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

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

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


Get in on the Act - The Care Act 2014. Adult social care law will be modernised under the Care Act 2014 (CA 2014), including a cap on the amount those receiving care will have to pay towards the costs from April 2016. The Local Government Association (LGA) has set out the full range of proposals included in the CA 2014, which is divided into three parts, covering reform of adult social care, improving care standards and the establishment of the Health Education England and the Health Research Authority. The CA 2014 received Royal Assent on 14 May 2014.

One chance to get it right: improving people's experience of care in the last few days and hours of life. The Leadership Alliance for the Care of Dying People, made up of 21 national health and care organisations, has published this report to form a response to the recommendations set out in More Care, Less Pathway, the independent review of the Liverpool Care Pathway.

Criminal Justice and Courts Bill – Fact sheet: Offences of ill-treatment or wilful neglect of persons receiving health care or adult social care services. Background to, and details of, the proposed new statutory criminal offences of ill-treatment or wilful neglect by individual care workers or care provider organisations that are being introduced under the Bill. There will be two offences: one will apply for an individual perpetrator, and the other offence, formulated differently, will apply for organisations.

The relative's property disregard. Guidance for local authorities on how to apply the relative’s property disregard during a financial assessment of what a person can afford to contribute. The guidance has been updated in light of the decision in R (Walford) v Worcestershire CC [2014] EWHC 234 (Admin), which considered the scope and application of the property disregard under para.2(b)(ii) of Sch.4 to the National Assistance (Assessment of Resources) Regulations 1992. This requires a local authority to disregard the value of any premises owned by a local authority supported resident where the property is occupied in whole or in part as their home by a family member or relative who is aged 60 or over or is incapacitated.

House of Commons Health Select Committee: Managing the care of people with long-term conditions. This report finds that 15m NHS patients in England with long-term conditions such as diabetes, arthritis and asthma account for 70% of the annual expenditure of the NHS in England. It argues that demographic and cost pressures on the NHS from patients with long-term conditions is only likely to increase in the coming years, with one projection estimating that the bill for treatment of long-term conditions will require the NHS to find £4 billion more each year by 2016. 

Can we live with how we’re dying? Advancing the case for free social care at the end of life. This report from Macmillan Cancer Care estimates that £137m was spent delivering hospital care to 36,400 cancer patients – 100 people a day - who died in hospital in 2012 despite saying that they wanted to die at home. If these people had been provided with community care to help them die at home it would have halved the cost to the NHS (£69m) and the money could be spent elsewhere. If this was available for people with other terminal conditions, the potential cost saving would be much higher. The report sets out the economic and moral case for providing free social care to people at the end of life for the very first time.

Husband, partner, dad, son, carer? A survey of the experiences and needs of male carers. This report was commissioned by Carers Trust to look into the experiences and needs of male carers, and to help raise awareness of the fact that they might not be getting the support they need. It finds that more than four in ten (42%) unpaid carers in the UK are male. Over half (53%) of the male carers surveyed felt that their needs were different to those of female carers, many citing that men find it harder to ask for help and support and that balancing work and caring is challenging, particularly if they are the main earner. 

Housing associations and the NHS: new thinking, new partnerships The treatment and care of more people in their own communities and the provision of more support to allow them to stay in their own homes or in specially designed accommodation is vital if our society is to cope with an ageing population and the growing number of people with multiple long-term conditions. Furthermore, given the increase in demand and the consequential rise in healthcare costs, it is essential to secure efficiency savings and productivity improvements wherever possible. Much greater integration of health and housing is widely seen as one way of meeting these challenges. The report provides a snapshot of current thinking around some elements of the agenda, including using surplus NHS land to improve clinical outcomes. The report aims to stimulate a debate across both disciplines and help shape the policy response. 

Better care for older people. This online resource aims to support doctors in their day-to-day care of older patients. The resource gives practical advice, including from leading clinicians, on how to put older patients first and use GMC guidance to handle their clinical, emotional and psychological needs. It contains a mixture of guidance, case studies, scenarios, articles and tips to prepare doctors for caring for the growing number of older patients.

Expanding choice and improving the quality of end of life care. The DH has launched a review of choice in end of life care to make sure adults at the end of life, their carers and family have more choice. The review will be undertaken by an independently-led programme board chaired by Claire Henry, Chief Executive of the National Council for Palliative Care (NCPC) which is the umbrella charity for all those involved in palliative, end of life and hospice care in England, Wales and Northern Ireland. It will provide advice to government on improving the quality and experience of care for adults at the end of life, their carers and those who are important to them by expanding choice. The board will present its findings and advice to Government in February 2015. 

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

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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.

The NHS LA’s response to the recommendations contained in the Marsh Review. The NHS Litigation Authority (NHS LA) has published a report detailing how it has responded to the recommendations following a review of the NHS LA in 2011 by Marsh an independent insurance broker. The Marsh review endorsed the NHS LA’s stewardship and administration as effective and made a series of improvement recommendations.

Report of the Chief Coroner to the Lord Chancellor: First Annual Report: 2013-2014. An annual report by the Chief Coroner brings a number of matters to the attention of the Lord Chancellor, including the implementation of the statutory reforms which came into force in July 2013, the additional package of reforms which the Chief Coroner has devised and developed, and actions taken by the Chief Coroner under his powers and duties in the Coroners and Justice Act 2009.

NHS Safety Thermometer records an increase in Harm Free Care. There has been an increase in the percentage of patients receiving 'Harm Free Care' according to data released by the Health and Social Care Information Centre (HSCIC) today. In April 2012, when data was first recorded, 89.7 per cent of the patients surveyed received harm-free care. This figure has increased to 93.6 per cent in March 2014.

Mediating claims in the NHS. Supporting patients, their families and the NHS to resolve disputes fairly

Mortality measurement: the case in favour. This report was written in response to recent criticism in the media and the healthcare world of the use of risk-adjusted mortality measures. The authors advocate a multidimensional approach to measuring healthcare – including the use of risk-adjusted mortality measures – as the best way of monitoring safety and improving quality.

Safe staffing for nursing in adult inpatient wards in acute hospitals. This guideline covers safe staffing for nursing in adult inpatient wards in acute hospitals. It recommends a systematic approach at ward level to ensure that patients receive the nursing care they need, regardless of the ward to which they are allocated, the time of the day, or the day of the week.

NHS Litigation Authority Report and accounts 2013/14: Annual Review. The NHS Litigation Authority annual review of 2013 includes a summary of the Authority's performance, looks to the year ahead and reports an unprecedented number of new clinical negligence claims over the past year. It discusses how changes in the legal market, particularly changes to claimant's legal funding arrangements, have impacted on the Authority's work. It also suggests that some claimant solicitors have attempted to claim excessive and disproportionate costs.

Restoring confidence in medical devices. Action Plan after the PIP scandal tightened control in Europe. Consumers are safer following the implementation of measures included in a joint action plan in the member states of the European Union, reports the European Commission. Rules governing the use of medical devices are now better enforced and there has been particular success in tightening the control of notified bodies. The joint actions were introduced following a scandal involving defective breast implants manufactured by the French company Poly Implant Prothèse (PIP).

Sign Up to Safety. Sign Up to Safety is a new national patient safety campaign that was launched on 24 June 2014, with the 3 year objective to reduce avoidable harm by 50% and save 6,000 lives. It aims to deliver harm free care for every patient, every time, everywhere. It champions openness and honesty and supports everyone to improve the safety of patients. Organisations who sign up to safety commit to strengthen patient safety by: setting out the actions they will undertake in response to the five Sign up to Safety pledges and agree to publish this on their website for staff, patients and the public to see; and committing to turn their actions into a safety improvement plan (including a driver diagram) which will show how organisations intend to save lives and reduce harm for patients over the next 3 years.
Dr Suzette Woodward has been appointed Campaign Director for Sign up to Safety.

Fundamental standards: improving quality and transparency in care. The Government has announced legislation which introduces fundamental standards for health and social care providers. Subject to parliamentary approval, the draft Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 will become law in April 2015. The new measures are being introduced as part of the Government’s response to the Francis Inquiry’s recommendations and are intended to help improve the quality of care and transparency of providers by insuring that those responsible for poor care can be held to account.
The consultation response states that:
  the Duty of Candour will be introduced for NHS bodies only in October 2014;
  the fit and proper persons requirement will be introduced for NHS bodies only in October 2014;
  the fundamental standards will be introduced for all providers in April 2015;
  the Duty of Candour and fit and proper persons requirements will be extended to all CQC-registered providers from April 2015.

Statutory duty of candour for health and adult social care providers. From October 2014, subject to parliamentary approval, NHS providers will be required to comply with the duty of candour. Providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

Fit and proper person's test regulations. From October 2014, subject to parliamentary approval, directors of NHS providers must meet a fit and proper person test. The Care Quality Commission will be able to insist on the removal of directors that fail this test.

Fundamental standards for health and social care providers. From April 2015, subject to parliamentary approval, all health and social care providers will be required to meet fundamental standards of care as a condition of their registration with the Care Quality Commission.

New powers to check doctors’ English skills a ‘milestone’ for patient safety. The independent regulator of doctors has campaigned for changes to be made to legislation since 2010, after voicing concerns that European doctors were being allowed to register with a licence to practise medicine in the UK without being asked to evidence their English language knowledge. This has been a long-standing requirement for doctors trained outside the European Union.

Warning over NHS trust finances.Nineteen NHS trusts have been referred to ministers after auditors raised concerns about their financial health.

NHS 'falling short on complaints handling' The NHS still has a long way to go to improve the way it handles complaints, although there are signs of improvement, a survey suggests.

Mid Staffs services safe but not sustainable, warns Chief Inspector of Hospitals. Professor Sir Mike Richards, Chief Inspectors of Hospitals has urged the organisations overseeing the moving of services from Mid Staffordshire NHS Foundation Trust to other providers to develop a clear transition plan without delay. This follows an urgent inspection of the trust carried out at their request. The inspection team, chaired by Mr Andy Welch, Medical Director of Newcastle upon Tyne Hospitals NHS Foundation Trust, concluded that services were safe, but staffing levels were only just adequate in some areas, particularly on medical wards. The inspection team was not assured about the sustainability of services and warned that should recruitment or retention fall by even one or two people in some key posts, services would become unsafe. The CQC’s full report on the inspection will be published next month.

Bevan Brittan Events
CTG Masterclass (cardiotocograph interpretation) Medical Seminar. 18 September 2014 : 09:15 - 16:45 (registration opens at 08:30). Location: Bevan Brittan LLP, Kings Orchard, 1 Queen Street, Bristol, BS2 0HQ. The course covers the pathophysiology of CTG, NICE guidance, acid-base balance, the technology behind CTG and ST-Analyser (STAN) together with an overview of clinical cases and medico-legal learning points. The course will be led by experts in the field including Mr. Edwin Chandaharan and his research team from St George’s Hospital, London.

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

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Commissioning for outcomes: A narrative from and for clinical commissioners. The clinical commissioner narrative, developed by the Quality Working Group of the NHS Commissioning Assembly, describes the challenges and opportunities offered by outcome-based commissioning. The purpose of this document is to stimulate discussion amongst commissioners on the practical tools we now require developing for all 211 CCGs, as well the barriers we need removing, to support our commissioning for improved outcomes. It is one of the support offers to come out of the Commissioning for Outcomes task and finish group - a sub-group of the CCG Development Working Group - which was established at the beginning of 2014 to look at the best ways of offering practical help to commissioners who want to explore innovative ways of contracting and commissioning.

Annual Assessment of the NHS Commissioning Board (known as NHS England) 2013-14. The Health Secretary’s assessment report covers the extent to which NHS England met its mandate and business plan objectives, and fulfilled its duties to improve the quality of services, reduce inequalities and secure public involvement.  

Bevan Brittan Updates
A NICE impact on CCG commissioning. "The effect of my ruling is that in reality the CCG could not lawfully disagree with the medical or scientific rational for NICE's recommendation." Bevan Brittan LLP has recently acted in the case of Rose v Thanet CCG. This was a case that started off as a challenge to the CCG's exceptional funding decision but ended with the Judge commenting on how CCGs should implement NICE guidance.

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

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Bevan Brittan Updates
Staff engagement case studies. NHS Employers has been working with three NHS organisations to profile particular aspects of their approaches to engagement. These case studies focus on the journey, the challenges and the outcomes of three NHS trusts. Some of the key outcomes include, major improvements in national staff survey results, reductions in sickness absence and staff feeling more valued.

Industrial action and contingency planning. This question and answer briefing provides guidance to employers in the NHS on managing the legal and practical issues presented by the threat of industrial action.

Medical engagement: A journey not an event. This King's Fund report considers what is good medical engagement, and in those organisations where it exists, how has good medical engagement been created and sustained. The report is based on case studies of four NHS trusts with acknowledged high levels of medical engagement. It aims to help other organisations that are seeking to create cultures in which doctors want to engage more in the management, leadership and improvement of services.

Improving NHS care by engaging staff and devolving decision-making. This report details the conclusions of the Review of Staff Engagement and Empowerment in the NHS, commissioned by the Minister for Care and Support, Norman Lamb MP, in November 2013, and chaired by Chris Ham, Chief Executive of The King's Fund. The review found compelling evidence that NHS organisations with high levels of staff engagement – where staff are strongly committed to their work and involved in decision-making – deliver better quality care

Whistleblowing framework – Call for evidence: Government response. Sets out the Government's response to the July 2013 consultation that looked at the effectiveness of the whistleblowing framework under the Enterprise and Regulatory Reform Act 2013. It states that the Government will introduce new measures to give more information and support to employees who blow the whistle on wrongdoing in the workplace. It also reaffirms the position that claimants who win their case should have their employment tribunal costs reimbursed.

Everything you need to know about sickness absence: a simple guide for NHS managers. This online tool aims to further improve the management of staff sick leave in the NHS. It answers questions such as, what do you do when a staff member calls in sick? How do you handle long-term or recurring absences? How can managers reduce stress, support staff to return to work and prevent sickness absence from becoming an issue in the first place?

The Government's response to the review of the impact and implementation of the European Working Time Directive on the NHS. The Department of Health has accepted all recommendations made in an independent review of the impact and implementation of the European Working Time Directive on the NHS and health professionals and committed to: identifying training time that is not working time; raising awareness of the voluntary opt-out; and reviewing working patterns and rotas.

Surgeon sacked after reporting lack of equipment. Arjuna Weerasinghe compiled an incident report to alert the Basildon and Thurrock University Hospitals NHS Foundation Trust to the lack of necessary equipment, after an operation in 2010 in which he was unable to obtain a packing wick to stem an extensive bleed. He also claimed he caught pneumonia from the hospital operating theatres which had allegedly not been deep-cleaned for years. However the trust maintained Mr Weerasinghe was sacked for gross misconduct in 2012 after he ‘mislead’ hospital bosses over his illness. The case is likely to raise concerns over the whistleblowing process.

More flexibility for NHS doctors under European Working Time Directive. Doctors would be able to train and work more flexibly under changes being considered as part of the government's response to a review of the impact and implementation of the European Working Time Directive on the NHS. The review found the implementation of the Directive had mixed results and has submitted recommendations to ensure patient safety by making sure training time is included in working patterns and appropriate rest times and breaks are taken.

Bevan Brittan Updates
Associative disability discrimination – an update. Are employers obliged to make reasonable adjustments for non-disabled employees who have caring responsibilities for a disabled person? Jodie Sinclair reports on a recent Court of Appeal decision that provides clarification on this question.

Mum's NOT the word: flexible working extended. Anyone who believes that flexible working is largely limited to working mothers will have their thinking challenged this week, as a new universal right to request flexible working has now been introduced. Sarah Lamont outlines what's changed and highlights some practical steps that employers should consider.

Employment news round-up, June 2014. Alastair Currie rounds-up this month's news items which will be of interest to all those working with employment law, including: the latest information on employment tribunal usage; new sources of help and guidance for employers on topics as diverse as TUPE, the World Cup and immigration; equal pay audits and details of a new bill which will impact on employers who offer accommodation to employees.

If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.

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Navigating the gap between volume and value. This guide provides step-by-step information on the financial planning process and how it can help an organisation evaluate the impact of repositioning initiatives as it moves towards value-based care and payment.

Future organisational models for the NHS: Perspectives for the Dalton review. Ahead of the Dalton Review, which is examining ways to encourage the best providers to support those that are struggling, the King's Fund has published a paper with the Foundation Trust Network that explores some of the organisational models that providers could use to meet their current strategic and financial challenges

Spending on NHS and non-NHS providers. This briefing focuses on the breakdown of commissioner spending on NHS and non-NHS providers in the acute, community and mental health sectors. It updates previous analysis published by the Nuffield Trust and the Institute for Fiscal Studies in May 2013 on the private/public provider mix in the NHS and is extracted from a forthcoming report.

NHS financial temperature check briefing. This briefing summarises finance directors’ views on financial challenges facing the NHS.

Off-payroll arrangements at NHS foundation trusts. This report presents the findings of a review into off-payroll employment in NHS foundation trusts. Monitor worked with the Health and Social Care Information Centre to make sure that NHS foundation trusts understand and are complying with tax arrangements recommended by HM Treasury.

Recovering costs of NHS healthcare from visitors and migrants. Sets out timelines for the NHS to improve systems that recover the cost of healthcare for migrants and visitors who use the NHS. NHS to save £500m through non-EU patient charges. The Department of Health's plans to charge non-EU patients for NHS treatment could save the health service up to £500m a year. Health secretary Jeremy Hunt hopes the measure will stop visitors and migrants abusing the system by charging them 150% of the cost of treatment.

Into the red? The state of the NHS' finances - an analysis of NHS expenditure between 2010 and 2014. This report looks at how the finances of the hospitals and commissioning groups that make up the NHS in England have held up under austerity. It finds that, after holding up well under austerity since 2010, the NHS’ finances are starting to come under severe financial pressure.

NHS National Tariff Payment System 2015/16: engagement. Monitor and NHS England’s long-term aim is to develop a transparent, flexible and accountable NHS payment system that rewards good-quality, efficient care that delivers the best possible outcomes for patients. The proposed changes to the 2015/16 National Tariff Payment System are designed to help maintain financial discipline while promoting quality high-quality care for patients in tough economic conditions. The proposals would also encourage a speedier expansion of innovative patterns of care to meet the needs of patients. Healthcare providers and commissioners are encouraged to respond to these proposals in order to influence the final national tariff which will be published later in the year. This consultation closes on 15 August 2014.

NHS liabilities rise to over £25bn. The NHS has outstanding liabilities of £25.6bn for clinical negligence, up 13 per cent in a year. Lawyers argue that action must be taken to cap the cost of negligence settlements

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

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Foundation Trusts

Monitor: regulating NHS foundation trusts. The Commons Public Accounts Committee has published a report of its inquiry into Monitor's role regulating NHS FTs. The Committee finds that the number of NHS FTs in difficulty is growing, casting doubt on Monitor’s effectiveness as their regulator. At the time of its hearing Monitor estimated that 39 of 147 FTs would be in deficit by the end of 2013–14. Some had been in breach of their regulatory conditions for over four years. Furthermore it found potential conflicts between Monitor’s traditional role of regulating NHS FTs and its new responsibilities. At present Monitor relies heavily on consultants and it is not clear whether the organisation can build the capacity to carry out effectively its expanded remit. Responsibility for overseeing the provision of healthcare is fragmented, and there is a strong risk of regulatory overlaps and gaps between Monitor’s role and those of other bodies, including the Care Quality Commission, the NHS Trust Development Authority, NHS England and the DH.
Monitor has issued a response in which it states that it is working hard with its NHS partners to support trusts in solving all these problems. It acknowledges there is always room for improvement, and it is already taking action along many of the lines recommended by the Committee.

NHS foundation trusts: Code of Governance. Monitor has published updated guidance for NHS FT boards on leading their organisations and making decisions effectively. A small number of corrections and amendments have been made to the Code, in response to errors brought to Monitor's attention by the sector and to ensure consistency with guidance elsewhere.

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

Back to topInformation Sharing Publications/Guidance
Extension of the Information Commissioner’s powers under the Data Protection Act 1998. Based on evidence presented by the Information Commissioner and the responses from NHS bodies and others to the consultation document, the Government believes a compelling case has been made for extending the Information Commissioner’s Office’s powers of compulsory audit to public authority NHS bodies.

Information governance framework - policies. This document brings together a range of guidance policies and procedures on the information governance framework. 

Code of practice on confidential information HSCIC are inviting a wide range of stakeholders to review and provide feedback on a draft code of practice on confidential information.

NHS patient data sold. An inquiry into NHS patient data has found the data hospital records of millions of patients have repeatedly been sold to insurance firms to help set critical illness premiums. Patient information is believed to have been passed to private companies on 588 occasions. The review also warns of major failings in the handling of sensitive data over the past ten years.

Data breach at Welsh health board after patient details sent to wrong address. The Information Commissioner’s Office (ICO) has found Betsi Cadwaladr University Health Board in breach of the Data Protection Act after sensitive information was sent to the wrong address.

Bevan Brittan Updates
Mandatory ICO Data Protection Audits likely to be introduced for NHS by the end of the year. The Government believes that there is a compelling case for extending the Information Commissioner's powers of compulsory audit of NHS bodies. It is the Government's view that this will encourage NHS bodies to improve their compliance with the data protection framework, incentivise NHS data controllers to sign up to consensual audits and improve public confidence in regards to the protection of sensitive personal data by NHS bodies.

If you wish to discuss any issues around information sharing please contact Jane Bennett.

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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.

Mental health and behaviour in schools – Departmental advice for school staff. The DfE has issued practical advice for schools on how to identify and support those pupils whose behaviour suggests they may have unmet mental health needs. It helps teachers better identify underlying mental health problems in young people and helps ensure that pupils with unmet mental health needs get the help they need sooner.

National confidential inquiry into suicide and homicide by people with mental illness: annual report 2014 – England, Northern Ireland, Scotland and Wales. This report finds that mental health patients are at their highest risk of dying by suicide in the first two weeks after leaving hospital. It calls for suicides within 3 days of hospital discharge and deaths and serious injuries caused by restraint to be NHS ‘never events’.

Making mental health count: the social and economic costs of neglecting mental health care. This report argues that even in those OECD countries with a long history of deinstitutionalisation, there is still a long way to go to make community-based mental health care that achieves good outcomes for people with severe mental illness a reality. It addresses the high cost of mental illness, weaknesses and innovative developments in the organisation of care, changes and future directions for the mental health workforce, the need to develop better indicators for mental health care and quality, and tools for better governance of the mental health system.

Changes to Mental Health Act (1983) Code of Practice. This consultation seeks comments on proposed changes to legislation governing the treatment of people with mental health problems. The consultation closes on 12 September 2014.

Consultation on profession-specific standards of proficiency for practitioner psychologists. HCPC are consulting on revised standards of proficiency for practitioner psychologists. The deadline for responses to the consultation is 17 October 2014.

National group to drive improved healthcare support for people with learning disabilities. Announces that NHS England has asked Sir Stephen Bubb, the Chief Executive of charity leaders network ACEVO, to head a new group of experts and advisors to develop a national guide for how we provide health and care for those with learning disabilities. The group will also include healthcare, charity and voluntary sectors, as well as with people with learning disabilities and their families. It aims to design more innovative and integrated local commissioning of healthcare and housing to best support people with learning disabilities at home and in their communities, reducing reliance on hospital care. The group will provide a final report by the end of October 2014 to inform commissioning.

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

Proactive care programme: CCG support for implementation. This guidance note sets out the key role that CCGs can play, working with member practices, to help make sure that the 2014/15 enhanced service "Avoiding unplanned admissions: proactive case finding and patient review for vulnerable people"(the Proactive Care Programme) delivers the maximum benefits for patients. This includes making sure that GP practices are able to use risk stratification tools to identify those patients who should be offered the new service.

Technical requirements for 2014/15 GMS contract changes. NHS Employers and the BMA's General Practitioners Committee have agreed changes to the General Medical Services contract for 2014/15 for England. This document contains three technical requirements for 2014/15 GMS contract changes, including detail on the shingles vaccination programmes and further detail on the avoiding unplanned admissions enhanced service.

Health literacy. This report warns that half of all adults in England find the health advice given to them by doctors and health professionals too complicated, leaving them at a higher risk of emergency admission into hospital and serious health conditions. Recommendations for GPs include the need to work with hospital colleagues to improve ‘health literacy environments’ such as introducing clearer hospital signage and information for patients.

Inquiry into future of patient care. An independent inquiry has been set up by RCGP to look at how the NHS can best provide care for patients at a time of constrained resources, to meet the needs of the rapidly increasing number of patients with multiple long term conditions. The inquiry is calling for written evidence from interested organisations and individuals, to help inform the proceedings, to be submitted by 16 July 2014.

Extending the scope of the Electronic Prescription Service. Seeks views on electronic prescribing of NHS prescriptions for Schedules 2 and 3 controlled drugs, and whether these proposals should extend to private care. The consultation closes on 9 October 2014.

Out-of-hours GP services in England. Although some parts of the NHS in England are achieving value for money for their spending on out-of-hours GP services, this is not the case across the board, according to this report. It finds that the number of cases handled by out-of-hours GP services has fallen, from an estimated 8.6 million in 2007-08 to 5.8 million in 2013-14. The report also estimates that out-of-hours GP services also cost less now, in real terms, than they did in 2005-06, but NHS 111 makes cost comparisons difficult.

Premises survey: Lack of investment is holding GP services back. A new BMA survey has revealed the scale of GP concerns about their premises. 4,720 GP practices responded to the BMA survey, describing how doctors were struggling to provide essential services in buildings that are cramped and outdated. Six out of 10 GPs are forced to share consulting rooms or ‘hot-desk’ around their surgeries at a time when consultations numbers are rising and more care is being moved into the community.

£3.5m to develop primary care services in Wales. The Welsh Government announces funding in 2014-15 to support action to improve health and reduce inequalities in the most deprived communities; develop primary care teams and provide eye care services closer to people’s homes.

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

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Public Health

Health profiles 2014. These profiles bring together existing information into one place to provide a snapshot of health and wellbeing across each local authority in England. They contain data on a range of indicators for local populations such as the proportion of children in poverty, adult smoking rates, levels of child and adult obesity, hospital stays and early mortality rates. The profiles are designed to provide local government and health services with ‘conversation starters’ to highlight local issues and priorities, and discuss how to tackle these. They show potential problems and opportunities by making comparisons with other areas and with the national average.

CLeaR local tobacco control assessment. The CLeaR model is an approach to improving local tobacco control in England through self-assessment followed by peer-assessment. Public Health England has published these resources to support local public health organisations that undertake the CLeaR assessments to review and improve their tobacco control work.

Healthy Lives, Healthy People: A public health workforce strategy. Sets out actions for various partners in the new public health system to support and develop the public health workforce. It will help embed public health capacity within the wider workforce to support delivery of the public health outcomes framework. The commitments will be delivered by a range of organisations including PHE, DH, HEE and local authorities. The strategy will be reviewed in 2015.

A framework for personalised care and population health for nurses, midwives, health visitors and allied health professionals. This Framework has been developed as a resource to support nurses, midwives, health visitors and allied health professionals’ access to best evidence and support them in delivery of their public health role. It is also a tool for clinical leaders, managers and commissioners to develop services which use the knowledge and skills of healthcare practitioners to deliver the best health outcomes for the populations they serve.

Commissioning of public health services for children. From 1 October 2015, the responsibility for commissioning children’s public health services, including health visitors, will transfer from NHS England to local authorities. The DH, alongside its partners, has produced six documents to support local authorities and other stakeholders through the transition. The documents identify six areas where health visitors have the most impact on the health and wellbeing of children aged 0-5. There is also an overview of the six areas. Local authorities should use this information to ensure that health visiting services are commissioned effectively. The documents are mainly intended for use by commissioners and providers of early years services, health visitors, early years practitioners and local authorities.

Local authority health scrutiny. This guidance explains the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 (SI 2013/218). It provides local authorities with advice about how to implement them to ensure that existing health services are providing effectively for local communities.

Who we are and what we do: our business plan for 2014 to 2015. Public Health England has published its business plan for 2014 and 2015. It sets out PHE’s core functions, outlines the key steps and actions it will be the taking over the next year to protect and improve the public’s health and reduce inequalities, and highlights some of its achievements in its first year.

Local authorities improving oral health – Commissioning better oral health for children and young people. This guidance makes recommendations to help local authorities review and develop their oral health improvement strategies, focusing on their new role as commissioners of oral health improvement programmes. 

Access all ages 2: exploring variations in access to surgery among older people. This report, by the Royal College of Surgeons and Age UK, warns that age discrimination in the NHS may still be preventing older people from having access to life-saving surgery. An analysis of surgery rates across England’s 211 CCGs, for six common procedures which are known to be effective in older people, shows there was widespread variation in the rates of surgery for people aged over 65 and 75, depending on where they live.

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

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Monitor's annual plan for 2014/15. Describes how Monitor aims to use its regulatory functions to fulfil its mission of making the health sector work for patients.

Monitor and the Department of Health: framework agreement. This framework agreement defines the critical elements of the relationship between Monitor and the Department of Health.

Monitor: regulating NHS foundation trusts. This report finds the number of NHS foundation trusts in difficulty is growing, possibly casting doubt on Monitor’s effectiveness as their regulator. It suggests that responsibility for overseeing the provision of healthcare is fragmented, and there is a strong risk of regulatory overlaps and gaps between Monitor’s role and those of other bodies, including the Care Quality Commission, the NHS Trust Development Authority, NHS England and the DH. The report makes several recommendations for improvement.

GMC defines licence to practise rules for doctors overseas. The GMC has confirmed that doctors undertaking training fellowships abroad should not give up their licences to practise unless they are permanently emigrating.  

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

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Government’s response to the House of Lords Committee on Public Service and Demographic Change Report ‘Ready For Ageing?’: One year update. The HL Committee published its report "Ready For Ageing?" in March 2013, providing a comprehensive analysis of the potential impact of an ageing population on public services. The Government in its response set out its strategy of helping people plan for later life, creating a personalised health and care system and putting more power in the hands of local communities. This update gives details of the steps it has taken since then to help address the challenges of an ageing society, including: helping people live fuller working lives; putting in place a new pensions system; making health and care more personalised and sustainable; and supporting people to live independent lives in older age.

Ensuring access to working antimicrobials. This report argues that it is essential that the government puts urgent measures in place to drastically reduce the unnecessary prescription of antibiotics. It also highlights the need for better education of medical students and greater focus on antimicrobial resistance during clinical career development.

Understanding the rise in Fitness to Practise complaints from members of the public. Enquiries made by the general public to the General Medical Council (GMC) about doctors’ fitness to practise rose from 5,168 in 2007 to 10,347 in 2012. The report found that an increase in complaints has been seen across the UK, which suggests wider social trends rather than localised issues; pointing towards problems with the wider complaint-handling system and culture. It highlights the increased profile of the GMC, press coverage of medical complaints and social media as potential factors in the rise in complaints.

Visitor & Migrant NHS Cost Recovery Programme Implementation Plan 2014–16. This implementation plan sets out a timeline for how the Visitor and Migrant NHS Cost Recovery Programme will be rolled out over the next two years. It is intended to give the NHS a clear idea of the timeline and sequence for building on existing systems and developing new ones. The programme aims to help the NHS recover costs from visitors and migrants from both the European Economic Area (EEA) and outside. It also covers EEA member states.

Understanding the new NHS: a guide for everyone working and training within the NHS. This guide outlines the organisations, systems and processes that define, sustain and regulate the NHS.

NHS and Department of Health investigations into Jimmy Savile. Kate Lampard, a former practising barrister and former Deputy Chair of the Financial Ombudsman Service, was appointed by the Secretary of State in October 2012 to provide independent oversight of three independent investigations into the role of Jimmy Savile in the NHS. Kate Lampard has overseen the joint Broadmoor Hospital investigation by the Department of Health and West London Mental Health Trust and the investigations at Leeds General Infirmary and Stoke Mandeville Hospital to ensure a robust process is followed. She has also provided general oversight of the smaller investigations conducted by the relevant legacy Trust. Her wider report in the lessons learned will be published this Autumn. The reports into the activities of Jimmy Savile in relation to hospitals/hospice premises have been published by the relevant hospital trusts and are available from this web page.
See also the joint statement from NHS England, NHS Trust Development Authority, Care Quality Commission and Monitor.

Guidance for healthcare professionals on drug driving. The Government has issued guidance to healthcare professionals on what they need to be aware of when the new drug-driving offence comes into force in March 2015. The guidance also contains an explanation of the statutory 'medical defence' available to patients who have been prescribed medicine and have taken it in accordance with the advice of a healthcare professional.

Better care plans to provide dignity, independence and reduce A&E admissions. Plans to improve out of hospital care for the elderly and vulnerable will reduce emergency admissions.

NHS 111 commissioning standards. Sets out the standards and core requirements for NHS 111 services. NHS 111 is a vital service in helping people with urgent care needs get the right advice in the right place, first time. It is an important building block within the urgent and emergency care system, and supports patients navigate round a very complicated system. This free to use service is now available all over England, 24 hours a day, 365 days a year and call volumes are growing each month. The aim is to develop this service further and to respond to what people have told us, while ensuring that the safety and quality continue to be improved. The Commissioning Standards document is for CCGs, as commissioners responsible for NHS 111 and the performance of local urgent care systems, and has been jointly developed with them. The intent is not to prescribe how commissioners deliver these requirements but to ensure that patients can depend upon receiving the same high quality service wherever they live or access NHS 111 services in England.

Ensuring access to working antimicrobials. The government has been urged to put urgent measures in place to reduce the unnecessary prescription of antibiotics by the House of Commons Science and Technology Select Committee. Clear responsibilities should be set at all levels of the NHS and the veterinary profession to ensure antibiotics aren’t being given to people and animals who do not need them, and preventing antibiotic resistance.

Ambulance survey 2013 - 2014: technical document. In this survey almost 3,000 people gave their views of ‘Hear and Treat’ services – a ‘999’ service, in which trained call handlers give medical advice over the telephone to avoid ambulances and paramedics being sent out when they are not needed. The survey asked people, amongst other things, whether they felt reassured by staff, whether they were treated with dignity and respect, whether they understood the advice given to them and whether they received an explanation if an ambulance was not sent out.

Guidance on implementing the Friends and Family Test. NHS England has published guidance for introducing the friends and family test following its announcement in April that the test is to be used by all NHS provider organisations

Dalton Review 2014: new options for providers of NHS care. The DH is seeking information and insight about organisational forms for providers of NHS care: what works best, and what changes are needed to improve the delivery of services, as part of Sir David Dalton's independent review into new options for providers of NHS care. The closing date for comment is 31 August 2014.

Protecting health and care information: a consultation on proposals to introduce new regulations. The Government is seeking views on proposals to strengthen controls and safeguards on the use of an individual’s health and care data. Under the proposals, new regulations will place strong controls around the disclosure of data which might potentially identify individuals by the HSCIC and accredited safe havens. In addition, the new regulations will address concerns about restrictions on the sharing of confidential personal information with NHS and social care case managers who need to have access to this information in relation to those for whom they are responsible for arranging health or care services. The consultation closes on 8 August 2014.

South London and Maudsley NHS Foundation Trust: Monitor launches investigation. Announces that Monitor is investigating how well the board of South London and Maudsley is performing following concerns about its effectiveness.

Surgery manager charged with NHS fraud after undercover sting. Surgery manager, Asif Butt, is to be charged with one count of fraud by abuse of position, the Crown Prosecution Service has announced. It is alleged that between 13 June 2012 and 4 August 2012, Butt committed fraud by dishonestly arranging for six people to be added to the NHS register, giving them access to free health care. Those six people were not entitled to free healthcare as they were not legally resident in the UK.

Bevan Brittan Updates
Housing and Health – why integration matters: the challenges that are driving the need for integration. Jonathan Turner considers how the housing sector has to change to meet its challenge of providing fit for purpose accommodation for the old and infirm and to work closely with the health and social care sectors to ensure its tenants are able to access the support they need in as straightforward and cost-effective manner as possible.

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

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