19/08/2013
Legal intelligence for professionals in health and social care
Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector 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
Publications/Guidance
The Cavendish review: an independent review into
healthcare assistants and support workers in the NHS and social
care settings. This independent review by Camilla Cavendish
makes a number of recommendations on how the training and support
of both healthcare assistants who work in hospitals, and social
care support workers who are employed in care homes and people’s
own homes, can be improved to ensure they provide care to the
highest standard. It 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.
Care home top-up fees: the secret subsidy. This report argues that some families end up subsidising elderly relatives’ care home fees because councils do not give them the advice and support they’re legally obliged to provide.
More care, less pathway: a review of the Liverpool
Care Pathway.This report sets out recommendations regarding the
Liverpool Care Pathway (LCP) and end of life care following an
independent review of the LCP chaired by Baroness Julia Neuberger.
The panel recommends that use of the LCP should be phased out over
the next six to 12 months, and be replaced by a personalised end of
life care plan, backed up by good practice guidance specific to
disease groups. Other recommendations include:
a general principle that a patient
should only be placed on the LCP or a similar approach by a senior
responsible clinician in consultation with the healthcare team;
unless there is a very good reason, a
decision to withdraw or not to start a life-prolonging treatment
should not be taken during any ‘out of hours’ period;
an urgent call for the Nursing and Midwifery Council to issue
guidance on end of life care;
an end to incentive payments for use
of the LCP and similar approaches; and
a new system-wide approach to
improving the quality of care for the dying.
The Care and Support Minister Norman Lamb has written to all NHS Trusts outlining the action
to be taken following the review of the Liverpool Care Pathway. The
Government will issue a full response to the Review in the autumn.
He asks all Trusts to ensure that they provide the option of an
independent assessor for complaints about the LCP or similar
pathways, and to support this, the DH will shortly publish a list
of independent experts who will be available to patients, their
families and carers, and Trusts. Trusts should also consider
whether new evidence exists that would warrant a re-examination by
the trust of past complaints about the LCP or similar pathway. They
should appoint a Board member with the responsibility for
overseeing any complaints about end of life care and for reviewing
how end of life care is provided.
Guidance for doctors and nurses caring for people
in the last days of life. This guidance has been issued by the
National Council for Palliative Care as interim guidance following
the independent review of the Liverpool Care Pathway (LCP). It aims
to settle uncertainties with respect to the immediate care of
patients and stresses where the LCP is being used properly, this
should not stop abruptly.
Commissioning care and support for older people with high support needs. Practical guidance for commissioners of older people’s services on the range of models and approaches available for supporting older people with high support needs. It describes the options that are available, what makes them successful and beneficial, and suggests five priorities for commissioners.
Divided in dying. This report highlights the need for better advance care planning at the end of life and the urgent need to put in place workable guidance to replace the Liverpool Care Pathway as soon as possible. The report found that almost half of those who have lost someone close to them through a short or long illness, feel their loved one died badly (45%). In cases where the dying person had recorded their end of life wishes, relatives and friends are more likely to report that they had a good death (58%).
Consultations
Caring for our future: consultation on reforming
what and how people pay for their care and support. Seeks views
on the practical details of how the changes to the funding system
should happen and be organised locally. The issues that the
consultation will be exploring in particular are: how the capped
costs system should work; how the deferred payments should be
administered; and how people should be supported in making informed
choices about their care. The consultation closes on 25 October
2013.
If you wish to discuss any queries you may have around care please contact Stuart Marchant.
Children
Publications/guidance
Commissioning children’s palliative care: a guide
for Clinical Commissioning Groups (CCGs). This document
describes the population of children who need palliative care; the
services and professionals who provide it; and recommendations for
the commissioning of children’s palliative care within the context
of the five stages of commissioning set out by the NHS Institute
for Innovation and Improvement.
National child measurement programme: operational guidance for the 2013 to 2014 school year. This annual guidance advises local commissioners and providers of the national child measurement programme on how the programme should be implemented. The programme is part of the Government’s commitment to tackling the public health challenge of excess weight.
Designing and commissioning services for children and young people with asthma: a good practice guide. This guidance aims to help guide commissioners, service developers and providers on best practice asthma care. It sets out the 20 points that good asthma services need to include, and highlights what commissioners can do to drive improved asthma care at each part of the care pathway, with examples of good practice at each step.
Consultations
Should children be involved in clinical
research? Would you let your child take part in clinical
research? How much say should children have in these decisions?
Should they be encouraged? These and other such questions are at
the heart of a new inquiry from the Nuffield Council on Bioethics,
which has today opened a consultation on the ethical issues arising
from children taking part in clinical research. The consultation
seeks the views of young people, parents, professionals involved in
clinical research with children and young people and anyone else
with an interest in these issues.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah or Penelope Radcliffe.
Clinical Risk/Health and Safety
Publications/Guidance
The safer management of controlled drugs: annual
report 2012. This sixth annual report into the management of
controlled drugs covers the year ending 31st December 2012. It
covers all schedules of controlled drugs, including narcotics,
amphetamines and anabolic steroids. It warns that whilst the
arrangements for monitoring controlled drugs have worked well over
the past six years, continued vigilance is needed to make sure this
good practice continues.
‘Care left undone’ during nursing shifts:
associations with workload and perceived quality of care. This
report aims to examine the nature and prevalence of care left
undone by nurses in English National Health Service hospitals and
to assess whether the number of missed care episodes is associated
with nurse staffing levels and nurse ratings of the quality of
nursing care and patient safety environment. It recommends that
hospitals could use a nurse-rated assessment of ‘missed care’ as an
early warning measure to identify wards with inadequate nurse
staffing.
A promise to learn – a commitment to act: improving
the safety of patients in England. Professor Don Berwick was
asked by the Prime Minister to carry out a review of patient safety
following publication of the Francis Report into the breakdown of
care at Mid Staffordshire Hospitals. His four key findings are
that:
The quality of patient care,
especially patient safety, should be paramount;
Patients and carers must be empowered,
engaged and heard;
Staff should be supported to develop
themselves and improve what they do; and
There should be complete transparency
of data to improve care;
The report makes a number of recommendations; however, it does not
recommend that a statutory duty of candour for healthcare workers
is introduced – instead it finds that this duty is adequately
addressed in professional codes of conduct and guidance. Above all
else, the report argues that cultural change is the most important
factor in continuously reducing harm. It distinguishes clearly
between mistakes and negligence and the need for a transparent
culture where mistakes are reported and learnt from. The report is
clear that the most important task for the NHS is to build a
culture of learning and improvement. It aims to complement rather
than duplicate the Francis Inquiry, which has already made 290
concrete recommendations for change.
Safer Wards, Safer Hospitals Technology Fund
update. NHS England has announced an update on the Safer
Hospitals, Safer Wards Technology Fund which offers NHS Foundation
Trusts and NHS Trusts access to a £260m technology fund, after the
deadline for Expressions of Interest closed on 31 July.
Guidance for employers on sharing information about
a healthcare worker where a risk to public or patient safety has
been identified. This document outlines a set of key principles
for employers to consider in relation to the sharing of relevant
information between the private and public health sectors, when the
conduct or performance of a healthcare worker comes into question
and a substantiated risk to patient or public safety has been
identified. It specifically focuses on strengthening existing
policy and legislative levers, and includes a number of tools to
help employers ensure that workable measures are introduced within
their organisations which facilitate the sharing of relevant
information in the interest of patient and public safety.
Review into the quality of care and treatment
provided by 14 hospital trusts in England: overview report. Sir
Bruce Keogh has published his final report following his
investigation of 14 NHS trusts in England as part of a review into
higher-than-expected hospital death rates. He found that, while
there were some examples of good care, none of the 14 hospitals
investigated was providing consistently high quality care to
patients. They identified patterns across many of the hospitals. As
well as the national overview report, which outlines all
key findings and recommendations, there are also final reports for each individual hospital
trust.
The Health Minister has announced that all 14 Trusts investigated by
Professor Sir Bruce Keogh’s review team will have to undertake
strict improvement plans and 11 will be placed into “special
measures” to ensure that Sir Bruce’s recommendations are fully
implemented and patient care improves.
Delivering safe care, compassionate care. Sets out the Welsh Government's findings about lessons for Wales from the report of the Mid Staffordshire NHS FT Public Inquiry. It re-states the core values of the NHS in Wales, and how they will be preserved in the future.
The Francis report (report of the Mid-Staffordshire NHS foundation trust public inquiry) and the Government’s response. This briefing sets out the main issues arising from the public inquiry led by Robert Francis QC, and other preceding reports, into serious failings in care at Mid-Staffordshire NHS Foundation Trust. It also provides some information on the Government’s response to the Francis report, which was published on 6 February 2013.
Workplace health and safety standards. This revised version of these standards include updated chapters on health and safety management systems to reflect HSE’s Plan, Do, Check Act process; lone working and an updated chapter on sharps injuries reflecting the new health and safety (sharps instruments in healthcare) regulations 2013, as well as updated links and signposts to all relevant information.
Cases
R (Nicklinson and Lamb) v Ministry of Justice; DPP
and Attorney General (Interested Parties); CNK Alliance Ltd (Care
Not Killing) and British Humanist Association (Interveners); R (AM)
v Director of Public Prosecutions [2013] EWCA Civ 961 (CA). The
Court of Appeal has dismissed appeals brought by three people with
catastrophic physical disabilities concerning the illegality of
assisted suicide and euthanasia. The court refused to create a
defence of necessity to a charge of murder or assisting suicide. It
found that the blanket legal prohibition on providing assistance to
those wishing to die was not a disproportionate interference with
Art.8 ECHR. However, the DPP's policy concerning the factors to be
taken into account when deciding whether to prosecute such cases
was insufficiently clear in relation to healthcare
professionals.
See also Court of Appeal assisted suicide judgment – CPS
statement. In a statement made in relation to the Court of
Appeal's decision on assisted suicide, Director of Public
Prosecutions Keir Starmer said that while he respects the court's
judgment, he believes it would be appropriate for the Crown
Prosecution Service, if possible, to have the benefit of the views
of the Supreme Court before any amendments are made to the DPP's
Guidelines in this area of the law. An application has been made by
the CPS for permission to appeal to the Supreme Court.
Bevan Brittan Updates
“A promise to learn – a commitment to act” – The Berwick Review on
Improving the Safety of Patients in England. Last week saw the
publication of the report of the National Advisory Group, chaired
by Professor Don Berwick, on improving the safety of patients in
England (“the Report”). The Report was heralded as one of the
centrepieces of the Government’s response to Robert Francis QC’s
report into the Mid Staffs Inquiry in February; at the time of
receiving that report David Cameron said he had asked Don Berwick
“to make zero harm a reality in the NHS” stating that “bedsores and
hospital infections… are unacceptable - end of story”.
The Berwick Review on Improving the Safety of Patients in England - Implications for the Independent Sector. Last week saw the publication of the report of the National Advisory Group, chaired by Professor Don Berwick, on improving the safety of patients in England (“the Report”). An interesting feature of the Report is the extent to which it also impacts upon the independent sector which this alert examines.
If you wish to discuss any clinical risk or health and safety issues please contact Joanna Lloyd, Stuart Marchant or Julie Chappell.
Commissioning
Publications/Guidance
Approved costing guidance. This guide sets out
costing principles, costing standards, and guidance for both
reference costs and patient-level information and costing systems
collections for 2012/13. It also gives details of the requirements
that providers of NHS-funded services will need to comply with to
meet the pricing conditions of the NHS provider licence.
Commissioning care and support for older people with high support needs. Practical guidance for commissioners of older people’s services on the range of models and approaches available for supporting older people with high support needs. It describes the options that are available, what makes them successful and beneficial, and suggests five priorities for commissioners.
Resources for commissioners of women's health services. This new e-resource aims to support CCGs and NHS England in the commissioning of women’s health services. It brings together standards for hospital-based obstetric and gynaecological care with community-based sexual and reproductive healthcare advice. It is also accompanied by a digital booklet, which provides a brief introduction to the medical specialties and highlights examples of best practice and innovation in UK health organisations.
European cross-border healthcare: information for commissioners. Sets out the associated roles and responsibilities of NHS England, CCGs and CSUs and summarises the requirements of the EU Directive on cross border healthcare, which became UK law in October 2013.
Commissioning for carers: Key principles for Clinical Commissioning Groups. This guidance from the Carers' Trust demonstrates how commissioning for carers can help CCGs deliver desired outcomes and make savings across health and social care.
Designing and commissioning services for children and young people with asthma: a good practice guide. This guidance aims to help guide commissioners, service developers and providers on best practice asthma care. It sets out the 20 points that good asthma services need to include, and highlights what commissioners can do to drive improved asthma care at each part of the care pathway, with examples of good practice at each step.
News
A further 46 CCGs make significant progress in
clearing conditions and directions in the post Authorisation
process. NHS England has announced that a further 46 CCGs have
fully discharged their conditions and directions, meaning they’ve
satisfied the all 119 criteria, while two CCGs with legal
directions have addressed all their concerns and the legal
directions lifted. This means that a total of 152 (72%) CCGs are
free of all conditions placed upon them by NHS England. The number
of CCGs with directions has been reduced from 14 to 8 and two CCGs
that had legal directions in place are now recommended for full
authorisation.
Bevan Brittan Updates
Commissioning Outcome-Based Incentivised Contracts. Fragmented care pathways can deliver suboptimal patient
experiences and, when combined with perverse incentives from the
financial structure, often mean increased costs and poor value for
money. These problems can be addressed if the same care is
delivered through a seamless and efficient care pathway. This is
why CCGs are starting to consider using a model of outcome based
commissioning with an accountable lead provider (also known as
"COBIC" or Capitated Outcome-Based
Incentivised Contracts) to deliver
care to patients with health needs that span domiciliary, primary,
community and acute care. Examples of this approach include the
delivery of substance misuse services in Milton Keynes, and in
procurement are musculoskeletal services in Bedford and frail
elderly care services in Oxfordshire.
If you wish to discuss the issue of commissioning please contact David Owens.
Complaints
Publications/Guidance
NHS hospital complaints. The Parliamentary &
Health Services Ombudsman has published three pieces of research
that aim to support the government review into how NHS hospitals
deal with complaints:
The NHS hospital complaints system: a case
for urgent treatment?: analyses the evidence from example cases
and explores the themes underlying patient’s experience of
complaint handling;
NHS governance of complaints handling: gathers
evidence of how NHS trust boards use information from complaints to
put things right and to learn;
Designing good together: transforming
hospital complaint handling: outlines feedback from patients,
complainants, carers and NHS staff who participated in a two-day
workshop on the NHS hospital complaints system.
If you wish to discuss the issue of complaints more generally please contact Julie Chappell.
Employment/HR
Publications/Guidance
Using social media in your recruitment process: the
essential guide for HR directors and managers. This briefing is
aimed at HR directors and managers and looks at how NHS
organisations can utilise social media platforms to increase the
number of job applications; and also how a permissive approach to
social media can improve an organisation's recruitment success.
New to managing doctors? A guide for HR practitioners. The transition to the new NHS architecture has meant some HR practitioners may be working with doctors for the first time. This guide signposts those new to managing doctors to information on this new aspect of the role.
Hospital locums quality assurance survey. The NHS Revalidation Support Team is seeking employer feedback about quality assurance arrangements for hospital locums. The survey is aimed at HR directors, workforce managers and medical staffing managers of secondary care and mental health organisations and runs until 25 August 2013.
Supporting medical students with mental health conditions. This guidance provides advice to medical schools on all aspects of supporting medical students with mental health conditions. It includes suggesting preventative measures that may help to reduce mental health problems in their students, the use of occupational health and how to handle students with mental health conditions in relation to fitness to practise.
Guidance for employers on the sharing of information about healthcare workers. Guidance for employers on sharing information about healthcare workers has been produced in partnership with the Independent Healthcare Advisory Services (IHAS). This document outlines a set of key principles for employers to consider in relation to the sharing of relevant information between the private and public health sectors, when the conduct or performance of a healthcare worker comes into question, and a substantiated risk to patient or public safety has been identified.
Medical education’s front line: a review of training in seven emergency medicine departmentsThis review found that high workloads and inconsistent supervision are putting off doctors from training in emergency medicine. The findings come from GMC checks on the training of doctors at six emergency medicine departments in England and one in Jersey over a two-month period. Concerns ranged from a lack of supervision of doctors in training at night to inadequate staffing levels. The report identifies a number of ways in which NHS trusts may be able to improve the quality of education and training in emergency medicine.
NHS working longer review. The NHS Working
Longer Review group commissioned Bath University to undertake an
audit of existing research into the impact of working beyond aged
60. This was to provide the review group with an understanding of
what evidence is already available in relation to the impact of
people working beyond 60 on a number of key areas. The final report
addresses NHS capacity and performance; workforce demographics; 50+
employment migration; push and pull variables; and staff
retention.
NHS job evaluation handbook (fourth edition).
This handbook has been updated to reflect the changes in the NHS
and the end of central funding in England for Computer Aided Job
Evaluation system.
How do they manage? A qualitative study of the
realities of middle and front-line management work in health
care. This project addressed three questions. First, how are
middle management roles in acute care settings changing, and what
are the implications of these developments? Second, how are changes
managed following serious incidents, when recommendations from
investigations are not always acted on? Third, how are clinical and
organisational outcomes influenced by management practice, and what
properties should an ‘enabling environment’ possess to support
those contributions? Recommendations for future research concern
the assessment of management capacity, the advantages and drawbacks
of service-line organisation structures, the incidence and
implications of extreme managerial jobs, evaluating alternative
serious incident investigation methods, and the applicability of
high-reliability organisation perspectives in acute care
settings.
Survey on female leaders in healthcare. This
survey, conducted in conjunction with the HSJ, suggests that women
are still facing barriers to becoming senior leaders in the NHS.
Just under half of the respondents thought having children put
their career at a disadvantage, and two thirds felt a greater
pressure to prove themselves than their male counterparts. Other
respondents said that they struggled with a culture of an old boys’
network and attitudes to women leaders. Over a third said they had
encountered sexual discrimination and over half said they had been
bullied in the workplace.
Preparing for your F1 post. This resource for foundation year doctors in the UK draws on the experience of doctors and risk management professionals to prepare F1 doctors for their foundation year. It covers medico-legal scenarios which may be encountered as well as preparing F1 doctors for any time management challenges which may arise.
Consultations
Engagement exercise on information for nurses and
midwives about professional indemnity insurance as a condition of
registration. Views are sought on draft information on the new
professional indemnity insurance requirement, which becomes a
condition of registration with the Nursing and Midwifery Council
(NMC) from winter 2013. It will also become mandatory under the NMC
Code. The consultation is open until 6 September 2013.
Consultation on the profession-specific standards of proficiency for operating department practitioners. These standards of proficiency explain the key obligations that the HCPC expects of registered health, psychological, and social care professionals. They contain generic standards that apply to all registrants, and profession-specific standards that set out the different requirements for specific professions. The review is an opportunity to make sure the standards of proficiency are relevant to each profession. The closing date for comments and feedback is 18 October 2013.
News
Consultant contract – heads of terms agreed.
Announces that NHS Employers has published draft heads of terms for possible reform of the
consultants' contract, which have been jointly agreed by the BMA.
The document sets out a framework for future detailed negotiations
on amendments to the current consultant contract in England and
Northern Ireland and to the Clinical Excellence Awards scheme.
Bevan Brittan Updates
Employment news round-up, July 2013. Aside from news
of the new Royal Prince, the other hotly anticipated media event of
this month is (possibly) Mike Smith's round-up of July's employment
law developments. William and Kate will not be the only people
adjusting to a new world of change this month: in the employment
law sphere, we have seen some key developments this month,
including the introduction of fees in the employment tribunal and
employment appeal tribunal, new employment tribunal rules, the
re-naming of Compromise Agreements as 'Settlement Agreements' and
the introduction of ‘pre-termination discussions’. We also report
on the ‘employee shareholder’ scheme and a new whistleblowing call
for evidence.
Establishment challenged – redundancy law rewritten. In a ground-breaking decision, the Employment Appeal Tribunal (EAT) has made a major change to collective redundancy law. The EAT looked at whether the collective redundancy consultation duty is triggered when 20 or more employees across a whole organisation are potentially affected by proposed redundancies; or when 20 or more employees are potentially affected at any individual establishment, within the larger organisation (such as various regional offices)? As the EAT characterised it, should employers take a site by site 'atomised' approach or a 'holistic' approach? As Julian Hoskins reports, the EAT has said that a holistic approach should be taken, thereby dramatically widening the scope for employers' collective consultation obligations to bite.
How far must an employer go to make reasonable adjustments? Should an employer always waive the requirement for a competitive interview where a disabled employee would be 'substantially disadvantaged ' by the process? In the case of Wade v Sheffield Hallam University, the Employment Appeal Tribunal (EAT) considered whether a university breached its duty to make reasonable adjustments by refusing to waive a competitive interview requirement. The EAT held that an employer will not be expected to transfer a disabled employee to a role without an interview if the employer genuinely believes the employee to be unsuitable. Alastair Currie reports.
TUPE Regulations officially 'static' As we reported in our recent Alert, the European Court of Justice has published its long awaited decision on whether the TUPE Regulations are 'static' or 'dynamic' in relation to the enforceability of collective agreements on a public to private sector TUPE transfer. As Sarah Lamont (a nationally recognised authority in this area) explains, this decision is highly relevant to private to public sector outsourcing exercises.
If you require further information about any of the items raised in this section please contact Julian Hoskins or James Gutteridge.
Finance
Publications/Guidance
Approved costing guidance. This guide sets out
costing principles, costing standards, and guidance for both
reference costs and patient-level information and costing systems
collections for 2012/13. It also gives details of the requirements
that providers of NHS-funded services will need to comply with to
meet the pricing conditions of the NHS provider licence.
Personal health budgets (PHBs) - a revolution in personalisation. This report responds to public and GP key fears about the government introduction of PHBs. It describes how patients make decisions normally made by a GP; what could happen to traditional services and asks whether NHS money should be spent on non-traditional equipment and activities.
Payment by Results Q&A for 2013-14. This
additional guidance has been issued in response to feedback on the
existing guidance for 2013-14.
National Audit Office 2012-13 update on indicators
of financial sustainability in the NHS. There was a surplus of
£2.1bn across the NHS in 2012-13, matching that in 2011-12.
However, there are signs of increasing pressure.
NHS staff: social indicators. This briefing note provides overview statistical information on the NHS workforce in England.
2012-13 update on indicators of financial sustainability in the NHS. This update report found that there was a surplus of £2.1 billion across the NHS as a whole in 2012-13, matching that in 2011-12. Measured by the total surplus or deficit of hospital trusts, financial performance for the NHS appears stronger in 2012-13 than it did in 2011-12 however there are signs of increasing pressure.
Consultations
Caring for our future: consultation on reforming
what and how people pay for their care and support. Seeks views
on the practical details of how the changes to the funding system
should happen and be organised locally. The issues that the
consultation will be exploring in particular are: how the capped
costs system should work; how the deferred payments should be
administered; and how people should be supported in making informed
choices about their care. The consultation closes on 25 October
2013.
News
Prime Minister announces £500 million to relieve
pressures on A&E. Announces funding for A&E departments
identified as being under the most pressure over the next two years
to ensure they are fully prepared for winter. It will be targeted
at ‘pinch points’ in local services. There will also be a £15m cash
injection to NHS 111 to prepare the service for potential winter
pressures. Professor Sir Bruce Keogh is leading a review into the
demands on urgent and emergency care and how the NHS should
respond; he will report in the autumn.
If you require further information about any of the items raised in this section please contact David Owens.
Foundation Trusts
Publications/guidance
Your statutory duties: A reference guide for NHS
foundation trust governors. This Monitor guide lays out the
statutory duties for governors of NHS foundation trusts, as
provided by the National Health Service Act 2006 and amended by the
Health and Social Care Act 2012. It is written for governors and is
advisory only – this means there is no requirement to "comply or
explain" (i.e. to comply with the guidance or explain reasons for
non-compliance).
Bevan Brittan Articles
Updated guidance for NHS Foundation Trust
governors. Monitor, in association with (among others) the
Care Quality Commission and the Foundation Trust Governors'
Association, has recently published an updated reference guide for
NHS foundation trust governors in relation to their statutory
duties.
If you require further information about any of the items raised
in this section please contact Vincent
Buscemi.
Back to top
GovernancePublications/guidance
Good practice guidance on patient group
directions. This guidance has been developed to help
individuals and organisations who are considering the need for,
developing, authorising, using and/or updating PGDs to ensure they
are appropriate, legal and that relevant governance arrangements
are in place within commissioning and provider organisations. The
guidance underlines that supplying and/or administering medicines
under PGD should be reserved for situations where this offers an
advantage for patient care without compromising patient safety and
where there are clear governance arrangements and
accountability.
Bevan Brittan Updates
Directors' liability in health and social care. As the
Government and various regulators map out the steps they are
putting in place in response to the failings highlighted by the Mid
Staffs Inquiry and the appalling mistreatment of residents at
Winterbourne View, one of the key themes emerging is the focus on
accountability for poor standards of care not just at corporate
level but also for individual board members.
If you require further information about any of the items raised in this section please contact David Owens. Back to top
Information and Data SharingPublications/guidance
ICO fines NHS Surrey for failing to check the
destruction of old computers. NHS Surrey has been fined
£200,000 by the Information Commissioner's Office after a
second-hand laptop was sold via an online auction, and later found
to contain the records for around 3,000 patients. NHS Surrey
employed a data destruction company to wipe old computer equipment,
with the agreement any salvageable materials could be sold after
the secure destruction of the hard drives. NHS Surrey had no
contract in place with the provider to explain the legal
requirements and failed to monitor the data destruction
process.
Standards for the clinical structure and content of patient records. This is the latest version of healthcare record standards which will inform the development of electronic health records by both clinicians and industry. It aims to help meet the Secretary of State for Health’s challenge to the NHS to ‘go paperless’ by 2018.
Guidance for employers on sharing information about a healthcare worker where a risk to public or patient safety has been identified. This document outlines a set of key principles for employers to consider in relation to the sharing of relevant information between the private and public health sectors, when the conduct or performance of a healthcare worker comes into question and a substantiated risk to patient or public safety has been identified. It specifically focuses on strengthening existing policy and legislative levers, and includes a number of tools to help employers ensure that workable measures are introduced within their organisations which facilitate the sharing of relevant information in the interest of patient and public safety.
Interim statement on care.data. NHS England has announced plans to introduce a new system for collecting and analysing data called care.data. The first stage of the new system will involve primary care data from GP practices. Whilst the Information Commissioner’s Office understands that this initiative has the potential to enable the health service to derive significant public health benefits from the large amount of data it generates, it has to be recognised that much of the data is about individuals their treatment and conditions. This is data that the public would expect to be handled carefully. Under the Data Protection Act this is considered sensitive personal data and the Act has specific requirements that organisations must meet if they wish to process personal data. It does not mean it cannot be used but rather that it is handled in a way which complies with the law. Currently every indication is that the organisations concerned are making a concerted effort to ensure compliance with the DPA and they have shown a strong desire to work with the ICO to make this happen. However, there is still a lot of work to be undertaken to ensure that all of the obligations of the DPA will be met.
Summary report of qualitative research into public attitudes to personal data and linking personal data. This report is the result of focus group research which examined public attitudes towards sharing personal data with researchers for public good. The focus groups had a generally positive attitude to the potential benefits of sharing data, for patients themselves and for society. And their doubts were more sophisticated than merely worrying about information falling into malicious hands, or supposedly anonymous information being linked back to identifiable individuals. Some of the worries expressed by the focus groups linked to wider worries about the changing role of the NHS.
News
Information Commissioner's Office Decision Notices
- Complaint upheld against Monitor. The Information
Commissioner has upheld a complaint against Monitor following a
Freedom of Information request. This relates to minutes of a Board
meeting in 2009 that were published on Monitor’s website but
subsequently amended in January 2010.
If you wish to discuss the issue of information and data sharing generally please contact Jane Bennett.
InquestsPublications/Guidance
Major overhaul of Coroner Services in England and
Wales. From 25 July 2013, a reformed coroner system will mean
that all 96 coroners in England and Wales will work to the same
standards, meaning coroners will: speed up the release of bodies
after post mortem; permit less invasive post-mortem examinations;
and be required to complete inquests within six months of the date
on which they are made aware of the death, unless there are good
reasons not to.
If you wish to discuss the issue of inquests more generally 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. Current topics being discussed are:-
Section 37/41 - Consent to
treatment.
DOLs or MHA in OPMH.
Commencement of 72 hours?
CQC reporting requirements re children on adult wards
Training - If you would like to know about our free lunch
time training sessions just ask
Claire Bentley. You can attend in our London, Bristol or
Birmingham office.
Publications/Guidance
Building resilient communities. This report
calls on every council to prioritise mental health within their
public health strategy. It brings together the evidence base and
people’s experiences about what makes resilient people and
communities. It offers practical steps to help teams design
wellbeing and resilience services aimed at preventing the
development of mental health problems, and to measure their
impact.
The Esteem Team: Co-ordinated care in the Sandwell
Integrated Primary Care Mental Health and Wellbeing Service.
This case study looks at the Sandwell Esteem Team, part of the
Sandwell Wellbeing Hub in the West Midlands. The hub is a holistic
primary and community care-based approach to improving social,
mental and physical health and wellbeing in the borough of
Sandwell. This case study is part of a research project undertaken
by The King’s Fund and funded by Aetna and the Aetna Foundation in
the United States to compare five successful UK-based models of
care coordination.
National audit of dementia care in general
hospitals 2012-13: second round audit report and update. This
audit report has identified continuing problems in the quality of
care received by people with dementia in hospitals in England and
Wales. Although there has been positive change, the audit shows
that many patients are not receiving key health assessments. It
also reveals that less than half of hospital executive boards are
routinely involved in reviewing hospital performance data on
quality of care received by people with dementia, and two in five
hospitals do not provide dementia awareness training to new
staff.
"Alone with my thoughts": recommendations for a new
approach to young people's mental health support. This report
has been released to accompany the launch of a free online
counselling service for young people. The report is based on a
YouGov survey of over 2000 young people which found that over half
of those who had shown signs of depression as children felt that
they had been let down in their experience of mental health
support. It calls for early intervention and prevention as well as
increased professional support and advice.
Getting on? Growing older with autism. This report
sets out some of the key issues facing older people with autism and
what Government and other bodies need to do to make sure they have
the services and support they need.
The NHS structure and mental health. This
chart illustrates changes to mental health
services in the new NHS structure.
Mental Capacity Act 2005 – Code of practice.
How to act in the best interests of someone lacking capacity,
including issues relating to medical treatment, is included in the
new code of practice for decisions made under the Mental Capacity
Act 2005. It sets out required actions when acting on behalf of
people who cannot act for themselves and is relevant to such groups
as attorneys appointed under a lasting power of attorney, deputies
appointed by the Court of Protection and independent mental
capacity advocates.
Healthy young minds, healthy communities:
conference report. This is a report of an event held jointly by
RSPH and the Institute of Health Visiting which was designed to
explore the extraordinarily close links between early experiences,
both in the womb and as a young infant, and the health of the
community and public. It mentions the topics covered by the
conference, including identifying the evidence base for the impact
of early experience during pregnancy and the first two years in
infants and young children, the implications of the evidence for
health visiting practice and the public mental health implications
of the evidence for policy makers.
Government response to the Confidential Inquiry
into premature deaths of people with learning disabilities.
This response sets out a range of actions across 18 recommendations
in the Confidential Inquiry to improve access, experience and
outcomes for people with learning disabilities and family
carers.
National audit of dementia care in general
hospitals 2012-13. This second report of the National Audit of
Dementia has identified continuing problems in the quality of care
received by people with dementia in hospitals in England and Wales.
It shows that less than half of hospital executive boards are
routinely involved in reviewing hospital performance data on
quality of care received by people with dementia, and two in five
hospitals do not provide dementia awareness training to new staff.
Problems with the quality of information and communication are also
an issue. It also shows that several aspects of care have improved
since the first report in 2011.
Six lives: progress report on healthcare for people
with learning disabilities. This progress report finds that
whilst some improvements have been made, people with learning
disabilities are still experiencing poor care, and face
unacceptable inequalities in health and social care.
Supporting medical students with mental health conditions. This guidance provides advice to medical schools on all aspects of supporting medical students with mental health conditions. It includes suggesting preventative measures that may help to reduce mental health problems in their students, the use of occupational health and how to handle students with mental health conditions in relation to fitness to practise.
Cases
A NHS Trust
v DE, FG, JK and A local Authority and B Partnership
Trust. [2013] EWHC 2562 (Fam) Mrs Justice Eleanor King has
sanctioned the sterilisation of a man "in is best interests" in a
landmark legal ruling. See judgment.
R (Modaresi) v Secretary of State for Health [2013] UKSC 53
(Sup Ct). The Supreme Court has held that the Secretary of
State had not erred in refusing to exercise his discretion under
s.67(1) of the Mental Health Act 1983 to refer a mental patient's
case to the First-tier Tribunal in circumstances where the tribunal
had unlawfully declined to hear the patient's s.66 challenge to her
detention.
Legislation
Public Guardian (Fees, etc) (Amendment) Regulations 2013. The fee
for applying to register an enduring, or a lasting, power of
attorney is reduced from £130 to £110, and the fee for a repeat
application to register a lasting power of attorney is reduced from
£65 to £55. The changes take effect on 1 October 2013.
News
Woman with learning difficulties will be forcibly
checked for possible cancer, judge rules. The Court of
Protection has ruled that a woman with severe learning difficulties
who has refused to undergo medical examinations for a possible
cancer of the uterus can be sedated and forcibly treated. The case
was brought by the woman's local NHS trust, who wanted to agree a
way to go ahead with formal diagnostic examinations.
Commission acts to support right to life for people
detained under Mental Health Act. A judicial review funded by
the Equality and Human Rights Commission has begun into the failure
of a hospital trust to independently investigate the death of a
woman compulsorily detained under the Mental Health Act.
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
Securing the future of general practice: new models of primary care. This report from the Nuffield Trust and The King’s Fund examines the new GP organisations forming to allow care provision at greater scale. To inform the challenges facing primary care, the former Midlands and East Strategic Health Authority – now NHS England (Midlands and East) – commissioned the Nuffield Trust and The King's Fund to undertake a review of UK and international models of primary care, focusing on those that could increase capacity and help primary care meet the pressures it faces. It proposes a set of design principles to be used when determining primary care provision that can: address the pressures facing GPs; ensure the needs and priorities of patients and the public are met; and enable general practice to be fit for the future.
The GP practice: A guide for community pharmacists and pharmacy staff. Following the publication last month of the updated guide to community pharmacy, the updated guide to general practice has also been published. It aims to support GPs and community pharmacists in developing more effective working relationships and in turn, improve primary care services for patients.
News
GP surgeries must inform patients about data plan -
or face legal action. GP practices could face prosecution under
the Data Protection Act 1998 if they fail to take steps to inform
patients that data will be taken from their records and used by the
NHS and private companies from autumn 2013
If you wish to discuss any of the items raised in the above section please contact David Owens.
Public Health
Publications/Guidance
Government response to the House of Commons
Communities and Local Government Committee eighth report of session
2012–13: the role of local authorities in health issues. This
document outlines the DH's response to the CLG Committee's report
on the role of local authorities in health issues. It addresses the
points and issues raised around the transfer of responsibility for
public health to local authorities, the role and responsibilities
of health and wellbeing boards, and accountability and
governance.
Building resilient communities. This report
calls on every council to prioritise mental health within their
public health strategy. It brings together the evidence base and
people’s experiences about what makes resilient people and
communities. It offers practical steps to help teams design
wellbeing and resilience services aimed at preventing the
development of mental health problems, and to measure their
impact.
National child measurement programme: operational
guidance for the 2013 to 2014 school year. This annual guidance
advises local commissioners and providers of the national child
measurement programme on how the programme should be implemented.
The programme is part of the Government’s commitment to tackling
the public health challenge of excess weight.
Delivering accident prevention at local level in the new public health system. This handbook sets out the current level of accidents and their associated costs, and outlines how accident prevention fits into the new arrangements for public health. It also includes 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.
If you wish to discuss any of the items raised in the above section please contact Olwen Dutton.
Regulation
Publications/Guidance
Response to the review of the Human Fertilisation &
Embryology Authority (HFEA) and Human Tissue Authority (HTA).
This independent report sets out 18 recommendations, primarily for
regulators, to improve the efficiency, transparency and
accountability of the work carried out by the HFEA and HTA. It
concluded that while they provide effective regulation and achieve
high levels of public and professional confidence, efficiencies can
be gained from reducing regulation. The Government has considered
this report and accepts all the recommendations. The Department
will work closely with both bodies on implementation of these
recommendations.
If you wish to discuss any of the items raised in this section please contact Stuart Marchant.
General
Publications/Guidance
Better procurement, better value, better care: A
procurement development programme for the NHS. Sets out details
of the NHS Procurement Development Programme, which aims to help
the NHS save £1.5bn by 2015 to 2016. The programme sets out four
major actions: achieving immediate efficiencies and productivity
gains; improving data, information and transparency; improving
outcomes at a reduced cost through clinical procurement review
partnerships; and improving leadership and capability of
procurement in the NHS. The report also gives examples of how money
can be saved in the main NHS spending areas.
Friends and Family Test data. The Friends and Family Test (FFT) is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care. It is initially for providers of NHS funded acute services for inpatients (including independent sector organisations that provide acute NHS services) and patients discharged from A&E (type 1 & 2) from April 2013. This release of information covers the first three months of the survey.
Urgent and emergency services. This report presents the findings of the Commons Health Committee's review of urgent and emergency care services in England that was designed to determine how emergency care can be restructured in order to meet the demands of societal and demographic change. It concludes that the problems that have manifested themselves within emergency care cannot be attributed to any one factor or failure within the system. The Committee notes that reduced bed capacity is an important factor in limiting the flexibility of hospitals, but neither this, nor problems with out of hours care or the failures associated with NHS 111, can sufficiently explain why emergency care is operating under such sustained stress. It identifies a broader failure resulting from fragmented provision of emergency and urgent care and a structure that is confusing to patients. A&E departments remain the default option for many patients and hospitals must ensure that they have the flexibility to meet demand by providing sufficient bed numbers. The Committee is mindful of pressures which will build during next winter and is concerned that current plans lack sufficient urgency. It recommends that NHS England should ensure that Urgent Care Plans are agreed for each area before 30 September 2013. The Committee goes on to argue that there is a requirement to restructure provision of urgent and emergency care if patient need is to be met in the longer term.
Urgent and emergency care: a prescription for the future. This report sets out ten priorities for action to address the challenges faced by urgent and emergency care services. The challenges discussed in this report include: rising demand; ageing population; complex discharge issues; handover and flow; and recruitment into urgent and emergency care services.
Hospitals must now prove merger benefits. The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust must submit evidence of the benefits to consumers that might result from their merging, the Competition Commission (CC) has announced. The CC has raised concerns that the merger of the two trusts would reduce patient choice in a number of clinical specialities.
The NHS belongs to the people: a call to action. In this document, NHS England calls on the public, NHS staff and politicians to have an open and honest debate about the future shape of the NHS in order to meet rising demand, introduce new technology and meet the expectations of its patients. It sets out the challenges facing the NHS, including more people living longer with more complex conditions, increasing costs whilst funding remains flat and rising expectation of the quality of care. It argues that the NHS must change to meet these demands and make the most of new medicines and technology and that it will not contemplate reducing or charging for core services.
Managing the transition to the reformed health
system. This report examined the transition to the new reformed
NHS and found that whilst some organisations were prepared for the
changes, the transition to the system is not yet complete. It also
found that quality of care assurance data during the transition
period is limited due to the lack of data on the quality of primary
care; that getting staff in place presented the biggest challenge
in the run up to April 2013; and that the reforms are reported to
have cost £1.1 billion up to 31st March 2013, 15% more than
expected at this point.
NHS buildings: obstacle or opportunity?There
has been little real attention given to how the NHS estate could
help to improve efficiency, move more care out of hospitals and
exploit new technologies. This perspectives piece demonstrates how
models of care are still designed around buildings, and asks
whether re-thinking the way that the NHS uses its estate could
catalyse change.
Age is just a number: the report of the parliamentary enquiry into older age and breast cancer. This is a report of an inquiry which aimed to examine the variations and barriers preventing all patients diagnosed with breast cancer having access to the services, treatments and care that will benefit them most, regardless of their age. It lays out a series of key recommendations on ways to improve diagnosis, treatment and care, representing the culmination of the findings of the inquiry.
NHS buildings: obstacle or opportunity? The
King's Fund has published a paper as part of its Perspectives
programme that demonstrates how models of care are still designed
around buildings, and asks whether re-thinking the way that the NHS
uses its estate could catalyse change.
The NHS belongs to the people – A call to
action. This publication from NHS England sets out the
challenges facing the NHS, including more people living longer with
more complex conditions, increasing costs whilst funding remains
flat and rising expectation of the quality of care. It says clearly
that the NHS must change to meet these demands and make the most of
new medicines and technology and that it will not contemplate
reducing or charging for core services. NHS England predicts that
by 2020/21 the gap between the NHS budget and rising costs of
caring for an ageing population, with increasingly complex health
conditions, could reach £30bn per annum.
News
Researchers get £124m funding to tackle major
health challenges. Announces funding from the National
Institute for Health Research for 13 research teams. The money will
be invested in health research which includes work to reduce the
risk of dementia through exercise as well as strategies to improve
the nutrition and health of those who have already been
diagnosed.
£93 million package of support announced for UK’s
health industries. Announces the award of £93.2m funding for
business and academic health projects, including £25.9m from third
wave of Biomedical Catalyst a new £38m National Biologics
Manufacturing Centre to be based in Darlington, and an additional
£29.3m invested in innovative health companies.
NHS Innovation Fellowship – partner with the NHS to
drive innovation. NHS England has launched a new scheme
inviting applications to oversee the NHS Innovation Fellowship that
will help improve patient care and deliver value for money. The NHS
Innovation Fellowship will bring together 15 world-class innovators
to work with NHS senior leaders, clinicians and Academic Health
Science Network leaders to embed and foster a culture of innovation
across the health and care system.
Surveillance camera code of practice comes into
force. Announces the coming into force of the new Surveillance Camera Code of Practice, issued
under s.29 of the Protection of Freedoms Act 2012, that sets out
guidelines for CCTV and Automatic Number Plate Recognition systems
in public places to ensure their use is open and proportionate and
that they are able to capture quality images. It sets out 12
guiding principles that system operators should adopt. Relevant
authorities (as defined by s.33 of the 2012 Act, which include
local authorities and police forces in England and Wales) must have
regard to the Code when exercising any functions to which the Code
relates; other operators and users of surveillance camera systems
in England and Wales are encouraged to adopt the code
voluntarily.
Legal loophole means NHS overpaying manufacturers for drugs. The taxpayer is losing millions of pounds each year as drug companies are taking advantage of a legal loophole to drive up the prices of medicine sold to the NHS. The scheme involves manufacturers selling drugs to purchasing firms acting outside of the government's price regulation system, who are then free to mark up the prices. Some medicines sold to the NHS have increased by up to 2,000% of their original price.
If you wish to discuss any of the items raised in this section please contact Claire Bentley.