Health and Social Care Update - April 2013

15/04/2013

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

Care

Publications/Guidance
Care Update Issue 2: March 2013. The CQC Care Update: Issue 2, March 2013 gives its latest view of the performance of care services in England in the nine-month period up to 31 December 2012. It reports on some encouraging signs of improvement in some care sectors, highlights some early warning signs of areas where quality may be getting worse, and notes those areas of care that still fall short of what is acceptable.

The Francis public inquiry report: a response. This policy response offers an analysis of several key themes from the Francis report including funding, patient-level data, commissioning and regulation. It endorses the inquiry report’s main message that listening to and understanding patients must come first, and makes recommendations around standards, recruitment processes, regulatory arrangements, the responsibility of the CQC, and data collection.

Mid-Staffordshire NHS FT public inquiry: the RCS view The Royal College of Surgeons has published its views and recommendations following the publication of the public inquiry into failings of care at Mid-Staffordshire NHS Foundation Trust.

Time to listen in NHS hospitals: Dignity and nutrition inspection programme 2012. The Care Quality Commission (CQC) has published its first dedicated review of privacy, dignity and nutrition in both care homes and hospitals. CQC inspected 500 care homes and found that while 84 per cent respected people's privacy and dignity and 83 per cent met people's nutritional needs a number of hospitals and care homes need to make improvements.

House of Lords and House of Commons Joint Committee on the Draft Care and Support Bill: Session 2012-13: Report, together with formal minutes. This report warns that the government has not fully thought through the implications of its social care reforms and may leave local authorities open to a deluge of disputes and legal challenges. It also warns that without greater integration with health and housing, and a focus on prevention and early intervention, the care and support system will be unsustainable.

Patients first and foremost: the initial Government Response to the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. The quality of patient care is to be placed at the heart of the NHS in an overhaul of health and care, according to the Government's response to the Francis Inquiry. Hospitals and care homes will be encouraged to strive to be the best and the families of patients will be informed of any errors in their treatment or care. Organisations registered with the Care Quality Commission will have a statutory duty of candour, to reveal their errors.
See Bevan Brittan's client alert: The hard work begins: The Government's initial response to the Francis Report.

Budget 2013: what it means for carers. This briefing is a short summary of the major areas of the ways in which the March 2013 Budget will affect carers and their families. In addition to downgrading forecasts for economic growth, the Chancellor announced a number of tax changes including some tax cuts, additional cuts to public spending, support with childcare vouchers, and the bringing forward of significant policies including state pension reform and a cap on the costs of care.

Cases
Health and safety prosecution. The former owners of a Buckinghamshire care home have been sentenced for serious safety failings after a frail 76-year-old woman died following a fall from a hoist.

Journal Articles
Impact report - the Mid Staffordshire Inquiry. Policy makers, commissioners and regulators within the NHS are currently reeling from the 290 recommendations made by Robert Francis QC in his Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published on 6th February 2013. Stuart Marchant has written an article for Care Managment Matters in which he explains the details of the Francis report and its implications for the care sector.

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

Children

Publications/guidance
Working together to safeguard children. Professionals with responsibility for safeguarding children will have to move their focus away from processes onto the needs of the child, following publication of a revised 'Working Together to Safeguard Children' guidance. The guidance, which consolidates information on the core legal requirements for individuals and organisations to keep children safe, comes into effect from 15 April 2013.

A call to end violence against women and girls: Action plan 2013. A Home Office publication sets out how the Government has maintained its commitment to end violence against women and girls. Steps to address this issue since March 2012 include extending the domestic violence definition to include those aged 16-17; setting up five new rape crisis centres; and establishing a fund to help local areas prevent future incidents of domestic violence.

Securing excellence in child health information services: IT operating model. This operating model aims to ensure the safe transfer of commissioning responsibilities from PCTs to ensure that all existing information systems and associated support for child health information, including the Personal Child Health Record [“Red Book”], continue to exchange data with partners and share information with parents and carers. These changes come into force on 1 April 2013. The new arrangements as described in the operating model will be kept under review.

Child health profiles. These profiles provide a snapshot of child health and well-being for each local authority in England using key health indicators, which enables comparison locally, regionally and nationally. By using the profiles local organisations can work in partnership to plan and commission evidence-based services based on local need. The profiles allow you to compare the outcomes in your local population with others in order to identify and learn from better performing areas. A child health profile is available for each top level local authority in England.

News
Children and young people with special educational needs to benefit from new legal health duty. Announces that the Children and Families Bill currently going through Parliament will include a new legal duty on CCGs to have to secure services in education, health and care plans for children and young adults, so that local authorities, health professionals and volunteers come together to organise services, and set out a clear expectation of what parents, children and young adults with SEN will get.

NICE publishes first joint health and social care quality standards. Announces that NICE has published quality standards on the well-being of looked-after children and young people.

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

Clinical Risk/Health and Safety

Publications/Guidance
Good medical practice. The guidance makes clear that a doctor’s responsibility goes beyond providing good clinical treatment – the doctor must take a lead role in making sure that patients receive high quality compassionate care and that their dignity is always respected. The latest version is also more explicit about doctors’ responsibilities when patients’ basic care needs are not being met, particularly for those patients who are unable to drink, feed or clean themselves. For the first time it includes guidance on doctors’ use of social media.

Comprehensive cervical cancer prevention and control: a healthier future for girls and women. This guidance note advocates a comprehensive approach to cervical cancer prevention and control. It is aimed at senior policy makers and programme managers. It describes the need to deliver effective interventions from childhood through to adulthood, including community education, social mobilization, HPV vaccination, screening, treatment and palliative care. It also outlines the complementary strategies for comprehensive cervical cancer prevention and control, and highlights collaboration across national health programmes (particularly immunisation, reproductive health, cancer control and adolescent health), organisations and partners.

Exploring patient participation in reducing health-care-related safety risks. This report presents an overview of the legal influences on patient safety and explores the relationship between patients’ rights, patient participation and patient safety. It provides a synthesis of studies of patient involvement, with detailed examples from Bulgaria, France, the Netherlands, Poland and Portugal. It highlights the need to strengthen a continuum of information between various levels of care, including patient experiences, health literacy and engagement. It offers recommendations on the macro-, meso- and micro-levels of health service delivery

Safety culture: what is it and how do we monitor and measure it? This report reflects the discussions at a roundtable session held by the Health Foundation to discuss what is understood as ‘safety culture’, why it is important and how it can be measured and monitored.

Legislation
Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (SI 2013/645). Healthcare employers will need to have specified arrangements in place from 11 May 2013 for when an employee suffers an injury from a sharp object. Additional obligations are imposed, including the need for employees to report on occurrences of such injuries.

National Health Service (Clinical Negligence Scheme) Amendment Regulations 2013 (SI 2013/497). Membership eligibility is extended for the Clinical Negligence Scheme for Trusts (CNST), a statutory indemnity scheme established under the NHS Act 2006 in the NHS (Clinical Negligence Scheme) Regulations 1996. The scheme covers clinical negligence liabilities arising from the carrying out of the members' functions with regards to the NHS. Amendments are also made to the way the scheme is administered.

News
Keep out of dangerous hospitals, GPs warn: vulnerable patients are "safer in the community". An appeal by NHS Alliance, which represents GPs and other primary care staff, warns that patients need to be kept away from dangerous hospitals and that tens of thousands of vulnerable and elderly patients should be transferred into the community where they can be kept safe. The Alliance has also called for a "paradigm shift" in the way the NHS is run to avoid a repeat of the Mid Staffordshire scandal.

New symbol to identify medicines undergoing additional monitoring. An inverted triangle will shortly appear on the inside leaflet of certain medicinal products on the EU market, following a legal act adopted by the European Commission on 7 March 2013. The symbol will allow patients and health care professionals to easily identify medicinal products that are undergoing additional monitoring, and its accompanying text will encourage them to report unexpected adverse reactions through national reporting systems.

Francis Report: statutory duty of candour. The Health Foundation, along with Action against Medical Accidents (AvMA), National Voices, National Association of LINks Members, The Patients Association and Patients First, have written to Jeremy Hunt MP, the Minister for Health, calling on the Government to legislate for a duty of candour to becomes a statutory requirement in order to foster a culture of accountability.

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

Commissioning

Publications/Guidance
Emergency preparedness, resilience and response: a guide for ambulance commissioners. This briefing supports commissioners by outlining the scope and importance of emergency preparedness, resilience and response (EPRR) and their own role in it, key questions and answers regarding EPRR, and sources of further information and guidance. It draws on the national specification for ambulance emergency preparedness, published in 2012 by the National Ambulance Resilience Unit (NARU), and the NHS Commissioning Board’s newly published core standards for EPRR.

Securing excellence in commissioning for the Armed Forces and their families. The NHS CB has published this single operating model for the commissioning of health care for the armed forces and members of their families who are registered with Defence Medical Services (DMS) GP practices. It sets out where commissioning responsibility lies for all members of the armed forces community, i.e. serving armed forces, their families, reservists and veterans.

Securing excellence in commissioning for offender health. This single operating model aims to initiate a move away from regionally and locally isolated commissioning to a clear and consistent national approach. It sets out the national strategy for commissioning and how it will be co-ordinated via the four NHS Commissioning Board regional teams. It also outlines how the NHS Commissioning Board will move towards a national contract framework with a national set of service specifications, standards, policies and quality measures.

Interim generic policies for direct commissioning. These interim generic policies underpin NHS England's direct commissioning responsibilities. The policies cover all aspects of directly commissioned services, including specialised, primary care, screening, military and offender health. Following their publication, the interim policies will be subject to a programme of engagement with patients and the public over the next 6-12 months to further refine them and agree final versions.

Clinical policies and statements for specialised services commissioning. These clinical policies and statements aim to ensure that specialised services are commissioned using a nationally consistent approach.

Transforming our health care system: ten priorities for commissioners. This paper outlines ten priorities for commissioners in the new NHS and has been updated to reflect changes in the healthcare system since 1st April. It lays out ten priorities for action; why they are important; what the potential impact is; and how to achieve these changes.

Quality and Outcomes Framework (QOF) guidance for GMS contract 2013/14. As part of the 2013/14 GMS contract changes, the DH have implemented a number of changes to the QOF effective from 1st April 2013. It applies in England only and is intended to assist NHS Commissioning Board area teams and general practices in understanding and working through the 2013/14 QOF.

Safeguarding vulnerable people in the reformed NHS – Accountability and Assurance Framework. This document replaces previous guidance issued by the NHS Commissioning Board in September 2012. It describes how safeguarding measures will work in the new NHS system from April 2013. It focuses on the statutory requirements to safeguard children, but the same key principles will apply in relation to arrangements to safeguard adults.

NHS standard contract update. NHSE has issued two alerts updating users about the NHS Standard Contract:
Care Homes – Never Events: For the attention of commissioners of Care Homes: Action is required to ensure that new and varied commissioning contracts include the Never Events applicable to Care Homes. Commissioners should read this alert and take the appropriate action in respect of their Care Homes contracts as soon as possible.
Community and Mental Health Services – Operational Standards, National Quality Requirements and Reporting Requirements: For the attention of commissioners of Community and Mental Health services. Action is required to ensure that new and varied commissioning contracts include the appropriate Operational Standards, National Quality Requirements and Reporting Requirements. Commissioners should read this alert and take the appropriate action in respect of their Community and Mental Health contracts as soon as possible.

Bevan Brittan Updates
Commissioning for Impact - Early Interventions, Social Impact Bonds and Local Integrated Services Trust (LIST). Some of you may remember Total Place, a project that originated in local government but caught the imagination of many in public services. It added up the total cost of supporting the most vulnerable groups in any one area and the outcomes were in many cases quite staggering. Quite simply we give poor value to taxpayers by spending their money on the "stock" - the effect of chaotic lives, troubled families, poor health, inadequate housing - and should spend it on the "flow", intervening early in the causes, be it high reoffending rates, excessive numbers of children in care, or the elderly in and out of hospitals with long term conditions much of which could have been prevented or better managed in a community/domiciliary setting. This article looks at how you, as health commissioners, can implement some of those changes. It is not theoretical – it is happening already in a range of public services, just much slower in health for fairly obvious reasons arising from the structural changes.

Courting disaster: the litigation challenge for CCGs It is said that no news is good news. So interest in the Winterbourne case or the Heslop report is encouraging only because it identifies bad practice. Likewise, if litigation is a measure of the success of a particular state of affairs, the courts’ involvement in care packages for vulnerable patients is a sign that not all is well. For CCGs, the prospect of taking on the mantle of litigation arising from care arrangement disputes may present a significant challenge. Some of the key issues are set out in this article.

Francis for Clinical Commissioning Groups. Of the 290 recommendations in the Francis Report into the Mid-Staffs inquiry, many would have an impact on the role of PCTs. With their abolition now looming, this begs the question of what CCGs should do in response to the Inquiry Report as they take on the commissioning mantle.

Regulating the commissioning of health services – revised regulations now laid From 1 April 2013, Clinical Commissioning Groups and the NHS Commissioning Board must comply with new NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 that cover not only the award of new contracts but also the setting up of qualified provider lists and frameworks. These new regulations have quickly followed the initial regulations after widespread concerns on their potential implications as originally drafted. This article sets out what the new regulations say and what they will mean for commissioners, and highlights some of the areas which still lack clarity and where further guidance may be needed.

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

Complaints

News
Review of NHS complaints system. A review of how complaints are handled by the National Health Service (NHS) has been launched with the aim of ensuring patients’ grievances are listen to and acted upon. The review follows the many reported failings uncovered at Mid Staffordshire NHS Foundation Trust. The review will canvas the opinion of patients, carers, and staff to establish how complaints are currently dealt with, and will set out recommendations for improvements relating to its findings which will be reported to the Secretary of State for Health by 30 July 2013.

More investigations for more people. From 2 April 2013, the Parliamentary and Health Service Ombudsman will be investigating more complaints and sharing more information with government organisations and the NHS, marking the first step in delivering plans to have more impact for more people.

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

Employment/HR

Publications/Guidance
Bring your own device (BYOD). Information Commissioner's Office guidance provides advice to companies which allow employees to use personal computing devices, such as smart phones and tablets, to process personal data for which the company is responsible.

Revalidation: starters and leavers guidance for employers. This guidance aims to provide employers with information on how revalidation and the responsible officer regulations might alter current practice in relation to: pre employment checks; induction processes and processes during employment; leaving employment; and practice for locum doctors and doctors on temporary or fixed-term contracts.

Increasing staff engagement with social media. This briefing looks at how use of social media can improve staff engagement. It is aimed at the HR community but will also be of interest to communications teams and line managers. It discusses how social media platforms can be used to engage staff and provides examples of good practice.

Social media highway code This publication aims to help UK doctors navigate their way around the ethical and confidentiality dilemmas of social media. It is intended to help and encourage healthcare professionals to communicate effectively using various social media channels, whilst adhering to the conventions that their patients, their colleagues and the public might reasonably expect.

Appraisal and objective setting: top tips for employers in the NHS. This guidance document sets out some key messages to help employers with their appraisal systems. It focuses on helping managers prepare and undertake appraisals, set objectives and plan what should be done between appraisals.

Working for health equity: the role of health professionals. This report demonstrates that the healthcare system and those working within it have an important and often under-utilised role in reducing health inequalities through action on the social determinants of health. It discusses the best ways to reduce inequities through workforce education and training, practical actions to be taken during interactions with patients, ways of working in partnership, and the role of advocacy. It also includes a section on the health system, which analyses which mechanisms and structures are supportive of actions to reduce health inequality, and where further development might be needed.

NHS pension scheme: Government response to consultation. The Government response to the consultation on draft NHS pension scheme regulations is published. The draft regulations were confirmed with some proposals modified or withdrawn based on the comments received.

Sickness absence savings calculator. This interactive web-based sickness absence savings calculator allows employers to calculate their current cost of sickness absence and establish what potential savings could be released by achieving their organisation’s target sickness absence rate.

Consultations
Consultation on the NHS Pension Scheme, Additional Voluntary Contributions and Injury Benefits (Amendment) Regulations 2013: Government Response. This document provides a summary of the consultation findings and a response to the comments received. A total of 3,198 responses were received. The vast majority of respondents were individuals working within the NHS as general practitioners, hospital doctors or consultants. The draft regulations were confirmed with some proposals modified or withdrawn based on the comments received.

Contribute to the Cavendish Review. The Cavendish independent review will look at how the training and support of healthcare and care assistants can be improved, so that patients can receive the best care. DH is encouraging people to contribute to the review. The closing date for contributions to the review was 12 April 2013.

Bevan Brittan Updates
Health developments. Sarah Michael provides an update on two recent employment law developments affecting the heath sector: the Government has published its ‘key early priorities’ in response to the Mid Staffordshire Inquiry, and NHS Employers has published its amendments to Agenda for Change terms and conditions of employment, incorporating the changes agreed by the NHS Staff Council.

Employment Law Tracker Update – your ultimate guide. Given the amount of legislative change proposed this year and the alterations to the proposed timetable, you might be forgiven for losing track a little. Just in time for Easter, the Government has freshly hatched a batch of new developments on the employment law front: in addition to the annual legislative changes due to come into force in April, this month also saw BIS publish a revised timetable of changes to employment law – and confirm that the new requirement for claimants to pay fees for employment tribunal claims will be in place this Summer. Julian Hoskins provides an update on the new BIS timetable, and other recently announced dates for implementation of employment law reform. It’s going to be a busy year but this will help you stay on track…

Employment news round-up, March 2013. This month’s news round-up is brought to you by Sarah Michael and covers: NHS ‘gagging’ clauses; dealing with difficult employees; caste discrimination; fit note guidance; parental leave extension; the new tax-free childcare scheme and consultation on pension protection following a TUPE transfer: and a new case on obesity and disability discrimination.

Victimisation and references – an Equality Act ‘hiccup.’ It has been settled law for some time that employers may be liable for post-employment victimisation claims. However, as Laurie Child explains, earlier this month, the EAT decided that there is in fact no provision for post-employment victimisation under the Equality Act 2010, thereby leaving a gap in post-employment protection of employees - and leaving the Government open to accusations of having failed to implement EU law correctly.

Employment tribunal cases settled by judicial mediation. Since the publication of the Robert Francis report into the Mid Staffordshire Hospital in February, there has been a lot of discussion about the need for a culture of openness, transparency and candour in healthcare services.

Ban on NHS 'gagging orders' Much has been said about the need for openness, transparency and candour in healthcare services, since the publication of the Robert Francis report into the Mid Staffordshire Hospital last month. One of the specific issues in this regard, raised by the report, was that individuals were apparently prevented from raising concerns about patient safety because of so-called ‘gagging clauses’ in agreements with the hospital. Jeremy Hunt has announced that so-called ‘gagging clauses’ in NHS settlement agreements, which seek to prevent public interest disclosures regarding patient safety and patient care, will be ‘banned’ with immediate effect.

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

Finance

Publications/guidance
NHS trust and NHS foundation trust special administrator - guide for unsecured creditors. This guidance is aimed at unsecured creditors and informs them on their rights under special administration to NHS trusts and foundation trusts. It includes an overview of the special administration process and how the liabilities of NHS trusts will be treated in the event that these organisations are put into special administration.

Detailed guidance for external assurance on quality reports 2012/13. This document sets out detailed guidance for NHS foundation trusts and their auditors to enable them to carry out the external assurance engagement on 2012/13 quality reports.

Dental charges are increased by 2.5% and prescription charges are increased by a similar level for single prescription charges and wigs from 1 April 2013. Those in designated pathfinder areas enrolled in universal credit will have an exemption from NHS charges and receive assistance with NHS travel costs.

Budget 2013. The Chancellor has delivered his Budget to Parliament on 20 March 2013, alongside the publication of the Office for Budget Responsibility’s updated forecasts for growth and borrowing. Key points for health professionals are:
Public sector net borrowing is forecast to fall by a third over the three years from 2009-10, from its post-war peak of 11.2% of GDP, to 7.4% of GDP in 2012-13.1 It is then forecast to continue to fall to 5.0% of GDP in 2015-16 and 2.2% of GDP in 2017-18. Public sector net debt as a share of GDP is forecast to peak at 85.6% of GDP in 2016-17, before falling to 84.8% of GDP in 2017-18.
A reduction in resource Departmental Expenditure Limits (DEL) by £1.1bn in 2013-14 and £1.2bn in 2014-15. Individual departmental budgets will be published in a Spending Round on 26 June 2013. Health, schools and Official Development Assistance will be protected.
Public sector pay awards in 2015-16 will be limited to an average of up to 1%.
Increase in capital spending plans by £3bn p.a. from 2015-16, to lock in recent increases in capital spending over the Spending Review 2010 period, funded through reductions in current spending. The Government will also set out long-term plans to 2020-21 for the most economically valuable areas of capital expenditure in the 2015-16 Spending Round.
Government procurement from small firms to rise fivefold.
Tax relief for investment in social enterprises. The Government will consult formally on the details of the relief by summer 2013 and the relief will be introduced in Finance Bill 2014.
The Government will implement the £72,000 cap on reasonable social care costs, drawing on the Dilnot Commission’s recommendations, and extend the means test to give more people access to financial support for their residential care costs from April 2016.

Department of Health: progress in making NHS efficiency savings. This Public Accounts Committee report examined progress to date in making NHS efficiency savings, on the basis of evidence from the Department of Health. Conclusions drawn included the following: the Department of Health's data on reported efficiency savings is unreliable; financial pressures may be causing some hospital trusts to cut staff with damaging effects on the quality and safety of care; there are concerns over rationing of treatments; there is a need to fundamentally change the way healthcare is provided to secure the level of savings needed in the future; the public debate needs to be better informed; and that it is not currently clear who will take strategic decisions in the reformed NHS.

Accelerating the release of public sector land – Funding support for NHS trusts. This letter from Dr Dan Poulter, Parliamentary Under Secretary for Health, announces that NHS organisations are to get financial incentives and support to continue to release surplus land for 100,000 new homes by 2015. Two principal funds will be available for NHS Trusts to consider: investment in a site enabling it to come to the market quicker or more easily and/or an acquisition by the Homes & Communities Agency of the Trust's surplus land and buildings. Further details are in the Annexes. The letter gives details of how NHS trusts can apply for funding for investment and acquisition from DCLG.

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

Publications/guidance
NHS foundation trusts: review of nine months to 31 December 2012. This third report for 2012/13 aims to provide a snapshot of the health of the NHS. It summarises the key themes drawn from reviewing the quarterly reports of the 144 trusts authorised up to 31 December 2012.

NHS trust and NHS foundation trust special administrator - guide for unsecured creditors. This guidance is aimed at unsecured creditors and informs them on their rights under special administration to NHS trusts and foundation trusts. It includes an overview of the special administration process and how the liabilities of NHS trusts will be treated in the event that these organisations are put into special administration.

The OFT's role in reviewing NHS mergers: Frequently asked questions. An Office of Fair Trading (OFT) publication sets out further details on the regulator's remit and role in respect of NHS mergers, to provide greater clarity to NHS foundation trusts, NHS trusts, their advisors and other interested parties. In particular, the OFT explains how it will review mergers between NHS foundation trusts and NHS trusts under the provisions of the Enterprise Act 2002.

Detailed guidance for external assurance on quality reports 2012/13. This document sets out detailed guidance for NHS foundation trusts and their auditors to enable them to carry out the external assurance engagement on 2012/13 quality reports.

Statutory guidance for Trust Special Administrators appointed to NHS foundation trusts This statutory guidance is to be referred to primarily by those organisations and individuals responsible for the execution of the duties of a Trust Special Administrator. The guidance covers how the failure regime applies to NHS foundation trusts only, and does not apply to NHS trusts.

Monitor calls for doctors to play key role in Trust Special Administration Monitor set out a key role for clinicians in guidance about how Trust Special Administrators should carry out their statutory role. The move is intended to ensure Trust Special Administrators are well placed to act in the interests of patients. The guidance includes detailed instructions to help Trust Special Administrators engage with the local population as they draw up plans for patient services.

Applying for NHS Foundation Trust Status: Guide for Applicants (April 2013) This document covers all of the stages of the foundation trust application process, including Monitor's assessment process and the application outcome.

How to make a complaint about patient choice or competition This briefing explains how you can make a complaint to Monitor about patient choice or competition. It provides advice on making a complaint, what you can expect and where to find further information.

An introduction to Monitor's role This introduction to our role includes an overview of our new responsibilities such as safeguarding choice and preventing anti-competitive behaviour, and setting prices for NHS-funded services.

Monitor emphasises continuity of regulatory regime as it takes on new powers From April 1 Monitor took on new powers as the sector regulator for health, with a duty to protect and promote the interests of patients.

Annual plan review 2013/14 This page contains information, templates and documents related to the annual plan review 2013/14, including some rather interesting training videos.

Accounts and FTCs process 2012/13 This page contains copies of the guidance that Monitor has issued to foundation trusts relating to the accounts and FTCs process and Alignment Project in 2012/13.

Bevan Brittan Updates
Health and Social Care Act: Implications for foundation trust governance and constitutional arrangements. On 27 March 2012, the Health and Social Care Bill received Royal Assent and became the Health and Social Care Act 2012. The provisions are being brought into force by commencement orders and the reforms mean that all Foundation Trusts (“FTs”) and Aspirant Trusts will need to revisit their Constitutions and to begin making preparations to revise these to ensure that they are consistent with the Act. We appreciate that you’ve already had to make amendments, but such changes won’t be enough for this year, you will need to do substantially more.

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

Publications/Guidance
Quality at a glance: using aggregate measures to assess the quality of NHS hospitals. This is the first ever overall assessment of NHS hospital quality in England, and aims to contribute to the ongoing debate about how best to measure quality in the NHS. Findings include: many of the lowest performing trusts on the quality index are subject to regulatory intervention; foundation trust status is a good indicator of high performance on the quality index; patient experience and waiting times matter most to members of the public who responded to the poll; and that condition-specific ratings are deemed more useful to patients than general ratings when making informed decisions about their care.

Effective governance to support medical revalidation. Revalidation is a new system of checks on doctors that was launched by the GMC in December 2012 to provide patients with greater confidence that UK doctors are keeping up to date and fit to practise. Doctors need access to a regular appraisal focusing on the GMC's professional standards and their organisation's clinical governance systems to complete their revalidation. Organisations need these same systems to be working effectively to deliver safe and high quality care to patients. The GMC has published this handbook for Boards and governing bodies to help them assess if their organisations have strong enough systems in place to support quality patient care and revalidation.

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

Publications/guidance
Bring your own device (BYOD). Information Commissioner's Office guidance provides advice to companies which allow employees to use personal computing devices, such as smart phones and tablets, to process personal data for which the company is responsible.

Functions, powers and resources of the Information Commissioner. Responsibilities of the Information Commissioner are likely to increase as a result of new EU data protection laws and data protection enforcement recommendations in the Leveson Report--but the Commissioner is facing a potential funding shortfall of £42.8 million. Parliament's Justice Committee, in a report on the functions, powers and resources of the Information Commissioner's Office (ICO), warns the ICO's work could be compromised by the funding cuts, and says it should be granted greater independence from the executive by being made directly responsible to, and funded by, Parliament.

Fundamental review of data returns: consultation response. This document forms the government response to the consultation on the fundamental review of data returns, which aimed to ensure that all data is collected and processed efficiently, and any burden on information providers is kept to a minimum. It provides a summary of the responses received and highlights the key themes from the consultation. It also sets out further actions to be taken.

Securing excellence in child health information services: IT operating model. This operating model aims to ensure the safe transfer of commissioning responsibilities from PCTs to ensure that all existing information systems and associated support for child health information, including the Personal Child Health Record [“Red Book”], continue to exchange data with partners and share information with parents and carers. These changes come into force on 1 April 2013. The new arrangements as described in the operating model will be kept under review.

Consultations
Assessment notices under the Data Protection Act 1998 – Extension of the Information Commissioner’s powers. Seeks views on proposals to extend the powers of the Information Commissioner to carry out compulsory assessments of NHS bodies’ compliance with the Data Protection Act 1998 and its data protection principles. The proposals are informed by the Information Commissioner’s experience working with NHS bodies to improve their compliance with data protection law. The consultation closes on 17 May 2013.

News
Medical receptionist prosecuted after unlawfully accessing patient's details. The Information Commissioner's Office has prosecuted a former receptionist at a GP surgery in Southampton for unlawfully obtaining sensitive medical information relating to her ex-husband's new wife. West Hampshire Magistrates' Court imposed a fine of GBP 750 on Marcia Phillips and ordered her to pay a GBP 15 victim surcharge and GBP 400 prosecution costs for a breach of the Data Protection Act s.55.

EMIS EPR Viewer helps half a million patients benefit from Bristol record sharing project. A&E doctors are now able to provide safer emergency care round the clock to some 500,000 patients across the Bristol area – thanks to a secure electronic record sharing agreement with 50 local GP practices. The Patient Record Network (PRN) enables A&E doctors to view patient records within minutes via EMIS’ EPR Viewer, which makes key information from the patient’s GP record available to other clinicians. They previously relied on phoning or faxing GP practices for patient vital information, with no access outside surgery opening hours. GPs believe it could save patients’ lives. The initiative is the result of local collaboration between ‘GP Care’ – a Bristol based organisation set up by GPs – and acute hospitals serving South Gloucestershire, Bristol and North Somerset, including the Bristol Royal Infirmary and Frenchay Hospital.

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

Inquests

Publications/guidance
Summary of reports and responses Under Rule 43 of the Coroners Rules: Eighth Report: For period 1 April 2012 - 30 September 2012. A Ministry of Justice report gives details of coroners' reports and responses received from organisations asked to consider action to prevent future deaths between 1 April and 30 September 2012.

Cases
R (Lagos) v HM Coroner for City of London; Anele Austin (Interested Party) [2013] EWHC 423 (Admin) (Admin Ct). In this matter, a coroner had been aware of the likelihood that the deceased had taken her own life. However, he had been entitled to record an open verdict as the evidence did not satisfy him beyond reasonable doubt that she had committed suicide.

R (Shaw) v HM Coroner for Leicester City and South Leicestershire [2013] EWHC 386 (Admin) (Admin Ct). The Administrative Court held that an inquest, challenged by the claimant on the grounds that there had been delay in the conduct of the inquest and bias on the part of the assistant deputy coroner, had been lawful.

R (Sreedharan) v HM Coroner for the County of Greater Manchester [2013] EWCA Civ 181 (CA). The Court of Appeal held that a coroner had a broad discretion as to the nature and extent of an inquiry into the death of a patient by an overdose of a lethal drug which had been prescribed by his general practitioner. There was no error of law in the coroner's refusal to leave a verdict of suicide to the jury.

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

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. 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
The right care: creating dementia-friendly hospitals. This letter to chief executives of Acute Trusts follows up on a campaign by the Dementia Action Alliance launched in October 2012, which aimed to encourage all hospitals to commit to becoming dementia-friendly by March 2013.

Making a difference in dementia: Nursing vision and strategy. The DH has launched a new nursing vision and strategy for dementia care that makes clear that every nurse can make a difference to the care of people with dementia. This new resource will support the Prime Minister’s Dementia Challenge by raising the profile of the wider nursing contribution to dementia care and describing what is expected of all nurses to meet the level and quality of care expected in all care settings.

Safeguarding vulnerable people in the reformed NHS: accountability and assurance framework. This document updates and replaces Arrangements to secure children’s and adult safeguarding in the future NHS issued by the NHS Commissioning Board in September 2012. It describes how safeguarding measures will work in the new NHS system from April 2013.

CIPOLD is the Confidential Inquiry into premature deaths of people with learning disabilities. A report of the confidential inquiry into the premature deaths of people with learning disabilities reveals that 43% of the deaths reviewed were premature and 28% might have been avoided by better healthcare. The Department of Health funded the inquiry which identified failings in understanding of the Mental Capacity Act, use of information systems and co-ordination of care.

Deprivation of Liberty Safeguards 2011/12. This report on CQC's monitoring of the Deprivation of Liberty Safeguards reveals that there is still a widespread lack of understanding of the wider Mental Capacity Act. The evidence presented in the report shows that in some care homes and hospitals, people’s freedom to make decisions for themselves is restricted without proper consideration of their ability to consent or refuse. It makes recommendations for commissioners and providers to improve their understanding of the safeguards and Mental Capacity Act; that care providers implement policies that minimise the use of restraint; and that robust review processes and mechanisms are established in order to understand the experience of people subject to the safeguards.

Changes to LPA registration and bonds for deputies. The Law Society advises that from April 1, 2013, the Office of the Public Guardian (OPG) intends to make changes to the lasting power of attorney (LPA) registration process. The Law Society sets out information on the changes that will affect the time it takes OPG to register an LPA and the forms that are used. It also explains the new rules which will make it easier for court-appointed deputies to change their security bond provider. These changes remain subject to parliamentary process.

People wanting to manage a bank account for someone else. This guidance published on 3 April 2013 provides the first universal framework for banks and building societies to apply a consistent approach when helping relatives or carers to manage an account on behalf of another person who is elderly, vulnerable or unable to manage their own affairs. The guidance will help bank and building society staff to recognise and understand Lasting Powers of Attorney, Deputyship Orders and other third party management arrangements.

Guidance on childhood conduct disorders. Conduct disorders, and associated antisocial behaviour, are the most common mental and behavioural problems in children and young people. This new NICE guideline updates and replaces 'Parent-training/education programmes in the management of children with conduct disorder' (NICE technology appraisal guidance 102, published June 2006). It offers evidence-based advice on the recognition and management of conduct disorders in children and young people.

Smoking and mental health. A major new report from the Royal College of Physicians (RCP) and Royal College of Psychiatrists (RCPsych) says that smoking in people with mental disorders is neglected by the NHS. Smoking and mental health says that much of the substantially lower life expectancy of people with mental disorders relates to smoking, which is often overlooked during the management and treatment of their mental health condition.

Whole-person care: from rhetoric to reality (Achieving parity between mental and physical health). In this report, an expert working group defines ‘parity of esteem’ in detail, and examines why parity between mental and physical health does not currently exist and how it might be achieved in practice.

NICE support for commissioners of dementia care. This resource supports commissioners, clinicians and managers to commission high-quality evidence-based care for people with dementia and their carers. It provides practical advice for commissioners to improve the integration of health and social care. This will help ensure that more people with dementia receive an early diagnosis and can access the care and support that they, and their carers, need to live well and independently with dementia for as long as possible.

Transforming care: A national response to Winterbourne View Hospital. Department of Health review: Final report. This report sets out the Government's final response to the events at Winterbourne View hospital. It sets out a programme of action to transform services for people with learning disabilities or autism and mental health conditions or behaviours described as challenging. The proposals include:
by Spring 2013, DH will set out proposals to strengthen accountability of boards of directors and senior managers for the safety and quality of care which their organisations provide;
by June 2013, all current placements will be reviewed, everyone in hospital inappropriately will move to community-based support as quickly as possible and no later than June 2014;
by April 2014, each area will have a joint plan to ensure high quality care and support services for all people with learning disabilities or autism and mental health conditions or behaviour described as challenging, in line with best practice;
the Care Quality Commission will strengthen inspections and regulation of hospitals and care homes for this group of people, including unannounced inspections involving people who use services and their families; and
a new NHS and local government-led joint improvement team will be created to lead and support this transformation.
This programme is backed by a Concordat signed by more than 50 partners, setting out what changes they will deliver and by when. The Government will publish a progress report on these actions by December 2013.

What about the children? Joint working between adult and children's services when parents or carers have mental ill health and/or drug and alcohol problems. This thematic inspection by Ofsted and the Care Quality Commission explored how effectively adult and children’s services worked together to ensure that children affected by their parents’ or carers’ difficulties were supported and safe. The report draws on evidence from cases in nine local authorities and partner agencies and from the views of parents, carers, children, practitioners and managers. It calls on the government to make it a mandatory requirement for mental health services to collect data on children whose parents or carers have mental health difficulties and report on such data nationally.

Whole-person care: from rhetoric to reality (Achieving parity between mental and physical health). In our society mental health does not receive the same attention as physical health. People with mental health problems frequently experience stigma and discrimination, not only in the wider community but also from services. This is exemplified in part by lower treatment rates for mental health conditions and an underfunding of mental healthcare relative to the scale and impact of mental health problems. There is an ambition for the NHS to put mental health on a par with physical health. However, the concept of parity in this context is not always well understood. In this report, an expert working group defines ‘parity of esteem’ in detail, and examines why parity between mental and physical health does not currently exist and how it might be achieved in practice.

Parents need greater support to manage conduct disorders. Parents of children and young people with conduct disorders should be offered training programmes to help them deal with antisocial behaviour, says NICE. The guideline also emphasises the importance of early diagnosis to ensure that children and their families can access treatment and support.

Dementia: scoping the role of the dementia nurse specialist in acute care. This report highlights the significant contribution dementia nurse specialists could make in hospital settings, based on research which found that if properly funded and trained they could reduce hospital stays for older people by one day on average, saving almost £11m p.a. It recommends that there should be at least one whole-time dementia specialist nurse for every 300 hospital admissions for people with dementia.

NHS standard contract update. NHSE has issued an alert updating users about the NHS Standard Contract. Community and Mental Health Services – Operational Standards, National Quality Requirements and Reporting Requirements: For the attention of commissioners of Community and Mental Health services. Action is required to ensure that new and varied commissioning contracts include the appropriate Operational Standards, National Quality Requirements and Reporting Requirements. Commissioners should read this alert and take the appropriate action in respect of their Community and Mental Health contracts as soon as possible.

As life goes on: a closer look at how support services respond to the changing needs of people with sight loss. This follow-up study on the changing needs of people with long term sight loss finds continuing problems in the system including a lack of follow-up and emotional support; and difficulties in accessing social services meaning that people with long term sight loss are still not getting the help they need. Recommendations include: integrating services to make referrals between services smoother and provision of information more consistent and thorough; and raising awareness amongst GPs to increase awareness of the interaction of sight loss with other health conditions, and the links between sight loss and mental health.

News
NICE publishes first joint health and social care quality standards. Announces that NICE has published quality standards on the supporting people to live well with dementia.

Centre for Mental Health comments on the Government's response to the Francis Report.

Families kept waiting as secret court struggles with caseload. The Court of Protection, which handles cases for people who are not able to make their own decisions, is under increasing pressure from medical cases in which it must decide whether to prolong someone's life through treatment or allow death to take its natural course.

Bevan Brittan Events
Annual Mental Health Law Update - London. 24 April 2013 : 10.00am - 1.00pm. The pace of change in mental health law gives rise to a range of challenges for mental health professionals, both clinical and in management. This seminar will give an outline of what those changes mean for day to day practice as well as how they will affect the structure and policy behind mental healthcare provision.

Annual Mental Health Law Update - Birmingham. 26 April 2013 : 10.00am - 1.00pm. The pace of change in mental health law gives rise to a range of challenges for mental health professionals, both clinical and in management. This seminar will give an outline of what those changes mean for day to day practice as well as how they will affect the structure and policy behind mental healthcare provision.

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

Primary Care

Publications/Guidance
The patient online: the road map. This guidance aims to support GP practices in providing online access for patients. It looks at the principles of online access to records by patients; steps to offering access; and the principles around training, education and support for practices. Issues around information governance, including third party data and GP workload, are taken into account.

Memorandum on the provision of out-of-hours GP service in Cornwall. This report finds that whistleblowers played a significant role in highlighting concerns around the out-of-hours GP services provided by Serco in Cornwall, prompting both the PCT and provider to take action.

GP contracts - Response to consultation. This is the Government's response to the consultation on GP contracts. The proposed changes were intended to maintain current levels of investment in general practice, while promoting continuous improvement in the quality of services.

New enhanced services for 2013/14. The PCC has published a briefing that outines the four new enhanced services that have been developed by NHS England as part of the 2013/14 GMS contract changes. These are offered to practices on a preferred (opt in) basis. Each service should be offered to all GP practices providing list based primary medical care services under GMS, PMS and APMS contracts.

News
Thousands of patients with long-term conditions and dementia could benefit as GP contract proposals are unveiled. Announces changes to the GP contract from April 2013, which will see millions of pounds redirected into better care for patients. Under the changes, GP practices will need to match the high quality care seen in the best performing practices by ensuring that more patients are offered the best standards of care in 20 key areas. These are areas that are known to have an impact on reducing avoidable deaths, for instance for people who have heart disease. This approach will be extended to other areas of care in 2014 so that even more patients benefit. GP practices will be rewarded for taking more proactive steps to identify people who may have dementia so that they and their families can receive earlier support. Rewards are also available for identifying and improving care for those people most at risk of avoidable emergency admissions to hospital.

GP admits to assisting in suicide of three patients. A retired GP has admitted helping three patients commit suicide by prescribing medication which, if taken in excessive amounts, would prove fatal. The cases were reported voluntarily, with the intention of supporting changes to the law on assisted suicide. Prosecutors found there was no public interest in pursuing legal action.

CQC takes on regulation of GP providers in England. The Care Quality Commission (CQC) takes over the regulation of NHS general practitioner (GP) providers in England from April 1, 2013. Primary medical care services including GP providers are now required to register with the CQC.

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

Public Health

Publications/Guidance
Transfer of public health staff from PCTs to local authorities – pension provision post 1 April 2013. This letter from the Public Health England transition team to Directors of Public Health and PCT HR directors sets out the agreement on pension provision for transferring staff, 'new starters' post 1 April 2013 and the groups of staff to whom ongoing access to the NHS pension scheme has been agreed. With the letter are FAQs to assist staff in understanding how their current pension arrangements will be affected by the transfer to local authorities and information about NHS pension direction orders, automatic enrolment and NHS injury benefits.

Local Healthwatch Regulations explained – lay and volunteer involvement and restrictions on activities of a political nature. The LGA and DH have jointly published guidance to help Local Healthwatch audiences understand the legal requirements that have been set out in regulations. The guide explains and provides clarity in relation to those provisions in Part 6 of the NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012 (SI 2012/3094) relating to lay person and volunteer involvement in local Healthwatch, and restrictions on activities of a political nature.

Working with the voluntary and community sector: a guide for health and wellbeing boards. This guide describes the value of and mechanisms for health and wellbeing boards to work closely with the voluntary sector and discusses different ways of working with the voluntary sector to access its expertise and networks.

Falling drug use: the impact of treatment. This commentary piece accompanies the release of prevalence data on the usage of opiates and crack cocaine. It identifies a shift away from more harmful drugs, particularly amongst younger users and this is mirrored by a fall in the number of people entering treatment for drug dependency.

Child health profiles. These profiles provide a snapshot of child health and well-being for each local authority in England using key health indicators, which enables comparison locally, regionally and nationally. By using the profiles local organisations can work in partnership to plan and commission evidence-based services based on local need. The profiles allow you to compare the outcomes in your local population with others in order to identify and learn from better performing areas. A child health profile is available for each top level local authority in England.

A framework for sexual health improvement in England This framework sets out the Government’s ambitions for improving sexual health. It is designed to be used by local organisations when they are looking at how best to provide sexual health services in their area. It aims to provide the information, evidence base and support tools to enable those involved in sexual health improvement to work together effectively.

The role of local authorities in health issues: eighth report of session 2012–13. This CLG Select Committee report urges councils to fully grasp the opportunities provided to them in the new health care structure by adopting a holistic approach to public health. It also raises concerns over the complex accountability mechanisms of the reformed system, particularly regarding who will be in charge in the event of a health emergency. It recommends that the government set out clearly and unambiguously the lines of responsibility. It also notes that the incentive in the funding formula is in need of review.

Working for Health Equity: The role of health professionals working for health equity. This report demonstrates that the healthcare system and those working within it have an important and often under-utilised role in reducing health inequalities through action on the social determinants of health.

Guidance on commissioning weight management services. This document provides best practice guidance to help improve the commissioning of weight management services in local areas.

Memorandum of understanding between Public Health England and the Care Quality Commission. Sets out how PHE and the CQC will work together and alongside one another in delivering their respective statutory functions. There is also a Service Level Agreement between PHE and the CQC.

Introduction to the PHE Health and Wellbeing Directorate. The Health and Wellbeing Directorate of Public Health England (PHE) works with partners to develop and implement health programmes and address the social factors that affect people’s health. This guide sets out the Directorate's programmes, priorities and approach.

Statutory guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. The DH has published statutory guidance that explains the duties and powers duties and powers for health and wellbeing boards in relation to Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) under s.116 and s.116A of the Local Government and Public Involvement in Health Act 2007 as amended by the Health and Social Care Act 2012. Health and Wellbeing Boards must have regard to this guidance when preparing their JSNAs and JHWSs, and will have to be able to justify departing from it.

Health improvement in local government: Challenges and opportunities. This report from the Royal Society for Public Health is the third in a series of briefings reviewing changes in commissioning public health in England, with a particular focus on public health improvement. Based on in-depth interviews with a range of professionals working in public health and associated fields, it provides an update on health improvement commissioning as public health moves into local authorities, while also identifying key opportunities and challenges that arise as a result of the transition.

Commissioning Sexual Health Services and Interventions: Best Practice Guidance for Local Authorities. This guidance is designed to help local authorities to commission high quality sexual health services for their local area. From 1 April 2013, local authorities will be responsible for commissioning most sexual health interventions and services as part of their wider public health responsibilities, with costs met from their allocated public health grant.

Briefing launched on Public Health Indicator for Eye Health. From 1 April 2013, the new Public Health Outcomes Framework will track changes in the number of people who are certified as blind or partially sighted and have lost their sight from one of the three major causes of preventable sight loss. An eye health briefing has been launched about the indicator.

Health visitor implementation plan quarterly progress report: October to December 2012. This report is an update on progress with the health visitor implementation plan 2011 to 2015. The main aims of the implementation plan are to improve services and health outcomes in the foundation years for children, families and local communities, through expanding and strengthening the health visiting service.

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

Regulation

Publications/Guidance
Monitor statement to the Government's initial response to the Mid Staffordshire Public Inquiry report. Monitor supports the statement of common purpose published by the Secretary of State in the Government's initial response to the findings of the Public Inquiry chaired by Robert Francis. They accept their share of responsibility for the failures in regulatory oversight of Mid Staffordshire NHS Foundation Trust and commit to working closely with partners to make sure that patients come first in all their future regulatory work.

2012 accountability hearing with the Nursing and Midwifery Council: Ninth Report of Session 2012-13: Report, together with formal minutes, oral and written evidence. A Health Committee report on the 2012 accountability hearing with the Nursing and Midwifery Council discusses the issues the organisation has faced in adequately managing fitness to practice cases, financial planning, and dealing with high turnover in senior management positions. The report provides recommendations for achieving the effective delivery of public protection.

A fair playing field for the benefit of NHS patients: Monitor's independent review for the Secretary of State for Health. This is the first major report to be published by Monitor in its new role as sector regulator for health. It addresses the extent to which all potential providers of NHS care have a fair opportunity to offer their services to patients.

Monitor guidance. Monitor has published a number of guides on its new role, including:
An introduction to Monitor's role
Enforcement guidance
Guidance for commissioners on ensuring the continuity of health care services
The respective roles of Monitor, the Office of Fair Trading and the Competition Commission in relation to mergers involving NHS trusts and NHS foundation trusts
How to make a complaint about patient choice or competition
Statutory guidance for Trust Special Administrators appointed to NHS foundation trusts
Compliance Framework 2013/14.

Consultations
Consultation on draft Monitor guidance on merger benefits. Seeks views on draft guidance on how Monitor will provide advice to the OFT on the benefits for patients of mergers involving NHS foundation trusts. The closing date for comments is 25 June 2013.

Licence conditions - choice and competition. Seeks views on draft guidance that sets out Monitor's interpretation of the choice and competition conditions of the NHS provider licence and explains how it will assess whether a licensee's behaviour is consistent with these conditions. The closing date for comments is 25 June 2013.

Consultation on guidance on the application of the Competition Act 1998 in the health care sector. Monitor has concurrent, or shared, powers with the OFT to enforce provisions of the Competition Act 1998 and the Treaty on the Functioning of the European Union in relation to the provision of health care services in England. This draft guidance explains how Monitor will use these powers. The closing date for comments is 25 June 2013.

Consultation on guidance on Monitor's approach to market investigation references. Seeks views on draft guidance on the approach that Monitor will take when using its concurrent powers with the OFT to make market investigation references to the Competition Commission under the Enterprise Act where it has reasonable grounds for suspecting that any feature, or combination of features, of a market is preventing, restricting, or distorting competition. The closing date for comments is 25 June 2013.

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

General

Publications/Guidance
Terminology for litigants in person. The Master of the Rolls has issued guidance on the terminology used for litigants in person. The Civil Justice Council considered those conducting legal proceedings on their own behalf, previously called Litigants in Person (LiPs) should in future be referred to as self-represented litigants (SRLs). Lord Dyson MR considers the use of SRL would be confusing as LiPs are still referred to in statute. LiP should be the sole term used from now on.

Representing yourself in court. The Bar Council has produced a 70-page guide to help people represent themselves in court.

Access to clinical trial information and the stockpiling of Tamiflu. This study follows correspondence from a number of MPs raising questions about access to all clinical trials information for UK regulators when licensing and appraising new medicines; and the decision to stockpile Tamiflu.

Volunteering in health and care. This report considers the role and value of volunteers in health and social care. It looks at the important part that volunteers play in improving patient experience, addressing health inequalities, and building a closer relationship between services and communities.

Making connections: a transatlantic exchange to support the adoption of digital health between the US VHA and England’s NHS This report looks at what the NHS can learn from the United States' Veteran's Health Association, which is the largest implementer of telehealth anywhere in the world. It draws on the innovative progress that has been made in the NHS through their experience of telehealth and makes recommendations for both organisations.

Transforming local care: community healthcare rises to the challenge. This briefing shows how the community health sector is driving the transformation of local care systems, and how innovative community healthcare providers are enabling people to stay healthy and independent and avoid crises that lead to unplanned hospital admissions. It also details the challenges that need to be overcome to build upon this work and drive forward the necessary shift of care into the community.

Buying better outcomes: Mainstreaming equality considerations in procurement – A guide for public authorities in England. This guide from the Equality & Human Rights Commission explains how public authorities may approach the task of ensuring that they comply with the public sector equality duty (PSED) obligations at different stages of the procurement cycle and takes them through equality issues that they may need to consider at each stage.

NHS (Procurement, Patient Choice and Competition) Regulations 2013: Department of Health response to legal opinions. Sets out the DH’s response to legal opinions published by 38 Degrees on the application of the NHS (Procurement, Patient Choice and Competition) Regulations 2013 (SI 2013/257) and the NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013) (SI 2013/500). The Department does not agree with many of the conclusions drawn from the legal analysis about the likely effect of the provisions of the regulations.

Budget 2013 - implications for the NHS workforce. NHS Employers has produced a summary of the key implications of the Budget for the NHS.

The Government’s response to the Health Select Committee’s eighth report of session 2012-13 on the National Institute for Health and Clinical Excellence (NICE). This publication outlines the Government's response to the House of Commons Health Select Committee's report on the re-establishment of NICE as a new statutory body. The Government welcomes the committee's report and the suggestions will frame the future development of NICE.

The new structure of the NHS in England. This slideshow outlines the main changes to management, accountability and funding structures resulting from the Health and Social Care Act.

British Social Attitudes survey data. According to advance data published by The King's Fund, public satisfaction with the NHS stabilised last year after a record fall. Satisfaction with the way that the NHS is run now stands at 61 per cent, the third highest level since the survey began in 1983.

The NHS Constitution for England. The NHS Constitution sets out rights for patients, public and staff. It outlines NHS commitments to patients and staff, and the responsibilities that the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. All NHS bodies and private and third sector providers supplying NHS services are required by law to take account of this constitution in their decisions and actions. The DH has published this revised version which makes changes to the sections on: patient involvement; feedback; duty of candour; end of life care; integrated care; complaints; patient information; staff rights, responsibilities and commitments; and dignity, respect and compassion. There are also some technical amendments to ensure that the NHS Constitution is up-to-date for the introduction of the new health and care system on 1 April 2013. In addition, as part of the Government's initial response to the report into the failings at Mid Staffordshire NHS Foundation Trust by Robert Francis QC, the Constitution has been changed to reflect that the NHS’s most important value is for patients to be at the heart of everything the NHS does.
See also the revised Handbook to the NHS Constitution, which explains the rights, pledges and responsibilities set out in the NHS Constitution in more detail.

Cases
Mid Essex Hospital Services NHS Trust v Compass Group UK and Ireland Ltd (t/a Medirest) [2013] EWCA Civ 200 (CA). The Court of Appeal held that there was no justification for implying a term into a contract for the provision of catering services to hospitals that the NHS trust would not act in an arbitrary, irrational or capricious manner when calculating service failures by the catering company or when making deductions from monthly payments in respect of those failures.

ASA Adjudication on Liverpool Cosmetic Surgery Ltd. Two issues were investigated, of which one was Upheld and one Not upheld. The Council considered that the time-limited nature of the ad trivialised the decision to agree to cosmetic surgery and therefore concluded that it was irresponsible. On this point the ad breached BCAP Code rule 1.2 (Social responsibility). However the ad did not breach BCAP Code rule 32.3 (Scheduling) as the ad did not contain any content which stated or implied that cosmetic surgery was socially necessary or desirable and made no reference to physical appearance. Furthermore, the clinic did not offer any cosmetic procedures to people under 18 years of age. In relation to this the council considered that the ad was unlikely to appeal to children and contained no content which was considered inappropriate for them to hear. The Council therefore concluded that a scheduling restriction was unnecessary.

Consultations
Cross border healthcare and patient mobility: Consultation on UK implementation of Directive 2011/24/EU (on the application of patients’ rights in cross-border healthcare). Seeks views on implementing EU Directive 2011/24 concerning patients’ rights to cross-border healthcare in other EEA member states. The proposals include: centralising cross-border administration at the NHS Commissioning Board from 1 April 2013; setting up a cross-border healthcare National Contact Point for England (within the NHS Commissioning Board) by October 2013; improving information on patients’ rights and entitlements; provisions for dealing with patients from other countries who want to use NHS facilities under the terms of the Directive; and how the processes of prior authorisation and patient reimbursement should work. There are also draft National Health Service (Cross-Border Health Care) Regulations 2013, intended to come into force on 25 October 2013. The consultation closes on 24 May 2013.

News
Pre-clinical trial data scam - first ever successful prosecution under Good Laboratory Practice Regulations. A man has been found guilty at Edinburgh Sheriff's Court for altering pre-clinical trial data designed to support applications to perform clinical trials. Steven Eaton was prosecuted under the Good Laboratory Practice Regulations 1999, the first time the Medicines and Healthcare Products Regulatory Agency has successfully used these regulations to bring a prosecution.

One in five 'unsuitable' for cosmetic surgery – patients dangerously misinformed by salespeople. The British Association of Aesthetic Plastic Surgeons unveils the results of an internal poll of its members, which highlights the importance of true ‘informed consent’ on the part of the patient.

Practising doctors to advise NHS on distinct areas of patient care. The NHS CB Medical Director Professor Sir Bruce Keogh has announced the names of 21 National Clinical Directors appointed to provide expert advice and research to the national medical directorate on conditions and services ranging from obesity and diabetes to emergency preparedness and critical care.

GP-led groups ready to take charge of NHS budgets in every community in England. Announces that the NHS CB has authorised the fourth and final wave of CCGs.

From 2015, patients, visitors and staff will no longer be able to smoke within the grounds of any NHS sites in Scotland. The Scottish Government's move is aimed at promoting smoke-free environments and healthier lifestyles. Under the plans, people who smoke will be offered advice and support to help them not to smoke during hospital visits, plus access to specialist smoking cessation services for those wanting to quit.

Bevan Brittan Updates
The hard work begins: The Government's initial response to the Francis Report. The Government’s has issued its initial response to the Francis Report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry. It sets out a five point plan intended to herald an end to failure and a call for excellence. This article gives a summary of what the plan will cover.

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

Health and Social Care Update - April 2013

15/04/2013

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Commissioning

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Complaints

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15/04/2013

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