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

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

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


Safely home: What happens when people leave hospital and care settings? This report from Healthwatch sets out the findings from its inquiry into people's experiences of the issues surrounding discharge and the impact it has on them when it goes wrong, focusing on older people, homeless people, and people with mental health conditions. Many people said that, although they may have been deemed medically safe to leave hospital, they did not feel safe or adequately supported to do so. Others told the inquiry about experiences of delays to their discharge and the significant consequences of being kept in care too long. The report found that there are five core reasons people feel their departure was not handled properly. It highlights how, when discharge goes wrong, it comes at significant cost, both to individuals and to the health and social care system.

Determination of ordinary residence disputes under the Care Act 2014. This note sets out the DH’s position on the determination of questions of ordinary residence referred to the Secretary of State under s.40 of the Care Act 2014, pending the Department’s appeal to the Supreme Court in the case of Cornwall Council v Secretary of State for Health. The Department may decide to stay some ordinary residence dispute determinations where it considers necessary and in the interests of good administration, certainty and consistency, pending clarification from the Supreme Court.

The Budget: Health and social care funding. This briefing from the King's Fund, written in advance of the Budget, warns that unless additional funding is found, a growing black hole in NHS finances could have significant consequences for patient care. Although there are opportunities for the NHS to improve productivity, the briefing argues that initiatives to reduce spending on agency staff and increase financial control will not be enough to offset growing deficits among NHS providers. It also warns that the £8bn p.a. increase in the NHS budget pledged by the government by 2020 is the bare minimum needed to maintain standards of care.

County care markets: Market sustainability & the Care Act. This report from the County Councils Network reveals the reality facing county care markets prior to Part 2 of the Care Act going live. Not only does the report provide evidence that the social care system is already unsustainably reliant on cross-subsidisation by those people that fund their own care, but also that the Care Act could lead to a significant alteration in the funding model currently keeping many local care markets afloat. The report says that as 'a direct result' of inadequate social care funding there is a growing gap between council fees and the levels required by providers to sustain viable markets for older people’s care in many areas. It warns that care homes are at risk from low council fees and there is a likelihood that the Care Act will reduce compensatory high fees from self-funders.

Public perceptions of the NHS and social care: winter 2014. This report provides the results from an IPSOS Mori survey of public perceptions of the NHS and social care services. The survey is the latest in a series of surveys that have tracked public perceptions and attitudes since spring 2000.

Sustainability, innovation and empowerment: A five year vision for the independent social care sector. This report from Care England, the largest representative body for independent social care providers, warns of a collapse in the social care system if providers and commissioners do not work together and more nurses are not recruited into the independent sector. It states that the next five years will be crucial in ensuring that the care and support services that many people rely on remain sustainable.

Micro-enterprises: small enough to care? Presents the findings of an evaluation of micro-enterprises in social care in England by the University of Birmingham, which ran from 2013 to 2015. The aim of the project was to test the extent to which micro-enterprises deliver services that are personalised, valued, innovative and cost-effective, and how they compare with small, medium and large providers. The study investigated whether micro-enterprises outperform larger care providers in delivering support that is personalised, valued, innovative and cost-effective. It also looked at the factors which were facilitating and inhibiting the micro-enterprise care sector. Organisations were classed as micro if they employed five or fewer full-time equivalent staff, and were independent of any larger organisation.

Better Care Fund in 2016/17 - London Councils’ core design principles. London Councils, the cross-party body that represents the 32 London borough councils and the City of London, is urging the Government to take early action to clarify the approach to the BCF in 2016/17 to give boroughs, CCGs and their partners time to develop ambitious plans to take integration a meaningful step forward in that year. It has also set out eight core design principles that it believes should be adopted as a framework for making the BCF in 2016/17 a further significant step forward in health and care integration, while allowing for flexibility to develop ambitious plans to reflect local circumstances and priorities.

Statement on CQC's roles and responsibilities for safeguarding children and adults. Following legislative changes and the introduction of the new inspection regime for health and adult social care services in England, the CQC has updated its information on how it works with its partners to make sure people are protected from abuse, neglect and maltreatment.

Creating a better care system. This report by Ernst & Young, commissioned by the LGA and based on sector views, proposes to the Government to use next month's Budget to divert £1.3bn into a transformation fund each year until 2019/20, equalling a fund of £5.2bn by the end of the decade, to develop a new health and social care system. It argues that a transformation fund would help local government leaders to protect the future of social care for the elderly and disabled by investing resources into a system which focuses on keeping people healthy and out of hospital, rather than putting the majority of money into providing care for serious conditions. Local authorities and health partners recognise that social care must be properly funded to enable councils to alleviate pressure on health services.

Over a million older people struggling to cope at home with zero care. A survey by Age UK reveals that the number of older people who have difficulty with basic tasks such as getting out of bed, washing and dressing but who get no help has now soared to over one million. It contends that cuts to community services and social care funding have a knock on effect on the NHS as the numbers of unplanned 'emergency' hospital admissions of those aged 65+ have increased by over 22% in the past seven years.

Wales replaces the axed UK Independent Living Fund. Announces a new £20m fund to support more than 1,600 disabled people in Wales with their care needs, following the closure of the Independent Living Fund by the UK Government. From 1 July 2015, disabled people in Wales with significant care needs will receive direct cash payments from local authorities to help meet the cost of the care and support they need. Funding of £20.4m has been ring-fenced for the scheme for July 2015 to the end of March 2016, which is based on the number of people receiving ILF when the current scheme closed on 30 June.

Health needs of older people: apply for business funding. Innovate UK is inviting businesses and other organisations to apply for a share of £1m funding from NHS England to develop ideas that can address challenges facing older people with multiple-morbidities and specifically in the problem areas of: Falls, Incontinence and Decline in Functional Ability. Up to 12 contracts could benefit from £100,000 phase 1 product development funding through SBRI Healthcare. This competition is open to single companies or organisations from the private, public and third sectors, including charities. The deadline for applications is noon on 11 August 2015.

Terminally ill children let down by poor end-of-life care. Research by the Royal College of Nursing has found that terminally ill children are being let down by a lack of staff, training and resources in children’s community health services. A UK-wide survey of children’s nurses found that many children are not being given the choice to die at home as there are not enough trained staff to provide 24/7 care in this setting.

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

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Clinical Risk/Health and Safety

Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.

NHS Litigation Authority Annual Report and Accounts 2014/15. ​​In its latest annual report , the NHS Litigation Authority (NHS LA) examines the drivers of the costs of clinical negligence claims and outlines initiatives to support its members in their work to improve safety. Figures for the past year show that the NHS paid out more than £1.1bn to patients and their legal representatives, and estimates that figure will rise to £1.4bn over the coming year reflecting the significant increase in claims that were reported a few years ago. Provisions for future payments relating to incidents occurring prior to 31 March 2015 are £28.6bn, an increase of £2.5bn in the year. Approximately one third of the total sum paid out last year went to the legal profession, most of which was paid to claimants’ lawyers. The NHS LA has stated its support for a move to a position where legal costs are more proportionate to damages whilst ensuring that those with valid claims have a place to go for skilled and experienced support.

Learning not blaming: the government response to the Freedom to Speak Up consultation, the Public Administration Select Committee report 'Investigating Clinical Incidents in the NHS', and the Morecambe Bay Investigation. This report sets out the Government’s position on the Morecambe Bay Investigation, Freedom to Speak Up and the Public Administration Select Committee report on clinical incidents. The three reports cover distinct areas, and the government response addresses the points and recommendations raised in each report. There are some themes common to each report, including the importance of openness, honesty and candour; listening to patients, families and staff; finding and facing the truth; learning from errors and failures in care; and people and professionalism.

How the NHS in England compares to other countries in publishing selected transparency metrics. This analysis looks into how the NHS in England compares to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States in publishing information on quality of care, patient experience and outcomes.

Older people’s experiences of dignity and nutrition during hospital stays: secondary data analysis using the adult inpatient survey. According to this report, an estimated one million people in later life are affected by poor or inconsistent standards of dignity or help with eating in hospitals. It calls for action to improve standards and ensure dignity in care.
Openness and honesty when things go wrong: the professional duty of candour. This guidance, developed in collaboration with the Nursing and Midwifery Council, sets out what is expected of every nurse, midwife and doctor practising in the UK when something goes wrong.

Someone to talk to – the guardian service. Barking, Havering and Redbridge University Hospitals NHS Trust was one of the first trusts to implement a guardian service – an initiative designed to encourage staff to speak up in a confidential setting when they have a concern. This case study looks at the trust's approach and the positive impact the role is having both on staff and on the organisation's raising concerns culture.

Safeguarding NHS staff from violent and aggressive patients. Updated NICE guidance will help to safeguard NHS staff and patients by preventing violent situations and offering clear advice on managing them safely if needed.

Public service markets: putting things right when they go wrong. Over 10m people who used public services (approximately 1 in 5) in the UK last year faced problems when using those services, according to this report by the National Audit Office. The problems ranged from fairly straightforward issues, such as types of food in care homes, to serious and life-threatening safeguarding issues. The report says that consumers find the complaints and redress system confusing, that they have to deal with many different organisations, and that they have a low awareness of which ones to turn to. It finds that system-wide improvements are inhibited by poor central leadership and that public service organisations do not make enough use of complaints to improve services and there are serious impediments to doing so.

Every complaint matters – A seven-point plan for the NHS and social care. Healthwatch has published a seven-point action plan to help ensure that the complaints system gives patients what they need and ensures the NHS and social care services can learn from their mistakes. Its analysis suggests as many as 2,000 incidents a day across the NHS are going unreported as a result, with the number likely to be much higher when users of social care are factored in.

Report on selected summaries of investigations by the Parliamentary and Health Service Ombudsman. This report contains a snapshot of summaries of the complaints the Ombudsman has investigated over a two month period (October and November 2014), during which it upheld 41 per cent of the complaints it investigated. Approximately 80 per cent of investigations are about the NHS in England as opposed to UK government departments and their agencies. During this two month period, most of the NHS investigations were about hospital trusts, followed by GP practices and then mental health trusts. 

Health board sentenced after patient death. A Scottish health board has been fined £40,000 after a patient died when he was served food by hospital staff despite being deemed ‘nil by mouth’.

NHSLA complains of increase in "plainly excessive" claimant costs bills. The NHS Litigation Authority (NHSLA) has complained of "an increasing number of plainly excessive and disproportionate costs bills" and reports that it succeeded in reducing the £326m costs claimed in 2014/15, by £107m. The NHSLA reports that 46 per cent of claims concluded in 2014/15 were resolved with no damages payment, and that it successfully defended 64 per cent of cases that reached trial.

Bevan Brittan Articles
The Duty of Candour - all clear now? The introduction of the Statutory Duty followed Sir Robert Francis QC's recommendations in the Mid Staffs Inquiry and, in the period between the Inquiry reporting in February 2013 and the Duty taking affect, has been the subject of considerable discussion.

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

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Good practice in ambulance commissioning. The National Ambulance Commissioners Network (NACN) has collected and brought together a number of good practice examples to contribute to the ongoing debate on finding new approaches to the provision of emergency services, and the role that clinical commissioners can play in driving those new approaches forward. The briefing shares innovative ways of commissioning emergency care, so as to help ambulance commissioners to think about new ways of working, in partnership with providers, to deliver effective and efficient ambulance services in their local area.

Non-Medical Non-Clinical (NMNC) agreement. The Crown Commercial Service has developed this agreement to provide the NHS, and other public sector organisations, with access to temporary and fixed term staff in white and blue collar roles, across eight lots. The agreement has been specifically developed to help manage the legal and commercial risks associated with engaging temporary staff, with suppliers required to ensure compliance with NHS Employers Employment Check Standards. The NHS Agenda for Change pay rates are used and the agreement includes provision for compliance with Agency Worker Regulations. 

Local Healthwatch governance – A self-assessment toolkit for local Healthwatch and local Healthwatch Commissioners. This toolkit is designed to support local Healthwatch (LHW) and local commissioners in establishing successful governance for an effective LHW organisation. It sets out some key governance questions for LHW and local commissioners to think about in development discussions and in renegotiating contracts. 

Unbundling recovery: Recovery, rehabilitation and reablement national audit report. The aim of a recovery, rehabilitation and reablement (RRR) clinical audit is to improve the quality of patient care and outcomes by delivering a seamless RRR service for acute admitted patients, based on their clinical and bio-psycho-social needs, rather than just their diagnosis or where the care is currently delivered. This report describes how an audit methodology used previously for surgical conditions can be used to assess whether the rehabilitation aspects of a patient's acute hospital stay could be better provided. It shows how, with some further evidence, a locally derived tariff for recovery, rehabilitation and reablement could be developed to support service improvements.

Local estates strategies: A framework for commissioners. This framework explains how CCGs and their partners can create strategic estate plans that cover primary, community and non-clinical estates. It advises that commissioners should produce high quality local estates strategies in collaboration with a wide range of local stakeholders (including the wider public estate). The formation of a Local Estates Forum (LEF) will be key to developing a sufficiently robust understanding of the available estate and aligning it to commissioning intentions to extract maximum value from NHS resources and reduce wastage.
The DH and NHS England have asked Community Health Partnerships and NHS Property Services to help unlock space and value across the NHS estate and create the infrastructure to deliver new models of care. Both organisations already offer expert strategic estates planning services to NHS commissioners and this is now being tailored to meet the challenges set out in the national blueprint, the Five Year Forward View.

Transforming our health care system: Ten priorities for commissioners. This updated King's Fund paper, originally published in March 2011, sets out how health care commissioners must shift the current emphasis on acute and episodic care towards prevention, self-care and integrated and well co-ordinated care to cope with an aging population and increased prevalence of chronic diseases. And they will need to direct resources to the patients with greatest need and redress the 'inverse care law' by which those who need the most care often receive the least.

Commissioning and statutory funding arrangements for hospices in England: Survey results 2015. Sets out the findings of a survey by charities Hospice UK and Together for Short Lives of local hospices' experiences of the commissioning and statutory funding environment. It concludes that statutory funding for adult and children’s hospices in England is fragile, unfair and unsustainable. There are early signs that the lack of fair and sustainable funding is already having an adverse effect on hospice services. This could lead to more pressure on already overstretched NHS services if hospices are forced to reduce the level of care they provide. Hospice UK and Together for Short Lives are calling on the Government to set out how it will bring about fair and sustainable statutory funding for hospice and palliative care.

NHS England’s response to a public consultation "Investing in specialised services". This report sets out NHSE's planned investment decisions for certain specialised services as part of its annual commissioning round. The decision follows a public consultation on the principles and processes NHS England will follow when making investment decisions. Appendix A lists the 39 proposed new investments that will be routinely commissioned.

Is the NHS Standard Contract a barrier to commissioning VCSE organisations? Regional Voices has been told that voluntary, community and social enterprise (VCSE) organisations find the NHS Standard Contract a barrier to having their services commissioned by the NHS. Consequently NHS chief, Simon Stevens, has committed to exploring a shorter version of the NHS Standard Contract for low-value contracts. Regional Voices, with NHS England, has launched a survey to help understand specific issues which organisations have experienced in using the NHS Standard Contract. The survey closes on 27 July 2015.

Bevan Brittan Articles
SEND Joint Commissioning – Can you resist a challenge? Last year the Children and Families Act came into force.  This requires local authorities and CCGs to make sure that there are arrangements in place for joint commissioning the education, health and care provision reasonably required by a child.

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

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Emergency Care

Patient Safety Alert: Harm from delayed updates to ambulance dispatch and satellite navigation systems. NHS England has issued a Patient Safety Alert to ensure ambulance satellite navigation systems are up-to-date.

Updated: Selection criteria and frequently asked questions (FAQs) for Urgent and Emergency Care Vanguards. NHS England has invited expressions of interest from organisations and partnerships across England to become vanguard sites for a further new care model focusing on urgent and emergency care (UEC). The successful applicants will form the fifth group within the overall New Care Models Programme. These FAQs give detailed guidance on the application process and the expectations of the submissions. The FAQs have been updated in response to feedback from potential applicants.

Good practice in ambulance commissioning. The National Ambulance Commissioners Network (NACN) has collected and brought together a number of good practice examples to contribute to the ongoing debate on finding new approaches to the provision of emergency services, and the role that clinical commissioners can play in driving those new approaches forward. The briefing shares innovative ways of commissioning emergency care, so as to help ambulance commissioners to think about new ways of working, in partnership with providers, to deliver effective and efficient ambulance services in their local area.

West Midlands Ambulance Service NHS Trust – Improving health and wellbeing across 5,000 square miles. This case study looks at how the Ambulance Trust developed a health and wellbeing strategy with a focus on the importance of line managers. This resulted in a reduction in sickness absence of 0.64 per cent. Line managers are regularly trained and receive up-to-date health and wellbeing information. They now give health and wellbeing focused appraisals, providing staff with the opportunity to talk about their health.

'Common sense' plea over ambulance speeding fines. The BBC reports that ambulance trusts spent hundreds of hours having to appeal against speeding fines issued to emergency vehicles by police forces. Health bosses have called for the automatic exemption on emergency vehicles to be better enforced. Some trust staff are spending 40 hours a month appealing against the fines. The web page includes statistics on penalty charge notices issued to ambulance trusts.

If you wish to discuss the issue of emergency care please contact Claire Bentley.

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Publications and Guidance
Safeguarding NHS staff from violent and aggressive patients. Updated NICE guidance will help to safeguard NHS staff and patients by preventing violent situations and offering clear advice on managing them safely if needed.

Health and safety competencies for NHS managers. This guidance looks at the nine key competency areas required for managers, identifying the core skills for every managerial post. It will help health and safety professionals and representatives to assess whether their managers have the right skills and competencies to manage health and safety effectively.

10,000 steps a day and 1,000 kgs in weight - a health and wellbeing initiative with a difference. This case study shows how Chesterfield Royal Hospital NHS FT encouraged its staff to exercise and lose 1,000kg in weight, as part of the Global Corporate Challenge which challenged staff to take 10,000 steps a day over a 100 day period.

Evaluating the evidence on employee engagement and its potential benefits to NHS staff: a narrative synthesis of the literature. The objective of this research was to evaluate evidence and theories of employee engagement within the NHS and the general workforce to inform policy and practice. Four research questions focused on definitions and models of engagement; the evidence of links between engagement and staff morale and performance; approaches and interventions that have the greatest potential to create and embed high levels of engagement within the NHS; and the most useful tools and resources for NHS managers in order to improve engagement.

The Royal College of Nursing response to the Nursing and Midwifery Council (NMC) evaluation of the revalidation pilots. The Nursing and Midwifery Council is requiring all nurses and midwives to undergo revalidation every three years, in order to renew their registration. This paper outlines the RCN position on the NMC revalidation pilot. The RCN believes that the right model of NMC revalidation, which is effective and proportionate, can help to protect the public and also to create and sustain a strong culture of professionalism amongst nurses. Their response sets out a number of areas on which the NMC must urgently provide clarity, in order to instil confidence in the nursing workforce and indeed the wider healthcare system that current proposals will be effective, including third party confirmation and the NMC’s emphasis on the use of appraisal as the vehicle for revalidation.

Contract reform for consultants and doctors and dentists in training – supporting healthcare services seven days a week. A report on contract reform for both consultants and doctors & dentists in training, in order to help deliver the aim of providing healthcare services seven day a week.

Enabling the delivery of healthcare services every day of the week. A report on the barriers and enablers, within the Agenda for Change pay system, for delivering healthcare every day of the week.

Bevan Brittan Articles
Surprise European ruling on doctors' working time. In an unexpected decision, the European Court of Justice (ECJ) has departed from the advice of the Advocate-General (given back in March) and held that Irish contractual terms regarding junior doctors' training do not breach the Working Time Directive.  

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

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Publications and Guidance
Open book accounting and supply chain assurance. The NAO has called for government to negotiate greater access to, and make better use of, information about how much outsourced public services are actually costing suppliers and therefore how much profit they are making. An NAO survey found that such information, known as open-book accounting data, is currently available in only 31% of contracts and that, even then, it is not always received. The NAO has identified five approaches to collecting and using information on suppliers. It recommends that every major contract have a strategy for the collection and use of information and that every government department have a policy on when it will use open-book accounting. According to the NAO’s survey, currently only 23% of government organisations have a policy on when to use open-book accounting.

Better value in the NHS: The role of changes in clinical practice. In a time of severe financial constraint, the NHS is being asked to make productivity savings of £22bn by 2020/21. However, this report from the King's Fund argues that, rather than looking at efficiency and costs, the NHS should be focusing on getting better value from its budget. The report looks at trends in NHS productivity in three areas – generic prescribing, length of stay and day case surgery – in which the NHS has made significant and sustained gains in productivity over a number of years, allowing more (and often better) care to be delivered within the same budget. It then outlines a number of areas where the NHS has opportunities to improve value in the future, focusing in particular on changes in clinical practice. With the NHS facing a huge financial challenge over the next few years, the report argues that action is needed at all levels of the system focused on improving value for every pound spent in the NHS. 

Quarterly monitoring report: issue 16 According to this report, more than 60 per cent of NHS trust finance directors think controls on agency spending announced in June will not significantly reduce the amount spent on agency staff. The regular survey carried out for the report also found that three-quarters of trusts intend to recruit more permanent nurses in the next six months, suggesting that the NHS is continuing to prioritise quality of patient care despite rising financial pressures.

If you wish to discuss any finance issues please contact Claire Bentley.   

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Foundation Trusts

Consultation on changes to the NHS foundation trust annual reporting manual 2015/16. Monitor is seeking views on its proposed changes to the draft NHS foundation trust annual reporting manual for 2015/16. The consultation closes on 31 July 2015.

Bennett lays down billion pound challenge to NHS foundation trusts. Monitor's chief executive David Bennett is calling on NHS FTs to redouble their efforts to make efficiency savings in order to bring down a deficit that threatens to reach £1bn this year.

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

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Information Sharing

Bevan Brittan Publications
Commission to review Freedom of Information law. The Cabinet Office has announced that it is launching a review of the Freedom of Information Act 2000. The independent Commission will "consider whether there is an appropriate public interest balance between transparency, accountability and the need for sensitive information to have robust protection, and whether the operation of the Act adequately recognises the need for a ‘safe space’ for policy development and implementation and frank advice".

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

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Mental Health

Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.

Transforming care for people with learning disabilities – Next steps: Progress report. This reports sets out progress made with the ambitious programme of system wide change to improve care for people with learning disabilities and/or autism, and behaviour that challenges. The report is clear that while progress is being made, there is still much more to do to ensure that where it is appropriate, people are cared for in the community and close to home. Over three quarters of GPs (77%) think their patients with dementia rely on family as they don't get enough help from health and social care services, while half of GPs think the NHS is doing too little to care for people with the condition.

Dementia 2015: Aiming higher to transform lives. This is the Alzheimer's Society's fourth annual report looking at quality of life for people with dementia in England. It contains the results of its annual survey of people with dementia and their carers, and an assessment of what is currently in place and needs to be done to improve dementia care and support in England over the next five years. It states that now is the crucial turning point for dementia, and the Government's commitment to dementia needs to be met by a fully-fledged national action plan for the 2020 challenge. The report provides a snapshot of how well people are living with dementia, what support they are receiving and what barriers they face to living well. It makes practical recommendations to the new Government on the steps that need to be taken to make quality of life better for people with dementia.

Child and Adolescent Mental Health Service and Schools Link pilot scheme. NHS England and the DfE are inviting CCGs to apply to become one of 15 pilot sites to improve mental health services for children and young people. The pilot schemes will test the impact of joint training of linked staff in school settings and local NHS funded child and adolescent mental health services (CAMHS) to improve care and ensure timely, appropriate referrals. The closing date for expressions of interest is 31 July 2015. A national roll-out of the scheme is planned for next year.

Note for adult safeguarding boards on the Mental Health Crisis Concordat. The Mental Health Crisis Care Concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis. The LGA and ADASS have published a note for adult safeguarding boards on the Mental Health Crisis Care Concordat. Included in this document is a checklist which safeguarding adults boards can use to assess their progress with the local implementation of the Concordat. Some examples of good practice in safeguarding adults boards' involvement with the implementation of the Concordat are also included.

Right here, right now. This CQC report looks at the quality, safety and effectiveness of care provided to those experiencing a mental health crisis. The findings show that there are clear variations in the help, care and support available to people in crisis and that a person’s experience depends not only on where they live, but what part of the system they come into contact with.

Psychological support for people living with cancer. The London Mental Health Strategic Clinical Network, in partnership with the Transforming Cancer Services Team for London, has produced this guidance to support commissioners and service providers in improving psychological support across the cancer pathway. The 10 recommendations cover commissioning, workforce education, training and supervision, and service development and delivery.

How can and should UK society adjust to dementia? The Joseph Rowntree Foundation has published a paper that aims to stimulate debate about new ways forward in understanding, and ways to meet the needs of the growing number of people living with dementia. The publication explores the application of the social model of disability to dementia. It looks in detail at what this social model is, and where it has come from, bringing together the authors’ interests in disability and ageing, and training in disability studies and health and social geography.

Mental health crisis review – experiences of black and minority ethnic (BME) communities. The Race Equality Foundation was commissioned by the Care Quality Commission to conduct a series of interviews and focus groups with black and minority ethnic people, in specific areas, who had experience of crisis care. These areas were: Ealing, Lambeth, Northampton, Sandwell and Southampton. This report presents the results of this work and provides an insight into patient experience of mental health crisis care from a BME perspective.

Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. Avoid medication as first resort for challenging behaviour. Antipsychotic mediation should only be used in particular circumstances and not as a first resort when managing behaviour that challenges in people with learning disabilities, says NICE.

Mental capacity and deprivation of liberty. The Law Commission is seeking views on how the law should regulate deprivations of liberty involving people who lack capacity to consent to their care and treatment arrangements, in light of the Supreme Court's decision in P v Cheshire West and Chester Council; P v Surrey CC [2014] UKSC 19. It states that the majority in Cheshire West were clear that disabled people have the same rights as anyone else and this must be the starting point. The task is to find the best solution. The consultation closes on 2 November 2015.

Bevan Brittan Events
Court of Protection Update - Bevan Brittan's Court of Protection team is hosting a practical update session in each of our offices which will cover relevant legislation, guidance and case law and their impact on managing cases involving incapable patients.
Court of Protection Update - Birmingham. 03 November 2015 : 10:00 - 13:30 (registration opens at 09:30 and event will be followed by lunch)
Court of Protection - Bristol 04 November 2015 : 10:00 - 13:30 (registration opens at 09:30 and seminar will be followed by lunch)
Court of Protection - London 05 November 2015 : 10:00 - 13:30 (registration opens at 09:30 and seminar will be followed by lunch).

Bevan Brittan Articles
Mental Capacity and Deprivation of Liberty. On 7 July 2015 the Law Commission published its Consultation Paper on Mental Capacity and Deprivation of Liberty. In this alert we explain the key proposals put forward.

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

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Primary Care

What are community health services? The NHS Confederation has published this very simple guide that explains what community health services are and the key role they can play in supporting people and delivering care. It states that community health services cover ‘cradle-to-grave’ services that many of us take for granted. They provide a wide range of care, from supporting patients to manage long-term conditions, to treating those who are seriously ill with complex conditions. Most community healthcare takes place in people’s homes. Teams of nurses and therapists coordinate care, working with professions including GPs and social care. Additionally community health provides preventative and health improvement services, often with partners from local government and the third sector. Although less visible than hospitals, they deliver an extensive and varied range of services employing some 250,000 staff.

General practice in England. This Commons Library briefing paper provides general background for Members and their staff on NHS primary medical services provided by general practitioners (GPs) in England. It gives an overview of commissioning arrangements as well as information on changes to GP contracts and funding arrangements.

Primary care co-commissioning submission and approval process for 2015/16. Information on the application process and key dates for CCGs who wish to apply in 2015/16 to take on new delegated and joint commissioning arrangements for the majority of GP services. The deadline for applications by CCGs for fully delegated commissioning of primary care in 16/17 is 2 October 2015. For joint commissioning arrangements, there are go-live dates of 1 October 2015, 1 January 2016 and 1 April 2016.

A blueprint for building the new deal for general practice in England. Sets out the RCGP's comprehensive plan for the future of general practice. It includes five actions for the new government to consider: investment of 11% of the budget in general practice; increasing the workforce; free-up GPs time for patient care; allow time for GPs to innovate; and improve GP premises.

Improving acute inpatient psychiatric care for adults in England: interim report. The Commission on Acute Adult Psychiatric Care was set up by the Royal College of Psychiatrists in response to widespread concerns about the provision of acute inpatient psychiatric beds and alternatives to admission available for patients. This interim report is based on the Commission’s initial observations about acute inpatient psychiatric services for adults in England and its discussions with patients, carers, advocates, health and social care professionals and policy makers. It finds that the so-called bed or admission crisis in adult mental health is very significantly a problem of discharges and alternatives to admission that can only be addressed through changes in services and management of the whole service.

Examples of outstanding practice. The CQC has been inspecting general practices under a new inspection model since October 2014, and has now published approximately 1,200 GP practice inspection reports. This online tool brings together a collection of some of the most innovative and effective examples of outstanding practice that CQC inspectors have found since implementing the new methodology.

New deal for general practice. The Health Secretary Jeremy Hunt has announced the first steps in a new deal for general practice, so as to improve the quality and continuity of care for vulnerable patients and deliver better access, 7 days a week, for everyone. This includes:

  • increasing the primary and community care workforce by at least 10,000, including an estimated 5,000;
  • more doctors working in general practice, as well as more practice nurses, district nurses, physicians’ associates and pharmacists;
  • significant improvements in the quality of primary care facilities;
  • new models of care to deliver access 7 days a week;
  • more support for community pharmacists;
  • developing better data and metrics to assess quality in general practice; and reducing bureaucratic burdens on general practice to release more clinical time for patients.

See also Jeremy Hunt's message to NHS staff on the new deal for GPs.

NHS dentist access: real choice is out of reach. Research by Which? reveals that 31% per cent of NHS dentists who say they’re accepting new patients on the Government's NHS Choices are actually not, and those that are often have lengthy waits. The findings came from a mystery shop to uncover the true state of NHS dentist availability, after the consumer body's campaign to Clean Up Dental Costs revealed the difficulties that some people face when trying to find an NHS dentist.

New £15m scheme to give patients pharmacist support in GP surgeries. NHS England has launched a new £15m scheme to fund, recruit and employ clinical pharmacists in GP surgeries, as part if the New Deal for General Practice. The three year initiative will give patients the additional support of an expert pharmacist in their GP surgery. Examples of the benefits patients can expect include extra help to manage long-term conditions, specific advice for those with multiple medications and better access to health checks. The pharmacists will be employed directly by the general practice to help patients, while also easing GP workload and improving communication between general practice, hospitals and community pharmacists. It will focus on areas of greatest need where GPs are under greatest pressure, and aims to build on the success of GP practices already employing pharmacists in patient-facing roles. 

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

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Public Health

Making it better together: A call to action on the future of health and wellbeing boards. The LGA and NHS Clinical Commissioners have launched an ambitious call to action and a set of proposals to local system leaders and the Government to strengthen the impact and leadership of health and wellbeing boards across the country. The document also outlines the LGA and NHS Clinical Commissioners shared commitment to support boards to reach their full potential as system leaders driving forward changes that will improve the health of their communities.

NHS public health functions agreement: Variation to the 2014-15 agreement on public health functions to be exercised by NHS England. Provides for variations to the NHS public health functions agreement that sets out the arrangements under which the Secretary of State delegates responsibility to NHS England for certain public health services (known as Section 7A services).

Focus on the health and care of young people, June 2015. These statistics on the health, care and wellbeing of young people in England, from birth to young adulthood, bring together in one place for the first time a range of information, including use of hospital services, talking therapies, prescribing, immunisations and lifestyle trends. The HSCIC report aims to provide a more joined-up picture of key areas of health and care among younger age groups.

NHS public health functions (Section 7A) and co-commissioning of primary medical services. Guidance for teams co-commissioning public health with CCGs on the practical management of commissioning public health in a co-commissioning environment, where legal responsibility for Section 7A services remains with NHS England. The document is intended to support effective relationships between CCGs and integrated regional teams for public health commissioning. It also highlights the role of professional experts, including screening and immunisation leads, in providing advice to CCGs.

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

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How CQC regulates NHS 111 services: Provider handbook. Sets out CQC's approach to inspecting NHS 111 services against those areas that users say matters most to them and assess whether the services are safe, caring, effective, responsive to people’s needs, and well-led.

Review of the contingency planning team/trust special administration procedure at Mid Staffordshire NHS Foundation Trust: lessons learned. This report describes the lessons Monitor has learned from the regulatory procedure at Mid Staffordshire NHS Foundation Trust, the actions it has taken to apply these lessons, and how that experience is informing the pre-emptive approach it now follows to help organisations in struggling local health economies avoid chronic difficulties.

The Royal College of Nursing response to the Nursing and Midwifery Council (NMC) evaluation of the revalidation pilots. The Nursing and Midwifery Council is requiring all nurses and midwives to undergo revalidation every three years, in order to renew their registration. This paper outlines the RCN position on the NMC revalidation pilot. The RCN believes that the right model of NMC revalidation, which is effective and proportionate, can help to protect the public and also to create and sustain a strong culture of professionalism amongst nurses. Their response sets out a number of areas on which the NMC must urgently provide clarity, in order to instil confidence in the nursing workforce and indeed the wider healthcare system that current proposals will be effective, including third party confirmation and the NMC’s emphasis on the use of appraisal as the vehicle for revalidation.

Changes to the information we publish and disclose about a doctor’s fitness to practise. The GMC is seeking views on a number of changes to the information it publishes about doctors who have been through a fitness to practise investigation and received a sanction. The proposals aim to make its approach to publishing this information more open and transparent for patients, and also fairer to doctors. The consultation closes on 23 September 2015.

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

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Smoking: harm reduction. This NICE quality standard covers ways of reducing harm from smoking. In particular, this includes people who are highly dependent on nicotine and who may not be able (or want) to stop smoking in one step, who may want to stop smoking without giving up nicotine, who may want to reduce the amount they smoke without stopping, or who want to abstain temporarily from smoking. 

Report of the Chief Coroner to the Lord Chancellor – Second Annual Report 2014 to 2015. This is the Chief Coroner's second annual summary of the operation of coroner services under s.36 of the Coroners and Justice Act 2009, following the implementation of the Act’s reforms in July 2013. The report summarises his work to promote consistency in the resourcing of and practices in coroner offices across England and Wales. It highlights how the Chief Coroner is working towards a greater consistency in all areas of the coroner domain and is encouraging bringing coroner services together under one roof.

Accelerated Access Review: UK mapping. As part of its work to set out new pathways for development of medicines and medical technology, ultimately to give NHS patients quicker access, the Accelerated Access Review team commissioned Monitor Deloitte, CASMI and King’s Fund to conduct a study into the barriers to getting patients faster access to innovation. The report maps the existing innovation pathways for medicines, devices and diagnostics.

Insights on earlier adoption of medical innovations. The Accelerated Access Review asked RAND Europe to conduct a study to identify and gain insight into international examples of best practice where the use of new drugs, devices and diagnostics were already being accelerated. The study explored systems across the world through which drugs, devices and diagnostics pass rapidly, identifying what works both in theory and in practice.

Accessible information standard. The accessible information standard will be implemented on 31 July 2016 and aims to provide people who have a disability, impairment or sensory loss with information that they can easily read or understand. This means informing organisations how to make sure people get information in different formats, for example in large print, braille or via a British Sign Language interpreter.  

Report on the effect of the NHS Constitution. This report seeks to clarify the effect of the NHS Constitution on those who use NHS services and who work in the NHS. It is the second report by the Secretary of State on the effect of the NHS Constitution. It has been prepared not only to meet the legal duty imposed by the Health Act 2009, but also to understand its real, practical impact over the six years since its launch. It shows the progress made, as well as the lessons that can be learned for the future, and identifies the areas in which improvements must be made to further the impact of the NHS Constitution.

Meeting the challenge: Future visions of healthcare. With the newly elected Conservative Government promising to pick up where they left off, the healthcare sector is likely to look somewhat different in a decade’s time – both in terms of the demands it faces and how it meets those challenges. This Localis essay collection gathers a range of expert views on what the future of healthcare might look like.

The Department of Health's agencies and partner organisations. Information and contact details for the DH's agencies and partner organisations (arm's length bodies).

Hospital competition improves performance. This report shows that hospital competition can improve healthcare by improving the quality of management practices. The research measured the management quality of 100 public hospitals through a management survey of clinicians and managers, and used data published by the government to assess the performance of NHS hospitals in England.  

Ma v St George's Healthcare NHS Trust [2015] EWHC 1866 (QB). M brought libel proceedings against the NHS Trust. She contended that words in hospital referral forms publications meant that her behaviour had been reprehensible in such a manner as to raise rational child safeguarding concerns for her daughter. The court held, dismissing her claim, that a child safeguarding referral form sent from hospital staff, who had been attempting to treat M's child where M's behaviour had been confrontational and erratic, to an on-site health visitor liaison officer whose responsibilities included child safeguarding, was necessary and proportionate and was protected by qualified privilege. Malice had not been established to defeat that defence.  

Budget confirms £10bn funding commitment. The NHS Confederation summarises the key announcements for health bodies in the Summer Budget.

Bereaved to benefit from action on cremation and coroner services. The Justice Minister Caroline Dinenage has announced that a consultation on changes to rules for cremations will take place later this year. It will include government proposals to tackle the issues revealed by an independent report published last month into practices at Emstrey Crematorium in Shropshire, which found unacceptable failures in the cremation of infants which denied families the closure they deserved. A separate review will be carried out of the out-of-hours services provided by coroners in England and Wales to make sure they are sensitive to the needs of the whole community, including those whose beliefs require burials to take place quickly. The Chancellor has also announced that an additional review will be launched by DCLG into existing crematorium facilities, to make sure they are adequate for all community needs in the present day.

Patients across the country set to benefit from the roll out of proven healthcare innovations. NHS England has announced the 17 successful applicants who have won funding to develop healthcare innovations for hospitals and GP practices in England. The innovations will help to prevent disease, speed up diagnosis, improve safety and efficiency of services and increase patient participation in decision making, self-management and research.

New social contract between the public, health and care services. The Health Secretary Jeremy Hunt has given a speech to the Local Government Association conference in which he called for a new social contract between the public, health and care services. He urged the public to take more personal responsibility for looking after the elderly, for their own health, and in using finite NHS resources. He argued that, while integration of health and social care is vital to delivering the highest standards of health and care, personal responsibility needs to sit alongside system accountability.

Patients to be told price of prescribed drugs in bid to save NHS £300m. The Independent reports that patients will be told the price of every drug they are prescribed that costs the NHS more than £20 in a scheme to help reduce waste and encourage patients to complete courses of medicine. Under the plans, drug packets will be marked with a label stating that they have been “funded by the UK taxpayer” along with the total price that the prescription costs the health service. The move aims to give patients a more accurate picture of the costs of illness to the NHS and encourage people to take responsibility for their health. It follows a study, commissioned by the Government, which found that wasted medicines cost the NHS £300m a year.

Health must begin at home – Stronger collaboration with housing could save the NHS billions of pounds a year. Dr Michael Dixon, chair of NHS Alliance, argues that housing organisations could save the NHS billions of pounds a year, stating that “health must begin at home”. Ensuring people have a safe and warm home to return to after a hospital stay would help swifter discharges, while a reduction in emergency admissions and GP appointments could be achieved through preventative measures. His speech marks the launch of an NHS Alliance-driven initiative to better understand the correlation between housing and health, ‘Health Begins At Home’. NHS Alliance has collaborated with the housing sector to develop a brand new Housing for Health online resource to support this initiative that will allow housing and health professionals to network and share learning and good practice, and aims to review and update evidence as it becomes available.

Bevan Brittan Articles
Commission to review Freedom of Information law. The Cabinet Office has announced that it is launching a review of the Freedom of Information Act 2000. The independent Commission will "consider whether there is an appropriate public interest balance between transparency, accountability and the need for sensitive information to have robust protection, and whether the operation of the Act adequately recognises the need for a ‘safe space’ for policy development and implementation and frank advice".

What the Lowell Goddard Inquiry means for you Justice Lowell Goddard opened the Independent Inquiry into Child Sexual Abuse on 9 July 2015. As has been widely reported, her five principle work streams will include an examination of institutions run by local authorities and charities led by Professor Alexis Jay OBE (one of the Inquiry's appointed experts and author of the report on sexual exploitation of vulnerable children in Rotherham). Adoption, fostering and social work services will also be reviewed and Goddard has promised that "no-one will have immunity from scrutiny" by virtue of their position.

PPUs – do the CMA investigation powers constrain new PPUs? A first decision under the jurisdiction On 2 July the Competition and Markets Authority (CMA) published its first decision under its new jurisdiction created by the Private Healthcare Market Investigation Order 2014 in relation to the establishment of a new PPU.

Strategic estate partnerships: Maximising the value in NHS estate Since their inception in 2010, strategic estate partnerships (SEPs) or strategic infrastructure and efficiency partnerships (SIEPs) as they are also known, have really started to gain currency as a way of maximising value and aligning the estate more closely with clinical and commercial strategy.


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