Health and Social Care Update - March 2013

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.

06/03/2013

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   Information and Data Sharing
  Children   Inquests
  Clinical Risk/Health and Safety   Mental Health
  Commissioning   Obesity
  Complaints   Primary Care
  Employment/HR   Public Health
  Finance   Regulation
  Foundation Trusts   General 
  Governance

 

Care

Publications/Guidance
Infection prevention and control in care homes: information resource. An information resource and summary for care workers on the prevention and control of infection in care homes has been published. These aim to assist staff in taking all reasonable steps to protect residents and staff from acquiring infections and cross infection; and provide information and guidance on infection prevention and control that will assist managers undertaking risk assessments and in developing policies.

Not just a number: Home care inspection programme – National overview. Presents the findings of the CQC's review of home care services that was carried out between April - November 2012. The review looked at whether people receiving care at home are treated with dignity and respect, have a choice about the care they receive and benefit from effective systems to keep them safe. The findings show that good care is being delivered, but a minority of people are affected by late or missed calls, lack of continuity of care workers, poor care planning and more. Throughout the review, the CQC found that 74 per cent of the 250 inspected services are meeting all five of the national standards it checked against.  

Patients to get better care from healthcare assistants. Announces a new independent review that will look at how the training and support of healthcare and care assistants can be strengthened so that they give better care to patients. The review, led by Camilla Cavendish, will look at how healthcare assistants can have the training and support they need to provide essential services to the highest standards and at how recruitment can be strengthened to place the right people, with the right values and behaviours, in the right settings. The review will report back to Government at the end of May.

Evidence-based planning and delivery of local support for carers. These findings outline responses from a survey of local authorities to find out how they collect information about their local carer populations, how they use this information to understand local needs, and plan and deliver support for carers.

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

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Children

Publications/guidance
Report of the children and young people's health outcomes forum This report outlines proposals on how health-related care for children and young people can be improved. Recommendations include: integration and partnership; safe and sustainable services; and workforce education and training. It also recommends a number of new outcomes measures and the strengthening of existing indicators, making specific recommendations for different organisations within the health and care system to ensure these improvements are achieved.

Better health outcomes for children and young people. This pledge aims to make improvements to the health of children and young people and is part of the government’s response to the Children and Young People’s Health Outcomes Forum. It commits signatories to put children, young people and families right at the heart of decision making and improve every aspect of health services - from pregnancy through to adolescence and beyond.

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

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Clinical Risk/Health and Safety     

Publications/Guidance
Infection prevention and control in care homes: information resource. An information resource and summary for care workers on the prevention and control of infection in care homes has been published. These aim to assist staff in taking all reasonable steps to protect residents and staff from acquiring infections and cross infection; and provide information and guidance on infection prevention and control that will assist managers undertaking risk assessments and in developing policies.

Clinical case scenarios for ectopic pregnancy and miscarriage. NICE has produced some clinical case scenarios to support the guidance on ectopic pregnancy and miscarriage. The clinical case scenarios illustrate how the recommendations from the guidance can be applied to the care of women presenting to GPs, A&E services and early pregnancy assessment services.

New stroke prevention treatment recommended by NICE. Patients with atrial fibrilation can now be offered apixaban (Eliquis) as an alternative to warfarin to reduce the risk of stroke and blood clots, says NICE. Patients with AF must also have one or more risk factors such as prior stroke or ischaemic attack, hypertension or diabetes.

Caring for people with liver disease: a competence framework. This framework, produced jointly with NHS Liver Care is aimed at all nursing staff working in all clinical settings across primary, secondary and tertiary care. It recognises that nursing staff have a key role in health promotion and aims to empower them to identify the signs and risk factors of liver disease, make brief interventions and signpost patients to support services. It also supports staff to build their levels of competence throughout their career trajectories. The competences described are cross-referenced to the NHS Knowledge Skills Framework to help to embed the framework in practice.

Independent providers of NHS care – CNST regulation and policy update. Draft regulations enabling private providers of NHS healthcare and local authorities to join the Clinical Negligence Scheme for Trusts (CNST) as direct members have been submitted to ministers and the Treasury for sign-off. Changes are still subject to Parliamentary approval, but the NHSLA expect the regulations to come into force by April 2013.

Understanding public protection: exploring views on the fitness to practise of health and care professionals. This report outlines results from a project designed to explore with members of the public and professional stakeholders their understanding of the concept of ‘public protection’ and of fitness to practise; their interpretation of terms used in this debate; their views on the ongoing discussion surrounding public protection and fitness to practise; the information about individuals they believe would be relevant to the regulator in determining fitness to practise, and whether there is any variance in this dependent on the profession (e.g. public facing versus non public facing professions).

Acting on concerns: your professional responsibility. This manual advises clinicians on how to act if they consider patients are receiving poor care. It guides surgeons on how best to collaborate with colleagues to monitor performance and quality of care, deal with problems, raise concerns and support others to do the same.

Consultations
Ministry of Justice: Damages Act 1996 - The discount rate - Review of the legal framework. Date of publication: 12 February 2013 Deadline date: 7 May 2013. This consultation seeks views on two subjects relating to the setting of the discount rate under section 1 of the Damages Act 1996: Whether the legal parameters defining how the rate is set should be changed, and whether there is a case for encouraging the use of periodical payment orders instead of lump sum payments.

News
The Health and Safety Executive is reportedly considering a full investigation into a death at Stafford Hospital in 2007. The HSE originally suspended its investigation into Gillian Astbury's death pending the outcome of an inquiry, which found she died due to systematic failures at the hospital. Managers and staff could face prosecution under the Health and Safety at Work etc Act 1974.

Inaccurate antibiotic test kits could be causing doctors to prescribe patients the wrong antibiotics, an investigation by the British Medical Journal (BMJ) has discovered. The test kits, which are used to determine which type of antibiotic should be administered to the patient, reportedly contained either too much or too little antibiotic, giving false readings which could potentially have led doctors to prescribe incorrect medication.

Bevan Brittan Updates
Mid Staffordshire NHS Inquiry Report - Key points: Clinical Governance. The lessons learned and recommendations set out in the Francis report are clearly intended to have an impact outside Stafford Hospital. Among many problems highlighted the report identifies:

  • A lack of openness to criticism
  • A lack of consideration for patients
  • Defensiveness

If you wish to discuss any of the items raised in this section please contact  Joanna LloydStuart Marchant or Julie Chappell

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Commissioning

Publications/Guidance
Securing excellence in commissioning NHS dental services. From April 2013, the NHS CB will take commissioning responsibility from primary care trusts for all NHS dental services: primary, community and secondary, including dental out of hours and urgent care. This will include commissioning dental services provided in high street dental practices, community dental services, and dental services at general hospitals and dental hospitals. This document focuses on commissioning the entire dental pathway as an integrated model of service delivery. It sets out a proposed operating model for commissioning specialist and community dental services and the care pathway to ensure consistency in delivery of dental services. There is also a factsheet and FAQs.

Consultations
Securing the best value for patients: Consultation response document. Sets out the DH’s response to the August 2012 consultation on proposals to protect patients' interests by ensuring commissioners operate within a framework of rules to secure the best clinical services for patients and deliver best value. The new NHS Procurement, Patient Choice and Competition Regulations 2013 (SI 2013/257) come into force from 1 April 2013 - for details, see below. Monitor will be consulting on its guidance for commissioners on the regulations in the coming months.

Ensuring fair and transparent pricing for NHS services: response to consultation. Sets out the Government's response to the consultation on proposals to enable commissioners and providers of services for whom the National Tariff will apply, to object to Monitor’s proposed methodology for calculating national prices. Under the proposed arrangements, if a sufficient proportion choose to object, Monitor would have to reconsider its proposals or refer the matter to the Competition Commission.

Bevan Brittan Updates
CCGs - From shadow to substance. As 1 April 2013 approaches and CCGs receive their authorisation, it is important for all CCGs to focus on what they need to do now to ensure they are able to be effective from inception. There is already a wealth of advice available from various sources, including the NHS Commissioning Board and the BMA. This article outlines some of the key areas of legal significance.

Mid Staffordshire NHS Inquiry Report - Key points: Relationships with commissioners and oversight bodies. The Francis report makes challenging reading for commissioners.  It is clear that although the successive reforms to the NHS may have amounted to mitigating circumstances, the commissioners, and indeed other interested parties, failed to take adequate steps to prevent the problems at Mid Staffordshire, or to uncover and prevent them from continuing.  The report recognises that the system is on the cusp of change but “the experience of Stafford shows an urgent need to rebalance and refocus commissioning into an exercise designed to procure desired standards of service for patients as well as to identify the nature of the service to be provided”.

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

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Complaints

 

Events
Seminar: Questions and Answers with the Parliamentary and Health Service Ombudsman. 13 March 2013 : 9.30am - 11.30am (Registration at 9.15am).  Location: Bevan Brittan LLP, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. We are delighted to welcome Anne Harding, Legal Advisor and Martin Pike, Director of Health Investigations at the Parliamentary and Health Service Ombudsman to Bevan Brittan. The PHSO will present on Listening and Learning: The Ombudsman’s review of complaint handling by the NHS and look at the conclusions of that report. There will be an opportunity to ask questions and the PHSO will consider its approach to complaint handling, investigations and compensation.

If you wish to discuss the issue of complaints more generally please contact Julie Chappell

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Employment/HR

 

Publications/Guidance
Managing NHS hospital consultants. This report from the National Audit Office examines the management of NHS hospital consultants and the new contract for hospital consultants that was introduced in October 2003. It finds that the 2003 contracts delivered many of the expected benefits but feels there is room for improvement in how trusts manage their consultants.

How to: procure an agency member of staff. This guide aims to outline the different approaches to procure an agency member of staff. It offers practical tips, suggestions and approaches to reduce expenditure on agency staff procurement.

Religion or belief in the workplace – A guide for employers following recent European Court of Human Rights judgments. On 15 January 2013, the ECtHR published its judgments in four combined cases about religious rights in the workplace (Eweida v United Kingdom [2013] ECHR 37). The judgment affects employer responsibilities for policies and practices protecting religion or belief rights in the workplace, the rights of employees (including job applicants) and the rights of customers. The judgments may be referred to the Grand Chamber of the European Court of Human Rights but in the meantime, the Equality and Human Rights Commission has published this new guidance that includes a selection of examples of requests and how employers might deal with them. See also Religion or Belief in the workplace: an explanation of recent European Court of Human Rights judgments and the Questions and Answer section that addresses some key employer questions.

Understanding public protection: exploring views on the fitness to practise of health and care professionals. This report outlines results from a project designed to explore with members of the public and professional stakeholders their understanding of the concept of ‘public protection’ and of fitness to practise; their interpretation of terms used in this debate; their views on the ongoing discussion surrounding public protection and fitness to practise; the information about individuals they believe would be relevant to the regulator in determining fitness to practise, and whether there is any variance in this dependent on the profession (e.g. public facing versus non public facing professions).

Acting on concerns: your professional responsibility. This manual advises clinicians on how to act if they consider patients are receiving poor care. It guides surgeons on how best to collaborate with colleagues to monitor performance and quality of care, deal with problems, raise concerns and support others to do the same.

Effective governance to support medical revalidation. The General Medical Council (GMC) has issued new guidance to assist Boards in checking their organisations are placing quality and safety at the centre of their services for patients. The guidance supports the new process of revalidation, providing a consistent check on doctors in order to give patients confidence in the advice and treatment they receive.

Workforce planning implications and learning points from Francis 2013. This paper is designed to contribute to an effective response to the Francis inquiry report by helping senior leaders in health, social care and public health to identify its key workforce implications. It aims to inform and stimulate discussion on the changes that the Francis report recommends at a strategic level, as well as providing advice to leaders as they consider how to engage staff to bring about individual change in the workforce.

NHS staff survey 2012. A total of 202,000 NHS staff were invited to participate in this survey by postal questionnaire. Responses were received from 101,000 staff, a response rate of 50% (compared to 53.7% in 2010). The results are primarily intended for use by NHS organisations to help them review and improve staff experience so that staff can provide better patient care. The Care Quality Commission will use the results from the survey to monitor ongoing compliance with essential standards of quality and safety. The NHS Commissioning Board will use the results to aid commissioning decisions. The survey will also support accountability of the Secretary of State for Health to Parliament for delivery of the NHS Constitution.

Consultations
Responses to consultation on future of audit staff in trusts. The responses to the consultation on future of audit staff in trusts are now available. There were 66 responses in total.

News
GMC warns over doctors’ working hours. Some doctors in training are tired and stressed because of their working patterns which could be putting patients at risk, the General Medical Council (GMC) has warned in research published on 14 February 2013. Some doctors may still be working nearly 100 hours a week during their busiest shifts, increasing the potential for mistakes. The research was aimed at understanding the impact of the Working Time Regulations, which are intended to promote health and safety by restricting the hours doctors work.

The National Whistleblowing Helpline which provides free, confidential, and independent advice for those working in the NHS and adult social care has recently launched their 'Bridging the Gap' campaign. The campaign aims to support employers to reinforce messages to embed a cultural change where individuals can feel safe to openly raise concerns and managers feel equipped to respond confidently and effectively. Free posters and fliers for staff and managers can be downloaded from the National Whistleblowing website or by telephoning 08000 724 725.

New powers to check language skills of doctors. The Government is to introduce new checks to make sure that all doctors who work for the NHS can speak English well enough to treat patients. From 1 April 2013 there will be a legal duty to make sure a doctor can speak the necessary level of English to perform their job in a safe and competent manner before they can treat patients in a hospital or GP practice. There will also be single national list that every GP will have to be on before treating NHS patients. Every GP will have to demonstrate their ability to speak English to be accepted on to this list. The Government is also proposing to give the GMC new powers to prevent the grant of a licence to practise medicine in the UK to a doctor where there are concerns about their ability to speak English.

Bevan Brittan Updates
Employment news round-up: February 2013. This month’s news round-up is brought to you by Alastair Currie and includes the latest news on: TUPE (whether it is ‘static’ or ‘dynamic’); whistleblowing; changes to unfair dismissal as a result of the recent BNP case on politically motivated dismissals; details of new guidance following the recent Eweida case on religious discrimination; and details of new developments on collective redundancy, family friendly rights and settlement agreements.

Young, gifted and broke: Age-related redundancy payments. In Lockwood v Department of Work and Pensions, the Employment Appeal Tribunal has confirmed that an enhanced redundancy payment for older workers did not amount to direct age discrimination, when objectively justified by a strong social policy objective.  In this case, the strong social policy objective was the provision of a 'financial cushion' for older workers that reflected the extra difficulties they experienced after losing their jobs.  George Pennington explains more.

Mid Staffordshire NHS Inquiry Report - Key points: Workforce Issues. As Mr Francis QC points out in the report, much has been said about whistleblowing during the Inquiry, and much has been written about it since the Inquiry concluded. It is clear from the report that, while Mid Staffordshire had in place a whistleblowing policy and procedure, it faced serious difficulties in the implementation of that policy.

If you require further information about any of the items raised in this section please contact Julian Hoskins or James Gutteridge.   

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Finance

Publications/guidance
Approved costing guidance. This guide sets out costing principles, costing standards, and guidance for both reference costs and Patient-Level Information and Costing Systems collections for 2012-13. It also gives details of the requirements that providers of NHS-funded services will need to comply with to meet the pricing conditions of the NHS provider licence.

Best practice tariffs and their impact. The DH introduced best practice tariffs (BPTs) in 2010/11 as a means of reducing unexplained variation in clinical quality and ensuring that best practice is widespread. BPTs are structured and priced so that they adequately reimburse and incentivise high quality and cost-effective care. This briefing sets out the Audit Commission's assessment of how BPTs impact at a local level and how implementation can be improved, and looks in detail at their influence on day case surgery, fragility hip fractures and acute stroke. It also reports the Commission's findings from a review of the quality of the data underpinning BPTs payment as part of the Payment by Results assurance framework. The Commission makes recommendations to both national tariff setters and the local bodies they aim to incentivise. There is also a data pack to help providers benchmark their achievement of best practice against other trusts and identify how much income they could earn by improving their performance.

Policy statement on care and support funding reform and legislative requirements. Following the Government’s announcement to implement a new funding model for adult social care, based on the recommendations of the Dilnot Commission on the Funding of Care and Support, this document sets out further detail on what the new system will mean and how it may be legislated for. It will support pre-legislative scrutiny of the draft Care and Support Bill. Section 1 describes the case for change, and the Government’s objectives in bringing forward these proposals for a reformed system. Section 2 describes how this would work for individuals and the changes that might be provided for in legislation, including where revisions might be required to the proposals set out in the draft Care and Support Bill. Provisions to enact these reforms would be included when legislation is introduced.
The new measures for funding care include, from April 2017:
 a  £75,000 cap on care costs; and
 financial support for those with assets of less than £123,000.
For a summary of the proposals, see the DH press release.

How is the health and social care system performing? February 2013 quarterly monitoring report. This quarter's monitoring report finds that, while most NHS organisations are on track to meet financial targets, it is clear that pressures are growing towards the end of the second year of the Nicholson Challenge. For the first time, the report also includes a survey of directors of adult social services in English local authorities alongside its usual survey of NHS finance directors.

Consultations
Direct payments for healthcare: A consultation on updated policy for regulations. The DH is seeking views on the Government's proposals for regulations and guidance on direct payments for healthcare policy as personal health budgets are rolled out more widely across England. This paper proposes some changes to the regulations based on learning from the recent pilot programme and discussions with personal health budget holders, healthcare professionals and other organisations. It discusses what services will be excluded, for example acute and unplanned care and GP services. It also asks for views on issues including eligibility, paying family members for carrying out administrative functions, allowing local authorities to make direct payments for healthcare and separate bank accounts. The consultation closes on 26 April 2013.

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

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Foundation Trusts 

Publications/guidance
Draft statutory guidance for Trust Special Administrators appointed to NHS foundation trusts This draft guidance is aimed at Trust Special Administrators who may in future be appointed to run NHS foundation trusts where the provision of quality services is threatened. Views on how individuals who take on the duties of a Trust Special Administrator will be appointed and carry out their statutory roles are sought from from providers, commissioners and other interested parties until 11 March 2013.

Bevan Brittan Updates
The inside track on the Mid Staffordshire NHS Foundation Trust Public Inquiry: Five questions for Bevan Brittan’s adviser to the CQC. In a follow-up to our recent alert on the report of the Mid Staffordshire NHS Foundation Trust Inquiry, Julian Hoskins discusses the practical impact of the report on workforce issues, in a Q&A with Carlton Sadler - the Bevan Brittan Senior Associate who led the team advising one of the core participants in the Inquiry, the Care Quality Commission.

Mid Staffordshire NHS Inquiry Report – Implications for Foundation Trust Governors. Governance was a central theme of Robert Francis QC’s report on the failings at Stafford Hospital. While Foundation Trust boards and various regulators bore the brunt of the criticisms, the report also has implications for Foundation Trust governors.

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

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Governance 

Publications/Guidance
Lessons from Europe: provider governance. This briefing outlines key insights from a seminar which examined the impact of recent reforms in hospital governance in Spain and the Netherlands. It identifies lessons for NHS managers and policymakers in England on how to approach the challenge of effective provider governance as the present NHS reforms are implemented.

Patient-led assessments of the care environment (PLACE). This letter provides information on the new system for assessing the quality of the hospital environment, which replaces Patient Environment Action Team (PEAT) inspections from April 2013. PLACE assessments will apply to all hospitals delivering NHS-funded care, including day treatment centres and hospices. PLACE assessments put patient views at the centre of the assessment process, and use information gleaned directly from patient assessors to report how well a hospital is performing in the areas assessed – privacy and dignity, cleanliness, food and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or staff behaviours. The assessments will be undertaken annually, and results will be reported publicly to help drive improvements in the care environment. The results will show how hospitals are performing nationally.

NHS governance review. This annual review by Grant Thornton assesses NHS governance and how these arrangements are communicated. It also draws on comparisons from last year and survey responses from over 60 NHS leaders, to highlight areas for improvement and provide practical advice for achieving best practice. The review is based on desk-top research of over 100 NHS trust, FT and PCT annual reports.Effective governance to support medical revalidation. The General Medical Council (GMC) has issued new guidance to assist Boards in checking their organisations are placing quality and safety at the centre of their services for patients. The guidance supports the new process of revalidation, providing a consistent check on doctors in order to give patients confidence in the advice and treatment they receive.

The non-executive directors' guide to hospital data. This briefing introduces the scale of NHS activity, the range of activity, the patient pathway and the major datasets. It aims to help non-executive directors better understand NHS data and how it can be used to determine what is going on in their hospital.

Bevan Brittan Updates
Mid Staffordshire NHS Inquiry Report – Implications for Foundation Trust Governors. Governance was a central theme of Robert Francis QC’s report on the failings at Stafford Hospital. While Foundation Trust boards and various regulators bore the brunt of the criticisms, the report also has implications for Foundation Trust governors.

Mid Staffordshire NHS Inquiry Report - Key points: Leadership, Culture and Corporate Governance. In his introduction to the report Robert Francis QC makes the point that the failure at Mid Staffordshire was “primarily caused by a serious failure on the part of a provider Trust Board.  It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention. Above all, it failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities.”  The buck stops with the Board, and some of the wide-ranging recommendations set out in the report will have a direct impact on Board composition, conduct and performance.

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

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Information and Data Sharing

News
ICO urges more care with personal data as Nursing and Midwifery Council receives £150,000 penalty The Information Commissioner’s Office has urged organisations to review their policies on how personal data is handled, after the Nursing and Midwifery Council was issued a £150,000 civil monetary penalty for breaching the Data Protection Act.

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

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Inquests 

Consultations
Implementing the coroner reforms in Part 1 of the Coroners and Justice Act 2009: Consultation on rules, regulations, coroner areas and statutory guidance. A Ministry of Justice consultation seeks views on the implementation of the coroner reforms in Pt 1 of the Coroners and Justice Act 2009, including proposals concerning: coroner investigation regulations; inquest rules; fee and allowance regulations; coroner areas; and statutory guidance for bereaved people. Comments by April 12, 2013.

Cases
R (Lagos) v HM Coroner for City of London (2013). It was not appropriate to order disclosure of a police report which had been submitted to a coroner to assist him in understanding relevant issues before giving a verdict on the cause of death of a claimant's wife. However, the claimant was entitled to disclosure of police photographs of the crime scene to assist him in his application for judicial review of the coroner's verdict of suicide.

News
Coroners can now move inquests. A change to the Coroners Act 1988 announced by the Ministry of Justice will see coroners no longer restricted to holding inquests within their own district. Coroners will now be able to relocate an inquest if it is in the best interest of the bereaved family and others, such as witnesses.

Bevan Brittan Updates
Being an Inquest Witness: Part 1 - Statement Writing. This article covers key tips on how to prepare a statement in order to best assist the Coroner in the context of an Inquest.

If you wish to discuss any of the items raised in this section please contact  Joanna Lloyd

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Mental Health

 

Bevan Brittan Mental Health Extranet.
This is a free resource for Bevan Brittan NHS clients. Bevan Brittan has a wealth of mental health knowledge it would like to share with NHS clients. We have therefore developed an online searchable extranet designed to bring various sources of mental health information and guidance into one place.

The extranet also contains a forum for use by members to share knowledge and information. Current topics are:-
 Impact of the Health and Social Care Act 2012 on the MHA
 Witholding information from parents
 Lesbian, gay and bisexual health

If you would like information about how to access the Bevan Brittan Mental Health Extranet please email Claire Bentley by clicking here.

Training - If you would like to know about our lunch time training sessions just ask Claire Bentley.  You can attend in our London, Bristol or Birmingham office.

Publications/Guidance
Housing, dementia and the maintenance of independence. This report by the ADASS Housing Policy Network and the Housing Learning and Improvement Network (LIN) looks at emerging housing policy and practice developments in relation to supporting people with dementia. It explains that housing conditions and access to appropriate care and support can impede the ability of people with dementia to remain independent. It makes a number of thoughtful points and ends with a useful list of 10 'top tips' of things that social care professionals should do.

Independent Mental Capacity Advocacy service: fifth annual report. This annual report provides statistical information on the continued increase in referrals to this statutory advocacy service and makes recommendations to clinical commissioning groups and local authorities about its use for those who lack capacity. It also provides an overview on the service over the past five years.

Working with schizophrenia: pathways to employment, recovery and inclusion. This report examines the impact of schizophrenia on an individual's ability to enter or remain in the labour market, outlining how such barriers can be addressed by policymakers, employers, and healthcare professionals as well as those with the condition and their carers.

Service users’ experiences of recovery under the 2008 care programme approach (CPA) This study explored how effective service users find CPA in promoting recovery as they understand it. Study participants were service users and survivors of 18 and above who have experienced the CPA since October 2008 and who live in a London borough. The findings demonstrate that whilst service users hold some positive views about the 2008 CPA, they also think that significant improvements are needed if they are to recover.

Monitoring places of detention: Third Annual Report of the United Kingdom's National Preventive Mechanism: 1 April 2011 - 31 March 2012. This is the third annual report of the UK’s National Preventive Mechanism (NPM), the group of 18 organisations designated to fulfil the UK’s obligations to ensure the independent monitoring of the treatment of and conditions for people deprived of their liberty. These obligations arise from the UK’s status as a party to the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). The purpose of monitoring is to prevent ill-treatment in all places of detention – from prisons to children’s homes to secure hospitals.

The Fifth Year of the Independent Mental Capacity Advocacy (IMCA) Service - 2011 /2012. This is the annual report on the Fifth Year of the Independent Mental Capacity Advocacy (IMCA) service. It provides statistical information on the continued increase in referrals to this statutory advocacy service and makes recommends to CCGs and LAs about its use for those who lack capacity.

Turning young lives around: how health and justice services can respond to children with mental health problems and learning disabilities who offend. This briefing paper seeks to encourage effective joint working between health and wellbeing boards and youth justice services. It aims to ensure that local strategies reflect the needs of children and young people who offend, especially those with mental health problems and learning disabilities. It outlines a practical action agenda and provides examples of good practice.

Legislation
Mental Health (Discrimination) Act 2013. Members of Parliament (MPs) and members of the devolved assemblies and parliament will not, from 28 April 2013, lose their seats if detained under the Mental Health Act 1983 for more than six months. Further action is taken to remove the stigma associated with mental illness. Those receiving voluntarily regular treatment for a mental health disorder and not institutionalised will not be barred from jury service from a date to be determined by the Secretary of State.

News
A new scheme, 'Books on Prescription' has been developed by the Reading Agency charity, and aims to support adults with mild to moderate mental health conditions. The new scheme will begin in May 2013 throughout England and will involve a prescription list of thirty books being made available in public library authorities.

Successful applicants announced for stage 1 of the Department’s dementia environment funding. Announces the successful applicants for stage 1 of the £50m funding of capital projects to improve care environments for people with dementia. This document gives details of the organisations and their projects that have been approved to move forward and develop the stage 2 ‘committed to proceed’ applications.

'Inadequate staffing' put mental health patients at risk, CQC warns.

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

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Obesity 

Publications/Guidance
Measuring up: the medical profession's prescription for the national obesity crisis. This report sets out recommendations from a range of medical professions - from surgeons to psychiatrists to paediatricians to GPs - on tackling the obesity crisis in the UK. The recommendations include food-based standards to be made mandatory for hospitals; £300m over the next three years to be spent on increasing the provision of weight management services; and a duty on sugary soft drinks.

Statistics on Obesity, Physical Activity and Diet - England, 2013. The NHS Information Centre. This statistical report presents a range of information on obesity, physical activity and diet, drawn together from a variety of sources. The topics covered include: Overweight and obesity prevalence among adults and children, Physical activity levels among adults and children, Trends in purchases and consumption of food and drink and energy intake and Health outcomes of being overweight or obese. Over the period 2001/02 to 2011/12 in almost every year more than twice as many females than males were admitted to hospital with a primary diagnosis of obesity. In 2011/12 almost three times as many women as men were admitted with a primary diagnosis of obesity (8,740 women compared to 2,993 men).

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

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Primary Care

Publications/Guidance
Performers List Regulations 2013: Response to consultation document. Sets out the Government's response to the October 2012 consultation on how to amend the Performers Lists system to reflect the changes made by the Health and Social Care Act 2012 and recommendations made by previous reviews. PCTs are to be abolished from April 2013 and the duties and powers of PCTs in relation to performers lists are to be transferred to the NHS Commissioning Board (NHS CB). The Secretary of State has decided that national performers lists held by the NHS CB will replace the current system of separate PCT lists. This will ensure alignment with the NHS CB’s responsibility for commissioning NHS primary care services. Respondents supported the majority of the proposed changes; however, there were concerns about the proposal to give the NHS CB power to remove performers who did not provide a minimum service. These concerns highlighted considerable practical challenges in implementing this proposal so the DH has decided that this will not be implemented at this stage but the NHS CB will lead further work to develop the proposal and determine whether minimum service can be sensibly introduced into the Performers Lists Regulations.

Francis report: implications for CCGs and general practice. This briefing from Primary Care Commissioning looks at the implications of the Francis report on the Mid Staffs public inquiry for CCGs and general practice.

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

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Public Health

Publications/Guidance
Prevention of unintentional injuries in under 15s. New evidence update Prevention of unintentional injuries in under 15s.

Influencing local commissioning for health and care – Guidance for the voluntary and community sector. This policy briefing from Regional Voices gives an overview of HWBs, Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies, and the role of the voluntary sector.

Public Health England people transition policy – FAQs for Module 2. Sets out a series of frequently asked questions about module 2 of the people transition policy, for terms and conditions for staff on transfer into Public Health England. Module 2 also sets out terms and conditions for staff joining after 1 April 2013.

Transfer of public health staff from PCTs to LAs. Updated slides on transition issues for the transfer of public health staff from PCTs to local authorities, prepared for events organised by the HR Concordat Steering Group for senior managers in both PCTs and local authorities.

Public Health England’s organisational structure and National Executive. PHE has finalised its organisational structure in advance of taking on its full range of responsibilities on 1 April 2013. it has also completed appointments to the PHE National Executive. This page links to an organogram and to a senior management chart.

Medicines watchdog launches side effect campaign. The Medicines and Healthcare products Regulatory Agency (MHRA) has launched a public health campaign in partnership with pharmacy organisations to highlight the need for the public to report any suspected side effects from medicines through the Yellow Card Scheme.

District action on public health – How district councils contribute towards the new health and wellbeing agenda in local government. This publication from the District Councils' Network discusses how district councils can play an important role in the new public health system and help to deliver lasting improvements to health outcomes and reductions in health inequalities. It includes a number of best practice case studies of service delivery and public health collaboration in two-tier areas.

Guidance: local authority charging for public health activity. From April 2013, upper tier and unitary local authorities in England have a new duty to take steps as they consider appropriate for improving the health of the people in their areas. This guidance sets out what public health improvement activity local authorities can charge for and what services must be free at the point of use, under the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013 (see below).

Sexual health commissioning: frequently asked questions These FAQs have been produced by the LGA and Public Health England. They address a number of transitional issues relating to the transfer of responsibility for commissioning sexual health services to local government. In addition to these FAQs the Department of Health will shortly publish guidance on local government’s mandatory responsibilities for sexual health.

News
Local councils are being encouraged to review any investments they have in tobacco companies before they take on responsibility for public health from April 2013. Leading health bodies are concerned about a possible conflict of interest.

Bevan Brittan Events
Health and Well Being Boards Event. 19 March 2013 : 10:00am - 1:00pm (Registration from 9:30am). Location: Bevan Brittan LLP, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. We are delighted to invite you to an event hosted at our London office on Tuesday 19 March. This event will focus on the duties of integration imposed by the Health and Social Act and look at how this can be achieved, highlight some of the considerations that will have to be borne in mind and cover possible innovative solutions to achieve the new duties around both integration and the public health agenda. It will also review the new HWB regulations and the impact of these upon the HWBs as they come into effect on 1st April 2013.

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

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Regulation

Publications/Guidance
The new NHS provider licence. Monitor has published its new Provider Licence that contains obligations for providers of NHS services that will allow Monitor to fulfil its new duties in relation to: setting prices for NHS-funded care in partnership with the NHS Commissioning Board; enabling integrated care; preventing anti-competitive behaviour which is against the interests of patients; supporting commissioners in maintaining service continuity; and enabling Monitor to continue to oversee the way that foundation trusts are governed. The licence is the main tool with which Monitor will regulate providers of NHS services. It will license foundation trusts from April 2013, and other eligible NHS providers from April 2014. This web page also links to the licence standard conditions and a summary of consultation feedback.
Monitor is holding four regional events in London, Leeds and Birmingham to update NHS providers and commissioners on the preparations for the new regulatory system. These will cover the NHS provider licence and how it will be enforced, and will be an opportunity to feed back views on the proposed risk assessment framework.

Not just a number: Home care inspection programme – National overview. Presents the findings of the CQC's review of home care services that was carried out between April - November 2012. The review looked at whether people receiving care at home are treated with dignity and respect, have a choice about the care they receive and benefit from effective systems to keep them safe. The findings show that good care is being delivered, but a minority of people are affected by late or missed calls, lack of continuity of care workers, poor care planning and more. Throughout the review, the CQC found that 74 per cent of the 250 inspected services are meeting all five of the national standards it checked against.  

Consultation
Launch of consultation on legislation on indemnity insurance. This consultation seeks feedback on draft regulations on the requirement for all regulated healthcare professionals to hold an insurance or indemnity arrangement as a condition of their registration with the relevant regulatory body. The consultation closes on 17 May 2013.

Bevan Brittan Updates
Regulatory Matters - Will pointing the finger of blame work? The challenge for all is to create real and lasting differences in the health and social care spectrum.  This article examines some common themes about achieving change.

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

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General

Publications/Guidance
Procurement Policy Information Note 03/13 – Promoting tax compliance and procurement. The Cabinet Office is conducting a very short (one week) consultation on its proposed approach to using the procurement process to deter tax avoidance and evasion. This draft guidance advises that from 1 April 2013, during the selection stage of all central government above-threshold EU procurements, a supplier will be required to make a declaration regarding their tax compliance at the selection stage of the procurement procedure. The contracting authority will require this declaration or "self-certification" to establish whether the supplier has had an "occasion of non-compliance" (as defined in the guidance), during the specified time period. Where a supplier is unable to self-certify that there have been no "occasions of non-compliance", they will be required to supplement their response with an explanatory statement. The deadline for comments is 22 February 2013.
In response to a query from us, the Cabinet Office has stated that the PPN guidance applies to all central government bodies, executive agencies and NDPB but not to wider public sector bodies such as the NHS although, as always, the wider public sector are encouraged to adopt a similar approach.

Procurement Policy Note – Supplier financial risk issues (Information Note 02/13). This PPN gives advice on carrying out an assessment of potential providers' financial or economic standing as part of a procurement exercise. It stresses that all such assessments should be undertaken in a manner that is proportionate, flexible and not overly-risk averse while ensuring taxpayer value and safety is protected and the relevant EU procurement law is complied with. Financial standing should only be considered as part of the overall selection criteria; it may not, on its own, reflect potential providers’ ability to deliver.

Improving government procurement. This report provides an overview of the procurement reform strategy, reviews the governance and accountability arrangements in place, and examines progress in its implementation. It considers several departments, including the Department of Health.

Acting on Concerns: Your Professional Responsibility. The Royal College of Surgeons (RCS) has published a comprehensive manual that advises clinicians on how to act if they consider patients are receiving poor care.

HIV outpatient pathway updated guidance. Newly updated guidance is now available to support the implementation of the mandatory adult HIV outpatient and Payment by Results currency.

Language support: challenges and benefits for users and providers of health and social care services. This briefing paper identifies and discusses different approaches to language support in health and social care, by comparing the use of professional and volunteer interpreters. It identifies key implications for policy and practice from both a patient and a provider perspective, and offers an understanding of how interpreting can reduce health inequalities.

Government Response to the House of Commons Health Committee Report of Session 2012-13: 2012 accountability hearing with the General Medical Council. This Command Paper provides the Government’s response to the three recommendations directed to the Department of Health around  Language Competency and Right of appeal against MPTS decisions.

Regulations for controlled drugs in the community. The Department of Health (DH) has published its responses to the consultation on changes to the Controlled Drugs (Supervision of Management and Use) Regulations 2006. Designated bodies are required to appoint Controlled Drugs Accountable Officers (CDAO), to supervise the safe usage of controlled drugs. The DH launched a consultation concerning an overhaul of the role of CDAOs following the Health and Social Care Act 2012.

Red Tape Challenge on controlled drugs regulation—Final response. The electronic prescribing of all controlled drugs has been advocated by the Department of Health (DH). The DH’s final assessment of the review of controlled drugs acknowledges multiple areas of concern, such as the unofficial policy of a presumption of guilt. It comes after the introduction of the Red Tape Challenge and the DH’s assessment of the impact on the regulation of health professions.

Fertility: assessment and treatment for people with fertility problems. NICE have updated their guidelines on the treatment of infertility so that more women can receive appropriate and timely fertility treatment such as IVF. Under the updated recommendations, under certain criteria, women aged between 40 and 42 years should be offered one full cycle of IVF. It also recommends that IVF treatment should be made available for eligible women earlier than was previously recommended.

When maternity doesn’t matter: dispersing pregnant women seeking asylum. This report shows that the UK Border Agency's dispersal policies are putting the health of pregnant women and their babies at risk. By moving them to accommodation around the county, women are uprooted from essential healthcare and their support networks, leaving them isolated and vulnerable. It recommends that the Department of Health should facilitate data collection by NHS trusts of incidents in which UKBA dispersal and relocation practices have prevented delivery of effective maternity care, as well as facilitating communication of the data to the UKBA.

Asthma quality standard. This quality standard on the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older argues that an integrated approach to services is vital. The new quality standard on asthma consists of a prioritised set of specific, concise and measurable statements that, when delivered collectively, should contribute to improving the effectiveness, quality, safety and experience of care for people with the condition.

Fertility: Assessment and treatment for people with fertility problems. This guideline from NICE offers best practice advice on assisting people of reproductive age who have problems conceiving.

HIV outpatient pathway updated guidance. This guidance is being published to support the implementation of the mandatory adult HIV outpatient and Payment by Results currency. This documentation replaces the previously published guidance.

Securing excellence in IT services: operating model for offender health care. This document sets out how the management of IT systems will be organised for offender health care from April 2013. It provides a system which ensures the safe transfer of offender health IT from PCTs to the NHS Commissioning Board so there is clarity for all stakeholders, safety for patients and business continuity for the NHS.

The NHS Friends and Family test: Publication guidance. From April 2013 all patients will be asked a simple question to identify if they would recommend a particular A&E department or ward to their friends and family. The results of the test will be used to improve the experience of patients by providing timely feedback alongside other sources of patient feedback. It will highlight priority areas for action. This document gives guidance to providers of NHS funded services on calculating and presenting the NHS friends and family test results. It details how scores will be calculated and how national and local publication should be carried out.

Using staff survey data to assist with an organisational response to the Francis report. The national NHS staff survey provides a very useful source of data to help identify the scale and nature of any issues in many of the areas identified by the Francis Report. This resource sets out some tips and guidance on analysing local survey results.

Legislation
Cosmetic Surgery (Minimum Standards) Bill: House of Commons 2nd reading. The sponsoring MP has nominated 3 May 2013 for the second reading. As the House is not expected to sit on this day it is unlikely to be debated on this date. The sponsoring MP may choose another day for the second reading. 

Draft Care and Support Bill 2012-13. This briefing note provides general information on the draft Care and Support Bill that was announced in the Queen’s Speech on 9 May 2012 and published by the Government on 11 July 2012.

Consultations
New licensing regime for providers of NHS services - Response to closed consultation. This is the government response to the consultation on proposals for implementing a new licensing regime for providers of NHS services. It summarises the responses to that consultation and details the content of the regulations that the Secretary of State now intends to make.

Help to shape the national strategy for equality, health inequalities and human rights – have your say. Working as part of the NHS Equality and Diversity Council (EDC), the NHS CB is inviting a wide range of views to inform the development of the national strategy to promote equality and reduce health inequalities. The strategy will set out a clear approach, reflective of the values of the NHS Constitution, for promoting equality and reducing health inequalities for all groups across the life course. The survey will close 31 March 2013.

News
NHS competition rules to be changed. The BBC reports that the Government is to rewrite the NHS (Procurement, Patient Choice and Competition) Regulations 2013 (SI 2013/257) that were due to come into force on 1 April 2013, after concerns were raised that they would open up many more services to competition from private companies and could disrupt services for patients. The Health Minister Norman Lamb has said that the DH is acting quickly to improve the drafting so that there can be no doubt that the regulations go no further than the previous set of principles and rules. This announcement follows on from a statement from Lord Howe on the regulations in which he clarified their intended effect.

The Government has announced changes to the Patents Act to allow clinical and field trials and health technology assessment for new drugs to be carried out without risk of being sued for patent infringement. The large majority of respondents to a recent consultation supported such a move.

Grayling seeks to ban inmates from access to IVF treatment. The Secretary of State for Justice has proposed a ban on prisoners having access to fertility treatment and has indicated that he is prepared to take on the European Court of Human Rights which has previously ruled that blocking access to such treatment may breach an inmate's right to a "private and family life".

NHS charges from April 2013 announced. The NHS prescription charge in England will increase by 20p from £7.65 to £7.85 for each quantity of a drug or appliance from 1 April 2013.

Independent review invites public to share their experiences of the Liverpool Care Pathway. Members of the public are invited to share their experiences of the Liverpool Care Pathway for Dying Patients (LCP), both good and bad, as part of the review being chaired by Senior Rabbi and Crossbench Peer, Baroness Julia Neuberger.

More to receive IVF under draft fertility guidelines. Some women in their early 40s should be allowed to have fertility treatment on the NHS, according to draft updated guidelines from NICE.

£11 million funding boost to improve NHS prosthetic care for war veterans. Announces that NHS services are to receive £11m additional funding over two years to improve prosthetic and rehabilitation services for ex-servicemen and women, similar to those which the Armed Forces provide for men and women currently serving in the army, navy and air force. Nine NHS facilities across the country will receive a share of up to £6.7m to access the latest technology and provide the highest quality of prosthetic care for veteran amputees; the remainder of the funding will go towards other prosthetics services. 

Bevan Brittan Updates
DNAR: A matter of life and death. Decisions not to attempt resuscitation can generate a great deal of controversy.  This article focuses on the competing tensions, guidelines and points of consideration in this complex and challenging area.

Mid Staffordshire NHS Trust inquiry report published - Key points briefing. Robert Francis QC's report today heralds the conclusion of possibly the largest ever public inquiry into the regulation of healthcare in this country. The report is extensive, running to 1782 pages and making 290 recommendations.The findings and recommendations in the report are of fundamental significance not only for the NHS but also beyond.

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

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