimbursement of expenses for living donors. The policy is designed to inform healthcare professionals and commissioning authorities about the principles and processes that underpin financial reimbursement for living organ donors. The principle of reimbursement is founded on the premise that there should be no financial incentive or disincentive in becoming a living organ donor
Plans to improve NHS Continuing Healthcare assessment processes. A letter to CCG Accountable Officers and CCG Clinical Leaders explaining the actions that CCGs are expected to take to improve the NHS Continuing Healthcare assessment processes.
Integrated support and assurance process. These documents describe the integrated NHS England and NHS Improvement process for supporting commissioners and providers looking to procure and bid for complex contracts.
Commissioning policy: reimbursement of expenses for living donors. NHS England has published a policy to inform healthcare professionals and commissioning authorities about the principles and processes that underpin financial reimbursement for living organ donors.
If you wish to discuss the issue of commissioning please contact David Owens.
Employment/HR
Publications/guidance
Encouraging speaking up through trust wide engagement. This case study outlines how York Teaching Hospital NHS Foundation Trust improved their levels of staff engagement across multiple sites and promoted awareness about raising concerns and the role of the Freedom to Speak Up guardian.
A journey to improved staff engagement. Case study of Imperial College Healthcare NHS Trust, looking at how a number of new and innovative methods have been implemented to improve staff engagement and take staff on a journey, where they become a valuable part in the whole process.
Re-employment of staff in receipt of NHS pension scheme benefits. This document provides guidance on how to consider applications from staff wishing to retire and return to work for the NHS. It aims to help employers put in place policies and procedures so that decisions to re-employ staff can be justified in terms of service need and value for money.
Developing people – improving care: a national framework for action on improvement and leadership development in NHS-funded services. This updated framework focuses on helping NHS and social care staff to develop four critical capabilities: systems leadership; established quality improvement methods; inclusive and compassionate leadership; and talent management.
Re-employment of staff in receipt of NHS Pension Scheme benefits – Guidance for employers and staff. Guidance to help employers consider applications from staff who wish to "retire and return" to work for the NHS. Used appropriately, "retire and return" can benefit both employers and employees by helping retain valuable skills and experience for patient care as well as supporting staff health and wellbeing, work/life balance and potentially realising financial savings through reduced recruitment costs, agency spend and employer pension contributions. Employers should have policies and procedures so that decisions to re-employ staff who have taken their NHSPS benefits can be justified on the grounds of service need and value for money.
Consultant physician wellbeing survey 2017. Sets out the findings from a Royal College of Physicians survey that asked questions about wellbeing that had not previously been explored in the annual census of consultant physicians. It was sent to one-third of substantive consultant physicians currently at work in the UK (with a response rate of 30%). The key findings include that, more than 50% of the time, 78% of consultants felt valued by patients and 70% by colleagues/staff, but only 26% felt valued by the hospital. Only 35% of consultants felt fulfilled more than 50% of the time.
Latest NHS staff sickness absence statistics published for April 2017. The latest figures released by the NHS Digital show that NHS staff sickness absence has decreased from 4.01 per cent in April 2016 to 3.69 per cent April 2017. This is the lowest monthly rate since May 2011 when it was also 3.69 per cent.
New scheme launched to help NHS whistleblowers. NHS England has launched a nationwide pilot to help NHS whistleblowers back into work. The Whistleblowers Support Scheme will offer a range of services including career coaching, financial advice and mediation for primary care staff who have suffered as a result of raising concerns about NHS practice. Working Transitions has been appointed to run the pilot until March 2018.
Bevan Brittan Updates
Holiday pay and voluntary overtime - Bevan Brittan Briefing
If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.
Finance
Publications and Guidance
NHS funds held on trust This guidance introduces the general principles determining the financial responsibilities of trustees of NHS charities. It outlines how funds held on trust are handled and managed, including the processes for transferring funds to other bodies.
Personal health budgets: Refreshed programme of support. NHS England provides an ongoing programme of support for professionals who are involved in the delivery of personal health budgets. This programme of support aims to support the further roll-out of personal health budgets, in order to achieve the Government’s Mandate expectations of 50,000 -100,000 personal health budgets by 2020/21, as well as supporting CCGs in line with their responsibilities regarding the legal right to have a personal health budget for people who are eligible for NHS Continuing Healthcare and continuing care for children.
NHS hospitals to be assessed on how they use their resources from the autumn.
Commissioning policy: reimbursement of expenses for living donors. NHS England has published a policy to inform healthcare professionals and commissioning authorities about the principles and processes that underpin financial reimbursement for living organ donors.
NHS funding and privatisation: the facts. A lecture and article by the scientist Professor Stephen Hawking outlining his views on the NHS have prompted a lively debate about a number of issues. The King's Fund looks at the facts about two of these: whether the NHS is being privatised and if it has been given the funding it needs.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
Independent Healthcare
Publications/Guidance
Divided by choice? Private providers, patient choice and hospital sorting in the English National Health service This study examines the impact of the NHS reforms of the 2000s which enabled privately-owned hospitals to enter the NHS market. It finds that post-reform, poor and ethnic minority patients were much less likely to choose private hospitals; and that the key factors in choice related to the geographic distribution of hospitals and health-based criteria for treatment from private providers.
NHS funding and privatisation: the facts. A lecture and article by the scientist Professor Stephen Hawking outlining his views on the NHS have prompted a lively debate about a number of issues. The King's Fund looks at the facts about two of these: whether the NHS is being privatised and if it has been given the funding it needs.
Private healthcare order 2014: directions issued to seven hospitals. Following the CMA's 2014 investigation of the private health care sector, private hospitals are now required to submit information on their quality of care to the Private Healthcare Information Network (PHIN) for publication. Seven hospitals have been directed to publish information on the quality of their private healthcare services after failing to meet the deadline. These directions have been issued to the hospitals and they demand that this information is provided by the end of October 2017.
HCA and University Hospitals Birmingham: PPU arrangements. The CMA’s decision on whether to review the private patient unit (PPU) arrangements between a private hospital operator and an NHS trust.
News
Private hospital firm takes NHS to court over rogue surgeon. An NHS trust that employed breast surgeon Ian Paterson is being taken to court by a private provider, which claims the health service has a legal responsibility to compensate private patients.
If you wish to discuss any issues raised in this section please contact Vincent Buscemi.
Information sharing/data
Publications and Guidance
Developing a consensus on data sharing to support NHS clinical genetics and genomics services. This paper outlines the key issues arising from an evidence session which was held to explore whether and how the NDG might help to address concerns about the legitimacy of genomic data sharing within the NHS for direct care and routine service delivery.
The north-south NHS divide: how where you are not what you need dictates your care. This report outlines the findings of an examination of data from 209 CCGs to assess patient access to medical technology. It finds wide variation in access between the north and south of England and argues that CCG performance against access indicators should be made clearer to patients.
Issues to consider when implementing pharmacy access to local electronic health records. This briefing outlines a list of issues to be considered by local pharmaceutical committees and community pharmacy contractors when pharmacy access to local electronic health record systems is being planned.
News
ICO warns NHS employees that unlawfully accessing patient records is an offence
How secure is your patient data? As more and more patient information is stored online and in electronic form, the risk of data theft increases. In less than a year, in May 2018, the European General Data Protection Regulation (GDPR) comes into effect. Are you ready?
What’s Data Protection Got To Do With Human Rights? It’s 2017 and data is being generated at an extraordinary rate. There are so many new types of information being gathered, it’s difficult to keep up. Everything from our GPS trackers and DNA profiles to IP addresses is up for grabs.
Bevan Brittan Updates
GDPR Implementation: The Government's Statement of Intent
If you wish to discuss any issues raised in this section please contact Jane Bennett.
Mental Health
Publications/Guidance
Dementia in older age: barriers to primary prevention and factors These evidence reviews, authored by the Personal Social Services Research Unit at the London School of Economics, aim to aid commissioners and researchers make decisions about prioritisation of primary prevention measures relevant to dementia. The reviews find evidence that changing some behaviours in midlife can reduce the chances of getting dementia in older age.
Government response to the Health Select Committee's inquiry into suicide prevention The government’s response to the Health Select Committee’s inquiry into suicide prevention responds to the committee’s recommendations for improving delivery of the cross-government suicide prevention strategy.
Stepping forward to 2020/21: Mental Health Workforce Plan for England. The DH and Health Education England have launched a plan that sets out measures to tackle the 'historic imbalance' in workforce capacity and fulfil ambitions to improve mental health services. The Government has committed £1.3bn to transform mental health services, with a pledge to treat an extra 1m patients by 2020 to 2021, provide services 7 days a week, 24 hours a day, and integrate mental and physical health services for the first time.
Supporting mental health in schools and colleges. The DfE has published key findings from research into mental health provision in schools and colleges. The research included a national survey of provision, and case studies exploring decision-making, models of delivery and experiences of different approaches to mental health provision followed by a workshop to consolidate learning from the research.
Implementation guide and resource pack for dementia care. This guide sets out what good quality assessment, diagnosis and care looks like in relation to formal guidance, in addition to the views and expectations of people living with dementia and their carers. The guide is shaped by the framework set by the NHS Mandate and has two clear requirements to enhance dementia care, through: increasing the number of people being diagnosed with dementia, and starting treatment, within six weeks from referral; and improving the quality of post-diagnostic treatment and support for people with dementia and their carers.
Inpatient provision for children and young people with mental health problems. This Education Policy Institute (EPI) report examines the state of child and adolescent mental health inpatient services in England. The analysis explores the latest evidence and NHS data on admissions, quality of care, staffing and capacity.
Better care for people with co-occurring mental health, and alcohol and drug use conditions. Public Health England guidance for commissioners and providers of mental health and alcohol and drug treatment services on commissioning and providing better care for people with co-occurring mental health, and alcohol and drug use conditions. it supports implementation of the Five Year Forward View for Mental Health and represents an action from the Mental Health Crisis Care Concordat national action plan.
Delivering high quality end of life care for people who have a learning disability. This guidance document provide resources and tips for commissioners, service providers and health and social care staff providing, or delivering care to people with a learning disability at the end of their lives.
Survival guide – Care & Treatment Reviews. This Bringing Us Together guide has been written to help families understand and cope with the CTR process. A CTR is a meeting to check that a person’s care and treatment is meeting their needs. A CTR may be held for anyone with learning disabilities, autism or both who may be at risk of admission to, or who is already in, a specialist learning disability or mental health hospital. The guide begins at the point before a crisis has developed, takes them through assessment and treatment, and ends with discharge and beyond.
Position statement on children and young peoples' mental health. This intercollegiate statement, produced in conjunction with the Royal College of Paediatrics and Child Health and the Royal College of Psychiatrists, outlines five principles to improve the care and support of children and young people (CYP) with mental health problems. The guidance highlights the need for a shared vision for CYP mental health across all professions and agencies.
News
No secure care place available for 'dangerous' teenager, UK judge told .
NHS accused of "cheating" over mentally ill children placements. The British Medical Association has criticised the way child mental health treatment placements are recorded, where in 2015 the definition of referrals being "out of area" was changed to only if the postcode of the place they were treated was outside "the footprint of the specialised commissioning hub covering where the patient resides", which can result in children being sent up to 200 miles from home for treatment.
£500,000 to improve eating disorder services for young people in Wales. The Welsh Health Secretary has announced that an additional £500,000 p.a. will be invested by the Welsh Government to improve the care that young people with eating disorders receive when they turn 18.
Bevan Brittan Events
Court of Protection Seminars - SAVE THE DATE
In October and November, Bevan Brittan's specialist Court of Protection team is hosting practical update sessions in Bristol, Birmingham, London and Leeds. These sessions 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. They will offer guidance on the sort of problems that are faced by front-line practitioners and service planners. The sessions are aimed at all those working in organisations responsible for the care of vulnerable or incapable people both as care providers or commissioners. The sessions will run from 10:00 – 15.30. Registration for all sessions will open at 09:30 and lunch will be available.
- 31 October – Bristol
- 7 November – London
- 8 November – Birmingham
- 9 November – Leeds
If you would like to register your interest in one of the above seminars click on this link.
Bevan Brittan Mental Health Extranet
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.
Issues that are currently being discussed on our forum are:-
Exploring the safety net: public authorities' duties to vulnerable persons
Changes to s135/136 Mental Health Act 1983 (ss80 - 83 of the Policing and Crime Act 2017 and related regulations) Updated inform
If you wish to discuss any mental health issues please contact Simon Lindsay or Stuart Marchant.
Primary Care
Publications/Guidance
Primary Dental Services Statements of Financial Entitlements (Amendment) Directions 2017. These Directions implement changes to the Statements of Financial Entitlements with effect from 1 April 2017. The changes relate to: a 1.14% uplift to GDS contracts and PDS agreements values; a 1% increase to dental foundation trainees’ salaries; and a 1% increase to dental foundation trainers’ training grant.
GP Forward View: Assessment of progress Year 1. The RCGP has carried out an assessment of the first year of the General Practice Forward View, which contains detailed set of commitments to support general practice over the following five years.
General Practice – Developing confidence, capability and capacity: a ten point action plan for General Practice Nursing. This action plan describes the changes required to improve recruitment and retention, and encourage the return of nurses to general practice. All ten actions should be seen as part of an overall plan to develop general practice nursing. The actions identified complement each other and the GPN ten point action plan should be seen in the overall context of the General Practice Forward View.
The recruitment, retention and return of nurses to general practice nursing in England. This report, authored by Ipsos MORI, outlines the findings of qualitative research into the drivers and barriers to entry into general practice nursing (GPN). It finds that the general perception is that general practice is more suitable for older or more experienced nurses. As student placements in general practice are rare, there is a lack of opportunity for students to develop an understanding of the GPN role. The research also highlights the need for greater support for GPNs and the lack of standardisation in pay for GPN roles.
Improving access for all: reducing inequalities in access to general practice services This guide, aimed at GP commissioners and providers, is designed to promote understanding of groups in the community who are experiencing barriers in accessing services. It provides resources to help address those barriers as improvements in access to GP services are rolled out.
Primary Care Home: Evaluating a new model of primary care. This report from the Nuffield Trust evaluates the Primary Care Home model - a way of organising care for groups of up to 50,000 patients. The model was developed by the National Association of Primary Care (NAPC) and seeks to link staff from general practice, community-based services, hospitals, mental health services, social care and voluntary organisations to deliver joined-up care.
Expansion of the GP international recruitment programme. This guidance describes how NHS England is working with partner organisations to expand the GP international recruitment programme. In order to meet targets for GP recruitment set out in the General practice forward view, the programme is being brought forward two years and proposals for the recruitment of an extra 601 doctors has been approved.
News
Lease incentives for GP practices. The General Practice Forward View committed to providing financial support to every GP practice that is a tenant in an NHS Property Services or Community Health Partnerships building to enter into a new lease. This offer is available until 30 November 2017 and includes: Reimbursement of Stamp Duty Land Tax for the initial term (up to 15 years); Contributing up to £1,000 plus VAT of legal fees related to the lease transaction; Reimbursement of management fees for the financial year 2016/2017 and 2017/2018. There is also guidance for the tenants of NHS Property Services and Community Health Partnerships.
Clinical Practice Research Datalink. The National Institute for Health Research is appealing for general practices to join the Clinical Practice Research Datalink, a national organisation dedicated to improving public health. Practices are invited to contribute anonymised patient data used to develop guidance on clinical and drug safety. Benefits to practices include extra income and access to prescribing and patient safety reports among other resources. CPRD is a not-for-profit, government research service that has worked with GP practices for 30 years.
10,000 new NHS dental places to be created in Wales. Announces that additional places are being created as part of a wider package of investment to develop new and improved NHS dental services across Wales.
If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.
Providers
Publications/Guidance
A journey to improved staff engagement. Case study of Imperial College Healthcare NHS Trust, looking at how a number of new and innovative methods have been implemented to improve staff engagement and take staff on a journey, where they become a valuable part in the whole process.
Practical value in the NHS. This King's Fund article summarises a roundtable discussion with health service providers to better understand their approach to value improvement. It was initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care.
Neurological conditions delivery plan. The Welsh Government has published a plan that focuses on raising awareness of neurological conditions, ensuring quick diagnosis of patients, providing fast and effective care, and helping people live with their condition. The plan also aims to improve the information available on neurological conditions and treatment; as well as help target research into causes, treatments and cures.
Guidance on implementing the overseas visitor charging regulations. Updated guidance for NHS bodies who need to charge overseas visitors for NHS hospital treatment, under the NHS (Charges to Overseas Visitors) Regulations 2015 (SI 20105/238). The guidance incorporates changes made by the NHS (Charges to Overseas Visitors) (Amendment) Regulations 2017 (SI 2017/756) that come into effect from 21 August 2017 and 23 October 2017. There are also template letters, guidance and posters to help the NHS recover the costs of health care from visitors and migrants.
Integrated support and assurance process. These documents describe the integrated NHS England and NHS Improvement process for supporting commissioners and providers looking to procure and bid for complex contracts.
If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.
Public Health
Publications/Guidance
Government response to the Health Select Committee's Inquiry into suicide prevention. Responds to the Committee’s recommendations, published in December 2016, for improving delivery of the cross-government suicide prevention strategy.
Local Government support for health and wellbeing through the Arts and Culture. This LGA briefing sets out some of the ways in which the arts and culture can help local government better support the health and wellbeing of its communities.
London and health: the best and worst of cities. In this King's Fund blog, Chris Naylor examines how the capital compares with other English cities on selected health indicators, and asks what role cities should play in health improvement.
10 minutes brisk walking each day in mid-life for health benefits and towards achieving physical activity recommendations - evidence summary. 'Everybody active, every day' is a national, evidence-based approach to support all sectors to embed physical activity into the fabric of daily life and make it an easy, cost-effective and ‘normal’ choice in every community in England. This report, based on a rapid review of the evidence, summarises the potential benefits of 10 minute blocks of brisk walking as part of a contribution to the CMO recommended levels of activity.
Partnership approaches to improving health outcomes for young people. The case studies in this LGA report showcase different approaches to supporting the health of young people. Whilst the approach and focus of the work in local areas varies, each case study provides an opportunity to reflect on what made the initiative a success and how local authorities might use this learning in their own areas.
Consultations
Physical activity and the environment (update). NICE is seeking views on draft guidance that aims to help people to be more active through improvements to the built environment and better access to the countryside. Among a number of recommendations, the guideline advises local authorities to encourage people to visit their parks and local open spaces. There are new recommendations for people with reduced mobility, such as people with disabilities, visual impairments or those who may find it challenging to get around, such as parents using prams. NICE also recommends that pedestrian crossings should be made accessible for all. The consultation closes on 2 October 2017.
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/Guidance
Issues to consider when implementing pharmacy access to local electronic health records (EHRs). This PSNC Briefing provides a list of issues to be considered by Local Pharmaceutical Committees (LPCs) and community pharmacy contractors when pharmacy access to local electronic health record systems is being planned.
NHS hospitals to be assessed on how they use their resources from the autumn.
Consultations
Professional standards for pharmacy services: an updated draft for consultation. The Royal Pharmaceutical Society is seeking views on draft updated standards for hospital pharmacy services which support the development of safe, quality services that put patients and their needs first. The consultation closes on 11 September 2017.
Consultation on guidance to ensure a safe and effective pharmacy team. The General Pharmaceutical Council is consulting on new guidance for pharmacy owners which outlines what they are expected to do to ensure everyone in the pharmacy team can provide safe and effective services to patients and the public. The proposed guidance for pharmacy owners covers both registered and unregistered staff, including managers who are not registered pharmacy professionals. The consultation document explains how the GPhC plans to strengthen and assure the regulatory framework for unregistered pharmacy staff. The new guidance will replace the current policy on minimum training requirements for dispensing/ pharmacy assistants and medicines counter assistants. The consultation closes on 11 October 2017.
Cases
General Medical Council v Theodoropoulos [2017] EWHC 1984 (Admin). The court held that it was appropriate to hear the GMC's appeal in misconduct proceedings against a doctor who was absent through no fault of his own. The extent of his disadvantage in relation to the appeal was limited to the appropriate approach to sanction, where he had been found to have engaged in dishonest conduct by the Medical Practitioner's Tribunal, and there was no indication that the tribunal had reached a wrong decision, nor was the appeal against its factual findings.
R (Bestway National Chemists Ltd (t/a Well Pharmacy)) v Welsh Ministers [2017] EWHC 1983 (Admin). The court held that in refusing a pharmacy permission to relocate from its existing town centre premises to an out of town health park, and granting another pharmacy permission to operate from new premises there, the Welsh Ministers had properly exercised their judgement on the appropriate arrangements for the provision of pharmaceutical services in the area.
Irvine v General Medical Council [2017] EWHC 2038 (Admin). The court held that the GMC's Medical Practitioners Tribunal Service Panel had been entitled to erase the appellant consultant from the register. He had dishonestly carried on in private practice for almost five years knowing that he was not a member of either the Medical Defence Union or the Medical Protection Society and knowing that, as a consequence, he was without professional indemnity cover and in breach of his professional obligation to be adequately insured.
General Medical Council v Nwachuku [2017] EWHC 2085 (Admin). The court held that the GMC's disciplinary tribunal had erred in finding that a doctor's fitness to practise had not been impaired by his serious misconduct. N's dishonesty in submitting a false timesheet for personal gain had been serious, his attempt to avoid responsibility for it should have been considered an aggravating factor, and the tribunal had placed undue weight on his reflective statement which did not show that there was no risk of repetition of the misconduct.
News
More CCGs given NHS England legal directions. HSJ reports that NHS England has placed Solihull, North Lincolnshire and North Derbyshire CCGs under legal directions. The three CCGs have been ordered to produce, or comply with, financial recovery plans.
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
Social Care
Publications/Guidance
What’s it like to live in a care home? findings from the Healthwatch network. Between January 2016 and April 2017, local Healthwatch staff and volunteers across England visited 197 care homes across 63 different local authority areas to find out what day to day life is really like for many of those living in care homes. This report summarises what people told local Healthwatch and common issues that need to improve.
Results of a national survey of support to adult care homes in England: A specialist palliative care provider perspective. This survey of organisations providing specialist palliative care services to care homes highlights the good work they do and identifies the key challenges they face. The report, commissioned by Public Health England, undertaken by the Marie Curie Research Centre at Cardiff University, with input from the National Council for Palliative Care and Hospice UK, examines the role of specialist palliative care in providing support to care homes in England.
Better Care Fund Planning Requirements 2017-19: Frequently asked questions. NHS England has published a set of frequently asked questions to help local areas develop their Better Care Fund plans.
See also the LGA's Better Care Fund planning requirements 2017-19 – Frequently asked questions, that are intended to support councils in local discussions and joint working with partners.
What are the priorities for health and social care? Ahead of the party conference season, the King's Fund assesses the state of health and social care and sets out the big issues facing the government
Advancing care. This review provides an overview of recent NIHR research on improving the health and care of care home residents, focusing on three themes relating to the care of older people in care homes: Living well – maintaining good health and quality of life; ageing well – managing long term conditions associated with ageing; and dying well – ensuring a good quality end of life. It highlights current research taking place now and explores new approaches being developed in this important area.
Home care: what people told Healthwatch about their experiences This report analyses the experiences of people who use home care services, their families and front line staff across England. It finds that whilst many people have positive experiences, there is space for improvement in care planning, staff skills, consistency and continuity in services and communication and feedback.
Consultations
People's experience in adult social care services: improving the experience of care for people using adult social care services. NICE is seeking views on a draft guideline on how to help adults who need social care to feel in control and be able to live life as they want. NICE says staff should avoid making assumptions about a person’s capacity to be in control of their own care, e.g. if they are severely disabled. It suggests using communication aids, such as a picture book, to help people express their views. Interpreters can also be brought in to help people speak in their chosen language. The guideline also includes recommendations on assessing people’s needs in line with statutory requirements and planning care. It covers any area where adults receive social care, including people’s own homes, residential care and community settings. It says commissioners should provide an independent advocate for people who may struggle to communicate their needs. The closing date for comments is 3 October 2017.
News
Reduce bed-blocking or face cuts, councils told. Councils have been told to reduce hospital bed-blocking by up to 70% by next month or face funding cuts.
Extra 71,000 care home places needed in England by 2025, predict researchers. An extra 71,000 care home places will be needed to be created in England over the next decade, as care needs rise in line with increased life expectancy, according to predictions.
If you wish to discuss any queries you may have around social care please contact Stuart Marchant.
General
Publications/Guidance
Personal health budgets: Refreshed programme of support. NHS England provides an ongoing programme of support for professionals who are involved in the delivery of personal health budgets. This programme of support aims to support the further roll-out of personal health budgets, in order to achieve the Government’s Mandate expectations of 50,000 -100,000 personal health budgets by 2020/21, as well as supporting CCGs in line with their responsibilities regarding the legal right to have a personal health budget for people who are eligible for NHS Continuing Healthcare and continuing care for children.
PSNC Briefing 057/17: How recent changes will affect your payments. The funding imposition has led to changes in payments made to community pharmacy contractors in recent months. This PSNC Briefing aims to highlight the changes that have taken place and help community pharmacy contractors to understand how recent changes may be affecting their cashflow.
Developing a consensus on data sharing to support NHS clinical genetics and genomics services. This paper outlines the key issues arising from an evidence session which was held to explore whether and how the NDG might help to address concerns about the legitimacy of genomic data sharing within the NHS for direct care and routine service delivery.
Re-employment of staff in receipt of NHS pension scheme benefits. This document provides guidance on how to consider applications from staff wishing to retire and return to work for the NHS. It aims to help employers put in place policies and procedures so that decisions to re-employ staff can be justified in terms of service need and value for money.
The north-south NHS divide: how where you are not what you need dictates your care. This report outlines the findings of an examination of data from 209 CCGs to assess patient access to medical technology. It finds wide variation in access between the north and south of England and argues that CCG performance against access indicators should be made clearer to patients.
Criminal exploitation of children and vulnerable adults: county lines. Guidance for frontline professionals on dealing with county lines, part of the Government’s approach to ending gang violence and exploitation.
Issues to consider when implementing pharmacy access to local electronic health records. This briefing outlines a list of issues to be considered by local pharmaceutical committees and community pharmacy contractors when pharmacy access to local electronic health record systems is being planned.
Developing people – improving care: a national framework for action on improvement and leadership development in NHS-funded services. This updated framework focuses on helping NHS and social care staff to develop four critical capabilities: systems leadership; established quality improvement methods; inclusive and compassionate leadership; and talent management.
Re-employment of staff in receipt of NHS Pension Scheme benefits – Guidance for employers and staff. Guidance to help employers consider applications from staff who wish to "retire and return" to work for the NHS. Used appropriately, "retire and return" can benefit both employers and employees by helping retain valuable skills and experience for patient care as well as supporting staff health and wellbeing, work/life balance and potentially realising financial savings through reduced recruitment costs, agency spend and employer pension contributions. Employers should have policies and procedures so that decisions to re-employ staff who have taken their NHSPS benefits can be justified on the grounds of service need and value for money.
Consultant physician wellbeing survey 2017. Sets out the findings from a Royal College of Physicians survey that asked questions about wellbeing that had not previously been explored in the annual census of consultant physicians. It was sent to one-third of substantive consultant physicians currently at work in the UK (with a response rate of 30%). The key findings include that, more than 50% of the time, 78% of consultants felt valued by patients and 70% by colleagues/staff, but only 26% felt valued by the hospital. Only 35% of consultants felt fulfilled more than 50% of the time.
Reducing inequalities in health: towards a brave old world? In this King's Fund blog, David Buck considers what recent research and data can tell us about progress on tackling health inequalities, and argues that when planning for the future we should look to the past.
Joint statement on handling conflicts of interest. This joint statement, produced alongside other health professions regulators, sets out expectations on how health and care professionals are expected to manage conflicts of interest.
Consultations
Consultation on the Security of Network and Information Systems Directive. Seeks views on the Government’s plans to implement the Security of Network and Information Systems Directive ("NIS Directive") that will help make sure UK operators in health and other infrastructure are prepared to deal with the increasing numbers of cyber threats. It will also cover other threats affecting IT, such as power failures, hardware failures and environmental hazards. This paper sets out the Government’s proposed transposition approach and asks a series of questions on a range of detailed policy issues relating to transposition. The proposals include fines of up to £17m or 4 per cent of global turnover for organisations who fail to implement effective cyber security measures. Operators will be required to develop a strategy and policies to understand and manage their risk; to implement security measures to prevent attacks or system failures, including measures to detect attacks, develop security monitoring, and to raise staff awareness and training; to report incidents as soon as they happen; and to have systems in place to ensure that they can recover quickly after any event, with the capability to respond and restore systems. The consultation closes on 30 September 2017.
Expansion of undergraduate medical education: Response to consultation. Sets out the Government's next steps in implementing the expansion of undergraduate medical places in England. It announces that the Government will increase the number of student places at medical schools in England by 1,500. From next year, existing medical schools will be able to offer an extra 500 places to future doctors. Health Education England and the Higher Education Funding Council for England will proceed with a competitive bidding process for the allocation of the remaining 1,000 medical school places
News
ICO warns NHS employees that unlawfully accessing patient records is an offence
NHS England relaxes position on clinicians' use of WhatsApp
How secure is your patient data? As more and more patient information is stored online and in electronic form, the risk of data theft increases. In less than a year, in May 2018, the European General Data Protection Regulation (GDPR) comes into effect. Are you ready?
If you wish to discuss any issues raised in this section please contact Claire Bentley.
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