Health and Social Care Update October 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	Information and Data Sharing
Children	Inquests
Clinical Risk/Health and Safety	Mental Health
Commissioning	Primary Care
Complaints	Public Health
Employment/HR	Regulation
Estates and facilities	General
Finance

Care

Publications/Guidance
Professional standards for homecare services. The Royal Pharmaceutical Society (RPS) has published overarching developmental standards to provide a best practice framework for the implementation and delivery of homecare services. Homecare services, where medicines are provided to patients direct from the manufacturer are increasingly being commissioned so the RPS, working with the Department of Health Homecare Strategy Board, has produced ten standards to ensure patient safety and the effective management of medicines delivered via the homecare route. The standards will help patients experience a consistent quality of homecare services, irrespective of homecare provider, that will protect them from incidents of avoidable harm and help them to get the best outcomes from their medicines.

Is the quality of care in England getting better? QualityWatch Annual Statement 2013 This report, in partnership with the Health Foundation, provides an overview of initial research into the quality of health and social care services in England. The assessment draws on analysis of nearly 150 quality indicators spanning primary care and community services, hospital care, mental health services and social care. These have been evaluated in relation to six domains of care quality: access; safety; effectiveness; person-centred care and experience; capacity; and equity. A longer version of this report will be published later this autumn.

Commissioning for excellence in care homes. This guidance is aimed at commissioners who wish to develop models of health care delivery which more effectively meet the needs of care home residents.

A new approach to inspecting social care services. New plans to monitor, inspect and regulate care homes and other social care services have been proposed by CQC Chief Inspector of Adult Social Care, Andrea Sutcliffe.

Close to Home recommendations review. This report presents the Equality and Human Rights Commission’s assessment of what local authorities, Government, the Care Quality Commission and the Local Government Ombudsman have done in response to recommendations directed at them in the Close to Home inquiry report. The EHRC concludes that local authorities should change how they commission home care, and in particular ensure that workers are paid the minimum wage. The report warns that the way care is currently commissioned is unsustainable, leading to inadequate pay, poor working conditions for care workers and increasing threats to older people's human rights. Although the EHRC recognises the severe financial pressures local authorities face, it found that the rates that some local authorities pay don't appear to cover the actual costs of delivering care. Many care workers are not paid for travel time or the time between visits, which means that they could be working for less than the legal minimum wage. The EHRC is now calling for all contracts commissioning home care to include a requirement that care workers are paid at least the National Minimum Wage, including payment for travel time and costs. Local authorities should be transparent and set out how the rates they pay cover the costs of safe and legal care, with cost models published on their websites.

Ending 15 minute care. This research by Leonard Cheshire Disability reveals that the public overwhelming oppose 15-minute care visits, while some local authorities are delivering more than three-quarters of their care in 15 minute care visits. The research is based on a ComRes poll of of 2,025 British adults and also Freedom of Information requests to find out how local authorities are using 15-minute care visits.

District nursing - who will care in the future?This Policy+ publication reviews data on the district nursing workforce, looks at the issues to be considered in planning, and considers whether the workforce needed to provide district nursing care in the future will be available.

Care Bill: Carers UK analysis of main provisions for carers. This policy briefing finds that the Care Bill currently going through Parliament represents the biggest change to social care in the last 60 years by consolidating over 30 pieces of statute and numerous pieces of guidance, regulations and directions. It outlines measures to improve carers’ rights in some areas and finds that new rights to assessment mean that adults caring for adults should find it easier to have their needs for support considered.

News
Councils warned about care home fees following ombudsman’s report. The LGO has issued advice to local authorities about their responsibilities for the actions of the care homes they work with, following an investigation into Merton LBC in which a contracted private care home asked a family to pay top-up fees, which they had no right to demand. The LGO found that as the contract for care was between the council and the private care home, there should have been no fee negotiation between the care home and the woman’s family. The care home was not entitled to any more funding than the council’s usual rate.

Health board fined after failing to protect worker from attack. Lothian Health Board has been fined £32,000 after a nurse was attacked while making a home visit to a patient with mental health issues. The Board, also known as NHS Lothian, failed to appropriately manage the risks which workers may be exposed to when making solitary visits to patients with histories of violence towards staff.

Bevan Brittan Updates
CQC: The potential for 'Big Brother' Care Homes. Covert surveillance and mystery-shopper style inspections may form part of the new CQC inspection regime for care homes and domiciliary care. Andrea Sutcliffe, one of three new CQC chief inspectors announced the possibility of using these techniques to tackle potential abuse and neglect in care homes as part of a 'fresh start' to inspection and regulation across the country.

Home truths - Local authorities' commissioning of home care. Olwen Dutton and Clare Taylor look at the Equality & Human Rights Commission's report Close to Home, which reviewed how local authorities commission home care. The report warns that the way care is currently commissioned is unsustainable, leading to inadequate pay, poor working conditions for care workers and increasing threats to older people’s human rights.

The Liverpool Care Pathway – what next? The Liverpool Care Pathway (LCP) attracted a great deal of publicity following publication of an Independent Review in July 2013.

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

Back to top

Children

Publications/guidance
Clearer vision needed to support vulnerable children. A final report by the Scottish Parliament's Education and Culture Committee, to be issued on 23 September 2013, will conclude that too many of Scotland's most vulnerable young people have been left in unsuitable home environments when they should have been taken into care. The Committee asserts that a shared vision of what success would look like for children in care must be established, and sets out its recommendations.

Child protection: improving partnership working between hospitals and local authorities. This report looks at how acute paediatric and local authority statutory child protection services in England work together in cases of suspected child maltreatment. In particular, the study looks at what is viewed locally as good practice in staffing, identifying cases where child maltreatment should be considered, referring cases to social care and information-sharing, and to explore what supports interface arrangements that professionals deem most effective. It focuses on emergency departments and maternity services and their links with local authority social care.

Coordinating epilepsy care: a UK-wide review of healthcare in cases of mortality and prolonged seizures in children and young people with epilepsies. This report covers a themed case review of mortality and serious morbidity in children and young people with epilepsy at all stages of the care pathway, including primary and emergency care. It aimed to evaluate the standards of care provided to the children concerned against the existing evidence based guidelines.

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

Back to top

Clinical Risk/Health and Safety

Publications/Guidance
Stretched to the limit: A survey of Emergency Medicine consultants in the UK. This report from the College of Emergency Medicine describes the working practices of consultants and other senior decision makers in the Emergency Department, the pressures they face and the impact on their working lives. It shows that overall 62% regard the job they are doing running the Emergency Medicine service as unsustainable in its current form and 94% of respondents regularly work in excess of their normal planned hours to help deliver the service. This has potentially serious repercussions for safe working by senior medical decision makers and is also reducing the attractiveness of the specialty to new trainees and causing difficulties in retaining doctors and consultants who are leaving the UK in greater numbers. The consultants in the survey also highlighted pressures on their nursing colleagues with whom they work in teams within the Emergency Departments.

Quality and safety in the NHS. The quality of care in the English NHS is too often compromised by a lack of clearly defined goals, too much regulation, and highly variable staff support, according to the largest ever study of NHS culture and behaviours.

After Francis – Making a difference. The NHS needs to ensure open dialogue about care quality does not just take place in cases of service failure, according to a report by the Commons Health Committee. The report responds to the recommendations set out in the Francis Report on the Mid Staffordshire NHS Foundation Trust public inquiry. The committee believes the duty of candour imposed on all NHS providers is not adequately understood or applied; and calls for responsibility for monitoring patient safety data and practice to be transferred from NHS England to the Care Quality Commission (CQC).

Joint briefing: the Francis Inquiry. This two-part briefing aims to explain why the Francis Inquiry and the resulting reforms are important to social care providers. Part 1 introduces the background to the inquiry and the evolving policy response, while part 2 considers some of the implications of the inquiry and other recent reviews for social care providers. It also recommends a number of key areas for the attention of chief executives, directors and chairs of boards.

Quality improvement made simple. This guide focuses on one important element of the quality agenda: quality improvement. It looks in particular at what are known as organisational or industrial approaches to quality improvement. These aim to bring about a measurable improvement by applying specific methods within a healthcare setting.

Health Foundation Insight research programme studies. Eight new research studies, funded by the Health Foundation, are set to generate significant knowledge that can inspire improvement in patient safety and person-centred care. The 2013 Insight programme aims to generate new knowledge in the areas of patient safety or person-centred care, where: there is the potential for greatest impact; there is a need to develop the evidence for improvement; or the findings are most likely to inspire improvement in the quality of care. 

Improving safety of medical devices. The Commission has adopted measures to improve the safety of medical devices and help restore patient confidence following events, such as the PIP breast implants scandal which affected tens of thousands of women in Europe and around the world. In short, these measures will give watchdogs a louder bark and sharper teeth. Significant elements include:
1. From now on there will be a joint assessment conducted by experts from the European Commission and Member States prior to the designation of any notified body.
2. Member States will have strengthened surveillance and monitoring of the notified bodies. Anybody which fails to meet the requirements will have its designation withdrawn.
3. Further clarification of the skills and experience that staff of notified bodies have to have.
4. In terms of functioning of notified bodies, they will be able to carry out random and unannounced factory audits and to check samples of materials and final products (for substitutions or adulteration of materials).
The measures are laid down in a Commission Implementation Regulation on the designation of notified bodies (responsible for inspecting manufacturers of medical devices) and a Recommendation clarifying the tasks of these bodies in terms of control and checking of medical devices.

BIRTH 2 UK - Maternity Training: 3,500 multi-disciplinary training places available in 2014!More than 3,500 midwives and other healthcare professionals in the maternity sector are being offered the opportunity to receive expert training from Baby Lifeline, a national charity which helps pregnant women and new-born babies. The training has been developed in response to the NHS Litigation Authority "Ten Years of Maternity Claims" report which found that legal action from maternity negligence represented the highest value and second highest number of clinical negligence claims reported in the UK.  

Legislation
Personal Injuries (NHS Charges) (Reviews and Appeals) and Road Traffic (NHS Charges) (Reviews and Appeals) Amendment Regulations 2013 (SI 2013/2586). Appeals in relation to recovery of NHS charges through the NHS Injury Cost Recovery scheme will be lodged directly with Her Majesty's Courts and Tribunal Service (HMCTS) from 7 November 2013. The new process is intended to provide greater transparency for the appellant with all rules on the appeal process in one place and governed by one set of rules.

News
Hunt sets out tough new approach to turn around NHS hospitals. NHS Trusts with the highest standards of patient care and safety will help those that are underperforming, under plans outlined by Health Secretary, Jeremy Hunt. Eleven Trusts placed in 'special measures' will be partnered with one of the best NHS Trusts in new improvement contracts. NHS Foundation Trusts placed in special measures will also have their freedom to operate as an autonomous body suspended and a tougher inspection regime will be introduced.

NHS Trust fined after radiologist exposed to radiation. United Lincolnshire NHS Trust has been fined £30,000 and has been ordered to pay £15,128 in costs, for allowing an interventional radiologist to be exposed to too much radiation while conducting CT scans with x-rays.

NHS Trust faces unlimited fine. NHS trusts Mid Staffordshire NHS Trust has admitted failing to ensure the safety of Gillian Astbury, a diabetic who died in 2007 after not being given insulin. The Trust is facing an unlimited fine and the case has been committed to Stafford Crown Court after magistrates ruled their sentencing powers were insufficient.

Black Triangle scheme implemented across Europe. The UK’s Black Triangle scheme, used to intensively monitor the safety of new medicines, has been adopted for use in Europe following new legislation.

Medical watchdog criticised for slow response over implant scandal. According to an internal document seen by the investigative website Mediapart, the French state medical watchdog did not act fast enough on reports of faulty breast implants marketed by the company Poly Implant Prothese (PIP), allowing thousands of women to continue having the substandard silicone prostheses fitted at a potential risk to their health. It reported that the French watchdog had learned of an increased risk of the implants rupturing in 2006. They were taken off the market in 2010, but Mediapart said the report suggested the watchdog could have acted as early as 2007 or 2008 and prevented thousands more women having the implants. Dominique Maraninchi, head of the watchdog, renamed ANSM, said a public report in 2012 into its role had been sufficient and denied any cover-up.

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

Back to top

Commissioning

Publications/Guidance
Who Pays? Determining responsibility for payments to providers August 2013. This document sets out the circumstances in which a clinical commissioning group (CCG) is responsible for paying for a patient’s care and specifies those circumstances in which a CCG is liable to make a payment to a provider in respect of services commissioned by another CCG. It replaces an earlier version December 2012. Note that there is a post on the Mental Health Act Forum in relation to this guidance.

Planning for a sustainable NHS: responding to the ‘call to action.’Sir David Nicholson, Chief Executive, has written out to commissioners to highlight some of the challenges facing the NHS. The letter aims to help focus people’s attention and thinking regarding the work that needs to start so that plans can be developed for the future.

Commissioning for excellence in care homes. This guidance is aimed at commissioners who wish to develop models of health care delivery which more effectively meet the needs of care home residents.

New EU directive on public procurement. This NHS Confederation briefing provides an overview of key aspects of the new EU Public Procurement Directive and its implications for NHS commissioners and providers.

Local price setting and contracting practices for NHS services without a nationally mandated price: A research paper. This paper from Monitor assesses just how effective local contracts have been in delivering more for patients. Approximately £40bn of total NHS expenditure in 2011/12 was spent on local contracts for services that do not have nationally mandated prices. The research highlights some of the challenges that commissioners face in agreeing local contracts that deliver the best outcomes for patients. Monitor found that effective local contracting in some health care markets is being undermined by several factors, in particular: some commissioners do not have strong contracting skills; commissioners are not always able to negotiate with providers on equal terms; and contract enforcement is not always credible as commissioners are sometimes unwilling to use financial sanctions.

Transforming participation in health and care: Guidance for commissioners. This guidance supports two legal duties under the Health and Social Care Act 2012, requiring clinical commissioning groups and commissioners in NHS England to enable: patients and carers to participate in planning, managing and making decisions about their care and treatment through the services they commission; and the effective participation of the public in the commissioning process itself, so that services reflect the needs of local people. It highlights a range of ways in which NHS commissioners can fulfil their statutory responsibilities and seize the opportunity to deliver personalised and responsive care to all. It includes a wide range of tools, resources and case studies that commissioners will find useful when developing their own responses.

Prescribed specialised services commissioning intentions 2014/15-2015/16. This document serves as notice to all providers of specialised services in England, and will be supported by other, more technical guidance, which will outline clearly which specialised services will be commissioned by NHS England, and which are the responsibility of CCGs.

Legislation
Health and Social Care Act 2012 (Consequential Amendments) (No.2) Order 2013 (SI 2013/2341). Legislation is updated in order to ensure the NHS Commissioning Board and clinical commissioning groups are subject to duties related to the safe and timely discharge of patients, to reflect the changes in responsibility for the commissioning of and provision of health services in England, and to remove reference to Primary Care Trusts. The amendments will come into force from 1 November 2013.

Bevan Brittan Updates
Home truths - Local authorities' commissioning of home care. Olwen Dutton and Clare Taylor look at the Equality & Human Rights Commission's report Close to Home, which reviewed how local authorities commission home care. The report warns that the way care is currently commissioned is unsustainable, leading to inadequate pay, poor working conditions for care workers and increasing threats to older people’s human rights.

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

Back to top

Complaints

Publications/Guidance
Watchdog welcomes research into outcomes of complaints. The Care Inspectorate has welcomed the results of research it commissioned on its complaints process in 2012. The care watchdog received 3234 complaints, of which 1763 were registered as formal complaints and investigated.

If you wish to discuss the issue of commissioning please contact Julie Chappell.

Back to top  

Employment/HR

Publications/Guidance
Raising concerns: guidance for nurses and midwives. This guidance sets out broad principles that will help nurses and midwives think through the issues and take appropriate action in the public interest. This new edition includes information on recent legislation that offers protection to whistleblowers as well as updated information on organisations nurses and midwives can go to for further advice.

Beyond breaking point? This report is based on a survey of over 2000 nursing staff and argues that patient care in the UK is being put at risk by staff cuts and excessive workloads, leading to unprecedented nurse stress and ill health. It also raises concerns about the working culture which is operating in the care system in the UK, both in hospitals and community care. It calls on employers to take urgent action to protect staff welfare and patient care as well as for the Health and Safety Executive to take enforcement action where employers are failing to meet the legal requirement to assess and manage the risk of work related stress. 

Cash in the attic: realising the proceeds from government-owned property. This report details how the government could bring in around £23bn from sales of excess real estate holdings and around £17bn from privatisations by 2017-18. It finds that most health assets are either hospital-related or are land and buildings occupied by PCTs. The estimated value of the English fixed assets in the 2007 National Asset Register is about £40 billion.

Supporting staff wellbeing with digital tools.. This guide explores how significant it is that staff maintain their wellbeing as a preventative strategy in tackling staff illness and ‘presenteeism’ as well as acting as an example to patients and service users. It explores how digital tools can be a cost effective and evidence based method that can play a part in organisational support for staff.

News
Royal College of Surgeons chair taskforce to review implementation of EU Working Time Directive in the NHS. The Secretary of State for Health has announced that the Royal College of Surgeons is to chair an independent review of the implementation of Directive 93/104 (Working Time Directive) on the NHS and doctors. The review will make sure that continuity of patient care and opportunities for training are not being compromised. The taskforce will report in January 2014 with recommendations for government policy.

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

Back to top

Estates

Publications/Guidance
Cash in the attic: realising the proceeds from government-owned property. This report details how the government could bring in around £23bn from sales of excess real estate holdings and around £17bn from privatisations by 2017-18. It finds that most health assets are either hospital-related or are land and buildings occupied by PCTs. The estimated value of the English fixed assets in the 2007 National Asset Register is about £40 billion.

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

Back to top

Finance

Publications/Guidance
Urgent and emergency services - Government response. Details of how the Government plans to respond to the pressures on urgent and emergency care, including measures such as providing an extra £500m of funding for winter 2013 and winter 2014, have been set out in this response to the House of Commons Health Select Committee's report on emergency services.

Closing the NHS funding gap: how to get better value health care for patients. Monitor has published a report that discusses how the health sector can close a £30bn funding gap while providing good quality services to patients that are free at the point of use and fit for the needs of patients in the 21st century. This funding gap will be the greatest financial challenge the NHS has faced in recent years. It will require difficult decisions to be made. The NHS will have to achieve 'more for less' at a higher rate than it ever has before. One 'huge heave' will not be enough, and the NHS will have to ensure that improvements in productivity do not lag behind the rest of the economy. NHS England has called for an 'honest and realistic debate' on the challenge that the NHS faces. This report kicks off the debate, outlining the opportunities which are available to deliver better care and close the financial gap.

Local price setting and contracting practices for NHS services without a nationally mandated price: A research paper. This paper from Monitor assesses just how effective local contracts have been in delivering more for patients. Approximately £40bn of total NHS expenditure in 2011/12 was spent on local contracts for services that do not have nationally mandated prices. The research highlights some of the challenges that commissioners face in agreeing local contracts that deliver the best outcomes for patients. Monitor found that effective local contracting in some health care markets is being undermined by several factors, in particular: some commissioners do not have strong contracting skills; commissioners are not always able to negotiate with providers on equal terms; and contract enforcement is not always credible as commissioners are sometimes unwilling to use financial sanctions.

Legislation
National Health Service (Cross-Border Healthcare) Regulations 2013 (SI 2013/2269). New rules and procedures are introduced for reimbursement where a patient obtains a healthcare service in another member state and seeks reimbursement of the costs of their expenditure. The changes will have effect from 25 October 2013.

National Health Service (Direct Payments) (Amendment) Regulations 2013 (SI 2013/2354). These regulations, which come into force on 14 October 2013, amend SI 2013/1617 which governs the rules for the making of direct payments for health care to secure the provision of certain health services under the National Health Service Act 2006. They insert new review provisions for applicants who have had their original application for a direct payment refused, for those whose direct payments have been reduced and for those who have had a particular service within their care plan refused. They also re-insert two paragraphs of the previous regulations governing direct payments (SI 2010/1000) which have not been replicated in the Direct Payments Regulations. These paragraphs allow an individual living in the same household, a family member or a friend to be paid to provide care using part of a patient’s direct payment in very limited circumstances and were left out in error.

Consultations
The 2014/15 National Tariff Payment System: a consultation notice. New rules will come into force next year allowing local experiments in ways of paying for NHS-funded services in order to develop innovative new models of care for patients. The national tariff for 2014/15 will encourage providers and commissioners to develop local payment approaches that enable better integration of care so services are less fragmented and easier for patients to access. Monitor is now consulting on the new payment system. The consultation closes on 31 October 2013. 

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

Back to top

Information and Data Sharing

Publicatons/guidance
Information: To share or not to share? Government response to the Caldicott Review. Individuals will be provided with increased confidence in the security of their personal health information, according to the Government's response to the Caldicott Review. The response has been published alongside new guidance from the Health and Social Care Information Centre which requires individuals' rights to object to the use of their data to be respected. NHS England has published information for patients and healthcare staff about information sharing and the new care data service.

Freedom of Information requests - Commons Library Standard Note. A House of Commons Library Standard Note gives a brief summary of rights to make requests for information in relation to freedom of information legislation, to enable requesters to understand the statutory background. 

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

Back to top

Inquests

Publications/guidance
New reforms to increase diversity of coroners. Legal executives can train to become coroners, according to new reforms aimed at improving the coroner system. The reforms, which have been announced by the Ministry of Justice, seek to increase diversity of the judiciary by allowing legal executives to preside over coroner hearings where previously only solicitors and barristers were allowed to.

If you wish to discuss the issue of inquests more generally please contact Joanna Lloyd.

Back to top

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:-
 Treating patients who have been recalled from a CTO and admitted to the ward
 Inspectors with hidden cameras: coming to a ward near you?
 Audit pack for s17A
 Hospital ward staff and recalled and revoked CTO patients
 Practical Guidance on S.117
 Commissioning Guidance for S.136

Bevan Brittan 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
Mental illness and unhappiness. This paper is a contribution to the second World Happiness Report. It argues that: mental health is the biggest single predictor of life-satisfaction; depression and anxiety are more common during working age than in later life, accounting for a high proportion of disability, major economic costs, and financial losses to governments worldwide; in rich countries treatment is likely to have no net cost to the Exchequer due to savings on welfare benefits and lost taxes, and even in poor countries a reasonable level of coverage could be obtained at a cost of under $2 per head of population per year.

New evidence update on obsessive compulsive disorder. The new evidence update provides a summary of new evidence relevant to NICE clinical guideline 31 ‘Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder’ (2005).

Major national survey prompts CQC to call for improvements in community mental health care. People who use community mental health services should be more involved in decisions about their own care, the Care Quality Commission (CQC) has concluded following the results of a survey. The survey examined the views of 13,000 people who use community mental health services in England. Of particular concern to the CQC is a lack of patient involvement in care plans and not having their views taken into account when deciding which medication to take.

Smoking and mental health. This briefing provides the background to smoking prevalence and the consequences for people with mental illness. It examines the evidence of what works to reduce harm from smoking for this group, and how providers are implementing the smoking ban in practice.

What happens when people with learning disabilities need advice about the law? This qualitative report, jointly commissioned by the Legal Services Board, Legal Services Consumer Panel and Mencap, is based on a mixture of focus groups and interviews with people with learning disabilities, their carers and solicitors.

Crossing boundaries: improving integrated care for people with mental health problems. This report sets out the findings from the Mental Health Foundation’s inquiry into integrated health care for people with mental health problems, which ran from April 2012 to June 2013. The aim of the inquiry was to identify good practice, generate discussion, and draw up key messages on integrated healthcare for people with mental health problems.

World Alzheimer report 2013: journey of caring - an analysis of long-term care for dementiaThis report reveals that, as the world population ages, the traditional system of “informal” care by family, friends, and community will require much greater support. It finds that globally, 13% of people aged 60 or over require long-term care but between 2010 and 2050, the total number of older people with care needs will nearly treble from 101 to 277 million.

The Driving Up Quality Code is a code for providers and commissioners. Signing up is a commitment to driving up quality in services for people with learning disabilities.

Lethal discrimination. This report finds that people with serious mental illness die an average of 20 years earlier than the rest of the population, the majority from preventable causes. It calls on the Government to take immediate action.

Approved mental health professionals (AMHP) competency - mapping tool. This tool aims to demonstrate how competencies required by social workers working as AMHPs meet professional development requirements for regulatory registration. The tool is designed to enable social worker AMHPs to map their continuing professional development targets within The College’s Professional Capabilities Framework to the standards of proficiency they need to meet for registration with the Health and Care Professions Council.

Starting today: Future of Mental Health Services. This report explores the findings of the inquiry into the Future of Mental Health Services. The inquiry aims to review the provision of mental health services in the UK in the light of current and future health and socio-economic development, promote debate on the proper aims and ambitions of mental health services, and consider how to make mental health services fit for purpose to deal with challenges 20-30 years in the future.

Debate on 10 October: Parity of esteem for mental and physical health – Lords Library Note. A House of Lords Library Standard Note provides background reading for the debate to be held on 10 October 2013 on the implications of parity of esteem for mental and physical health, as required by the Health and Social Care Act 2012.

Bridging the gap: the financial case for a reasonable rebalancing of health and care resources This report argues that the resourcing of mental health care must increase if the NHS is to improve the nation’s health while meeting its productivity challenge. It says that under-investment in mental health services and a lack of integration with physical health services have created a bottleneck in health care improvement, constrained physical health outcomes and has impaired broader economic performance. Aside from the significant human cost, the financial cost of untreated mental ill health among people treated for physical illness is some £13 billion - almost as much again as the NHS spends on mental health care.

At risk, yet dismissed: the criminal victimisation of people with mental health problems. This report argues that people with mental health problems are up to ten times more likely to become victims of crime than the general population. It also found people with severe mental illness were more likely to be repeat victims of crime, yet were far less likely to be satisfied with their treatment by police.

News
Health board fined after failing to protect worker from attack. Lothian Health Board has been fined £32,000 after a nurse was attacked while making a home visit to a patient with mental health issues. The Board, also known as NHS Lothian, failed to appropriately manage the risks which workers may be exposed to when making solitary visits to patients with histories of violence towards staff.

Pressures on adult safeguarding continue to mount as referrals rise by 4%.

Reduction in fee for lasting powers of attorney. Application and registration fees for appointing someone the Lasting Power of Attorney (LPA) and Enduring Powers of Attorney (EPA) have been reduced to £110. The fee, which was previously £130, has been reduced to reflect savings caused by an online application process. 

Bevan Brittan Events
Court of Protection Update Wednesday 20 November 2013 10.30am - 4pm. Bevan Brittan’s Court of Protection Team will be running a legal update session, based in a practical context, on how to manage cases involving incapable patients. The session will discuss navigating a pathway through complex care-planning and legal proceedings; funding issues; preparation of evidence; dealing with serious medical treatment cases and an update on recent caselaw. The session will include a workshop on making effective capacity and best interest decisions. The course is free and is aimed at legal service managers, commissioners, healthcare managers and clinical staff involved in planning, implementing or monitoring care packages for incapable or vulnerable patients.Registration will commence at 10:00am. A sandwich lunch will be provided.

Bevan Brittan Articles
A smoke free mental health environment: where are we now? From 1 July 2008 smoking became illegal in any enclosed or substantially enclosed part of any mental health establishment. Residential mental health units had been given an extra year to prepare for implementation. Implementing the smoke free legislation in mental health settings was felt to be particularly challenging, given a higher prevalence of smoking amongst people with mental illness; with up to 70% of patients smoking in mental health units. Five years on from the implementation of the ban, where are we now?

Interferences with Article 8: what justification? Interferences with patient's rights under Article 8 are an increasingly prevalent area of challenge in the mental health arena; they arise both in the context of inpatients and regarding care packages in the community.

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

Back to top

Primary Care

Publications/Guidance
Securing the future of General Practice in London. This document aims to set out the building blocks to ensure safe and sound delivery of General Practice over the weeks and months ahead, as NHS England nationally and in London pursue their programmes of ‘transformation’, including the transformation of primary medical services.

Seven day, 8am – 8pm, GP access for hard working people. Announces that innovative GP practices will shortly be able to apply to a new £50m Challenge Fund to set up a pioneer programme to extend their opening hours. Pioneers will be established in every region of the country which together are expected to cover up to half a million patients. Ministers want to use the pilots as the first step to rolling the scheme out across the country and encouraging hundreds more GP practices to sign up. As well as seven day a week access and evening opening hours, these new pioneer GP groups will also test a variety of forward-thinking services to suit modern lifestyles, including greater use of Skype, email and phone consultations for those who would find it easier. More detail on the process for selecting and supporting these sites and practices will be set out later in December, with the first pioneers up and running from April 2014. Initial results will be reviewed at a high-level summit next summer to determine what has worked well for patients, and how good practice can be shared across the rest of the country.

News
GPs likely to become named clinician for vulnerable older people. Jeremy Hunt has revealed GPs are the current favourite to fulfil the role of the named clinician responsible for people’s care. This follows on-going engagement on the government’s proposals to improve care for vulnerable older people.

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

Back to top

Public Health

Publications/Guidance
NHS Health Check: frequently-asked questions. These frequently-asked questions (FAQs) have been produced by the Local Government Association (LGA) and Public Health England (PHE). They address a number of transitional issues relating to the transfer of responsibility for commissioning NHS Health Check to local government.

Directors of Public Health in local government: Roles, responsibilities and context. This statutory guidance describes both the statutory and non-statutory elements of the Director of Public Health (DPH) function and sets out principles critical to their appointment, to delivery of an effective public health strategy and to other aspects of their relationship with their employer and the Secretary of State.

Directors of Public Health in local government: Guidance on appointing directors of public health. This non-statutory guidance sets out arrangements that are designed to allow local authorities to have confidence in the DPH appointments they make, build on their own good practice, while meeting national requirements set out in the Health and Social Care Act 2013 and statutory guidance. The new arrangements took effect from 1 April 2013 and this guidance applies to appointments made after that date.

Good practice in joint health and wellbeing strategies – A self-evaluation tool for health and wellbeing boards. This NHS Confederation briefing provides guidance to HWBs on good practice in planning, developing and delivering JHWSs, based around key questions to consider and top tips on approaches that might be taken. It includes case studies to illustrate the good practice.

Judging whether public health interventions offer value for money. This NICE briefing for local authorities and partner organisations summarises the economic and health benefits that can be gained from public health interventions and the methods that can be used to measure them. It is particularly relevant to health and wellbeing boards. It also highlights what could be gained by placing greater emphasis on 'prevention rather than cure' in relation to health.

Policy in practice: Implementing NHS Health Check. NHS Health Check is a national programme which identifies people at risk of developing preventable illness including heart disease, stroke, diabetes and kidney disease so they can take action to avoid or delay ill-health. Local authorities took over responsibility for the NHS Health Check programme in April 2013 as part of their new public health responsibilities. This September the first set of local authority performance data was published by Public Health England. This LGIU briefing describes the NHS Health Check and the role of councils and clinical commissioning groups, identifies some examples of good practice and suggests questions for councils and health and wellbeing boards to consider.
See also the LGA's NHS health check - frequently asked questions that address a number of transitional issues relating to the transfer of responsibility for commissioning NHS Health Check to local government.

Directors of public health: role in local authorities. This guidance describes both the statutory and non-statutory elements of the role of director of public health, and sets out the arrangements that allow local authorities to have confidence in their appointments. The appointment guidance offers more detailed advice and good practice on the process for the joint appointment of directors of public health by local authorities and Public Health England.

Consultations
Needle and syringe programmes (update): guideline consultation NICE is conducting an update of NICE public health guidance 18 (2009). The updated guidance has been extended to focus on providing needle and syringe programmes (NSPs) for young people aged under 16 who inject drugs and users of performance and image-enhancing drugs.

Knowledge strategy: Harnessing the power of information to improve the public's health. A Public Health England consultation seeks views on its proposed strategic approach to knowledge and information to improve the public's health. The consultation closes on 8 November 2013.

Topics for new NICE quality standards and guidance to improve the quality of public health. NICE has launched a consultation on potential further topics for quality standard development to help improve the quality of public health. Where there are no existing relevant guidelines, this topic list will inform the development of future guidelines. The closing date for comments is 20 December 2013.

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

Back to top

Regulation

Publications/Guidance
A new approach to inspecting social care services. New plans to monitor, inspect and regulate care homes and other social care services have been proposed by CQC Chief Inspector of Adult Social Care, Andrea Sutcliffe.

News
Government strengthens health regulator’s independence. Announces that the Care Quality Commission (CQC) is to be given greater independence to ensure it can act fearlessly as the nation’s chief whistleblower on health. Under the proposals, the Health Secretary will relinquish a range of powers to intervene in the operational decisions of the CQC so the CQC will no longer need to ask for Secretary of State approval to carry out an investigation into a hospital or care home. It will also remove the Secretary of State’s power to direct CQC on the content of its annual report. In addition, the newly created positions of Chief Inspector of Hospitals, General Practice and Adult Social Care, will be enshrined in law. This will place the positions on a permanent footing and ensure that individuals who are appointed to the roles are able to speak up for patients without fear of political interference.
The Government proposes to make these amendments to the Health and Social Care Act 2008 through the Care Bill that is currently before Parliament. 

Monitor clarifies process on awarding foundation trust status. No more NHS trusts will be granted foundation status by Monitor until the health sector regulator receives assurance from the Care Quality Commission (CQC) that applicants are providing a good standard of care for patients. However, Monitor is trying to ensure that those trusts in the process of applying for foundation trust status are prioritised for an updated CQC inspection.

Doctors who have not responded to requests from the General Medical Council (GMC) to provide information for their revalidation have been told that their licence to practise is at risk.

Bevan Brittan Updates
CQC: The potential for 'Big Brother' Care Homes. Covert surveillance and mystery-shopper style inspections may form part of the new CQC inspection regime for care homes and domiciliary care. Andrea Sutcliffe, one of three new CQC chief inspectors announced the possibility of using these techniques to tackle potential abuse and neglect in care homes as part of a 'fresh start' to inspection and regulation across the country.

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

Back to top

General

Publications/Guidance
Future hospital: caring for medical patients. This report aims to improve care for acute medical patients and puts the patient experience and the concept of ‘clinician citizenship’ back into the very heart of healthcare. It suggests restructuring the wards where acutely ill patients are treated, and a new organisational and management structure whose responsibilities for acutely ill medical patients will stretch out from the hospital into the wider community, developing the idea of a local healthcare system.

London: a call to action. This report, produced by NHS England, argues that health inequalities and the capital’s growing demand for healthcare from an ageing population means the existing model of NHS health and care is unsustainable. The report asks for feedback from patients and the public in order to inform the vision of the future of healthcare in London.

Co-ordinated Action Against Domestic Abuse (CAADA) Themis practice briefing 1. This briefing is aimed at Independent Domestic Violence Advisors (IDVAs) working within a hospital setting. It has been created in response to emerging data from CAADA’s Themis project, which highlights some particular characteristics of the client group and areas to consider in relation to practice. The project explores whether support for domestic abuse victims can be provided at an earlier point in the abusive relationship by co-locating IDVA services in hospital settings (both A&E and maternity). It also examines whether co-located services can address the gaps in service provision for victims who are hidden from criminal justice agencies.

GMC seeks views on plans to check language skills of European doctors. Patients will be better protected following new checks to ensure the English language skills of doctors from Europe are good enough to safely treat them, in plans revealed by the General Medical Council.

Best practices in prevention, control and care for drug-resistant tuberculosis. This report contains best practices in prevention, control and care with the aim of improving the transfer of knowledge and experiences between countries in the European Region, and to help in improving the health system approach. It looks at access to testing and access to treatment as well as recording, reporting and treatment outcome monitoring. It also contains policy guidance. 

How is the health and social care system performing? Quarterly monitoring report This report finds that the NHS will struggle to meet its target of delivering £20 billion in productivity improvements by 2015. The survey that informs this report highlights the growing pressures on NHS providers and a growing pessimism amongst finance directors that they will meet the Nicholson Challenge.

The dismantled National Programme for IT in the NHS.The public purse is still paying significant costs for the failed National Programme for IT in the NHS, despite its being dismantled by the government, the Public Accounts Committee has reported. The Department of Health (DH) estimates the current cost of the National Programme is £9.8bn, but the Committee has pointed out this figure does not take into account the future costs associated with its re-set contract with Computer Sciences Corporation (CSC), which is still not settled after two years of negotiations, or the legal costs associated with its termination of Fujitsu's contract. According to the Committee's report the benefits of the programme currently only amount to half of its costs and two-thirds of the predicted benefits have yet to be realised. The Committee has concluded it is doubtful the DH will achieve its aim of a paperless NHS by 2018 given the current state of affairs.

Clinical trials. Lack of transparency in many clinical trials is 'unacceptable', according to a report by the Commons Science and Technology Committee. The Committee says many trials remain unregistered and unpublished meaning the information they generate remains invisible to the scientific community and the public. The Committee wants the government to facilitate greater sharing of the raw data generated during a trial. It also highlights the recent fall in the number of trials, which is partly attributed to the requirement for multiple governance approvals from participating NHS organisations.

UK five year antimicrobial resistance strategy 2013 to 2018. This guidance sets out actions to slow the development and spread of antimicrobial resistance with a focus on antibiotics. 

Acute oncology on the acute medical unit. This toolkit aims to improve the care of cancer patients admitted to hospital as an emergency with medical problems due to their cancer or their treatment. It stresses the importance of patients having access to cancer specialists as soon as possible, and suggests that NHS trusts set up acute oncology services, which can work with the team in the acute medical unit to help in the management of patients with acute oncology problems.

Focus on preventable admissions. This report from the QualityWatch programme, in partnership with the Health Foundation, explores patterns of emergency admissions across England for people with ambulatory care sensitive (ACS) conditions. Analysis of the data shows that 20 per cent of emergency admissions were for ACS conditions and the rate of admission has grown by 26 per cent since 2001/02.

Focus on hip fracture: trends in emergency admissions for fractured neck of femur, 2001 to 2011. This QualityWatch report, in partnership with the Health Foundation, explores the quality of care and outcomes of treatment for hip fracture, drawing on 10 years’ of hospital inpatient activity data. Looking at 10 years’ of hospital inpatient activity data, the report finds that the number of hip fracture admissions increased by 15.5 per cent between 2001/02 and 2012/11. The increase appears to be mainly due to the general ageing of the population.  

Guidance note on disability and emergency risk management. This short, practical guide that covers actions across emergency risk management, such as risk assessment, prevention, preparedness, response, recovery and reconstruction. Developed primarily for health actors working in emergency and disaster risk management at the local, national or international level, and in governmental or nongovernmental agencies, the guidance note points out the health-related actions that are required to ensure that both mainstream and specific support are available and accessible to people with disabilities in emergencies.

Survey of public perceptions of the NHS and social careFindings of the survey of public perceptions of the NHS and social care.

News
Judge orders MMR jab. A High Court judge has ordered two girls, aged 15 and 11, to have the measles, mumps and rubella (MMR) vaccination against their will. Their parents, who are divorced, disagreed over the decision. Mrs Justice Theis ruled it was 'in their best interests' to have the jab. It is the second time a court has ruled on a parental dispute over the MMR, and the first involving children of this age.

Friends and Family Test extended across public services. The DH has announced the extension of the NHS Friends and Family Test across the NHS and other public services. The test, which asks “Would you recommend this service to your friends and family?”, will be extended to all NHS services in England, including mental health services, community nursing, and outpatient appointments by the end of March 2015. The test will also assess Jobcentre Plus services (learning from which will be incorporated into the next phase of the Work Programme), further education courses and all service providers of the youth scheme National Citizen Service.

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

Back to top