Health and Care Update - November 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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Training Events	Independent Health
Acute and emergency care	Information Sharing/data
Children/young people	Inquests and Inquiries
Clinical Risk/Patient Safety	Mental Health
Digital Health	Primary Care
Employment/HR	Prison Health
Finance	Regulation
Health Inequalities	Social Care
Housing	General

 

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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. 

Birth Injury Cases. What Can Neuroradiology Evidence Do For You? Join us on 23 January 2024 at 12.30pm for this webinar with Dr Felice D’Arco who will discuss the following:-
• The basics of MRI;
• Main radiological appearances in perinatal hypoxic ischaemic injury; and
• Punctate white matter lesions of the infant, a controversial entity with profound medico-legal implications. REGISTER HERE

Quantum Update For Clinical Negligence Practitioners. Join us for this webinar on 6 February 2024 at 12.30pm with Eliot Woolf KC who will review important recent clinical negligence quantum decisions and discuss how to put helpful developments into practice. REGISTER HERE

PSIRF and the Duty of Candour  - 5 December 2023

Employment and Immigration Law Update - Our 2023 Roundup - 6 December 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.  

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Acute and emergency care

Publications/guidance

Implementing recommendations: shared insights to reduce claims in emergency medicine.

New podcast: Learning from emergency department claims. NHS Resolution have launched a new podcast on learning from emergency department claims. In this episode they discuss with representatives from NHS England, Getting It Right First Time, and the Royal College of Emergency Medicine, how to use claims data to improve patient safety. 

Front door frailty: advice on setting up services. Front door frailty (FDF) services exist to identify people living with frailty as soon as they present to a hospital, to ensure that they are diverted to appropriate services as quickly as possible and, ideally, to ensure they are discharged to their normal place of residence (home or care home) the same day. Evidence suggests that these services benefit older patients as well as reducing pressure on hospitals. They have had a positive impact everywhere they have been introduced. This guide sets out five principles that should underpin FDF services to older people presenting at emergency departments. It provides tips on establishing services from those who have been through the process.

Caring for adults with learning disabilities in acute hospitals. This briefing shines a light on what it describes as a worrying fragmentation of communities across the UK, with those living in the most deprived communities at greatest risk of falling into a trap of long-term loneliness. It highlight the link between loneliness and numerous physical and mental illnesses, ranging from depression and dementia to cardiovascular diseases.

If you wish to discuss any queries you may have around acute and emergency issues please contact Claire Bentley.

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Children and young people 

Publications/Guidance 

An overview of child protection legislation in England. A broad overview of the legislative framework for child protection and child safeguarding in England.

Duties to report child abuse in England. A briefing on reporting child abuse in England, including Government plans to introduce a mandatory reporting duty.

Registration of stillbirth. This Commons Library briefing paper deals with current registration provisions relating to stillbirths and consideration of whether the law should be changed.

Inquiry into the life opportunities of young carers and young adult carers. The first ever parliamentary inquiry into young carers and young adult carers has revealed that a lack of support is having a devastating impact on their education, wellbeing and future prospects. The inquiry, supported by national charity Carers Trust, found that 15,000 children, including 3,000 aged 5–9, spend 50 hours or more a week looking after family members because of illness, disability or addiction. The report recommends the urgent introduction of a cross-government national carers strategy, including a properly resourced action plan for young carers and young adult carers. The government should also work with young carers and young adult carers on immediate plans to improve early identification, increase access to support, and reduce the numbers of young people providing excessive levels of care.

Reducing health inequalities faced by children and young people. This report sets out the data and evidence of the health inequalities experienced by children and young people. It outlines the rationale for shifting attention towards this age group to prevent health inequalities later in life. It also considers the role that trusts can play in targeting interventions towards improving the health and wellbeing of children and young people who are more likely to experience inequalities. The report also highlights the existing work of trusts to reduce children and young people’s health inequalities within case studies from Barts Health NHS Trust and Gateshead Health NHS Foundation Trust.

Independent review of disagreements in the care of critically ill children – the report and recommendations.

If you wish to discuss any queries you may have around children please contact Deborah Jeremiah or Ruth Shedlow.

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Clinical Risk / Patient Safety

Publications/Guidance 

NHS Resolution have released their Annual Statistics including factsheet 5.

Factsheet 5 – member and health authority statistics 2022-23 – This factsheet provides information about members and health authority claims NHS Resolution handled in 2022-23.

Four interactive GIRFT pathways have now gone live. The easy-to-navigate, web-based tools are designed for use by clinicians, nurses and allied health professionals (AHPs), guiding users through best practice examples of the processes and key decisions they should work through.

• Suspected Cauda Equina Syndrome
• Essential safety checks for people with diabetes 
• Management of patients presenting to ED with a foot problem
• Initial management of hyperglycaemia in adults in the ED
• Management of patients admitted in hypoglycaemia >

Thirlwall Inquiry: terms of reference. The Department of Health and Social Care has published the terms of reference for the Thirlwall Inquiry, set up to examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital. The terms of reference cover three broad areas: the experiences of the parents of the babies named in the indictment; the conduct of clinical and non-clinical staff and management, as well as governance and escalation processes in relation to concerns being raised about Lucy Letby and whether these structures contributed to the failure to protect babies from her; and the effectiveness of governance, external scrutiny and professional regulation in keeping babies in hospital safe, including consideration of NHS culture. The inquiry is currently setting up its infrastructure so that it can begin its investigations. This will be established by 17 November 2023.

Claims mediation. Supporting claimants, patients, their families and the NHS to resolve disputes fairly. Guidance for healthcare professionals and NHS staff

Preventing needlestick injuries. 2,600 claims for needlestick injuries were received by NHS Resolution with incident dates between 2012 – 2022 (fiscal years). Of these, there were 1,947 successful claims which cost the NHS £10,799,616 (total damages paid plus legal costs). The total cost for this time period could be higher as 167 claims remain open.

Saving lives, improving mothers’ care: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. This report, the tenth MBRRACE-UK annual report of the Confidential Enquiry into Maternal Deaths and Morbidity, includes surveillance data on women who died during or up to one year after pregnancy between 2019 and 2021 in the UK. In addition, it also includes confidential enquiries into the care of women who died between 2019 and 2021 in the UK and Ireland from obstetric haemorrhage, amniotic fluid embolism, anaesthetic causes, infection, general medical and surgical disorders, and epilepsy and stroke. The report also includes a Morbidity Confidential Enquiry into the care of women with morbidity following repeat caesarean birth.

Investigation report: Safety management systems - an introduction for healthcare. A Health Services Safety Investigations Body report explores the use of safety management systems (SMS) and how they could contribute to more effective safety management in healthcare. It calls for an overall systems approach which encompasses all aspects of healthcare including non-clinical services, which can have a significant impact on patient safety. It identifies three key opportunities to create an organised approach to safety management: SMS development; safety accountability frameworks; and safety maturity frameworks across the system. The report also sets out what future work on SMS and applicability to healthcare could look like, for example mapping current safety management activities in healthcare to SMS principles and identifying opportunities for improvement.

'I love the NHS, but…': preventing needless harms caused by poor communications in the NHS. This report makes a case for the urgent need to improve communication within the NHS. It found that more than half (55%) of people have experienced poor communications from the NHS in the past five years, and 1 in 10 say their care has been affected as a result. Demos calls on the government for: an expansion of the system of care co-ordinators; an expansion of the system of care navigators in GP surgeries; and improvements to the uptake and use of the NHS app.

Homecare medicines services: an opportunity lost. Homecare medicines services deliver medicines and provide medicine-related care to patients in their homes: teaching them to self-inject, and delivering medicine that might need special transport. Half a million NHS patients use homecare services in England, and the sector of for-profit companies providing these services is growing. The Committee heard multiple reports of delays and errors by homecare providers, resulting in patients receiving care later than scheduled. The Committee has concluded that this key service is not working the way it should and, in some cases, is causing patients serious harm. It sets out three key recommendations for improvement.

NHS injury costs recovery scheme: April 2023 to March 2024. Data on the funds collected by the Compensation Recovery Unit and funds paid to the NHS.

Consultations

Fixed recoverable costs in lower damages clinical negligence claims – a supplementary consultation on disbursements. A supplementary consultation on disbursements within the fixed recoverable costs scheme for clinical negligence claims up to a value of £25,000 in England and Wales. This consultation closes at
11:59pm on 22 December 2023

Cases

Anna Callaghan v. South Tees Hospitals NHS Foundation Trust (High Court, 19 May 2023 – Ellenbogen J.) In this case, involving the death of a week-old baby from Group B streptococcus bacterial meningitis and septicaemia, the court considered allegations of negligence centred around midwifery care and alleged premature discharge from hospital. 

Bevan Brittan Events

PSIRF and the Duty of Candour  - 5 December 2023

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.

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Digital Health

Publications/guidance

Smart prescribing: harnessing technology in the fight against AMR. Antimicrobial resistance (AMR) is a threat to global health and security. This report examines a critical, but often under-represented area of the United Kingdom's approach to AMR – optimising antimicrobial prescribing. It considers how better digital approaches to the problem of AMR could act as a critical exemplar of applying AI-based tools and wearable technology for the betterment of society and discusses how technology can be harnessed to support optimal antimicrobial prescribing behaviours.

Health at a glance 2023. Health at a glance provides a comprehensive set of indicators on population health and health system performance across OECD members and key emerging economies. They cover health status, risk factors for health, access to and quality of health care, and health system resources. This edition also has a special focus on digital health, which measures the digital readiness of OECD countries’ health systems, and outlines what countries need to do to accelerate the digital health transformation.

What do technology and AI mean for the future of work in health care? Recent developments in artificial intelligence (AI) have sparked fears about the potential threat to jobs in many industries, including health care. Drawing on labour market modelling, this long read analyses what makes health care different from other industries predicted to be more heavily impacted by new technologies.

Assistive technology research and development work: 2021 to 2022. Outlining the role of assistive technology in making independent living easier for older people and disabled adults and children.

News

AI to speed up lung cancer diagnosis deployed in NHS hospitals. Funds of £21 million will be allocated to 64 NHS trusts across England to support implementation of AI tools to speed up the diagnosis and treatment of lung cancer.

If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.

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Employment/HR  

Publications/guidance

Understanding and reducing tensions between clinical and non-clinical staff in the NHS, in relation to agile working. Increasing the level of flexibility offered to employees at work has become a key priority for NHS organisations. However, organisations have reported signs of rising tensions between clinical and non-clinical workers with respect to their different agile working opportunities. This research report explores interpersonal tensions between clinical and non-clinical staff in the NHS in relation to flexible working.

The case for an increase to NHS non-executive director remuneration: a collation of evidence from NHS Providers. This briefing draws on NHS Providers' survey responses and discussions with leaders from member trusts and foundation trusts. It is intended to support NHS England’s work on non-executive director and chair remuneration.

Why there’s still work to be done to close the gender pay gap in the NHS and social care. The latest figures on the gender pay gap in the UK show that it is reducing. However, Danielle Jefferies (Senior Analyst at The King's Fund) explains there is still work to be done to close the NHS gender pay gap and the gap across the wider health and social care sector.

What we know about the UK’s working-age health challenge. This research suggests that current policies have not done enough to address developments in the health of the working-age population. Promoting a healthier workforce will require long-term thinking and concerted action across sectors. In response, the Health Foundation is announcing a new, independent Commission for Healthier Working Lives to build consensus on the actions needed to address these issues.

Surviving healthcare: sexism and sexual violence in the healthcare workforce. The report is an analysis of 150 survivor stories submitted to the Surviving in Scrubs website since it was launched in 2022. It details findings on the incidents, factors and challenges unique to health care that permit sexism and sexual violence in the health care workforce. The report contains recommendations to health care organisations to better support survivors and end these behaviours.

The homecare deficit 2023. Based on analysis of data from all 276 public bodies in the UK that buy homecare from independent providers, this report presents detailed evidence of continued and serious systemic under-funding of homecare. Prolonged lack of government funding has increased the occurrence and risks of poor workforce experience; it has also led to higher staff turnover, increased unmet need, poor quality care, and reduced sustainability of services.

NHS England’s Long Term Workforce Plan. The NHS Long Term Workforce Plan was published by NHS England on 30 June 2023. Since publication, NHS Providers has analysed and gathered feedback on the plan and its aspirations, and worked with members and stakeholders as implementation progresses. It is concerned that elements of its implementation remain uncertain. This briefing provides a summary of NHS Providers' view on the plan as it relates to trusts and foundation trusts.

Being a staff member and a carer in the NHS: who should care? Of the 12 million staff working for the NHS, an estimated 250,000 are also carers. In this guest blog, Raka Maitra explores why there are significant benefits to the NHS and patient care in supporting doctor carers.

The state of medical education and practice in the UK: workforce report 2023. This report finds that doctors are increasingly moving away from the traditional postgraduate training model and instead choosing greater flexibility and less linear career pathways. These can include training breaks, working part-time or as locums, undertaking research or choosing to work as specialty and associate specialist (SAS) or locally employed (LE) doctors. The report argues that instead of viewing this changing landscape as a threat to workforce stability, it could in fact help to reduce burnout and dissatisfaction, improve work-life balance, support informed career decisions, and increase the likelihood of doctors remaining in UK practice.

Who cares? A review of reports of exploitation in the care sector. The care sector is susceptible to worker exploitation and modern slavery. Many people providing their labour in the sector receive low pay and the work is considered low-skilled. Due to the transient nature of the workforce and the historic reliance on migrant workers, current labour shortages have created a further opportunity for workers to be exploited. This report finds the number of care workers contacting the Modern Slavery & Exploitation Helpline has rocketed. Many of these workers are from overseas, and have paid huge fees to unscrupulous employers or recruitment agencies to come to the UK on special visas designed to fill vacancies in the care sector.

National Minimum Wage statistics. This briefing looks at trends in the UK National Minimum Wage, minimum Wage jobs and how the UK compares internationally.

NHS staff from overseas: statistics. One in six NHS staff in England report a nationality other than British. This briefing has statistics on the nationality of NHS staff for doctors, nurses and other groups, figures on EU nationals, and changes since the Brexit vote. See also article from Tijen Ahmet - UK Net Migration 2023: What’s the story?

Whistleblowing and gagging clauses. This briefing covers legal protections for workers who whistleblow at work, as well as attempts to silence workers using settlement agreements.

The gender pay gap. This briefing paper provides statistics on the size of the gender pay gap in the UK and how it varies by factors such as age, occupation and location.

News

Labour considers plan for student loan write-offs to tackle NHS staffing crisis

Over 50,000 extra nurses in NHS – hitting government target early. It marks the largest ever sustained growth in the NHS nursing workforce, with the expanded workforce delivering hundreds of thousands of extra appointments

Government puts offer to consultants to pave way to end strikes. The offer will invest in modernising the consultants’ pay structure – reducing the number of pay points and the time it takes to reach the top

Bevan Brittan Updates

UK Net Migration 2023: What’s the story? - Tijen Ahmet

Employment Eye October 2023 - Jodie Sinclair

AI and Employment Law: taking the human out of human resources - Alastair Turnbull

Bevan Brittan Events

Employment and Immigration Law Update - Our 2023 Roundup - 6 December 2023

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.

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Finance  

Publications/guidance

IFS Green Budget: October 2023. This report provides a comprehensive and independent assessment of the state of the public finances ahead of the Chancellor’s Budget and Spending Review. Chapter 8 considers the implications of the NHS workforce plan.

Hospital discharge funds: experiences in winter 2022–23. In this report, The King's Fund hears from commissioners and service providers in six local areas to find out how they experienced the process of receiving additional funding to reduce delayed discharge in 2022–23.

Investing to save: the capital requirement for a more sustainable NHS in England. This report finds that NHS capital budgets need to nearly double from £7.7 billion to £14.1 billion – an extra £6.4 billion – if the NHS is to clear the building repairs backlog and overhaul the estate to enable greater productivity and faster patient care. Capital funding drives productivity but the NHS has lagged behind other countries in terms of capital investment for more than five decades. The NHS now has the sixth lowest number of CT and MRI scanners per million people of the Organisation for Economic Co-operation and Development (OECD) countries. NHS leaders have said that increasing capital funding is their top financial priority ahead of the next election, alongside reform of how the capital regime operates.

The Autumn Statement 2023: what was announced and what does it mean for health and care services? Siva Anandaciva (Chief Analyst at The King's Fund) looks at the gains and losses for health and social care services in the Chancellor’s Autumn Statement.

Waiting time prioritisation in the health sector: evidence from hip replacement surgery. Waiting times for planned health care treatments have been slowly increasing in England in the past decade, and increased sharply during the Covid-19 pandemic. One policy to reduce the impact of waiting times on patients’ health is for doctors to prioritise patients according to need. This study uses hospital administrative data from 2015 to 2021 on hip replacements in England to investigate the extent to which publicly funded patients with higher need, measured by preoperative health, are prioritised on the list by public and private providers.

NHS spending plans and reality over the past 10 years. This explainer looks back over the past decade to show how repeated spending increases on the NHS pushed above what governments planned and expected.

Spending on public health. Public health services are crucial for preventing disease, reducing health inequalities and improving the population’s health, but how are these services funded? 

Health and care finances tracker. Ahead of a general election where NHS and social care funding will be a crucial issue, Nuffield Trust have launched a finances tracker which explains the key numbers to understand in this debate. Sally Gainsbury has also written an explainer and thread which looks back over the past decade to show how spending increases on the NHS pushed above what governments planned and expected.

The immigration health surcharge. Temporary migrants in the UK usually pay an annual 'surcharge', which raises funds for healthcare spending. The surcharge is due to rise to £1,035 per year in 2024.

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Health Inequalities 

Publications/Guidance

State of ageing 2023. This report aims to shine a light on the diversity and inequality among the country’s older populations, including the growing financial pressures felt by many. It looks at housing, financial security, employment, and health and wellbeing.

Tackling Inequality Commission report. This report sets out the findings of the Diabetes UK Tackling Inequality Commission, which was established earlier in 2023. The Commission looked at the multiple factors that contribute to health inequalities among people with diabetes, particularly people living in deprivation and people from Black and South Asian communities. The report concludes with a series of broad recommendations addressing the changes needed at all levels, from the individual to government.

UKHSA annual business plan: 2023 to 2024. The UK Health Security Agency (UKHSA) business plan for 2023 to 2024 outlines the agency’s key deliverables and activities to protect and improve public health and reduce health inequalities. The business plan is one of a series of products that set out the agency’s priorities and accountabilities, along with the UKHSA strategic plan 2023 to 2026 and the annual UKHSA remit letter from ministers.

Acting on the social determinants of health to reduce health inequalities: innovative approaches by provider trusts. This report outlines how five trusts have taken action to improve employment, increase income, improve education, and reduce air pollution. The report includes 13 lessons on adopting an innovative approach to tackling the social determinants of health, based on 22 interviews with people leading and implementing these approaches in these organisations. The lessons set out how this work can be implemented, summarising common drivers and incentives, considering how data and expertise can be used, sharing some common conditions for change, and looking ahead to greater scale and impact.

Tackling health inequalities on NHS waiting lists: learning from local case studies. This latest report by The King's Fund looks at how identifying health inequalities and adopting an inclusive approach to NHS waiting lists has been used to reduce the backlog after the Covid-19 pandemic.

A national framework for NHS: action on inclusion health. This briefing looks at NHS England's inclusion health framework, which highlights the key actions trusts could take to ensure their services are equitable and accessible for inclusion health groups.

The economic cost of health inequalities in England: prepared for The Times Health Commission. Oxera's report, commissioned by The Times, estimates the economic costs of health inequalities in England, focusing on the financial impact of avoidable deaths due to deprivation-related health disparities. Health inequalities reduce workforce productivity, decrease tax revenue, and increase health care spending. The Covid-19 pandemic has exacerbated this issue, and the report calls for a review of government policies on health, education, and social spending.

Ethnic inequalities in Improving Access to Talking Therapies (IAPT). This review of 10 years of anonymised patient data has found that historically, people from Black and minoritised ethnic backgrounds have experienced poorer access to, and outcomes from, NHS talking therapies. It finds that poor outcomes can be tackled and even disappear when access is improved and culturally sensitive therapy is provided.

Reducing health inequalities faced by children and young people. This report sets out the data and evidence of the health inequalities experienced by children and young people. It outlines the rationale for shifting attention towards this age group to prevent health inequalities later in life. It also considers the role that trusts can play in targeting interventions towards improving the health and wellbeing of children and young people who are more likely to experience inequalities. The report also highlights the existing work of trusts to reduce children and young people’s health inequalities within case studies from Barts Health NHS Trust and Gateshead Health NHS Foundation Trust.

Infant mortality and health inequalities. This short research briefing examines the progress to date in reducing the infant mortality rate in England.

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.

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Housing 

Publications and guidance

Social care, housing, health and winter: autumn survey report 2023. In this survey, almost two-thirds (63%) of social care leaders say that community-based care and support is not widely available in their local area. Just under half (49%) of adult social care directors indicated that in their area there is only limited availability of preventive services focused on reducing the number of avoidable admissions to hospital and residential care. It concludes that improving care at home, more sheltered, extra care and dementia-focused housing, investment in crisis resolution intermediate care, and better information and advice for older and disabled people would prevent many from needing hospital or residential care, reducing pressures across health and social care every winter.

Housing: key resources for constituency casework (England). This paper provides a guide to some reliable sources of information to help answer the most common constituents' housing questions.

Bevan Brittan Updates

Supported Accommodation for 16-17 Year Olds: New Ofsted Registration and Regulation - Siwan Griffiths

The Key Reforms of the Social Housing (Regulation) Act 2023 - Focus on Vulnerable Residents - Julia Jones

The Key Reforms of the Social Housing (Regulation) Act 2023 - Safety and Quality Standard - Louise Mansfield

The Key Reforms of the Social Housing (Regulation) Act 2023 - Transparency, Influence and Accountability Standard - Sarah Greenhalgh

For more information contact Julia Jones. 

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Independent Health 

News

Partnering with the independent sector to help cut waiting lists. Steve Barclay addressed the IHPN Annual Summit and Dinner 2023, discussing how partnering with the independent sector can help diagnose and treat more patients.

Bevan Brittan Updates

CQC: State of Care Report 2023/24 - Independent Healthcare - Carlton Sadler

For more information contact Tim Hodgetts or Julie Charlton 

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Information sharing/data 

Bevan Brittan Updates

Data Matters - November 2023 - Melanie Carter.

For more information contact Jane Bennett. 

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Inquests and Inquiries  

Publications/Guidance

Challenging coroners’ decisions. A briefing on how to challenge a decision of a coroner or the outcome of an inquest in England and Wales.

Independent inquiry into the issues raised by the David Fuller case. Phase 1 report. This is the phase 1 report by the independent inquiry into the issues raised by the David Fuller case. The inquiry has been established to investigate how David Fuller was able to carry out inappropriate and unlawful actions in the mortuary of Maidstone and Tunbridge Wells NHS Trust, and why they went apparently unnoticed for so long. A phase 2 report, looking at the broader national picture and the practices and procedures in place to protect the deceased in the NHS and other settings, is planned for publication at a later date.

UK Covid-19 inquiry public hearings: module 2, week 6 (20 November – 23 November 2023). This week the inquiry heard from witnesses including Sir Patrick Vallance, Professor Sir Chris Whitty and Professor Sir Jonathan Van Tam. The inquiry heard evidence on the timing of lockdowns, difficulties in getting data on NHS capacity, and the interactions between government and its scientific advisers. This briefing summarises the proceedings most relevant to NHS trusts, and is the sixth in the series of weekly briefings on the inquiry’s public hearings on module 2.

If you wish to discuss any queries you may have around inquests, please contact Amanda Wright- Kluger, Toby De Mellow or Claire Leonard. 

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Mental Health 

Publications/Guidance

National Development Team for Inclusion. A review of advocacy for people with a learning disability and autistic people who are inpatients in mental health, learning disability or autism specialist hospitals. This report covers in-depth research about people’s views and experiences of accessing, commissioning, working alongside and delivering a range of types of independent advocacy for people with a learning disability and autistic people who are inpatients in mental health, learning disability or autism specialist hospitals. It highlights the systemic, legislative, cultural, service level and human issues that impact on people’s experiences of independent advocacy while they are in hospital, as well as sharing ideas about how these can be improved.

Cases

Health Board v AZ.  [2023] EWHC 2517 (Fam) The court gave guidance on best interests applications concerning the termination of a childhood pregnancy. The guidance was approved by the President of the Family Division.

University Hospitals Southampton NHS Foundation Trust v T & Ors [2023] EWCOP 54. Judgment giving reasons for decision to allow the applicant Trust to sedate T for three days to carry out an urgent invasive medical procedure.

Manchester University NHS Foundation Trust v Y [2023] EWCOP 51. Application by an NHS Trust to treat Mr Y's fractured and dislocated shoulder. The application was granted.

Sandwell and West Birmingham Hospitals NHS Trust v GH [2023] EWCOP 50. Application by the NHS Trust for declarations that GH lacked capacity to make decisions about treatment for breast cancer. The declarations were made. 

GK & Anor v EE (formerly known as RK) & Anor [2023] EWCOP 49. Application by EE's parents seeking i) an injunction under the inherent jurisdiction preventing EE from undergoing any form of gender affirming medical treatment and ii) to instruct an expert psychologist and an expert psychiatrist in those proceedings. 

East Suffolk and North Essex NHS Foundation Trust v DL & Anor [2023] EWCOP 47. Hearing to determine what treatment plan should be put in place to feed and hydrate the P.

News

National system launched to rapidly identify trends in suicides. New suicide surveillance system launched to tackle emerging methods of suicide and clamp down on those seeking to sell dangerous products to vulnerable people.

Bevan Brittan Events

Distinguishing unwise decision-making from lacking capacity - 12 December 2023

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 or Hannah Taylor. 

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Primary Care 

Publications/Guidance 

Recording GP appointments: consolidated guidance. This guidance aims to support practices, primary care networks (PCNs) and integrated care boards (ICBs) to ensure that GP appointment data (GPAD) recording is being undertaken accurately locally by consolidating key information together in one place.

Strengthening primary and community care services: the foundation for most care and treatment. This briefing shows how people's experiences of primary care can be used to support the development of a long-term vision for the NHS to strengthen these services.

If you wish to discuss any issues in primary care then please contact  Joanne Easterbrook or Ben Lambert. 

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Prison Health

Publications/Guidance 

A review of health and social care in women’s prisons. The National Women’s Prisons Health and Social Care Review was established in 2021, driven by a commitment to improve health and social care outcomes for all women in prison and upon their release. The review has been informed by women with lived experience, led by an independent chair, and guided by a multi-agency board with input from HM Prison and Probation Service, and NHS England.

Inequality on the inside: Using hospital data to understand the key health care issues for women in prison. Is good-quality health care being provided for women in prison? As the government proceeds with plans to build 500 more prison places for women, this new Nuffield Trust analysis uses HES data to look at women prisoners' use of hospital services, finding that they face a series of challenges and risks in prison because of barriers to accessing health and care services.

Younger prisoners facing health care crisis. Serious challenges remain over the health and care of children in young offender institutions, as well as for younger people in prisons. This report from Nuffield Trust shows that missed appointments and admissions relating to violent incidents or self-harm are more common among younger people in prisons, while support for people with neurodivergent conditions remains a concern. Read the press release for the report.

If you wish to discuss any issues in prison health then please contact Joanne Easterbrook or Julie Charlton 

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Regulation 

Publications/Guidance 

Culture and regulation: the necessary partnership for quality and safety. In the wake of the Lucy Letby case, new professional regulation is likely to be introduced. Suzie Bailey (Director of Leadership and Organisational Development at The King's Fund) explores what will be needed from any new regulation.

If you wish to discuss any issues in regulation then please contact Stuart Marchant 

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Social Care  

Publications/Guidance 

The public’s perspective: the state of health and social care. This report, looking at health and social care from the public's perspective, warns that we risk 'a two-tier health and care system' unless the NHS takes faster action to tackle access issues. The report examines ten key areas of care, including GPs, dentists, hospitals and social care, based on the experiences of 65,000 patients. While much of the support the NHS provides is good, the research has found that accessing this support in the first place remains the biggest challenge people face.

State of caring 2023: the impact of caring on health. This report finds that caring responsibilities for relatives or friends who are older, disabled or seriously ill are having a significant impact on people’s capacity to work and earn a full-time wage. The research shows that 40% of unpaid carers providing high levels of care are giving up work to care, while 22% are reducing their working hours.

Reforming adult social care in England. This report looks at how the Department of Health and Social Care is responding to the challenges facing adult social care in England, and its progress with delivering the reforms set out in the 2021 White Paper. This report examines: key pressures and challenges in adult social care in England; the Department's response to increasing pressures in adult social care during 2022; and how the Department is delivering reform and progress against its commitments. The report concludes that the Department of Health and Social Care has much to do if it is to achieve its 10-year ambition for reforming adult social care, and must manage significant risks.

Adult social care workforce in England. An overview of key issues and policy concerning the adult social care workforce in England.

Bevan Brittan Updates

CQC: State of Care Report 2023/24 - NHS Trust - Siwan Griffiths

CQC: State of Care Report 2023/24 - Social Care Focus - Siwan Griffiths

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.

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General 

Publications/Guidance

Maternity and neonatal voices partnership guidance. This guidance advises integrated care boards and trusts on statutory obligations in maternity and neonatal services, and actions and responsibilities in the three-year delivery plan. It also suggests areas to consider when commissioning, setting up, supporting and sustaining maternity and neonatal voices partnerships (MNVPs).

Parental responsibility in England and Wales. An overview of parental responsibility in England and Wales, including how it is gained and lost.

If you would like to sign up for any of our Bevan Brittan publications click here.

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