12/06/2018
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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| Mental Health | |
| Primary Care | |
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Bevan Brittan Free Training Events
SAVE THE DATE – BEVAN BRITTAN'S ANNUAL MENTAL HEALTH SEMINARS AND ANNUAL COURT OF PROTECTION SEMINARS
Back by popular demand, we are very pleased to announce that we will be running our free annual Mental Health seminars in October and annual Court of Protection Seminars in November. We have some dates to save in your diaries and will offer more detail about the content of the sessions nearer the event.
Mental Health Seminar - SAVE THE DATE
Please register your interest in attending by clicking on the following links:
Court of Protections Seminars - SAVE THE DATE
Please register your interest in attending by clicking on the following links:
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. You can sign up to watch the training sessions remotely via our webinar facility. Just ask Claire Bentley.
The lunchtime training sessions coming up are:-
Cybersecurity
Bevan Brittan Digital Health Forum: Cybersecurity - Exploring some of the lessons learned from the Wannacry attack and successfully managing risks. Bevan Brittan's quarterly Digital Forum is part of a series of events bringing together providers, consumers, industry leaders and regulators operating in the health and care sector to share views and discuss key issues and emerging themes within the digital health tech space. 20 June 2018
Procurement Updates
Birmingham - 25 June
London - 13 June
Leeds - 27 June
Bristol - 28 June
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
How CQC monitors, inspects and regulates urgent care services. This guidance has been updated. to include:
• Updates to the provider information request so that CQC can better understand the care and the service provided.
• Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means CQC will not always consider all five key questions on each inspection.
• More information on follow-up inspections.
Reducing emergency admissions: Forty-Fourth Report of Session 2017-19. A Committee of Public Accounts report warns hospitals, GPs, community services and social care need to work together more effectively to reduce emergency admissions. It states NHS England needs to deliver on its five-year plan to move care into the community and out of hospitals. The report highlights the consequences of the Government's failure to properly fund and coordinate preventive health care and social care.
Under pressure: safely managing increased demand in emergency departments. This CQC report presents the findings from its inspections of emergency departments over winter 2017/18, and workshops aimed at understanding the issues facing staff and what needs to change. The inspections found that the quality and safety of urgent and emergency care remains a concern with 50% of urgent and emergency services rated as "requires improvement" or "inadequate" overall, and 8% of services rated "inadequate" for safety. There were also specific concerns around delayed ambulance handovers; plus people were waiting for long periods of time before their first clinical assessment, and patients who needed urgent care were not always identified in a timely way. It calls for wider action for health and social care services to work together. A joint approach will help the whole health and care system to manage capacity as demand grows.
Emergency hospital admissions in England: which may be avoidable and how? New research led by the Health Foundation looks at trends in emergency admissions over the past decade and reviews some of the interventions aimed at reducing them. It also also identifies opportunities to reduce emergency admissions.
Mapping the NHS winter. This report from NHS Providers highlights the scale of pressures faced by NHS trusts and front line staff through the toughest winter on record. The report reveals that the number of people coming in to A & E over winter period, between December 2017 and March 2018, rose to more than 5.8m. It shows how, despite extensive preparations and extraordinary commitment from front line staff resulting in record numbers of patients being treated, services were unable keep up with demand. Finally, the report sets out what must be done to ensure the health service is ready next time.
Accident rescue charities VAT waiver grant funding: Guidance on eligibility and how to apply. In the 2017 Budget, the Chancellor announced a one-off grant fund to help accident rescue charities in England recover the cost of normally irrecoverable VAT. A fixed fund of no more than £100,000 has been made available in 2018/19 for the grant. DHSC, working with HM Treasury, will administer this grant funding scheme. Accident rescue charities must submit the expression of interest form to assess whether they qualify to make a claim. The form must be submitted by 30 June 2018.
News
London Ambulance Service taken out of special measures. The BBC reports that London Ambulance Service has been taken out of special measures after two-and-a-half years, following a new CQC report which said the ambulance service was "good" overall and is "outstanding" for patient care.
If you wish to discuss any queries you may have around acute and emergency care please contact Claire Bentley.
Children
Publications/guidance
Childhood obesity: Time for action. The Commons Health and Social Care Committee has identified several key areas which demand attention as a matter of urgency by the Government before it finalises the refreshed version of the 2016 childhood obesity plan. The Committee is calling for an effective childhood obesity plan with a joined-up, whole systems approach and one which focuses particularly on tackling the ever-widening health inequality due to childhood obesity between the richest and poorest areas.
Good progress but more to do: teenage pregnancy and young parents. The case studies in this LGA briefing highlight the continuing good work of local authorities in both helping young people prevent unintended pregnancy and supporting young parents. The focus on teenage pregnancy seen in England during the last 15 years or so has been one of the success stories in the public health field. The conception rate for young women aged 15 to 17 has fallen by 60 per cent since 1998 with a similar reduction in conceptions to under-16s. Both are at lowest level since record-keeping began in the late 1960s. However, the teenage birth rate still remains higher than a number of other western European countries and the progress made has been uneven across England.
News
70,000 more toddlers to get their first dental check-up as NHS England targets childhood dental health. NHS England is calling on dentists to see an additional 70,000 pre-school children as part of a drive in the health service’s 70th year, to help young families to get into the habit of good dental health. The Starting Well Core initiative will include additional support to the dental profession, including training materials and guidance for caring for your children, and a programme of communication to encourage the public to take up the offer of a Dental Check By One, for babies in the first year.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah.
Clinical Risk/Patient Safety
Publications/Guidance
Williams review into gross negligence manslaughter in healthcare. The review makes recommendations to support a more just and learning culture in the healthcare system. It covers:
• the process for investigating gross negligence manslaughter
• reflective practice of healthcare professionals
• the regulation of healthcare professionals
This rapid policy review into gross negligence manslaughter in healthcare was chaired by Professor Sir Norman Williams. The review was set up to look at the wider patient safety impact of concerns among healthcare professionals that simple errors could result in prosecution for gross negligence manslaughter, even if they happen in the context of broader organisation and system failings.
Clinical correspondence handling in the NHS: Forty-Third Report of Session 2017-19. A Committee of Public Accounts report on clinical correspondence handling in the NHS warns that nearly £2.5 million has been wasted reviewing misdirected clinical correspondence and that patient harm cannot be ruled out.
Accessing and using documents to counter fraud in the NHS: code of practice. This code of practice sets out the best practice for authorised officers involved in securing, using and handling NHS documents and and using them to counter fraud in the health service. It is relevant to anyone in the NHS who may be asked to produce documents.
News
Boards told they are failing on infection control. NHS trust boards have been told to do more on infection risks after an analysis by NHS Improvement found many were not receiving detailed information. Less than half of the 134 acute providers examined by NHSI had presented an annual infection prevention and control report to the board, despite this being a requirement under the Health and Social Care Act 2008.
Jeremy Hunt to strip General Medical Council of powers. The General Medical Council is to be stripped of its right to appeal tribunal decisions on doctors’ fitness to practise, less than three years after it was granted the power. Health and social care secretary Jeremy Hunt is set to announce the change later today as part of a raft of new patient safety measures.
Trust pays £10,000 after patient death caused by staff shortages. An NHS trust has paid £10,000 to the family of a woman who died after “delayed and inadequate” investigations left her with terminal cancer. Staffing shortages meant key tests for 73 year old Pamela North were not carried out by Barking, Havering and Redbridge University Hospitals Trust leading to her avoidable death, a report by the Parliamentary and Health Service Ombudsman has said.
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. You can sign up to watch the training sessions remotely via our webinar facility. Just ask Claire Bentley.
The lunchtime training sessions coming up are:-
If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Catherine Radford or Penelope Radcliffe.
Commissioning
Publications/Guidance
Dental contract reform: evaluation of the first year of prototyping 2016-2017. This is the third evaluation report produced as part of the dental contract reform programme. It has been developed to provide a general overview of the prototyping programme over the first year and focuses on: access and accessibility; quality and appropriateness of care; oral health; sustainability for dental practices; and value for money.
NHS operational productivity: unwarranted variations - Mental health services; Community health services. Lord Carter has published the findings of his review that looked at the productivity and efficiency of mental health and community health services in the context of the Five Year Forward View and its delivery plan. The review identifies unwarranted variation in the delivery of mental health and community health services, as well as the potential savings of nearly £1 billion that could be made in efficiencies by 2020/21.
Technical requirements for 2018/19 GMS contract changes. NHS Employers, on behalf and NHS England and the BMA’s General Practitioners Committee (GPC), has now published version 1 of the 2018/19 General Medical Services technical requirements document which outlines the clinical codes, payment, management and information count wording supporting the GMS contract.
What has the STP or ICS ever done for me? Since they were introduced in 2016, sustainability and transformation plans, and the partnerships (STPs) that have evolved from them, have taken up a considerable amount of NHS leaders’ time. Those STPs assessed as being most advanced by NHS England have been designated as integrated care systems (ICSs), of which there are currently 10 in England. Others are expected to be announced soon. Over time, NHS England hopes that all STPs will progress to become ICSs, recognising that the geographical footprints they cover may change in the light of developing understanding of their role. In this blog, Chris Ham reflects on the progress in ICSs and STPs so far, and assesses what they have achieved.
Ordinary residence: anonymised determinations 2017. DHSC has published a number of ordinary residence determinations, made under s.40 of the Care Act 2014, to show how it arrives at decisions to resolve disputes in the health and social care sector. The determinations have been anonymised so that they do not name the individuals or councils involved.
2017/19 NHS Standard Contract: updated May 2018. The NHS Standard Contract has been updated. A summary of the changes can be found in section 3 of the updated NHS Standard Contract Technical Guidance.
If you wish to discuss the issue of commissioning please contact David Owens.
Employment/HR
Publications/guidance
Our international health service This report looks at the possible implications of Brexit on the NHS workforce. It finds that more than a quarter of NHS doctors – including almost half in some vital specialities – and almost one in six nurses, are from overseas. It finds signs that the NHS is finding it increasingly difficult to attract the clinical staff it needs from the EU, which could add significant new pressures to the NHS in the future.
Workforce health and wellbeing framework. Sets out the standards for what NHS organisations need to do to support staff feeling well, healthy and happy at work. The interactive document makes the case for staff health and wellbeing, sets out clear actionable steps for each of the 14 areas and includes guidance on how organisations can plan and deliver a staff health and wellbeing plan.
Improving staff retention. This collection of practical resources aims to to help NHS organisations to improve staff retention. It includes a mixture of retention improvement guides, government policy documents and case studies on trust initiatives to improve retention.
Legislation
Employment Rights Act 1996 (NHS Recruitment – Protected Disclosure) Regulations 2018 (SI 2018/579). These regulations, which came into force on 23 May 2018, prohibit certain NHS employers from discriminating against job applicants because it appears to the employer that the applicant has made certain disclosure of information ("whistleblowing"). For these purposes, an employer discriminates against an applicant if the employer refuses the applicant's job application or otherwise treats the applicant less favourably than other applicants.
Bevan Brittan Insights
Employment Eye May 2018 - Jodie Sinclair
If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.
Finance
Guidance on overseas visitors hospital charging regulations. Guidance for NHS bodies who need to make and recover hospital charges from overseas visitors.
Making money work in the health and care system This report, written with PwC, explores how financial flows could be redesigned to find a better way to make money work in the health and care system. It sets out why change is necessary and proposes a number of radical financial reforms so that benefits to patients are maximised and resources are put to their most effective use.
Hypothecated funding for health and social care: how might it work? Hypothecation is the earmarking of a tax to be spent on a specific area of public expenditure. It is now being debated across the political parties and by other think tanks as one of the routes by which the money for that could be found. There are strong advocates and equally strong opponents of hypothecation. This short paper from the King's Fund examines both sides of the argument. It seeks to set out the problems hypothecation is meant to solve, and the conditions under which it might do so, and provides a brief history of hypothecation in the UK.
Securing the future: funding health and social care to the 2030s. Analysis from the IfS suggests that UK spending on healthcare will have to rise by an average 3.3% a year over the next 15 years just to maintain NHS provision at current levels, and by at least 4% a year if services are to be improved. Social care funding will need to increase by 3.9% a year to meet the needs of an ageing population and an increasing number of younger adults living with disabilities. The report aims to help understand how and why spending has risen over time, where the money is spent, how costs are likely to develop in the future, and how we might go about meeting those costs.
NHS at 70 - Public attitudes to the health and care system. Ipsos MORI was commissioned to find out the public's views towards funding of the NHS, and their priorities when receiving care, to inform a debate on the NHS at 70 that was held in London on 9 May 2018. This presentation summarises the poll's findings. It shows that the public continue to show strong support for the NHS as it approaches its 70th anniversary; however, there is real concern about the future funding of the NHS, and a majority agree it needs more money. If the NHS does receive more money, the public prioritise urgent and emergency services, and also mental health services, followed by community and adult social care services and children’s services.
Spending on and availability of health care resources: how does the UK compare to other countries? King's Fund article looking at how health spending in the UK compares to other countries and how the NHS measures up on some of the key resources this spending pays for, in light of the recent announcement by the Prime Minister to bring forward a new long-term funding settlement for the NHS.
News
NHS discount deal opens up new cancer treatment In a deal that was the first test of a policy that allows NHS England to restrict or delay medicines that will cost more than £20 million a year, even if deemed cost-effective, pharmaceutical company MSD has agreed a confidential discount for immunotherapy drug Pembrolizumab, which costs £84,000 per patient at full price, which will now be available for about 1,800 lung cancer patients a year.
If you wish to discuss any queries you may have around finance please contact Claire Bentley.
Independent Healthcare
Publications/Guidance
Memorandum of Understanding agreements with health insurers. These agreements represent a public commitment from the health insurers to share information with CQC about the quality and safety of independent healthcare services. They will use this information to improve how it monitors quality and safety in these services, as part of maintaining an effective regulatory system, to ensure people are provided with safe, effective, compassionate, high-quality care.
Review of private patient unit arrangements. Private patient units are arrangements by which private hospital operators can manage or operate privately-funded care in the UK. This draft guidance sets out principles for the management of mergers and competition in this market. The consultation closes on 22 June 2018.
News
Hunt warned over private hospital safety after NHS patient death
If you wish to discuss any queries you may have around independent healthcare please contact Vincent Buscemi.
Information sharing/data
Publications/Guidance
Using data in the NHS: the implications of the opt-out and GDPR. The safeguards governing the use of personal data, including patient data, changed on 25 May 2018. This King's Fund briefing explains the implications of these changes for the use of patient data.
See also Five ways patient data is saving the NHS that looks at five case studies of patient data being used in the NHS.
New Toolkit to help keep information safe. NHS Digital has launched the new Data Security and Protection Toolkit, replacing the previous Information Governance Toolkit, to help keep patient information safe. The Data Security and Protection Toolkit is an online self-assessment tool that enables health and social care organisations to measure and publish their performance against the National Data Guardian’s ten data security standards. All organisations that have access to NHS patient data and systems – including NHS Trusts, primary care and social care providers and commercial third parties – must complete the Toolkit to provide assurance that they are practising good data security and that personal information is handled correctly.
Accessing and using NHS documents to counter fraud: code of practice. Best practice guidance for government officials on getting access to NHS documents and using them to counter fraud in the health service. Part 10 of the NHS Act 2006 requires the production of documents to counter fraud in the health service upon request, under the Secretary of State’s counter fraud functions. The Secretary of State has delegated counter fraud responsibilities to a national body and its authorised officers. This code of practice sets out the best practice to be followed by authorised officers in securing, using and handling documents. It is also of relevance to anyone in the NHS who may be requested to produce documents.
Network and Information Systems Regulations 2018: Guide for the health sector in England. The Network and Information Systems Regulations 2018 (SI 2018/506), which came into force on 10 May 2018, place security and reporting requirements on 'operators of essential services', including in the healthcare sector. DHSC has incorporated the regulations into its approach to implementing the National Data Guardian’s 10 data security standards. These data security standards apply to all health and care organisations. This guide sets out what this means in practice for health and care organisations, including compliance with the regulations and how this will be overseen.
News
NHS launches public campaign to highlight new stronger protections around health and care information. NHS England has launched a six week public campaign to raise awareness of new stronger protections for patient information. It will initially focus on the General Data Protection Regulation and then from early June it will promote the choice the public have with the new national data opt-out.
Bevan Brittan Insights
Surrogacy, Adoption, and Information Governance - Julia Jones
If you wish to discuss any queries you may have around information sharing please contact Jane Bennett.
Inquests
Publications/Guidance
Guidance No.27 Jury Irregularities. Guidance No.27 from the Chief Coroner is intended to assist coroners on the recommended process and procedures for dealing with any kind of jury irregularity during an inquest.
Guidance No.28 Report of death to the Coroner: decision making and expediated decisions. Guidance from the Chief Coroner, issued following the judgment in R. (on the application of Adath Yisroel Burial Society) v Senior Coroner for Inner North London (Admin), is intended to be a practical guide to assist coroners in situations where a bereaved family has made a request to the coroner for urgent consideration of the death of a loved one and/or early release of the body, or the coroner become aware of features of a particular death which may justify treating it as especially urgent. It states the "proper respect should be given to representations based on religious belief".
Cases
R (Adath Yisroel Burial Society) v HM Senior Coroner for Inner North London [2018] EWHC 969 (Admin). The court held that a coroner's refusal to prioritise burials on the basis of the religion of the deceased or their families was unlawful. The policy discriminated against those with certain religious beliefs, unlawfully fettered the discretion of the coroner's decision-making when exercising her statutory powers and was irrational.
Events
Clinical Risk Webinars - These are internal hour long lunch time training sessions that are attended by our team of solicitors. You can sign up to watch the training sessions remotely via our webinar facility. Just ask Claire Bentley.
There is a lunchtime training session coming up on inquests:-
If you wish to discuss any issues raised in this section please contact Ceri Catton or Will Pickles.
Mental Health
Publications/Guidance
NHS operational productivity: unwarranted variations - Mental health services; Community health services. Lord Carter has published the findings of his review that looked at the productivity and efficiency of mental health and community health services in the context of the Five Year Forward View and its delivery plan. The review identifies unwarranted variation in the delivery of mental health and community health services, as well as the potential savings of nearly £1 billion that could be made in efficiencies by 2020/21.
Mental health, human rights and standards of care This report assesses the quality of institutional care for adults with psychosocial and intellectual disabilities in the WHO European region. Out of all the quality ratings made, only 25 per cent showed compliance with international standards, suggesting that long-term institutional care in the region has room for improvement.
Transforming care – The challenges and solutions. This publication from the Voluntary Organisations Disability Group (VODG) identifies the learning from the Provider Taskforce’s project, the London Demonstrator, that aimed to develop support assessment and proposals for people with learning disability, autism or both. It worked with a priority group of 27 people originally from London who had been in inpatient settings for longer than five years. This report sets out the work carried out, the learning and recommendations for next steps both in London and nationally.
Dementia-friendly rural communities guide. Rural communities have an important part to play in tackling the social and economic impact of dementia, by supporting people living with dementia to be part of their local community. This guide gives best practice advice on how to create a dementia-friendly community in rural areas and shares successful case studies from across the country.
Dementia – the true cost: fixing the care crisis An investigation by the Alzheimer's Society has discovered that each year tens of thousands of people with dementia are being admitted to hospital via accident and emergency because inadequate social care is leaving them unprotected from falls and infections. This report urges the government to improve access to integrated care and support, provide quality training for health and care staff and cover additional care charges for people with dementia.
Ordinary residence: anonymised determinations 2017. DHSC has published a number of ordinary residence determinations, made under s.40 of the Care Act 2014, to show how it arrives at decisions to resolve disputes in the health and social care sector. The determinations have been anonymised so that they do not name the individuals or councils involved.
Tackling 'burning injustices' that blight Britain A collection of essays by prominent backbenchers from all the UK’s main political parties, seeks to highlight some of Britain’s burning injustices, and provide solutions to help address them. The collection includes a short essay by Norman Lamb on improving mental health provision.
After a diagnosis of dementia: what to expect from health and care services. Guide for anyone diagnosed with dementia and the people who care for them, with details about what support they should get. It includes information about: what is in a care plan; how health care and social care services can help; support available to family and friends who are carers; and how to take part in research.
Consultations
Safety and security arrangements in high security psychiatric hospitals. Seeks views on proposed changes to the High Security Psychiatric Service (Arrangements for Safety and Security) Directions and associated guidance that set out minimum required standards of safety and security for Ashworth, Broadmoor and Rampton high security psychiatric hospitals. The consultation closes on 23 August 0218.
News
£15 million boost for local mental health crisis services. Announces that 51 projects will receive funding through the Beyond Places of Safety scheme, that funds clinics, crisis cafés and other community services designed to prevent people from reaching crisis point.
New NHS pledge offers sex crime victims a lifetime of mental health care. A new NHS five-year sexual assault strategy is to offer victims of sexual assaults access to trauma care, including counselling, throughout their lifetime. The number of rapes being reported to police has doubled in the past three years, with an 89% rise in all sexual offences recorded in England, the highest figure on record, with 138,045 sexual offences being reported to police in the 12 months ending September 2017.
Bevan Brittan Events
SAVE THE DATE – BEVAN BRITTAN'S ANNUAL MENTAL HEALTH SEMINARS AND ANNUAL COURT OF PROTECTION SEMINARS
Back by popular demand, we are very pleased to announce that we will be running our free annual Mental Health seminars in October and annual Court of Protection Seminars in November. We have some dates to save in your diaries and will offer more detail about the content of the sessions nearer the event.
Mental Health Seminar - SAVE THE DATE
Please register your interest in attending by clicking on the following links:
Court of Protections Seminars - SAVE THE DATE
Please register your interest in attending by clicking on the following links:
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.
Bevan Brittan Insights
Introduction to CTO Recall: Part 2 - Clemmie Robertshaw
Reducing the Number of Compulsory Admissions: Positive Changes for Practitioners and Patients? - Alice O'Donoghue
If you wish to discuss any mental health issues please contact Hannah Taylor, Simon Lindsay or Stuart Marchant.
Primary Care
Publications/Guidance
How CQC monitors, inspects and regulates urgent care services. This guidance has been updated. to include:
• Updates to the provider information request so that CQC can better understand the care and the service provided.
• Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means CQC will not always consider all five key questions on each inspection.
• More information on follow-up inspections.
Innovative models of general practice This report looks at innovative models of general practice from the UK and other countries. It identifies key design features that could be important in designing effective GP services in the future.
Investigation into NHS spending on generic medicines in primary care. This investigation looks at the 2017-18 increase in NHS spending on certain generic medicines, possible causes of the price increases in the market for generic medicines, and how the Department of Health and Social Care responded to the price increases.
Local Health and Care Record Exemplars. Provides a summary of the Local Health and Care Records Exemplars programme that will demonstrate how information can be shared safely and securely, and for what purposes, across venues of care within localities at scale. The primary focus of Local Health and Care Record Exemplars will be on improving and coordinating individual care. Building on this, local communities will be able to utilise this information to support local health and care planning and management as well as to better understand the health and care needs of their local population. There will be national capital funding of up to £7.5m for each of the localities for 2018/2019 and 2019/20204, which will be released through milestone payments based on progress.
Quick Reference Guide for Healthcare Professionals: Conditions for which over the counter items should not routinely be prescribed in primary care. This interactive, quick reference tool summarises the CCG guidance on conditions for which over the counter items should not routinely be prescribed in primary care.
NHS England’s management of the primary care support services contract with Capita. In August 2015, NHS England entered into a seven-year, £330 million contract with Capita Business Services Ltd to deliver primary care support services with the aim of saving 35 per cent of costs. According to this report, NHS England and Capita misunderstood the risks in outsourcing primary care support services resulting in services to 39,000 GPs, dentists, opticians and pharmacists that were below an acceptable standard.
Primary care home: community pharmacy integration and innovation. This report aims to inspire further integration of community pharmacy within primary care homes to improve patients’ health and support them to manage their conditions. It argues that by learning from those leading the way and exploring innovative ways of working together general practice and community pharmacy could have a bigger impact on improving the health and care needs of their local population.
2018/19 General Medical Services (GMS) contract: Guidance and audit requirements for GMS contract. NHS Employers has published the 2018/19 GMS guidance and audit requirements to support commissioners and practices in the GMS contract changes for 2018/19.
News
NHS England announces new £10 million fund to help retain GPs. The fund will support local health services, focusing on supporting newly qualified GPs or those within their first five years of practice, who are seriously considering leaving general practice or who are no longer clinically practising in the NHS in England but remain on the National Performers List (Medical). £7m will be made available through regional-based schemes to help GPs to stay in the workforce, by promoting new ways of working and by offering additional support through a new Local GP Retention Fund. A further £3m will also be made available to establish seven intensive support sites across the country in areas that have struggled most to retain GPs. Details on these sites and plans for retention efforts there will be announced next month.
New local health and care partnerships could save lives. NHS England has announced that three areas (Greater Manchester, Wessex and One London) have been chosen to become 'Local Health and Care Record Exemplars'. Each of these new partnerships is made up of either one or multiple Sustainability Transformation Partnerships (STPs) and each will receive up to £7.5m over two years to put in place an electronic shared local health and care record that makes the relevant information about people instantly available to everyone involved in their care and support.
70,000 more toddlers to get their first dental check-up as NHS England targets childhood dental health. NHS England is calling on dentists to see an additional 70,000 pre-school children as part of a drive in the health service’s 70th year, to help young families to get into the habit of good dental health. The Starting Well Core initiative will include additional support to the dental profession, including training materials and guidance for caring for your children, and a programme of communication to encourage the public to take up the offer of a Dental Check By One, for babies in the first year
Government could scrap some controversial NHS reforms. The government is understood to be considering whether to scrap some of the controversial NHS reforms introduced by the coalition in England in 2012. The changes included abolishing primary care trusts and replacing them with new local clinical commissioning groups. BBC analysis
Mental health "game-changer" care leads to 75 per cent reduction in hospital admissions. Improved mental health care for patients with physical ailments has reduced demand for GP appointments and cut hospital admissions by three quarters in a pilot scheme as part of a programme of new services that NHS England is rolling out across the country.
Chair appointed to lead independent review into GP partnership model. Announces that Dr Nigel Watson has been appointed chair of the independent review into the GP partnership model. Dr Watson is chief executive of Wessex Local Medical Committee and is a member of the BMA's General Practitioners Committee. The review will look at how the partnership model needs to evolve in the modern NHS.
If you wish to discuss any mental health issues please contact Vincent Buscemi.
Procurement
Publications/Guidance
NHS England’s management of the primary care support services contract with Capita. This NAO report critically examines NHS England's seven-year, £330m contract with Capita to deliver primary care support services. The report concludes that NHS England’s financial objectives for outsourcing primary care support services were ambitious. However, neither NHS England nor Capita fully understood the complexity and variation of the service being outsourced. As a result, both parties misjudged the scale and nature of the risk in outsourcing these services. The service to primary care practitioners, including Capita’s delivery of PCSE, has fallen a long way below an acceptable standard. This had an impact on the delivery of primary care services and had the potential to seriously harm patients, although no actual harm to patients has been identified. NHS England was unable to stop Capita’s aggressive office closure programme, without cancelling the contract, even though it was having a harmful impact on service delivery. While some services have now improved, it is deeply unsatisfactory that NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively. Although NHS England has saved significant sums of money, value for money is not just about cost reduction. NHS England will need to address the current service failures over the remaining life of the contract if it is to achieve both the savings and service improvements it intended.
Public Sector contract. The CCS has published the Core Terms and generic schedule templates that make up the Public Sector Contract standard template for framework contracts for common goods and services. It says that when setting up a new framework contract, CCS will use: the standard core terms (used in every procurement), and relevant schedules (some schedules must be used, while others are optional). These schedules are templates. They will be customised for every procurement by CCS and will be found in the bid pack for new procurements.
Less waste, more health: A health professional's guide to reducing waste. This report from the Royal college of Physicians explains how health professionals can positively influence societal health and wellbeing by making simple changes to the procurement and disposal of medical supplies. It states that the NHS has a duty to improve efficiency and reduce carbon dioxide emissions, ensuring that healthcare today doesn’t compromise health and healthcare availability in the future. To achieve this, all NHS staff must become resource advocates, procuring, using and disposing of all resources in the most efficient way. This report illustrates the financial and environmental co-benefits of addressing the issue of waste in the NHS. It includes a range of case studies and 12 recommendations.
Events
Procurement Updates
Birmingham - 25 June
London - 13 June
Leeds - 27 June
Bristol - 28 June
Bevan Brittan Insights
Commission publishes guidance on 'Innovation Procurement' - Trevor Watt
New Procurement Policy Note on GDPR (General Data Protection Regulation) 02/18 - Susie Smith.
If you wish to discuss any queries you may have around procurement please contact Vincent Buscemi.
Providers
Publications/guidance
How to check the identity of a CQC inspector. CQC have been made aware that a small number of providers have been contacted by people posing as CQC inspectors or claiming to be affiliated to CQC. If you are unsure about the identity of an inspector, or any contact via phone or email from someone claiming to represent CQC, please contact CQC enquiries team on 03000 616161.
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 2017. It has been updated with clarification of advice to the NHS on sharing non-medical information with the Home Office.
Community services: Taking centre stage. This report by NHS Providers says promises to bring more patient care closer to home by prioritising NHS community services have fallen flat. The report presents striking examples of good practice where community service providers have successfully developed new ways of working, collaborating with other services to improve care for patients. But it concludes that in practice, support on the ground has failed to match the rhetoric, leaving many providers marginalised, underfunded and short staffed.
Working with dogs in health care settings. The RCN has developed a universal protocol to support organisations considering working with dogs in health care settings and allied health environments. The protocol sets out clear guidelines that all health care settings can follow when introducing animals into the care environment. It follows an RCN survey last year which found that although the majority of respondents thought animals were hugely beneficial to patients, most nurses said animals were not allowed in their workplace.
Mapping the NHS winter. This report from NHS Providers highlights the scale of pressures faced by NHS trusts and front line staff through the toughest winter on record. The report reveals that the number of people coming in to A & E over winter period, between December 2017 and March 2018, rose to more than 5.8m. It shows how, despite extensive preparations and extraordinary commitment from front line staff resulting in record numbers of patients being treated, services were unable keep up with demand. Finally, the report sets out what must be done to ensure the health service is ready next time.
The state of the provider sector: NHS community services: taking centre stage This report presents striking examples of good practice where community service providers have successfully developed new ways of working, collaborating with other services to improve patient care. However, it concludes that in practice, support on the ground has failed to match the rhetoric, leaving many providers marginalised, underfunded and short staffed.
If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.
Public Health
Publications/Guidance
New data reveals 420,000 cases of STIs diagnosed in 2017 Public Health England figures show there were 420,000 cases of sexually transmitted infections diagnosed in 2017, with cases of syphilis continuing to rise.
Childhood obesity: Time for action. The Commons Health and Social Care Committee has identified several key areas which demand attention as a matter of urgency by the Government before it finalises the refreshed version of the 2016 childhood obesity plan. The Committee is calling for an effective childhood obesity plan with a joined-up, whole systems approach and one which focuses particularly on tackling the ever-widening health inequality due to childhood obesity between the richest and poorest areas.
Good progress but more to do: teenage pregnancy and young parents. The case studies in this LGA briefing highlight the continuing good work of local authorities in both helping young people prevent unintended pregnancy and supporting young parents. The focus on teenage pregnancy seen in England during the last 15 years or so has been one of the success stories in the public health field. The conception rate for young women aged 15 to 17 has fallen by 60 per cent since 1998 with a similar reduction in conceptions to under-16s. Both are at lowest level since record-keeping began in the late 1960s. However, the teenage birth rate still remains higher than a number of other western European countries and the progress made has been uneven across England.
Heatwave Plan for England. Updated version of the Heatwave Plan for England that aims to prepare for, alert people to, and prevent, the major avoidable effects on health during periods of severe heat in England. It recommends a series of steps to reduce the risks to health from prolonged exposure to severe heat.
Health matters: preventing Type 2 diabetes. This professional resource outlines how to optimise the NHS Diabetes Prevention Programme (NHS DPP) in order to identify those already found to be at risk of developing Type 2 diabetes and offer support that will help them reduce their risk of developing the disease.
Sugar reduction: report on first year progress. This detailed report assesses industry progress in the first year of the sugar reduction programme, measuring how far the food industry has gone towards reducing the sugar children consume through everyday foods. As part of the Government’s plan to reduce childhood obesity, the food industry was been challenged to cut 20% of sugar from a range of products by 2020, with a 5% reduction in the first year. Progress towards meeting the 5% ambition is the focus of this report and is assessed against a 2015 baseline. The assessment shows an encouraging initial start from retailers and manufacturers, achieving a 2% reduction in both average sugar content and calories in products likely to be consumed in one go.
Problem parental drug and alcohol use – A toolkit for local authorities. PHE has developed this toolkit for commissioners of alcohol and drug services. It will also be useful to commissioners of children and family services. It helps commissioners to understand the extent of problem parental alcohol and drug use in their area and how this can impact on children aged between 0 and 18 in the same household. PHE is also inviting local authorities to bid for a share of £4.5m joint funding, aimed at improving the support services for children of dependent drinkers and alcohol dependent parents. The closing date for applications is 17 July 2018.
Sexual and reproductive health: RCN report on the impact of funding and service changes in England. This report brings together the results of a RCN survey with nurses working in sexual and reproductive health. It provides clarification and evidence following increasing concerns reported from those working in England on the impact of service provision following the changes to commissioning after the Health and Social Care Act 2012. The survey of over 600 nurses working in the field found services severely understaffed, with few registered nurses, an inadequate mix of skills and little access to training.
Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups. This NICE quality standard draws attention to some of the specific areas of inequality for people from black, Asian and other minority ethnic groups, such as increased health risks, poor access to and experience of services, and worse health outcomes. It aims to support public authorities in considering their equality duty when designing, planning and delivering services. Any actions taken to achieve the statements should be tailored to the ethnic profile of the local population, and particular consideration should be given to disadvantaged or excluded groups and ethnic groups with poor outcomes.
Going the distance. This joint report by the Royal Society for Public Health and Ukactive focuses on the exercise professional workforce and how it can play an enhanced role in supporting the public’s health. It calls for GP drop-in and smoking cessation services inside gyms and leisure centres, to help ease pressure on local health facilities and improve access to health improvement services.
Talking about the 'return on investment of public health'– Why it’s important to get it right. This article by David Buck looks at the increasingly common misunderstanding and misuse of the term 'return on investment' and its conflation with 'cost saving' to public services.
News
Focus on brisk walking, not just 10,000 steps, say health experts. Public Health England (PHE) and the Royal College of General Practitioners (RCGP) are encouraging adults to incorporate brisk walking into their days as a way to improve their general health and wellbeing. To help adults to introduce more moderate intensity physical activity into their day, PHE has created an 'Active 10' app that combines intensity and time, rather than just distance.
New funding for suicide prevention in England. PHE has announced that £25m funding has been awarded to allocated to eight sustainability and transformation partnerships that are worst affected by suicide, to develop suicide prevention and reduction schemes. The funds are set to improve suicide prevention strategies, signposting and raising awareness through to improving quality for safer services and will help drive better surveillance and collection of data on suicide, attempted suicide and self-harm.
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/Guidance
Williams review into gross negligence manslaughter in healthcare. The review makes recommendations to support a more just and learning culture in the healthcare system. It covers:
• the process for investigating gross negligence manslaughter
• reflective practice of healthcare professionals
• the regulation of healthcare professionals
This rapid policy review into gross negligence manslaughter in healthcare was chaired by Professor Sir Norman Williams. The review was set up to look at the wider patient safety impact of concerns among healthcare professionals that simple errors could result in prosecution for gross negligence manslaughter, even if they happen in the context of broader organisation and system failings.
How CQC monitors, inspects and regulates urgent care services. This guidance has been updated. to include:
• Updates to the provider information request so that CQC can better understand the care and the service provided.
• Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means CQC will not always consider all five key questions on each inspection.
• More information on follow-up inspections.
How to check the identity of a CQC inspector. CQC have been made aware that a small number of providers have been contacted by people posing as CQC inspectors or claiming to be affiliated to CQC. If you are unsure about the identity of an inspector, or any contact via phone or email from someone claiming to represent CQC, please contact CQC enquiries team on 03000 616161.
Social Work England secondary legislation: assessment of impacts. This impact assessment, produced in partnership with the Department for Education, responds to a public consultation on the regulatory framework for Social Work England, the new regulatory body for social workers in England.
Brexit: medicines, medical devices and substances of human origin – government response to the Health and Social Care Committee's 4th report of session 2017 to 2019. Sets out the Government’s response to the Health and Social Care Committee’s March 2018 report that examined the regulatory arrangements needed to guarantee safe and effective supply of medicines, medical devices and products after the UK exits the EU. It welcomes the Committee's report and states that the Government is committed to a smooth and orderly withdrawal from the EU and recognises the importance of a close and cooperative relationship between the UK and EU in the field of medicines regulation and science and research collaboration.
News
Fitness to practise improvements made. The General Medical Council has made a catalogue of improvements to its fitness to practise processes. Changes include increasing support available to doctors, and obtaining key information shortly after receiving a complaint to help decide whether an investigation is needed.
Bevan Brittan Insights
HSE and CQC Prosecutions for Health and Safety: Guidance for Public Authorities - Hannah Taylor
Finality and equal treatment in regulatory procedures – even where a mistake has been made - Trevor Watt
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
Social Care
Publications/Guidance
Review of Adult Social Care Relative Needs Formulae. The research proposes a new formula to be used within the local government finance settlement. It will be considered as part of the government’s review of local authorities’ relative needs and resources, which is led by the Ministry of Housing, Communities and Local Government.
Carers action plan 2018 to 2020 – Supporting carers today. Sets out the cross-government programme of work to support carers over the next two years, ahead of the forthcoming Social Care Green Paper which will set out long-term sustainable solutions for the social care system. It is structured around five themes: Services and systems that work for carers; Employment and financial wellbeing; Supporting young carers; Recognising and supporting carers in the wider community and society; and Building research and evidence to improve outcomes for carers. The measures include:
• a new scheme to improve employment support for carers, promoting best practice for flexible working, to enable carers to continue to work alongside their caring role;
• a new £500,000 Carer Innovations Fund to promote creative and innovative ways to support carers; and
• funding for a review of best practice in identification of young carers and access to support.
A fork in the road: next steps for social care funding reform. This King's Fund paper considers the costs of social care funding options, public attitudes to them and the implications for policy reform. It pulls together new financial modelling, public perceptions work and policy analysis to identify the problems with adult social care in England and outline options for its reform. It identifies and makes explicit the advantages and disadvantages, impact and consequences of adopting one option over another. It concludes that reforming the current system will be expensive, but that if reform is chosen, England is now at a clear 'fork in the road' between a better means-tested system and one that is more like the NHS, free at the point of use for those who need it.
Adult social care – a national or a local service? This is the second think piece in the LGA's series 'Towards a sustainable adult social care and support system'. It contains articles by five experts who each have a distinct and different vantage point from which to observe adult social care but are united around the core idea that responding to the needs of local people requires a response that is local, too.
What can England learn from the long-term care system in Japan? Following years of local authority budget cuts, the English social care system is struggling to provide sufficient care for those who need it. While pressures in social care are not a new problem, there is widespread recognition that it is an increasingly pressing priority. A forthcoming Green Paper is expected to lay the foundations for developing a new system of funding and provision. It is in this context that the Nuffield Trust went to Japan, to consider what lessons may be drawn from the introduction of its comprehensive long-term care system which has demonstrated that it is possible to achieve fundamental social care reform despite formidable demographic, economic and social pressures.
Consultations
Adult Placement services regulations. Seeks views on draft Adult Placements Services (Service Providers and Responsible Individuals) (Wales) Regulations 2019 that will place requirements on independent and local authority adult placement scheme providers, principally under ss.27 and 28 of the Regulation and Inspection of Social Care (Wales) Act 2016, from April 2019. There is also draft statutory guidance for service providers and responsible individuals of adult placement services in meeting service standards, under s.29 of the 2016 Act. This forms part of phase 3 of implementing the Regulation and Inspection of Social Care (Wales) Act 2016. The consultation closes on 16 August 2018.
Advocacy services regulations. The Welsh Government is seeking views on draft Regulated Advocacy Services (Service Providers and Responsible Individuals) (Wales) Regulations 2019 and their accompanying statutory guidance. The regulations will place requirements on service providers and responsible individuals of advocacy services arranged by local authorities under their duty to assist children, looked after children and certain types of care leavers in making representation about their needs for care and support. This forms part of phase 3 of implementing the Regulation and Inspection of Social Care (Wales) Act 2016. The consultation closes on 16 August 2018.
Bevan Brittan Insights
King's Fund Report on Next Steps for Social Care Funding. - Monica Macheng
If you wish to discuss any queries you may have around social care please contact Stuart Marchant
General
Publications/Guidance
Missed opportunities: advance care planning report This report warns that reluctance to talk honestly about death is preventing people with cancer from dying ‘well’. It calls for Governments across the UK to honour their commitments to ensuring Advance Care Planning is used as an important part of a person-centred health service, so that people approaching the end of their lives receive the best care possible and their wishes for death and dying are fulfilled.
End of life care in England: a briefing paper. This briefing paper provides a brief summary of issues around end-of-life care, including an overview of evidence regarding the impact of location on quality and cost of care. It also analyses the data on location and cost of care in England and how it compares at a national and international level. It also provides an analysis of the policy agenda in the UK and suggests key areas where improvements should be made.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
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