Health and Social Care Update - September 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.

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

Care	Inquests
Children	Mental Health
Clinical Risk/Health and Safety	Personalisation
Commissioning	Primary Care
Employment/HR	Procurement
Finance	Providers
Foundation Trusts	Public Health
Governance	Regulation
Information Sharing	General

 

Care

Publications/Guidance
Testing the bed-blocking hypothesis: does higher supply of nursing and care homes reduce delayed hospital discharges? Presents findings from research by the University of York's Centre for Health Economics on the extent to which higher supply of nursing home beds or lower prices can reduce hospital bed blocking. It uses new local authority level administrative data from England on hospital delayed discharges in 2010-13. The results suggest that delayed discharges do respond to the availability of care-home beds but the effect is modest: an increase in care-homes bed by 10% (250 additional beds per local authority) would reduce delayed discharges by about 4%-7%. It also finds strong evidence of spillover effects across local authorities: higher availability of care-homes or fewer patients aged over 65 in nearby local authorities are associated with fewer delayed discharges. 

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

Children

Publications/Guidance
0 to 25 SEND code of practice: a guide for health professionals. This guide is for clinical commissioning groups, health professionals and local authorities. It explains the duties and responsibilities of health professionals who deal with children and young people with special educational needs and disabilities (SEND) and their families.

Bevan Brittan Updates
Delegation of children's social care functions – Regulations now in force. Finalised regulations came into force on 10 September 2014, enabling local authorities to delegate almost all of their social services functions relating to children. They also allow authorities to delegate certain functions under the Children Act 2004 relating to Children's Trust Boards, Children and Young People's Plans, and the duty to cooperate.

Are you ready for the Children and Families Act? The Children and Families Act requires CCGs and local authorities to work together to commission services for children and young people with disabilities and special educational needs. One of the key requirements is that by 1 September 2014 all local authorities publish a Local Offer setting out information about the provision expected to be available across education, health and social care, including those commissioned by CCGs. Therefore, each CCG must determine which services it will commission to meet the reasonable health needs of children and young people with SEN or disabilities for whom it is responsible and these services should be described in the Local Offer.

If you wish to discuss any of the items above or the issue of children more generally please contact David Owens or Deborah Jeremiah.

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.

Publications/Guidance
Pressure points: postnatal care planning. This report found that over a third (40%) of women were discharged from hospital before they were ready after having a baby. It also argues that women are not getting the level of postnatal care recommended by NICE and that continuity of care is suffering, leading to poorer care for women and their babies.

Patient safety alert – resources to support the prompt recognition of sepsis and the rapid initiation of treatment. NHS England has issued a patient safety alert to continue to raise awareness of sepsis and to signpost clinicians in the ambulance service, primary and community services and secondary care to resources developed by the UK Sepsis Trust, and others.

Patient safety alert - NHS England have issued an alert around the risks arising from breakdown and failure to act on communication during handover at the time of discharge from secondary care.

Good surgical practice. This guidance outlines the standards of practice that are expected of all surgeons as well as the skills, values and attitudes that underpin the profession and has been developed with surgeons and patient groups. It highlights surgical leadership and teamwork as crucial for achieving high-quality patient care and provides surgeons with a model that they should aspire to in day to day practice.

NHS LA Annual Review 2013-14 and Forward Look for 2014-17. This sets out the NHSLA achievements in 2013/14 and a high level summary of their future plans.

Cases
Re Ashya King (a child); Portsmouth City Council v (1) Nagmeh King (2) Brett King (3) Southampton Hospital Trust (4) Ashya King (by his children's guardian John Mellor [2014] EWHC 2964 (Fam) (Fam D). The court held that the State had no business interfering with the exercise of parental responsibility unless the child was suffering or was likely to suffer significant harm as a result of the child being given unreasonable care. Parents whose child required treatment following the removal of a brain tumour were given permission to take him to Prague for proton therapy where they had provided evidence of funding and transport arrangements, and the local authority and medical practitioners did not oppose the plan. 

News
MyNHS. This is a new comparison website tool that allows health and social care organisations to see how their services compare with those of others. MyNHS is a transparency web tool that compares on a range of outcomes at both national and regional level. It has been developed by NHS England, together with the DH, the HSCIS, the CQC and PHE. MyNHS gives commissioners, providers and professionals a central snapshot of published data, to drive improvements in the quality of care. The information currently covers hospitals, providers of social care and public health, and supports the wider commitment on ensuring more transparent health and care services.

Bevan Brittan Events
Improving Safety & Outcomes in the Delivery Suite – the Role of ‘Human Factors’ Medical Staff Training Bristol office. 10 October 2014 : 09:30 - 16:30 (registration opens at 08:45) This Birth 2 UK Training course will focus on the introduction of non-technical skills for proffessional members of acute maternity teams.

Improving Patient Safety and Learning from Claims in the NHS and the NHS LA Safety and Learning Service 07 October 2014 : 09:30 - 11:30 (registration opens at 09:00) Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF.  This seminar will be looking at current initiatives and the relationship between claims and patient safety. Bevan Brittan is delighted to welcome Michelle Anstiss, Safety and Learning Lead from the NHSLA. The NHS LA is committed to supporting the NHS to build a safety and learning culture through their work in learning from claims. She will provide an introduction to the new NHS LA Safety and Learning Service and an insight into how they are approaching patient safety and the Sign up to Safety campaign. This seminar will be an opportunity to share ideas and views and is essential for all those who lead on patient safety, manage complaints, claims, inquests and SUIs.

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

Commissioning

Publications/Guidance
Making it work: A guide to whole system commissioning for sexual health, reproductive health and HIV. The goal of ‘Making it work: a guide to whole system commissioning for sexual health, reproductive health and HIV’ is to help commissioners ensure that service users experience integrated, responsive services that deliver the best outcomes.

Exploring the commissioning of personalisation within a Capitated Budget Model. This briefing from NHS IQ describes the findings of a round table event to look at how capitated budgets for people with complex health needs could support personal budgets for people with two or more long term conditions. It sets out a number of key messages around practical implementation, including current barriers and solutions for overcoming them.

Integrated Personal Commissioning (IPC) prospectus. NHS England, LGA, Think Local Act Personal and ADASS are formally inviting health and social care leaders to help build a new integrated and personalised commissioning approach for people with complex needs. IPC is a new voluntary approach to joining up health and social care for people with complex needs. This proposal makes a triple offer to service users, local commissioners and the voluntary sector to bring health and social care spend together at the level of the individual. Applications must be made jointly by one or more clinical commissioning group and local authorities, with at least one voluntary sector partner. The closing date for IPC applications is 7 November 2014.
There is also guidance on the IPC programme: Getting serious about personalisation in the NHS.

Beginning with the end in mind: how outcomes-based commissioning can help unlock the potential of community services. This briefing, produced in collaboration with PwC, explains outcomes-based commissioning and outlines how it might help enable service transformation. It discusses the opportunities that outcomes-based commissioning gives for providers of community services, including the main technical considerations that will need to be addressed.

Funding healthcare: making allocations to local areas. This report examines how the DH and NHS England allocate funding to the local commissioners of healthcare. It finds that there is wide variation in the extent to which £79bn in central funding allocated to local health bodies differs from target allocations that are based on relative need.

Estimating NHS and social care spend: a tool for commissioners. This Excel-based tool aims to help NHS commissioners by approximating how their local care economy spends its money by age group, patient group and care settings, and how this may evolve over time. By filling in some basic variables, commissioners can create a quick, indicative patient segmentation for their locality.  

Health service bodies’ auditor panels and their independence: Consultation on secondary legislation for NHS Trusts and Clinical Commissioning Groups under the Local Audit and Accountability Act 2014. The DH is consulting on draft regulations that implement new constitutional requirements for the audit committees (acting as auditor panels) of NHS Trusts and CCGs. These are necessary to ensure audit committees are appropriately constituted to advise their governing board/body on the selection, appointment and maintenance of independent relationships with external auditors for their future audit contracts. The deadline for responses has been extended - the consultation now closes on 19 September 2014.

Bevan Brittan Articles
Are you ready for the Children and Families Act? The Children and Families Act requires CCGs and local authorities to work together to commission services for children and young people with disabilities and special educational needs. One of the key requirements is that by 1 September 2014 all local authorities publish a Local Offer setting out information about the provision expected to be available across education, health and social care, including those commissioned by CCGs. Therefore, each CCG must determine which services it will commission to meet the reasonable health needs of children and young people with SEN or disabilities for whom it is responsible and these services should be described in the Local Offer.

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

Employment/HR

News
Medical experts jailed for billing NHS for £430,000 while moonlighting at other hospitals. The Independent, 4 September 2014. The four perfusionists - specialists operating heart and lung machines during surgery - were employed by Basildon hospital in Essex, but they were not needed all the time. They set up a private company, London Perfusion Science Ltd, and worked at seven other hospitals over four years, accounting for 14,000 hours they failed to work for Basildon hospital, and for which they were paid. The group earned an extra £700,000 for their private work.  

Bevan Brittan Events
Developing Workforce Leaders Forum for Deputies 21 October 2014 : 18:00-19:30 followed by drinks Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. Jointly hosted event in conjunction with the HPMA. An interactive discussion forum for Deputy Directors of HR and Organisational Development within the healthcare sector. Similar to our Workforce Forum, this event focuses on strategic workforce issues and the role of Deputy Directors in managing, leading and influencing such matters. More information about this event will be provided closer to the date.

Bevan Brittan Updates
Clarity on MHPS capability proceedings. In a decision which has been widely welcomed by those applying the 'Maintaining High Professional Standards in the Modern NHS' (MHPS) procedure, the High Court has clarified the interrelationship between NCAS and the operation of MHPS, when considering doctors' capability proceedings. Members of the Bevan Brittan employment team summarise the decision and discuss its likely implications in the light of their experience of navigating the intricacies of MHPS.

Employment news round-up, September 2014. A new season and a new batch of employment law news items, including: industrial action; the latest news on tribunal usage and the fate of fees; 'what not to wear' at work (guidance on dress codes); new Tier 2 and Tier 5 guidance; and details of a raft of changes coming up: equal pay audits, new ante-natal appointment rights and shared parental leave. The clock is ticking to get policies in place, as Laurie Child reports.

TUPE update. Whilst some of us may have been taking some time out and relaxing over the summer holidays, the Employment Appeal Tribunal has been busy shining a light into some of the darker corners of the TUPE Regulations. Sarah Lamont rounds-up the recent run of TUPE cases.

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

Finance

Publications/Guidance
More than money: closing the NHS quality gap. The financial gap in NHS finances has been projected to reach £30bn by 2021. This report discusses the implications of this financial gap for quality of care in the NHS. It argues that additional resources alone will not be enough to close the ‘quality gap’: the difference between the quality of care the NHS should deliver, and what it is capable of delivering. Increasingly tight budgets make it likely that the quality gap will get wider. The report highlights the changes needed in order to change how the NHS delivers services and is able to improve care to make it more efficient.

Funding healthcare: making allocations to local areas. This report examines how the DH and NHS England allocate funding to the local commissioners of healthcare. It finds that there is wide variation in the extent to which £79bn in central funding allocated to local health bodies differs from target allocations that are based on relative need.  

Estimating NHS and social care spend: a tool for commissioners. This Excel-based tool aims to help NHS commissioners by approximating how their local care economy spends its money by age group, patient group and care settings, and how this may evolve over time. By filling in some basic variables, commissioners can create a quick, indicative patient segmentation for their locality.

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

Foundation Trusts

Publications/Guidance
Performance of the foundation trust sector: 3 months ended 30 June 2014. This quarterly review of NHS foundation trust performance reveals that they are providing more treatment, to more patients with more complex care needs in tough financial times. However, this increased activity, when combined with the continuing need to make cost savings and an over-reliance on expensive agency staff, is putting trusts under unprecedented pressure. 

NHS FT Newsletter  - September 2014.

NHS National Tariff Payment System 2015/16:engagement documents

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

Governance

Publications/Guidance
Additional guidance for health bodies on exercising functions. The Home Office has issued good-practice guidance to health bodies to help them carry out their role as responsible authorities under the Licensing Act 2003. It provides a list of PHE centre alcohol leads for each local alcohol action area (LAAA).

If you wish to discuss any issues relating to governance please contact Vincent Buscemi.  Information Sharing Publications/Guidance
Police and A&Es collaborate to tackle violence. A new standard on information sharing to tackle violence (ISTV) will help ensure A&E departments share data with police about attendees injured by violent crime. The Health and Social Care Information Centre, who published the standard, this will mean major A&E departments in England collecting and sharing non-confidential, aggregated data with Community Safety Partnerships (CSPs).

Consultations
ICO reviews data sharing code of practice. The Information Commissioner's Office is reviewing its data sharing code of practice, published in May 2011, and seeks comments on how the code is used and how it helps organisations comply with data protection and freedom of information obligations. Comments by 5 October 2014.

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

Inquests Publications/Guidance
Law Sheet No.4: Hearsay evidence. A Law Sheet by the Chief Coroner on hearsay evidence includes information on: the general rule; coroners and the strict law of evidence; the weight of hearsay evidence; hearsay evidence in practice; duty to act fairly; and directing the jury.

If you wish to discuss any issues around inquests please contact Joanna Lloyd.

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.

Publications/Guidance
Making parity a reality: six asks for the next government to improve the nation's mental health. This manifesto calls for a firm commitment from all parties to take action to ensure that the millions of people who do, and will experience mental health problems are given timely, appropriate care. It highlights the need for a waiting time target for mental health treatment; improved access to crisis and specialist services; and greater investment in evidence-based parenting programmes.

Premature deaths of people with learning disabilities: progress update This report outlines the action being taken to improve the experience of people with learning disabilities in hospital and reduce premature deaths. It shows progress against the 18 recommendations in the Confidential Inquiry into premature deaths of people with learning disabilities both locally and nationally.

Positive and proactive care. Reducing the need for restrictive intervention. Restrictive practices should only be used as a last resort, new guidance issued by the Department of Health (DH) and NHS Confederation has said. The guidance forms part of the government's Positive and Safe Programme, which aims to reduce all restrictive practices within two years and to end face-down restraint. It applies to health and social care staff working in both health and non-health settings. The Care Quality Commission will monitor and inspect against compliance with the guidance.

Dementia revealed: What primary care needs to know – A primer for General Practice. NHS England has published a new dementia toolkit to help GPs make more timely diagnosis of the crippling condition and, importantly, what they can do in terms of vital post-diagnostic support. The support covers many areas and is mainly directed at the person with the diagnosis or their carer. It relates to both emotional support and practical task-based help, including specific interventions such as cognitive stimulation therapy.

Dementia UK: The second edition. Prepared by LSE and King's College London and published by the Alzheimer's Society, this is the most comprehensive review of dementia in the UK to date. It reveals how people with dementia and their carers are left footing a £5.8bn social care bill for help with everyday tasks such as washing and dressing. The 1.3bn hours of unpaid care that carers provide would cost the state £11.6bn if they did not provide it for free. Meanwhile the current cost of dementia diagnosis and treatment to the NHS comes in at £4.3bn and local authorities pick up a further £4.5 bn. The new research also reveals that numbers of those affected by dementia is soaring. By the next general election in 2015, there will be 850,000 people living with dementia. If current trends stay the same and no action is taken, this number is expected to bypass 2m by 2051.
The Alzheimer's Society has also published Dementia 2014: An opportunity for change. Provides a snapshot of how well people with dementia are living in England, Wales and Northern Ireland. It draws together evidence from a survey of over 1,000 people with dementia.

Making financial decisions – Guidance for assessing, supporting and empowering specific decision-making. The guidance focuses primarily on how to assess an individual's capacity in relation to financial decision-making and gives practical suggestions about how to support someone to manage their money and financial decisions. It suggests what could be done to support an individual who is finding it difficult to make decisions about money in a way that maintains their independence for as long as possible. The emphasis throughout the guidance is on how to empower individuals. There is a short section on when it is appropriate to make best interests decisions about somebody's money and templates are provided to assist assessors or others in finding out what particular aspects of managing their money a person is finding difficult.Annual Report of the Chief Medical Officer 2013. Public Mental Health Priorities: Investing in the Evidence. This report includes a focus on the epidemiology of public mental health and the quality of the evidence base, ‘horizon scanning’ of innovation in science and technology, the economic case for good mental health and chapters outlining the importance of both treating mental health as equal to physical health and of focusing on the needs and safety of people with mental illness. The chapters also include authors’ suggestions for improvement.

Preventing suicide: a global imperative This report aims to increase awareness of the public health significance of suicide and suicide attempts, to make suicide prevention a higher priority on the global public health agenda, and to encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multi-sectoral public health approach. It provides a global knowledge base on suicide and suicide attempts as well as actionable steps for countries based on their current resources and context to move forward in suicide prevention.

Consultations
Inappropriate admissions guidance. Seeks views on draft guidance from the Welsh Government for Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services within Local Health Boards on their legal duty regarding the appropriate placement of children in hospital. It has been developed to reduce the number of inappropriate admissions of under 18s to adult mental health wards. The guidance details what the Welsh Government expects to ensure the safety of the patient. The consultation closes on 5 December 2014.  

News
Doctors win right not to force-feed anorexic patient. The Court of Protection has ruled that doctors can lawfully decline to force-feed an anorexic patient even if it means she could die within a matter of weeks. Mr Justice Cobb said a medical expert had told the court that if force-fed, the patient's "suicide risk would be phenomenal", and it would exacerbate her alcohol dependency, hastening her death. The judgment is thought to be the first time a court has ruled that doctors need no longer give life-sustaining treatment on the ground that the treatment itself would hasten death.

Government orders review of Deprivation of Liberty Safeguards.

Self-harm by mental health patients in NHS has risen by 56%, figures show.

Bevan Brittan Events
A year in the Court of Protection - Key cases for health and social care professionals
 Bristol 22 October 2014 : 10:00 - 13:00 (registration opens at 09:30) seminar will be followed by lunch.
 London 04 November 2014 : 10:00 - 13:30 (registration opens at 09:30) will be followed by networking lunch
 Birmingham 20 November 2014 : 10:00 - 13:30 (registration opens at 09:30) seminar will be followed by lunch.
Bevan Brittan's Court of Protection Team will be running a legal update session, based in a practical context, on how to manage cases involving incapable patients. The session will discuss navigating a pathway through complex care-planning and legal proceedings; when to go to Court and preparation of evidence; managing the media and an update on recent caselaw, including the latest on deprivation of liberty. The session will include a practical workshop.

Bevan Brittan Updates
Court guidance on obstetric cases for patients with mental disorder, illness or impairment. There are an increasing number of applications to the Court of Protection concerning pregnant women where there is a concern about the mother's capacity to make decisions regarding her pregnancy, the safe delivery of her child and her physical/mental wellbeing.

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

Personalisation

Publications/Guidance
Government response to the House of Commons Health Select Committee report into long-term conditions. This response to the Committee's July 2014 report explains the measures in place to improve the care, support and treatment of those with long term conditions, including: improving personalised care and support, mainly through the house of care (HOC) approach; guidance and tools for commissioners to implement and monitor HOC approach; and system changes to improve efficiency and patient outcomes.

Exploring the commissioning of personalisation within a Capitated Budget Model. This briefing from NHS IQ describes the findings of a round table event to look at how capitated budgets for people with complex health needs could support personal budgets for people with two or more long term conditions. It sets out a number of key messages around practical implementation, including current barriers and solutions for overcoming them.

Integrated Personal Commissioning (IPC) prospectus. NHS England, LGA, Think Local Act Personal and ADASS are formally inviting health and social care leaders to help build a new integrated and personalised commissioning approach for people with complex needs. IPC is a new voluntary approach to joining up health and social care for people with complex needs. This proposal makes a triple offer to service users, local commissioners and the voluntary sector to bring health and social care spend together at the level of the individual. Applications must be made jointly by one or more clinical commissioning group and local authorities, with at least one voluntary sector partner. The closing date for IPC applications is 7 November 2014.
There is also guidance on the IPC programme: Getting serious about personalisation in the NHS.

A wealth of information: your questions on personal health budgets answered. Personal health budgets are being rolled out across the NHS. To deliver good outcomes for people, commissioners and providers will need to pay close attention to how budgets are implemented. This briefing from the NHS Confederation in partnership with Think Local Act Personal, highlights relevant information, support and guidance and answers some frequently asked questions.

Patients in control: Why people with long-term conditions must be empowered. This report from IPPR argues that more should be done to recognise and support the huge amount of self-management done by people with long-term conditions and their carers, and to enable people to work in partnership with healthcare providers to agree the services that fit their needs. It presents the results of a new survey of over 2,500 people with long-term conditions, which asked them about their attitudes towards and experience of managing their conditions. It finds that if people are not given more control and supported to become experts at self-managing their conditions, they risk feeling abandoned and – if they are unable to self-manage – may be at an increased risk of health crises, which can require emergency health services. It makes a number of recommendations concerning: named contact people; ownership of medical records; better information and advice; peer support; healthcare plans; and personal health budgets.

Guidance regarding the right to have a personal health budget for adults eligible for NHS Continuing Healthcare and children eligible for continuing care. The 'right to ask' for a personal health budget of adults who are eligible for NHS Continuing Healthcare, and of children in receipt of continuing healthcare, will become a 'right to have' from October 2014. This guidance from NHS England supports commissioners in understanding the new responsibilities associated with the 'right to have' a personal health budget. There are also FAQs on personal health budgets.

If you wish to discuss any of the items above or the issue of personalisation more generally please contact David Owens or Deborah Jeremiah.  

Primary Care

Publications/Guidance
Revalidation update from RCGP. The RCGP has published further resources to support GPs through revalidation. They include the ninth edition of the RCGP Guide to the Revalidation of General Practitioners, originally published in 2008. Changes to the latest version include a revised section on review of practice, clarification of patient feedback processes, and an explanation of variations to the revalidation process in England, Northern Ireland, Scotland and Wales.

Update on the co-commissioning of primary care services. This letter from Ian Dodge, National Director, Commissioning Strategy NHS England, and Dr Amanda Doyle, Chief Clinical Officer, NHS Blackpool CCG, provides an update on NHS England's primary care co-commissioning programme, and sets out the programme oversight group's next steps.

News
The Care Quality Commission has announced that it will be inspecting NHS GP practices in a number of CCGs as part of ongoing testing of its new inspection approach.

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

Procurement

Publications/Guidance
The NHS terms and conditions for the supply of goods and the provision of services: Guidance. This DH guidance provides advice on the terms and conditions for the NHS when procuring goods and services from commercial organisations. It is for use with six contract documents that make up three sets of contracting terms and conditions for use by NHS bodies when procuring goods and services:
 the NHS Terms and Conditions for the Supply of Goods (Contract Version) and the NHS Terms and Conditions for the Provision of Services (Contract Version);
 the NHS Terms and Conditions for the Supply of Goods (Contract Version) and the NHS Terms and Conditions for the Provision of Services (Purchase Order Version);
 the NHS Framework Agreement for the Supply of Goods and the NHS Framework Agreement for the Provision of Services. 

Consultations
UK transposition of new EU Procurement Directives. The Cabinet Office is seeking views on draft Public Contracts Regulations 2015 that implement the Public Procurement Directive 2014/24 in England, Wales and Northern Ireland. Once in force, the new regulations will replace the current Public Contracts Regulations 2006. The draft Regulations use a “copy out” approach to the transposition of the provisions of the Directive, which means that they follow the language, layout and numbering in the Directive as closely as possible. This approach, together with other helpful information on drafting, is explained in the Technical Note on Drafting that accompanies the draft Regulations. The consultation closes on 17 October 2014.
See our alert: New draft Procurement Regulations published.

Articles
Bevan Brittan byte size procurement update 11: The Draft Public Contract Regulations 2015 - implementing optional provisions. Earlier this week we sent out a procurement alert to let you know that on 19 September the Cabinet Office launched a consultation on the draft Public Contracts Regulations for England, Wales and Northern Ireland. The consultation period will close on 17 October 2014. The draft Regulations transpose Directive 2014/24/EU and include some additional provisions not in the Directive. This byte size update highlights some of the optional provisions which will be of particular practical interest to those working in procurement.

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

Providers

Publications/Guidance
NHS healthcare providers: working with choice and competition. Monitor has published a series of guidance to help healthcare providers make the best decisions for patients, explaining how it applies competition rules. The series includes:
 Application of the Competition Act 1998 in the healthcare sector: guidance for providers: describes the powers Monitor shares with the Competition and Markets Authority and explains how it will use them in accordance with competition law;
 Choice and competition licence conditions: guidance for providers of NHS-funded services: explains the choice and competition conditions of the NHS provider licence and explains how Monitor applies these licence conditions in individual cases;
  Monitor’s approach to market investigation references: guidance for providers: informs patients, healthcare providers, commissioners, patient groups and other interested parties of how Monitor approaches its powers to make market investigation references under Part 4 of the Enterprise Act 2002.

Monitor has also published Choice and competition: hypothetical scenarios for NHS healthcare providers, with examples of the types of conduct that can breach the competition condition of the NHS provider licence and competition law. Each example looks at the effect of an agreement or conduct on patients and what Monitor’s analysis would be under the provider licence and competition law.

Consultations
Display of Performance Assessments: placing a legal requirement on registered providers to display the rating published by the Care Quality Commission. Seeks views on proposals to make it a legal requirement for providers to display the performance rating given to them by the CQC. The Care Act 2014 will give the CQC the power to assess health and social care providers’ performance and give each a rating. These ratings are designed to improve transparency by providing service users and the public with a clear statement about the quality and safety of care provided. The ratings will also incentivise providers to improve services. The Government believes that these ratings should be on display in all locations that provide care to ensure that providers are transparent about their performance. The consultation document includes draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2014. The consultation closes on 13 October 2014.

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

Public Health

Publications/Guidance
Due North: the Inquiry on Health Equity for the North. The independent Inquiry on Health Equity for the North was set up by Public Health England and led by an independent Review Panel of leading academics, policy makers and practitioners. This report details evidence on trends in health inequalities and flowing from this provides a set of recommendations, based on the root causes of health inequalities, for policies that can address social inequalities in health within the North and between the rest of England. It has sought to bring a fresh perspective to the issue of health inequalities, seeking to build upon the assets of the North to target inequalities, whilst also outlining what central government needs to do, both to support action at the regional level and re-orientate national policies to reduce inequalities.

National Conversation on Health Inequalities: event report. The National Conversation on Health Inequalities is a Public Health England programme about reducing differences in health. The aim is for local authorities to start talking about health inequalities in their communities. This report provides a summary of discussions and a brief synopsis of sessions of the National Conversation on Health Inequalities event that was held on 25 June 2014.

Local action on health inequalities – Evidence papers. PHE has published a series of eight evidence reviews and 14 short briefing papers that show evidence for interventions on social issues that lead to poor health, including ways to deal with health inequalities. Local authority professionals and public health teams can use them to get practical tips for dealing with these issues. They also show examples from local areas showing interventions that have been used to improve health.

Introduction of shingles vaccine for people aged 70 and 79 years. Updated information for healthcare professionals on the second year of the shingles immunisation programme. Shingles immunisation was introduced on 1 September 2013 for patients aged 70 and 79 on that date.

Imported fever service: enquiries process. This poster explains to doctors how to access the imported fever service, a national specialist advisory and diagnostic service for acute imported fever.

Global health strategy 2014 to 2019. This document sets out PHE's approach to global health for the next five years, and provides a framework for its international engagement. The strategy links to the PHE business plan and knowledge strategy, and will connect with PHE's emerging research and academic strategy, commercial strategy and infectious diseases strategy.

Children with special educational and complex needs – Guidance for Health and Wellbeing Boards. The Children and Families Act 2014 introduces a new statutory requirement for local services to work together when providing care and support for children and young people with special educational needs and disabilities (SEND). Health and Wellbeing Boards (HWBs) are responsible for overseeing the implementation of the new requirement. From September 2014, local authorities, CCGs and education services are expected to collaborate when assessing, commissioning and implementing care plans for children with SEND. This non-statutory guidance for HWBs advises on how best to oversee the implementation of changes made by the Act.

Survey of engagement with health and wellbeing boards. This report by Regional Voices contains results from a survey conducted earlier this year about how the Voluntary and Community Sector (VCS) is engaging with health and wellbeing boards (HWBs). Specific questions were asked to VCS representatives on HWBs, Healthwatch reps on the boards and to the wider VCS, interested in engaging with the HWB. The survey captures good practice and challenges and makes recommendations to help improve development of working links between the VCS and health and wellbeing boards. Encouragingly, some good practice for how boards involve the VCS is emerging. However, some issues remain.

Making it work: a guide to whole system commissioning for sexual health, reproductive health and HIV. PHE has published a guide for commissioners of sexual health, reproductive health and HIV services in local government, CCGs and NHS England that looks at how to pull the whole commissioning system together. It focuses on: interfaces in commissioning responsibility, detailing the areas where more than one commissioning organisation is responsible for different elements of care that an individual may need; and addressing the wider determinants of health, illustrating examples of how local areas are taking a wider view to address an area of need. The guide is available as one large document or as three separate parts: main guide, case studies and annexes.

0 to 25 SEND code of practice: guide for health professionals. This guide for CCGs, health professionals and local authorities explains the duties and responsibilities of health professionals who deal with children and young people with special educational needs and disabilities (SEND) and their families.

Consultations
Travelling to better health. The Welsh Government is seeking views on draft guidance that has been developed for the benefit of healthcare practitioners to assist effective working with gypsies and travellers. Research shows that gypsies and travellers suffer disproportionately when compared with the general population in relation to access to healthcare and health outcomes. The consultation closes on 30 October 2014.

Health Premium Incentive Scheme 2014/15 and public health allocations – A technical consultation. The DH is seeking views of local authority commissioners and financial directors, Directors of Public Health and local representative bodies such as Health and Wellbeing Boards, on plans for the introduction of the Health Premium Incentive Scheme (HPIS), which rewards local authorities for public health improvements made in line with selected indicators from the public health Outcomes Framework. The consultation focuses on the technical design of the scheme and the chosen indicators from the Outcomes Framework that will reward public health improvements. It also seeks views on technical aspects of public health funding allocations for 2015 to 2016. Annex B sets out the core allocations for public health funding for 2015 to 2016. The consultation closes on 23 October 2014.

New regulation planned for public health specialists. Non-medical and non-dental public health specialists will be regulated by the Health and Care Professions Council (HCPC) under Department of Health (DH) plans. Public health specialists can currently register on a voluntary basis with the UK Public Health Register (UKPHR). Comments are sought by the DH on a draft Order setting our details of how the regulation will work in practice, including fitness to practice cases, giving specialists time to register with the HCPC and protection of the title 'public health specialist'. The consultation closes on 17 October 2014.

Amendments to the Human Medicines Regulations 2012. Seeks views on a proposal to amend SI 2012/1916 that regulates the authorisation, sale and supply of medicinal products for human use, to enable Public Health England (PHE) to develop and authorise Patient Group Directions (PGDs). This proposal is intended to strengthen the health protection response to outbreaks of infectious disease and other incidents through extending the use of PGDs to staff employed by PHE. The aim is to ensure that in the event of an incident or outbreak PHE staff can take the appropriate rapid action to respond or to control the spread of disease. The consultation closes on 31 October 2014.

Smoke-free private vehicles carrying children under 18. The Welsh Government is seeking comments on proposals to prohibit smoking in enclosed private vehicles when children under the age of 18 are present. The changes to the law would make it an offence: to smoke in a private vehicle when someone under the age of 18 is present; or for the driver to fail to prevent smoking in a private vehicle when someone under the age of 18 is present. The consultation closes on 24 October 2014.

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

Regulation

Publications/Guidance
CQC to trial new inspection approach. Eight hospitals in England are going to be investigated under the Care Quality Commission's (CQC) new inspection approach. The investigations will take place in October 2014. Under the new model, health care providers will be awarded ratings from April 2015. There will also be a significant increase in the amount of information which is available to people to help them make choices about their care.

The Care Quality Commission has announced that it will be inspecting NHS GP practices in a number of CCGs as part of ongoing testing of its new inspection approach.

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

General

Publications/Guidance
Crowding in emergency departments. This guideline aims to assist managers and clinicians who are trying to reduce crowding in their hospital emergency departments. The guideline explains the causes and consequences of crowding and offers suggestions to reduce the effects of crowding and improve the safety of an emergency department.

Police and A&Es collaborate to tackle violence. A new standard on information sharing to tackle violence (ISTV) will help ensure A&E departments share data with police about attendees injured by violent crime. The Health and Social Care Information Centre, who published the standard, this will mean major A&E departments in England collecting and sharing non-confidential, aggregated data with Community Safety Partnerships (CSPs).

Measuring up? The health of NHS cancer services. This report highlights key concerns regarding the pressures on NHS cancer services following the NHS reorganisation and the Health and Social Care Act 2012. It calls for urgent action to increase investment, particularly in diagnostic services, and also highlights the need to review both the leadership and commissioning of cancer services so they are fit to meet the looming demands of an ageing population and the predicted rapid increase in cancer cases.

Growing older positively: The challenge of ageing with HIV. This report reviews how HIV is strategically planned for and managed in the UK today and develops recommendations for Government and the NHS in light of changes in the patient profile. The goal must be to ensure that with appropriate care and support everyone with HIV can live a long and fulfilled life.

A national study of acute care alcohol workers. Alcohol health workers are specialist staff working in hospital – usually nurses – who identify and work with patients drinking at levels that may impact or have already impacted their health. This study explores the coverage and funding of these posts within hospitals in the UK.

Guidance on implementing the overseas visitors hospital charging regulations. Updated guidance for NHS bodies in carrying out their duties under the NHS (Charges to Overseas Visitors) Regulations 2011 to make and recover charges for NHS hospital treatment from chargeable overseas visitors. It also includes guidance to safeguard the health of those not entitled to free hospital treatment and new guidance on sharing information on NHS debtors to subject them to immigration sanctions.

 Changes to overseas registration for applicants educated outside the European Union (EU) and European Economic Area (EEA). From the autumn of 2014, nurses and midwives who completed their training outside the EU and EEA will be subject to new assessments of the eligibility to gain entry to the NMC register. The new procedures aim to ensure that the hundreds of nurses and midwives who trained overseas and wish to practise in the UK are assessed in a robust and objective way.

 Legal food standards for NHS hospitals adopted. NHS hospitals will be legally required to adopt new food standards recommended in a Hospital Food Standards Panel report. The report looked at standards relating to patient nutrition and hydration, healthier eating, and sustainable food and catering services. Its recommendations included the adoption of five required food standards applicable to all hospitals and that every patient should also be screened for malnutrition. The Department of Health has since confirmed that under the NHS contract, hospitals will be required to adopt the standards.

Risks arising from breakdown and failure to act on communication during handover at the time of discharge from secondary care. This patient safety alert has been issued by NHS England as part of its work to improve the quality and timeliness of communication with primary and social care when patients are discharged from hospital. It is asking organisations for information about their current local practices and challenges that will help form a national picture around handover at discharge. They are also being asked to provide examples of successful local initiatives designed to improve their discharge handover processes. In addition, other groups including GPs, community nurses, social care, voluntary sector and medicines reconciliation are being asked to share their views on how the process can be improved.

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge. Hospital discharge is a vulnerable stage in the patient pathway. This study aimed to identify interventions and practices that support knowledge sharing and collaboration in the processes of discharge planning and care transition.

The costs of specialised care. This research paper from the Centre for Health Economics at the University of York analyses the relationship between costs of care and the delivery of specialised services. There is concern that national tariffs might fail to fully reflect the true costs associated with treating patients that require specialised care, because the Healthcare Resource Groups (HRGs), used to categorise patients and on which national tariffs are based, may not perfectly differentiate between patients that do and do not receive specialised care. This analysis identifies whether or not a patient received specialised care and evaluates whether and by how much such patients have higher costs than those allocated to the same HRG. It finds little overlap between the Specialised Services National Definition Sets (SSNDS) and Prescribed Specialised Services (PSS) definitions of specialised hospital care and estimates the additional costs of specialised care under each definitional system.

Mapping England's health and wellbeing boards' vision for dying people. According to this research, only around four in ten Health and Wellbeing Boards in England include the needs of dying people in their key strategies that shape health and social care services. The report makes various recommendations to address current issues relating to end of life care, especially with regard to quality, availability and coordination of care.

Priorities for the next Government. Sets out the King's Fund's view of the key challenges and priorities for the next Government. it states that the next Government must ensure that the focus on improving quality of care established in the wake of the Francis report is sustained. It will also need to set in train a transformation of services to meet the needs of patients more effectively. Looking further ahead, the big question is how to provide adequate funding to meet future demand for health and social care. It is essential that politicians are honest with the public about the scale of these challenges. The stakes are high – without a clear mandate for change, the next government may find itself helpless to address them.

Policy note: Application of new Fair Deal to ongoing contracts. Fair Deal is a non-statutory policy setting out how pension issues are to be dealt with when staff are compulsorily transferred from the public sector to independent sector providers of public services. This document gives guidance on DH policy about requests for former NHS staff to return to the NHS pension scheme and how requests should be made.

Annual review 2013-14: A year of putting patients first. NHS England has published its first Annual Review, that looks at some of the highlights over the last year and includes real life case studies which show how it has put patients first

Evidence for success: the guide to getting evidence and using it. This guide offers easy to follow, step-by-step guidance and resources to support organisations to use evidence to influence policy and practice. It also provides guidance on the use of evidence to influence funding and commissioning decisions and highlights other key resources.

News
Patient assessments show hospital improvements. Hospitals are improving non-clinical aspects of their services, according to a Health and Social Care Information Centre report which looked at feedback from patients about cleanliness, privacy and food.

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