Health and Social Care Update - July 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.

16/07/2013

Claire Bentley

Claire Bentley

Associate

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 Primary Care
Complaints Public Health
Employment/HR Regulation
Finance General
Foundation Trusts

Care

Publications/Guidance
Fairer charging policies for home care and other non residential social services – Guidance for councils with Social Services responsibilities. Updated statutory guidance issued under s.7 of the Local Authority Social Services Act 1970. It aims to help local authorities which decide to charge for any non-residential services to design reasonable and fair charging policies. It seeks to ensure greater consistency in charging policies.

Evaluating integrated and community-based care: how do we know what works? This report presents the key learning from evaluations of over 30 community-based interventions designed to reduce emergency hospital admissions. It identifies nine points that may help those designing, implementing and evaluating such interventions in future, in particular for the new health and social care integration ‘pioneer’ sites that will be appointed by the Department of Health by September 2013.

The DH has issued a new Local Authority Circular (LAC(DH)(2013)02): Charging for residential and non-residential social care that advises local authorities of changes to the social care charging arrangements and provides an overview of the changes and some additional statutory guidance. It has also published an update to Charging for Residential Accommodation guide (CRAG)

Fear of raising concerns about care. This survey of 1005 people found that 11% said they would be unlikely to raise a concern or complain about poor care. The main reasons suggested for why people wouldn’t speak up were: not wanting to be thought of as a trouble maker (26%); that it wouldn’t make a difference (25%) and that members of staff were so stretched that complaining wouldn’t help (15%). A smaller number (11%) said fear their care would get worse if they spoke up.

Healthcare fraud in the new NHS market: a threat to patient care. This report sets out the potential risks posed to patient care as a result of a marketised NHS. It identifies the prospects for fraud in the NHS as a result of the increased use of private providers to deliver NHS services, and analyses the government’s current approach to counter fraud policy. It compares the possibilities this could bring about with the situation in the United States, and proposes a number of policy responses for dealing with an increase in fraud in the NHS.

National survey of patient activity data for specialist palliative care services: MDS full report for the year 2011-2012. This report finds that specialist palliative care services have seen increased activity and more available beds in inpatient services. It shows that the mean number of patients seen in inpatient units is at its highest level in more than ten years, with the average number of available beds (those that are being or can be used) also at a high. The proportion of occupied beds has also remained high at 74.8%, reflecting efficient use of beds, although there remain considerable variations across the country. It also finds that people receiving specialist palliative care are more likely to be able to die at home - the place where most people say that want to die.

Ways and means. This report highlights factors which contribute to inequalities in end of life care. It reveals that the likelihood of what can be described as a ‘good death’ - one where the wishes of the patient and their family are met - can be significantly affected by where people live, their ethnicity and previous contact with social care. But the most critical factor is early diagnosis and timely initiation of support. It argues that tackling these inequalities requires placing an emphasis on training, communication and integration across health and social care. It recommends free social care at end of life be adopted as soon as possible, while ensuring that health and care professionals, who have a central role in providing well coordinated end of life care, are equipped and properly supported to talk about death. It concludes that a misplaced sense of delicacy must not prevent us from responding to people’s needs.

Help, I need somebody ... Putting patients at the centre of care. This briefing from the NHS Confed highlights the experiences of some of the independent sector organisations that have looked hard at the total package of care they provide in order to ensure they continue to meet the changing needs and demands of their patients. This briefing examines what makes the difference between good and outstanding, and share key findings from the independent sector. Some of the experiences seem obvious, while others are completely unexpected.  

Consultations
Draft national eligibility criteria for adult care and support. The DH have published a discussion document that sets out the plan for a new national minimum threshold for eligibility criteria for adult care and support, being introduced as part of the Care Bill, together with draft Care and Support (Eligibility Criteria) Regulations. The closing date for comments is 29 November 2013. There will then be a formal consultation in 2014.

Right care, right place, right time: How can we improve health and care for vulnerable older people? The DH has launched an informal consultation on plans for improving out-of-hospital care for vulnerable older people with long term conditions. It is inviting comments on ways to enable primary care, emergency care and social care services to work together as part of more integrated services to address to the totality of a person’s needs, rather than responding to individual conditions or care requirements. There is no deadline given for comments but the final plan will be published in October.

National information standard to coordinate end of life care. PHE is consulting on on proposed changes to the national information standard for end of life care coordination (ISB1580). This standard identifies the core content to be held in the Electronic Palliative Care Coordination Systems (EPaCCS) and aims to support communication and co-ordination of end of life care between the professionals and services delivering care. The consultation closes on 31 July 2013.

Strengthening corporate accountability in health and social care. Following such scandals in Winterbourne View and Mid-Staffordshire care facilities, the Government is concerned that the public's confidence in the health and care system has been undermined. As part of the Government's commitment to increase accountability in providers of health and care services, the DH is consulting on proposals to hold providers of poor care to account. The proposals include the suggestion that all directors of providers registered with CQC, such as NHS hospitals, private hospitals and care homes, must meet a new fit and proper person test. The CQC will be able to insist of on the removal of directors that fail this test. The consultation closes on 6 September 2013.

Refreshing the Mandate to NHS England – 2014 to 2015. Given the increasing challenges faced by NHS England, the Government feels it is appropriate to refresh its Mandate to reflect new developments and new evidence which has emerged since the publication of the first Mandate. The changes to the Mandate will reflect core priorities such as the current actions being taken by NHS England to improve the care people receive; working with NHS England to improve the care of older people and strengthening A&E services. The Government has set out its proposals for updating the Mandate for consultation; the consultation closes on 27 September 2013.

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

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Children

Publications/guidance
Dan Poulter's letter on private company representatives on maternity wards. The Health Minister Dr Daniel Poulter has written to chief executives of NHS trusts, NHS foundation trusts and heads of midwifery asking them to review practices for allowing representatives from private companies on maternity wards to ensure that women’s dignity and respect shortly after the birth of a baby is maintained.

Child sexual exploitation and the response to localised grooming. This HC Home Affairs Committee report scrutinises action being taken to combat child sexual exploitation. It finds that, despite recent criminal cases laying bare the appalling cost paid by victims for past catastrophic multi agency failures, there are still places in the UK where victims of child sexual exploitation are being failed by statutory agencies. The police, social services and the CPS must all bear responsibility for the way in which vulnerable children have been left unprotected by the system. In terms of support for victims and prosecution of offenders, a postcode lottery still exists and agencies are still failing to work effectively together. The Committee states that prevention and early intervention in cases of children at risk of sexual exploitation is essential and all local authorities must ensure that there is sufficient funding for prevention within the budget of any multi-agency team tasked with tackling child sexual exploitation.

Healthcare standards for children and young people in secure settings.

SAFER communications guidelines. These guidelines aim to improve the communication between health visitors and local authority children’s social care teams using the SAFER process. It covers what should be considered before referral, and provides support for efficient and appropriate telephone referrals of children who may be suffering, or are likely to suffer significant harm.

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

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Clinical Risk/Health and Safety

Publications/Guidance
Recommendations for the safe changeover of doctors in training have been published jointly by NHS Employers and the Academy of Medical Royal Colleges (AoMRC). Doctors in training in the UK have historically started new six-monthly rotations in February and August, with the majority of junior doctors rotating to new training programmes during the first week of August. There is increasing evidence to show that simultaneous changeover is associated with reduced efficiency and increased mortality. NHS Employers and the AoMRC have outlined four key recommendations to help organisations mitigate these potential problems.

The quality assurance framework: for nursing and midwifery and local supervising authorities for midwifery. This framework ensures that quality assurance activities operate effectively. It was informed by user feedback and aims to increase lay involvement; increase the proactive management of emerging risk; reduce the burden of regulation on well-performing educational institutions and local supervising authorities; and ensure that quality assurance focuses on outcomes of education and supervision of midwives as opposed to dictating how standards should be met.

Recommendations for safe trainee changeover. This guide offers simple, practical recommendations that can be implemented in organisations to help mitigate the problems associated with simultaneous trainee changeover.   

News
Southend hospital trust fined over fatal fall. Southend University Hospital NHS Trust has been prosecuted for serious safety breaches after a vulnerable patient fell from a third floor window to his death in July 2010

Care Quality Commission raises concerns over serious mistakes at hospital.  Plymouth Hospitals NHS Trust must urgently improve patient safety at Derriford hospital, after concerns were raised about the level of serious mistakes being made, the Care Quality Commission has warned. The hospital failed to meet over half of the nine national standards reviewed during an unannounced inspection and a worrying number of so-called 'never events' which are so serious, they should never happen.

If you wish to discuss any clinical risk or health and safety issues please contact Joanna Lloyd, Stuart Marchant or Julie Chappell.

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Commissioning

Publications/Guidance
CCG outcomes interactive tool. In December 2012, NHS England published a set of information packs for CCGs and local authorities that set out key data to inform the local position on outcomes. Following feedback, this tool has been produced which allows users to view maps, charts and tables of individual outcome indicators across CCGs. The CCG outcomes explorer tool allows users to explore the relationships between two outcomes or between demographic information and outcomes.

Commissioning treatment for dependence on prescription and over-the-counter medicines: a guide for NHS and local authority commissioners. PHE has published commissioning guidance for the NHS and local authorities on how to respond to the needs of people who are addicted to medicines. It sets out PHE’s expectation that support should be available in every area for people with a dependency on prescription or over-the-counter medicines, based on a full assessment of local need.

Public health services non mandatory contract 2013 to 2014. The DH has published a contract for use by local authorities when commissioning public health services that can be adapted for use for a broad range of public health services and delivery models. It provides a framework to hold providers to account for the delivery of these services to achieve improved health outcomes. There is also an Integrated Sexual Health Services: National Service Specification to help local authorities commission integrated sexual health care. This can be used alongside the non-mandatory public health services contract.

Commissioning treatment for dependence on prescription and over-the-counter medicines: a guide for NHS and local authority commissioners. This guidance sets out PHE’s expectation that support should be available in every area for people with a dependency on prescription or over-the-counter medicines, based on a full assessment of local need. It has been produced with input from experts on addiction to medicines, and outlines a number of sources that commissioners can use to identify the scale of misuse or dependence, and in relation to what medicines in their area.

National programmes of care and clinical reference groups. These interim specifications for the commissioning of specialised services, along with clinical commissioning policies, were the subject of a short, public consultation. While work on this continues, NHS England has adopted the specifications in their draft form. Reports detailing the findings from the consultation, and how they have been used to develop the draft documents, will be published on the NHS England website later this year.

Towards commissioning excellence: a strategy for commissioning support services. This strategy aims to enable CCGs to exercise informed choice of how they source their commissioning support and from whom; build a strong cohort of excellent commissioning support providers; and to strengthen collaboration between NHS CSUs and the voluntary sector.

Securing excellence in commissioning sexual assault services for people who experience sexual violence. This new framework aims to drive up local improvements in the quality of services, improve the outcomes of the victims of sex assault and rape, as well as reducing health inequalities. The plan will be delivered by four NHS England regional teams, supported by nine areas teams and London. They will work within a national framework with the aim of raising standards of care, reducing inconsistency and saving money.

Interim specifications for specialised commissioning. NHS England has published the interim specifications it has adopted for the commissioning of specialised services. The new service specifications, along with clinical commissioning policies, were the subject of a short, public consultation which ran from mid-December 2012 to February 2013. NHS England will now, through its 74 Clinical Reference Groups (CRGs), continue to work with patients, carers and patient groups in the further development of the services specifications for use in 2014/15.

Clinical commissioning hub. This resource on the RCP website brings together information to support the commissioning of secondary care services across medical specialties. It also reinforces the promotion of patient experience and education and training in commissioning decisions. The information on the hub includes: an overview of the new health service structures in England; details of how and why secondary care doctors should get involved in the new commissioning bodies; information and links to NICE quality standards; and evidence-based clinical guidance produced by the National Clinical Guideline Centre, which is hosted by the RCP.

Information governance and risk stratification: Advice and options for CCGs and GPs. Advice on how to conduct risk stratification while complying with the new legal framework following the implementation of the Health and Social Care Act 2012. The document sets out the role that risk stratification can play in managing the health of a population and explains how risk stratification arrangements in England are affected by the implementation of the 2012 Act and the re-organisation of the NHS on 1 April 2013. It considers how risk stratification may be conducted lawfully and where to obtain further information about the information governance of risk stratification. The appendices set out: a range of options that CCGs can use to conduct risk stratification legally; a detailed description of the law relating to risk stratification; FAQs on the information governance arrangements; a list of items excluded from disclosure; and a glossary of terms.  

If you wish to discuss the issue of commissioning please contact David Owens.

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Complaints

Publications/Guidance
Submission by the Health Service Ombudsman for England to the review of the NHS hospitals complaints system. The PHSO's submission to the review of NHS hospital complaints systems summarises key findings and recommendations drawn from case knowledge and new research.

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

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Employment/HR

Publications/Guidance
Draft heads of terms for negotiations to achieve a new contract for doctors and dentists in training This draft document has been jointly agreed with the British Medical Association (BMA), to achieve a new contract for doctors and dentists in training. It follows exploratory talks between the BMA and employers, including representatives from the devolved nations, after concerns that the 13-year-old contract is no longer working as well as it could for NHS employers, doctors and dentists in training and patients.

NHS standard contract 2013/14: Guidance on the variations process. NHS England has published guidance on the process to effect variations to contracts based on the 2013/14 NHS Standard Contract. It applies both to new 2013/14 contracts (whether they have been created as eContracts or in paper form) and to earlier contracts which have adopted the 2013/14 NHS Standard Contract terms by being transferred into eContracts. It applies to both local variations and variations mandated by NHS England.

Managing NHS hospital consultants. The consultant contract which was introduced in 2003 has missed the opportunity to deliver change in consultant performance and has provided poor value for money for the taxpayer according to the Public Accounts Committee's latest report on the management of NHS consultants. The Committee is concerned that consultants pay is not linked with performance and consultant's performance is not properly assessed. It is also concerned about the shortage of consultants in hospitals in more deprived areas and in certain specialities, in particular geriatric medicine. It has made a number of recommendations to the DH to improve the management of consultants.

Confidentiality clauses and special severance payments This report suggests that there is a lack of transparency, consistency and accountability in the use of compromise agreements in the public sector, and that little is being done to change this situation. It cites the whistleblowing over emergency care in the Mid-Staffordshire NHS Foundation Trust and other NHS bodies as examples.

National training survey. The national training surveys are carried out each year to monitor the quality of medical education and training in the UK. Results from 2013 show that satisfaction remains high with just over 80% satisfied with their training. However, over half of doctors surveyed (58.5%) said they worked beyond their agreed hours on a daily or weekly basis. 20% said handover arrangements before and after night duty were informal or that there were no arrangements at all.

Improving specialist and associate specialist (SAS) appraisal: a guide for employers. This guide aims to support employers to ensure that their SAS employees are able to engage fully with the appraisal process. It is based on many of the common concerns expressed by SAS doctors in workshops held in January 2013, and includes practical advice based on feedback, ideas and experience from SAS doctors themselves. It also sets out the steps that employers can take to acknowledge and develop SAS doctors’ skills.

Recommendations for safe trainee changeover. This guide offers simple, practical recommendations that can be implemented in organisations to help mitigate the problems associated with simultaneous trainee changeover.

Consultations
NHS Standard Contract for 2014/15: discussion paper for stakeholders. The current NHS Standard Contract, issued in February 2013, has a default duration of only one year, and NHS England will therefore need to issue a revised contract for use from 2014/15 onwards. NHS England will be updating the NHS Standard Contract for 2014/15 and will be mandating both the use of this updated version for contracts to take effect from 1 April 2014 onwards and the variation of ongoing contracts to incorporate 2014/15 terms with effect from 1 April 2014. This paper sets out some key issues on which NHSE would particularly welcome feedback from stakeholders. The closing date for comments is 2 August 2013.

Review of incentives, rewards and sanctions: discussion paper for stakeholders. "Everyone Counts: Planning for Patients 2013/14" set out NHS England's commitment to undertake a fundamental review of incentives, rewards and sanctions. This review is now getting under way, with involvement from the Commissioning Assembly working group on incentives. NHSE is now seeking views on possible changes to the regime of incentives, rewards and sanctions in the NHS business rules for 2014/15 and beyond. The main focus of the review is to have in place a cohesive approach across the national tariff, the incentives and sanctions within the NHS Standard Contract (including CQUINs), the Quality Premium, and the Quality and Outcomes Framework, to support NHSE's strategic intent. The consultation closes on 2 August 2013.  

News
Confidentiality clauses in public sector payoffs 'must not stop whistleblowers.' NHS and civil service employees who are unfairly dismissed and refuse to sign a compromise agreement could be jeopardising their future careers due to the lack of reference provided for that individual, a report from the National Audit Office (NAO) has shown. The report also indicated that many employees felt gagged by such compromise agreements, and that it was not made clear enough that employees still retained the right to blow the whistle on legitimate public interest concerns.  

Bevan Brittan Updates
Change blowing in: Whistleblowing update. Whistleblowing has barely been out of the headlines in recent months: criticisms in the Francis Report zeroed in on the importance of whistleblowers, and this was swiftly followed by changes to 'gagging clauses' in NHS Compromise Agreements. This month, we saw new legislation come into force which made significant changes to the way in which whistleblowing operates. With all the changes that have taken place, Julian Hoskins takes the opportunity to review whistleblowing past and present, and provide some practical suggestions on whistleblowing going forward. 

Employment news round-up. Alastair Currie looks at the latest developments that will be keeping HR practitioners and in-house Counsel busy over the Summer: the first tranche of this year’s law reform programme takes effect this month; UNISON has challenged the fee regime due to come into effect next month; the new Employment Tribunal rules have been published; Acas has published its guidance on pre-termination discussions and, finally, the new DBS online checking scheme is in place; and we provide an update on TUPE and how it applies to 'client team' transfers.

LEPs and the Spending Review The Chancellor, George Osborne and the Treasury Minister, Danny Alexander have announced further details of the Government's ambitious plans for LEPs over the next two years.

Tinker, Tailor, Soldier...Employer. Are employers entitled to ‘spy’ on their employees as part of a disciplinary investigation, even if the employer already has the information it needs in order to fairly dismiss the employee? The Employment Appeal Tribunal has looked at how a local Council has dealt with this question and has said that in certain circumstances, the answer is yes: employers may undertake covert surveillance of employees if misconduct is suspected, notwithstanding that the surveillance is part of an over-zealous investigation. Anne Palmer comes in from the cold and explains more. 

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
Healthcare fraud in the new NHS market: a threat to patient care. This report sets out the potential risks posed to patient care as a result of a marketised NHS. It identifies the prospects for fraud in the NHS as a result of the increased use of private providers to deliver NHS services, and analyses the government’s current approach to counter fraud policy. It compares the possibilities this could bring about with the situation in the United States, and proposes a number of policy responses for dealing with an increase in fraud in the NHS.

More than medicine. This report argues that ring-fencing budgets may not be enough to help the NHS deliver the support required by an ageing population, as unhealthy lifestyles and the number of patients suffering from multiple long-term conditions continue to take their toll on the UK’s healthcare services. It states that a complete overhaul of the healthcare operating model is needed if the NHS is to deliver better patient outcomes and care at lower costs. Key to this transformation, as pressure also increases to deliver higher quality care for less, will be the life sciences sector aligning its interests by partnering to share costs, data and risk to improve the value and effectiveness of the therapies offered to patients.

Spending Round 2013. HM Treasury has set out its plans for government spending, including departmental settlements, for the year 2015 to 2016. The health settlement provides for 0.1% real terms growth in 2015-16, meeting the Government’s commitment to increase health spending in real terms. The Government is also committed to ensuring that the NHS treats mental health as seriously as physical health, so in 2015-16 the NHS will expand access to talking therapies and improve its response to mental health crises. Measures announced include £3.8bn funding to support and reward integrated health and social care working in 2015-16, following the example of the Whole Place Community Budget pilots, and £200m for local authorities from the NHS in 2014-15 to ensure change can start immediately through investment in new systems and ways of working. It states that to achieve greater productivity, NHS England, working with local areas, will now lead further work, which is expected to focus on areas such as better procurement, making savings through improved use of technology, and reducing pressures on A&E by providing good alternatives and more support to older people and people with multiple long-term conditions.  

Consultations
Migrant access and their financial contribution to NHS provision in England – Sustaining services, ensuring fairness. Migrants to the UK will be asked to make a financial contribution to NHS healthcare under proposals from the Department of Health (DH) aimed at ending 'health tourism'. Views are sought on whether foreign nationals should be charged to use the NHS, what services they should be charged for, and how to ensure the system is able to identify patients who should be charged. Comments are requested by 28 August 2013.

News
NHS England response to Spending Review 2015/16. Sir David Nicholson, Chief Executive of NHS England, has commented on the establishment of the new health and social care integration fund and overall settlement for the NHS announced in the Spending Round 2015/16.  

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

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Foundation Trusts

Publications/guidance
Mid Staffordshire NHS Foundation Trust (Trust Special Administrators Extension of Time) Order 2013 (SI 2013/1483). This Order, which comes into force on 19 June 2013, extends the statutory period of 45 working days within which the trust special administrators of Mid Staffordshire NHS FT must provide a draft report to Monitor by 30 working days beginning with 16 April 2013. It also extends the statutory consultation period of 30 working days by 10 working days, commencing within the period of five working days beginning with the date on which the draft report is published.

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

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Information and Data Sharing

Publications/guidance
Information governance and risk stratification: Advice and options for CCGs and GPs. Advice on how to conduct risk stratification while complying with the new legal framework following the implementation of the Health and Social Care Act 2012. The document sets out the role that risk stratification can play in managing the health of a population and explains how risk stratification arrangements in England are affected by the implementation of the 2012 Act and the re-organisation of the NHS on 1 April 2013. It considers how risk stratification may be conducted lawfully and where to obtain further information about the information governance of risk stratification. The appendices set out: a range of options that CCGs can use to conduct risk stratification legally; a detailed description of the law relating to risk stratification; FAQs on the information governance arrangements; a list of items excluded from disclosure; and a glossary of terms.

If you wish to discuss teh issue of information and data sharing generally please contact Jane Bennett.

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Inquests

Publications/Guidance
Memorandum of Understanding between the Crown Prosecution Service, the Association of Chief Police Officers, The Chief Coroner and The Coroners' Society of England and Wales. A Memorandum of Understanding (MoU) has been signed by the CPS, ACPO, the Chief Coroner and the Coroners' Society to establish best practice in the handling of cases where it is suspected that a serious criminal offence may have caused the death of an individual. The agreement, which is available publically, was signed on 24 June 2013, sets out the way the CPS, police and coroners communicate and work together where there is suspicion that a serious offence has led to a death and a corresponding inquest. The CPS has also published complementary legal guidance specifically for prosecutors, providing operational advice on how to implement the principles of the MoU.

Implementing the coroner reforms in Part 1 of the Coroners and Justice Act 2009. In response to a consultation on implementing coroner reforms, the Ministry of Justice has announced that the laws, in force from 25 July 2013, mean that coroners will: be subject to a national code and standards; be able to speed up the release of bodies after post mortem; permit less invasive post-mortem examinations; complete inquests within six months, unless there are good reasons not to; provide greater access to documents and evidence; and be subject to revised training requirements. Coroner services will be overseen by the first Chief Coroner for England and Wales, Judge Peter Thornton QC.

Coroners' inquests - Commons Library Standard Note. A House of Commons Library Standard Note on coroners' inquests includes sections on: when inquests are held; why inquests are adjourned; what information a coroner can call for; and procedure at inquests.

Cases
 Worcestershire CC v HM Coroner for the County of Worcestershire [ 2013] EWHC 1711. The Worcestershire Safeguarding Children Board undertook a review following the death of a 16 year old looked after child and obtained individual management reviews (IMRs) and information reports (IRs). The defendant coroner was granted witness summonses requiring the disclosure of the IMRs and IRs. The claimants sought the summonses to be set aside, as the IMRs and IRs were protected by public interest immunity. The Queen's Bench Division held that the public interest in the pursuit of a full and appropriately detailed inquest into the death firmly outweighed the claim for non-disclosure.

Legislation
Coroners (Inquests) Rules 2013 (SI 2013/1616). These Rules regulate the practice and procedure relating to inquests conducted as part of an investigation into a death under the Coroners and Justice Act 2009. These Rules set out the procedure for managing the proceedings at an inquest and make provision relating to the disclosure of documents at an inquest and provision relating to inquests heard with a jury. Part 1 of the 2009 Act introduces a new regime for death investigations and inquests, which replaces the Coroners Act 1988 and the Coroners Rules 1984. Under the 2009 Act a coroner must conduct an investigation into violent or unnatural deaths, deaths where the cause is unknown and deaths which occur in custody or otherwise in state detention. In certain cases this investigation will include the coroner holding an inquest. These Rules form part of a package of new rules and regulations made under the 2009 Act which all come into force on 25 July 2013, at the same time as the 2009 Act. 

Coroners Allowances, Fees and Expenses Regulations 2013 (SI 2013/1615). Allowances consistent with their equivalents in criminal courts are payable to jurors, witnesses and post-mortem examiners in relation to a coroner's investigations into deaths from 25 July 2013. Records must also be kept in relation to expenditure and indemnifying coroners in their duties. These regulations consolidate the previous legislation. They form part of a package of new rules and regulations made under the 2009 Act.

Coroners (Investigations) Regulations 2013 (SI 2013/1629). These Regulations regulate the practice and procedure relating to investigations into deaths carried out under Part 1 of the Coroners and Justice Act 2009. They form part of a package of new rules and regulations made under the 2009 Act.

Coroners and Justice Act 2009 (Coroner Areas and Assistant Coroners) Transitional Order 2013 (SI 2013/1625). This Order specifies new coroner areas under the Coroners and Justice Act 2009 and sets out the minimum number of assistant coroners that must be appointed to each coroner area. As required by the 2009 Act, the coroner areas created by this order correspond with the coroners’ districts under the Coroners Act 1988 and have the same names.

Coroners and Justice Act 2009 (Alteration of Coroner Areas) Order 2013 (SI 2013/1626). The Coroners and Justice Act 2009 (Coroner Areas and Assistant Coroners) Transitional Order 2013, which came into force on 25th July 2013, constituted the former coroners’ districts under the Coroners Act 1988 as coroner areas under the Coroners and Justice Act 2009. This Order amalgamates 19 of those coroner areas into nine new coroner areas, in accordance with Sch.2 to the 2009 Act.

Coroners and Justice Act 2009 (Commencement No. 14) Order 2013 (SI 2013/1628). This Order brings the powers to make coroner rules and regulations under the Coroners and Justice Act 2009 into force on 3 July 2013. Section 43 of the 2009 Act enables the Lord Chancellor to make coroner regulations with the agreement of the Lord Chief Justice or a judicial office holder nominated by the Lord Chief Justice. Section 45 of the 2009 Act enables the Lord Chief Justice, or a judicial office holder nominated by the Lord Chief Justice, with the agreement of the Lord Chancellor to make designated rules. Part 1 of the 2009 Act introduces a new statutory regime for investigations and inquests into deaths. The majority of Part 1 is to be implemented in July 2013. These provisions are being commenced so that coroner rules and coroner regulations can be made shortly and brought into force at the same time as the majority of the provisions of Part 1 of the 2009 Act are brought into force (25 July 2013). 

News
Following discussion between the Chartered Institute of Legal Executives (CILEx) and the Ministry of Justice (MoJ) on implementing the reforms of the Coroners and Justice Act 2009, the MoJ has confirmed that Fellows of CILEx can become coroners as well as apply for the Judicial Appointments Commission posts previously reserved for Law Society and Bar Council members.

Bevan Brittan Updates
Being an Inquest Witness: Part 2 - Giving Evidence at the Hearing. This article examines the realities of giving evidence at an Inquest hearing and provides practical guidance and tips for witnesses.

The New Coronial Regime – Past, Present and Future. This article examines the key changes arising from the Coroners and Justice Act 2009 which are due to take effect in June 2013.

If you wish to discuss teh issue of inquests more generally 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.

If you would like information about how to access the Bevan Brittan Mental Health Extranet please email Claire Bentley. Current topics being discussed are:-
 DOLS or MHA in OPMH
 s136 - Commencement of 72 hours?
 Reporting requirement regarding children on adult wards.
 CTO and holidays
 To redetain or not to redetain
 Renewal periods
 136 suite and seclusion
 Brady Tribunal - what do you think?
 Case on disclosure of Sensitive Material to the Coroner
 Training for associate hospital managers
 CTOs: Do the ends justify the means?

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
Thematic review of mental health care announced. Following recent concerns about access to appropriate treatment for people with mental health issues, CQC is to carry out a review of emergency mental health care. Areas likely to be covered include the use of s.136 of the Mental Health Act which gives police powers to take individuals suffering from mental health issues to a ‘place of safety’ where an assessment is made of their medical needs.

A criminal use of police cells? The use of police custody as a place of safety or people with mental health needs. This review looked at the extent to which police custody is used as a place of safety under section 136 of the Mental Health Act.

Mental health crisis care: physical restraint in crisis A report by MIND on physical restraint in hospital settings in England June 2013

All babies count: spotlight on perinatal mental health. This report calls on health ministers to address gaps in mental health services for pregnant women and new mothers. It argues that the wellbeing of more than one in 10 newborn babies in England could be improved if all new mothers with mental illness had equal access to good services. It highlights a geographical variation in access to mental health services for new mothers with less than half of mental health trusts providing specialist mental health services for expectant and new mums.

A voice and a choice: a showcase of four years of new ideas and practice. This report explores the need for new ways of supporting young people’s mental health, as well as what commissioners are looking for in an ideal support service. It outlines examples of current best practice, the challenges encountered, and acquired learning from supporting young people’s mental health and wellbeing.

Support for commissioning for self-harm. This guide encourages commissioners to work with clinicians and managers to commission high-quality evidence-based care for people who self-harm.

New online application service for Lasting Powers of Attorney. A new online system has been designed to make it simpler and quicker to apply for Lasting Powers of Attorney (LPA), a legal document which allows the applicant to appoint someone to make decisions about their welfare, money or property if they were to lose capacity in the future. The government has also announced it will launch a consultation shortly on options to make the process fully digital, in order for forms to be submitted online.

Public Health England reports on learning disabilities. Public Health England has published its first annual report on the situation of people with learning disabilities in England and the services and support they receive.

Healthcare standards for children and young people in secure settings.

National Confidential Inquiry into Suicide and Homicide Annual Report 2013. This annual report presents an update on numbers and changing trends in suicide and homicide by patients across the UK. Key points:
 Homicide by mental health patients has fallen; figures are the lowest since 1997.
 Suicide in England has risen in the patient population and probably reflects a rise in suicide in the general population which has been attributed to the current economic difficulties.
 In recent years, more suicides have occurred under Crisis Resolution/Home  Treatment than in in-patient setting (all countries). Many of these deaths occur in patients that live alone and have refused treatment.
 Hanging remains the main method in patients suicide and has risen. There has been a rise in opiate self-poisoning (all countries).
 Substance misuse continues to be a common factor in patient suicides (all countries).
 The introduction of CTO's may have contributed to the fall in patient homicides in England. The effect on suicides is unclear.
 Suicide by in-patients continues to fall (all countries).
 Victims of patient homicide are more likely to be spouses of family members than strangers (all countries).  

Legislation
Care Quality Commission (Additional Functions) Amendment Regulations 2013 SI 2013/1413. Previous regulations regarding the duty on the CQC to review decisions to withhold items from patients in secured hospitals and to monitor their phone calls are amended in order to take account of legislative changes. The amendments have effect from 15 July 2013.

Consultations
Committee on the Mental Capacity Act 2005. The House of Lords Committee on the Mental Capacity Act 2005 has published its call for evidence. The Committee has been appointed to consider and report on the Mental Capacity Act 2005. It has been given a reporting deadline of 28 February 2014. They will be examining whether the Government’s implementation programme was effective in embedding the guiding principles of the Act in every day practice, and whether there has been a noticeable change in the culture of care.

Mental wellbeing of older people in residential care: quality standard consultation. This consultation seeks views and feedback on the development of advice for care homes to help them promote the mental wellbeing of older people by supporting and empowering those they look after. Proposed measures include putting older people at the heart of decisions about their care; ensuring they are seen as individuals and that their care reflects this; giving them opportunities to participate in activities to promote their health and wellbeing and spotting possible signs of ill-health before problems get too serious. The consultation is open until 2 August 2013.

News
Mental health homicide inquiry delays 'allow risky practice to continue’. An analysis shared with Community Care reveals that some independent inquiries into mental health homicides are taking over 10 years to be published. 

Former Broadmoor healthcare assistance charged with conspiracy to commit misconduct in a public office. A healthcare assistant who worked at Broadmoor Hospital has been charged with conspiracy to commit misconduct in a public office for selling information on patients and work undertaken by an unnamed member of the royal family. The charges are part of Operation Elveden. Mr Neave will be appearing at Westminster Magistrates' Court on 18 July 2013.

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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Primary Care

Publications/Guidance
Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study. This study examines the association between access to primary care and emergency department visits in England. Findings show that the number of visits to hospital emergency departments in England has increased by 20% since 2007-08, placing unsustainable pressure on the NHS.

Fit note The Department for Work and Pensions (DWP) has published revised guidance to help GPs and healthcare professionals use the fit note which replaced the old sick note. The revised guidance clarifies that a GP’s advice in the fit note should focus on someone’s general fitness for work and not necessarily be tied to their current or most recent job. This allows patients and employers maximum flexibility to discuss what changes could help someone return to work.

The NHS – changes, pressures and what it means for patients. The BMA has launched a new initiative "changingnhs.com" to help GPs explain NHS changes and pressures to patients and the public. The web page pulls together key information, provides links to other useful sites, and explains what the BMA, representing UK doctors and medical students, thinks about it all.

Information governance and risk stratification: Advice and options for CCGs and GPs. Advice on how to conduct risk stratification while complying with the new legal framework following the implementation of the Health and Social Care Act 2012. The document sets out the role that risk stratification can play in managing the health of a population and explains how risk stratification arrangements in England are affected by the implementation of the 2012 Act and the re-organisation of the NHS on 1 April 2013. It considers how risk stratification may be conducted lawfully and where to obtain further information about the information governance of risk stratification. The appendices set out: a range of options that CCGs can use to conduct risk stratification legally; a detailed description of the law relating to risk stratification; FAQs on the information governance arrangements; a list of items excluded from disclosure; and a glossary of terms.

Royal College of General Practitioners (RCGP): The 2022 GP – A vision for general practice in the future NHS. This report argues that major investment is needed in general practice in order to keep the NHS sustainable and to ensure it provides value for money, whilst ensuring safe patient care. It examines the pivotal role of general practice in a world in which patients will rely more than ever on the skill and compassion of their GP. It looks forward to a future in which GPs work in new ways to meet growing need and complexity whilst improving patient care and access to GP services.

A guide for working together: The Care Quality Commission and patient participation groups. Patient Participation Groups (PPGs) offer views on a GP’s services from the patients’ perspective. To deliver high quality services, the CQC considers that it is important that GP practices involve patients and the public in making decisions about services and evaluating their success. This guidance helps people who are involved in a PPG, patient reference group or a patient panel attached to a GP practice, to work in partnership with the CQC when it is inspecting GP practices. 

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
Code of Conduct: Public Health England. PHE has adopted a Code of Conduct that incorporates both the Civil Service Code, which also applies to all its staff, and its professional responsibilities. This PHE Code applies to all staff employed by PHE, secondees, agency staff and individuals holding honorary contracts.

RoSPA: Delivering accident prevention at a local level in the new public health system. This handbook gives local authorities guidance on how to reduce the burden of accidents by encouraging people to take responsibility for their own safety, health and wellbeing. It sets out the current level of accidents and their associated costs, and outlines how accident prevention fits into the new arrangements for public health. Part 2 contains a raft of case studies, fact sheets and research papers, highlighting how accident prevention can be delivered successfully, with subjects including falls prevention, home safety for under-5s, water safety, local transport plans and how to link up with other agendas such as child welfare.

Public health services non mandatory contract 2013 to 2014. The DH has published a contract for use by local authorities when commissioning public health services that can be adapted for use for a broad range of public health services and delivery models. It provides a framework to hold providers to account for the delivery of these services to achieve improved health outcomes. There is also an Integrated Sexual Health Services: National Service Specification to help local authorities commission integrated sexual health care. This can be used alongside the non-mandatory public health services contract.

Making a local difference: State of play and challenges ahead for health and wellbeing boards. The NHS Confederation has published a report that assesses the current state of play in terms of HWBs' progress towards making a real difference to local health outcomes. It outlines the main lessons to guide HWBs towards effectiveness that have emerged from the work of the National Learning Network, and sets out a series of challenges for boards in terms of what still needs to be done if they are to make a significant impact on local population health. It finds that many of these organisations have already made substantial progress in improving health outcomes in their local areas. It furthermore identifies five major learning opportunities from their 'shadow period'.

National health visitor plan – Progress and future implementation. The National Health Visitor Plan sets out how the DH, NHS England, PHE and HEE will work with the health profession, families and communities to achieve the Government’s health visiting commitment to increase the workforce by 4,200, transform the service by April 2015 and support its sustainability beyond 2015. This document details how the partner organisations will work with the health profession, families and communities to achieve this commitment.

Commissioning treatment for dependence on prescription and over-the-counter medicines: a guide for NHS and local authority commissioners. PHE has published commissioning guidance for the NHS and local authorities on how to respond to the needs of people who are addicted to medicines. It sets out PHE’s expectation that support should be available in every area for people with a dependency on prescription or over-the-counter medicines, based on a full assessment of local need.

Developing the public health contribution of nurses and midwives: tools and models. The DH and PHE, working with NICE, have produced professional guidance documents to provide nurses and midwives with the evidence-base to help them extend the range and reach of their inputs at patient, family and community levels. The guides cover:
 the actions to be taken at the three levels of public health practice;
 the use of evidence in public health nursing practice;
 measuring the impact of nursing and midwifery on public health outcomes (by nursing group and by life course);
 the use of NICE guidance by the four public health outcome domains; and
 the visual strategies for public health midwifery practice.

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
Partnership agreement between Monitor and NHS England. This partnership agreement sets out Monitor and NHS England's strategic intent and commitment to work together. It outlines the respective duties, roles and responsibilities of each organisation and the strategic context, placing patients and improved outcomes at the heart of the shared vision. It sets out the partnership objectives, values and behaviours, and the priority areas in which NHS England and Monitor will work closely together.

The Care Quality Commission re: Project Ambrose. This report, carried out by Grant Thornton on behalf of CQC, reveals the failures in CQC's oversight of University Hospitals Morecambe Bay (UHMB) in 2010. It highlights false assurances which were made to both the public and Monitor and the slow pace of action taken by CQC following the identification of failures at the UHMB.

Consultation
Consultation on changes to the way we inspect, regulate and monitor care services. CQC has launched a consultation on its plans to ensure health and social care providers give people safe, effective, compassionate and high quality care. These plans follow from the recommendations made in the Government’s response to Robert Francis’ report into failings at Mid Staffordshire NHS Foundation Trust Patients First and Foremost, alongside comments from service users, the public and other reviews. It focuses on hospital care; there will be a further consultation on adult social care and general practice later this year. The consultation closes on 12 August 2013.

Strengthening corporate accountability in health and social care. Following such scandals in Winterbourne View and Mid-Staffordshire care facilities, the Government is concerned that the public's confidence in the health and care system has been undermined. As part of the Government's commitment to increase accountability in providers of health and care services, the DH is consulting on proposals to hold providers of poor care to account. The proposals include the suggestion that all directors of providers registered with CQC, such as NHS hospitals, private hospitals and care homes, must meet a new fit and proper person test. The CQC will be able to insist of on the removal of directors that fail this test. The consultation closes on 6 September 2013. 

Legislation
Draft National Health Service (Licence Exemptions, etc.) Regulations 2013. These draft regulations, which are scheduled to come into force on 1 April 2014, provide exemptions to the requirement for a provider of NHS services to hold a licence with Monitor; and define, for the purposes of licensing, the person who provides healthcare services.  

Bevan Brittan Updates
A new start and strengthening corporate accountability in health and social care. The last few weeks have seen the launch of two consultations which map out the forthcoming wholesale re-design of the regulation of the health and social care sector in the wake of the Mid Staffordshire Inquiry and the scandal at Winterbourne View:
 A New Start – a CQC consultation was published on 17 June 2013
 Strengthening corporate accountability in health and social care – a Department of Health consultation was published on 4 July 2013.

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

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General

Publications/Guidance
The Cavendish Review – An independent review into healthcare assistants and support workers in the NHS and social care settings. Camilla Cavendish was asked, in the wake of the Francis Inquiry into Mid-Staffordshire NHS Trust, to review what could be done to ensure that unregistered staff in the NHS and social care treat all patients and clients with care and compassion. Her report makes a number of recommendations on how the training and support of both healthcare assistants and social care support workers can be improved to ensure they provide care to the highest standard. The Review proposes that all healthcare assistants and social care support workers should undergo the same basic training, based on the best practice that already exists in the system, and must get a standard ‘certificate of fundamental care’ before they can care for people unsupervised.

How is the new NHS structured? This collection of work from the King's Fund aims to explain how the NHS is now structured, including how providers are regulated, who can influence the commissioning of services and how the money flows:-
 Slide set
 The new NHS - animation
 A guide to the new NHS - Pinterest board

Mapping 100,000 genomes: strategic priorities, data and ethics. Genomes of up to 100,000 patients or infections in patients will be sequenced over the next 5 years leading to better and earlier diagnosis and more personalised care. The Chief Medical Officer established 3 working groups to consider the strategic priorities, data and ethical implications of this work. These reports outline the final recommendations of those groups.

Managing the transition to the reformed health system. Although new organisations set up as part of the reformed health system were ready to start functioning on time, the transition to the system is not yet complete. 

Department of Health business plan 2013 to 2015. Sets out the DH's work priorities and actions for implementing government priorities. It details progress with the Structural Reform Plan and also sets out the top level management structure and responsibilities of the Department. The Annex gives details of cross-cutting priorities.

Revised fit note guidance. This revised guidance clarifies that the advice on the fit note should focus on general fitness for work and not necessarily be tied to their current or most recent job. This allows patients and employers maximum flexibility to discuss what changes could help someone return to work. Guidance is available for GPs, employers and line managers, hospital doctors and occupational health practitioners.

Domestic Violence and Abuse - Professional Guidance. This guidance helps health professionals to recognise factors that may indicate domestic violence and abuse and describes steps to ensure appropriate support and referral where necessary. It highlights best practice, information and learning resources. This guidance acknowledges that because of the role of midwives, health visitors and school nurses, they are often one of the first to become aware of domestic violence and abuse issues within families. They therefore have a significant part to play.

Flat-lining: lack of progress on NHS reform. This report collects available evidence on the progress of NHS reform in this parliament. It highlights concerns on the increase in A&E visits and emergency admissions; the rise in A&E waiting times; and an increase in hospital occupancy rates

Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study. This study examines the association between access to primary care and emergency department visits in England. Findings show that the number of visits to hospital emergency departments in England has increased by 20% since 2007-08, placing unsustainable pressure on the NHS.

Code of Conduct for operational PFI/PPP contracts. HM Treasury have issued a Code setting out the basis on which public sector bodies and their PPP partners agree to identify and make savings in operational PFI and PPP contracts. It aims to help the public and private sectors work together on existing contracts for hospitals and other public infrastructure projects. It applies to all PPP contracts that signatories are parties to, such as PFI contracts, PF2 and other variants of PPP contracts. The code sets out commitments from both public and private sector parties on constructive engagement, flexibility and improving operational efficiency, that will support an overall improvement in contract management relationships and behaviours and the creation of a more effective working environment between customers and suppliers.

Commission on the Future of Health and Social Care. The King's Fund has launched a major review of health and social care under the leadership of an independent commission chaired by Kate Barker. The Commission on the Future of Health and Social Care in England will consider whether the boundary between health and social care should be redrawn by revisiting the post-war settlement and asking fundamental questions about whether it is still fit for purpose. This includes examining how the NHS and social care are funded and organised, and what the alternatives might be to current arrangements. The Commission will also consider the different entitlements to these services, and whether now is the time for these to be changed, including addressing the thorny question of the role of the state and individuals in paying for health and social care. The Commission will produce an interim report early in 2014, ahead of its conclusions and recommendations in September 2014. It will be issuing a call for evidence early on in its work and will be engaging with stakeholders to test ideas and options as they emerge.  

Consultations
Sustaining services, ensuring fairness: A consultation on migrant access and their financial contribution to NHS provision in England. Seeks views on proposals to change the way that the NHS charges foreign nationals who use the NHS, and to recovering the cost of treatment to visitors from the European Economic Area. The consultation asks who should be charged in future, what services they should be charged for, and how to ensure that the system is better able to identify patients who should be charged. The consultation closes on 28 August 2013.

News
Revealed: how UK justice is dispensed out of hours down the phone line – investigation by "The Independent" shows judges making life-or-death decisions away from the public gaze. An investigation by The Independent has found that out-of-hours rulings by the Court of Protection are being made over the phone, with incomplete evidence, in proceedings that are not always recorded. Legal experts believe that the out-of-hours service can be used cynically to expedite rulings that would have been more rigorously opposed in court. MP John Hemming will call for an urgent inquiry into the practice after it emerged that no one knows how many such judgments are made.

Bevan Brittan Updates
Healthcare at the Sharp End. 11 May 2013 saw the implementation of the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013. This article examines the main provisions and effect of those Regulations.

Personal Health Budgets and CCGs - There is much we do not yet know? Moving forward from the Pilot Project, this article considers the types of budget, and potential future challenges for personal health budgets and CCGs in meeting an individual's health and wellbeing needs.

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

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