31/03/2022
Bevan Brittan provides high quality, comprehensive advice to the NHS, independent healthcare sector and local authorities. 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, independent sector and local authorities which have been published in the last month.
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Bevan Brittan Free Training Events
Clinical Risk Webinars
Bevan Brittan Clinical Risk/Health, Care and Regulatory Law Team Training - These are internal hour long lunch time training sessions. You can sign up to watch the training sessions remotely via our webinar facility. Please contact Claire Bentley.
Bevan Brittan London Claims and Health Care Forum: The Covid Edition. 21 April 4pm - 5.30pm. We invite you to join us at this Covid panel forum. An interactive in person discussion looking at some of the key Covid litigation, health, care delivery and regulatory issues London trusts are facing.
Diabetes and lower limb complications - a thematic review of clinical negligence claims. 26 April 12.30pm - 1.30pm. Nicole Mottolini, podiatrist and clinical fellow, Safety & Learning at NHS Resolution will give an overview of the clinical themes identified from the thematic analysis of clinical negligence claims.
Controlling and coercive behaviour. 3rd May 12.30pm Ella Garside (Senior Independent Domestic and Sexual Violence Advisor from Next Link Domestic Abuse Services) and Bethany Scarsbrook (St John’s Chambers) will look at understanding the impact of controlling and coercive behaviour and the practical and legal issues that arise from it.
Please note that registration for each webinar will close when the webinar starts, so please do ensure you have booked your place in advance to guarantee attendance.
Acute and emergency care
Publications/guidance
Learning from Emergency Medicine compensation claims. NHS Resolution has published a set of three reports which explore clinical issues that contribute to compensation claims within Emergency Departments. In total, 220 cases were examined, where the incidents occurred between 2014 and 2018 and a legal liability had been established. The first report looks at high-value and fatality-related claims over £1m; the second report assesses missed fractures; and the third report evaluates hospital-acquired pressure ulcers and falls in ED. Each report also contains clear recommendations to help prevent further incidents. One of the main findings across all the reports is that ED clinical services should provide timely identification of diagnoses and treatment plans for patients. This should include what to look out for and actions that should be taken if the patient deteriorates. Good record-keeping and communication to support handover and ‘safety netting’ for patients – where they are followed up in a timely and appropriate manner – underpins the delivery of timely diagnoses and the delivery of effective treatment plans.
News
Supporting the campaign to #WorkWithoutFear. Dr Layla McCay welcomes the new campaign launched by the Association of Ambulance Chief Executives.
If you wish to discuss any queries you may have around acute and emergency issues please contact Claire Bentley.
Children and young people
Publications/Guidance
SEND review: right support, right place, right time. A Department for Education Green Paper consults on a stronger system for children with special educational needs and disabilities (SEND), setting out the Government's vision for a single, national SEND and alternative provision system that will introduce new standards in the quality of support given to children and young people across education, health and care. The new national plan will focus on ending the postcode lottery that leaves too many with worst outcomes than their peers. Proposals include a simplified Education, Health and Care Plan, a legal requirement for councils to introduce "local inclusion plans", and new national framework for councils for banding and tariffs of high needs. Comments by 23.45 on 1 July 2022.
The Cass Review: Independent review of gender identity services for children and young people: Interim report. Dr Hilary Cass' interim report reviewing gender identity services for children and young people has been submitted to NHS England. The review criticises the clinic run by Tavistock and Portman NHS Foundation Trust, which has been sending children for experimental hormone treatment, finding that its gender identity services are "not a safe or viable long-term option". Dr Cass concludes a "fundamentally different service model is needed", with treatment redistributed to regional hubs across England.
The government’s response to the Health and Social Care Committee report: children and young people’s mental health This is the government’s response to the 25 recommendations made by the Health and Social Care Committee (HSCC) in its report published in December 2021.
Children's social care market study - final report. The Competition and Markets Authority's (CMA) final report into its market study into children's social care provision finds that there is a shortage of appropriate places in children's homes and with foster carers, meaning that some children are not getting the right care from their placement and that some children are also being placed too far away from where they previously lived or in placements that require them to be separated from their siblings.
Disabled children and young people up to 25 with severe complex needs: integrated service delivery and organisation across health, social care and education This guideline covers support for disabled children and young people with severe complex needs, from birth to 25 years. It aims to encourage education, health and social care services to work together and provide more co-ordinated support to children and young people, and their families and carers. It includes recommendations on principles for working, identifying needs and involving other services, personal budgets and direct payments, and more.
"Children in Crisis: the role of public services in supporting Vulnerable Children" - Government Response. The Government's response to the Public Services Committee report on the role of public services in overcoming child vulnerability, which called on the Government to pledge to return to higher 2010 levels of investment in early help services to support children and families, and urgently set out a national cross-Government funded strategy with a plan for a nationwide roll-out of Family Hubs at its heart. The response notes that Departments have undertaken, or are undertaking, reviews into the services that support vulnerable children and families, and that the Government particularly welcomes the emphasis on early intervention and improving collaboration between services to deliver better outcomes.
Children and young people’s mental health: government response The government’s response to the Health and Social Care Committee report: Children and young people’s mental health. In response to the publication of a Health and Social Care Committee report evaluating government progress on delivering commitments on a range of mental health services in England, the Department of Health and Social Care states that the Government and the NHS remain committed to continuing to increase access, reduce waiting times, and improve outcomes and experience in mental health support for children and young people. It states that it is aware that the COVID-19 pandemic posed significant challenges to children and young people's sense of wellbeing with data showing the prevalence of mental health issues in children and young people has increased. It notes that the Department has also introduced the first waiting time standard for children and young people eating disorder services so that 95% of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for routine cases.
Engaging young people in health services research and design: key constructs and ethical challenges This scoping review differentiates and maps the range of ways in which the sector is involving young people in health service research and development, identifies key concepts and definitions in the literature, and highlights governance issues and contradictions arising from the range of approaches.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah or Ruth Shedlow
Clinical Risk / Patient Safety
Publications/Guidance
Independent review of maternity care at Shrewsbury and Telford Hospitals NHS Trust. This report identifies more than 60 Local Actions for Learning for the Trust and another 15 key Immediate and Essential Actions to improve all maternity services in England, including financing a safe and sustainable maternity and neonatal workforce and ensuring training for the whole maternity team meets the needs of today’s maternity services. The report states that trust Boards must have oversight and understanding of their maternity services. Trust boards must ensure that they listen to and hear local families and their own staff.
Learning from Emergency Medicine compensation claims. NHS Resolution has published a set of three reports which explore clinical issues that contribute to compensation claims within Emergency Departments. In total, 220 cases were examined, where the incidents occurred between 2014 and 2018 and a legal liability had been established. The first report looks at high-value and fatality-related claims over £1m; the second report assesses missed fractures; and the third report evaluates hospital-acquired pressure ulcers and falls in ED. Each report also contains clear recommendations to help prevent further incidents. One of the main findings across all the reports is that ED clinical services should provide timely identification of diagnoses and treatment plans for patients. This should include what to look out for and actions that should be taken if the patient deteriorates. Good record-keeping and communication to support handover and ‘safety netting’ for patients – where they are followed up in a timely and appropriate manner – underpins the delivery of timely diagnoses and the delivery of effective treatment plans.
Litigation related to anaesthesia: analysis of claims against the NHS in England 2008-2018 and comparison against previous claim patterns An Association of Anaesthetists report reviews 1,230 claims relating to anaesthesia in England and recommends the establishment of a structure for national review and learning from all cases of litigation. It finds that the absolute costs related to anaesthesia claims rose over 300%, totalling £115 million in the period 2008-2018 but the mean cost per closed claim fell by 16% to £74,883, when retail price index adjustments were applied. The report aims to provide important insights into current and changing patterns in claim distributions that may aid improvements in quality of patient care and reduce future litigation.
Openness and honesty when things go wrong: the professional duty of candour. Nursing and Midwifery Council guidance, produced in collaboration with the General Medical Council, sets out professionals' responsibility to be open and honest about what happened when things go wrong in health and care. It has been updated with information on reporting systems, terminology, and the support available to health and care professionals.
UK COVID-19 Inquiry: draft terms of reference. The inquiry will examine, consider and report on preparations and the response to the pandemic in England, Wales, Scotland and Northern Ireland, up to and including the inquiry’s formal setting-up date. In doing so, it will consider reserved and devolved matters across the United Kingdom, as necessary, but will seek to minimise duplication of investigation, evidence gathering and reporting with any other public inquiry established by the devolved administrations.
NHS backlogs and waiting times in England This report finds that the NHS has not met the 18-week maximum waiting time standard for elective care since February 2016 nor the eight key standards for cancer care in totality since 2014. It concludes that any transparent and realistic assessment of what elective and cancer care services can achieve by 2024–25 needs to include an assessment of the number of staff that will be available, how staff who have been working under intense and consistent pressure will be supported, and how patients will be kept informed about their own progress through waiting lists.
Consultation
Acquired brain injury: call for evidence. A Department of Health and Social Care consultation seeks views on ideas to help develop and build the Government's acquired brain injury strategy to identify ways to improve services and support. Rather than a formal consultation on specific proposals, it constitutes a request for ideas on which the Government can build. Comments by 23.45 on 6 June 2022.
News
New taskforce to level-up maternity care and tackle disparities The taskforce will explore inequalities in maternity care and identify how the government can improve outcomes for women from ethnic minority communities.
Government to crack down on unregulated cosmetic procedures The Government has announced that an amendment to the Health and Care Bill 2021-22 will give the Secretary of State for Health and Social Care the power to introduce a licensing regime for non-surgical cosmetic procedures such as Botox and fillers. It will ensure consistent standards and protect individuals from those without licences, including from the potentially harmful physical and mental impacts of poorly performed cosmetic procedures. The move follows on from new legislation making it illegal to administer such treatments to under 18s, and banning adverts on all forms of media targeting under 18s.
Government failure to learn pandemic lessons will come at high cost to generations. The Public Accounts Committee says the “UK government was underprepared for a pandemic like COVID-19” which has “exposed limitations in how the government manages risks” and also a “failure to learn”, from both simulation exercises and actual incidents.
NHS announces £127m maternity boost for patients and families The NHS in England has announced a £127 million funding boost for maternity services across the England that will help ensure safer and more personalised care for women and their babies. The major investment will boost the workforce and help improve the culture in maternity units. More than £50 million will be provided to Trusts across the country over the next two years to boost staffing numbers in maternity and neonatal services.
Calls for migrant maternity care fees to be axed. The Royal College of Obstetricians and Gynaecologists has called for immediate suspension of charging for NHS maternity care for migrant women because members say the policy is harming the health of pregnant women and their babies. It is the first time the health professionals' body has issued a position statement on this issue. It also calls for a review by NHS trusts to improve practice when dealing with this group of women, and introduction of minimum standards for interpreting services.
Bevan Brittan Updates
UK Covid Inquiry: Terms of Reference & suggested areas of focus. Joanna Lloyd
Botox – Is there ever too much? Monica Gosling
Bevan Brittan Events
Bevan Brittan London Claims and Health Care Forum: The Covid Edition. 21 April 4pm - 5.30pm. We invite you to join us at this Covid panel forum. An interactive in person discussion looking at some of the key Covid litigation, health, care delivery and regulatory issues London trusts are facing.
Diabetes and lower limb complications - a thematic review of clinical negligence claims. 26 April 12.30pm - 1.30pm. Nicole Mottolini, podiatrist and clinical fellow, Safety & Learning at NHS Resolution will give an overview of the clinical themes identified from the thematic analysis of clinical negligence claims.
How we can help
We are working with clients on formulating policies and making it easier to balance treatment with finite resources. We are helping with social care policies and day to day activities such as contact and isolation, human rights issues and life/death decisions. We are working on notifications of harm and death, RIDDOR, CQC compliance, judicial review, infection control law and grappling with the new regulations and guidance. For more information click here. If you wish to discuss any clinical risk or patient safety issues please contact Joanne Easterbrook or Tim Hodgetts.
Digital Health
Publications/guidance
At your service: a proposal to reform general practice and enable digital healthcare at scale This report sets out a proposal for reform to general practice, addressing issues around integration, workforce, digital transformation and scaled provision. It argues that a new model of general practice is required to better meet the needs of patients and the taxpayer.
Virtual wards This report discusses virtual wards, an innovation due to be implemented at scale in the NHS as a method of addressing patient waiting lists. With the help of remote treatment options and supported by technology, patients are monitored and cared for in their own homes. The report lists the advantages and disadvantages of this approach.
Virtual wards and Covid-19: an explainer 'Virtual wards' have existed for a number of years, but Covid-19 has led to further research and pilot schemes exploring their use. This explainer explores how they have been used during the pandemic and what the future holds for them.
Digital boards two years on: digital transformation in practice The NHS Providers’ Digital Boards development programme is delivered in partnership with Public Digital and is designed to support boards in leading the digital transformation agenda. The programme is commissioned by Health Education England as part of its Digital Readiness Education Programme and is supported by NHS England and NHS Improvement. Digital Boards aims to build board understanding of the potential and implications of the digital agenda and increase the confidence and capability of boards to harness the opportunity that digital provides through board resources, webinars, peer learning and free board development sessions for individual trusts. This briefing looks at what has been achieved through the programme and what is still to come.
MedTech Funding Mandate policy 2022/23: guidance for NHS commissioners and providers of NHS-funded care This guidance aims to direct the NHS on which medtech innovations are effective and likely to give savings on investment; and to ensure the NHS has a sustainable approach to overcoming the financial barriers to adopting medical devices, diagnostics and digital products.
News
Government wants 80% of social care providers to use digital records by 2024
If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.
Employment/HR
Publications/guidance
Improving retention guide This guide supports line managers and employers to consider the key areas which affect workforce retention.
DHSC: workforce management information Documents relating to workforce management information summary data for the Department of Health and Social Care.
Equality, diversity and inclusion: targets, progress and priorities for 2022 The GMC has published its first update on progress towards the equality, diversity and inclusion targets it set last year. The report shows: the gap between employer referral rates for ethnic minority doctors and international medical graduates, compared with white doctors, has reduced slightly; fairness measures for medical education and training remain at similar levels; as an employer, the GMC has improved ethnic minority workforce representation at all levels and progression rates for ethnic minority staff.
Race 2.0: time for real change This report highlights the scale and scope of the challenge to improve racial equality across the NHS, alongside the commitment of boards, trust leaders and NHS Providers to drive real change in this area. The report sets out trust leaders' views on what constitutes good practice. Ten key priorities were identified, including: building closer engagement with staff and community networks; fostering safe spaces; better education; focusing on personal values and behaviours; and openly challenging discrimination. But despite this good practice, the new report also found just 4 per cent of trust leaders said race equality was fully embedded as part of their board’s business.
Government over halfway to delivering 50,000 more nurses by 2024 The government is on track to meet its manifesto commitment to deliver 50,000 more nurses in the NHS by 2024, with over 27,000 more nurses now working across the NHS. A progress report shows that overall total nurse numbers now stand at 327,907, as of December 2021, compared to 300,904 in September 2019. By March 2024, there are set to be around 351,000 full-time equivalent nurses to provide world-class care across the health service. The new report also sets out the government’s plans for reaching the target.
Productivity of the English National Health Service: 2019/20 update This report updates the Centre for Health Economics’ time-series of National Health Service (NHS) productivity growth for the period 2018/19 to 2019/20. NHS productivity growth is measured by comparing the growth in outputs produced by the NHS with the growth in inputs used to produce them. NHS outputs include all the activities undertaken for NHS patients wherever they are treated in England. It also accounts for changes in the quality of care provided to those patients. NHS inputs include the number of doctors, nurses and support staff providing care, the equipment and clinical supplies used, and the facilities of hospitals and other premises where care is provided.
The National Health Service Pension Schemes (Member Contributions etc.) (Amendment) Regulations 2022. This report sets out the reasons for changing the amount that members contribute to the NHS pension scheme. It takes into account the desirability of not making any changes at this point in time. The report is a statutory report and has been laid before parliament.
McCloud remedy part 1: proposed changes to NHS Pension Schemes Regulations 2022 - consultation outcome. Following consultation on proposed draft legislation making changes to NHS Pension Schemes Regulations necessary to implement the first part of the McCloud remedy, the Department of Health and Social Care intends to take forward the proposed changes to scheme regulations. The draft amending regulations will be finalised, subject to increasing the timeframe for members making an election in relation to AVC benefits. Once the Public Service Pensions and Judicial Offices Bill has received Royal Assent, the amending regulations will be laid before Parliament and come into force on 1 April 2022.
NHS Pension Scheme: proposed amendments to continue the suspension of restrictions on return to work introduced by the Coronavirus Act 2020 (Section 45) - response to consultation Following a consultation proposing to amend NHS Pension Scheme regulations and continue the easements provided by the Coronavirus Act 2020 s.45 until 31 October 2022, the Department of Health and Social Care's response sets out the continuation of retire and return easements in the NHS Pension Scheme which will take effect immediately following the expiry of s.45 of the 2020 Act. It also confirms that these temporary easements will run to 31 October 2022.
Changes to member contributions in the NHS Pension Scheme A Department of Health and Social Care statutory report sets out why the Department proposes to make regulations to amend the amount that members contribute to the NHS Pension Scheme, to update the member contribution structure that will take effect on 1 October 2022. The proposed Regulations provide for members' contribution rates to be based on actual annual rates of pensionable pay, updated member contribution rates and pay thresholds and a structure that allows the member contribution thresholds to be updated annually.
NHS Pension Scheme: continued suspension of abatement and the 16-hour rule until 31 October 2022 Information about changes to the temporary suspension of some NHS Pension Scheme regulations to support retired staff to return to the NHS.
The Department of Health and Social Care's written evidence to the Senior Salaries Pay Review Body (SSRB) for the 2022-23 pay round The Senior Salaries Review Body (SSRB) has been asked to make observations on the current levels of pay for very senior managers (VSMs) in the NHS and executive and senior managers (ESMs) in DHSC’s arm’s length bodies. The written evidence seeks to enable the SSRB to make independent observations on the levels of pay of VSMs and ESMs in order to form part of the wider SSRB report, which will include observations on the levels of pay for other senior public sector workers. The written evidence includes information on NHS senior pay strategy along with recruitment and retention information.
Pay and Conditions Circular (MD) 1/2022. This circular informs employers of the pay arrangements applicable from 1 April 2022 for doctors and dentists in training, and specialty doctors and specialists on the 2021 terms and conditions of service.
Update on temporary pre-employment check guidance An update on the temporary pre-employment check guidance issued at the start of the COVID-19 pandemic.
New code of practice on preventing illegal working The Home Office has published a new code of practice on preventing illegal working. The code will outline how the Home Office will determine the amount of the civil penalty for employing an illegal worker. Employers will need to be aware of the code of practice, which will take effect on 6 April 2022, and impact on recruitment and right to work checks.
NHS disabled staff experiences during Covid-19 This report outlines the working experiences of NHS disabled staff during the first wave of the pandemic, access the key findings and recommendations.
News
Visa costs driving doctors from the NHS Overseas doctors on a path to settlement should be granted free indefinite leave to remain in recognition of their vital services to the NHS, the BMA has argued.
Drive to recruit NHS reservists NHS reservists will be recruited to support the health service as staff tackle COVID-19 backlogs.
Foreign nurses working in UK forced to pay if they quit. The Royal College of Nursing and human rights lawyers are calling for an urgent government review after an Observer investigation uncovered evidence of the use of clauses in the contracts of international nurses working for NHS trusts and private care homes which require them to pay thousands of pounds if they try to quit their job or return home early. Nurses affected by the repayment terms said they had been pushed into debt or locked into long-term payment agreements after leaving roles, even in cases of bullying or family emergencies. The Department of Health said it was aware of repayment clauses being used to recoup upfront costs where candidates do not meet the terms of their contract, but it would be "concerned if repayment costs were disproportionate or punitive".
The regions lagging in drive to recruit 50k nurses revealed.
Javid backs report calling for GPs to be ‘directly employed’ by the NHS
How we can help
We can offer support and advice on managing many workforce issues including flexing your workforce to respond to the pandemic, managing bank staff, redeployment, vulnerable groups, sick pay, leave options, supporting staff well-being, presenteeism, remote and home working, through FAQs, helpline or policy guidance and practical day to day advice.
If you wish to discuss any employment issues generally please contact Jodie Sinclair, Alastair Currie or James Gutteridge.
Finance
Publications/Guidance
Ukrainians fleeing war granted free access to NHS healthcare Ukrainians arriving in England will be able to access NHS healthcare free of charge, including GP and nurse consultations, hospital services, and urgent care centres. The changes, made in Regulations on 17 March 2022, cover any NHS treatment that started on or after 24 February 2022, the date the full-scale Russian invasion began, providing support to as many people as possible.
The economic case for investing in the prevention of mental health conditions in the UK This report estimates that mental health problems cost the UK economy at least £117.9 billion annually in 2019 – approximately 5 per cent of the UK’s GDP. Almost three quarters of the cost (72 per cent) is due to the lost productivity of people living with mental health conditions and costs incurred by unpaid informal carers who take on a great deal of responsibility in providing mental health support in our communities. The report, produced together with the London School of Economics and Political Science, makes the case for a prevention-based approach to mental health that would both improve mental wellbeing while reducing the economic costs of poor mental health.
Productivity of the English National Health Service: 2019/20 update This report updates the Centre for Health Economics’ time-series of National Health Service (NHS) productivity growth for the period 2018/19 to 2019/20. NHS productivity growth is measured by comparing the growth in outputs produced by the NHS with the growth in inputs used to produce them. NHS outputs include all the activities undertaken for NHS patients wherever they are treated in England. It also accounts for changes in the quality of care provided to those patients. NHS inputs include the number of doctors, nurses and support staff providing care, the equipment and clinical supplies used, and the facilities of hospitals and other premises where care is provided.
Calls for migrant maternity care fees to be axed. The Royal College of Obstetricians and Gynaecologists has called for immediate suspension of charging for NHS maternity care for migrant women because members say the policy is harming the health of pregnant women and their babies. It is the first time the health professionals' body has issued a position statement on this issue. It also calls for a review by NHS trusts to improve practice when dealing with this group of women, and introduction of minimum standards for interpreting services.
MedTech Funding Mandate policy 2022/23: guidance for NHS commissioners and providers of NHS-funded care This guidance aims to direct the NHS on which medtech innovations are effective and likely to give savings on investment; and to ensure the NHS has a sustainable approach to overcoming the financial barriers to adopting medical devices, diagnostics and digital products.
Economic and fiscal outlook: March 2022 This report sets out forecasts for the economy over a five-year horizon and outlines the impact of the economic outlook on the NHS and associated public services, particularly in relation to pressures on the health service.
If you wish to discuss any queries you may have around finance please contact Claire Bentley.
Health Inequalities
Publications/Guidance
New taskforce to level-up maternity care and tackle disparities The taskforce will explore inequalities in maternity care and identify how the government can improve outcomes for women from ethnic minority communities.
Shifting the Dial: evaluating a community programme to promote young Black men’s mental health Young Black men are overrepresented in restrictive mental health settings, but are less likely to get early community-based mental health support. This report shares learning from a three-year project to promote the mental health and wellbeing of young Black men in Birmingham. The project built upon the findings from CMH’s evaluation of an earlier pilot, Up My Street. Shifting the Dial has worked with more than 500 young Black men, offering peer support, mentoring, theatre productions, skills development and community events.
GMC publishes update on tackling inequality The General Medical Council (GMC) has published its first update on progress towards the equality, diversity and inclusion targets it set last year. The regulator set targets to eliminate disproportionate complaints from employers about ethnic minority doctors, by 2026, and to eradicate disadvantage and discrimination in medical education and training by 2031.
Race 2.0: time for real change This report highlights the scale and scope of the challenge to improve racial equality across the NHS, alongside the commitment of boards, trust leaders and NHS Providers to drive real change in this area. The report sets out trust leaders' views on what constitutes good practice. Ten key priorities were identified, including: building closer engagement with staff and community networks; fostering safe spaces; better education; focusing on personal values and behaviours; and openly challenging discrimination. But despite this good practice, the new report also found just 4 per cent of trust leaders said race equality was fully embedded as part of their board’s business.
Building public understanding of health and health inequalities This publication draws on polling and recent research to explore the reasons behind public attitudes towards health and health inequalities.
Addressing racial and ethnic inequities in data-driven health technologies This report highlights the opportunities and barriers for artificial intelligence to improve the health of the UK’s minority ethnic groups. Data-driven technologies like artificial intelligence (AI) are powerful tools demonstrating potential in the diagnosis and treatment of diseases such as skin cancer. Yet these could inadvertently worsen the health inequalities experienced by minority ethnic groups if current challenges such as biased algorithms, poor data collection and a lack of diversity in research and development are not urgently addressed. The report calls for further research and transparent discussion on the creation and use of these technologies in health care.
Investing in regional equality: lessons from four cities This report sets out the findings of a study exploring what cities have been doing to reduce inequality, and which methods have proven most effective. The researchers worked with local organisations in Leipzig in Germany, Cleveland in the United States, Nantes in France, and Fukuoka in Japan to understand the initiatives and strategies that were being used to overcome inequality and provide opportunities. The findings are intended to assess what ‘levelling up’ looks like in a broad context, while providing evidence-based guidance so future government policies can be as impactful and targeted as possible.
If you wish to discuss any queries you may have around health inequalities please contact Claire Bentley.
Mental Health
Publications/guidance
Out of sight - who cares? Restraint, segregation and seclusion review: Progress reports Two Care Quality Commission reports comment on the progress achieved, partly achieved, or not achieved following the publication of its "Out of sight - who cares?" report, which looked at the use of restraint, seclusion and segregation in care services - and highlight the main areas where further work is still needed.
Mental health clinically-led review of standards This report sets out the wide-ranging support received through the national consultation on the proposed new standards for mental health care, and highlights some of the key considerations to support their successful implementation.
Running hot: the impact of the pandemic on mental health services This briefing sets out the case for change in mental health services and recommendations on how to address the increasing post-pandemic demand.
The economic case for investing in the prevention of mental health conditions in the UK This report estimates that mental health problems cost the UK economy at least £117.9 billion annually in 2019 – approximately 5 per cent of the UK’s GDP. Almost three quarters of the cost (72 per cent) is due to the lost productivity of people living with mental health conditions and costs incurred by unpaid informal carers who take on a great deal of responsibility in providing mental health support in our communities. The report, produced together with the London School of Economics and Political Science, makes the case for a prevention-based approach to mental health that would both improve mental wellbeing while reducing the economic costs of poor mental health.
Five-year NHS autism research strategy for England. A five-year NHS autism research strategy, to facilitate the use of the best current evidence when making decisions about autism services provided by or paid for by the NHS in England.
HSCC’s expert panel mental health evaluation: government response. The government’s response to the HSCC’s expert panel evaluation on the government’s progress on commitments in mental health services in England.
Shifting the Dial: evaluating a community programme to promote young Black men’s mental health Young Black men are overrepresented in restrictive mental health settings, but are less likely to get early community-based mental health support. This report shares learning from a three-year project to promote the mental health and wellbeing of young Black men in Birmingham. The project built upon the findings from CMH’s evaluation of an earlier pilot, Up My Street. Shifting the Dial has worked with more than 500 young Black men, offering peer support, mentoring, theatre productions, skills development and community events.
Cases
Q, Re [2022] EWCOP 6. Application seeking declarations that Q lacks capacity to litigate, make decisions about her medical treatment and had lacked capacity when making an advance decision to refuse treatment.
LF v A NHS Trust & Ors [2022] EWCOP 8. Application by father of G, his adult daughter, to discharge reporting restrictions in proceedings relating to where she should be cared for when she is discharged from her current placement in a children’s hospital.
Manchester University NHS Foundation Trust v WV [2022] EWCOP 9. Decision about whether William, a 17 year old who lacks capacity due to autism and ADHD, should have a kidney transplant.
S v Birmingham Women's And Children's NHS Trust [2022] EWCOP 10. Application concerning whether a woman has capacity to consent to the termination of her pregnancy.
A Local Authority v ST (Costs application) [2022] EWCOP 11. Application for costs by the Official Solicitor following an ineffective hearing concerning capacity to use social media.
PH v A Clinical Commissioning Group & Anor (Dismissal of proceedings) [2022] EWCOP 12. Application by mother of PH, under s16 MCA 2005, for orders concerning her son's future deprivation of liberty following his discharge from detention under MHA 1983.
Williams v Betsi Cadwaladr University Local Health Board. [2022] EWHC 455 (QB) A hospital-based psychiatric nurse had not breached her duty of care to a psychiatric out-patient who committed suicide shortly after his wife contacted the hospital, outside normal working hours, to say that he had become mentally unwell and wanted to be admitted. The nurse accurately described the two routes to admission and although the patient did not want to take either of them, there was nothing in the circumstances to justify the hospital departing from its usual admission procedures.
Consultations
Changes to the MCA Code of Practice and implementation of the LPS. This consultation seeks views on proposed changes to the Mental Capacity Act 2005 Code of Practice and implementation of the Liberty Protection Safeguards.
Legislation
Mental Capacity (Amendment) Act 2019: Liberty Protection Safeguards (LPS) Legislation and guidance on the Liberty Protection Safeguards (LPS) and the latest information on progress towards their implementation.
News
Teenage inpatient’s death sparks urgent coroner warning
NHS treating record number of young people for eating disorders
Bevan Brittan Updates
MCA and LPS - Consultation published. - Sarah Clarke
Covid-19 vaccination and best interest decision-making in the Court of Protection - Simon Lindsay and Beth Warner
How we can help
We are experts in advising commissioners, providers and care co-ordinators on the relevant legal frameworks. We deal with complex issues such as deprivation of liberty, state involvement, use of CCTV monitoring, seclusion, physical restraint and covert medication. We can help providers with queries about admission and detention, consent to treatment, forensic service users, transfers, leave, discharge planning and hearings. We can advise commissioners on all matters concerning commissioning responsibility, liability and disputes. For more information click here
If you wish to discuss any mental health issues facing your organisation please contact Simon Lindsay, Hannah Taylor,or Stuart Marchant.
Primary Care
Publications/guidance
Trust in primary care services The independent NHS Race and Health Observatory have launched a survey to assess the levels of trust that different communities have in their primary care services.
At your service: a proposal to reform general practice and enable digital healthcare at scale This report sets out a proposal for reform to general practice, addressing issues around integration, workforce, digital transformation and scaled provision. It argues that a new model of general practice is required to better meet the needs of patients and the taxpayer.
Integrating additional roles into primary care networks How well are staff employed under the new Additional Roles Reimbursement Scheme being embedded within general practice teams? In this report we consider the experience of staff working in these roles and explore what might be done to address any challenges.
General practice contract arrangements in 2022/23 This letter sets out the GP contract arrangements for 2022/23 including changes to the core GP contract and the network contract directed enhanced service (DES).
Leading the Way: The role and value of nurses in general practice in England Sonnet, in partnership with Sheffield Hallam University, has published the results of research into general practice nurses (GPNs).
Reform general practice? This report sets out a proposal for reform to general practice, addressing issues around integration, workforce, digital transformation and scaled provision.
Legislation
NHS primary medical services directions These directions set out the legal framework under which general practitioners (GP) operate and are paid.
The General Medical Services Statement of Financial Entitlements (Amendment) Directions 2022 | Department of Health and Social Care 8 March | This direction sets out the legal framework under which general practitioners (GP) operate and are paid.
News
Access to and delivery of general practice services: a study of patients at practices using digital and online tools This briefing examined data from 146 GP practices in England using the askmyGP online consultation system between 1 March 2019 and 30 September 2021. The analysis found that that 10 per cent of patient care requests made to GP practices indicate a preference for a face-to-face consultation. Recently, the increasing use of online consultations systems such as askmyGP caused concern about the risk of digital tools creating inequalities by making it difficult for some patients to access care. However, the analysis shows that patients often choose remote over face-to-face consultations and that GP practices can mitigate the risk of digital exclusion via a blended approach.
GPs attack "bullying" solicitors over Covid exemption letters.
Bevan Brittan Videos
Bevan Brittan has collaborated with NHS Resolution to produce a series of videos outlining key areas in general practice that frequently give rise to claims. Members of our clinical negligence team draw on their wealth of experience in dealing with claims to highlight the common areas of risk, provide guidance on how to mitigate or avoid these issues, and what steps to take if a complaint or a claim is received. The first five videos in this series are available to watch now. See below:-
Consent - Daniel Morris
Medical record keeping - Ben Lambert
Administrative errors - Susan Trigg
What to do if you receive a complaint or claim - Joanne Easterbrook
Common pitfalls - Helen Carrington
Other useful resources from NHS Resolution for primary care are set out below:-
1. General Practice Indemnity schemes
2. Understanding the Clinical Negligence Scheme for General Practice
3. Handling claims under the Clinical Negligence Scheme for General Practice
4. Covid-19 guidance for general practice
How we can help
We can offer support and advice on managing contractual and operational issues affecting the delivery of primary care services, including emerging legislative changes, updated guidance and policy arrangements, workforce issues and any transactional – related matters relating to vertical integrations, STPs, PCNs, etc. For more information click here.
If you wish to discuss any issues in primary care then please contact Joanne Easterbrook, Susan Trigg, Vincent Buscemi or Ben Lambert.
Public Health
Publications/Guidance
Local government public health funding: putting the jigsaw together without the picture on the box. Funding for local public health has been getting more complicated, making it harder for directors of public health to plan, and for transparency for anyone looking on, seeking to understand what is happening. David Buck (Senior Fellow, Public Health and Inequalities, The King's Fund) looks at the different pieces of the jigsaw.
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/Guidance
Principles for the first year of system regulation The Health and Care Bill offers the legislative framework to accelerate integration and partnership working. However, if regulation and oversight arrangements are overly burdensome and not fit for purpose, there is a risk that leaders of integrated care systems will be inhibited in progressing towards integration, partnership working and driving the improvements in care the pandemic has shown are needed. This report sets out a set of principles that should drive the actions of regulators over the first year of system regulation and oversight.
Response to the Government Consultation: Healthcare regulation: deciding when statutory regulation is appropriate. In response to a Department of Health and Social Care consultation on the criteria used to make decisions on which health and social care professions should be regulated, the Professional Standards Authority provides feedback on the following areas: a comparison of the proposed criteria with those laid out in right-touch assurance; how the Government plans to implement this approach and the current and future role of the Authority; and approaching the question of deregulation.
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
Social Care
Publications/Guidance
Out of sight - who cares? Restraint, segregation and seclusion review: Progress reports Two Care Quality Commission reports comment on the progress achieved, partly achieved, or not achieved following the publication of its "Out of sight - who cares?" report, which looked at the use of restraint, seclusion and segregation in care services - and highlight the main areas where further work is still needed.
Social care reform: an independent review by Baroness Cavendish A report looking at how the government can lock in the lessons of the COVID-19 pandemic to build a more robust, sustainable and joined-up system of social care.
Explaining integrated care systems to the public: slide deck Resources to help communicators engage with the public about changes in the health and care system in England.
Children's social care market study - final report. The Competition and Markets Authority's (CMA) final report into its market study into children's social care provision finds that there is a shortage of appropriate places in children's homes and with foster carers, meaning that some children are not getting the right care from their placement and that some children are also being placed too far away from where they previously lived or in placements that require them to be separated from their siblings.
People at the Heart of Care: adult social care reform white paper This white paper sets out a 10-year vision for adult social care and provides information on funded proposals that we will implement over the next 3 years.
Impact assessment of the implementation of Section 18(3) of the Care Act 2014 and fair cost of care This report, commissioned from LaingBuisson, analyses two key aspects of the government’s adult social care reforms: proposals to allow private payers (self-funders) to ask councils to arrange care on their behalf at lower local authority rates; and the intention to introduce a new ‘fair cost of care’, which aims to increase care fees paid by councils to make the care market sustainable. The study concludes that the government’s allocation ‘seriously underestimates’ the amount of new funding required and could cause a ‘severe sustainability risk’ to care homes across the country. Widespread care home closures could leave councils struggling to find beds for those who require care and trigger a deterioration in the quality of care between local authority and private placements.
News
Care providers to receive fairer costs for providing care. Local authorities in England will be supported by £1.36 billion from the Health and Social Care Levy to pay a fairer rate of care to adult social care providers. The Market Sustainability and Fair Cost of Care Fund will increase the support available for the care sector as part of the Government's 10-year vision for reform set out in the People at the Heart of Care white paper.
Government wants 80% of social care providers to use digital records by 2024
How we can help
For ways in which we can help with Social Care issues click here.
If you wish to discuss any queries you may have around social care please contact Siwan Griffiths.
General
Publications/Guidance
Visiting healthcare inpatient settings during the COVID-19 pandemic. Visiting is welcomed in inpatient settings, in a very careful and COVID-secure way. This guidance supersedes and replaces the NHS ‘visitor guidance’ dated 16 March 2021
NHS Standard Contract 2022/23 The NHS Standard Contract is mandated for use by commissioners for all contracts for healthcare services other than primary care.
Explaining integrated care systems to the public: slide deck Resources to help communicators engage with the public about changes in the health and care system in England.
A guide to integrated care systems (ICSs) – definitions and background To help provide clarity, the British Healthcare Trades Association (BHTA) has produced this simple guide, highlighting and defining some key terms related to integrated care systems.
Genome UK: shared commitments for UK-wide implementation 2022 to 2025 The shared commitments set out how the genomics community across the UK will collaborate during 2022 to 2025 to progress the government’s vision for genomic health care. The Genome UK strategy was published in 2020 and set out a vision and aspirations for how genomic health care would be transformed over the next 10 years. The shared commitments are a collection of high-level implementation commitments agreed between the UK government and the devolved governments, across the three pillars and five cross-cutting themes of the Genome UK strategy to support its UK-wide implementation.
Obesity Statistics. 28% of adults in England are obese and a further 36% are overweight. This briefing provides statistics on the obesity among adults and children in the UK, along with data on bariatric surgery and international comparisons.
Integrated care communications toolkit This toolkit was developed to help communicate the changes taking place in the health and care system. Resources have been produced to help with explaining integrated systems to the public, elected members and officers of councils, and non-executive directors. The toolkit also includes a jargon buster and some FAQs.
Integrated care partnerships: engagement findings In September 2021, the Department of Health and Social Care (DHSC), NHS England (NHSE) and the Local Government Association (LGA) published 'ICP engagement document: integrated care system (ICS) implementation'. Following that publication, the DHSC, NHSE and the LGA conducted an engagement exercise with those who have an interest in the formation of integrated care partnerships. This paper sets out the key findings from the engagement process. It also proposes next steps and outlines how the DHSC, NHSE and the LGA intend to support and guide the development of these new partnership arrangements going forward.
Health system recovery from Covid-19: International lessons for the NHS. The challenges confronting the NHS in recovering from the pandemic are huge, with elective services that were scaled down during the worst of the crisis now with waiting lists of over 6 million patients. Yet worldwide, the pandemic has left even the most well-equipped health systems vulnerable. What approaches have other countries used to move towards recovery, and what might the NHS learn? This major new Nuffield Trust report looks across 16 different countries to gain an understanding of the recovery challenge wo
News
Public satisfaction with NHS drops to 25-year low
Legal aid sector put on sustainable footing for years to come For the first time ever, legal representation will be made free for all under-18s and parents challenging doctors over withdrawal of their child’s life support, as will legal help for families at inquests where there has been a potential breach of human rights.
NHS patient, visitor and staff car parking management Information on how car parking provided by NHS trusts and NHS foundation trusts should be managed.
Events
Controlling and coercive behaviour. 3rd May 12.30pm Ella Garside (Senior Independent Domestic and Sexual Violence Advisor from Next Link Domestic Abuse Services) and Bethany Scarsbrook (St John’s Chambers) will look at understanding the impact of controlling and coercive behaviour and the practical and legal issues that arise from it.
Bevan Brittan Publications
If you would like to sign up for any of our Bevan Brittan publications click here.
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