Health and Social Care Update - March 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	Housing and homelessness
Acute and emergency care	Independent Health
Children/young people	Mental Health
Clinical Risk/Patient Safety	Primary Care
Digital Health	Regulation
Employment/HR	Social Care
Health Inequalities	General

 

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Bevan Brittan Free Training Events 

Bevan Brittan Clinical Risk/Health, Care and Regulatory Law Team Training - These are internal hour long lunch time training sessions.  You can sign up to watch the training sessions remotely via our webinar facility. Please contact Claire Bentley. 

1. Case Law Update - Mental Capacity Act 2005. Join us for this session with Rhys Hadden from Serjeants’ Inn Chambers on 20th April to consider:

• key case law and important updates from the past 12 months;
• any updates on the revisions to the Code of Practice to the Mental Capacity Act 2005; and
• what is the latest with the Liberty Protection Safeguards?

2. Extravasation & Clinical Negligence. Amy Walsh, an experienced IV nurse, will address on 25th April the clinical negligence issues surrounding extravasation including:

• incidence and aetiology,
• presentation and recognition,
• management, treatment and prognosis of this iatrogenic injury.

3. No Blame Culture and Patient Safety. Dr Leslie Hamilton, assistant coroner and retired cardiac surgeon, will speak on 27th April about the importance of creating and maintaining a no-blame culture within NHS and independent healthcare organisations.

4. Human Rights – Important cases and developments. Edward Bishop KC of Deka Chambers will on 9th May give a brief summary of:

• the foundations of human rights claims in the healthcare context; and
• recent important cases.

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

SEDIT dashboard now available on Model Health System. The GIRFT-developed Summary Emergency Department Indicator Table (SEDIT) can now be accessed directly within the Model Health System (MHS) data platform. A new quick-link has been added to MHS dashboard (Browse > Acute Hospital Services > Emergency Medicine) where the SEDIT link appears on the left-hand menu options, enabling emergency department (ED) teams to have a seamless user interface between the two data platforms. The SEDIT has been designed to help ED teams better understand their demand, capacity, flow and outcomes using in-built graphs, charts and filtering tools.

Why are delayed discharges from hospital increasing? Seeing the bigger picture. This report finds that in December 2022, more than 13,000 of a total of around 100,000 hospital beds in England were occupied by patients who were medically fit for discharge. This number has increased by 57 per cent over the past two years, representing an additional 6,000 people waiting in hospital who do not need to be there. This reduces the availability of hospital beds for newly admitted patients, contributing to longer A&E and ambulance waiting times. Delays can also have a significant impact on patients: longer hospital stays increase the risk of hospital-acquired infections and patients may lose mobility and cognitive function.

Progress with delivering the Emergency Services Network. According to this report, plans for a new communication network for emergency services have fallen further behind schedule, with the Home Office spending almost £2 billion on it since the programme began in 2015. The new Emergency Services Network will enable every police, fire and ambulance service across England, Scotland and Wales to continue to communicate by voice and data, between the field and control rooms.

News

Stretched A&E staff ‘rarely saw exec team’, review finds Trust executives and senior managers at York and Scarborough Teaching Hospitals have been criticised by a former national director for their lack of support for an under-pressure A&E.

Recovery Watch: ‘Grey area’ over key A&E target Performance against the four-hour accident and emergency target is now firmly back in the glare of regulators, with trusts tasked with hitting the target for 76 per cent of cases by March next year.

Thousands of English NHS 999 calls answered in Wales Thousands of 999 calls are being transferred to the Welsh Ambulance Service because they are taking more than five minutes to answer in England, HSJ can reveal.

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 

Born into Care: Best practice guidelines for when the state intervenes at birth. Nuffield Family Justice Observatory guidelines aim to inform multi-agency practice when the state takes safeguarding action pre-birth, at birth and in the immediate follow-up period, after discharge from hospital. Not intended to prescribe practice, the document sets out a series of generic statements that local authorities, health trusts and other organisations can adapt to their local contexts in conversations with families and practitioners.

Guide to the Supported Accommodation Regulations including Quality Standards. Following consultation, a Department for Education (DfE) document sets out guidance on the Supported Accommodation (England) Regulations 2023 on providing supported accommodation for children and young people. The Regulations include the quality standards for supported accommodation for young people aged 16 or 17 as well as detail on the OFSTED-led registration and inspection regime. The DfE has also published a response to the consultation and states it will ban unregulated accommodation through amended draft Regulations and lay them in early April 2023. Alongside this, OFSTED will publish registration guidance for providers.

Supporting care experienced parents: P-06-1161 Routine collection and publication of data of how many babies/children return to their care experienced parents care at the end of a Parent and Child Placement. A Petitions Committee report calls for more support to be given to young people who have been in care or are in care when they become parents. It recommends: all public bodies adopt the corporate parenting good practice charter; continued support for edge of care multi-agency services; an update to legislation to ensure all care experienced parents have the statutory right to parental advocacy; and suitable housing for every care experienced parent.

Children’s mental health services 2021-2022. This report finds that the NHS estimates that 18 per cent of children aged 7 to 16 years and 26 per cent of those aged 17 to 19 have a probable mental health disorder, up from 17 per cent in 2021. It aims to assess children’s ability to access timely treatment, and to understand how that has changed in recent years.

Voice of the Infant Best Practice Guidelines and Infant Pledge. A Scottish Government publication provides guidance on how to take account of infants' views and rights in all encounters they may have with professionals in statutory or third sector services, or in public spaces such as shops, libraries or galleries. It offers suggestions about how those who work with babies and very young children can notice, facilitate and share the infant's feelings, ideas and preferences.

Special Educational Needs and Disabilities (SEND) and Alternative Provision (AP) Improvement Plan Right Support, Right Place, Right Time. Following consultation, a Department for Education and Department of Health and Social Care Command Paper set out the special educational needs and disabilities (SEND) or in alternative provision (AP) Improvement Plan for England. It confirms investment in training for thousands of workers so children can get the help they need earlier, alongside thousands of additional specialist school places for those with the greatest needs - as 33 new special free schools are approved to be built. The system will be underpinned by national SEND and AP standards, whilst new guides for professionals will help them provide the right support.

Review of the Children's social care implementation strategy and family hubs rollout: Inquiry. A Public Services Committee inquiry looking at the Government's proposed strategy for children's social care, following the independent review of children's social care, and the rollout of Family Hubs. The Committee will be holding a short series of evidence sessions to discuss the Government's approach and what further action is needed.

Order 13.32 - Abduction - NHS Disclosure Order. In light of the merger between NHS Digital and NHS England on 1 February 2023, the Courts and Tribunals Judiciary sets out an updated order for use when seeking information as to the whereabouts of a child. Such orders, previously directed to the Health and Social Care Information Centre, must now be directed to NHS England. The order will be incorporated in the suite of Standard Orders upon their publication later in 2023.

The importance of ethnicity for understanding young people’s experiences of health inequalities: themes from available data. In this data report, the Association for Young People's Health reviewed a range of publicly available data sources for information and shared the data to highlight the health inequalities experienced by young people from ethnic minority backgrounds.

Summary of risk factors and learning for improved practice around working with children aged two and under. This briefing looks at case reviews published between 2018 and 2022 which involved children aged two and under.

Surge in children and young people seeking support for eating disorders. The continuing effects of the cost-of-living crisis coupled with the fallout from the pandemic have seen a doubling in the numbers of children with eating disorders who need urgent care.

Cases

SS v Essex CC. [2023] EWHC 417 (KB) Following settlement of a claim brought against a local authority by a vulnerable adult who alleged that she had been abused and neglected by her foster carers, in terms of which the local authority admitted both negligence and vicarious liability and paid the claimant GBP 325,000 in damages as well as GBP 200,000 on account of costs, the court held in a Part 20 claim brought by the local authority that the foster carers were responsible for "the same damage" and thus liable to make contribution under the Civil Liability (Contribution) Act 1978.

News

Transformational reform begins for children and young people with SEND. Plan for better, fairer access to high quality special educational needs and disabilities support.

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 

Risk assessments during the maternity care pathway. Following its national learning report, "Assessment of risk during the maternity pathway", a Healthcare Safety Investigation Branch follow up report looks at risk assessments during the maternity care pathway. It considers whether terms such as "midwifery led", "obstetric led" or "shared care" should be changed in favour of more personalised care for pregnant women.

Spotlight on maternity care: your stories, your rights. A Parliamentary and Health Service Ombudsman report looks at maternity complaints and concludes that too many women and babies are being put at risk as expectant and new parents are repeatedly "failed" by maternity services, and that despite a number of major reviews into maternity services, lessons are not being learned.

Learning from paediatric medication errors. From 1 April 2010 until 31 March 2020, NHS Resolution identified 193 paediatric medication error claims concerning children under the age of 18. Prescribing errors are often due to the incorrect dose being prescribed. This latest resource in the Did You Know series on medication errors highlights learnings from closed paediatric medication error claims. 

Learning from venous thromboembolisms. From 1 April 2012 until 31 March 2022, NHS Resolution documented 687 closed claims relating to venous thromboembolism (VTE) injuries. VTE is a significant cause of mortality, long-term disability and long-lasting ill-health problems – many of which are avoidable. This latest resource details how clinicians can take preventative action to improve outcomes for patients at risk of VTE. 

Launch of resources on preventing needle stick injuries. NHS Resolution received 2,600 claims for needlestick injuries for incidents occurring between 2012 – 2022. Needlestick injuries can be costly to investigate and increase the of risk blood-borne infections. Fortunately, the harm and cost of most needlestick injuries are largely avoidable. NHS Resolution have created two new resources to share the learning from these claims and help organisations identify how to prevent future injuries. 

Being fair 2 – improving organisational culture in the NHS. This report from NHS Resolution sets out the benefits to an organisation of adopting a more reflective approach to learning from incidents and supporting staff

Operational checklist added to outpatient resources. A practical, operational checklist supporting NHS service managers to reduce long waits for outpatient appointments is now available from GIRFT and Outpatient Recovery and Transformation Programme (OPRT) teams. The Clinically-led Outpatient Guidance: checklist follows on from joint guidance released in 2022, offering practical advice for the 15 specialties with the highest number of +78 week waits. The new checklist is a supplementary resource to be used in conjunction with Clinically-led Specialty Outpatient Guidance, helping operational teams identify gaps and opportunities.

Government response: Consultation on legislative proposals for clinical trials. Following analysis of the responses received to a consultation on proposals to improve and strengthen the UK clinical trials legislation, the Medicines and Healthcare Products Regulatory Agency announces that it will begin drafting legislation to reform the UK clinical trials regulatory framework to: ensure patients and their safety are at the focus of all clinical trials and bring the benefits of clinical trials to everyone; create a proportionate and flexible regulatory environment; cement the UK as a destination for international trials; and provide a framework that is streamlined, agile and responsive to innovation. Under the new framework it will be faster and easier to gain approval and to run clinical trials in the UK.

Managing NHS backlogs and waiting times in England: Thirty-Eighth Report of Session 2022-23. A Public Accounts Committee report states that cancer waiting times are at their worst recorded level and NHS England will not meet its first cancer recovery target. It claims that NHS England made "unrealistic assumptions about the first year of recovery, including that there would be low levels of COVID-19 and minimal adverse effects from winter pressures. The Committee expresses serious doubts that the wider NHS recovery plan will be achieved to time. It calls on the NHS to refocus on its strategic duty to offer direction to the whole NHS.

The National Safety Standards for Invasive Procedures (NatSSIPs). The Centre for Perioperative Care has published national safety standards for invasive procedures. For the first time, all hospitals across the UK will adopt the same standards for all invasive procedures, including the increasing number of procedures undertaken in maternity units, emergency departments and radiology departments. The standards are intended to help NHS organisations provide safer care and empower patients to be active participants in safety checks.

Cases

Case of note: White (deceased) v. Secretary of State for Health and Social Care (High Court, 2 December 2022 – Jeremy Hyam KC). In this case, the court considered whether or not a death had been caused through wrongful exposure to asbestos dust whilst the deceased worked at Sefton General Hospital in Liverpool, between 1949 and 1960. The Secretary of State was the defendant, having inherited liabilities from bodies running Sefton Hospital at the relevant times. 

News

Pathway supports clinicians to diagnose and treat Cauda Equina Syndrome without delay. A new pathway helping clinicians to better diagnose and care for patients suspected of having a rare and serious spinal condition is now available from the Getting It Right First Time (GIRFT) team.

Covid clinical negligence protocol cut number of litigated claims. The COVID-19 clinical negligence protocol, a collaboration between NHS Resolution, Action against Medical Accidents and the Society of Clinical Injury Lawyers, that was launched in August 2020 and last updated in June 2021, which was agreed in the wake of COVID-19 to better manage clinical negligence claims during the pandemic is remaining in place after it appeared to reduce the number of contested cases. There has been a 6% reduction in litigated cases in the last two financial years, equating to 572 cases, where the average difference in costs paid to claimant solicitors on litigated versus non-litigated closed cases was around £57,000 per claim. However, NHS Resolution has cautioned that it had still to investigate the impact of COVID on the number of claims before it could be certain about the extent to which the fall in litigated claims was due to the protocol.

Bevan Brittan Updates

CNZ v Royal Bath Hospitals NHSFT & The Secretary of State for Health and Social Care - Alison Garrett

Informed consent: the frontline reality v the law - Angus Kirkwood

Bevan Brittan Events

Extravasation & Clinical Negligence. Amy Walsh, an experienced IV nurse, will address on 25th April the clinical negligence issues surrounding extravasation including:

• incidence and aetiology,
• presentation and recognition,
• management, treatment and prognosis of this iatrogenic injury.

No Blame Culture and Patient Safety. Dr Leslie Hamilton, assistant coroner and retired cardiac surgeon, will speak on 27th April about the importance of creating and maintaining a no-blame culture within NHS and independent healthcare organisations.

Human Rights – Important cases and developments. Edward Bishop KC of Deka Chambers will on 9th May give a brief summary of:

• the foundations of human rights claims in the healthcare context; and
• recent important cases.

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.

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Digital Health

Publications/guidance

Building a shared understanding of emerging technologies. The Government Office for Science has published its Rapid Technology Assessments (RTAs), which are accessible introductions to different technology areas for policy makers. The RTAs give policymakers an accessible overview of a technology area, including: what the technology is and what its most recent developments are; how this technology could be applied; what opportunities this technology presents for the UK and what the challenges are to realise these; and how research and industry activity in this technology is changing and how development in the UK compares to other countries. the recent RTAs cover topics including: artificial intelligence; novel batteries; digital twins; 4D printing; nucleic acid technologies; and synthetic genomics.

Life sciences companies supercharged with £277 million in government and private investment. Four life sciences companies from across the UK will benefit from the first tranche of Life Sciences Innovative Manufacturing Fund (LSIMF) grants.

Potential of tech in care is not being recognised, report finds. A new report has found that only a handful of councils, housing and care organisations are delivering digital care in people’s homes at scale to cut hospital admissions, speed up emergency response times, and reduce long waits for formal social care. Despite much evidence that concludes using technology in social care keeps people safe, healthy and happy at home, the report found no large-scale use of digital services. There are isolated examples of activity but little integration within the broader social care and health ecosystem.

The Topol Review: Preparing the healthcare workforce to deliver the digital future. The Topol Review, an independent report on behalf of the Secretary of State for Health and Social Care, outlines recommendations to ensure the NHS is a global leader in using digital technologies to benefit patients. Recommendations are made by the Review's: genomics, digital medicine, artificial intelligence and robotics panels and the organisational development working group.

Artificial Intelligence and Digital Regulations Service launches. The NHS Health Research Authority has announced the launch of the Artificial Intelligence and Digital Regulations Service website. The service, which is a partnership between the Health Research Authority, National Institute for Health and Care Excellence, Care Quality Commission, and the Medicines and Healthcare products Regulatory Agency, aims to clearly set out the information and guidance that developers and adopters need to follow to develop safe, innovative technologies in health and social care.

Supporting digital inclusion in health care. Digital technologies can improve health and care services, but does everyone benefit from these changes? This King's Fund research project considers the unique ways technology can include, but also exclude, people and communities. 

Evaluation of government commitments made on the digitisation of the NHS. This report from an independent panel of experts has found the government is making inadequate progress on vital commitments to digitise the NHS. Government commitments evaluated by the panel include the delivery of integrated health and care records, the rollout of the NHS app and ensuring a workforce had the necessary digital skills. Despite some encouraging progress, the panel found that key government commitments on workforce and the use of patient information were either not met or were not on track to be met. It found that overall progress towards improving the digital capabilities of the NHS was too slow, and often lacked support and funding.

Bevan Brittan Updates

Reflections on the big themes of Digital Health Rewired 2023 - Dan Morris

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

Educator Workforce Strategy. A Health Education England strategy aims to ensure that the NHS has a sustainable supply of educators to support the development of the healthcare workforce. Recommendations made in the strategy will be used by the Workforce, Training and Education directorate to develop, with stakeholders, an implementation plan which will sit alongside the Long Term Workforce Plan for the NHS. Priorities include: introducing career frameworks for educators of all professions; promoting the NHS aspirations to improve equality, diversity and inclusion; and embedding evolving and innovative models of education.

McCloud remedy part 2: proposed changes to NHS Pension Schemes Regulations 2023. A Department of Health and Social Care consultation seeks views on a draft Statutory Instrument making changes to NHS Pension Schemes Regulations necessary to implement the second part of the McCloud remedy. The second part removes the effect of transitional protection by offering eligible members a choice over the set of benefits they wish to receive for any pensionable service during the period 1 April 2015 to 31 March 2022. Comments by 23.45 on 6 June 2023.

NHS Pension Scheme: proposed amendments to scheme regulations - consultation response. Following consultation, the Department of Health and Social Care welcomes the overall positive reception to its proposals to change the revaluation date in the National Health Service Pension Scheme Regulations 2015 and move the date that dynamising factors are applied to 1995/2008 Scheme practitioner pensionable earnings from 1 April to 6 April from April 2023. The Department therefore intends to proceed with these changes to the 2015 Regulations which will become effective on 1 April 2023.

Stressed and overworked: what the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries means for the UK. This analysis finds that UK GPs experience the highest stress and lowest job satisfaction compared with GPs in nine other high-income countries. The report analyses data from an international survey of 9,526 GPs in 10 high-income countries, including 1,010 in the UK, carried out by the Commonwealth Fund. It finds that the majority of GPs in all countries are dealing with higher workloads than before the pandemic. UK GPs report higher levels of emotional distress and bigger rises in workload than GPs in nearly all other countries, with many considering leaving the profession altogether. 71 per cent of UK GPs find their job ‘extremely’ or ‘very stressful’, the highest of the 10 countries surveyed.

Unprofessional behaviours: actions need consequences. Are there clear consequences for unprofessional behaviours in your organisation? Dana James-Edwards, former Head of Diversity and Inclusion at The King's Fund, reflects on why consequences are essential in tackling unprofessional behaviours.

NHS staff survey 2022. The annual survey, carried out in autumn 2022, covers staff in all 215 NHS trusts in England, across all roles. This year’s results demonstrate staff discontent on pay that is reflected in a fall in staff feeling well rewarded. However, many top-level indicators have stabilised this year, staying broadly the same as in 2021. The results also find an improvement in staff perception of support for learning and development and an increase in feelings around positive teamworking and support from line managers.

Tackling disadvantage in medical education: analysis of postgraduate outcomes by ethnicity and the interplay with other personal characteristics. This report explores the extent that inequalities persist in medical education, for example an 18 percentage point difference between the specialty exam pass rate of UK-trained Black doctors and UK-trained white doctors. It also considers good practice, and highlights the importance of evaluating interventions to enable a better understanding of initiatives that successfully support trainees from different backgrounds.

NHS employee suicide: a postvention toolkit to help manage the impact and provide support. This toolkit was developed to help NHS organisations develop and implement a process to manage the impact of an employee suicide on colleagues. Postvention refers to the actions taken to provide support after someone dies by suicide. This can ensure that timely and appropriate care and support is provided that can help individuals with their grief, manage the impact on the organisation and reduce the risk of further deaths by suicide.

Tackling disadvantage in medical education. This report explores the extent that inequalities persist in medical education, for example an 18 percentage point difference between the specialty exam pass rate of UK-trained Black doctors and UK-trained white doctors.

NHS workforce in England. This briefing covers the NHS workforce in England, including key targets, recruitment and retention issues, workforce planning and government policy.

Progression of UK doctors in training. The GMC has published it's latest data the on progression of doctors in postgraduate medical education.

News

NHSE blames junior doctors’ strike for impending elective target failure. A senior NHS England figure has blamed the junior doctors’ strike for trusts’ impending failure to hit a flagship target to eliminate 78-week waiters by next month, but HSJ  understands the service would have fallen short even without the medics’ walkout.

Health chiefs say NHS pay offer must be fully funded after government pledge. Health leaders and unions have redoubled their demands for the NHS pay offer to be fully funded, after the Treasury said some new money would be made available. Unions are now consulting their members on the offer, which includes a one-off bonus of up to 8.2% for this year and a pay rise of 5% from April, plus more for the lowest paid. With existing budget plans only allowing for a 3.5% rise, ministers had previously declined to say how the offer would be paid for, stoking fears of fresh cuts to under-pressure services.

Will Jeremy Hunt foot the bill for NHS staffing? The signs aren’t promising Unions, regulators and NHS England all say staff shortages are affecting health of medics and patients.

Four-day junior doctors strike announced. The British Medical Association has announced a fresh wave of escalated strike action that will see junior doctors walk out for four days in April. The union confirmed the strikes will last from 7am on 11 April until 7am on 15 April. It will involve  a stoppage of all work including nights, on-call shifts and non-residential work, as happened in the three days of strikes earlier this month. Trusts will need to arrange emergency cover to ensure patient safety.

Bevan Brittan Updates

Employment Eye March 2023. - Jodie Sinclair

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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Health Inequalities 

Publications/Guidance

Delays to processing asylum claims in the UK. The briefing looks at how asylum delays have changed over time, the possible reasons for the increase in delays, the effect of this on asylum seekers, and the Government's plans to reduce the backlog.

Asylum statistics. This briefing summarises statistics on asylum seekers in the UK and refugees who arrive through resettlement programmes.

Supporting clinicians to address health inequalities in practice. This report looked at clinicians’ confidence in talking about and understanding health inequalities. It finds that most clinicians feel they haven't received enough training on health inequalities and would like more as part of their medical education. Of the almost 1,000 clinicians surveyed, 67 per cent of respondents had not received teaching or training in health inequalities within a training programme or as part of their degree, and only 26 per cent felt confident in their ability to reduce the impact of health inequalities in their medical practice.

Racism is the root cause of ethnic inequalities in health. According to this briefing, racism is the cause of health inequity, from birth through to adulthood and into later life. It finds that racism is a key driver of ethnic inequalities in health, both directly and indirectly. It has an impact in childhood – with children from ethnic backgrounds being born at a lower birthweight and not hitting developmental milestones, to life-limiting long-term illness, and mental illness in adulthood. It also finds that racism leads directly to poorer health through stress or worsening mental health; and indirectly, by exposure to targeted marketing of harmful substances, and toxins in the environment.

The importance of ethnicity for understanding young people’s experiences of health inequalities: themes from available data. In this data report, the Association for Young People's Health reviewed a range of publicly available data sources for information and shared the data to highlight the health inequalities experienced by young people from ethnic minority backgrounds.

Tackling inequality and disadvantage: key actions policy makers, commissioners and provider organisations can take when developing an approach with a digital component. This briefing, launched by members of the VCSE Health and Wellbeing Alliance, highlights how groups of people who experience the greatest barriers to accessing health and care are often the most likely to experience digital exclusion. It also contains additional, detailed insights into how digital exclusion affects groups who experience health inequalities, including people with learning disabilities, people seeking asylum, people in contact with the criminal justice system, people from Black, Asian and minority ethnic communities and others. The guidance also highlights the key actions people who design health and care can take to tackle inequality and disadvantage when using digital tools.

How we can help

We have a multidisciplinary team advising NHS commissioners and providers on all aspects of tackling health inequalities, ranging from:

• advising on the new legal framework and compliance with the relevant statutory duties, particularly in the context of service reconfiguration;
• addressing workforce inequalities;
• taking action on patient safety to reduce health inequalities;
• the role of the Care Quality Commission in tackling health inequalities; and
• lessons to be learnt from the Covid-19 pandemic.

If you wish to discuss any queries you may have around health inequalities please contact Olivia Carter or Julia Jones.

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Housing and homelessness 

Publications/Guidance

Social Housing Reform in England: What Next? This briefing outlines the measures set out in the Government’s social housing white paper, stakeholder reaction and the next steps for social housing reform.

Better housing for better health. This paper highlights the need for housing to be an essential part of future strategies to improve health and for making better use of resources to achieve better health outcomes.

The cost of poor housing by tenure in England. This report analyses the impact of substandard housing to the NHS, broken down by tenure type (owner occupied, private rental and social housing). The research finds that more than 700,000 homes in England are defined as excessively cold and that the NHS spends more than £540 million a year treating people affected by the worst properties.

If you wish to discuss any queries you may have around housing and homelessness please contact Julia Jones.

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Independent Health 

Publications/guidance

Collection of Private Healthcare activity data by NHS England: Change Proposal. An NHS England consultation seeks views on recommendations that NHS England should collect and process information on healthcare activity carried out at private hospitals. The Acute Data Alignment Programme would result in NHS-funded and private healthcare activity data being available in one place for the first time, offering a more comprehensive insight into the quality of treatment and care across both the NHS and private healthcare settings. Comments by 20 April 2023.

Abortion: procedures for approval of independent providers. Procedures for approval of independent sector providers of treatment for termination of pregnancy.

Lack of private sector help putting elective target at risk, says trust. University Hospitals of North Midlands Trust and Staffordshire and Stoke-on-Trent ICS have said they risk missing the imminent waiting list target, after struggling to get as many patients treated in the independent sector as they hoped.

For more information contact Tim Hodgetts or Julie Charlton  

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Mental Health 

Publications/guidance 

Autism: Overview of policy and services. This briefing provides an overview of policies and services for autistic people in England.

Mental health policy in England. This House of Commons Library briefing provides an overview of mental health policy in England. It examines the Coronavirus Act 2020 which provided for temporary changes to the detention and treatment of patients under the Mental Health Act 1983 and includes background to the draft Mental Health Bill published in June 2022

Care delivery within community mental health teams: Independent report by the Healthcare Safety Investigation Branch. A Healthcare Safety Investigation Branch report details an investigation into community mental health teams (CMHTs) to help support improvements in their work. Prompted by the suicide of a woman who had been referred and discharged into the care of a CMHT twice previously for attempted suicide, the investigation report emphasises that NHS trusts should move away from standardised scoring tools that categorise a patient as "high, medium or low risk", as they are a poor predictor of repeated self-harm or future suicide.

Mental Capacity small payments scheme: Government response. A Ministry of Justice post-consultation report for the "Mental Capacity Small Payments Scheme", which proposed potential changes to accessing limited funds belonging to an individual who lacks mental capacity without a lasting power of attorney or Court of Protection (CoP) order, summarises responses received and sets out a detailed response to the specific questions raised in the report. Respondents complained of the lengthy and complex CoP application forms and the time taken to complete the application, and it became apparent through the consultation of a general lack of awareness of the Mental Capacity Act 2005 (MCA) and the need to obtain legal authority to manage another person's financial affairs if they lack capacity when a child turns 18. Next steps include working with the CoP to improve application processing times and simplify court forms, and collaborating with other Government departments, charities, and the finance sector to increase awareness of the MCA among parents and caregivers of young people without capacity as they transition to adulthood. The Government will not seek to legislate for the introduction of a small payments scheme.

Supporting people with a learning disability and autistic people to live happier, healthier, longer lives: bitesize guide for local systems. This guide draws together a number of resources and provides a one-stop shop for professionals who put in place services and approaches to support children, young people and adults who have a learning disability or who are autistic to lead healthier, happier, longer lives.

Children’s mental health services 2021-2022. This report finds that the NHS estimates that 18 per cent of children aged 7 to 16 years and 26 per cent of those aged 17 to 19 have a probable mental health disorder, up from 17 per cent in 2021. It aims to assess children’s ability to access timely treatment, and to understand how that has changed in recent years.

Safe and wellbeing reviews: thematic review and lessons learned. As part of the NHS response to the safeguarding adults review concerning the deaths of Joanna, Jon and Ben at Cawston Park, a national review has been undertaken to check the safety and wellbeing of all people with a learning disability and autistic people who are being cared for in a mental health inpatient setting. This document sets out the themes emerging from the review findings.

Cases

Practice Guidance (CP: Closed Hearings and Closed Material). [2023] EWCOP 6 The Court of Protection issued guidance applicable to the rare occasions when it was necessary to consider whether a hearing should be closed and/or for material to be closed. The guidance sought to provide clarity as to the principles to be applied and considerations to be taken into account in the very limited circumstances under which such steps might be appropriate. Nothing in the guidance was intended to increase the number of closed hearings or applications for material to be closed.

A Local Authority v PG [2023] EWCOP 9 The Court of Protection discussed different approaches to making orders in respect of an individual with fluctuating capacity.

North Bristol NHS Trust v R [2023] EWCOP 5. Application for declarations that R lacks capacity to decide whether her unborn baby should be delivered pre-term by elective Caesarean section and that this would be in her best interests.

Bevan Brittan Events

Case Law Update - Mental Capacity Act 2005. Join us for this session with Rhys Hadden from Serjeants’ Inn Chambers to consider:

• key case law and important updates from the past 12 months;
• any updates on the revisions to the Code of Practice to the Mental Capacity Act 2005; and
• what is the latest with the Liberty Protection Safeguards?

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. 

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Primary Care 

Publications/Guidance 

Publication of general practice indemnity resources. NHS Resolution recently published new resources that support general practice staff to understand the scope of our two general practice indemnity schemes and when and whether a claim should be notified directly to NHS Resolution or their medical defence organisation. These encompass a reporting flowchart, an animation and an updated general practice indemnity scheme scope document, covering both schemes. 

NHS Resolution outlines its primary care offer. NHS Resolution offers support and insights to those working in primary care from across our four services: Claims Management, Practitioner Performance Advice, Primary Care Appeals and Safety and Learning. They have published a short digital brochure that outlines how each service supports those working in primary care to manage and reduce concerns, disputes and claims. 

Training the Future GP. A Health Education England report sets out its vision for the future of general practice specialty training. It outlines ways to reform the delivery of education to GP trainees, better preparing them for future practice in different models of care, addressing health inequalities, improving technology and enhancing areas of clinical care such as mental health.

General practice pay transparency: guidance. In accordance with amendments to the National Health Service (General Medical Services Contracts) Regulations 2015 and the National Health Service (Personal Medical Services Agreements) Regulations 2015 which require certain other individuals, namely "job holders", to self-declare their NHS earnings if these are above the earnings threshold for the relevant financial year, NHS England guidance sets out which individuals are required to make a pay transparency self-declaration and outlines the definition of NHS earnings for the purpose of general practice pay transparency. It also explains the process of making the self-declaration and how the data collected will be used.

Stressed and overworked: what the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries means for the UK. This analysis finds that UK GPs experience the highest stress and lowest job satisfaction compared with GPs in nine other high-income countries. The report analyses data from an international survey of 9,526 GPs in 10 high-income countries, including 1,010 in the UK, carried out by the Commonwealth Fund. It finds that the majority of GPs in all countries are dealing with higher workloads than before the pandemic. UK GPs report higher levels of emotional distress and bigger rises in workload than GPs in nearly all other countries, with many considering leaving the profession altogether. 71 per cent of UK GPs find their job ‘extremely’ or ‘very stressful’, the highest of the 10 countries surveyed.

Fit for the future: GP pressures 2023. This report, based on a survey of general practice staff, highlights the current workload and workforce pressures facing GPs and their teams, and the impact these are having on patients. GPs and their staff carried out 4.6 million (9 per cent) more appointments in December 2022 and January 2023 than in December 2019 and January 2020; however, the number of fully qualified full-time-equivalent GPs has dropped by 843 in the same period. The report sets out the RCGP's recommendations for the government to tackle the workforce and workload crisis in general practice, and support GPs and their teams to meet the health care challenges of the 21st century.

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

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Regulation  

Publications/guidance

Our regulatory activity: What's happening now. The Care Quality Commission has, following the decision to adjust its regulatory activity until the end of March 2023 to enable health and social care staff to carry on providing safe, high-quality care over winter months in the face of existing pressures, set out its plans from 1 April 2023 in areas including: registration; hospital services; and adult social care services.

Consultations

Revisions to the guidance on professional indemnity and insurance cover. A General Dental Council consultation seeks views on proposing changes to its guidance on indemnity and insurance to ensure it is up-to-date and better supports dental professionals to understand and meet their legal and regulatory obligations. The proposed changes explain the different types of cover available and highlight the additional benefits that dental professionals should consider when arranging cover, such as advice and support for their wellbeing during a claim. Comments by 20 June 2023.

Modernising the regulation of fertility treatment and research involving human embryos. A Human Fertilisation and Embryology Authority (HFEA) consultation seeks views on a review of the law on fertility treatment regulation and embryo research to prioritise recommendations for change. The survey is split into four areas where HFEA think modernisation is most needed: patient safety and promoting good practice; access to donation information; consent; and scientific developments. In each area HFEA provides a short summary of the current situation, then sets out the issues with the Human Fertilisation and Embryology Act 1990, and describes its proposals for change. Comments by 17.00 on 14 April 2023.

Cases

Z (Disclosure to Social Work England: Findings of Domestic Abuse), Re. [2023] EWHC 447 (Fam) Pursuant to the Family Procedure Rules 2010 Pt 12 (7) r.12.73(1)(b), the court ordered that a fact-finding judgment made in private law proceedings between the parents of a 10-year-old child should be disclosed to the regulatory body for social workers in England. The judgment made findings of domestic abuse against the father, a social worker, and it was both necessary and proportionate for it to be disclosed to the regulator. In so deciding, the court made observations designed to assist family courts dealing with the question of disclosure to regulatory bodies.

If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.

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Social Care  

Publications/Guidance 

Work in progress: Adult social care reform. The National Audit Office (NAO) seeks evidence for its study of the Department of Health and Social Care's (DHSC) overall responsibility for adult social care policy and its accountability to Parliament and the public for the performance of the care system as a whole. The NAO is due to release two reports into adult social care reform. The first report, on the current pressures and challenges in adult social care is to be released in Spring 2023. The second report, which is to be released in Autumn 2023, will examine: progress against commitments to reform adult social care; how the DHSC intends to use additional funding; and the level of understanding about the financial position of the adult social care system.

Challenging adult social care decisions in England and Wales. An Equality and Human Rights Commission (EHRC) report sets out its findings of an inquiry into adult social care decisions. Recommendations include: the UK Government making the Local Government and Social Care Ombudsman the statutory complaints standards authority for adult social care in England; and local authorities reviewing their compliance with provisions under the Care Act 2014 in England, or the Social Services and Well-being (Wales) Act 2014, in Wales in relation to accessible information.

CQC accused of failing to keep private nursing home residents safe. The Care Quality Commission (CQC) has been accused of failing to keep private nursing home residents safe after a family alleged that the regulator was not forthcoming with knowledge that the care home in which they placed their elderly relative was failing. The relatives said they relied on a "good" rating when they moved 89-year-old Bernard Chatting into a £1,200-a-week home in Dorset. After he experienced care so unsafe he ended up in hospital and died a few weeks later. The family claimed that the lack of care provided by the home was directly responsible for the premature end of Bernard's life.

Market Sustainability and Improvement Fund 2023 to 2024. The Market Sustainability and Improvement Fund was announced at the Autumn Statement in November 2022. The primary purpose of the fund is to support local authorities to make tangible improvements to adult social care services in their area, in particular to build capacity and improve market sustainability. This guidance is intended to support local authorities in administering the fund.

A people plan for social care: White Paper, March 2023 – a call to action. This plan examines, through the voices of people living and working in social care, the current landscape including shortcomings and also outstanding practices. It looks at various subjects such as the mental health and wellbeing of people using care, policy and regulation, and equality, diversity and inclusion. It makes a series of recommendations with the aim of improving social care.

Bevan Brittan Updates

Modern Slavery in the UK adult care sector - Louise Mansfield

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

Productivity of the English National Health Service: 2020/21 update. NHS productivity compares growth in health care outputs and inputs: the more outputs produced with a given amount of inputs, the higher the productivity growth. This assumes that more health care – such as operations in hospitals – generates more health for society. However, this report finds that this assumption did not necessarily apply during the pandemic because hospitals were told to cancel as much non-emergency care as possible to free up acute beds and reduce the risk of Covid-19 infection. It also describes how, at the same time, the overall cost of the health care inputs – such as staff, beds and medicines – remained or even increased because the pandemic required the employment of extra staff where possible and also extra spending on new safety measures.

Pandemic preparedness for the real world: why we must invest in equitable, ethical and effective approaches to help prepare for the next pandemic. This report warns the global health community to think beyond vaccines and lockdowns, proposing investment in a five point action framework for pandemic preparedness that responds to people’s experiences, knowledge and needs. The proposed five areas for investment are: health professionals; diverse knowledge, expertise and perspectives; reform of health, social and other systems and structures to support resilience to disease crises; people’s trust in politics; and ethics and social justice.

Health care funding: three key questions about funding in England. This analysis from The Health Foundation’s REAL Centre explores the latest health care funding figures for England, including how much funding has been committed, how it compares with historical levels and how it stacks up against what is needed to meet current pressures facing health services. The analysis is based on the March 2023 OBR economic forecast and Treasury figures on spending plans from 15 March 2023 (the Spring Budget 2023).

Technology-enabled lives: delivering outcomes for people and providers. This paper (produced in partnership with more than 30 organisations) highlights the lack of widespread adoption of digital social care services despite the public’s desire for technology to better support those who draw on social care and health services. The paper reveals that only a handful of councils, housing and care organisations are delivering digital care in people’s homes at scale. This is despite evidence that using technology in social care keeps people safe, healthy and happy at home.

Public satisfaction with the NHS and social care in 2022: results from the British Social Attitudes survey. This year's survey, published by The King's Fund and Nuffield Trust, found that overall satisfaction with the NHS fell to 29 per cent – a seven percentage point decrease from 2021. This is the lowest level of satisfaction recorded since the survey began in 1983.

Health and social care in England: tackling the myths. This updated explainer from the Kings Fund debunks five myths that often feature in political and media debate about health and care.

Cyber security strategy for health and social care: 2023 to 2030. How the government will work with health and adult social care organisations and the supply chain to achieve cyber resilience across the sector no later than 2030.

The public health approach to preventing gender-based violence: Consultation. An Equality and Social Justice Committee consultation seeks views on its inquiry focusing on the public health approach to preventing gender-based violence. The inquiry will explore how effective the implementation of a public health approach to preventing gender-based violence has been, and what more could be done. Comments by 10.00 on 28 April 2023.

NHS prescription charges from 1 April 2023. In a written statement to Parliament, the Department of Health and Social Care outlines the National Health Service charges in England to be introduced from 1 April 2023. Charges for NHS prescriptions will increase by 30 pence from £9.35 to £9.65 for each medicine or appliance dispensed, and charges for wigs and fabric supports will also be increased in line with the blended inflation rate of 3.21%.

Clinical waste strategy. NHS England's clinical waste strategy supports providers to make changes to waste management practices.

Pandemic Preparedness for the Real World: Why We Must Invest in Equitable, Ethical and Effective Approaches to Help Prepare for the Next Pandemic. This report warns the global health community to think beyond vaccines and lockdowns, proposing investment in a five point action framework for pandemic preparedness that responds to people’s experiences, knowledge and needs.

News

Study calls for nurses and midwives to approve abortions. According to Shaping Abortion for Change (Sacha), the largest study on abortion in the UK, nurses and midwives should be able to approve abortions, in what would be one of the biggest shake-ups of regulations in more than 55 years. Surveying more than 700 GPs, midwives, nurses and pharmacists in Britain, as well as interviewing women who had recently had an abortion, Sacha states that if adopted, a rule that stipulates that terminations have to be authorised by two doctors would be abolished. The study concluded that regulations should be changed to allow nurses and midwives to authorise an abortion, prescribe abortion medication and perform vacuum aspirations.

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

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