29/10/2022
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
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.
Patient Safety Incident Response Framework: A Panel Session. 7 November 10.30am
Tricky issues in Court of Protection Covid 19 Applications. 8 November 12.30pm
An overview of the key changes set out in the Health and Care Act 2022. 21 November 11.30am.
Employment Law Update: Case law and horizon scanning for HR and in-house legal advisers 6 December 11am.
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
NHS 111’s response to callers with Covid-19-related symptoms during the pandemic This investigation aims to support improvements in the delivery of NHS 111 and other telephone triage services during a national health care emergency. The investigation uses real patient safety incidents involving patients and their families who dialled NHS 111 (and were either managed through NHS 111 or the Covid-19 Response Service) for advice during the Covid-19 pandemic. It highlights the importance of ‘stand-up’ services and clear communication across the NHS and to the public when they are accessing telephone triage services in times of national emergencies.
People First: a response from health and care leaders to the urgent and emergency care system crisis. Suggestions in the report include: expanding use of urgent community response teams to attend minor injuries 999/111 calls, giving acute and social care providers direct access to GP and community service booking systems, and providing “rapid access” to support packages to help people avoid hospital admission.
News
Private ambulance service suspended over safety concerns Independent ambulance service Transcare Secure Services in Birmingham was suspended from operating for a month by the CQC after inspectors raised a number of concerns over staff training and safety procedures.
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
The Report of the Independent Inquiry into Child Sexual Abuse. The Independent Inquiry into Child Sexual Abuse published its final statutory Report, which was presented to Parliament pursuant to section 26 of the Inquiries Act 2005. In accordance with the Inquiry's Terms of Reference, the Report sets out the main findings about the extent to which state and non-state institutions failed in their duty of care to protect children from sexual abuse and exploitation and makes recommendations for reform.
Genetic testing service to deliver rapid checks for children The NHS will be able to diagnose and potentially save the lives of thousands of severely ill children and babies — within days rather than weeks — with a national genetic testing service.
Safeguarding children with disabilities in residential settings National safeguarding practice review into safeguarding children with disabilities and complex needs in residential settings.
Bruising in non-mobile infants: Child Safeguarding Practice Review Panel paper – England The Child Safeguarding Practice Review Panel has published a briefing paper exploring current guidance on the management of bruising in non-mobile infants. The aim of the briefing is to support safeguarding partners in reviewing their current policies on bruising in non-mobile infants and to make recommendations on how the evidence base and national guidelines can be further developed.
Child Safeguarding Practice Review Panel: Updated guidance – England The Child Safeguarding Practice Review Panel has published updated non-statutory guidance for safeguarding partners. The Panel was established under the Children and Social Work Act 2017 and has the power to commission reviews of serious child safeguarding cases and to work with local safeguarding partners to improve learning and professional practice arising from such cases. The new guidance, which replaces the previous version published in April 2019, sets out how the statutory guidance in chapter 4 of Working Together 2018 should be interpreted and implemented by safeguarding partners, and provides details on the processes of notification, rapid review and local child safeguarding practice reviews, the principles underpinning decision making, and what makes for good reviews.
Multi-agency safeguarding and domestic abuse: Child Safeguarding Practice Review Panel briefing – England The Child Safeguarding Practice Review Panel has published a briefing paper setting out key findings from a thematic analysis of rapid reviews and local child safeguarding practice reviews where domestic abuse featured. It summarises the most common themes that emerged in relation to multi agency safeguarding for children who are victims of domestic abuse and includes examples of practice and recommendations. The paper identifies the following four core practice principles for working with children and young people, their parents and networks in relation to domestic abuse: Domestic abuse informed; Whole family; Intersectional; Trauma informed.
NICE self-harm guidance: Children, young people and adults – England The National Institute for Health and Care Excellence (NICE) has published guidance covering assessment, management and preventing recurrence for children, young people and adults who have self-harmed. The guidance includes recommendations on information and support, consent and confidentiality, assessment and care by social care practitioners, interventions for self-harm, and supporting people to be safe after self-harm.
Consultations
Interim service specification for specialist gender dysphoria services for children and young people - public consultation. An NHS England consultation seeks views on a proposed interim service specification for services for children and young people with gender dysphoria. Once agreed, this interim service specification will be operational for a limited time only until a new service specification is formed in 2023/24 that will be used by a new configuration of regional providers. Comments by 4 December 2022.
News
'Widespread and serious failures' at Herefordshire Children's Services. 'Widespread and serious failures' are leaving children and young people in Herefordshire "not protected from harm".
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
Reading the signals: maternity and neonatal services in East Kent – the report of the independent investigation Following concerns raised about the quality and outcomes of maternity and neonatal care, an independent investigation into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust was commissioned. The primary reason for this report is to set out the truth of what happened, so that maternity services in East Kent can begin to meet the standards expected nationally, for the sake of those to come. The report identifies four areas for action. The NHS could be much better at: identifying poorly performing units; giving care with compassion and kindness; teamworking with a common purpose; and responding to challenge with honesty.
The second report: The evolution of the Early Notification Scheme An NHS Resolution second report on its Early Notification Scheme, established to provide a faster and more caring response to families whose babies may have suffered severe harm. The report offers an overview of progress made since the report into the first year of the scheme, which was published in 2019, and provides updates on the progress of the key recommendations which were made in the first report and reflects on modifications and improvements made to the scheme since its launch five years ago. It provides an analysis of the main clinical themes, based on a small cohort of cases, and makes recommendations to further improve outcomes for affected families.
Safer care for all: solutions from professional regulation and beyond. This report highlights some of the biggest challenges affecting the quality and safety of health and social care across the UK today. It describes a ‘fragmented and complex’ patient and service user safety framework and calls for action to address the safety issues. The report's main recommendation is the appointment of an independent Health and Social Care Safety Commissioner (or equivalent) for each UK country. These commissioners would identify current, emerging and potential risks across the whole health and social care system and bring about the necessary action across organisations. The report goes on to consider four important themes: tackling inequalities; regulating for new risks; facing up to the workforce crisis; and accountability, fear and public safety.
Can Deaf and disabled people’s organisations help shape health and care services in the UK? Disabled people have historically experienced a range of barriers to accessing health care. Manishta Sunnia's blog outlines how working in partnership with Deaf and disabled people’s organisations could enable health services to better meet the needs of those who use them.
Cases
Muyepa v Ministry of Defence [2022] EWHC 2648 (KB) Mr Justice Cotter set out detailed considerations for assessing witness credibility.
Consultations
Consultation on how MHRA communicate with healthcare professionals to improve medicines and medical devices' safety. A Medicines and Healthcare products Regulatory Agency consultation seeks comments to inform its review on how it communicates with healthcare professionals to improve the safety of medicines and medical devices. Comments by 23.45 on 18 January 2023.
News
New national incident reporting system delayed amid fears of patient safety ‘disaster’
Bevan Brittan Updates
The Patient Safety Incident Response Framework - Mark Amphlett
Medicines and Medical Devices Reform – MHRA launches consultation to improve safety of medicines and medical devices - Louise Brennan
Bevan Brittan Events
Patient Safety Incident Response Framework: A Panel Session. 7 November 10.30am
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
Digital transformation in the NHS This document contains views from across the NHS about progress on digital innovation and what more is needed to facilitate full digital transformation.
Digital inequalities research Digital inequalities research that provides an insight into the behaviour of people who do not use digital services in health and social care.
Expert Panel: Evaluation of Government commitments made on the digitisation of the NHS. An independent evaluation by the Health and Social Care Committee's Expert Panel will assess the Government's progress against its pledges on the digitisation of the NHS. It will evaluate Government commitments across: the care of patients and service users, including the NHS app, personalised digital care and integrated health and care records; and the health of the population, including making patient data available for research in a safe and trustworthy way.
News
Major reforms to NHS tech agenda accelerated. Plans to merge NHS Digital with NHS England have been accelerated to early January 2023 to support the Department of Health and Social Care's Plan for Patients. The proposed transfer of NHS Digital's functions into NHS England, originally due to take place by 31 March 2023, will create a single statutory body responsible for data and digital technology for the NHS.
Barking, Havering and Redbridge launch world’s first digital surgery clinic
If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.
Employment/HR
Publications/guidance
BMA-DAUK RMO survey 2022: results summary This survey of the experiences of resident medical officers (RMOs) in the UK, conducted by the BMA and Doctors Association UK (DAUK), finds widespread poor conditions, low pay and excessive working hours. RMOs – doctors who provide resident services largely in the independent health sector and are most frequently recruited abroad as international medical graduates – describe pay deductions, bullying and multiple instances of racism.
NHS recruitment drive for nurses The NHS has launched its annual nationwide drive to recruit more nurses, with tens of thousands of vacancies across England.
The state of the adult social care sector and workforce in England 2022 Key findings from this year's annual report include: there are 165,000 vacant posts – an increase of 52 per cent and the highest rate on record; the number of filled posts (posts with a person working in them) has dropped by 50,000 – the first drop in the number of social care workers ever; average vacancy rates across the sector are at nearly 11 per cent, which is twice the national average; care workers with five years’ experience are paid 7p per hour more than a care worker with less than one year’s experience; and the average care worker pay is £1 per hour less than health care assistants in the NHS that are new to their roles.
The mental health nurse’s handbook This handbook is a resource for mental health nurses and their employers to guide their preceptorship and supervision conversations, helping to focus on some key areas of practice. It is intended as a brief practical guide and provides links to other important and helpful resources.
Flexible working in primary care Six case studies of GP practices across England have been published by the Institute for Employment Studies (IES), showcasing several successful strategies to implement flexible working practices.
The future of general practice This report on urges ministers and NHS England to acknowledge a crisis in general practice and set out what steps they are taking to protect patient safety. It sets out steps to reverse the decline in the continuity of care, making it an explicit national priority with a new measure requiring GP practices to report on continuity of care by 2024. However, this will be more difficult to achieve unless the workforce crisis is also addressed.
Record numbers of staff working in the NHS Record numbers of staff are working in the NHS, latest provisional data published by NHS Digital shows
Hospital discharge and community support: staff action cards. These action cards summarise the responsibilities of health and care staff in the hospital discharge process.
Supporting doctors through the menopause The aim of this paper is to raise awareness of the impact menopause is having on the workforce, as well as to issue recommendations and help healthcare organisations, managers, and employers to better support health care workers so that they do not leave the workforce or suffer in silence if they struggle with managing menopause symptoms.
Employing workers overseas: key employment related considerations As the working landscape has altered due to the Covid-19 pandemic, more employees are now requesting to work flexibly and from agile locations. This may extend to employees choosing to move overseas and work remotely if their role permits this. This briefing was commissioned in response to questions raised from NHS workforce leaders about the legalities and practicalities of overseas remote working arrangements.
Long Covid: a framework for nursing, midwifery, and care staff This framework supports nurses, midwives and care staff in ensuring care remains at a high standard, as well as demonstrating the contribution to the long Covid response. It aims to give the opportunity to embrace collective leadership in supporting people and communities served and showcase good practice as it emerges across England.
Facing up to long Covid 'We need fifty words for fatigue.' In her new blog, Jo Maybin, Fellow at The King's Fund, shares her experience and learning from living with long Covid.
NHS Pension Scheme: proposed amendments to continue the suspension of restrictions on return to work: response to consultation. The government consulted on proposals to continue temporary retire and return easements in the NHS Pension Scheme to 31 March 2023. Consultation respondents argued that the suspension of Special Class Status abatement should be extended for longer than was initially proposed. This consultation response confirms that the government will extend the suspension of Special Class Status abatement to 31 March 2025.
RCP view on the NHS workforce: short- and medium-term solutions This policy paper outlines how staffing shortages are the biggest barrier to meeting demand for care and delivering health care sustainably in the long term. It describes how a long-term plan for increasing staffing numbers, including expanding medical school places, is needed to put the NHS workforce back on a sustainable footing, restore timely access to care and protect patient safety. But given the urgency of the situation, the RCP has set out a range of short- and medium-term solutions that will make a difference now, from affordable childcare and flexible working to overseas recruitment and a new ‘retire and return’ deal for consultants.
Peak leaving? A spotlight on nurse leaver rates in the UK Nursing is the largest profession in the NHS, but it suffers from substantial staffing shortages. This analysis reflects on the rate at which the health service is losing nurses, and considers the reasons why.
The state of medical education and practice in the UK: The workforce report 2022. A General Medical Council (GMC) report warns that barriers preventing thousands of doctors from being deployed to meet areas of high patient demand must be removed if NHS challenges are to be addressed. The GMC reports that the number of doctors in those roles is growing at six times the rate of GPs and that by 2030 they could be the largest group in the medical workforce. But existing rules, such as the Performers List, which details practitioners approved to work in primary care, restrict the roles those doctors, known as specialty and associate specialist and locally employed doctors, can fulfil.
Consultations
Employment Practices and data protection - Information about workers' health. An Information Commissioner's Office consultation seeks views on guidance, which forms part of online resources on employment practices and data protection, on handling information about workers' health. Comments by 26 January 2023.
News
The state of medical education and practice in the UK: the workforce report 2022 This report finds that the number of doctors joining the workforce overall has grown by around 17 per cent over the past five years, but that growth is not consistent. It varies considerably between different groups of doctors, leaving a shortfall in primary care that puts at risk patients’ ability to access GP services. The number of specialty and associate specialty (SAS) and locally employed (LE) doctors on the GMC register has increased at six times the rate of GPs, largely driven by doctors coming from overseas. Current rules actively prevent these doctors from working in areas such as primary care, and the GMC is proposing the government change the Performers List criteria to allow more doctors to work in general practice.
Bevan Brittan Updates
Agency workers – the solution to strike action? Heather Stickland
Bevan Brittan Events
Employment Law Update: Case law and horizon scanning for HR and in-house legal advisers 6 December 11am.
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
Analysis: The link between investing in health and economic growth This analysis finds that growth in health care investment has a clear relationship with economic growth. The analysis brings together longitudinal data from multiple sources linked at the local level across all of England. It shows that for each £1 spent per head on the NHS, there is a corresponding return on investment of £4 – showing an economic benefit to investing in our National Health Service.
Valuing health: why prioritising population health is essential to prosperity This report calls on the government to consider the health of the population as crucial to sustainable economic growth, rather than being dependent on a prosperous economy. Raising alarm about rapidly declining population health and widening health inequalities, the report identifies that the nation is facing a ‘ticking time-bomb’ of ill health, with current government policies insufficient to meet the scale of the challenge. To date, principal discourse centres on health care and treatments, rather than developing and sustaining trajectories that preserve health.
For more information contact Claire Bentley.
Health Inequalities
Publications/Guidance
Digital inequalities research Digital inequalities research that provides an insight into the behaviour of people who do not use digital services in health and social care.
Acting on the evidence: ensuring the NHS meets the needs of trans people Richard Murray, Chief Executive at The King's Fund, takes a look at the evidence around poor access to health services and poor outcomes experienced by trans people and asks what more the NHS can do to better meet people’s needs.
Health disparities and health inequalities: applying All Our Health This guidance will help frontline professionals and organisations use their trusted relationships with individuals, families and communities to address the impact of health disparities and health inequalities on groups or populations. It also recommends important actions that managers and staff holding strategic roles can take.
Valuing health: why prioritising population health is essential to prosperity This report calls on the government to consider the health of the population as crucial to sustainable economic growth, rather than being dependent on a prosperous economy. Raising alarm about rapidly declining population health and widening health inequalities, the report identifies that the nation is facing a ‘ticking time-bomb’ of ill health with current government policies insufficient to meet the scale of the challenge. To date, principal discourse centres on health care and treatments, rather than developing and sustaining trajectories that preserve health.
Poverty and the health and care system: the role of data and partnership in bringing change Health and care systems can mitigate, reduce and prevent poverty's effects on health, but to do this they need to be much better at sharing and acting on data. This long read, published in partnership with the Centre for Progressive Policy, sets out the available data, explores existing good practice and what needs to happen next.
Inquiry to assess the impacts of menopause and the case for policy reform: concluding report. This report outlines how menopause symptoms can have a debilitating impact on the day-to-day lives of women. The findings of the report demonstrate that widespread action is needed across all spheres to improve the situation for those going through the menopause, and the families, friends and colleagues affected by it. It raises concerns about the socio-economic divide emerging between women who are able to access the right treatment, and those who lose out in the postcode lottery and do not have the financial means to seek treatment elsewhere. It makes 13 recommendations for the government, NHS and other bodies to initiate change and dispel the long-held taboo around menopause.
The role of homes and buildings in levelling up health and wellbeing. This research briefing, prepared to support a Westminster Hall debate on the role of housing in reducing health inequalities, explores the link between housing and health and summarises the statistics and current government position on this topic.
Homeless and Inclusion health nursing: case studies This collection of case studies demonstrates the role that specialist homeless and inclusion health nurses play in protecting and improving the health and wellbeing of the most disadvantaged members of society.
Housing and health: a reading list. This reading list draws together reports and other material demonstrating the relationship between housing and health.
Housing our ageing population This report, commissioned by the Local Government Association from the Housing Learning and Improvement Network, makes a number of recommendations to the government on how best to meet the needs of people in later life with case studies demonstrating how councils are addressing the housing needs of an ageing population.
How we can help
We have a multidisciplinary team advising NHS commissioners and providers on all aspects of tackling health inequalities, ranging from:
- advising on the new legal framework and compliance with the relevant statutory duties, particularly in the context of service reconfiguration;
- addressing workforce inequalities;
- taking action on patient safety to reduce health inequalities;
- the role of the Care Quality Commission in tackling health inequalities; and
- lessons to be learnt from the Covid-19 pandemic.
If you wish to discuss any queries you may have around health inequalities please contact Olivia Carter or Julia Jones.
Housing and homelessness
Publications/Guidance
The role of homes and buildings in levelling up health and wellbeing. This research briefing, prepared to support a Westminster Hall debate on the role of housing in reducing health inequalities, explores the link between housing and health and summarises the statistics and current government position on this topic.
Homeless and Inclusion health nursing: case studies This collection of case studies demonstrates the role that specialist homeless and inclusion health nurses play in protecting and improving the health and wellbeing of the most disadvantaged members of society.
Housing and health: a reading list. This reading list draws together reports and other material demonstrating the relationship between housing and health.
Housing our ageing population This report, commissioned by the Local Government Association from the Housing Learning and Improvement Network, makes a number of recommendations to the government on how best to meet the needs of people in later life with case studies demonstrating how councils are addressing the housing needs of an ageing population.
#HealthNow Literature review update: how has patient experience changed for people who are homeless? People experiencing homelessness face significant health inequalities. They encounter barriers to accessing the health care they need and often have poor experiences of engaging with health care services. This report examines research published since the Groundswell 2020 #HealthNow literature review and outlines the findings from its five #HealthNow research reports.
Bevan Brittan Updates
Hoarding and mental capacity. The case of AC and GC [2022] EWCOP 39 Julia Jones.
If you wish to discuss any queries you may have around housing and homelessness please contact Julia Jones.
Independent Health
Publications/Guidance
BMA-DAUK RMO survey 2022: results summary This survey of the experiences of resident medical officers (RMOs) in the UK, conducted by the BMA and Doctors Association UK (DAUK), finds widespread poor conditions, low pay and excessive working hours. RMOs – doctors who provide resident services largely in the independent health sector and are most frequently recruited abroad as international medical graduates – describe pay deductions, bullying and multiple instances of racism.
CMA open letter to private healthcare consultants and hospitals. In an open letter, the Competition and Markets Authority (CMA) has warned it will take enforcement action against healthcare providers over concerns prospective patients are not being given the essential information they need. The CMA has stated that some private healthcare providers have not been providing prospective patients with clear and consistent information that would allow them to compare providers, in breach of the Private Healthcare Market Investigation Order 2014.
The bet against the NHS – how likely is a two-tier healthcare system in the UK? This briefing unpacks the background and policy landscape creating increased concerns for the health care system in the UK. It explains how for-profit health care provision has grown in the past two decades, the role of the government in creating an environment that encouraged this growth, and the effect this has on patients and the way we access treatment based on ability to pay rather than level of need.
Role of the independent sector in elective care recovery. Given the role anticipated for the independent sector in elective care recovery from the coronavirus pandemic, this long read explores the sector’s role to date, looks at how this has changed since the pre-pandemic period, and considers what it might mean for patients waiting for different types of treatments, and living in different parts of England.
News
'Sustained growth' in private patient demand continues to boost Spire - LaingBuisson
Doctors see increasing numbers turning to private healthcare | Healthcare Markets
19 October 2022 | More than 90% of doctors have seen an increase in patients struggling to access NHS services over the last five years, according to a new report from medical publisher Medscape UK.
Bevan Brittan Updates
Medicines and Medical Devices Reform – MHRA launches consultation to improve safety of medicines and medical devices - Louise Brennan
For more information contact Tim Hodgetts or Julie Charlton
Information Sharing/Data
Publications/Guidance
Secure data environment for NHS health and social care data - policy guidelines In Data saves lives: reshaping health and social care with data, the government committed to implementing secure data environments as the default way to access NHS health and social care data for research and analysis. The strategy also sets out its intentions for the use of secure data environments to access NHS health and social care data through 12 clear guidelines. This publication provides additional background and detail on how these guidelines have been developed and their intended outcome.
Online access to GP health records. From 1 November patients with online accounts (including the NHS App or other patient online apps) will automatically be able to view new entries in their health records.
Poverty and the health and care system: the role of data and partnership in bringing change Health and care systems can mitigate, reduce and prevent poverty's effects on health, but to do this they need to be much better at sharing and acting on data. This long read, published in partnership with the Centre for Progressive Policy, sets out the available data, explores existing good practice and what needs to happen next.
For more information contact James Cassidy or Jane Bennett.
Inquests
Bevan Brittan Updates
What student suicides and the inquest process mean for Higher Education providers - Samantha Minchin
If you wish to discuss any queries you may have around inquests, please contact Toby De Mellow, Samantha Minchin or Claire Leonard.
Mental Health
Publications/guidance
National Deprivation of Liberty Court: Data trends – England & Wales. The Nuffield Family Justice Observatory has published its first briefing on data trends from the new National Deprivation of Liberty (DoL) court. The court deals with all new applications seeking authorisation to deprive children of their liberty under the inherent jurisdiction and is currently in its pilot phase. In the first two months of the national DoL court, there were 237 applications: 101 in July and 136 in August. The data briefing includes information on how the data was collected, the age and gender of children subject to applications, regional variations in applications, and who made the applications.
The mental health nurse’s handbook This handbook is a resource for mental health nurses and their employers to guide their preceptorship and supervision conversations, helping to focus on some key areas of practice. It is intended as a brief practical guide and provides links to other important and helpful resources.
World Mental Health Day: rising cost of living and mental health This insight from the House of Commons Library, written for World Mental Health Day, explores how financial situations can affect mental health and what we can learn from past economic events.
Cases
Re A (Covert Medication: Closed Proceedings [2022] EWCOP 22. Judgment concerning best interests of A and whether she should receive covert medical treatment and reporting of proceedings where there had been closed and open hearings.
Gloucestershire City Council v AB [2022] EWCOP 42 (3 October 2022) Application concerning care plans for AB where there is a risk that she will self-harm.
Newcastle Upon Tyne NHS Foundation Trust and MB [2022] EWCOP 43. Applications by NHS trust seeking declarations that MB lacked capacity for making decisions about treatment for suspected T-cell lymphoma and for authorisation of a treatment plan.
Lancashire & South Cumbria NHS Foundation Trust & Lancashire County Council v AH [2022] EWCOP 45. Judgment concerning whether a patient with diabetes and learning disability has capacity to decide issues around her treatment.
News
Mental health: Stories from clinicians and young people – England The BBC has published a new episode of their investigative documentary series Panorama exploring the challenges faced by mental health clinicians and young people with mental health conditions. The episode can be found on the BBC website.
Bevan Brittan Events
Tricky issues in Court of Protection Covid 19 Applications. 8 November 12.30pm
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
Online access to GP health records From 1 November patients with online accounts (including the NHS App or other patient online apps) will automatically be able to view new entries in their health records.
Flexible working in primary care Six case studies of GP practices across England have been published by the Institute for Employment Studies (IES), showcasing several successful strategies to implement flexible working practices.
The future of general practice This report urges ministers and NHS England to acknowledge a crisis in general practice and set out what steps they are taking to protect patient safety. It sets out steps to reverse the decline in the continuity of care, making it an explicit national priority with a new measure requiring GP practices to report on continuity of care by 2024. However, this will be more difficult to achieve unless the workforce crisis is also addressed.
Under pressure: an analysis of primary care pressures facing integrated care systems at launch This report identifies 16 of 42 regions where primary and secondary care services are under high levels of pressure going into this winter. The research finds widespread variation in access to services including a nearly four-fold variation in the proportion of patients waiting three weeks or more for a GP appointment.
News
The state of medical education and practice in the UK: the workforce report 2022 This report finds that the number of doctors joining the workforce overall has grown by around 17 per cent over the past five years, but that growth is not consistent. It varies considerably between different groups of doctors, leaving a shortfall in primary care that puts at risk patients’ ability to access GP services. The number of specialty and associate specialty (SAS) and locally employed (LE) doctors on the GMC register has increased at six times the rate of GPs, largely driven by doctors coming from overseas. Current rules actively prevent these doctors from working in areas such as primary care, and the GMC is proposing the government change the Performers List criteria to allow more doctors to work in general practice.
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 and arising from the delivery of primary care services, including complaints, inquests and claims, regulatory scrutiny, emerging legislative changes, updated guidance and policy arrangements, workforce issues and any transactional – related matters relating to vertical integrations, STPs, PCNs, etc.
If you wish to discuss any issues in primary care then please contact Joanne Easterbrook, Susan Trigg, Vincent Buscemi or Ben Lambert.
Provider
Publications/Guidance
Guidance on good governance and collaboration. New guidance on good governance and collaboration that sets out expectations on how trusts should collaborate and links effective collaboration to a governance licence condition under the provider licence.
Code of governance for NHS provider trusts. An NHS England updated code of governance for NHS provider trusts which sets out an overarching framework for the corporate governance of trusts. The new code will cover both foundation trusts and NHS trusts. It will come into effect from 1 April 2023 and replace the 2014 "NHS Foundation Trust Code of Governance".
Addendum to your statutory duties – reference guide for NHS foundation trust governors.
Consultations
Consultation for changes to the NHS provider licence. An NHS England consultation seeks comments on changes to the NHS provider licence to support effective system working and the delivery of high-quality sustainable care. The licence forms part of the oversight arrangements for NHS providers, serves as the legal mechanism for regulatory intervention, and underpins mandated support at our most challenged providers. Comments by 9 December 2022.
Consultation on the revised NHS enforcement guidance. NHS England has updated its Enforcement guidance to reflect the Health and Care Act, 2022 and current practice. The revised guidance sets out NHS England’s approach to enforcement of integrated care boards and providers. NHS England has a statutory duty to consult on the proposed changes to the Enforcement guidance. Following the consultation, the final version of the revised guidance will be issued during 2023/24.
If you wish to discuss any queries you may have around regulation please contact Vincent Buscemi.
Public Health
Publications/Guidance
Public health grant: what it is and why greater investment is needed Investment in prevention represents excellent value for money compared with health care spend. Yet recent announcements have continued the trend of disinvesting in the wider funding that helps to maintain and improve people’s health. The public health grant has been cut by 24 per cent on a real-terms per person basis since 2015/16.
If you wish to discuss any queries you may have around regulation please contact Claire Bentley.
Regulation
Publications/Guidance
State of Care 2021/22. A Care Quality Commission (CQC) publication provides the CQC's annual assessment of health care and social care in England, looking at the trends, sharing examples of good and outstanding care, and highlighting where care needs to improve. The report concludes that: the health and care system is in gridlock and this is clearly having a huge negative impact on people's experiences of care; that people in need of urgent care are at increased risk of harm due to long delays in ambulance response times, waiting in ambulances outside hospitals and long waiting times for triage in emergency departments; large numbers of people are stuck in hospital longer than they need to be, due to a lack of available social care; and that people's inability to access primary care services is exacerbating the high pressure on urgent and emergency care services. At the heart of these problems are staff shortages and struggles to recruit and retain staff right across health and care.
Safer care for all: solutions from professional regulation and beyond. This report highlights some of the biggest challenges affecting the quality and safety of health and social care across the UK today. It describes a ‘fragmented and complex’ patient and service user safety framework and calls for action to address the safety issues. The report's main recommendation is the appointment of an independent Health and Social Care Safety Commissioner (or equivalent) for each UK country. These commissioners would identify current, emerging and potential risks across the whole health and social care system and bring about the necessary action across organisations. The report goes on to consider four important themes: tackling inequalities; regulating for new risks; facing up to the workforce crisis; and accountability, fear and public safety.
Whistleblowing disclosures report 2022: healthcare professional regulators This report is part of a co-ordinated effort with seven other regulators to address serious issues that health and care professionals in the UK have raised. The most common themes of the disclosures this year related to patient safety and care, leadership and management, health and safety, and behaviour.
Bevan Brittan Updates
CQC: Assessment Framework Focus - Siwan Griffiths
CQC State Of Care 2021/22 – a system in Gridlock. - Carlton Sadler
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
Social Care
Publications/Guidance
Annual review of adult social care complaints: 2021-22. This report finds that the cost of providing care has become an increasingly common theme in the complaints made to the Local Government and Social Care Ombudsman over the past year. The review, which covers both council and independent care complaints, said it is seeing more cases where councils are failing to provide care, or are limiting care, while using cost as the justification. However, since the last comparable year before the pandemic the Ombudsman has received 16 per cent fewer complaints about adult care as a whole.
The state of the adult social care sector and workforce in England 2022. Key findings from this year's annual report include: there are 165,000 vacant posts – an increase of 52 per cent and the highest rate on record; the number of filled posts (posts with a person working in them) has dropped by 50,000 – the first drop in the number of social care workers ever; average vacancy rates across the sector are at nearly 11 per cent, which is twice the national average; care workers with five years’ experience are paid 7p per hour more than a care worker with less than one year’s experience; and the average care worker pay is £1 per hour less than health care assistants in the NHS that are new to their roles.
New horizons: what can England learn from the professionalisation of care workers in other countries? This report finds that perceptions of care work as low skilled continue to persist, despite the pandemic highlighting just how vital care workers are. In recent years there has been increased debate around the ‘professionalisation’ of this staff group, which generally refers to the creation of a statutory register of staff and their professional regulation. This report reviews what the evidence shows about the professionalisation of care workers in other countries.
Proposed reforms to adult social care (including cap on care costs)This briefing provides information on the Government's proposals for adult social care reform, including the cap on care costs.
Bevan Brittan Updates
CQC: Assessment Framework Focus - Siwan Griffiths
CQC State Of Care 2021/22 – a system in Gridlock. - Carlton Sadler
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
Accelerating genomic medicine in the NHS. An NHS England publication outlines its strategy for embedding genomics in the NHS over the coming five years. It states that, over the five years, the NHS will push the boundaries to improve care and treatment options for its patients, developing shared clinical and access standards, data platforms and governance, and an interoperable informatics infrastructure.
Hospital discharge service: action cards These action cards summarise the responsibilities of health and care staff in the hospital discharge process.
Integrated workforce thinking across systems: practical solutions to support integrated care systems (ICSs) Improved outcomes in population health and health care is one of the fundamental purposes of integrated care systems (ICSs). To achieve this, partners from across both health and social care must come together to plan and develop a workforce that integrates and connects across all parts of the system to deliver personal, person-centred care to their local populations now and in the future. This is a new way of working for some in health and social care, so this guide builds on emerging lessons to support people to do this successfully across sectors and within multi-agency services.
Introducing Integrated Care Systems: joining up local services to improve health outcomes. The National Audit Office (NAO) has published a report on the introduction of Integrated Care Systems (ICS), which join up local care services from the NHS, local government and other partner organisations to improve health outcomes by planning and delivering services together. ICSs were introduced into legislation by the Health and Care Act 2022 and have been in effect since 1 July 2022. The report includes an introduction to ICSs, describing their structure, objectives, and governance arrangements, an assessment of the ICSs finances, staffing and activity levels, some of the wider challenges facing the health and care sector and an assessment of ICSs’ prospects and recommendations from the NAO on how best to manage the risks and realise the opportunities ICSs are likely to face.
Analysis: The link between investing in health and economic growth Growth in healthcare investment has a clear relationship with economic growth, new analysis finds.
Operating framework for NHS England. An NHS England publication outlines its operating framework on how it will operate in the new structure created by the Health and Care Act 2022. The framework describes the roles that NHS England, integrated care boards and NHS providers will now play, working alongside partners in the wider health and care system, and shows how accountabilities and responsibilities will be allocated to improve local health and care outcomes. The framework has been co-created with 300 system leaders, organisations and stakeholders, including Health Education England and NHS Digital.
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