Health and Social Care Update - January 2011

Legal intelligence for professionals in health and social care.

This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

Care	Governance
Children	Health and Safety
Commissioning	Mental Health
Data Protection	Primary Care
Employment/HR	Prison Health
Finance	Regulation
Foundation Trusts	General

 

Care 

Publications/guidance
Social care and hospital use at the end of life. This briefing summarises a Nuffield Trust report to investigate the use and estimated costs of hospital and social care services for large groups of individuals at the end of their lives, in three PCT/local authority areas. The Nuffield Trust believe that this is the first time such an estimate has been derived for large populations and that this type of analysis is the first step to achieving better quality of care for the available resources.

The Palliative Care Funding Review - interim report. This report makes recommendations for immediate improvements to the palliative care system, including investment to support 24/7 access to community services. It highlights the need to define the core services that should be funded by the NHS as a statutory responsibility and how these can be balanced with services that are supported by society. 

If you wish to discuss any of the items raised in this section please contact Carlton Sadler.

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Children 

Publications/Guidance
Routine childhood immunisation from November 2010. This is the routine childhood immunisation schedule from November 2010. It shows the immunisations that were previously given at two separate visits at 12 and 13 months of age now combined into one visit between 12 and 13 months. 

General paediatric surgery: survey of service provision in district general hospitals in England. This report finds that children who need common, general or urological operations face delays or long journeys to specialist centres for routine elective and emergency surgical care. It suggest that a shortfall in safe, sustainable and accessible general paediatric surgery in district general hospitals will continue unless local hospitals adopt measures to share resources, services and expertise and surgical training opportunities are taken up. 

Tackling health inequalities in infant and maternal health outcomes: report of the Infant Mortality National Support Team. This report sets out the work of the Infant Mortality National Support Team in addressing inequalities and improving infant and maternal health in disadvantaged areas. 

DfE: Review of the Children's Commissioner in England - Children and Young People's Guide. This report is aimed at children and young people and says what the commissioner‘s role should be. Its recommendations will make the role stronger so that it has more impact for children in England. 

Getting better? Improving outcomes for children and young people - research messages for the health service. This briefing has been prepared to highlight the key research messages from The Centre for Excellence and Outcomes in Children and Young People’s services (C4EO) for commissioners and providers of health services for children and young people across a number of thematic areas. These messages help to illustrate some of the interventions that have been proven to have a positive impact and make a difference in people’s lives.  

If you wish to discuss any of the items raised in this section please contact Penelope Radcliffe, Tracey Lucas or Deborah Jeremiah.

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Commissioning

Publications/Guidance
NHS Outcomes Framework 2011/12. This first NHS Outcomes Framework sets out the outcomes and corresponding indicators that will be used to hold the NHS Commissioning Board to account for the outcomes it delivers through commissioning health services from 2012/13. The Framework sets the direction of travel for improving quality and encourages a change in culture and behaviour, with a renewed focus on tackling inequalities in outcomes in five areas:

•   preventing people from dying prematurely;
•   enhancing the quality of life for people with long-term conditions;
•   helping people to recover from episodes of ill health or following injury;
•   ensuring that people have a positive experience of care; and
•   ensuring people are treated in a safe environment and protecting them from avoidable harm.

See also Transparency in outcomes - a framework for the NHS: Government response to the consultation, which sets out the Government's formal response to the July 2010 consultation. It explains the engagement process that took place during the 12 week consultation period and provides a summary of the consultation responses.

Clinical nurse specialists in cancer care; provision, proportion and performance. The 2010 census of cancer specialist nurses in England has now been published. It builds on the previous censuses which help to map the specialist nurse workforce in cancer care and help to inform commissioning of specialist nurse posts in a more structured and equitable fashion than had previously been possible.

Provider economics impact assessment model. The Department of Health in partnership with the NHS Confederation have produced this model with associated guidance and summary to better understand provider economics. The purpose of the model is to enable commissioners and providers to analyse the potential impact of commissioning decisions on service continuity and provider sustainability; and to understand how the financial system risks of decommissioning and reconfiguring services will materialise in differing economic scenarios and whether services provide value for money.  

If you require further information about any of the items raised in this section please contact David Owens. 

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Data Protection

Bevan Brittan Updates
Are you fit to disclose? In this article, Ceri Catton examines the General Medical Council’s (GMC) power of disclosure and provides practical tips if you are presented with a request for documents by the GMC.

Substantial monetary fine handed to Local Authority for breach of the DPA. In handing down the first monetary penalty under the Data Protection Act 1998 (DPA) , the Information Commissioner's Office (ICO) has this week given a very clear signal to all public authorities in relation to the priority that must be given to data security.

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Employment/HR

Publications/Guidance
An independent review into the approach and behaviour of NHS South West in relation to the dismissal of John Watkinson by Royal Cornwall Hospitals NHS Trust. On 17 July 2010 the Secretary of State for Health asked Sir David Nicholson, Chief Executive of the NHS in England, to initiate a review into the approach and behaviour of the NHS South West in relation to Royal Cornwall Hospitals NHS Trust, in particular, to the dismissal of John Watkinson and, by association, the Trust’s position in relation to the provision of upper GI services in Cornwall. This independent report details the findings of the review by Verita. 

Consultations
Liberating the NHS: developing the healthcare workforce. This consultation document sets out proposals to establish a new framework for developing the healthcare workforce and seeks views on the systems and processes that will be needed to support it. The final date for responses is 31 March 2011. 

News
General Social Care Council: A duty to whistleblow.   

Bevan Brittan Updates
Reasonable adjustments - case round up. Two key recent decisions have looked at the question of the reasonableness of adjustments required for disabled employees: whether costly adjustments for a blind employee were reasonable; and whether it is a reasonable adjustment to allow a police officer suffering from depression to be reinstated following her resignation.  Julian Hoskins reports.

Two-tier code withdrawn - employment news special bulletin. Alec Bennett provides a special bulletin on the sudden (if not unexpected) withdrawal of the public sector version of the ‘two-tier code’, plus we detail this year’s annual payment increases and provide an update on employment equalities developments.

Why does HR need to know about bribery? You could be forgiven for wondering why the new Bribery Act 2010 is something which should be on HR managers’ radars – after all, what has HR got to do with the murky waters of an old-fashioned sounding criminal offence?  Quite a lot is the answer.  Bribery will have a wider definition than you might think, and HR will have an important role in implementing anti-bribery measures.  These are key to establishing a defence to the ‘corporate offence’ in the Act.  Additionally, as ever, employment policies, procedures and contractual documentation are likely to need amending. David Widdowson explains more.  

If you require further information about any of the items raised in this section please contact Claire Bentley.

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Finance

Publications/Guidance
DfE: Unit costs of health and social care. This publication, funded by the Department of Health is now in its eighteenth year. It brings together information from a variety of sources to estimate the most up-to-date nationally-applicable unit costs for a wide range of health and social care services in England.

Clinical responses to the downturn. This joint publication brings together practical recommendations from focus groups with seven specialty medical societies and royal colleges, each of which were asked to suggest ways that clinicians in their own specialties can release NHS resources while maintaining or enhancing quality. Seven medical specialties address how they can help tackle the NHS financial challenge.

Monitoring use of money to implement End of Life Care Strategy and expenditure on specialist palliative care. Templates to monitor how the additional money provided to help implement the End of Life Care Strategy has been invested in 2010/11, and expenditure on specialist palliative care in 2010/11, have been issued to SHA and PCT Directors of Finance.

Provider economics impact assessment model. The Department of Health in partnership with the NHS Confederation have produced this model with associated guidance and summary to better understand provider economics. The purpose of the model is to enable commissioners and providers to analyse the potential impact of commissioning decisions on service continuity and provider sustainability; and to understand how the financial system risks of decommissioning and reconfiguring services will materialise in differing economic scenarios and whether services provide value for money. 

If you require further information about any of the items raised in this section please contact Claire Bentley.

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Foundation Trusts

Publications/Guidance
Making sustainability add up. This report looks at how foundation trusts can account for sustainability and the work they have been doing in this area.

NHS foundation trusts: review of six months to 30 September 2010. Monitor requires each NHS foundation trust board to submit a quarterly report. Performance is monitored against these reports to identify where potential and actual problems might arise. This is the second quarterly report of 2010-11 and is based on data submitted by the 130 NHS foundation trusts authorised at 30 September 2010.

Consultations
Consultation on additional annual reporting requirements. The financial sections of Monitor’s Annual Reporting Manual went out for consultation on 15 October 2010. This new consultation document sets out their proposals for updated annual non-financial reporting requirements for NHS foundation trusts for 2010-11, and for seeking external assurance on Quality Reports.

If you require further information about any of the items raised in this section please contact David Owens. 

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Governance

Publications/Guidance
The Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance. This code of practice sets out the criteria against which a registered provider's compliance with the requirements relating to cleanliness and infection control will be assessed by the Care Quality Commission. It also provides guidance on how the provider can interpret and meet the registration requirement and comply with the law. The code of practice comes into force on 1 April 2011 for existing registered providers and primary dental care and independent sector ambulance providers, and 1 April 2012 for primary medical care providers.  See also the Response to the consultation on the new Code.

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Health and Safety

Publications/Guidance
The Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance. This code of practice sets out the criteria against which a registered provider's compliance with the requirements relating to cleanliness and infection control will be assessed by the Care Quality Commission. It also provides guidance on how the provider can interpret and meet the registration requirement and comply with the law. The code of practice comes into force on 1 April 2011 for existing registered providers and primary dental care and independent sector ambulance providers, and 1 April 2012 for primary medical care providers.
See also the Response to the consultation on the new Code.

Guidance on safe nurse staffing levels in the UK. This report sets out the range of different factors that influence the total demand for staff and highlights the variety of methods for planning or reviewing staffing levels.

A&E clinical quality indicators: implementation guidance and data definitions. This is the implementation guidance for the new A&E clinical quality indicators, which will be introduced in April 2011, replacing the 4-hour standard. The measures will provide a comprehensive view of the quality of care across the A&E departments in England, including outcomes, clinical effectiveness, safety, experience and timeliness.

News
Training failures led to patient death. Health and Care Services (UK) Ltd has been fined £80,000 with £40,823 costs by Leeds Crown Court for breaching s.3 of the Health and Safety at Work etc Act 1974. The charges arose from an incident in 2004 when a 42 year old man, who had learning and behavioural issues, was physically restrained for around 90 minutes by staff at a nursing home. He was eventually released and crawled unaided to his room, but was found dead a short time later. The court heard that Health and Care Services (UK) Ltd, part of the Craegmoor group, failed to ensure staff were adequately trained to carry out the safe physical restraint of residents. The Commission for Social Care Inspectorate had previously highlighted an urgent need for safe restraint training but the investigation found that no such training was given. The company therefore failed to comply with a regulatory requirement, and failed to take all reasonably practicable steps to protect patients at the nursing home.  

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Mental Health

Bevan Brittan Online Resources
NEW! Bevan Brittan Mental Health Portal. Bevan Brittan has a wealth of mental health knowledge it would like to share with clients. We have therefore developed an online resource which has been designed to bring various sources of mental health information and guidance into one place. The aim is simple - to keep professionals in mental health up-to-date with what is happening in an ever changing landscape. If you would like more information please contact Claire Bentley.  

Publications/Guidance
Independent investigation report - Graham Burton. Report to the North East Strategic Health Authority of the Independent Investigation into the healthcare and treatment of Graham Burton. 

The Office of the Public Guardian has published In the "Best Interests" of us all - Public Guardian Annual Report 2010.

Rethink briefing note: jury service. In this briefing note Rethink urge the government to reconsider their position that they do not intend to change the provisions in the Juries Act 1974 relating to eligibility for jury service of people with mental health conditions.

Valuing People Now summary report March 2009 - September 2010. This report covers progress that has been made within the last 18 months under Valuing People Now. It focuses on the key priorities of improving outcomes for people with learning disabilities in health, housing, and employment, and shows where more work is needed to make the lives of people with learning disabilities better. Published with the report is additional guidance containing good practice examples about different aspects of the Valuing People Now programme.

Commissioning mental wellbeing. Using a public health approach that identifies root causes of poor mental health, this brief offers cost-effective evidence based interventions and approaches to promote wellbeing. It will be of interest to all those working at senior level in the NHS, Local Government and the Voluntary Sector and in or through the proposed Health and Wellbeing Boards, which will have the central and leading role to play in improving population health and mental wellbeing at a local level. This brief provides a summary and guide to action for Boards, senior managers in the NHS, Local Government and the Voluntary Sector and Directors of Public Health.

Supporting people with mental health conditions into paid employment: a briefing for Work Programme providers. Despite very low levels of employment today, people with a mental health diagnosis can get jobs and almost all would like to be in paid work. Failing to help them to achieve their employment aspirations is a waste of potential which Work Programme providers are ideally placed to overcome.

Race Equality Action Plan: a five year review. This review looks back at the five year DRE programme, which ended in January 2010. The key challenges, successes and learning it describes will inform future mental health policy.

National Oversight Group annual report 2009-10. The National Oversight Group for High Secure Services brings together significant partners to provide oversight for the high secure services on behalf of the Secretary of State for Health.

Carers and personalisation: improving outcomes. A guide on emerging evidence, including examples to illustrate how the principles of personalisation have been applied, emphasising the value of finding ways forward that make sense and work best locally.

Mental health and the productivity challenge. Improving quality and value for money. The King’s Fund and Centre for Mental Health, with the support of the Royal College of Psychiatrists and the NHS Confederation’s Mental Health Network, have worked together to explore how mental health services could be delivered in a different and more cost-effective way. The consensus from their work, including an expert seminar and a review of evidence, is that there is scope for mental health services not only to improve their own productivity but also to support productivity improvements in other parts of the NHS.

Commissioning mental wellbeing for all - A toolkit for commissioners. The toolkit, commissioned by NMHDU and Developed and produced by Karen Newbigging and Chris Heginbotham, The International School for Communities, Rights and Inclusion - University of Central Lancashire, provides a resource for local authority and health commissioners to improve the mental wellbeing of people living in their areas.

Implementing Fulfilling and Rewarding Lives: Statutory guidance for local authorities and NHS organisations to support implementation of the autism strategy. The guidance aims to secure the implementation of this strategy for adults with autism in England by giving guidance to local authorities, NHS bodies and NHS Foundation Trusts on training of staff, the diagnosis of autism, and the leadership and planning of services. It will help these bodies to develop services that support and meet the locally identified needs of people with autism and their families and carers.
See also the summary and response to the consultation on the draft statutory guidance, which highlights the key themes from the consultation and sets out the Government's response.

National audit of dementia (care in general hospitals): preliminary findings of the core audit. A report into the care received by nearly 8,000 patients with dementia in 206 hospitals in England and Wales has revealed that few hospitals provide mandatory training for their staff in awareness of dementia. It also shows that many patients with dementia are not having assessments of their mental health or state of nutrition and that there are serious delays for patients referred to in-hospital psychiatry liaison services.

Learning Disabilities and Health Reform grant: the NHS Campus Closure programme. This letter from Anne Williams, National Director for Learning Disabilities, to NHS and local authority chief executives outlines the arrangements for monitoring the final months of the campus closure programme. A new grant will be issued to local authorities from 2011/12 from the Department of Health: the Learning Disability and Health Reform grant. This is a non ringfenced specific grant worth around £1.3bn and includes revenue arising from the closure of campuses when people move from the NHS to social care accommodation.

Recovery is for all: Hope, agency and opportunity in psychiatry. A position statement by consultant psychiatrists, South London and Maudsley NHS Foundation Trust & South West London and St George's Mental Health NHS Trust. This position statement was developed following a joint workshop on Recovery for consultant psychiatrists in two London NHS Trusts, the South West London and St George's Mental Health NHS Trust and the South London and Maudsley NHS Foundation Trust. A smaller group of consultants was given the task of developing a coherent view of Recovery and of summarising the key factors that support the relevance of Recovery principles for the practice of clinicians and the future development of mental health services. The group was comprised of clinicians from the major specialities of psychiatry: General Adult Psychiatry, Older Adults, Child and Adolescent, Forensic, Addictions and Learning Disabilities.

An evaluation of six community mental health pilots for veterans of the Armed Forces. This publication is the result of an independent evaluation into the Community Veterans Mental Health Pilots. The report suggests that care specialists with knowledge of the armed forces should be used to support veterans with mental health conditions.

Cases
Secretary of State for Work and Pensions v SS(DLA) [2010] UKUT 384. The tribunal held that:
    The tribunal's decision was by a majority but the decision notice said it was unanimous. 
    This was an error of law which could have been corrected if the subsequent statement of reasons had acknowledged the mistake. 
    There is no legal obligation to state whether a decision is unanimous or by a majority. 
    However the absence of that legal obligation does not prevent a tribunal from giving that information and if they do so the statement should be accurate. 
    If the decision is by a majority and a statement of reasons is prepared a brief statement of the reasons of the dissenting minority member should be given. 
    The decision of the tribunal was set aside and the case was sent back to a new tribunal for rehearing.

David Robert Perrins v (1) Richard Philip Holland (2) Sharon Ruth Moore (as executors of the estate of Robert Perrins, Decd) (3) Anne Dooney [2010] EWCA Civ 1398. A party who had refused an offer to settle and who had unsuccessfully challenged the validity of a will, and who had refused an offer to settle, should pay the opponent's costs.

Consultations
Mental capacity guidance. The OFT has launched a consultation on its draft guidance for creditors on mental capacity. The draft guidance is designed to explain the steps the OFT expects creditors to take to identify borrowers who might lack the mental capacity to make informed borrowing decisions, where it isn't known that they lack capacity but there is reason to believe, or at least reasonable grounds to suspect, that this might be the case. It also outlines the OFT's view of the appropriate way for creditors to deal with borrowers who do or might lack capacity, and explains the practices and procedures it considers they should put in place. Consultations closes on 4 March 2011. 

If you wish to discuss any of the items raised in the above section please contact Simon Lindsay.  

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Primary Care

Publications/Guidance
Local innovations in wheelchair and seating services. This document aims to support PCTs and local wheelchair service managers in the commissioning and delivery of wheelchair and seating services by capturing current examples of local innovations that improve quality in wheelchair commissioning and delivery.

Transfer and transform. Plans are underway to transfer community service provision from PCTs by April 2011. The presence of these services in the community and their close day-to-day working relationships with GPs means they are well placed to deliver the improvements that strike at the heart of the Government’s planned NHS reforms. This briefing sets out the key points from NHS Confederation's discussions with members who have experience of transferring services, including their learning about how best to transfer services, what exactly should be transferred, the cultural issues to consider and the necessary governance arrangements.

2011-12 PCT allocations. Details of the £89bn funding for PCTs to spend next year on commissioning services for patients – a 3% increase from 2010/11. It includes money for commissioning dentistry, ophthalmic and pharmacy services as well as, for the first time, money to support social care. See also the press release.

More for less 2009/10: are efficiency and productivity improving in the NHS? This briefing paper reviews how and where PCTs spent their money, how trust income changed and how successful the NHS has been in moving care out of hospitals to more cost-effective settings. The most recent data suggests that the NHS has seen no identifiable changes in past trends. There are few signs of progress in key areas required to meet its target of saving £15-20bn by 2014.

Support for sessional GPs. This report presents the findings of a research project into the support needs of sessional GPs and how these are being met using a range of support system models. The study identified isolation as a major theme in the experience of sessional GPs and makes recommendations towards improving support networks.

Joined-up care - delivering seamless care: a practical guide to making change happen. All PCT provider services will be undergoing fundamental changes in the way that they are organised in 2011, with different models emerging through the Transforming Community Services programme. This guide provides practical advice to making change happen and it outlines the principles and methods need to help develop patient centred care. Also available are case studies; a guide to measuring improvement; and a literature review.

Energise your estate the low carbon way: meeting public sector estate cost efficiency challenges through effective energy and carbon management. This report has found that primary care could save more than £47 million over the next five years through the adoption of better energy efficiency. It examined the carbon emissions of every PCT and calls on all trusts and their successor bodies to adopt long-term carbon management strategies to minimise their emissions - in addition to the ‘quick wins’ achievable through modest changes in practice.

A risky business: the White Paper and the NHS. This report by Civitas argues that the wholesale abolition of PCTs proposed in the NHS White Paper could have a negative impact on patient care, and should be halted in favour of a more incremental approach to commissioning reform.

If you wish to discuss any of the items raised in this section please contact David Owens.

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Prison Health

Publications/Guidance
Seasonal flu 2010/11 in prisons and other closed institutions within the criminal justice system in England. The Health Protection Agency has recently reported an increase of seasonal flu activity above baseline in England and have produced guidance regarding this. This winter, we know that influenza A H1N1 (2009) (Swine Flu) is prominent among other circulating flu viruses, including Influenza B.  

Consultations
Breaking the cycle: effective punishment, rehabilitation and sentencing of offenders. The Ministry of Justice Structural Reform Plan published in July 2010 set out a commitment to introduce a 'rehabilitation revolution' and conduct a review of sentencing policy. This consultation sets out the resulting proposals which aim to break the destructive cycle of crime and protect the public, through more effectively punishing and rehabilitating offenders and reforming the sentencing framework. Closing date is 4 March 2011.

News
The Ministry of Justice has announced that there were 58 apparently self- inflicted deaths among prisoners in England and Wales in 2010.

If you wish to discuss any of the items raised in this section please contact Nadia Persaud.

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Regulation

Publications/guidance
Quality Accounts. Quality Accounts aim to enhance accountability to the public and engage the leaders of an organisation in their quality improvement agenda. This letter from Bruce Keogh, NHS Medical Director and David Bennett, Chief Executive of Monitor sets out the key findings from the evaluation of the 2009-10 Quality Accounts and sets out clear expectations for the 2010-11 Quality Accounts. Also available is a toolkit aimed at providers of NHS services, in order to offer advice as they set out to produce their Quality Accounts for June 2011.

Management of NHS hospital productivity. Hospital productivity has fallen over the last ten years, according to this report. It finds that over the period since the ‘NHS Plan’ in 2000 there have been significant increases in hospital funding, to deliver improvements in the patient care, and designed in part to increase productivity. It concludes that hospitals have used their increased resources to deliver against national priorities, but they need to provide more leadership, management and clinical engagement to optimise the use of additional resources and deliver value for money.

News
The conduct committee of the GCSC has suspended a social worker for a year. They found that misconduct was proved and that Parts 4,5 and 6 of the allegations amounted to serious misconduct. These Parts related to: requesting the service user to sign financial papers after she had been diagnosed by a consultant psychiatrist as having a lack of mental capacity; failing to ensure that an application for a Court of Protection order in respect of a service user was made expeditiously, or at all; and failing to keep adequate and accurate records in respect of two service users. 

Consultations
Review of the regulation of public health professionals. This report looks at the issue of professional regulation within public health on behalf of the Chief Medical Officers in England, Scotland, Wales and Northern Ireland. The Public Health White Paper invites views on the report, and asks a specific consultation question on this report. 

If you wish to discuss any of the items raised in this section please contact Carlton Sadler.

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General

Publications/Guidance
The Operating Framework for the NHS in England 2011/12. Sets out what needs to happen over the transition year 2011/12. All parts of the health service are required to work across organisational boundaries to respond positively to the reform set out in Equity and Excellence: Legislation for, whilst ensuring that service quality and financial performance are maintained and improved at a time of change.
See also David Nicholson's letter Managing the transition and the 2011/12 Operating Framework. 

Trading medicines for human use: shortages and supply chain obligations. This guidance sets out the key legal and ethical obligations that manufacturers, wholesalers, NHS Trusts, registered pharmacies and dispensing doctors have in the supply and trading of medicines. It was developed jointly with eleven organisations, including the Department of Health, representing the different parts of the supply chain. This revised guidance updates the guidance published in November 2009.

Short guide to reorganising arm’s length bodies. This paper highlights key issues for public bodies to consider in closing and merging arm’s length bodies.

Euro-wide health profiles. New Euro-wide health profiles show how the UK compares to the rest of Europe, revealing the highest levels of overweight and obese adults. The profiles, produced as part of an EU-funded project, brought together by 12 partner EU states led by the Association of Public Health Observatories in the UK, compare all regions across 27 countries in Europe using 37 health and health service indicators.

SCIE Report 37: Personalisation, productivity and efficiency. This report examines the potential for personalisation, particularly the mechanism of self-directed support and personal budgets, to result in cost efficiencies and improved productivity as well as improved care and support, resulting in better outcomes for people's lives. It provides an overview of some emerging evidence on efficiency from the implementation of personalisation so far.

Healthy lives, healthy people White Paper - Our strategy for public health in England. This White Paper sets out details of the Government’s long-term vision for the future of public health in England, as outlined in the Health White Paper "Equity and excellence - liberating the NHS". The aim is to create a "wellness&" service, Public Health England (PHE), and to strengthen both national and local leadership. PHE will be created as a service that gives more power to local people over their health, whilst keeping a firm national grip on crucial population-wide issues such as flu pandemics. The White Paper also sets out how funding from the overall NHS budget will be ring-fenced for spending on public health. Early estimates suggest that current spend on areas that are likely to be the responsibility of PHE could be in the range of £4bn. The majority of public health services will be commissioned by local authorities from their ring-fenced budget or by the NHS, all funded from PHE's new public health budget. In addition:
 Directors of Public Health will be employed by the relevant upper-tier or unitary local authority and be the ambassadors of health issues for the local population; they will lead discussion about how the ring-fenced money is spent and also influence investment decisions right across the local authority.
 The Government will take forward detailed proposals for the establishment of health and wellbeing boards in every upper-tier local authority. 
The core elements of the new system will be set out in the forthcoming Health and Social Care Bill that is due to be published early this year. The consultation closes on 8 March 2011.  

Private healthcare - A scoping paper. The OFT has announced plans to launch a market study into private healthcare. The study will examine the nature of competition in the market, and whether the market is fully competitive. Ahead of the formal launch in Spring 2011, the OFT is seeking views on the proposed scope of the study.

National Cancer Patient Experience Survey Programme - 2010: national survey report. This national report provides insights into the care experienced by cancer patients across England who were treated as day cases or inpatients during the first three months of 2010. 158 NHS Trusts providing cancer services identified patients and 67,713 patients chose to respond. The 2010 survey builds on a previous survey undertaken in 2000 involving over 65,000 cancer patients and a smaller survey undertaken in 2004 involving 4,300 patients. The 2010 survey is the first to involve patients with all types of cancer. It is also the first national survey in this country in which the word cancer has been explicitly used.

National heart failure audit: 2010. This audit aims to provide national comparative data to help clinicians and managers improve the quality and outcomes of their services. Findings can be used to assess achievement against National Service Framework goals and milestones and NICE guidelines for heart failure on an ongoing basis. The information is used in the NHS to develop improved strategies to minimise hospitalisations for heart failure. It can also be used to inform patients about the quality of heart failure care and to support patient choice.

Avoiding hospital admissions: what does the research evidence say? This review of research evidence was commissioned to establish which interventions work in avoiding emergency or unplanned hospital admissions.

NHS dental contract: proposal for pilots December 2010. From April 2011 the Government will be running a new series of pilots in 50 to 60 locations around the country. Designed to test three different contract models, this exercise will help inform the development of a new national NHS dental contract. Based on registration, capitation and quality, the new contract will have three main objectives: improve the quality of patient care; increase access to NHS dental services; and improve oral health, especially the oral health of children.

Payment by results 2011-12 road test package. The road test exercise provides an opportunity for the service to test out the new tariff, and supports the planning process. The main focus of the road test is to gather comments on the draft 2011-12 PbR guidance and PbR Code of Conduct. The covering letter from David Flory, NHS Deputy Chief Executive, details the changes made to the proposed 2011-12 tariff arrangements since his letter of 30 September 2010.  

Consultations
A new value-based approach to the pricing of branded medicines: a consultation. The Department of Health is consulting on proposals for a new value-based system of pricing medicines which aims to give NHS patients better access to effective and innovative medicines. The document sets out the principles that would underpin the move to value-based pricing, outlines how the new system could work across the UK and seeks views on a number of key issues. All responses to this consultation must be received by 17 March 2011.

Healthy Lives, Healthy People: transparency in outcomes, proposals for a Public Health Outcomes Framework. Seeks views on a proposed outcomes framework for public health. It looks at five areas to: protect the population’s health from major emergencies; tackle factors which affect health and wellbeing and health inequalities; help people to live healthy lifestyles and make healthy choices; prevent ill health; and prevent people from dying prematurely. It should be read alongside the consultations on the NHS Outcomes Framework and the ongoing consultation on Transparency in Outcomes: A Framework in Adult Social Care Together, which together will set out the outcomes that local government, the health and care sectors are responsible for achieving. The consultation closes on 31 March 2011.

Healthy Lives, Healthy People: consultation on the funding and commissioning routes for public health. Seeks views on details of the proposed key public health functions and responsibilities across the public health system that were described in the recent Public Health White Paper and on the proposed commissioning and funding arrangements for delivery of public health services. It discusses the approach that should be taken to allocating public health funds to local authorities, and the design of the health premium which will reward areas for their achievements and incentivise action to reduce health inequalities. Localism will be at the heart of this new system. Local authorities will have statutory duties to take steps to improve the health of their populations. This will open up opportunities for them to take innovative approaches to public health involving new partners. It also discusses what activity should be funded from the public health budget and the appropriate allocations of responsibility for public health activity in the new system. The consultation closes on 31 March 2011.

Cases
Exel Europe v University Hospitals Coventry and Warwickshire NHS Trust [2010] EWHC 3332 (TCC). This procurement case related to the sell off of the Healthcare Purchasing Consortium. The issue was whether the American Cyanamid principles continued to apply in cases where a discontented tenderer sought to prevent the placing of the contract. The court held that the American Cyanamid principles applied to applications under reg.47H of the Public Contracts Regulations 2006 for interim orders to lift restrictions imposed under reg.47G. It was doubtful that E's complaint that there had only been one tender gave rise to a serious issue: provided that all the rules had been followed in setting up the process, that did not give rise to a legitimate complaint. There was a serious issue, however, in relation to the complaint that the Trust's discussions with C, with whom it was considering setting up a public private partnership, had given C an unfair advantage. The relative strength of the claim would be taken into account in the exercise of discretion under reg.47H. The public interest could be taken into account in the balance of convenience; that included the public interest in securing valid public procurements, though that did not necessarily have an overriding impact. It also included the efficient running of the NHS. There was an urgency for the procurement exercise to go ahead and damages would be an adequate remedy. The requirement that the Trust refrain from entering into the contract with C during the proceedings would therefore be brought to an end.

News
Extra money to help people leaving hospital. The DH has announced an extra £162m funding to local health and care services to spend this financial year on helping people to leave hospital more quickly, get settled back at home with the support they need, and to prevent unnecessary admissions to hospital. The funding will bring forward the plans being put in place by health and local authorities to work together using NHS funding to support social care, as announced in the Spending Review. It will also enable local services to respond to pressures this winter. The extra funding is in addition to the previously announced £70m that the NHS will spend this year on reablement services, and there will be a further provision of £300m by 2014-15 for continued investment in these front line services.

Innovation is the key to a better NHS. The Health Minister Lord Howe has launched the NHS Innovation Challenge Prizes scheme. The Challenge Prizes will be awarded for achievement of specific challenges, and will range from significant improvements in delivery to major clinical breakthroughs. The value of the awards will vary and reflect the nature of the challenge and the benefit of the innovation to the NHS and its patients. An Expert Panel made up of leading medical scientists, academics, industry experts and innovators will judge applications and recommend what awards should be made. Prizes will only be awarded if they demonstrate significant added value to patients and the NHS.

Bevan Brittan Updates
Claims case round-up December 2010. Laura Miskelly looks at the following cases including; L.G. Blower Specialist Bricklayer Ltd v Reeves (2010); B v Nuffield Hospitals (2009); and Drake & Starkey (executrices of the estate of James Wilson, Deceased) -v- Foster Wheeler Ltd (2010).

Moving the goal posts - the discount rate debate. Damages for successful Claimants in serious personal injury and clinical negligence cases could soon be dramatically increased, following confirmation from the Lord Chancellor, Ken Clarke, that he would reconsider the level of the discount rate in claims for personal injury compensation. 

The Jackson costs report. The release of Sir Rupert Jackson’s Final Report on civil litigation costs earlier this year led to a flurry of articles speculating on the likely implications of his recommendations. The Government has now (15 November 2010) published its Consultation Paper seeking views on the key recommendation that CFA success fees and ATE insurance premiums should no longer be recoverable from the losing party. 

Bevan Brittan Online Resources
NEW! Bevan Brittan Mental Health Portal. Bevan Brittan has a wealth of mental health knowledge it would like to share with clients. We have therefore developed an online resource which has been designed to bring various sources of mental health information and guidance into one place. The aim is simple - to keep professionals in mental health up-to-date with what is happening in an ever changing landscape. If you would like more information please contact Claire Bentley.  

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