Health and Social Care Update November 2013

This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.

18/11/2013

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 Governance
Children Mental Health
Clinical Risk/Health and Safety Primary Care
Commissioning Procurement
Complaints Public Health
Employment/HR Regulation
Estates and facilities General
Finance

 Care

Publications/Guidance
Review of the adult care homes sector: Focus on Enforcement regulatory reviews. Focus on Enforcement asks the public to help identify where regulation can be improved, reduced or done differently in specific areas. This review examined businesses that are required to register with the Care Quality Commission, because they carry out regulated activity, i.e. providing accommodation for people who require nursing or personal care.

Future ambitions for hospice care: our mission and our opportunity. This is the final report of the Commission into the Future of Hospice Care that was set up to explore how hospices should adapt to meet the challenges and opportunities of the next 10-15 years. It describes the future for hospice care and identifies the challenges and the opportunities for hospices to shape a system of palliative and end of life care that might match future need.

Identification of the ordinary residence of people in need of community care services. Following the NHS reforms, which took effect from 1 April 2013, the Department of Health has issued updated guidance on determining ordinary residence for people requiring local community care services. It explains how to decide where a person is ordinarily resident for the purposes of the National Assistance Act 1948 and certain other legislation. It also sets out how to identify where responsibility lies between authorities for the funding and/or provision of care for people aged 18 and over who are assessed as needing social care services.

Financing home care charges. This briefing provides information about the local authority means-test for care home charges for the elderly.

Time to choose: Making choice at the end of life a reality. This report from Macmillan Cancer Support looks at the barriers that prevent people from having genuine choice at the end of life. It finds that almost three quarters of cancer patients in England who die in hospital beds wanted to die at home. The vast majority of health professionals agree that access to social care services is crucial for keeping people out of hospital; however, two years after the Palliative Care Funding Review (PCFR) recommended that social care should be free for those at the end of life, thousands of cancer patients are still spending their last remaining days and hours on a hospital ward. The report sets out new recommendations for improving choice at end of life for cancer patients and calls on the Government to make social care free for everyone in the last weeks of life before the end of this Parliament in 2015.

What we know now 2013. This report from PHE's National End of Life Care Intelligence Network (NEoLCIN) summarises the key findings of the network over the last year on where people die and what influences this. The research looked at the influence of marital status and ethnicity on place of death, patient experience, the role of community and palliative care and many other factors. It found that the proportion of people dying at home or in care homes increased from 38% in 2008 to 44% in 2012. However, it also found there were large variations in the proportion of deaths in hospital between 2009 to 2011. Local authorities with highest and lowest rates ranged from 69% in some areas to 38% in others, although the reasons for this are complex.

Legislation
Delayed Discharges (Continuing Care) Directions 2013. These Directions, which come into force on 11 November 2013, set out the duties of NHS Trusts when giving notice of a patient’s likely need for community care services under s.2 of the Continuing Care (Delayed Discharges etc) Act 2003. They require the NHS Trust to take reasonable steps to ensure that an assessment for eligibility is carried out

News
'Ending 15 minute care': Department of Health response. The DH has responded to a report by by Leonard Cheshire Disability which revealed 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 DH has highlighted its Homecare Innovation Challenge, which has brought together local authorities, care providers and carers to look at how care can be improved, including the way councils buy their services. The department also intends to work with the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) to develop a set of commissioning standards to support local authorities to gauge how effectively they are commissioning services, and to bring about improvement led by the social care sector.

Care Quality Commission recommends Essex hospital trust is put into special measures. The Chief Inspector of Hospitals has recommended that Colchester Hospital University NHS Foundation Trust should be placed into special measures. Professor Sir Mike Richards’ call follows serious concerns, highlighted during a Care Quality Commission (CQC) inspection, regarding the quality of some services for cancer patients at the trust. CQC inspectors found a number of cancer patients may have suffered undue delays in treatment and there were inaccuracies with waiting time data relating to cancer treatment. In its inspection report, CQC says some hospital staff reported they were pressured to change data relating to patients and their treatment to make it seem people were being treated in line with national guidelines. As a result some patients may not have had the treatment they needed in time. Staff also reported having raised concerns about this but that this information was not acted upon by the trust. The concerns and the recommendation have been referred to Monitor and also to Essex Police.

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

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Children

Publications/guidance
Chief Medical Officer's annual report 2012: Our children deserve better: prevention pays. This report looks at children and young people from before birth to age 25. It looks at several particular groups of children and young people: those with neurodevelopmental disabilities, those with mental health problems, looked-after children and those in the youth justice system.

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

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Clinical Risk/Health and Safety

Publications/Guidance
Clinical Digital Maturity Index. NHS England and EHI Intelligence have announced the launch of the Clinical Digital Maturity Index (CDMI), a benchmarking tool that enables NHS hospitals to better understand how investing in, then effectively using information technology can improve patient safety and outcomes, reduce bureaucracy, and deliver efficiencies.

Bevan Brittan Updates
Public bodies and independent contractors – Supreme Court rules on non-delegable duty of care. Local authorities and other public bodies could now be held liable for the acts of independent contractors, following the Supreme Court's landmark judgment in Woodland v Essex CC, in which it ruled that a school owed a non-delegable duty of care to its pupils.

Bevan Brittan Events
Clinical Risk and Complaints Forum 28 November 2013 : 09:30am - 11:30pm (registration from 09:15am) Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, London, EC4M 7RF. We are delighted to welcome Lynne Spencer, Head of Communications at the NHSLA to Bevan Brittan who will present on the NHSLA approach to managing and responding to press enquiries and publicity in the NHS.
The London Clinical Risk Team will follow with a session on the duty of candour,
apologies and admissions.

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

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Commissioning

Publications/Guidance
Commissioning for Value – a comprehensive data pack to support clinical commissioning groups (CCGs). These packs aim to show CCGs ‘where to look’ as a first stage to identify opportunities to improve outcomes and increase value for local populations. The localised information will support discussions about prioritising areas for change, utilising resources and will help local leaders make improvements in healthcare quality, outcomes and efficiency. They are meant to be of particular interest to CCG clinical and management leads with responsibility for finance, performance, improvement and health outcomes and to area team leads and to CSU teams supporting CCGs in this work. 

Managing financial difficulties in health economies: lessons for clinical commissioning groups. This report examines why some health economies have been more successful than others in balancing their finances and outlines some key lessons for clinical commissioning groups. It suggests that effectively managing finances is a careful balancing act between delivering short-term balance and strategic planning; between challenge and collaboration; and between an internal and economy-wide focus.

The reformed health service, and commissioning arrangements in England. This House of Commons Library briefing note provides an overview of the major reforms to the health service in England under the Health and Social Care Act 2012. It shows the key funding, commissioning and accountability structures under the old and new systems, and focuses on new health service commissioning arrangements and the formal powers and duties of NHS England and CCGs.

News
Commissioning for Value. Commissioning for Value is a collaboration between NHS Right Care, NHS England and Public Health England. The programme is about identifying priority programmes which offer the best opportunities to improve healthcare for populations – improving the value that patients receive from their healthcare and improving the value that populations receive from investment in their local health system. NHS England is delivering bespoke Commissioning for Value insights packs to all 211 CCGs, with an offer of follow-up events and support. These packs are for use by the local health community and its partners, GP commissioners and leaders and CCG Senior Management Teams and Health and Wellbeing Boards. They will support local discussion about prioritisation and utilisation of resources. The packs are the first stage in identifying where local health economies can prioritise their efforts to have the most impact in healthcare improvement for populations – where to look. They use existing data about Programme Budget spend, Health Outcomes and healthcare variation to identify the best “value opportunities” which CCGs may want to priorities in their strategic commissioning planning.

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

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Complaints

Publications/Guidance
A review of the NHS hospitals complaints system: putting patients back in the picture. This independent report looks at how complaints about care in NHS hospitals made by patients, their carers and representatives are listened to and acted on by hospitals. The recommendations cover: improving the quality of care; improving the way complaints are handled; ensuring independence in the complaints procedures; and whistleblowing. It was commissioned after the Francis report into Mid Staffordshire highlighted that complaints are a warning sign of problems in a hospital. The review was co-chaired by the Rt. Hon Ann Clwyd MP and Professor Tricia Hart, Chief Executive, South Tees Hospitals NHS Foundation Trust. The review reflects on a 'decade of failure' to reform the way in which complaints are handled, and demands urgent action in the next 12 months. To ensure there is real change as a result of the review, the review has taken the unusual step of securing undertakings from key health organisations to ensure that action will be taken within the next year.

The state of medical education and practice in the UK report: 2013. This report has found that many patients are unsure how to raise concerns about poor medical care and more needs to be done to help them.

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

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Employment/HR

Publications/Guidance

Seven-day services in the NHS. There is a growing movement towards more NHS services being available seven days a week which is being driven by: a desire to improve the quality of care; service redesign and reconfiguration; and improving access and convenience. This page gives an overview on the background to seven-day services; the BMA's position paper; and evidence on seven-day services in hospitals.

Securing the future of excellent patient care: Final report of the independent review led by Professor David Greenaway. The Shape of Training Review looked at how to make sure that over the next 30 years, we continue to train doctors who are fit to practise in the UK, are able to meet patient and service needs, and provide safe and high quality care. It focused on postgraduate medical education and training across the UK. It also considered doctors’ expectations and opportunities when they begin a medical career, and their decisions about what they want to specialise in during postgraduate training. This final report offers an approach which will ensure doctors are trained to the highest standards and prepared to meet changing patient needs and which will be fit for purpose for many years to come, and a framework for delivering change and for doing so with minimum disruption to service. It makes a number of recommendations, including that implementation of the recommendations must be carefully planned on a UK-wide basis and phased in, to allow the stability of the overall system to be maintained while reforms are being made, and a UK-wide Delivery Group should be formed immediately to oversee the implementation of the recommendations.

Senior salaries review body (SSRB) review for 2014: written evidence from the Department of Health. This document provides evidence from the Department of Health to SSRB. Pay raises for very senior managers employed by the Department of Health's arms length bodies and by ambulance trusts that have not attained foundation trust status are determined by the government in light of recommendations made by the SSRB. The SSRB takes evidence from the Department of Health and the Managers in Partnership trade union before making its recommendations.

Department of Health organogram. The organogram covers posts occupied by permanent members of staff, fixed-term appointees, inward secondees and an interim or consultant where they are filling a permanent post. Also included are details of the salary and responsibility attached to each senior post (where available) and the estimated cost of the teams supporting the delivery of these responsibilities.

Securing the future of excellent patient care: final report of the independent review led by Professor David Greenaway. This report is the result of an independent review which examined postgraduate medical education and training in the UK to ensure that doctors now and in the future are able to meet the changing needs of patients, society and health services. It recommends that a new way of training doctors is needed for a changing healthcare landscape; arguing that patients and the public will need doctors who are able to provide general care in broad speciality areas across a range of different settings. 

News
Government gives go-ahead to contract negotiations. The BMA reports that the DH has given its mandate for negotiations for consultants in England and Northern Ireland, and all junior doctors following months of initial talks between the BMA, NHSE (NHS Employers) and representatives from the devolved nations over national NHS doctor contracts. Separate talks between the BMA and NHSE for juniors and consultants each resulted in a draft heads of terms document, setting out the scope of the negotiations. For juniors, this includes ensuring the correct balance between service and training, working hours and patterns, and quality-of-life issues. For consultants, this includes clinical excellence awards, seven-day services and a fairer and more transparent pay structure.

Review of senior NHS salaries and redundancy arrangements in arm's-length bodies. NHS Employers reports that the Health Secretary Jeremy Hunt has written to the chief executives of the health arm's length bodies (ALBs) in England asking them to review their senior salaries and redundancy arrangements. As part of the process they have been asked to assess and review, whether the number of staff in their organisations that command salaries over £100,000 is appropriate and publically justifiable. The results of the review may lead to a limit being set on the overall number of posts in ALBs paid over £100,000. The letter also outlined proposals for new rules on redundancy payments in ALBs. The Secretary of State has also asked Monitor and the Trust Development Authority to write to governors of FTs and trusts asking them to follow the lead of ALBs in applying such restraint on redundancy payments for their most senior managers.

New toolkit will help hard-pressed medical registrars with workload. The Royal College of Physicians has published a new acute care toolkit The medical registrar on call to help hard-pressed medical registrars improve their workload, training opportunities and supervision, with clear, practical guidance on best practice.

Bevan Brittan Updates
Employment news round-up, October 2013  This month's news round-up is brought to you by Joanna Smart and covers: 'surrogacy leave' – the latest position; age discrimination and enhanced severance payments; changes to the 'right to accompanied'; the impact of fees in the employment tribunal and updates on the Judicial Review of the legality of tribunal fees and the introduction of employer 'penalties'.

Fair Deal' on pensions. On 4 October 2013, the Treasury published the revised Fair Deal Guidance, confirming the Government’s previously stated intention that, in future, employees who are transferred out of many forms of public service employment on outsourcing contracts will be able to remain members of their existing public service pension scheme. In addition, on a re-tendering of an existing contract, employees will be able to transfer back into the public-sector pension scheme to which they would have been entitled to be a member before the original transfer. Alec Bennett sets out the detail.

Private medical treatment is a 'reasonable adjustment' You may be forgiven for thinking that the provision of private healthcare would be beyond the scope of an employer's duty to make 'reasonable adjustments' for disabled employees. But, apparently not - according to the Employment Appeal Tribunal ('EAT') in the recent case of Croft Vets v Butcher. Jodie Sinclair explains more.

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

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Estates

Publications/Guidance
Reporting of defects and failures - Estates and Facilities Alert (EFA/2013/003). This alert highlights the importance of reporting defects and failures involving non-medical devices and the dissemination of estates and facilities alerts.

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

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Finance

Publications/Guidance
Lessons from Europe: The value of tariff redesign. The NHS national tariff system, known as ‘payment by results’ (PbR), was designed at a time of financial growth in a policy context focused on reducing waiting times. Recently, incentive and information problems have seen commissioners and providers turn to local negotiations instead of PbR. With responsibility for pricing structures being shifted to NHS England and the pricing function moving to Monitor, this NHS Confederation briefing reviews the European experience of paying for specialist health services and examines whether it is time to redesign the NHS tariff in England to facilitate the development of new models of care.

The marginal rate for emergency admissions. Responding to a review of the 30% marginal rate rule for emergency admissions, NHS Confederation has expressed members' view that the rate has realised limited benefits since it was introduced in 2010/11. Members from across the NHS raised concerns about a lack of transparency in how funds are collected and reinvested and the limited involvement of local commissioners and providers.

Effective clinical and financial engagement: a best practice guide for the NHS. This guide promotes collaborative working and increase understanding between NHS clinicians and finance professionals by: highlighting the characteristics of effective engagement between NHS clinicians and finance professionals; providing a toolkit to help NHS trusts to objectively assess the level of clinical and financial engagement in their organisation; including the recommendations of the Mid Staffordshire NHS Foundation Trust Public Inquiry that are relevant to effective clinical and financial engagement; and supporting clinical and financial professionals to help their NHS organisations to achieve quality outcomes and efficiency through working together.

Maternity services in England. A National Audit Office (NAO) report examines whether the DH is achieving value for money from its spending on maternity services in England, and looks at the performance and management of these services. The NAO concludes that most women have good outcomes from NHS maternity services, but there are significant and unexplained variations in performance around the country.

Consultations
New requirements for NHS audit committees. The DH is seeking views on proposals for new constitutional requirements for the audit committees of NHS Trusts and CCGs. These proposals are designed to ensure that these audit committees are appropriately constituted to advise their governing boards on the selection, appointment and maintenance of independent relationships with external auditors from 2015 onwards, when the Audit Commission is expected to close (subject to the approval of Parliament). The consultation closes on 31 December 2013.

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

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Governance

Publications/guidance
Good governance for prison health in the 21st century: a policy brief on the organization of prison health. The document reviews the reasons for the classification of prison health as public health; describes the legal cornerstones of prison health and the principle of equivalence and integration that should underlie it; lists the persistent shortcoming of current arrangements and spells out the meaning of good governance for prison health in the 21st century.

Towards a framework for enhancing the performance of NHS boards: a synthesis of the evidence about board governance, board effectiveness and board development. This study aims to add to existing knowledge by (1) providing a theoretical contribution to board governance and relating it to the NHS context, (2) offering fresh insights into effective board composition, structures, processes and behaviours in the NHS, (3) furthering an understanding of how NHS boards can affect organisational performance and (4) summarising and analysing the range of board assessment tools and development interventions available for the NHS.

Sexual Health: Clinical governance. Sets out key principles to assist service commissioners and providers to operate clinical governance systems in sexual health services. It should be read alongside the non-mandatory Public Health Services Contract 2013-14 and the Integrated Sexual Health Services: National Service Specification.

NHS clinical commissioning groups code of governance. ICSA (the Institute of Chartered Secretaries and Administrators) has published an NHS Clinical Commissioning Groups Code of Governance to support clinicians in developing good governance arrangements and to help build and maintain public trust in clinicians and the NHS.

If you wish to discuss the issue of governance generally please contact Vincent Buscemi.

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Mental Health

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

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

Current topics being discussed are:-
 Discussion of case M.H. v. The United Kingdom  
  Venepuncture under the Mental Health Act
 Inspectors with hidden cameras: coming to a ward near you? 

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
Loneliness resource pack. This set of resources aims to help individuals, groups, communities and neighbourhoods take a closer look at and to reduce loneliness. It includes a briefing on the causes of loneliness; guidance; and session plans.

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England. The aim of this research was to carry out a programme of linked studies aimed at improving the management of self-harm, reducing the incidence of suicide and providing reliable data to evaluate the impact of the National Suicide Prevention Strategy for England (2002).

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study. The aim of this study was to increase equity of access to high-quality primary mental health care for underserved groups. The objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.

Dementia self-assessment framework. This tool was developed to ensure implementation of the nursing contribution to dementia care, including the 6Cs and dementia pathway. It was created by nurses and care staff to compare current dementia care with the best practice criteria.

12 minutes more ... The importance of physical activity, sports and exercise, in order to improve health, personal finances and the pressures on the NHS. This report reveals that early indicators of poor mental health are on the increase. It also finds that GPs are 46 times more likely to prescribe medication than explore medically proven alternative options, like exercise. This report calls for all GPs in the UK to take a ‘diagnose, consider exercise, refer, treat’ approach to physical activity when patients present with early signs of mental ill health.

Post-legislative scrutiny of the Mental Health Act 2007: response to the report of the Health Committee of the House of Commons. The Department of Health responds to the 11 Health Select Committee recommendations following the Mental Health Act 2007. The response covers:
•independent mental health advocate services
•supervised community treatment and places of safety
•deprivation of liberty safeguards

News
A social worker has been suspended from the Health and Care Professions Council (HCPC) Register for failing to progress cases and delaying the review of a service user under the Mental Health Act while working at Brent LBC.

Bevan Brittan Articles
Was there a winner at Aintree? On 30 October 2013, the Supreme Court handed down its first judgment on the Mental Capacity Act 2005 and in doing so gave some useful guidance about how the Act should be interpreted, not only in relation to the withdrawal of treatment deemed to be 'futile' (the central issue in this case) but generally in respect of best interests.

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

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Primary Care

Publications/Guidance
Letter to Area Teams re use of 084 numbers by General Practice. The national office of NHS England has written to all its 27 Area Teams regarding the use of 084 numbers by GPs, asking that they contact all relevant GP practices to remind them that they will be in breach of contract if they do not take all reasonable steps to stop patients being forced to call expensive 084 telephone numbers. New rules came into force in April 2010, telling GPs that they could no longer enter into telephone contracts that meant patients’ calls to surgeries cost more than a geographic-rate telephone call of the same duration. The DH also told GPs at that time that they should take all reasonable steps to end or change any existing contracts that didn’t comply with the rules. The letter explains what GPs can do to negotiate contract changes with their telephone providers. It adds that offering an alternative standard local telephone line alongside a more expensive 084 number is not good enough because patients cannot receive the same level of service, including queuing and direct-dialling facilities, as they do through the higher-rate line.

Developing general practice is a key solution to meet the challenges faced by the NHS. The BMA vision is that with adequate support and development, general practice can be enabled to be at the forefront of the transformation that the NHS needs.

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

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Procurement

Publications/Guidance
NHS procurement: improving transparency and understanding performance. The NHS Procurement Dashboard provides a set of core metrics that NHS healthcare provider organisations can use to measure their procurement practice and performance against. The overview and specification documents provide guidance on using the dashboard tool, to ensure consistency. The dashboard reporting template supports the collation of data and reporting on the NHS Procurement Dashboard core metrics. Key procurement terminology is also explained.

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

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Public Health

Publications/Guidance
NHS public health functions agreement 2014/15. This agreement sets out the arrangements under which the Secretary of State for Health delegates to NHS England responsibility for certain elements of public health functions for 2014 to 2015, which add to the functions exercised by NHS England under the National Health Service Act 2006. It sets out outcomes to be achieved and funding provided for NHS England to commission public health services. This agreement is made under s.7A of the 2006 Act as inserted by the Health and Social Care Act 2012. There are also a number of service specifications for various immunisation and screening programmes that provide details of the public health evidence and advice needed to support effective commissioning.

Money well spent? Assessing the cost effectiveness and return on investment of public health interventions. This LGA briefing for councillors and officers explains the importance of assessing value for money in helping local authorities fulfil their public health responsibilities.

Chief Medical Officer's annual report 2012: Our children deserve better – prevention pays. This year's annual report focuses on children and young people from before birth to age 25. It also looks at several particular groups of children and young people: those with neuro-developmental disabilities, those with mental health problems, looked-after children and those in the youth justice system. The main findings are:
spending money to help people early isn’t just a good thing to do, it’s sensible too. Sometimes a little help early on can make a huge difference to a person’s life. Children and young people should get help and information as soon as they need it;
the CMO has asked Cabinet Office, Public Health England and the Children’s Commissioner to consider holding a National Children’s Week every year;
people who work with children and young people should be trained to listen and behave in a way that makes sense. They shouldn’t use complicated or confusing words;
Schools and local councils should try to find a way to make sports facilities and swimming pools easier for everyone to use.
There are separate summaries of the report for CCGs, health and care professionals and local authorities that set out the key points for each group.

Social care and obesity – a discussion paper. This discussion paper considers the impact that obesity has on social care and the challenges facing social care now and in the future.

Health and wellbeing boards: one year on. This briefing from the King's Fund examines how HWBs have used their shadow year, what they have achieved, and whether they are providing effective leadership across local systems of care. The report, based on a survey of nearly half of the 152 HWBs, shows that local authorities have brought strong leadership to establishing the Boards and report good relationships with CCGs. Most have prioritised public health inequalities allaying concerns about the transfer of this remit to local authorities. However, there is little sign they have begun to grapple with immediate issues such as reconfiguration and integrated care, with the latter only mentioned by nine respondents.

Good governance for prison health in the 21st century: a policy brief on the organization of prison health. The document reviews the reasons for the classification of prison health as public health; describes the legal cornerstones of prison health and the principle of equivalence and integration that should underlie it; lists the persistent shortcoming of current arrangements and spells out the meaning of good governance for prison health in the 21st century.

Cold weather plan for England 2013. PHE has launched this Cold Weather Plan for 2013, which alerts people to the negative health effects of cold weather, enabling them to prepare and respond appropriately. The emphasis of this year’s plan is on long term planning and winter action and preparedness (levels 0 and 1). The plan is accompanied by a letter to local authorities, NHS England and CCGs on the key points of the plan and what they can do to help prevent cold-related illnesses, before cold weather sets in. There is also an Action Card that provides a checklist of action to take at each of the five alert levels.

Evaluation report: Warm Homes Healthy People Fund 2012 to 2013. The Warm Homes Healthy People Fund was established by the DH to support the aims of the Cold Weather Plan for England to protect the population from harm to health from cold weather. While the responsibility for the Cold Weather Plan has passed to Public Health England, the Warm Homes Healthy People Fund has not. Ring-fenced funding of £5.45bn for 2013 to 2015 was made available to local authorities to address public health priorities, determined at the local level. In setting their priorities, local authorities must take into account the Public Health Outcomes Framework which has excess winter deaths and fuel poverty as indicators. This report evaluates the success of the fund of Winter 2012 to 2013. It identifies the benefits of interventions targeted at people who may be more vulnerable to the effects of cold housing, including older people, young children and those living with long-term conditions. The report also highlights some of the challenges faced by local authorities and their local community partners to reduce the levels of deaths and illness in their local area of due to cold housing.

Sexual Health: Clinical governance. Sets out key principles to assist service commissioners and providers to operate clinical governance systems in sexual health services. It should be read alongside the non-mandatory Public Health Services Contract 2013-14 and the Integrated Sexual Health Services: National Service Specification.

News
Agreement puts environmental health at the heart of the public health agenda. PHE has announced that it has signed a Memorandum of Understanding with the Chartered Institute of Environmental Health that is designed to increase cooperation between the two organisations. The agreement highlights the unique and invaluable part played by the environmental health profession in reducing social inequalities, improving public health and creating fairer communities.

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

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Regulation

Publications/Guidance
A fresh start for the regulation and inspection of adult social care. This document outlines new plans to monitor, inspect and regulate care homes and other social care services. The proposals include a rating systems for care homes; expansion of the inspection teams; a discussion of the potential risks and benefits of a mystery shopper system; and collaboration with local Healthwatch in order to get its views on care homes in the community.

Walk-in centre review: Preliminary report. Following reports of walk-in centre closures, Monitor decided to review the provision of walk-in centre services in England. The NHS set up 238 walk-in centres during the last decade in order to improve access to primary care, be more responsive to the needs of patients, and offer greater choice. However, almost one in four of these centres has closed in recent years, despite being popular with patients. This report contains Monitor's preliminary findings and identifies some common issues in key areas: why walk-in centres are closing; the potential impact on patients of walk-in centre closures; whether commissioning practices are working in patients’ interests; and whether features of walk-in centre provision related to choice and competition are operating in patients’ interests. Monitor welcomes submissions that respond to the facts presented and their analysis and preliminary findings, and that offer any additional information that they should consider. The closing date for submissions is 3 December 2013.

Legislation
National Health Service (Licence Exemptions, etc) Regulations 2013 (SI 2013/2677). All organisations providing NHS services, rather than their employees or clinicians, will require a licence from Monitor from 1 April 2014. These regulations provide exemptions to the requirement for a provider of NHS services to hold a licence with Monitor and define, for the purposes of licensing, the person who provides health care services.

Consultations
Consultation on proposed Rules of Procedure for Determinations on National Tariff Methodology References under the Health and Social Care Act 2012. Draft rules of procedure for dealing with regulatory references from Monitor in relation to the NHS national tariff methodology have been published for consultation by the Competition Commission (CC). Those wishing to comment on the consultation should do so by 5 December 2013.

Call for evidence on smaller acute providers in England. This review aims to examine the challenges that smaller district general hospitals face in delivering high quality, sustainable care to patients, and how they are responding. Monitor is seeking feedback from patients, providers, commissioners, health care professionals and any other parties with an interest in providing acute care as it looks at the challenges facing these providers. The deadline for responses to this call for evidence is 10 December 2013.

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

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General

Publications/Guidance
Memorandums on the role of major contractors in the delivery of public services and managing government suppliers. These two reports urge the government and its private sector contractors to work together more effectively in taxpayers’ interest and address the issues behind the current crisis of confidence in contracting out public services. They set out some of the benefits that can be achieved through contracting but highlights three issues that deserve greater public scrutiny.

National partnership agreement between: The National Offender Management Service, NHS England and Public Health England for the co-commissioning and delivery of healthcare services in prisons in England. This agreement sets out: respective roles and objectives of each organisation; shared principles and objectives for all three organisations; shared development objectives and governance arrangements for each organisation.

Tackling female genital mutilation (FGM) in the UK: intercollegiate recommendations for identifying, recording and reporting. This report argues that new measures are required to ensure that young girls at risk of undergoing female genital mutilation are protected by the existing UK legal framework. The report makes nine recommendations for tackling FGM in the UK and considers issues such as the lack of consistent data collection about FGM in the NHS.

A refreshed equality delivery system for the NHS: EDS2. This refreshed document aims to help local NHS organisations, in discussion with local partners including local populations, review and improve their performance for people with characteristics protected by the Equality Act 2010.

i-care: information, communication and technology in the NHS. This report sets out seven key challenges for achieving the technology revolution within the NHS. It has been developed in answer to the Secretary of State for Health’s ambition to make the NHS ‘paperless’ by 2018.

Seven-day services in the NHS. The BMA has published information about the proposals to make more NHS services available all week round, including background, the BMA’s position and evidence about the impact of the plan on hospitals.

Improving diagnosis. This report found that over a third of young people with cancer (37%) are diagnosed through admission to accident and emergency. This is nearly three times the number of adults diagnosed in this way (13%). Of these young people, over a quarter (26%) had already been to see their GP with cancer symptoms. It also highlights that diagnosis through A&E is associated with poorer prognosis and poorer care experience.

A refreshed Equality Delivery System for the NHS – EDS2. NHS England has updated the toolkit to help NHS organisations to meet the requirements of the Equality Act 2010. The new system is designed to be more streamlined and simpler to use compared with the original EDS. It is aligned to NHS England’s commitment to an inclusive NHS that is fair and accessible to all.

The mandate: a mandate from the Government to NHS England: April 2014 to March 2015. This document sets out the ambitions for the health service for April 2014 to March 2015. It is structured around 5 main areas where the government expects NHS England to make improvements: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; treating and caring for people in a safe environment and protecting them from avoidable harm.

NHS pharmaceutical services: assessing applications. Guidance to help NHS England in the assessment and determination of applications to provide NHS pharmaceutical services under the new market entry test and the new performance sanctions regime.

Smart guides to engagement. This series is for everyone working in or with CCGs. The guides have been written by experts to provide straightforward advice on all aspects of patient and public engagement in an easily digested format. There are two new guides: Staff engagement: Good for everyone and Developing pathways: Using patient and carer experiences.

The reformed health service, and commissioning arrangements in England – Commons Library Standard Note. A House of Commons Library Standard Note provides an overview of the major reforms to the health service in England under the Health and Social Care Act 2012. It outlines the key funding, commissioning and accountability structures under the old and new systems, and focuses on new health service commissioning arrangements and the formal powers and duties of NHS England and Clinical Commissioning Groups under the Act.

Referral to treatment: Consultant-led waiting times – Rules suite, April 2014. The Handbook to the NHS Constitution states that patients have a right to start consultant-led treatment within a maximum of 18 weeks unless they choose to wait longer, or it is clinically appropriate that they wait longer. The maximum waiting times legislation requires commissioners to consider the Referral to Treatment: Consultant-led Waiting Times - Rules Suite. The April 2014 Rules Suite, updated to reflect changes to the commissioning of sexual health services, will come into effect on 1 April 2014, when the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013 come into force.

Emergency admissions to hospital: managing the demand. Many emergency admissions to hospital are avoidable and many patients stay in hospital longer than necessary, according to a report by the National Audit Office.

Resolving the emergency crisis. This document lists five areas in which the College of Emergency medicine are working to improve emergency care. It also identifies five priority areas for government and NHS leadership to ensure a stable long term future for A&E services.

Ensuring that patients' interests are at the heart of assessing public hospital mergers: joint statement from the Office of Fair Trading, the Competition Commission and Monitor. Sets out how the bodies work together to ensure that the interests of patients are always central to hospital merger decisions.

Interim gender dysphoria protocol and service guideline 2013/14. This guidance aims to address the significant variations in equity of access currently experienced by patients using gender identity services across England. It aims to achieve national consistency in the commissioning of these services, and is the culmination of extensive work to adapt the NHS Scotland protocol, ensuring that it meets the needs of patients; provides for the safe delivery of services, and reflects NHS England structures.

Sustainable development strategy 2013-2016. This strategy was developed in response to the increasing focus on sustainability across operational and procurement activity within the NHS. It focuses on five key themes designed to build sustainable development across its own operations and procurement activity to benefit the NHS: carbon; community; ethics and responsibility; natural resources; and waste.

Policy+: should all nurses be mentors? Becoming a mentor has long been regarded as an important step in a nurse’s career development and in many healthcare organisations is an essential criterion for promotion. The support and guidance mentors provide for student nurses and the assessments they make of students’ progress and competence are at the heart of nursing education. But is it time to rethink the role of mentor in nurses’ careers and in nursing education and to consider alternatives to the present situation in which most nurses become mentors? This issue of Policy+ presents views of higher education institute and service personnel on these questions, obtained as part of a recent project on mentorship.

Cross border healthcare and patient mobility in Europe: Information to accompany the implementation of Directive 2011/24/EU – on patients’ rights in cross-border healthcare. This information document accompanies the National Health Service (Cross Border Healthcare) Regulations 2013 (SI 2013/2269). It explains the rights and entitlements of patients and helps all relevant parts of the NHS understand the obligations set forward by the directive. It also includes some information for NHS providers, who may receive requests from overseas patients for treatment in the UK under the provisions of the directive. The regulations and the accompanying Directions from the Secretary of State, which can be found at Annex B of the information document, set out the obligations placed on NHS England and CCGs in England. The Directions specify in more detail what NHS England and CCGs must do to carry out the duties imposed on them by the regulations.

Qualitative and quantitative assessments of visitor and migrant use of the NHS in England. These two independent reports, commissioned by the DH, provide evidence of the impact that overseas visitors and migrants are having on GP practices and NHS hospitals. They give a first set of estimates for the number and costs of that care. The study estimates that £388m is spent each year on patients who find themselves in need of health care while in England and who should already be paying for their care, but who are often not processed and charged by the NHS. Only around 16% is currently recovered by the NHS. In addition, there is a cost of between £70m - £300m from people who deliberately travel to England to get free NHS treatment which could be significantly reduced through a better cost recovery system and deterring abuse.
The Government has announced a number of measures to tackle these issues, including: introducing a new health surcharge in the Immigration Bill, which will generate an estimated £200m; appointing Sir Keith Pearson as an independent adviser on visitor and migrant cost recovery; and identifying a more efficient system of claiming back costs by establishing a cost recovery unit, headed by a Director of Cost Recovery.

NHS charges for overseas visitors - Commons Library Standard Note. A House of Commons Library Standard Note provides general guidance about the charging regime that applies to overseas visitors using NHS hospital services, and the circumstances where visitors may be exempt from charges.

Guidance on overseas visitors hospital charging regulations. Guidance in making and recovering charges for NHS hospital treatment from overseas visitors not exempt from charges.

Refreshing the Mandate to NHS England – 2014-2015: Government response. By March 2015, the Government expects NHS England to make improvements in the quality of care it offers. An ambitious agenda to transform NHS patient care has been set by the refreshed Mandate to NHS England for 2014-2015. Objectives include helping people to live well for longer, providing safe, innovative care and making better use of resources. The refreshed Mandate will come into effect from 1 April 2014. 

Consultations
Controlling immigration – Regulating migrant access to health services in the UK. Summary of responses. An immigration health surcharge is to be introduced to prevent non-European Economic Area (EEA) migrants from obtaining health care free of charge under Home Office proposals, issued in response to consultation feedback. However, highly skilled workers and those seeking asylum will be exempt from the surcharge.

News
Sir Keith Pearson, Chair of Health Education England, has been appointed to advise the Department of Health on the recovery of NHS costs from migrants and overseas visitors. Sir Keith will work with NHS leaders to raise awareness of eligibility rules; identify patients not eligible for free care; implement better cost recover; and discourage abuse of the system.

Peers warn against Assisted Dying Bill. In a joint paper, Baroness Butler-Sloss, Lord Carlile QC and Lord Brennan QC have warned that the Assisted Dying Bill would amount to asking Parliament to write a "blank cheque" for euthanasia. The peers warned that the plan would leave vulnerable people at risk of abuse and would deny society the ability to use the law to single out suicide as something fundamentally to be discouraged. They also argued that as the law stands it strikes a balance between deterrence and compassion.

Drug companies agree new drugs deal with NHS. Prescriptions Drug companies have agreed a five year deal with the NHS which freezes the amount the NHS will pay no matter what drugs doctors prescribe. The deal will encourage doctors to use new medicines without concerns about the cost, in what the industry says is a "conservative gamble" to change NHS culture. Companies will pay back the cost of any drugs over the £12bn annual cap.

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

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