31/07/2023
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.
When might mediation be helpful in the Court of Protection context? 7th September 12.30pm
Recent developments in breach and causation for clinical negligence lawyers. 12th September 12.30pm
PSIRF and the Coronial Process 21st September 12.30pm
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
Acute inpatient mental health care for adults and older adults. Guidance to support the commissioning and delivery of timely access to high-quality therapeutic inpatient care, close to home and in the least restrictive setting possible.
Six steps to better care for older people in hospital. A key piece of guidance aiming to support hospital teams to improve care of older people living with frailty is now available, in a collaboration between GIRFT and the British Geriatrics Society (BGS). Six Steps to Better Care for Older People in Acute Hospitals accompanies a new GIRFT Hospital Acute Care Frailty Pathway, and offers detailed measures to improve care and reduce hospital-acquired dependency for those living with frailty.
Urgent and emergency care survey 2022. Care Quality Commission (CQC) statistics on people’s experiences of NHS urgent and emergency care services in England in September 2022.
Access to urgent and emergency care: Evidence to the Public Accounts Committee. Written evidence submission to the House of Common's Public Accounts Committee inquiry examining access to urgent and emergency care.
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
Learning from case review briefing on child sexual exploitation (CSE). This NSPCC briefing includes key learning around: identifying children and young people at risk of CSE; recognising and responding to signs of CSE; and the use of victim blaming language. Learning for better practice includes the need for ongoing and child centred support for young people experiencing CSE.
Invisible children: understanding the risk of the cost-of-living crisis and school holidays on child sexual and criminal exploitation. Barnardo’s has published a report on child exploitation across the UK which looks at the impact of the cost of living crisis and school holidays. Findings from survey data and Freedom of Information (FOI) requests to police and local authorities in the UK include: during months when there are school holidays of 2 weeks or longer, there are dips in the monthly average police records of child sexual exploitation, which increase again during term time; and there is a lack of specialist support services for children who experience exploitation. Recommendations include: all governments across the UK should invest in specialist support services and the UK Government should strengthen protections from online child criminal exploitation, including within the Online Safety Bill.
Keeping girls and young women safe: protecting and supporting the girls and young women at risk of exploitation, violence, gangs and harm. The Commission on Young Lives and Manchester Metropolitan University have published a report on girls at risk of child criminal and sexual exploitation. The report discusses issues around reliable data due to: under-reporting of concerns or offences relating to exploitation; and stereotypical assumptions held by the police and the public concerning girls’ behaviour. Recommendations include: prioritise the protection of girls from gang related harms in safeguarding frameworks; and provide education programmes that support girls and tackle misogyny.
The Family Court and domestic abuse: achieving cultural change. The Domestic Abuse Commissioner for England and Wales has published a report on protecting children in the Family Courts. The report draws on data from surveys with legal practitioners and roundtables and discusses: issues in the Family Court for children who have experienced domestic abuse; and centring the voice of the child.
Evaluation of the care leavers social impact bond programme. The Department for Education (DfE) has published an evaluation of projects supporting 16- to 25-year-old care leavers in England. Findings from the evaluation include: the programme contributed towards an improvement in education, employment and training (EET) outcomes for the care leavers involved and helped achieve improved stability and wellbeing outcomes.
Children’s social care data in England 2023. Ofsted has published inspections data and information about the providers and places of children’s social care in England. Findings include: there was a 9% increase in the number of children’s homes at 31 March 2023 and a 7% increase in the number of places compared with 31 March 2022.
Attainment gaps for children in social care. The Education Policy Institute has published a blog analysing the GCSE attainment gap for looked after children in England. The blog focuses on children who have been looked after in the previous 6 years, children in need with a child protection plan (CPP) in the previous six years, and children in need without a CPP in the previous 6 years. The analysis found that GCSE grade gaps widened markedly for all three groups in 2020 and each fell even further behind their peers in 2021.
The Birth Charter for women with involvement from children’s social care. Birth Companions has published a Birth Charter setting out how services and systems in England should support pregnant women and mothers of children under 2 involved with children’s social care. The principles call for: specialist and continuous support during pregnancy, birth and early motherhood; help in retaining or regaining care of their baby where possible; and access to independent advocacy support.
Keeping in touch: Looked after children and young people’s views on their contact arrangements
The Summary Paediatric Indicator Table (SPaedIT) brings together provider-level data summarising demand, capacity, flow and outcomes, all in one place in an easily-accessible dashboard. Refreshed monthly, the data is available across eight key paediatric surgical specialties and more than 35 metrics, supporting frontline NHS colleagues in the 180 providers treating children in England (specialist centres and DGHs), as well as policy makers and commissioners.
Child Health Clinical Outcome Review Programme - The Inbetweeners – a review of the transition from child into adult health services
Ofsted review into Start for Life services: terms of reference. A joint thematic review, to be undertaking by OFSTED and the Care Quality Commission (CQC), will consider Start for Life services, including their delivery through the family hub model. The review, which will conclude at the end of summer 2023, will: evaluate families' experiences of local services and whether these services are joined up effectively; identify ways in which families can be further supported to give their babies the best start in life; and identify whether the current level of inspection of Start for Life services is sufficient to capture any issues around join up and to improve families' experiences of local services.
Prevention in health and social care: vaccination: Tenth Report of Session 2022-23. A Health and Social Care Committee report on vaccination warns that the UK is at risk of losing its position as a global leader on vaccination without action to address challenges around uptake and bureaucratic processes in setting up clinical trials. It calls for urgent action to tackle declining rates among children, citing concern that England did not meet the 95% target for any routine childhood immunisations in 2021-22. The Committee highlights that the UK lags behind international competitors on support for clinical research, in particular in the clinical trials system, and calls for urgent reform. It also wants to see action now to ensure the readiness of relevant bodies to support innovations around preventative healthcare, such as personalised cancer vaccine, given an uncertain timeframe.
Strip search of children in England and Wales - analysis by the Children's Commissioner for England. A Children's Commissioner report, which analyses strip searches of children conducted by police under their stop and search powers across England and Wales, shows that the problem is not an isolated one, limited to London, and there is evidence of deeply concerning practice. Findings include evidence of widespread non-compliance with the statutory safeguards in place to protect children, including the lack of appropriate adults in more than half of searches and strip searches being conducted in schools, police vehicles, and within public view. Additional serious concerns relate to the poor quality of record-keeping and that Black children are up to six times more likely to be strip searched in comparison with national population figures.
Families first for children (FFC) pathfinder programme. A Department for Education policy paper Information about the families first for children (FFC) pathfinder and family networks pilot (FNP), that will work with local authorities to deliver children's social care reform, provides details of the programme which, from July 2023 to March 2025, will design and test radical reforms in a number of local areas, across the following policies: family help; child protection; family network support packages (FNSPs); and safeguarding partners. Dorset, Lincolnshire and Wolverhampton will be the first areas to deliver FFC.
Support for childcare and the early years: Fifth Report of Session 2022-23. An Education Committee report welcomes the Government's focus on childcare in Spring Budget 2023, but warns it has more work to do and should consider wider policy changes to ensure children benefit from high quality affordable childcare and to help parents and providers who are struggling. During the course of the inquiry the Government announced the largest expansion in public investment in childcare on record through an extension of its funded hours, however the overall system remains complex and the Committee has made a number of recommendations to increase choice, availability and flexibility for parents.
Consultations
Children and young people’s consultation: Inspecting supported accommodation. Ofsted has launched a consultation on inspecting supported accommodation for looked after children and care leavers aged 16 and 17. The consultation is aimed at children and young people and closes on 08 September 2023.
News
No care places left for most vulnerable children in England, MPs told. The BBC has published a news story on unregulated accommodation and the lack of places in children's homes in England. The news story highlights concerns around where vulnerable children will be placed due to a shortage of spaces in homes and the use of unregulated care settings.
Revealed: children’s care homes flood into cheapest areas of England, not where most needed. The Observer has published a news story about its investigation into children’s social care provision in England. Figures gathered by the Observer show a disproportionate number of children’s care homes are being placed in areas with the cheapest house sale prices in England. Concerns were raised around private companies locating homes where it is cheapest for them rather than where they are needed.
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
NHS Resolution has published its Annual report and accounts for 2022/23. It demonstrates the organisation’s ongoing commitment to an innovative dispute resolution strategy that has effectively reduced litigation rates and costs.
Improving patient safety culture – a practical guide. This guide brings together existing approaches to shifting safety culture as a resource to support teams to understand their safety culture and how to approach improving it.
England state of maternity services 2023. According to this report, if the number of NHS midwives in England had risen at the same pace as the overall health service workforce since the last general election, there would be no midwife shortage. It highlights the lack of investment in maternity services and the impact of staffing shortages on women. It also describes how more complex needs, including rising levels of obesity in pregnancy and increases in the number of older women having babies, are increasing demands on maternity services.
Government acts to boost the quality of care for mothers and babies. Measures to be taken on a national level to further improve safety standards in maternity care.
Maternity and neonatal services in East Kent report: government response. The government response to the ‘Reading the signals’ report of the independent investigation led by Dr Bill Kirkup CBE on maternity and neonatal services in East Kent.
Pregnancy Loss Review. A vision for improving the care and support available to families when baby loss occurs before 24 weeks' gestation.
Government response to the independent Pregnancy Loss Review. Sets out the immediate actions government will be taking in the short term in response to the recommendations made in the independent Pregnancy Loss Review.
Independent Neurology Inquiry - report. The report of the Independent Neurology Inquiry finds that Belfast Health Trust failed to intervene quickly enough in the practice of a doctor which led to Northern Ireland's largest ever patient recall. Recommendations include: the Department of Health (DoH) should review its guidance in relation to complaints, to ensure that patient safety is the overriding objective; the DoH should make clear how, when investigating complaints, healthcare organisations should detect and investigate poor practice; healthcare organisations should ensure that refusal or failure by a clinician, without good reason, to carry out an annual appraisal should result in a careful scrutiny of the clinician's broader practice by the organisation, who should regard the failure to follow policy as a performance issue; healthcare organisations should make every effort to provide consultants with opportunities to avoid lone working; and healthcare organisations should recognise that, whilst patient consent to review their notes is always desirable, if there are urgent matters of patient safety to be resolved then the need for consent should be overridden.
Government response to "Reading the signals: maternity and neonatal services in East Kent - the report of the independent investigation" A Department of Health and Social Care publication sets out the Government's response to the report of the independent review by Dr Bill Kirkup into the maternity and neonatal services at East Kent University NHS Foundation Trust, which was commissioned by NHS England following concerns about the quality and outcomes of care. This inquiry made five recommendations for the healthcare system. The Government's response sets out in detail how each recommendation is being implemented. The Minister for Mental Health and Women's Health Strategy also confirmed that she will also chair the new National Oversight Group to bring together the key people from the NHS and other organisations to look across maternity and neonatal improvement programmes and the implementation of recommendations from this and other maternity reviews.
Improving multi-agency information sharing. Government policy on information sharing and the use of a consistent child identifier.
Black maternal health: Government Response to the Committee's Third Report: Fifth Special Report of Session 2022-23. A Women and Equalities Committee report sets out the Government's response to its "Black maternal health" report. The Government rejects the recommendation to set a target and strategy to end disparities in maternal deaths but acknowledges that more must be done to ensure maternity care is consistent regardless of ethnicity. The Government confirms that NHS England will carry out a scoping exercise on a review of training curricula and continuing professional development requirements for all maternity staff.
Urology: towards better care for patients with kidney cancer. This guidance, a collaboration between Getting It Right First Time, the British Association of Urological Surgeons and the British Association of Urological Nurses, describes the key features of a good kidney cancer service and lists the quality actions teams can take to bridge any gaps they identify. It also includes a delivery checklist and case studies illustrating good practice.
Broken trust: making patient safety more than just a promise. This report states that the NHS must do more to accept accountability and learn from mistakes, particularly when there is serious harm or, worse, loss of life. The report sets out recommendations to improve patient safety. These include: better support for families affected by harm; embedding cultures that promote honesty and learning from mistakes; getting the right oversight and regulatory structures to prioritise patient safety; and an evidence-based and long-term workforce strategy that has cross-party support.
Consultations
Consultation outcome - Increasing the use of mediation in the civil justice system
Independent Neurology Inquiry (INI) Report Recommendations - Overarching INI Implementation Plan. The Department of Health seeks views on an overarching Independent Neurology Inquiry (INI) Implementation Plan, in response to the report of the INI which reviewed the governance of outpatient services in the Belfast HSC Trust, with a particular focus on neurology services; the corporate and clinical governance of health services delivered in the independent sector in Northern Ireland; and the records of all patients or former patients of Dr Michael Watt, who have died over the past 10 years. Comments by 18 August 2023.
Cases
McCulloch v Forth Valley Health Board. Supreme Court 2023 UKSC 26. The professional practice test was the correct legal test in determining what were the reasonable treatment options that a doctor had a duty of reasonable care to inform a patient about.
Wye Valley NHS Trust v Murphy 2023 7 WLUK 328. Permission to bring committal proceedings against a former patient whose claim for clinical negligence against an NHS trust had been dismissed for fundamental dishonesty was granted, as he had allegedly exaggerated his injuries and knowingly made false statements to bolster his claim so that he would receive more damages.
KJY v University College London Hospital NHS Foundation Trust. [2023] 7 WLUK 408. Two radiologists had failed to examine the hip area shown on the x-rays of a neonate days after his birth with reasonable and sufficient care. They had missed the resulting hip abnormality and the opportunity to diagnose the claimant with developmental dysplasia of the hip. They had breached their duty of care.
C v Sheffield Teaching Hospitals NHS Foundation Trust. 2023 EWHC 1770. The court assessed the appropriate level of general and special damages payable to an eight-year-old child who suffered from cerebral palsy, severe brain damage and spastic quadriplegia as result of clinical negligence during her birth. It determined, amongst other things, the appropriate award for pain, suffering and loss of amenity; the appropriate deduction for past gratuitous care; and whether an award should be made to cover the cost of installing a home hydrotherapy pool. Because most of the past-loss special damages related to expenses which had been funded by interim payments, it declined to follow the usual practice of awarding interest at half the special investment account rate.
Bevan Brittan Updates
Bevan Brittan Events
Recent developments in breach and causation for clinical negligence lawyers. 12th September 12.30pm
PSIRF and the Coronial Process 21st September 12.30pm
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
Overview of the Northern Ireland Executive's response to the COVID-19 pandemic - Third Report. A Northern Ireland Audit Office report summarises the Northern Ireland Executive's expenditure in response to the COVID-19 pandemic, which, at 31 March 2023, amounted to a total cost estimated to be £7.79 billion. The report also identifies several key lessons for departments which can be used in mainstream schemes and initiatives going forward. These include lessons on the use of self-declarations as a means of determining eligibility, the need for cross-departmental co-operation, and the importance of incorporating recovery and clawback arrangements to address potential error or fraud.
Over-exposed and under-protected: the long-term impact of Covid-19 on doctors. A significant number of doctors and other health care workers have developed post-acute Covid, including a large number who developed it as a result of workplace exposure to Covid-19. This paper examines the impact post-acute Covid symptoms have had on the medical workforce, personally and professionally. It provides a unique and valuable insight into the experience of UK doctors suffering from post-acute Covid.
If you wish to discuss any queries you may have around Covid and Claims please contact Daniel Morris.
Digital Health
Publications/guidance
Government must address past mistakes to deliver digital transformation in the NHS. This report from the Health and Social Care Committee highlights the need for the government to evaluate past mistakes in the NHS to succeed in implementing digital transformation in the NHS.
Digital and data strategy for health and social care in Wales. A Welsh Government publication details a refreshed digital and data strategy for health and social care in Wales. It sets out the expectation to leverage digital and data to advance the quality of health and social care services. It intends to improve the experience of health and social care users by designing digital and data services with patients, social care users, providers and clinicians.
Digital transformation in the NHS: Eighth Report of Session 2022-23. A Health and Social Care Committee report on the Government's ambition for digital transformation in the NHS warns it can only succeed if ministers address mistakes of the past. The Committee finds reason for optimism in the Government's approach however it cites evidence that parts of the health service still lack even the most basic, functioning IT equipment. They note previous attempts at digital transformation have been thwarted by out-of-date "legacy" IT systems and hardware unable to handle the demands of a modern digital health service. Concluding that a shortage of skilled digital professionals present a barrier to transformation, it recommends allowing additional pay and bonuses to recruit specialist staff.
News
£21 million to roll out artificial intelligence across the NHS. With the help of a new £21 million fund, which the Health and Social Care Secretary announced on 23 June, NHS professionals will have access to the most advanced artificial intelligence (AI) technologies to diagnose and treat patients more swiftly.
If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.
Employment/HR
Publications/guidance
Postvention guidance: supporting NHS staff after the death by suicide of a colleague. This guidance was developed with the input of NHS staff affected by a colleague's death by suicide and those who have provided support to staff affected by suicide. Staff members across a wide range of job roles and levels of seniority shared their experiences and insight as part of a nationwide study that aimed to understand the impact of colleague suicide on NHS staff.
Review Body on Doctors’ and Dentists’ Remuneration 51st Report: 2023. Recommendations and observations from the Review Body on Doctors’ and Dentists’ Remuneration on doctors’ and dentists’ pay in England, Scotland, Wales, and Northern Ireland.
Applying for health and social care jobs in the UK from abroad. Guidance for prospective international applicants for health and social care jobs in the UK.
The NHS workforce in England. This briefing covers the NHS workforce in England, including key targets, recruitment and retention issues, workforce planning and Government policy.
The NHS Long Term Workforce Plan explained by the Kings Fund. This explainer sets out the main commitments in the plan and provides the Kings Fund view of what they might mean, highlighting the opportunities and challenges for the health care system as the plan is put into practice.
The size and structure of the adult social care workforce in England: workforce supply and demand trends 2022/23. Workforce supply and demand is a key issue for the adult social care sector, and in recent years workforce supply has experienced significant fluctuations due to policy changes and external factors. The information in this short report provides the latest figures and also context surrounding this topic. The report looks at changes in the workforce since the start of the Covid-19 pandemic, and before where relevant, using Skills for Care’s workforce sector estimates between 2012/13 and 2022/23.
Progress in improving NHS mental health services: Sixty-Fifth Report of Session 2022-23. A Committee of Public Accounts report on the increasing pressures on NHS mental health staff at a time of spiking demand warns that the increased workload is leading to burnout for remaining staff, which contributes to a higher rate of staff turnover and a resulting vicious cycle of more staff shortages.
NHS staff receive pay rise. The Government has accepted the independent pay review bodies' pay recommendations for NHS staff. Most eligible dentists and doctors will receive at least a 6% pay rise. It follows nurses, paramedics and midwives also receiving a pay rise and one off payments.
Employment Outlook 2023: Artificial intelligence and jobs: An urgent need to act. An OECD employment outlook report on the potential impact of artificial intelligence (AI) has warned that a global "AI revolution" is imminent, threatening jobs in the professional sectors such as law, medicine and finance, representing approximately 27% of jobs across its 38 member nations, including the UK, US, Germany, Japan, Australia, and Canada. The report also highlighted risks associated with AI's increasing influence over workplaces, including potential AI biases in hiring decisions amid growing evidence of gender and racial bias in AI-facilitated recruitment processes.
Black maternal health: Government Response to the Committee's Third Report: Fifth Special Report of Session 2022-23. A Women and Equalities Committee report sets out the Government's response to its "Black maternal health" report. The Government rejects the recommendation to set a target and strategy to end disparities in maternal deaths but acknowledges that more must be done to ensure maternity care is consistent regardless of ethnicity. The Government confirms that NHS England will carry out a scoping exercise on a review of training curricula and continuing professional development requirements for all maternity staff.
Improving patient safety culture – a practical guide. This guide brings together existing approaches to shifting safety culture as a resource to support teams to understand their safety culture and how to approach improving it.
Stretched to the limit: tackling the NHS productivity challenge. This report explores the main barriers trusts are facing as they seek to recover performance and improve productivity. It also considers the financial impact of current pressures and the scale of the efficiency ask, which is even more stretching than in 2022/23.
NHS industrial action: the impact on patients, staff and performance. This briefing sets out the impact industrial action is having on patients, staff and NHS performance, including the NHS’ financial sustainability, productivity, and ability to tackle care backlogs.
NHS Pay Review Body: thirty-sixth report 2023. The NHSPRB provides independent advice on the pay of NHS staff. This report sets out the NHSPRB’s analysis of evidence provided by relevant organisations and makes observations on the pay of NHS staff paid under Agenda for Change for 2023 to 2024.
National training survey: 2023 results. This annual survey was completed by more than 70,000 doctors across the UK who are either in training or act as trainers. It included questions on discrimination for the first time this year, uncovering worrying insights into the experiences of trainees. Though most doctors in training say they work in supportive environments, more than a quarter (27 per cent) said they’ve experienced micro-aggressions, negative comments or oppressive body language from colleagues.
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
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.
Helping ambulance services reduce health inequalities: The Association of Ambulance Chief Executives (AACE), working on behalf of the UK’s NHS ambulance services, has released new guidance on how the ambulance sector can contribute to reducing health inequalities. The resources underline 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.
Cross-government co-ordination to improve health and reduce inequalities: Summary of a private roundtable. An Institute for Government report provides a summary of a roundtable discussion jointly organised by it and the Health Foundation in June 2023 of experts and officials with experience working in cross-government roles, on the barriers to more effective cross-government co-ordination and the opportunities for both the centre of government and individual departments to take a more ambitious whole-government approach to improving health and reducing 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.
Housing
Publications/Guidance
Older People's Housing Taskforce - call for evidence. A Department of Health and Social Care consultation seeks views to help to inform the deliberations of the Older People's Housing Taskforce. Split into three workstreams, the Taskforce invites input on: people, what they want, what they prefer, and what concerns they might have about their housing, now or in the future; products, including the type of housing, quality of design and the use of smart technology to aid independent living; and places, including how to open up investment to increase the volume and diversity of housing options for older people of lower and middle income and the impact of wider market conditions on investment in housing. Comments by 23.59 on 18 September 2023.
Living standards, poverty and inequality in the UK: 2023. Two reports by the Institute for Fiscal Studies explore recent trends in poverty, and government policies a ndards, poverty and inequality in the UK: 2023 imed at alleviating it, and how living standards have changed for different groups in the UK, with a particular focus on the cost of living payments and housing.
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
Regulating medical devices in the UK. What you need to do to place a medical device on the Great Britain, Northern Ireland and European Union (EU) markets.
Consultation on risk assessment framework for independent sector providers of NHS services. NHS England outlines the themes that arose during its consultation on an updated version of its Independent Provider Risk Assessment Framework (IPRAF), including: greater clarity on how the new approach will link with that of other regulators; greater clarity on how the new approach will link with other frameworks/processes within NHS England; and proportionality of oversight considering the risk posed.
Further open letter to private healthcare consultants and hospitals from CMA. Following its October 2022 letter to private healthcare consultants and hospitals, in which it warned it would take enforcement action against healthcare providers over concerns prospective patients are not being given the essential information they need, in breach of the Private Healthcare Market Investigation Order 2014, a further open letter from the Competition and Markets Authority (CMA) explains that it is now escalating its public enforcement action against non-compliant private hospitals and consultants.
Code on Genetic Testing and Insurance: call for evidence. A Department of Health and Social Care consultation seeks views on the Code on Genetic Testing and Insurance, the voluntary agreement between the UK Government and the Association of British Insurers which provides guidance on the role of genetic testing in insurance across the UK, and whether it may need to be revised to ensure it remains beneficial to both consumers and the insurance industry and that it remains fit for purpose.
Non-surgical Cosmetic Procedures: Licensing - Question for Department of Health and Social Care. In response to a written question asking when the consultation on a licensing scheme for non-surgical cosmetic procedures will be published, the Department of Health and Social Care states that: the Government intends to publish a public consultation on proposals for the scope of the treatments to be included within the licensing scheme for non-surgical cosmetic procedures later in summer 2023; and it will work with stakeholders to determine the education and training requirements that practitioners will have to meet, alongside hygiene, cleanliness and indemnity requirements, to demonstrate that they can practise safely.
For more information contact Tim Hodgetts or Julie Charlton
Information sharing
Publications/guidance
Improving multi-agency information sharing. The Department for Education (DfE) has published a policy paper on information sharing which explores the barriers and potential enablers to better information sharing in England. Recommendations for improving information sharing include: functioning, joined-up systems across agencies that enable the right data to be used securely by the right people at the right time; an accurate and well maintained ‘golden record’ about a child/family; and confident practitioners who are clear on their roles and responsibilities for sharing and seeking information.
For more information contact Jane Bennett.
Inquests
Publications/guidance
R. (on the application of Maguire) v HM Senior Coroner for Blackpool and Fylde. Supreme Court | [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.
Updates
Article 2 duties re-confirmed: The Systems Duty and Operational Duty
Events
PSIRF and the Coronial Process 21st September 12.30pm
If you wish to discuss any queries you may have around inquests, please contact Toby De Mellow or Claire Leonard.
Mental Health
Publications/guidance
Agreement to support mental health care and free up police time. The NHS, police and government commit to a new approach to ensure those requiring urgent mental health support receive timely care from the most appropriate agency.
National Partnership Agreement: Right Care, Right Person. A joint Department of Health and Social Care (DHSC) and Home Office document sets out a framework for how police and health services should improve the response to people with mental health needs. This agreement is between the DHSC, the Home Office, NHS England, the National Police Chiefs' Council, the Association of Police and Crime Commissioners, and the College of Policing. The agreement aims to work to end the inappropriate and avoidable involvement of police in responding to incidents involving people with mental health needs. Where it is appropriate for the police to be involved in responding, this will continue to happen, but the police should only be involved for as long as is necessary, and in conjunction with health and/or social care services.
Progress in improving NHS mental health services: Sixty-Fifth Report of Session 2022-23. A Committee of Public Accounts report on the increasing pressures on NHS mental health staff at a time of spiking demand warns that the increased workload is leading to burnout for remaining staff, which contributes to a higher rate of staff turnover and a resulting vicious cycle of more staff shortages.
Acute inpatient mental health care for adults and older adults. Guidance to support the commissioning and delivery of timely access to high quality therapeutic inpatient care, close to home and in the least restrictive setting possible.
Maternal mental health: a briefing for integrated care systems. This briefing aims to help integrated care systems (ICSs) understand the role they have in ensuring every new and expectant mother receives the right mental health support at the right time, close to home. It finds that, if untreated, maternal mental health problems can cost an average-sized ICS the equivalent of £190 million per year. The briefing outlines why maternal mental health is important and explains the steps ICSs can take to provide the right support. It also suggests ten key areas in need of immediate action: universal services; NHS talking therapies; specialist perinatal mental health services; inpatient services; maternal mental health services; voluntary and community sector support; family hubs; baby loss support; tackling stigma; and reducing loneliness and isolation.
Bevan Brittan Updates
Update on the DoL Streamlined Procedure
Bevan Brittan Events
When might mediation be helpful in the Court of Protection context? 7th September 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
Face-to-face health checks more than double in one year. The number of NHS Health Checks offered and carried out more than doubled in 2022 to 2023.
Supporting digital inclusion in general practice: 10 top tips. This guide has been produced by the Good Things Foundation and NHS England’s Primary Care Transformation Programme, supported by the voluntary, community and social enterprise (VCSE) Health and Wellbeing Alliance. It is aimed at health care staff in general practices, primary care networks (PCNs), integrated care systems (ICSs) and anyone else who is seeking to reduce digital exclusion in general practice, particularly among under-served and marginalised communities. It draws on examples of good practice shared by more than 30 primary care organisations and VCSE organisations in England.
The future of general practice: Government Response to the Committee's Fourth Report. A Health and Social Care Committee report sets out the Government's response to the Committee's report on the future of general practice which urged Ministers and NHS England to acknowledge a crisis in general practice and set out what steps they are taking to protect patient safety. The Government accepts or partially accepts the majority of recommendations made by the Committee, including: the need to ensure that trainee GPs are distributed across the country to support areas facing the greatest challenges in ensuring access to a GP; the need to simplify how patients interact with the NHS with improved access; and increased organisational support for GPs with a focus on back-office functions. Recommendations rejected include a number of measures that were intended to restore the doctor-patient relationship.
A vision for the future of primary care. Through insights gathered within a coalition of health and care charities, National Voices has identified nine proposals for the reform of primary care that it believes would make a significant 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.
If you wish to discuss any issues in primary care then please contact Joanne Easterbrook or Ben Lambert.
Regulation
Publications/Guidance
Improving regulation for the future: regulation survey 2023. This report explores NHS trust leaders' views of regulation over the past 12 months. Most trusts said that regulatory burden (52 per cent) and the number of 'ad hoc' requests (59 per cent) grew last year, at a time when services were more overstretched than many leaders can ever remember.
If you wish to discuss any issues around regulation then please contact Siwan Griffiths
Social Care
Publications/Guidance
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.
Variations in the delivery of palliative care services to adults. A Healthcare Safety Investigation Branch report sets out the findings of its investigation which aimed to improve the experiences of people accessing palliative and end of life care (PEoLC) services in England. In England the first national strategy for PEoLC was published in 2008 following recognition that people did not always die in their preferred location or receive high-quality care. Since then, national publications have described what people should be able to expect from PEoLC, but they have also highlighted continued concerns about the delivery of services in England. To help explore the delivery of PEoLC in England, the investigation considered the care and experiences of 77-year-old Dermot, who had been diagnosed with a myxofbrosarcoma, and his family.
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
Review of neonatal assessment and practice in Black, Asian, and minority ethnic newborns: exploring the Apgar score, the detection of cyanosis, and jaundice
Neonatal assessments include the Apgar score, a quick observation test used to assess babies minutes after birth, which was developed in 1952 and is now considered out of date by many health care professionals. The assessments are used as standard by health care professionals regardless of a baby’s skin tone and can give misleading scores. This report concludes that tests that indicate the health of newborns minutes after birth are limited and not fit for purpose for Black, Asian and ethnic minority babies, and need immediate revision.
Variations in the delivery of palliative care services to adults. This report sets out an investigation undertaken examining the quality and consistency of palliative care provided to adults. It finds that palliative and end-of-life care is ‘variable and inequitable’ across the NHS in England and that these differences may be more noticeable in areas where funding for services is limited or where care is being delivered across wide geographical areas.
Progress with the New Hospital Programme. This report finds that the New Hospital Programme has experienced delays and is expected to deliver 32 of the intended target of 40 new hospitals by 2030.
Getting the fundamentals right: how to better prepare for discharge pressures next winter. Delayed discharges, where a patient is medically fit to leave hospital but is not discharged, were a particular problem in England last winter. This long read highlights some possible solutions to help better prepare health and care services for discharge pressures next winter.
Stretched to the limit: tackling the NHS productivity challenge. This report explores the main barriers trusts are facing as they seek to recover performance and improve productivity. It also considers the financial impact of current pressures and the scale of the efficiency ask, which is even more stretching than in 2022/23.
NHS-funded IVF in England. Data showing how many in vitro fertilisation (IVF) cycles are funded by the NHS in each area of England.
The structure of the NHS in England. This briefing provides an overview of funding and accountability arrangements within the NHS in England. It also highlights issues including patient safety, NHS funding and performance.
NHS visitor and migrant cost recovery programme. Information and resources for NHS organisations, frontline staff and the public.
Women's reproductive health: Inquiry - Call for Evidence. The Women and Equalities Committee calls for evidence to inform its inquiry into menstrual and gynaecological health, and the challenges that women face when they are being diagnosed and treated for such conditions. Views are sought on: what constitutes healthy periods and reproductive health; women's experiences of being diagnosed with, undergoing procedures and being treated for gynaecological or urogynaecological conditions; disparities in the treatment and diagnosis of gynaecological or urogynaecological conditions; and barriers to treatment and diagnosis of gynaecological or urogynaecological conditions.
The Independent Pregnancy Loss Review - Care and support when baby loss occurs before 24 weeks gestation. A vision for improving the care and support available to families when baby loss occurs before 24 weeks' gestation.
Progress with the New Hospital Programme: Department of Health & Social Care, NHS England. A National Audit Office report examines whether the New Hospital Programme (NHP) is being managed in a way that is likely to achieve value for money. To reach its conclusions, it considered the extent to which the NHP: was designed and set up to manage the programme effectively; is making progress against its baselines for time, cost and quality; and is effectively identifying and managing the main risks to successful delivery. The report is organised in four parts, which cover: the need for new hospitals; progress made by the NHP between 2020 and 2023; issues, risks and opportunities for the NHP; and how the Government reset the NHP in May 2023. It concludes that the Department of Health and Social Care launched the NHP at a time when hospital construction was badly needed after years of underinvestment and in the context of a large maintenance backlog, but some schemes publicly promised in 2020 now face substantial delays and will not be completed by 2030, inevitably with implications for patients and clinicians. There could be substantial risks to value for money if the Government's intention to build as many new hospitals by 2030 were to lead to hospitals that were too small to meet the needs of the communities they serve or if costs were to be inflated because so many hospitals were being built at once.
If you would like to sign up for any of our Bevan Brittan publications click here.
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