09/12/2014
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
Publications/Guidance
Going home alone: Counting the cost to older people
and the NHS. The Royal Voluntary Service and the King’s Fund
have published a report which looks at the discharge from hospital
and re-admission of those aged over 75. It explores the possible
financial impact of appropriate and effective Home from Hospital
services. It finds that if Home from Hospital services could alter
the underlying causes of inappropriate admissions and were targeted
appropriately with full coverage across England, they might reduce
costs of re-admissions by around £40.4m per year. The evidence
suggests Home from Hospital schemes are a valuable service well
regarded by those who use them. Given that many older people who
are re-admitted to hospital feel they were discharged too early or
did not receive enough support, they are likely to play a valuable
role. Modelling suggests they could lead to significant cost
savings through reductions of re-admissions, but their prime
purpose is to improve health and wellbeing. The report argues for
more effective collaboration by charities, health professionals,
older people and their families to reduce re-admission rates.
Managing quality in community health care
services. This King's Fund report presents findings from a
small-scale study into how quality is managed in community
services. It explores how community care providers define and
measure quality and recommends important next steps to support
better measurement and management of quality.
The bigger picture – Understanding disability and
care in England’s older population. This project, sponsored by
the Strategic Society Centre and Independent Age, explores
disability and care at a national, regional and local authority
level in England. It brings together data from Census 2011, DWP and
HSCIC ‘administrative data’, as well as from Wave 6 of the English
Longitudinal Study of Ageing, to look at the prevalence of
disability, need and care of different types, and to ‘paint a
picture’ of the lives of different groups.
The Centre has also published a policy discussion paper that uses the findings
of the research to evaluate public policy in relation to the reach
of publicly funded support, unmet need, consistency v variation, as
well as to explore issues around the implementation of the Care Act
in light of findings from the research.
I’m still me: A narrative for coordinated support
for older people. This report from National Voices sets out how
coordinated (or integrated) care and support looks and feels to
older people, and is written from their point of view. The
publication, developed by older people working with National
Voices, UCL Partners and Age UK, challenges health and care
services to work together and improve the outcomes older people say
are most important to them – things like independence, social
interaction and relational support. I’m Still Me outlines five
themes that older people say are key to coordinated support:
independence; community interactions; decision making; care and
support; and terminology. It also sets out a series of "I
statements" that summarise what older people have said that they
want their support to look like.
If you wish to discuss any of the items above or the issue of care more generally please contact Stuart Marchant.
Clinical Risk/Health and Safety
Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.
Publications/Guidance
The NHSLA have updated their Duty of Candour slides. They cover:- • NHS LA
Duty of Candour Guidance • What is an apology • Saying sorry • Do's
and Don'ts on candour. The NHS LA have also published a briefing note on the Duty of Candour. This
covers:- • What is candour • When might it arise • What triggers
the statutory duty of candour • What does candour look like • What
is an apology • Do's and don'ts on candour
Safer staffing: a guide to care contact time.
This guide is for providers and commissioners as part of the drive
to deliver safe and effective care. It gives providers a suite of
toolkits to support them in making decisions to secure safe
staffing care for their patients and service users and recommends
that organisations review the contact time staff spend with their
patients. It also supports commissioners working with providers to
assure themselves that there is sufficient nurse, midwifery and
care staff capacity and capability to meet appropriate outcomes and
quality standards and to use commissioning and contractual levers
to help secure improvements.
Intrapartum care: care of healthy women and their babies
during childbirth. This guideline offers evidence-based advice
on the care of women and their babies during labour and immediately
after the birth. It covers healthy women with uncomplicated
pregnancies entering labour at low risk of developing intrapartum
complications. New recommendations have been added in a number of
areas, including choosing place of birth, care during the latent
first stage of labour, transfer of care, fetal assessment and
monitoring during labour and management of the third stage of
labour.
The efficient use of the maternity workforce and
the implications for safety and quality in maternity care: a
population-based, cross-sectional study. The performance of
maternity services is seen as a touchstone of whether or not NHS
care is high quality. Staffing has been identified in numerous
reports as being a critical component of safe, effective,
user-centred care. There is little evidence regarding the impact of
maternity workforce staffing and skill mix on the safety, quality
and cost of maternity care in the UK. The objective of this
research was to understand the relationship between organisational
factors, maternity workforce staffing and skill mix, cost and
indicators of safe and high-quality care.
Guidance for NHS bodies on the Fit and Proper
Persons requirement for directors and Duty of Candour. The
Health and Social Care Act 2008 (Regulated Activities) Regulations
2014 (SI 2014/ 2936) setting out fundamental standards of care will
come into force for all care providers on 1 April 2015; however,
two standards – the Duty of Candour and the Fit and Proper Persons
requirement for directors – have been brought into force earlier,
on 27 November 2014.
The Duty of Candour explains what
providers should do to make sure they are open and honest with
people when something goes wrong with their care and treatment.
The Fit and Proper Persons requirement
outlines what providers should do to make clear that directors are
responsible for the overall quality and safety of care. All NHS
board members will be required to undergo the Test before they are
appointed. This will include an assessment of their character and a
robust consideration of whether the person has the right
qualifications, skills and experience for the role. The CQC will
check during their inspections that providers have strong systems
in place to carry out these checks before an appointment is
made.
CQC has issued this interim guidance for providers on how to comply
with these requirements.
Briefing: The fit and proper person test. This
briefing provides an update on the requirements placed on NHS
provider organisations as of 27 November 2014 to ensure director
level appointments meet the ‘fit and proper persons test’ which has
been recently integrated into CQC’s registration requirements, and
falls within the purview of their regulatory and inspection
approach. Produced by the NHS Confederation, NHS Employers
organisation and NHS Providers, the briefing provides a summary of
the regulations themselves, as well as a practical toolkit to
support provider boards in assuring themselves that they have
followed a robust and due process with regards to the fit and
proper persons test.
Openness and honesty when things go wrong: the
professional duty of candour. This report came out of a recent
Public Policy Projects conference on the duty of candour. The
report comments that the draft guidance "clarifies what the
regulators expect from doctors, nurses and midwives, wherever they
work. It makes clear there is a responsibility to put right where
possible, to learn and to restore trust. It focuses on: • Telling
patients and families when something has gone wrong • What to
consider when apologising to patients or their families • Providing
a full explanation of what happened and the likely effects •
Promoting a culture of learning where errors and near misses are
reported so that future patients can be protected".
Patient Safety Collaboratives: Plan on a page.
NHS Improving Quality and NHS England are working nationally with
the Academic Health Science Networks to provide support and
opportunities for the Collaboratives to learn from each other,
ensuring the most effective and successful solutions are rapidly
spread and adopted across England. For the next five years, each
Collaborative will support individuals, teams and organisations to
build skills and knowledge about patient safety and quality
improvement to create space and time to work on the challenges, and
provide opportunities to learn from each other. This resource
summarises the Patient Safety Collaboratives current priority
plans.
State of Care 2013/2014. Basic safety and leadership
are key issues for healthcare. A new inspection approach by the
Care Quality Commission (CQC) to NHS Trusts, introduced in
September 2013, has resulted in some findings of outstanding care,
but also examples of care which requires improvement or is
inadequate. The CQC's report, State of Care 2013/14, sets out the
differences in quality between one Trust and another, from hospital
to hospital within Trusts, and between different services within
hospitals.
Selected summaries of investigations by the
Parliamentary and Health Service Ombudsman: April to June 2014.
This report presents a summary of 161 investigations carried out
between April and June 2014. The cases investigated included
several complaints about incorrect discharges from hospitals,
failings in diagnosis of cancer and another complaint concerned
poor case handling from the Child Support Agency.
Consultations
Openness and honesty when things go wrong: the
professional duty of candour. The GMC and NMC are asking for
views on draft guidance which is designed to support doctors,
nurses and midwives in fulfilling their professional duty to be
open and honest about mistakes. It also calls on clinical leaders
and employers to support doctors, nurses and midwives by creating
cultures in the workplace that are open, honest, and where people
learn from mistakes so that future patients are protected from
harm. The consultation closes on 5 January 2015.
News
Formal launch of MyNHS. Health Secretary Jeremy
Hunt has formally launched MyNHS – a new site on NHS Choices where people
can compare the performance of their local NHS hospital, their care
services and their local authority with up-to-date information.
people will also be able to search consultant outcome data on NHS
Choices.
Bevan Brittan Articles
CQC 'Fit and Proper Person' Requirement The first pieces
in the new framework of CQC standards – the 'Fit and Proper Person
Requirement' ("FPPR") and the statutory Duty of Candour – go live
for NHS bodies on 27 November 2014. (For independent healthcare and
adult social care providers these requirements will not take effect
until April 2015). Ahead of this launch, the Regulations (the
Health and Social Care Act 2008 (Regulated
Activities) Regulations 2014) have been finalised and CQC has
issued its Guidance for NHS bodies on how to comply with
FPPR and Duty of Candour.
Statutory Duty of Candour For NHS providers (NHS trusts and FTs) the statutory duty of candour goes live on 27 November 2014 (for independent healthcare and adult social care providers the duty will not take effect until April 2015). CQC have now issued guidance for NHS bodies on how to comply with the statutory duty. The guidance does not differ dramatically from the draft Guidance consulted upon but does provide some further clarification of how CQC expect the duty to be implemented:
If you wish to discuss any clinical risk or health and safety issues please contact Joanna Lloyd or Stuart Marchant. Commissioning
Publications/Guidance
Next steps towards primary care
co-commissioning. NHS England has published guidance for CCGs
setting out co-commissioning options, and providing CCGs and area
teams with the information and tools they need to implement the
right form of co-commissioning for their local health economy. The
guidance gives CCGs the opportunity to choose afresh the
co-commissioning model they wish to assume, in line with changes
set out in the NHS Five Year Forward View. The guidance looks at
three possible models of primary care commissioning that CCGs could
pursue: Greater involvement in primary care decision-making; Joint
commissioning arrangements; and Delegated commissioning
arrangements. . It clarifies the opportunities and parameters of
each model, including associated functions; governance
arrangements; resources; and any potential risks, with advice on
how to mitigate these. The document then sets out the steps towards
implementing co-commissioning arrangements, including the timeline
and approvals process.
The document is accompanied by a suite of practical resources and tools which are
appended to support local implementation of co-commissioning
arrangements.
Commissioning and contracting for integrated
care. This report from the King's Fund describes how CCGs in
England are innovating with two broad models – the prime contract
and alliance contract. It draws on experiences from five
geographical areas, covering different population and disease
groups (cancer, end-of-life care, musculoskeletal services, mental
health rehabilitation, and older people’s services). It concludes
by highlighting four lessons that CCGs, other commissioners and
providers should keep in mind as they embark on new models of
commissioning and contracting to support integrated care.
It has also published a summary of three contractual vehicles being
used by commissioners to deliver integrated services: Prime
contractor model; Prime provider model; and Alliance contract
model.
A shared agenda – Creating an equal partnership
with CCGs in health and wellbeing boards. This briefing from
NHS Clinical Commissioners shares the views and thoughts of CCGs on
the development and direction of health and wellbeing boards
(HWBs), as well as their ambitions for future joint working. CCGs
believe in the potential of HWBs as the place that can bring
together the NHS, local government and other key players in the
health and care system to find the right solutions for their
patients and local populations. It also highlights that HWBs are
still very much in development, and need time to grow and mature,
but they are not commissioning bodies.
Leading local partnerships: How CCGs are driving integration for their patients and local populations. This report from NHS Clinical Commissioners profiles some of the clinical commissioning groups across England who, despite still being relatively new organisations, are already driving new and innovative models of care that put the patient at the heart of the system, and are improving the health and wellbeing of their local populations.
Driving local change for effective and efficient eye care services. The UK Vision Strategy Commissioning for Effectiveness and Efficiency has launched commissioning guidance to help commissioners, local government partners, Local Eye Health Networks (LEHNS) and partnerships to plan and deliver eye care and sight loss services that maximise the best possible outcomes for their local communities. There is also a set of support tools.
Consultations
A consultation on arrangements for the transfer of
commissioning responsibility from NHS England to Clinical
Commissioning Groups: Renal dialysis services and Morbid obesity
surgery services. Seeks views on moving responsibility for
renal dialysis services and morbid obesity surgery services from
NHS England to CCGs. It asks what type of support CCGs will need
from NHS England to be able to commission these two services safely
and effectively. It also asks whether the transfer should happen
from 1 April 2015, if the DH can put that support in place. The
results will be analysed and used to inform decisions on when and
how the transfer in commissioning responsibility should be made.
The consultation closes on 9 January 2015.
If you wish to discuss the issue of commissioning please contact David Owens. Emergency Care
Publications/Guidance
Urgent and important: the future for urgent care in
a 24/7 NHS. The Urgent Care Commission, supported by an
unrestricted grant from Care UK, explores the provision of urgent
and out of hours care in England and makes eight recommendations to
improve standards and ensure the most efficient use of resources.
It also highlights concerns from GPs that out of hours care is
being hindered by a lack of integration with in-hours services and
insufficient resources to consistently provide high quality
care.
Accident and emergency survey 2014. The results of this annual patient survey finds that 80 per cent report a good A&E experience, but there are still problems with patient discharge and people waiting too long for pain relief. The findings demonstrate that departments are largely caring, however, more work needs to be done so that services are safer, are more effective and are more responsive to people’s needs.
News
National patient survey says 80% report a good
A&E experience, but there are still problems with patient
discharge and people waiting too long for pain relief. The CQC
has published results from the fifth accident and emergency
(A&E) survey which almost 40,000 people took part in. The
survey shows some encouraging results with almost eight out of 10
respondents saying their overall experience was good, rating it
seven or more out of ten and only 3 per cent of patients saying the
doctor or nurse did not listen to what they had to say. The
findings demonstrate that departments are largely caring, however,
more work needs to be done so that services are safer, are more
effective and are more responsive to people’s needs.
If you wish to discuss the issue of emergency care please contact Claire Bentley.
Employment/HR
Publications and Guidance
Guidance on prevention and management of stress at
work. NHS Employers have published comprehensive guidance to
help managers throughout the NHS reduce stress in the workplace and
better support staff who experience it.
News
Nearly one in ten doctors in training experience
bullying. A GMC survey of the 50,000 doctors in training has
found that nearly one in ten report that they have been bullied,
while nearly one in seven said they had witnessed bullying in the
workplace. While the survey shows that systems are generally
working well, it suggests there are still areas that need to be
improved. The GMC argues that bullying and undermining can affect
the safety of patients as it can make doctors in training more
reluctant to report concerns.
Bevan Brittan Articles
Employment news round-up, November 2014 November's
employment law developments, distilled by John Moore and including: the latest developments on
the recovery of public sector exit payments, the NHS 'five year
forward' plan proposals for partnership with employers, an update
on the mass zero-hours claims against Sports Direct, calls for
curbs on Council's TU 'facility time' and, finally, details of our
forthcoming events.
Holiday and overtime payments In a landmark decision, the Employment Appeal Tribunal decided earlier this month that holiday pay should include "non-guaranteed" overtime that is normally worked. This decision has attracted widespread interest, both in the mainstream media and amongst HR professionals. Now that the dust is settling on the EAT's decision, Sarah Lamont looks at the issues that are emerging, and considers the options available to employers.
Ill-health absences and disability In the recently decided case of General Dynamics Information Technology v Carranza the EAT considered a disabled employee's claims of failure to make reasonable adjustments in relation to a final written warning and unfair dismissal for sickness absence. Anne Palmer reports.
If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.
Finance
Publications/Guidance
Pressure Points – Postnatal care planning. The
Royal College of Midwives publishes a report on the funding of
maternity services.
The financial sustainability of NHS bodies. This report finds that the financial position of the NHS has worsened since 2012-13, with growing financial stress in NHS trusts and foundation trusts. It notes that financial risk is increasing in NHS trusts and foundation trusts, and those in severe financial difficulty continue to rely on in-year cash support from the Department of Health. In 2013-14, over £0.5bn extra money was issued to 21 NHS trusts and 10 foundation trusts to ensure that organisations in difficulty have the cash they need to pay staff and creditors.
The impact of hospital financing on the quality of inpatient care in England. This paper assesses the impact of Payment by Results (PbR) on hospital quality, using in-hospital mortality and 28-day emergency readmission targets. It examines the impact of PbR particularly across hip replacements, hernia repair and stroke care.
Reforming the payment system for NHS services: Supporting the Five Year Forward View. NHS England and Monitor have published plans describing radical changes to how healthcare is paid for, which will enable the NHS to introduce new models of care. This would enable the NHS to put into practice its long-standing commitment to better integrate hospital, community and mental health care, and provide a payment system to help introduce the examples of care models outlined in the Five Year Forward View launched in October 2014. The plans identify several payment approaches with potential to help realise the vision of the Forward View. The payment system is likely to comprise menus for locally determined payments, from which commissioners and providers could choose the most appropriate approaches for their local models of care and service contracts; a number of national prices for episodes of care delivered by centres of excellence and specialised services networks; and national guide prices for all other currencies. To develop the payment system so that it begins to support a rapid shift to new models of care by 2020, they now want to work in even closer partnership with local providers and commissioners of care, including those in social and primary care.
Reforming the payment system for NHS services: Supporting the Five Year Forward View. NHS England and Monitor have published plans describing radical changes to how healthcare is paid for, which will enable the NHS to introduce new models of care. This would enable the NHS to put into practice its long-standing commitment to better integrate hospital, community and mental health care, and provide a payment system to help introduce the examples of care models outlined in the Five Year Forward View launched in October 2014. The plans identify several payment approaches with potential to help realise the vision of the Forward View. The payment system is likely to comprise menus for locally determined payments, from which commissioners and providers could choose the most appropriate approaches for their local models of care and service contracts; a number of national prices for episodes of care delivered by centres of excellence and specialised services networks; and national guide prices for all other currencies. To develop the payment system so that it begins to support a rapid shift to new models of care by 2020, they now want to work in even closer partnership with local providers and commissioners of care, including those in social and primary care.
The efficient management of healthcare estates and facilities. This guidance is for NHS trusts, foundation trusts and other NHS organisations and contains advice on achieving efficiency savings and reducing costs in NHS estates. The building note is split into two parts: Part A outlines how efficiencies in the running of land and property can be achieved. Part B provides more detailed advice about the active management of land and buildings used for healthcare services.
Pressure Points – Postnatal care planning. The Royal College of Midwives publishes a report on the funding of maternity services.
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
Foundation trust annual planning for 2015/16.
This note sets out the planning priorities and timetable jointly
agreed by Monitor, NHS England and the NHS Trust Development
Authority for the 2015/16 NHS planning process. It includes 2015/16
planning requirements and the jointly agreed planning
timetable.
If you wish to discuss any issues relating to foundation trusts please contact Vincent Buscemi.
Governance
Publications/Guidance
Making an impact through good governance: a
practical guide for health and wellbeing boards. Now that
health and wellbeing boards are fully operational, their emphasis
is on being as effective as possible in their statutory and
influencing roles. This guide discusses how health and wellbeing
boards can make an impact through their governance structures and
procedures – delivering business within council constitutional
requirements, as required by statute – while enabling all board
members to participate as equal partners.
Bevan Brittan Updates
Better Care Fund: Implementing an Action Plan within the legal
framework - Section 75 and Governance arrangement The Better
Care Fund is coming soon – CCGs and local authorities need to be
ready for the 1 April implementation of the pooled fund regime for
the Better Care Funds, and this means you need to start work on
your S75 Agreements now.
If you wish
to discuss any issues relating to governance please contact
Vincent Buscemi.
Information Sharing
Publications/Guidance
In the picture: A data protection code of practice
for surveillance cameras and personal information. ICO have
published updated code of practice on use of CCTV and other
surveillance.
National Data Guardian appointed to safeguard
patients' healthcare information. Dame Fiona Caldicott has been
appointed to the new role of National Data Guardian for health and
care. The National Data Guardian will become the patients' champion
on security of personal medical information.
Interim guidance for Troubled Families Programme
early starter areas – Sharing health information about patients and
service users with troubled families. DCLG, DH, NHS England and
Public Health England have developed a national health offer to
support the expanded Troubled Families programme. This is an
initiative to improve the lives of up to 400,000 families with
multiple problems, including families with mental and physical
health problems, affected by domestic violence and with vulnerable
children. This data sharing protocol sets out how NHS and Adult
Social Care organisations can work within the Information
Governance Alliance’s five rules for information sharing to share
information in the interests of families, in order to identify
families who could benefit from the Troubled Families Programme.
There is also includes guidance for health professionals and their
partners on Leadership and on Health skills and
training.
Review of data releases by the NHS Information Centre: Summary of HSCIC progress against the review recommendations. Details the Health and Social Care Information Centre's progress with ensuring that patient data is always used safely and securely for the benefit of health and social care, while protecting patient privacy. Its non-executive board member Sir Nick Partridge led a review in June 2014 into how data was released by its predecessor, the NHS Information Centre. He made nine key recommendations to the HSCIC to guarantee greater openness and public confidence, stricter controls over data use and better clarity for data users. This report provides an update on the actions taken to implement the recommendations.
Consultations
Confidentiality and information sharing for direct
care. Seeks views on draft guidance to help health care
professionals make the right decisions about data sharing. There
are also explanatory notes. The consultation closes on
31 January 2015.
News
National Data Guardian appointed to safeguard
patients' healthcare information. Dame Fiona Caldicott has been
appointed to the new role of National Data Guardian for health and
care. The National Data Guardian will become the patients' champion
on security of personal medical information.
NHS patient records will still be sold to insurers. The deputy chairman of the Health and Social Care Information Centre has said that the NHS will continue to sell medical data insurers and other third parties. Sir Nick Partridge's comments come despite an investigation revealing that tens of thousands of patient records were unlawfully passed on.
Social worker suspended for serious breach of confidentiality. A social worker has been suspended from the Health & Care Professions Council (HCPC) Register for 12 months for a serious breach of confidentiality when he was employed in the Adult Safeguarding Team at Portsmouth City Council. Geneva Sibanda accessed the confidential records of three service users who were not in his care and for no professional purpose.
If you wish to discuss any issues around information sharing please contact Jane Bennett.
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
Report calls for new charter of rights for people
with learning disabilities. A report by NHS England calls for a
new charter of rights for people with learning disabilities or
autism, including a right to challenge decisions about where they
are to live.
Chief Coroner's guidance on Deprivation of Liberty. The purpose of this guidance is to give coroners a steer on the application of DoLS in the context of coroner work.
Deprivation of liberty. A Practice Direction by
the Courts and Tribunals Judiciary addresses: the procedure to be
followed in applications to the court for orders under s.21A of the
Mental Capacity Act 2005 relating to an authorisation to deprive a
person of his or her liberty; and the procedure to be followed in
applications under s.16(2)(a) of that Act to authorise deprivation
of liberty under s.4A(3) and (4) pursuant to a streamlined
procedure. See also Alex Ruck Keene's blog.
Winterbourne View – Time for change: Transforming
the commissioning of services for people with learning disabilities
and/or autism. Sir Stephen Bubb, chief executive of ACEVO, has
published an independent report on the future of services for
people with learning disabilities. The report makes a series of
recommendations for the NHS, local government, regulators and the
Government, that includes a robust NHS commissioning framework to
support people with learning disabilities and autism move out of
hospitals and into the community. He also sets out a roadmap for
action.
Frontline First: Turning back the clock? RCN
report on mental health services in the UK This special report
seeks to highlight the issues facing the mental health nursing
community and puts the case forward for greater investment in this
vital service in conjunction with Rethink Mental Illness.
Intelligent monitoring - trusts that provide mental
health services. These intelligent monitoring reports set out
the analysis that will guide the Care Quality Commission's
inspections of trusts that provide mental health services. Together
with local information from partners and the public, the
intelligent monitoring model helps to decide when, where and what
to inspect. For trusts that provide mental health services, the
model considers 59 different types of evidence, based on sources
that include the NHS staff survey, bed occupancy rates, the
national health outpatient survey and concerns raised by trust
staff.
CQC publishes inspection information for mental
health services. Information published by the Care Quality
Commission (CQC) about every NHS Trust in England which provides
mental health services, shows the majority appear to be of low
concern. The CQC has published the information to show the public
how it decides what to focus on and how it will inspect services
according to risk.
Commissioning better mental health services for
young people. The Mental Health Foundation has published a
guide to commissioning mental health services for young people.
The Mental Capacity Act (MCA) and care
planning. This report shows commissioners and providers of care
how to embed the principles of the MCA into care and support
planning across the board.
Acting as a litigation friend in the Court of
Protection. The Guidance aims to demystify the Court of
Protection generally and the role of litigation friend specifically
so as to enable more people to consider taking up the role -
thereby ensuring the better promotion and protection of the rights
of those said to be lacking capacity to take their own
decisions.
Children's and adolescents' mental health and CAMHS. The Health
Select Committee has concluded in a report that there are serious
and deeply ingrained problems with the commissioning and provision
of children’s and adolescents’ mental health services (CAMHS). Such
problems affect the whole system, from prevention and early
intervention through to inpatient services for the most vulnerable
young people. The Committee has made a number of recommendations to
the Department of Health (DH), Department for Education and NHS
England, including recommending that it be a priority for the
DH/NHS England taskforce to obtain up-to-date data on CAMHS.
Consultations
Draft revised statutory guidance to implement the
strategy for adults with autism in England. Seeks views on
draft statutory guidance for local authorities and NHS
organisations to support the implementation of Think Autism, the
update to the 2010 adult autism strategy. The draft guidance covers
areas including the training of staff who provide services to
adults with autism. It also contains additional elements introduced
by Think Autism focused on improving the way health and social care
services identify the needs of adults with autism and ensuring
identified needs are met more effectively to improve the health and
well-being of adults with autism, such as the planning of services,
preventative support and safeguarding and employment for adults
with autism. The consultation closes on 19 December 2014.
Cases
Cases A and B (Court of Protection: Delay and Costs)
[2014] EWCOP 48. In considering cost and delay in two cases,
the Court of Protection expressed the view that the case management
provisions in the Court of Protection Rules had proved inadequate
on their own to secure the necessary changes in practice.
Re AB [2014] EWCOP 49. The Court of Protection
considered an application by a health provider to withdraw
artificial nutrition and hydration from AB, who had been
unconscious since 2005 with no prospect of recovery. The court held
that it was in AB's best interests for artificial nutrition and
hydration to be withdrawn.
News
Deputy PM announces £150m investment to transform
treatment for eating disorders. Nick Clegg has announced new
investment to radically reform the treatment of children and young
people with eating disorders and pave the way for new waiting time
standards. The investment, which will be rolled out over 5 years,
is part of an ongoing campaign by the Government to bring mental
health services on a par with physical care. Money from expensive
institutional care will be channelled to local provision and act as
a base for the development of waiting time and access standards for
eating disorders for 2016 by: supporting schemes to get young
people with eating disorders and self-harm early access to services
in their communities with properly trained teams, making hospital
admission a last resort; and extending access to talking therapies
so that children and young people have a choice of evidence-based
therapies, a treatment plan agreed with their therapist and
monitored and recorded outcomes.
More mental health teams to be based at police
stations and courts. NHS England has announced that another 13
Liaison and Diversion trial schemes are to launch in April 2015 to
place mental health professionals in police stations and courts.
These schemes aim to ensure people who come into the criminal
justice system with mental health conditions, learning disabilities
and other vulnerabilities are recognised and are promptly referred
into health and other services to get the treatment or support they
need. These new schemes will join the existing ten areas that have
been taking part in a two year trial that began in April 2014, to
join up police and courts with mental health services. This will
mean half of the English population will be covered by such schemes
from April 2015. The model will be independently evaluated to
inform a business case for services to cover all of the English
population by 2017/18.
Mentally unwell teenager admitted to adult
psychiatric ward after two days in cell. A 16-year-old who
spent two days in a police cell due to no children’s mental health
beds being available was eventually admitted to an adult
psychiatric ward.
New National Forum on policy around mental capacity
and Lasting Powers of Attorney. A National Forum, with an
independent chair, will be established to raise awareness of the
Mental Capacity Act 2005 (MCA 2005) and its introduction of Lasting
Powers of Attorney (LPA), the Minister of State for Justice and
Civil Liberties has said. Simon Hughes, speaking at the ‘Compassion
in dying conference’, which explored support and information around
end of life decisions, said that it is important to ensure that
those people who lose or lack the ability to communicate autonomy
over decisions, do not lose their rights to do so.
Mental health taskforce announced. The Deputy
Prime Minister Nick Clegg has announced that he is to establish and
chair a new Mental Health Taskforce that will urgently examine: how
to improve mental health services for young people; welfare and
employment issues and helping people back into work; and how to
improve crisis care and prevent the large numbers of people with
severe mental health problems ending up in police cells and
prisons.
Fresh approach to school mental health support.
The DfE has announced that it will be working with the PSHE
Association to help schools know how to teach pupils about mental
health and banish the stigma which can leave young people with
mental health problems feeling isolated. In addition, it will set
out a blueprint for schools to use when delivering their
counselling services, which will be informed by young people and
experts to make sure the advice will meet the needs of the people
it is intended to support.
If you wish to discuss any of the items raised in the above section please contact Simon Lindsay or Stuart Marchant.
Personalisation
Publications/Guidance
Person-centred care made simple. The Health
Foundation has issued a guide to person-centred care that offers a
clear explanation of the principles of person-centred care, why it
is important, how it has developed, and some examples to help those
considering putting person-centred care in to practice. It is
written for anyone interested in health and health care, including
health care professionals and those who use the NHS.
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
An inquiry into patient centred care in the 21st
century: implications for general practice and primary care
This inquiry concluded that clinicians must work with patients in a
different way, providing personalised care and empowering patients
to play an active role in managing their health. The report also
calls for a shift in the way that general practice is delivered, so
that practices come together as federations or networks and work
with a range of other services to deliver coordinated and proactive
care in the community.
Choice of GP practice: Guidance on the new out of
area patient registration arrangements. From 5 January 2015 GP
practices may register patients who live outside their practice
area without home visiting and other urgent care obligations when
patient is at home and too ill to attend their registered practice.
This guidance explains how the new registrations arrangements will
work and associated issues to support implementation, including how
NHS England will ensure such patients can continue to access care
at or near home. It includes a commissioning framework to support
area team decisions on putting in place urgent primary medical care
services. This also provides a nationally priced enhanced service to be used
when commissioning services from local GP practices where these
feature in local strategies to deliver urgent care to out of area
patients when at home.
Out-of-hours GP services in England. The
Commons Public Accounts Committee has published a report on its
inquiry into Out of Hours GP services. It finds that people turn to
out-of-hours GP services when they are worried about their own
health or that of family or friends, and want urgent advice or
treatment. However, the urgent and emergency care system is complex
and people struggle to know which is the right service to use. The
Committee makes a number of recommendations, including that NHS
England should adopt a proportionate oversight regime which
provides it with assurance on the value for money of out-of-hours
GP services and allows it to identify poorly performing services
and make targeted interventions. NHS England should test whether
its guidance on conflicts of interest is being followed and assess
whether it offers enough safeguards. Where contracts for
out-of-hours GP services have been awarded since 1 April 2013, it
should seek documentary evidence that no one with an interest in
the successful provider organisation was involved in the
procurement process. Given the pressures on the NHS budget it is
important that NHS England should expedite the redesign of urgent
and emergency care services. NHS England, working with Monitor,
should urgently identify solutions for paying for urgent and
emergency care that address the current mis-aligned incentives and
promote the treatment of patients in the most appropriate setting
and the most effective use of NHS resources.
CQC publishes GP quality data. Almost eight out
of ten general practices (GPs) in England appear to be of 'low
concern' the Care Quality Commission (CQC) reported. Information on
every GP in England has been analysed and published to help the CQC
prioritise its inspections under the new regime, which was rolled
out formally in October 2014. The CQC's analysis indicated the
services which appear to be doing well, as well as areas where
people may not be receiving high-quality care. GPs have been placed
into bands based on this data, but the CQC emphasised it can only
judge the quality of care within a service once it has carried out
an inspection.
Report unveils plans for digital technology in healthcare. The
quality of patient care and health outcomes can be improved through
digital technology and innovation, according to a report from the
National Information Board (NIB). Under the plans, all patients
should have access to their GP records through apps and digital
platforms by 2015, and to all of the health records – hospitals,
community, mental health and social care services – by 2018.
Next steps towards primary care
co-commissioning. NHS England has published guidance for CCGs
setting out co-commissioning options, and providing CCGs and area
teams with the information and tools they need to implement the
right form of co-commissioning for their local health economy. The
guidance gives CCGs the opportunity to choose afresh the
co-commissioning model they wish to assume, in line with changes
set out in the NHS Five Year Forward View. The guidance looks at
three possible models of primary care commissioning that CCGs could
pursue: Greater involvement in primary care decision-making; Joint
commissioning arrangements; and Delegated commissioning
arrangements. . It clarifies the opportunities and parameters of
each model, including associated functions; governance
arrangements; resources; and any potential risks, with advice on
how to mitigate these. The document then sets out the steps towards
implementing co-commissioning arrangements, including the timeline
and approvals process.
The document is accompanied by a suite of practical resources and tools which are
appended to support local implementation of co-commissioning
arrangements.
Is general practice in crisis? This Nuffield
Trust policy briefing provides an evidence-based overview of the
current state of general practice in England, and offers
policy-makers some potential solutions. It examines demand for GP
services, the GP workforce, funding, and standards of access and
patient care. It then presents four ideas to help solve the
problems facing general practice and the wider NHS.
Not more of the same: Ensuring we have the right
workforce for future models of care. The Royal College of
General Practitioners has estimated that England needs more than
10,000 more GPs by 2022 to meet increased demand and warns of a GP
workforce crisis with consequences such as practice closures and
even longer waiting times for appointments. This paper from the NHS
Confederation sets out some considerations for developing a primary
care workforce that is fit for purpose now and in the future. It
argues that workforce planning and modelling assumptions in primary
care need to incorporate new, emerging and more sustainable models
of primary care.
Patient online support and resources guide.
This guide, developed by NHS England in partnership with the Royal
College of General Practitioners, provides help for general
practices to deliver patient services online. It contains practical
tools on implementing a range of online services including booking
appointments and ordering repeat prescriptions.
The
right workforce for future models of care. The NHS
Confederation has published a paper about the need to develop a
primary care workforce.
RCGP launches 'common sense' guide to Ebola for GPs
and their teams. The Royal College of General Practitioners
(RCGP) has published a step-by-step guide to help GP practices
prepare for and deal with the Ebola outbreak.
If you wish to discuss any queries you may have around primary care please contact David Owens.
Providers
Publications/Guidance
Examining new options and opportunities for
providers of NHS care: The Dalton Review. Sir David Dalton was
asked by the Secretary of State for Health to lead a review into
exploring ways to address the challenges faced by providers of NHS
care. He has now pubished his independent report in which he looks
at new options and opportunities to help the best leaders and
organisations in the NHS to do more for patients. His report
complements the Forward View [see below] and provides the
organisational 'delivery vehicles' that can help translate its
ideas into reality. He states that there are no 'right' or 'wrong'
organisational forms – what matters is what works. This report does
not champion one organisational model over any other but recognises
that it is for our system leaders to pursue the models that will
deliver the greatest benefits to the populations they serve. He
identifies five important themes:
one size does not fit all
quicker transformational and transactional
change is required
ambitious organisations with a proven track
record should be encouraged to expand their reach and have greater
impact
overall sustainability for the provider
sector is a priority
a dedicated implementation programme is
needed to make change happen.
Alongside his report are a number of supporting documents including
details of the collaborative, contractual and consolidation models that he
identifies.
If you wish to discuss any issues relating to providers please contact Vincent Buscemi.
Public Health
Publications/Guidance
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 help nurses, midwives, health visitors and allied health
professionals access 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.
Automated external defibrillators (AEDs): a guide for maintained schools and academies. Guidance for schools on how they can buy, install and maintain an automated external defibrillator. The Government has announced that schools can now opt to buy defibrillators at a reduced price, after it struck a deal, initially for 500 machines, through a reverse auction process run by NHS Supply Chain. The Government intends to order additional batches of defibrillators, with quantities based on school demand, through further reverse auctions.
16 days of action toolkit. 16 Days of Action Against
Domestic Violence is aimed at businesses to support them to take
action against domestic abuse and violence. Employers have a legal
obligation to assess dynamic risk and support the health and safety
and wellness of their employees. Companies can do more to aid their
employees who endure domestic violence, to train those who witness
it, and to protect staff as a whole, with the goal of securing
safety and mitigating financial loss. Spanning across 16 days from
25 November to 10 December 2014, a theme will be identified each
day to explore the various forms of domestic violence. This toolkit
is a step-by-step simple guide on how a company can tackle domestic
violence within these 16 Days. It includes posters, podcasts and
briefings.
In addition, the DH, PHE and the RCGP have highlighted the role that GPs can play in
combating domestic violence has been highlighted, in support of
International Day for the Elimination of Violence against
Women.
Tackling poverty: Making more of the NHS in England. As well as setting out the NHS funding challenge, NHS England’s five year forward view discusses the health system’s role in promoting healthy lifestyle change. But beyond this, there is a bigger opportunity still. Despite all the pressures, the NHS remains, and will continue to remain, a massive economic and social entity. Are we making the most of this enormous power? This report from the King's Fund considers this question as part of the Joseph Rowntree Foundation's wide range of evidence reviews to inform its anti-poverty strategy. The report thinks more broadly about the role of the NHS and its contribution to the wider determinants of health, with a focus on poverty.
Ebola: top facts and mythbuster. These documents set out the important facts about Ebola virus disease and dispel some common myths. They are for organisations to use, if they wish, in their communications with their staff and stakeholders.
Healthwatch – On the board toolkit: Developing
skills for effectiveness on health and wellbeing boards.
Toolkit from the LGA that supports local Healthwatch
representatives on their health and wellbeing board. It provides
guidance on the skills the local Healthwatch representative needs
to effectively represent the local Healthwatch on the HWB, along
with tools that representatives can use for self-development of
leadership capacity.
Health visiting programme and 0-5 commissioning of
public health services. This factsheet provides information for
health practitioners, providers and local authorities on the
Healthy Child Programme and the Health Visiting Programme, the
importance of health visiting, and the transfer of service
commissioning for 0 to 5 to local authorities from 2015.
Scope of 0-5 public health services transition.
Planning and paying for public health services for 0 to 5 year olds
will transfer from the NHS to local authorities in October 2015.
This paper sets out the scope of 0-5 children’s public health
commissioning in greater detail, providing background information
and further detail that capture existing commissioned services,
where they belong currently and where their future destinations are
planned.
There is also an updated Finance fact sheet on the timescales for NHS
Area Teams and local authorities in the run-up to the
commissioning.
Consultations
Introducing mandatory reporting for female genital
mutilation. The Home Office has launched a consultation on how
to introduce a mandatory reporting requirement on cases of FGM. It
focuses on what and who should be covered by the mandatory
reporting requirement: which agencies the requirement should be
applied to; how the requirement will work in practice, and; also
the sanctions that should be employed if professionals fail to
report FGM. It also seeks views on how the multi-agency practice
guidelines on FGM should be placed on a statutory footing most
effectively. The consultation closes on 12 January 2015.
DCLG has also announced the successful 17 frontline community
projects that will receive a share of £270,000 to help end FGM and
‘honour’ based violence by creating a network of community
champions.
If you wish to discuss any queries you may have around public health please contact Olwen Dutton.
Regulation
Publications/Guidance
New care inspection regime for hospices. The Care Quality Commission (CQC) has set out how it intends to regulate and inspect England's hospices and hospice services in a new handbook. Specialist teams, including trained members of the public (Experts by Experience), will inspect all hospice services by carrying out unannounced visits. Services will be rated from 'outstanding' to 'inadequate'. The inspection regime takes effect in January 2015.
Exploring CQC’s well-led domain: how can boards ensure a positive organisational culture? Following the Francis Report into the failures of care at Mid Staffordshire NHS Foundation Trust, and the Government’s response to the report, the Care Quality Commission (CQC) has introduced a more rigorous and wide-ranging approach to inspecting health care providers. The main purpose of inspections is to assess the quality of care delivered to patients. In making this assessment, CQC now also analyses the leadership and organisational culture of providers. The CQC’s inspections focus on five key lines of enquiry as part of its ‘well-led’ domain. These lines of enquiry derive from research undertaken by staff at The King’s Fund and the Centre for Creative Leadership into leadership and culture and draw on a strong evidence base.
Inspecting together: Developing a new approach to regulating healthcare in prisons, young offender institutions and immigration removal centres. The CQC is seeking views on how healthcare in prisons, youth offending institutions and immigration removal centres is regulated. This signposting statement sets out its initial thoughts on a new regulatory model for this sector. In January 2015 there will be a formal 8-week consultation on new guidance for all providers on the joint inspection framework, including how to comply with the new regulations and CQC’s enforcement policy.
Reforming the payment system for NHS services:
Supporting the Five Year Forward View. This paper from Monitor
and NHS England describes how the NHS payment system could begin to
look from 2020. It sets out several payment approaches that Monitor
and NHS England want to develop further with NHS providers and
commissioners, including those in social and primary care. The
payment models aim to support the development of: integrated care
approaches; urgent and emergency care networks; high quality
elective care and specialised services; and parity of esteem for
mental health services. The paper also sets out the improvements
needed to the information building blocks underpinning the NHS
payment system.
Capitation: a potential new payment model to enable
integrated care. Monitor has published this document to support
local service improvement and reconfiguration in 2015/16 and
beyond, highlight examples of successful local payment arrangements
in the NHS and enable evaluation of emerging potential payment
models for use in the NHS. It should be read alongside Monitor and
NHS England’s Guidance on locally determined prices for
2015/16.
See also Monitor's National tariff payment system 2015/16: a
consultation notice that sets out the proposed price lists and
payment rules for NHS services for 2015/16. The consultation closes
on 25 December 2014. The web page also links to a number of
supporting documents.
Bevan Brittan Articles
CQC proposed inspection approach for independent acute
healthcare. CQC last week launched their long awaited
consultation on their approach to regulating independent acute
healthcare. The consultation runs until 23 January 2015. The
document sets out a reasonable level of detail on the main features
of CQC's approach to regulation of the sector. However, on other
important points, the consultation is a 'blank canvas' simply
inviting suggestions as to how the approach should be developed.
Providers are strongly encouraged to review the consultation and
participate as fully as possible in shaping the direction of
regulation.
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
General
Publications/Guidance
National health screening. This report
highlights concerns that the risks and benefits of participating in
screening programmes, for conditions and diseases like cancer, are
not consistently communicated by either the NHS or private health
care providers.
91% of doctors want more guidance on patients recording consultations, MPS survey reveals. A survey by the Medical Protection Society (MPS) has revealed that one in five (19%) doctors have experience of patients recording their consultations. Of those, 40% were not made aware at the time that the patient was recording the consultation. The survey also revealed that 97% of respondents are not aware of any practice or trust policy on having consultations recorded, however almost three quarters (73%) believe they have a right to decline a patient’s request to record a consultation. In addition, 91% would like more guidance on what to do should a patient ask to record a consultation. The MPS has issued advice on dealing with consultations being recorded: Digital dilemmas - Patients recording consultations.
Waiting times for hospital treatment - Commons Library Standard Note. A House of Commons Library Standard Note on waiting times for hospital treatment presents data, charts and maps on the number of people treated (for both admitted and non-admitted pathways), waiting times by NHS area team and NHS provider, and data on individual treatment specialisms.
Department of Health's agencies and partner organisations. An updated list of the DH's arm's length bodies. For each organisation, it gives contact details and information on the executive team.
Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care. This report by the Academy of Medical Royal Colleges provides a framework for a way in which doctors can think critically about waste from a clinical perspective and provides examples of doctors improving the value of health care by reducing waste. Estimates suggest that around 20% of mainstream clinical practice brings no benefit to the patient as there is widespread overuse of tests and interventions.
Consultations
Language controls for nurses, midwives, dentists,
dental care professionals, pharmacists and pharmacy
technicians. Seeks views on changes that will allow the Nursing
and Midwifery Council, General Dental Council, General
Pharmaceutical Council and Pharmaceutical Society of Northern
Ireland to put in place systems for carrying out proportionate
language controls on European applicants and for taking fitness to
practise action where there are concerns about the English language
skills of professionals who are already in practice. There is also
a draft Health Care and Associated Professions
(Knowledge of English) Order 2015 that will implement the
changes, once finalised. The consultation closes on 15 December
2014.
Mandatory FGM reporting by healthcare professionals. Views are sought on how to introduce a mandatory reporting requirement in cases of female genital mutilation (FGM). The Home Office's consultation is specifically focused on the issues and professionals which should be covered by the mandatory reporting requirement--which agencies the requirement should be applied to, how it will work in practice, and sanctions to be employed for failure to report FGM. The consultation closes on 12 January 2015.
News
Hospital in bid to evict patients who are well
enough to leave. The Royal Bournemouth Hospital is threatening
to take legal action so it can evict recovered patients whose
relatives refuse to take them home. The hospital's allegations
relate mainly to elderly patients, who are to be given a week's
notice if they are well enough to leave. Those still on the ward
after the notice period ends could potentially face legal
action.
Simon Stevens announces winners of £2.5m Regional
Innovation Fund. NHS England has announced the 46 NHS Trusts that have received a share of the
£2.5m Regional Innovation Fund to help change patients’ lives and
improve care through innovation. The fund was launched in April to
support and promote the adoption and spread of innovation across
the NHS. It provides opportunities for clinicians to work in new
ways driving innovation which can change patients’ lives.
Organisations can apply for sums up to £50,000 for individual
applications and up to £250,000 for those working
collaboratively.
The King's Fund has set up an online Election
Tracker. As the political debate about the NHS gathers pace, it
will follow the key developments and provide commentary and
analysis on what the parties are saying about health and social
care.
Operating Department Practitioner struck off for
misconduct and dishonesty. An operating practitioner who stole
and took controlled drugs while working for University Hospitals of
Leicester NHS Trust has been struck off the Health & Care
Professions Council (HCPC) Register for misconduct and dishonesty.
Ziyaad Lorgat forged five signatures on the Controlled Drugs
Register, falsified hospital records logging the drugs issued to
patients, fell asleep while on duty, left his post without
permission, and stole and took controlled drugs.
Doctor summoned in first gender abortion
prosecution. Dr Prabha Sivaraman has been summoned to appear in
a criminal court accused of planning an abortion based on the
gender of an unborn child. In the first case of its kind to come to
court in the UK, Dr Sivaraman must appear before Manchester and
Salford Magistrates' Court in December 2014 to face an allegation
under the Offences Against the Person Act 1861. It is part of a
rare private prosecution brought by a pro-life campaigner after the
Crown Prosecution Service decided against charging Dr Sivaraman and
another physician, Dr Palaniappan Rajmohan. A hearing will be held
in January 2015 to decide whether a separate summons should be
issued against Dr Rajmohan
New system to ensure a more timely and consistent
approach for new and innovative medicines to be introduced in
Wales. Announces a new system for so-called “orphan” and
“ultra-orphan” medicines and treatments for patients with rare
diseases. The Welsh Health and Social Care Minister has also
announced that the Individual Patient Funding Request (IPFR)
process, which gives some patients access to innovative medicines
not routinely available on the NHS, is to be
strengthened.
