30/06/2023
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
There is no charge for any of the events listed below
Webinars
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.
Understanding responsibilities regarding referrals to the General Medical Council about professionals. 6 July 12.30pm.
Children and Young People: Placement and Restrictive Support Packages. 11 July 12.30pm
In discussion: harassment in health and social care services. 13 July 12.30pm
Liberty Protection Safeguards and the Deprivation of Liberty Safeguards – where are we now? 18 July 2023
Practical and Legal Guidance for Assessing Capacity 20 July 2023
Please note that registration for each webinar will close one hour before the webinar starts, so please do ensure you have booked your place in advance to guarantee attendance.
Acute and emergency care
Publications/guidance
Access to unplanned or urgent care. This report gives a factual overview of NHS services that may be used when people need rapid access to urgent, emergency or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect. It covers: general practice; community pharmacy; 111 calls; ambulance services (including 999 calls); urgent treatment centres; and accident and emergency departments.
Strengthening the role of the ambulance sector in reducing health inequalities. This consensus statement (agreed by major health organisations including NHS England (NHSE), the Office for Health Improvement and Disparities (OHID), the College of Paramedics (CoP), NHSE Workforce, Training and Education (NHSE-WTE, formerly Health Education England), NHS Providers (NHSP) and NHS Confederation (NHSC), which hosts the Integrated Care Systems (ICS) Leaders Network) underlines common goals and objectives in a concerted attempt to balance the playing field for all service users and overcome the challenges of health and social care inequality. It will ultimately result in ambulance services playing a key role in their ICSs’ objectives to reduce local health inequalities.
Bevan Brittan Events
Medical Emergencies in Challenging Times. Jonathan Jones, Consultant in Emergency Medicine, and Mark Newton, Consultant Paramedic, gave an overview of the challenges and potential solutions to the safe provision of emergency healthcare supporting patients and providers in the NHS in England.
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 inbetweeners: a review of the barriers and facilitators in the process of the transition of children and young people with complex chronic health conditions into adult health services. This report finds that the process of transition and subsequent transfer is often fragmented, both within and across specialties, and that adult services often sit only with primary care. The report’s recommendations highlight areas that are suitable for regular local clinical audit and quality improvement initiatives by those providing care to this group of patients. It suggests that the results of such work should be presented at quality or governance meetings, and action plans to improve care should be shared with executive boards.
Pregnancy, Mother and Baby Units (MBUs), and Maternal Separation from Children up to the Age of Two in Women's Prisons. A joint Ministry of Justice and HM Prisons and Probation Service framework document sets out the mandatory requirements that address the additional emotional, physical and practical needs of perinatal women and mothers in prison and how prisons support them. The policy is supported by operational guidance, containing best practice advice designed to aid implementation and the development of local policies.
Gone too far: Preventing children in care being moved miles from the people and places that matter to them. Research and analysis conducted by the charity Become, has found that both the number and proportion of children in the care system placed more than 20 miles away from home has increased each year between 2012 and 2021, including cases of children being placed 500 miles away. It also found that children who are moved more than 20 miles away from home are "more likely to have lower wellbeing and to experience emotional difficulties" than children who are placed closer to home. 840 children under the care of English local authorities were placed outside of the country, including 540 in Wales and 270 in Scotland, the study found. The charity is calling for a "national commitment" to stop children being placed miles from their home area when it is not in their best interests.
Government proposals for children's social care reform: Research Briefing. A House of Commons Library briefing summarises Government proposals for reform of children's social care in England. It's implementation strategy and consultation "Stable Homes, Built on Love", based on three independent reports, sets out "whole system reform". It also details responses to the Government's proposals.
Making financial decisions for young people who lack capacity: A toolkit for parents and carers. Ministry of Justice guidance provides advice for parents and carers on making financial decisions for a young person who lacks mental capacity. The toolkit provides information on: what lacking mental capacity means and the decision-making principles; the changes to decision-making responsibility when a child reaches adulthood; the relevant route to make financial decisions on behalf of a young person, including how to access a child trust fund; and if the young person is under the age of 18, how to prepare to make financial decisions when they reach adulthood.
Ethnicity of children in care and supervision proceedings in England. A Nuffield Family Justice Observatory briefing paper reports the findings from an analysis of the ethnic composition of children in care and supervision proceedings in England. The analysis examines: differences in the demographic characteristics of children from different ethnic groups in care proceedings; legal outcomes for those children; how long it takes to get to a final order; where children are living; and whether parents come back to court after the final order is made. The briefing also provides the basis for future work as it points to many questions that remain unanswered and under-investigated and it recommends areas for further enquiry.
Corporate Parenting Charter - A Promise from Wales. Welsh Government guidance sets out a pledge of commitment for public sector bodies in their role as corporate parent. The Charter, a set of promises that can be adopted by any public sector body when engaging with care-experienced children and young people, also sets out shared principles that all bodies and their leaders should follow when providing such services. The Social Services and Well-being (Wales) Act 2014, Pt 6 Code of Practice (Looked After and Accommodated Children) will be revised to include additional guidance on the Charter and published in 2024.
Growing problems, one year on: the state of children’s health care and the Covid-19 backlog. QualityWatch's 2022 annual statement showed that although the direct effects of Covid-19 on children and young people have generally been milder than for older groups, the impact of the pandemic was huge, with waiting lists for children and young people's care growing rapidly and mental health a serious concern. So, more than one year on from that report, have there been improvements in the state of health and care for our younger generations?
Refugee children. Barnardo’s has published a report outlining the blueprint for supporting displaced children seeking protection in the UK. The report, supported by charities including the NSPCC, makes five key recommendations including: the development of a strategic plan to welcome all displaced children; rolling out local welcoming hubs for displaced families; allowing all children arriving in the UK the means of obtaining safety with their families; increasing specialist foster care for separated children; and assigning all separated children a guardian.
Eating disorders and self-harm. The Lancet has published a study on rates of eating disorder and self-harm among adolescents and young adults in the UK since the beginning of the COVID-19 pandemic. Analysing around nine million GP records of young people aged from 10 to 24, the study found: eating disorders were 42% higher than expected for girls aged 13 to 16 and 32% higher than those expected for those aged 17 to 19; and levels of self-harm were 38% higher than expected for girls aged 13 to 16. The study found these increases largely attributable to increases within less deprived communities.
Children's homes: recruiting staff. This guidance explains what providers of children’s homes must do under the law when recruiting and employing staff.
Home-to-school travel. Local authorities’ responsibilities when making home-to-school travel arrangements for children of compulsory school age.
Consultations
Information sharing advice for safeguarding practitioners. Outlines the principles of information sharing for practitioners safeguarding children, young people and their families. This consultation closes at 11:59pm on 6 September 2023
Changes to statutory guidance: Working Together to Safeguard Children: Government consultation. A Department for Education consultation seeks views on its revisions to the Working Together to Safeguard Children statutory guidance. It follows the publication of "Stable Homes, Built on Love", which sets out a plan to transform children's social care. Updating Working Together is central to delivering on the first phase of the transformation journey, implementing strengthened multi-agency working across the whole system of help, support and protection for children and their families, re-balancing the system towards help at an early point, and ensuring strong, effective and consistent child protection practice. Comments by 23.59 on 6 September 2023.
Bevan Brittan Updates
Balancing privacy and open justice in health and care court cases involving children, young people and vulnerable adults. - Hannah Taylor
Bevan Brittan Events
Eating disorders and disordered eating: treating the body and the mind. Cases concerning eating disorders and disordered eating are becoming increasingly prevalent in the Court of Protection and High Court. This session considered some of the tricky practical, clinical and legal issues involved.
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
Groundhog Day 2: An opportunity for cultural change in complaint handling? A Public Services Ombudsman for Wales report calls for urgent cultural change to end the cycle of poor complaint handling in the Welsh NHS and sets out case examples which demonstrate that Health Boards too often respond to complaints defensively rather than seeing them as an opportunity for learning and improving the services they deliver. Themes identified in the report, which point to areas where learning and improvement is urgently needed to improve the patient and complainant experience, include a lack of openness and candour, and a lack of objective review of clinical care and treatment.
Rapid review into data on mental health inpatient settings: final report and recommendations. The rapid review into data on mental health inpatient settings was commissioned by ministers to produce recommendations to improve the way data and information is used in relation to patient safety in mental health inpatient care settings and pathways, including for people with a learning disability and autistic people. This report contains the findings of the review, including a set of recommendations for improvements in the way local and national data is gathered and used to monitor and improve patient safety in mental health inpatient pathways.
Cases
Bilal v St George's University Hospital NHS Foundation Trust. [2023] EWCA Civ 605 In a claim where a patient alleged that he had not given full and proper consent before undergoing spinal surgery and that alternative treatments had not been discussed, the term "reasonable" in respect of assessing alternative or variant treatments encapsulated the approach to clinical negligence in Bolam v Friern Hospital Management Committee [1957] 1 W.L.R. 582, [1957] 2 WLUK 94, [1957] C.L.Y. 2431. Material risks were to be judged from the patient's perspective, whereas it was for the doctor to assess what the reasonable alternatives were, and for the court to judge the materiality of the risk inherent in any proposed treatment, applying the test of whether a reasonable person in the patient's position would be likely to attach significance to the risk.
News
GMC admits error in taking apology as admission of guilt - Pulse Today.
Bevan Brittan Updates
Reasonable alternative treatment options in informed consent cases: Bolam persists - Emma Powell
Bevan Brittan Events
Medical Emergencies in Challenging Times. Jonathan Jones, Consultant in Emergency Medicine, and Mark Newton, Consultant Paramedic, provided an overview of the challenges and potential solutions to the safe provision of emergency healthcare supporting patients and providers in the NHS in England.
PSIRF: Engaging and involving patients, families and staff following a patient safety incident. The Patient Safety Incident Response Framework (“PSIRF”) is due to be implemented nationally this autumn. A key aspect of it is engaging and involving patients, families and staff following a patient safety incident.
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.
Covid
Publications/Guidance
The Covid-19 Inquiry. This explainer sets out what is the Covid-19 inquiry; what powers does it have; and what is its purpose and scope.
Covid-19 Inquiry public hearings: module 1, week 1 (13-16 June 2023). This briefing summarises the proceedings most relevant to NHS trusts, and is the first in the series of weekly briefings on the Inquiry’s public hearings. See also.
Excess deaths involving CVD in England since the onset of the Covid-19 pandemic: an analysis and explainer. This analysis finds that nearly 100,000 more people with cardiovascular disease than expected have died since the start of the Covid-19 pandemic in England. It means that, on average, there have been more than 500 additional deaths a week involving cardiovascular disease since the Covid-19 pandemic began.
Growing problems, one year on: the state of children’s health care and the Covid-19 backlog. A previous report showed that although the direct effects of Covid-19 on children and young people had generally been milder than for older groups, the impact of the pandemic was huge, with waiting lists for children and young people's care growing rapidly and mental health a serious concern. This report investigates whether there have been improvements in the state of health and care for children and young people.
If you wish to discuss any queries you may have around Covid and Claims please contact Daniel Morris.
Digital Health
Publications/guidance
Digital working in adult social care: What Good Looks Like. This report highlights how incorporating digital technology in adult social care can have transformative effects in improving patients' quality of care.
Patient empowerment: what is the role of technology in transforming care? NHS Confederation and Google Health collaborated on this report, which showcases how technology can be used as a tool to improve health and wellbeing.
A new perspective on autism support with modern technology. Dr Louise Morpeth, CEO at Brain in Hand, explores new technologies that can help improve access to health care for people with autism.
News
£21 million to roll out artificial intelligence across the NHS. The new technology will help diagnose patients more quickly for conditions such as cancers, strokes and heart conditions.
If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.
Employment/HR
Publications/guidance
NHS Long Term Workforce Plan. The first comprehensive workforce plan for the NHS, putting staffing on a sustainable footing and improving patient care. It focuses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history. See Bevan Brittan Update - Breaking Down The NHS Long Term Workforce Plan - Andrew Uttley and Alastair Currie.
Migration and the health and care workforce. This paper examines the role of migration and the impacts of immigration policy on the UK’s health and care workforce. The health and care industries faced significant staff shortages in 2023, with high vacancy rates in the NHS in England despite a growing clinical workforce. The UK immigration system admitted unprecedented numbers of overseas health and care workers in the year ending March 2023: almost 100,000 people, making up the majority of Skilled Worker entry visas.
All is not well: sickness absence in the NHS in England. According to this report, the NHS in England is facing a new normal of sickness absence in hospitals and community services, having seen a 29 per cent jump in the most recent calendar year compared with the year before the pandemic (an average of 5.6 per cent in 2022 vs 4.3 per cent in 2019), equating to an average of 17,000 additional staff off sick each day. It also finds that the levels of sickness absence is not equal around the country and that ambulance services have seen a particular spike, with three ambulance trusts seeing one in ten staff off sick on average every day in 2022.
NHS equality, diversity, and inclusion improvement plan. This improvement plan sets out targeted actions to address the prejudice and discrimination – direct and indirect – that exists through behaviour, policies, practices and cultures against certain groups and individuals across the NHS workforce. It has been co-produced through engagement with staff networks and senior leaders.
How it started… how it’s going: the experiences of migrants and people from ethnic minority backgrounds working in the NHS. It's 75 years since HMT Empire Windrush docked in Tilbury. Shilpa Ross, Policy Fellow at The King's Fund, considers the experiences of staff from ethnic minority groups in the newly formed NHS and the NHS of today and asks why, in the intervening years, so little has changed.
The NHS productivity puzzle: why has hospital activity not increased in line with funding and staffing? This report – written jointly by the Institute for Government and Public First, and funded by The Health Foundation – assesses why NHS hospitals are failing to deliver higher activity despite higher spending on the service and higher levels of staffing over the past couple of years. It argues that politicians need to focus on capital investment, staff retention and boosting management capacity, and sets out key questions for policy-makers to address if they want to solve the NHS crisis. It finds that most of the challenges identified in the report existed before the pandemic and have been exacerbated since.
Left behind: exploring the prevalence of youth worklessness due to ill health in different parts of the UK. This briefing note is part of the Young people’s future health inquiry, a three-year programme supported by The Health Foundation. It explores the prevalence of youth worklessness due to ill health in different parts of the UK. It finds that economic inactivity due to ill health among 18–24 year-olds has nearly doubled over the past decade, and is heavily concentrated among those with low levels of skills, with four-in-five young people who are too ill to work having only qualifications at GCSE level or below. There are considerable differences between parts of the UK, with young people in areas dominated by small towns and villages more likely to be workless due to ill health than those living in large cities such as Glasgow, Liverpool and London.
Retaining doctors in late stage career guidance. This guidance, produced in collaboration with the Academy of Medical Royal Colleges, is to support the retention of doctors in late-stage career. The guidance provides 10 recommendations for systems and employers to consider when supporting doctors in late career, working in secondary care settings, to stay and stay well in the NHS. The recommendations are aligned to the NHS people promise and include holding retirement conversations, supporting flexible working, and health and wellbeing
The post-foundation training break (“F3”): evaluating its impact on postgraduate medical training. An increasing number of doctors are taking a training break between Foundation Year 2 (FY2) and the start of core/specialty training (C/ST). The research aimed to understand how this break is managed and perceived, and its impact on career progression, including any equality, diversity and inclusion issues. The GMC commissioned the University of Nottingham, with partial funding from the Association for the Study of Medical Education, to research the impact of post-foundation training breaks (PFTBs), often known as ‘F3’.
Leading for all: supporting trans and non-binary healthcare staff. This report, developed in partnership with the LGBT Foundation, includes new data from a survey and interviews with trans and non-binary people in the NHS. It finds that 55 per cent experienced transphobia in the workplace and 47 per cent experienced negative or stereotypical assumptions about their gender identity. It aims to support leaders to become effective, active allies to their health care staff; take action to ensure working environments are inclusive; and guide decision-making when developing policies for trans and non-binary staff.
Nursing and midwifery national job profile review: evidence report. Following a request by the Royal College of Nursing (RCN) and the Royal College of Midwives (RCM), the NHS Staff Council’s Job Evaluation Group undertook a review of the national job profiles for nursing and midwifery. The aim of this review is to ensure that these profiles reflect current nursing and midwifery practice and are fit for purpose in all health and care settings. This report is the output from the evidence-gathering stage of the review project.
The state of medical education and practice in the UK Workplace experiences 2023. A General Medical Council (GMC) report, which includes data about doctors' workplace experiences and the effects they are having, has warned that urgent action is needed to break a "vicious cycle of unmanageable workloads, dissatisfaction and burnout that is causing UK doctors to take steps to quit". The GMC reports that doctors are changing their working patterns, places of work or even re-thinking their careers because they increasingly feel unable to cope, which effectively threatens patient safety.
NHS strike action in England. Strikes have been taking place across the NHS in England. This briefing looks at Government pay offers, what unions are asking for and when strikes will happen.
Role of the director of public health in local authorities. Describes both the statutory and non-statutory elements of the role of director of public health (DPH).
News
Over 1 million NHS staff to receive pay rises. Eligible workers on the Agenda for Change contract, which includes nurses, paramedics and 999 call handlers, will receive the pay rise, backdated to April.
‘Longest ever strike’ announced by junior doctors for next month. Junior doctors will take part in what is “thought to be the longest single period of industrial action in the history of the health service” for five days next month.
Bevan Brittan Updates
Breaking Down The NHS Long Term Workforce Plan - Andrew Uttley and Alastair Currie.
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, James Gutteridge or Andrew Uttley
Health Inequalities
Publications/Guidance
Strengthening the role of the ambulance sector in reducing health inequalities. This consensus statement (agreed by major health organisations including NHS England (NHSE), the Office for Health Improvement and Disparities (OHID), the College of Paramedics (CoP), NHSE Workforce, Training and Education (NHSE-WTE, formerly Health Education England), NHS Providers (NHSP) and NHS Confederation (NHSC), which hosts the Integrated Care Systems (ICS) Leaders Network) underlines common goals and objectives in a concerted attempt to balance the playing field for all service users and overcome the challenges of health and social care inequality. It will ultimately result in ambulance services playing a key role in their ICSs’ objectives to reduce local health inequalities.
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 Julia Jones.
Independent Health
Publications/guidance
Planned hospital care: the split between the NHS and the private sector. The role of private providers in supporting the NHS is often debated, so how is health care split between the NHS and the private sector and is it changing as a result of the pandemic? In a new explainer, Stuti Bagri and Sarah Scobie look at planned hospital care in England between 2019 and 2022, assess how things vary by region and procedure, and discuss whether it has any implications for the NHS’s recovery. See also
News
Private IVF treatment soars as NHS-funded cycles remains below pre-pandemic levels. More patients are paying for private IVF treatment as the number of cycles funded by the NHS remain below pre-pandemic levels, according to a new report from the Human Fertilisation & Embryology Authority (HFEA).
Private providers able to recover faster than the NHS in pandemic aftermath
For more information contact Tim Hodgetts or Julie Charlton
Information sharing
Consultations
Information sharing advice for safeguarding practitioners. Outlines the principles of information sharing for practitioners safeguarding children, young people and their families. This consultation closes at 11:59pm on 6 September 2023
Changes to statutory guidance: Working Together to Safeguard Children: G
For more information contact Jane Bennett.
Inquests
Publications/guidance
Girmaye Guyo: Prevention of future deaths report. A prevention of future deaths report has been sent to the Department of Health and Social Care and Ministry of Justice under the Coroners and Justice Act 2009 and the Coroners (Investigations) Regulations 2013 following the death of Girmaye Guyo from drowning. The report raises concerns that the Nearest Relative Power may (as it did in this case) present an opportunity for a patient and/or their nearest relative to apply to the responsible clinician for discharge in circumstances when the patient remains liable for their continued detention and that there does not appear to be a thorough procedure or legal test for clinicians to apply, and thus there is a risk that responsible clinicians may be faced with circumstances whereby a patient will be discharged from hospital despite them continuing to meet the criteria for detention. The recipients of the report must respond by 11 August 2023.
R. (on the application of Maguire) v HM Senior Coroner for Blackpool and Fylde [2023] UKSC 20. The circumstances surrounding the death of a person lacking capacity who had been placed in a residential care home, and who had died after refusing to be taken to hospital, had not required a coroner to request the jury to return an expanded verdict in accordance with the Coroners and Justice Act 2009 Pt 1 s.5(2). There had been no arguable systemic failure by the care home or the healthcare providers, and no arguable breach of their operational duty to protect life, such as to trigger the state's enhanced procedural obligation to investigate under ECHR art.2 and the requirement for an expanded verdict.
If you wish to discuss any queries you may have around inquests, please contact Toby De Mellow or Claire Leonard.
Mental Health
Publications/guidance
Rapid review into data on mental health inpatient settings: final report and recommendations. The rapid review into data on mental health inpatient settings was commissioned by ministers to produce recommendations to improve the way data and information is used in relation to patient safety in mental health inpatient care settings and pathways, including for people with a learning disability and autistic people. This report contains the findings of the review, including a set of recommendations for improvements in the way local and national data is gathered and used to monitor and improve patient safety in mental health inpatient pathways.
Delay to the Liberty Protection Safeguards (LPS). A Department of Health and Social Care (DHSC) letter to the chair of the Joint Committee on Human Rights confirms the Government's decision to delay implementation of the Liberty Protection Safeguards. The letter suggests that whilst accepting the need for change, the Government has decided that now is not the right time to introduce this reform. It also highlights that the DHSC and the Ministry of Justice intend to work together to consider the feedback and publish a response to the 2022 consultation on changes to the Mental Capacity Act (MCA) Code of Practice, with the aim of publishing a revised MCA Code that supports understanding and the application of the MCA which is essential to the application of Deprivation of Liberty Safeguards. See news item.
Student mental health in England: Statistics, policy, and guidance. This briefing includes data on student mental health, discusses whether universities have a duty of care, and highlights Government policy and sector guidance.
Individual placement and support for severe mental illness. Individual placement and support (IPS) is an evidence-based model of supported employment. The implementation of IPS has been part of the NHS Long Term Plan and preceding strategies for national mental health improvement for more than eight years and is a fundamental part of the ongoing transformation of community mental health services. This guidance is aimed at integrated care systems and outlines how IPS should be embedded within integrated models of primary and community services for patients with severe mental illness.
Making financial decisions for young people who lack capacity: A toolkit for parents and carers. Ministry of Justice guidance provides advice for parents and carers on making financial decisions for a young person who lacks mental capacity. The toolkit provides information on: what lacking mental capacity means and the decision-making principles; the changes to decision-making responsibility when a child reaches adulthood; the relevant route to make financial decisions on behalf of a young person, including how to access a child trust fund; and if the young person is under the age of 18, how to prepare to make financial decisions when they reach adulthood.
Deprivation of liberty. The Nuffield Family Justice Observatory have published a report on findings from an analysis of applications to the national deprivation of liberty (DoL) court and a review of the outcome of DoL applications in England and Wales. Findings include: over 70% of the children where DoL orders was sought to manage risks related to criminal exploitation, emotional difficulties, behaviours that were a risk to others and self-harm were placed in at least one unregistered placement; and the use of restraint was permitted in 69.4% of cases. Recommendations include: children should be given the opportunity to communicate their views to the court; and there is a need to develop more suitable, local placements for children with complex needs.
Cases
Gloucestershire Hospitals NHS Foundation Trust & Anor v Joanna [2023] EWCOP 21. Application for declaration that Joanna lacks capacity to decide about her obstetric care and to litigate and about her best interests.
MacPherson v Sunderland City Council [2023] EWCA Civ 574. Appeal against a committal order where the appellant had admitted breaching orders made preventing her from recording or videoing her daughter.
Shrewsbury and Telford Hospital NHS Trust v T & Anor [2023] EWCOP 20. Judgment giving reasons for refusing an anticipatory declaration involving obstetric care for T.
Nottingham University Hospitals NHS Trust & Anor v RL & Ors [2023] EWCOP 22. Capacity and best interests judgment concerning RL who has been refusing food in prison.
News
Government acts to improve patient safety in mental health care. Health and Social Care Secretary Steve Barclay announces inquiry into deaths of mental health inpatients in Essex will become statutory.
Bevan Brittan Events
What to do when P won’t engage in a capacity assessment? It is not an uncommon scenario for a person to refuse to engage with an assessment of their capacity. But what is the legal position when this happens and practically, what should professionals do?
Eating disorders and disordered eating: treating the body and the mind. Cases concerning eating disorders and disordered eating are becoming increasingly prevalent in the Court of Protection and High Court.
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
Tackling ableism in health care: the role of primary care. How can GPs improve access to primary care for disabled people? Deborah Fenney (a Fellow at The King's Fund) shares insights from the East of England Trailblazer Deprivation Fellowship Scheme, and highlights the need for wider system support.
Accessible and inclusive communication within primary care: what matters to people with diverse communication needs. This report sets out the key issues faced by people with specific communication needs within primary care and what they feel would make the biggest difference. It also outlines some key actions primary care leaders and teams can take to support inclusive communication.
A shift to multidisciplinary teams in general practice: what this means for people experiencing health inequalities and frequent users of primary care services. This report makes recommendations on how to improve experiences of multidisciplinary teams within general practice among populations who experience health inequalities and frequent users of primary care services. In particular, it highlights how primary care teams can build trust and assure people that general practice has oversight of their care.
A vision for the future of primary care. Through insights gathered within a coalition of health and care charities, this report identifies nine proposals for the reform of primary care that could make a difference for people living with health conditions and disability, and in particular people from groups that experience health inequalities, while also supporting the primary care workforce.
Bevan Brittan Updates
Patient Choice: What might this mean for commissioners and GPs? - Anna Davies
If you wish to discuss any issues in primary care then please contact Joanne Easterbrook or Ben Lambert.
Public Health
Publications/Guidance
After the pandemic: is the new public health system in England fit for purpose? The perspective of England’s directors of public health
The CHPI was commissioned by the Joseph Rowntree Charitable Trust to conduct research on the new public health structures that have been put in place in England since it was announced in 2020 that Public Health England was to be abolished. As the current pandemic has shown an effective, well organised accountable public health system is not only key to controlling the spread of a disease – permitting the wider economy and public services to function – but is also vital in addressing growing health inequalities.
Leading for population health: clinicians’ perspectives. Clinicians can play an important role in improving the health of their local communities through adopting a population health approach. In The King's Fund's latest long read, 10 clinicians share what helps and what hinders their efforts.
The Association of Directors of Public Health policy position: drugs. Substance use continues to create public health challenges across the UK, causing harm to individuals, families and communities. The number of substance-related deaths registered in England and Wales has increased since 2019 from 4,393 to 4,561, with highest rates of death in those aged 45 to 49 years, and it is estimated that alcohol and substance use costs the UK £21 billion. In this updated policy position statement, ADPH urges the government to recognise the impact of substance use on wider measures such as child protection, crime reduction and hospital admission and ensure that substance use services focus on outcomes including: harm reduction, social integration, recovery, tackling vulnerability,
safeguarding and exploitation.
Leading for population health: clinicians’ perspectives. Clinicians can play an important role in improving the health of their local communities through adopting a population health approach. In our latest long read, ten clinicians share what helps and what hinders their efforts.
Royal Society for Public Health: strategic plan 2022-2027. The RSPH has published its new strategy setting out its vision for public health for the next five years. This vision sets out a clear path for all members of the population to have better health and lead healthier lives for longer and reaffirms its mission to 'provide voice and vision to the wider public health workforce and beyond to support healthier lives'.
After the pandemic: is the new public health system in England fit for purpose? The perspective of England’s Directors of Public Health. The CHPI was commissioned by the Joseph Rowntree Charitable Trust to conduct research on the new public health structures that have been put in place in England since it was announced in 2020 that Public Health England was to be abolished. As the current pandemic has shown an effective, well-organised accountable public health system is not only key to controlling the spread of a disease – permitting the wider economy and public services to function – but is also vital in addressing growing health inequalities.
Population health management in primary health care: a proactive approach to improve health and well-being. This publication identifies key success factors at the system, organisational and clinical levels to enable population health management in primary health care (PHC). It includes 12 country examples from across the WHO European Region showing how population health management is used in PHC. The publication provides a set of 16 policy actions to help PHC providers move towards a population health management approach that are classified following the PHC levers of the WHO Operational Framework for Primary Health Care.
If you wish to discuss any issues in public health please contact contact Claire Bentley.
Regulation
Publications/Guidance
HCPC response to the Department for Science, Innovation and Technology and the Office for Artificial Intelligence's consultation on AI regulation: a pro-innovation approach. In its response to the consultation, "A Pro-innovation Approach to AI Regulation", the Health and Care Professions Council (HCPC) calls for further discussion around how professional regulators, and the professions that it regulates would interact with the framework put forward in the consultation, acknowledging that AI is still developing and the framework will need to be able to respond to a rapidly evolving landscape.
If you wish to discuss any issues around regulation then please contact Siwan Griffiths
Social Care
Publications/Guidance
Building a resilient social care system in England: What can be learnt from the first wave of Covid-19?. Social care in England entered the pandemic in a fragile state. With much already written about the government’s response to the Covid-19 pandemic in the social care sector, our new report in collaboration with the Care Policy and Evaluation Centre analyses the structural and systemic factors that influenced that initial national response. Covid had far-reaching impacts on social care and exacerbated many longstanding issues. This work seeks to highlight progress and identify where action is needed to create a more resilient system.
Safe care at home review. Joint review led by the Home Office and DHSC into the protections and support for adults abused, or at risk of abuse, in their own home by people providing their care.
Government proposals for children's social care reform: Research Briefing. A House of Commons Library briefing summarises Government proposals for reform of children's social care in England. It's implementation strategy and consultation "Stable Homes, Built on Love", based on three independent reports, sets out "whole system reform". It also details responses to the Government's proposals.
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If you wish to discuss any queries you may have around social care please contact Siwan Griffiths.
General
Publications/Guidance
Obesity policy in England. This briefing provides an overview of the Government's obesity policy in England.
The Hewitt Review: an independent review of integrated care systems. The Rt Hon Patricia Hewitt was commissioned to lead an independent review of integrated care systems in November 2022.
Government response to the HSCC report and the Hewitt Review on integrated care systems. Government response to the Health and Social Care Committee’s report on the autonomy and accountability of integrated care systems, and on the independent Hewitt Review.
National framework for NHS continuing healthcare and NHS-funded nursing care. This guidance sets out the principles and processes of the national framework for NHS continuing healthcare and NHS-funded nursing care.
Aligning the upper age for NHS prescription charge exemptions with the State Pension age: government response. Following consultation on aligning the upper age for the NHS prescription charge exemption with the state pension age, the Department of Health and Social Care has decided that the prescription charge upper age exemption will remain at 60, meaning that it will not align to the State Pension age.
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