Health and Social Care Update - May 2014

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.


Claire Bentley

Claire Bentley


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 Mental Health
Clinical Risk/Health and Safety Primary Care
Commissioning Procurement
Employment/HR Public Health
Finance General
Foundation Trusts


Learning for care homes from alternative residential care settings. This review explores the learning from delivery of care in residential services for children and young people, residential services and supported housing for people with learning disabilities and hospice care, and considers how this can be applied in care homes for older people.

Pay, conditions and care quality in residential, nursing and domiciliary services. This briefing examines the relationship between pay and conditions for workers in residential, nursing and domiciliary care services and the quality of care experienced by people using the service.

NHS waiting times for elective care in England. The success of NHS hospital Trusts in meeting the 18-week waiting time standards for non-emergency care means patients are waiting less time for treatment, though the challenge of achieving the standards is increasing as demand for Trusts' services grows, says a report on NHS waiting times for elective care in England from the Public Accounts Committee. The report's recommendations include a commitment for NHS England to work with clinical commissioning groups and Trusts to ensure patients are given full information in a clear way about their rights and responsibilities under the NHS Constitution. 

Social care funding reform – FAQs. The Care Act 2014 provides for a reformed system of funding social care costs. It establishes a cap on care costs to limit what people would pay for care over the period of their lifetime, and for the level of that cap to be reassessed annually. However, the Act does not set out in detail how the reformed system for paying for social care would work – this is to be detailed in regulations. The Government has not yet published its response to the consultation on the detail of how the system would work. This House of Commons Library Standard Note provides answers to questions relating to the reformed care system and how it would operate.

The Kingsmill Review: Taking care – An independent report into working conditions in the care sector. This review looked at poor working conditions in the care sector and the impact on quality of care, particularly non-payment of the minimum wage, high use of zero hour contracts, low levels of training and the factors associated with poor English language ability. It concludes that the care sector is in crisis – as well as the work being physically and emotionally demanding and often undertaken in unsocial hours, there is evidence of widespread exploitation of workers. The review makes a number of policy recommendations, including:
a Licence to Practise for care managers;
a ban on "zero hours" contracts;
local authorities must be required to perform due diligence to ensure that care workers are not being paid less than the National Minimum Wage;
local authorities follow the principles of the Care Charter, including an end to 15 minute slots, which are associated with non-payment of the minimum wage and poor quality of care.

The Care Certificate. Taking place across a range of health and social care settings, the Care Certificate pilot will test a set of standards designed to help employers to assess not only workers’ skills, but also the knowledge, behaviours and values that are required to deliver compassionate and quality care. Achievement of the Care Certificate should ensure that the support worker has the required values, behaviours, competences and skills to provide high quality, compassionate care. The Care Certificate pilot will be held in the spring and summer of 2014, with the introduction of the certificate planned for March 2015.

Working together to help people raise concerns about adult social care. The CQC and the Local Government Ombudsman (LGO) have announced a new arrangement for people who want to raise concerns about adult social care in England, which will make it easier for people to complain about their care. The new process will transfer enquiries between the organisations, saving people’s time and reducing the need for people to repeat information.

NHS Trusts get another chance to apply for £500 million of tech fund cash, as phase 2 is launched. Announces that the second wave of the £500m Integrated Digital Care Fund, (formerly the Safer Hospitals, Safer Wards Technology Fund), is now open to applications. NHS Trusts and local authorities, can apply for part of £240 million of funding to digitise and integrate patient information across the health and care sector, driving improvements in patient care. The closing date for applications is 14 July 2014.

Bevan Brittan Articles
Better care or worse financial problems?. There has been a flurry of media comment about the Better Care Fund and associated plans following an article in the Guardian suggesting that the Cabinet Office was calling for a delay in implementation as they were concerned about a lack of detail and credibility in the plans for savings in acute services. Brandon Lewis from DCLG has confirmed that there is no delay, but the underlying problem remains.

If you wish to discuss any of the items above or the issue of care more generally please contact Stuart Marchant.


Clinical Risk/Health and Safety

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.

Time for a People's Ombudsman Service: Fourteenth Report of Session 2013-14. A Public Administration Select Committee report calls for a "People's Ombudsman" and concludes that the Parliamentary and Health Service Ombudsman is out of date. The Committee asserts that citizens should have direct and more user-friendly access to the Ombudsman, which should also have "own-initiative" powers to investigate problems in government departments, agencies and the NHS.

Infection prevention and control quality standard. This quality standard contains six statements designed to reduce infection rates, including a statement recommending that patients should be looked after by healthcare workers who always clean their hands thoroughly, both immediately before and immediately after contact or care. It also aims to tackle the growing threat of antibiotic resistance by recommending that antibiotics be prescribed only in accordance with local antibiotic formularies - as part of a system to stem resistance of infections to antibiotics.

Recommendations for safe trainee changeover. Doctors in training in the UK have historically started new six-monthly rotations in February and August, with the majority of junior doctors rotating to new training programmes during the first week of August. There is an increasing body of evidence to suggest that simultaneous trainee changeover is associated with higher mortality, reduced efficiency and lower satisfaction. AoMRC and NHS Employers have worked with partner organisations to develop simple, practical recommendations that can help mitigate these problems.

Guide on the decision-making process regarding medical treatment in end-of-life situations. A Council of Europe guide, aimed primarily at health care professionals, on the decision-making process regarding medical treatment in end-of-life situations looks at what rights patients have, in which ethical and legal framework the decision-making process lies, and how and with whom decisions are made concerning medical treatment.

Why asthma still kills: the national review of asthma death. This report looked into the circumstances surrounding deaths from asthma from 1st February 2012 to 30th January 2013. The primary aim was to understand the circumstances surrounding asthma deaths in the UK in order to identify avoidable factors and to make recommendations to improve care and reduce the number of deaths.

Health Care and Associated Professions (Indemnity Arrangements) Order. In response to the consultation on the Health Care and Associated Professions (Indemnity Arrangements) Order, the Department of Health has decided to introduce the provisions to ensure that those who suffer at the hands of a negligent registered health professional can get compensation. The draft Order will be laid in Parliament shortly.

Safe nurse staffing of adult wards in acute hospitals. This draft guidance provides recommendations on safe staffing for nursing in adult inpatient wards in acute hospitals. The guidance was developed following the Francis and Berwick reports and aims to provide evidence-based guidance on safe staffing levels in hospitals. It also calls for hospital boards and senior management to take greater responsibility and includes step-by-step guidance on how to determine the number of nursing staff that should be funded. Feedback on the draft guidance is being sought from registered stakeholders until 10th June 2014.

MPs call for criminal investigation into pre-signed abortion forms. Eleven MPs have written to the Commissioner of the Metropolitan Police demanding a criminal investigation into the pre-signing of consent forms for abortion by 67 doctors. This follows the ruling out of further action on the matter by the General Medical Council, the doctors' regulator, which said the practice was 'wrong' and the doctors concerned had been ordered to 'obey the law'. Fitness to practise hearings are not being brought, the GMC said, because what was done was 'common practice'.

Payout for kidney transplant from donor with cancer. Kidney transplant patient Robert Law who was given a kidney from a donor with a form of cancer has been awarded a six-figure settlement. Mr Law was one of two people who had to undergo chemotherapy after receiving kidneys at the Royal Liverpool University hospital in 2010. NHS Blood and Transplant admitted negligence in 2012. The other transplant patient, Gillian Smart, is still negotiating a settlement.

Six-monthly patient safety incident data shows incident reporting in the NHS continues to improve.

Health Secretary asks Chief Medical Officer to review homeopathy studies. Health Secretary Jeremy Hunt has asked the Chief Medical Officer (CMO), Dame Sally Davies, to commission expert reviews of three homeopathic remedy studies by a commercial French company.

Thirteen-year-old can decide whether to abort baby. The Family Division has ruled that a 13 year old girl has the mental capacity to decide whether or not to proceed with her pregnancy. The Health Authority responsible for the girl's care sought the ruling to confirm whether the girl had the "appropriate capacity" to make decisions about the pregnancy and understand the options open to her. After hearing evidence from a psychiatrist who had interviewed the girl, the judge concluded that she did.

Eight in ten GPs fear missing serious illness in patients due to workload. Around eight in ten GPs (84%) say they worry about missing a serious condition in a patient due to their workloads, according to new research published by the Royal College of General Practitioners (RCGP).

Bevan Brittan Events
Labour Ward dilemmas. 04 June 2014 : 09:30 - 16:40 (registration opens at 08:45). Location: Bevan Brittan LLP. Kings Orchard, 1 Queen Street, Bristol BS2 0HQ. This Birth 2 UK Training course aims to review the optimal management of the labouring woman, with a focus on instrumental delivery, the second stage Caesarean section, vaginal birth after Caesarean section, the importance of suitable multidisciplinary learning and training and appropriate supervision and support for staff. 

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



National Surgical Commissioning Centre commissioning guides. The Royal College of Surgeons has published 28 commissioning guides, using a NICE accredited process, describing care pathways for patients with surgical symptoms. The guides are designed to assist CCGs to make decisions about appropriate healthcare for specific clinical circumstances and fulfil their obligation to commission healthcare for their population that meets the five domains in the NHS Outcomes Framework.

The asset register and disposal of assets: guidance for providers of commissioner requested services. This document provides guidance on what comprise 'relevant assets’ and on the principles in establishing and maintaining the register of relevant assets. It also outlines our approach to disposals of commissioner requested services assets when a provider has been notified that it is at risk of not being a going concern.

PHE publishes end of life care profiles for clinical commissioning groups. PHE’s National End of Life Care Intelligence Network has published end of life care profiles for CCGs for the first time. The profiles draw together a wide range of information to give an overview of variations in cause and place of death, by age and sex, for each CCG in England. The profiles will help commissioners and providers of end of life care get a clearer picture of the end of life care needs of their local populations. They will help with the planning and delivery of services and will support drives locally towards improving end of life care. In total, there are 170 indicators, presented in four separate tools, using Office for National Statistics mortality data from 2010 to 2012.

Update on specialised commissioning. This briefing announces that NHS England has set up an internal task force to make immediate improvements to the way in which specialised services are commissioned. The task force comprises seven distinct workstreams, with a particular focus on financial control in 2014/15 and planning for the 2015/16 commissioning round.

National Surgical Commissioning Centre – new commissioning guides. The commissioning guides are designed to assist CCGs to make decisions about appropriate healthcare for specific clinical circumstances and fulfil their obligation to commission healthcare for their population that meets the five domains in the NHS Outcomes Framework. New Commissioning guides published recently cover: Breast reduction surgery; Emergency surgery for acute abdominal pain; and Provision of general children's surgery.

Constitutional requirements of NHS Trusts’ and Clinical Commissioning Groups’ audit committees: Government response to consultation. Sets out the response to the October 2013 consultation on proposed new requirements for some NHS audit committees from 2015 onwards, when the Audit Commission is expected to close. Overall, respondents were supportive on proposals for the independence and composition of audit committees, although some concerns were raised in relation to increased costs associated for CCG audit committees. The DH has worked with NHS England to make some adjustments to the requirements, to take account of these concerns. In particular, it will not proceed with the proposal that the audit committee should normally comprise of independent non-executive members of the governing board as this has practical implementation issues for small committees, and works against the intentions of other requirements. The Government will now prepare the regulations in draft for a final consultation in the summer, and plan to lay the regulations before Parliament in the autumn.

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



Workforce planning guidance 2014/15. This guidance highlights the importance of planning the workforce based on current and future patient need and outlines the high level process for developing plans later this year.

Code of practice on preventing illegal working - Civil penalty scheme for employers. Employers must prevent illegal working in the UK by carrying out document checks on people before employing them to make sure they are allowed to work. A new code of practice sets out the factors the Home Office takes into account in deciding illegal working fines--also known as civil penalties--for those employing people who don't have the right to work in the UK. The Code updates the one issued in February 2008 and includes detail on changes to the illegal working scheme, including when employers need to carry out checks and an option for a reduction of the penalty through early payment.

Code of practice for employers - Avoiding unlawful discrimination while preventing illegal working. It is unlawful for employers to discriminate on grounds of race when conducting their duty to conduct document checks on people before employing them, the Home Office has said in its most recent code of practice for employers. The code advises employers on their recruitment policies to help them avoid accusations of discrimination. The information is intended to assist employers with striking a balance between their obligations to check permissions to work in the UK without discriminating against race.

Meeting the challenge - Employee engagement and the future of the NHS promotes employee involvement and has been produced by the Involvement and Participation Association. The report looks at how successful staff engagement has been created in eight trusts (Countess of Chester, Oxleas Mental Health Trust, Guys and St Thomas, Kingston, Frimley Park, Royal Marsden, Derbyshire Healthcare and Salford Royal). The report is an in-depth investigation of the approaches used to develop staff engagement in these organisations, with the aim of sharing ideas and best practice. The trusts involved range from specialist to acute general hospitals and mental health services and have either been high performers on staff engagement for some time and/or improved significantly in recent years.

Resources to support consultant and SAS doctor job planning. NHS Employers and the British Medical Association (BMA) have agreed joint guidance on job planning, which provides a useful framework for doctors and managers to agree objectives-based, patient-focused job plans. The guidance covers consultants and specialist and specialty (SAS) doctors. 

NHS pension scheme changes. The Department of Health is consulting on proposals to amend NHS Pension Scheme regulations. This consultation closes on 28 May 2014.

NHS faces largest tribunal payout. The NHS is facing its largest tribunal payout ever and total costs of £20m, over the suspension and dismissal of Dr Raj Mattu who lost his job at a Coventry hospital after warning that patients were dying on an overcrowded cardiac unit. In April 2014 an employment tribunal ruled he had been unfairly dismissed on grounds of disability after he was too ill to attend a disciplinary hearing because he was suffering from an auto-immune condition. Mattu has now submitted a claim for damages of more than £6.5m, on the grounds that at 54 and not having practised in more than a decade, he is unlikely to find work as a doctor again.

Bevan Brittan Updates
Employment news round-up, April 2014. This month's Employment news round-up is brought to you by Jodie Sinclair and covers Early Conciliation, new whistleblowing guidance for health and social care, a DBS review, a new code of practice on discrimination and illegal working and details of a government taskforce report on the Working Time Directive and its impact on doctors' training.

Whistleblowing & unmanageable complaints. Alastair Currie reports on a decision which provides some welcome clarity on dealing with employees whose (potentially valid) whistleblowing concern escalates into a 'campaign' which would be (as the employment tribunal put it) "sufficient to try and to exhaust the patience of any organisation."

Wishing, hoping and TUPEing. This month the Employment Appeal Tribunal (EAT) has considered what is meant by an 'intention' that a contract will be short term and, therefore, exempt from TUPE – can it be a 'hope' or a 'wish' that the contract will be short term, or does it need to be more concrete? This question was looked at in the context of employees providing home care to a patient pending a Court of Protection application. The EAT also looked at whether an employee who was suspended from work at the time of the transfer was 'assigned' for the purposes of TUPE. Sarah Lamont reports.

If you wish to discuss any employment issues or any of the items raised in this section please contact Julian Hoskins or James Gutteridge. 



How much does high quality care cost? This briefing outlines the results of an FTN members' survey and reveals the full scale of extra investment that NHS foundation trusts and trusts are making to improve patient care following the Francis and Keogh reviews and the introduction of the new CQC inspection regime. It calls for a new approach to funding service developments and improved financial risk sharing.

Written Ministerial Statement: European healthcare payments. Certain payments made to UK citizens who may need to access healthcare in another EU member state will cease from 1 July 2014, as announced by the Department of Health. The payments are reimbursements for European Health Insurance Card (EHIC) co-payments and residual S1 forms. They currently apply to UK citizens visiting or residing in other member states but the UK will no longer be obliged to make them, a move which could save up to £7m.

Two sides of the same coin: Balancing quality and finance to deliver greater value. This briefing brings together the views of NHS leaders and highlights the key messages arising from a roundtable held at the end of last year. These messages will be of interest to other NHS leaders who are tackling similar challenges, the national bodies and politicians supporting them in doing so, and members of the public who need to engage in this important debate.

The NHS productivity challenge: Experience from the front line. The unprecedented slowdown in the growth of NHS funding in England since 2010 required the NHS to pursue the most ambitious programme of productivity improvement since its foundation. It has broadly risen to the challenge, with pay restraint, cuts in central budgets, and the abolition of some tiers of management producing significant savings. But the strongest pressure has been applied and felt at the front line, by hospitals and other local service providers, faced with squeezing more and more value from every health care pound. This King's Fund report describes how six trusts have been grappling with the productivity challenge. It also suggests ways to divert the NHS and social care from their current trajectory, which is heading towards a major crisis.

Investigation into NHS Property Services Limited. The establishment of NHS Property Services did not fully comply with good practice, while the cash needed to cover its operational expenditure has exceeded the cash it has received, largely due to billing delays. An investigation by the National Audit Office (NAO) established the facts relating to five specific concerns about the Service which had been raised by the House of Commons Health Committee. These facts are set out in the NAO's report.

Healthcare and the economy 2: going with the flow. This paper identifies some of the themes of the current debate regarding the future of the NHS and urges government to produce a National Financial Plan and work towards a ‘National Service Guarantee’ to end the postcode lottery of treatment.

If you wish to discuss any of the items in this section or the issue of finance in healthcare please contact David Owens. 


Foundation Trusts

A guide to special measures. This guide, developed jointly by CQC, Monitor and NHS Trust Development Authority, describes how the special measures programme works for NHS trusts and foundation trusts. It explains: why trusts are placed in special measures; what will happen to trusts during special measures; the roles and responsibilities of key organisations involved; and when and how trusts will exit special measures. 

Supporting NHS foundation trusts considering a merger: proposed approach. Monitor has published the outcome of its consultation on its proposed new approach to facilitating a smoother and swifter path for mergers between NHS foundation trusts. It states that overall there was broad support for the proposed changes and Monitor is now in the process of implementing them. This document summarises the proposed changes, the feedback Monitor received on them, and the next steps.

Provider priorities for payment system in 2015-16. This briefing from the Foundation Trust Network looks ahead at the changes which NHS foundation trusts and trusts need in next year's payment and pricing system to help them better manage the financial risks expected in 2015/16, the most financially challenging year the NHS has faced for at least 15 years. The briefing highlights ten issues that NHS England and Monitor need to take into account in setting this year's payment and pricing system, and five enablers for ensuring this process works effectively.

If you wish to discuss any issues relating to foundation trusts please contact Vincent Buscemi. 


Mental Health

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.

Map of health-based places of safety. This map shows the location of 161 designated health-based places of safety in England for people detained under Section 136 of the Mental Health Act. It highlights restrictions in access to health-based places of safety for young people experiencing a mental health crisis.

Mental health and community health services inspection reports. These are the first reports from the new CQC programme of mental health and community health services inspections. These inspections are the first which involved significantly larger inspection teams than CQC has used in the past and looked at a wider range of services. Reports have been published on Coventry and Warwickshire Partnership NHS Trust; Devon Partnership NHS Trust; Bridgewater Community Healthcare NHS Trust; and Central Essex Community Services.

Recognising the importance of physical health in mental health and intellectual disability - Achieving parity of outcomes. The BMA's report offers a clear, comprehensive guide to the extent of the problem facing the NHS across the UK.

Keys to diversion: best practice for offenders with multiple needs. This report argues that CCGs across England should ensure they offer coherent and effective support for people with mental health problems who are diverted from police stations and courts. It identifies the key elements of successful liaison and diversion services in six services and finds that the most successful teams offer support for a wide range of a person’s needs, they build packages of support from a range of local agencies, and they stay in touch with people after they have been referred to other services.

Helping health and care services manage difficult patient behaviour. New advice for staff on the use of restrictive interventions for patients with difficult behaviour.

College of Policing reviews mental ill-health training, guidance and research. The College of Policing has launched a review of the training, guidance and research for police officers responding to victims, witnesses and offenders suffering mental ill-health. The wide-ranging review will inform an update of police guidance, known as Authorised Professional Practice, which will be put to consultation later in 2014.

Mental Health Casework Section Guidance - Section 17 leave.

The importance of promoting mental health in children and young people from black and minority ethnic (BME) communities. This briefing looks at the policy framework for mental health service provision and provides examples of existing practice which promote mental health for BME children and young people. It also highlights the impact of poor or incomplete data on commissioning and provision of mental health services for BME children and young people. It looks at specific factors that put children and young people from BME communities at risk of developing mental health problems as well as protective factors that can help build resilience. 

Care provider prosecuted after death of patient during restraint. Care provider Castlebeck Care (Teesdale) Ltd has been fined £100,000 after a patient died while being restrained using an unauthorised technique at a Nottinghamshire mental health hospital. The Health and Safety Executive (HSE) brought the prosecution for substantial care failings after the man suffered a cardiac arrest at Cedar Vale, a nurse-led facility for patients with severe challenging behaviour, in 2006.

Mentally-ill woman has Caesarean after court ruling. The Court of Protection has granted doctors permission to perform a caesarean on a mentally ill woman who is 36 weeks pregnant, ruling that the woman could lawfully be sedated, and restrained if necessary. Doctors said that a caesarean section would be in the best interests of the woman and the child, due to the woman's liver condition but it was unclear whether she would agree to the procedure.

Mental health patients forced to travel miles for care.

Bevan Brittan Events
Mental Health Law Annual Seminar - Bristol 12 June 2014 : 10:00 - 13:00 (registration opens at 09:30) seminar will be followed by lunch Location: Bevan Brittan, Kings Orchard, 1 Queen Street, BS2 0 HQ Bristol.

Mental Health Law Update Seminar - London. 17 June 2014 : 10:00 - 13:00 (registration opens at 09:30) seminar will be followed by lunch. Location: Bevan Brittan LLP, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF

Mental Health Law Annual Seminar - Birmingham. 18 June 2014 : 10:00-13:00 (registration opens at 09:30) the session will be followed by lunch. Location: Bevan brittan LLP, Interchange Place, Edmund Street, Birmingham , B3 2TA

Bevan Brittan's mental health team are delighted to invite you to our Annual Mental Health Seminar. The pace of change in mental health law has given rise to a range of challenges for mental health professionals, both clinical and in management. This seminar will give an outline of what those changes mean for day to day practice as well as how they will affect the structure and policy behind mental healthcare provision.

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


Primary Care

First 10 inspection reports from new GP out-of-hours inspections. These new-style inspections involved more clinicians than previously on inspection teams, including: GPs, nurses; practice managers; other clinicians; and trained members of the public. These reports cover: Bedford On Call; SELDOC Base - Dulwich Community Hospital; M-Doc Limited; Milton Keynes Urgent Care Services CIC; NEMS Community; Benefit Services Limited; North Nottinghamshire Out of Hours; PELC Out of Hours Service; SEEDS - Basildon Hospital; SEEDS - Thurrock Hospital; and Chesterton Medical Centre.

Co-morbidities: a framework of principles for system-wide action. This document sets out the current challenges faced in the health and social care system in treating people with 2 or more long term health conditions. It proposes changes to the system to improve care.

Good practice in improving care for vulnerable groups. This report includes examples of good primary care that improves registration and access to care. It outlines what makes good practice and explains why the chosen approaches are successful in improving access to primary care.

Ophthalmic special order products, general principles. The Royal College of Ophthalmologists and the UK Ophthalmic Pharmacy Group have published Ophthalmic Specials Guidance for prescribing unlicensed medicines, following concerns about the suitability and the cost of certain unlicensed ophthalmic preparations prescribed and dispensed in primary care.

Local health professionals to get more power to improve NHS primary care. The NHSD England Chief Executive Simon Stevens has announced a new commissioning initiative that will give new powers to England’s 211 clinically-led local CCGs to improve local health services. He is inviting those CCGs that are interested in an expanded role in primary care to come forward and show how new powers would enable them to drive up the quality of care, cut health inequalities in primary care, and help put their local NHS on a sustainable path for the next five years and beyond. NHS England will be writing next week to all CCGs in England with details of how to submit expressions of interest in taking on enhanced powers and responsibilities to co-commission primary care. Applications will need to describe the additional powers and responsibilities the CCG would like to assume. They will need to meet a number of tests, including showing they will help advance care integration, raise standards and cut health inequalities in primary care. They will also need to show how they will ensure transparent and fair governance - with a continuing oversight role for NHS England to safeguard against conflicts of interest – all in the context of the CCG’s five-year plan for its local NHS services. The closing date for CCG expressions of interest will be 20 June 2014.

If you wish to discuss any queries you may have around primary care please contact David Owens. 



NHS eProcurement Strategy. Actions to be taken to improve NHS data and information through eProcurement under the NHS Procurement Development Programme are set out in new guidance from the DH. The DH strategy is for all NHS purchase-to-pay transactions and all category management activities to be undertaken by electronic means to cover all non-pay expenditure, over a period of several years, and aims to help the NHS save £1.5bn by the financial year 2015 to 2016. The document also sets out how eProcurement can better support the NHS procurement processes that manage transactions and pricing with suppliers.

If you wish to discuss any queries you may have around procurement please contact Matthew Mo.


Public Health

Living well for longer: National support for local action to reduce premature avoidable mortality. This policy paper sets out the actions being taken across the national health and wellbeing partnership of Government, Public Health England (PHE) and NHS England to reduce premature avoidable mortality. It aims to help people understand how the national system as a whole is supporting local action to help people live well for longer. It includes actions already taken in prevention, early diagnosis and treatment, focusing on the 5 big killers: cancer, stroke, heart disease, lung disease and liver diseases. It includes examples of good practice and help for local commissioning and service delivery.

Heatwave Plan for England. This joint plan from Public Health England (PHE), NHS England, the DH and the LGA aims to prepare for, alert people to, and prevent, the major avoidable effects on health during periods of severe heat in England. It is based around the Met Office Heat-Health Watch alert system which alerts the public and health and social care services to forecast and actual severe hot weather in different parts of the country, so that appropriate action can be taken. It details the actions that can be taken by health and social care professionals, the public and others before and during periods of hot weather.

If you wish to discuss any queries you may have around public health please contact Olwen Dutton.



Violence in England and Wales in 2013: an accident and emergency perspective. This data was gathered from a scientific sample of 117 emergency departments (EDs), minor injury units (MIUs) and walk-in centres in England and Wales. The report finds that the numbers of people injured in serious violence dropped by 12% in 2013 compared to 2012, with an estimated 234,509 people attending EDs, MIUs and walk-in centres in England and Wales for treatment following violence.

A&E performance: England 2013/14. This briefing outlines key statistics on A&E performance in England. It looks at the number of people who have attended A&E; the pattern of A&E attendance over the year; and how different NHS trusts compare on waiting times.

Written Ministerial Statement: European healthcare payments. Certain payments made to UK citizens who may need to access healthcare in another EU member state will cease from 1 July 2014, as announced by the Department of Health. The payments are reimbursements for European Health Insurance Card (EHIC) co-payments and residual S1 forms. They currently apply to UK citizens visiting or residing in other member states but the UK will no longer be obliged to make them, a move which could save up to £7m.

Framework Agreement between the Department of Health and the Health and Social Care Information Centre (HSCIC). This document outlines out how the DH and HSCIC will work together, setting out roles, responsibilities, governance and accountability arrangements.

National care of the dying audit of hospitals. This report has found significant variations in care across hospitals in England. The audit shows that major improvements need to be made to ensure better care for dying people, and better support for their families, carers, friends and those important to them. While previous audits had been based on the goals of care within the Liverpool Care Pathway for the Dying Patient (LCP), the new audit sampled the care of dying people in hospital, regardless of whether they were supported by the LCP or other care pathways or frameworks, and included more hospitals than the previous audits.

Public satisfaction with the NHS and its services. The King’s Fund has published results relating to the NHS and health care issues from the British Social Attitudes survey 2013. The survey presents a picture of the public’s satisfaction with NHS services such as general practice, inpatients and outpatients as well as satisfaction with social care provided by local authorities. It finds that there has been no change in levels of overall satisfaction with the NHS since 2011 although there have been changes in the public’s views on specific services. This web page gives an overview of changes in satisfaction levels over time together with analyses of satisfaction by sub-groups of the population such as whether respondents had had recent contact with the NHS, age groups, political affiliation and country of residence.

Fire safety in the design of healthcare premises (HTM 05-02). The Department of Health has published guidance on fire safety in the design of new healthcare buildings and extensions. This revised guidance reflects the changes in legislation, structure of the NHS, and government policy. The guidance will help statutory regulations to be applied correctly so they meet the requirements of Part B of Sch.1 to the 2010 Building Regulations.

Improving food in hospitals and schools. Sets out the Government's response to Sustain’s school and hospital food campaign. The Government does not agree with Sustain’s view that legislation is necessary for improvement. There are other legally binding ways to introduce standards - e.g. the DH has set up a Hospital Food Standards Panel (HFSP), chaired by Dianne Jeffrey, that will advise on standards covering the nutritional content of patient meals, healthy eating for staff and visitors (and patients as appropriate), and sustainability, including local and sustainable procurement, food waste and animal welfare. Once the HFSP has made its recommendations, the DH will work with NHS England to ensure that they are appropriately highlighted in the NHS Standard Contract. If hospitals fail to meet the terms of the contract, commissioners can require remedial action to be taken. This means that any food standard in the NHS Standard Contract will be legally binding.

Antimicrobial resistance: global report on surveillance 2014. This report aims to provide a comprehensive picture of antibiotic resistance across the world, with data from 114 countries. The findings document resistance to antibiotics, especially so-called last resort antibiotics, in all regions of the world. It also shows the gaps in surveillance systems and the need for a standardized approach to tracking and monitoring the issue. 

New medicines, better medicines, better use of medicines – A guide to the science underpinning pharmaceutical practice. This Royal Pharmaceutical Society guide summarises the important role that pharmaceutical science has played and continues to play in the development and use of medicines and demonstrates the breadth of scientific knowledge and understanding necessary to underpin the full spectrum of pharmaceutical practice. The guide also highlights the major challenges and opportunities faced when creating new medicines, improving existing medicines or ensuring the better, safer use of medicines, and makes recommendations and calls for action.  

Medical Act 1983 (Amendment) (Knowledge of English) Order 2014 (SI 2014/1101). The General Medical Council (GMC) will be able to require registered doctors to demonstrate specific knowledge of the English language as part of the licensing process, with a license to practise being refused in circumstances where the medical practitioner cannot demonstrate they have the necessary knowledge of English to practise in a safe and competent manner. A new fitness to practise category of impairment relating to the necessary knowledge of English will also be introduced. The changes came into force on 30 April 2014.

CMA guidance on the review of NHS mergers. A Competition and Markets Authority (CMA) consultation seeks views on the CMA's approach when reviewing mergers involving providers of NHS services. The closing date for comments is 20 June 2014

Consultation on regulations to introduce a time limit on provisional registration. The GMC is consulting on draft General Medical Council (Provisional Registration) (Time Limits) Regulations 2014 that will limit the time that a doctor can hold provisional registration. The regulations will limit the time that a doctor can hold provisional registration to three years and 30 days. This will give doctors enough time to repeat the F1 year (subject to permission from their training provider) in order to meet the competencies required. After this their provisional registration will expire. The GMC will allow doctors to request an additional single extension of 12 months if they are working less than full time and would not be able to complete the F1 year within the new time limit. It expects to introduce the new regulations in early 2015. The consultation closes on 18 June 2014. .

New series of blogs on Urgent and Emergency Care Review. A&E Consultant Jonathan Benger is releasing a series of blogs updating the public on the work of the Urgent and Emergency Care Review. The first one, Wheels are in motion, recaps on the reasons for the Review.

Scaling up improvement. The Health Foundation has over £3m available for seven teams to take successful health care improvement interventions and deliver them at a larger scale. As part of its new Scaling Up Improvement programme, it is looking for projects that aim to improve health care delivery and/or the way people manage their own health care. The deadline for the first stage of the application process is 16 June 2014.

Bevan Brittan Update
Inquiries and Investigations – an overview of key issues. 04 June 2014 : Timings TBC. Location: Birmingham. With the need for transparency ever more at the forefront of expectations, public services are increasingly finding themselves the subject of scrutiny, ranging from internal investigations through to external reviews and inquiries. register your interest in this event

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

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