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

Children

Mental Health

Clinical Risk/Health and Safety

Primary Care

Commissioning

Procurement

Employment/HR

Public Health

Finance

General

 

Care

Publications/guidance

End-of-life care and physician-assisted dying: reflections and recommendations. This project, launched in November 2014, aimed to examine both the public and medical professionals' attitudes on aspects of end-of-life care and physician-assisted dying. While recognising the many excellent examples of end-of-life care provision, this research highlights the variability in the quality of care between and within geographical areas and between different medical conditions. The report outlines the main challenges to providing good end-of-life care and the ways we can address them. It highlights three overarching themes which have come out of the research: the need to ensure the provision of consistently high-quality end-of-life care; the need for ongoing education, training and support for doctors; and the central role of families and those close to the patient.

Care and support statutory guidance. Updated statutory guidance that supports implementation of Part 1 of the Care Act 2014 by local authorities, the NHS, the police and other partners. It supersedes the version issued in October 2014. The updated guidance takes account of regulatory changes, feedback from stakeholders and the care sector, and developments following the postponement of social care funding reforms to 2020. Note that the statutory guidance is now web-base and is no longer available in pdf format. There is also a table showing where changes have been made and detailing the more significant changes.

Local authority circular: Charging for care and support (LAC(DH)(2016)2): This circular advises local authorities of the social care charging arrangements for 2016 to 2017. It sets out the capital limits, Personal Expenses Allowance, Minimum Income Guarantee and the savings credit disregards

Behind the headlines. Almost 3 million hospital bed days have been lost between June 2010 and January 2016 due to a lack of social care provision at a cost of £910m, according to a new report by Age UK.

Reducing Health Inequalities and the Shared Delivery Plan 2015 to 2020; and assessment of fulfilment of the Secretary of State’s and NHS England’s health inequalities duties in 2015-16 and beyond. Letter from Jeremy Hunt, Health Secretary, to heads of health bodies setting out the criteria he will use to assess if they meet their legal duties on reducing health inequalities, as set out in the Health and Social Care Act 2012.   

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

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Children

Publications/guidance

RAND Corporation Using evidence to strengthen policies for investing in children. This evidence guide provides a starting point for policymakers who seek more information on how to use evidence to strengthen policies for investing in children. It will familiarise users with the basics of some approaches to using evidence to inform policies related to children including conducting needs assessments, selecting practices that have shown promise in previous implementation, developing a logic model to help plan a practice and determine if it has achieved its objectives, and conducting or overseeing various types of evaluation including theory-based evaluations and counterfactual impact evaluations.   

Bevan Brittan Articles

Children - which decision counts? Hannah Taylor. It is a well-known principle in English law that a competent adult’s refusal to treatment cannot be overridden – no matter how unwise or incomprehensible that decision may be. The same cannot always be said in relation to children, who, as a society we consider must be afforded an added protection against their own unwise or irrational decisions.

If you wish to discuss any queries you may have around children please contact Deborah Jeremiah

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Clinical Risk/Health and Safety

Bevan Brittan Training - If you are a client and 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

Saving babies' lives: a care bundle for reducing stillbirth. This guidance is part of a drive to halve the rate of stillbirths from 4.7 per thousand to 2.3 per thousand by 2030, potentially avoiding the tragedy of stillbirth for more than 1500 families every year. While the majority of women receive high quality care, there is around a 25 per cent variation in stillbirth rates across England. The guidance addresses this variation by bringing together four key elements of care based on best available evidence and practice in order to help reduce stillbirth rates.

The UK: your partner for patient safety This publication outlines some of the patient safety initiatives the UK is currently pursuing, and the organisations which are leading the way in standards of safety. The different sections also provide information on the partners who can best help you achieve your goal of safer, better healthcare.

From a blame culture to a learning culture. Health Secretary addresses the Global Patient Safety Summit on improving safety standards in healthcare.

NRLS Research and Development Final Report. This report from Imperial College London focuses on the current system used by NHS staff to report patient safety incidents, called the National Reporting and Learning System (NRLS). The report authors explain this system requires refinement and renovation, so as to take advantage of new technologies and recent behavioural insights. For example app-based technologies offer a simplified platform that engages staff in the incident reporting process. This will not only improve the ease of reporting, but also the accuracy of data reported. In particular, the report reiterates problems around under-reporting of safety incidents, and reveals structural concerns within the NRLS, that have inhibited its usefulness as a tool to drive safety improvement.

Patient Safety 2030 published by Imperial College London suggests a ‘toolbox’ for patient safety. This would include: using digital technology to improve safety; providing robust training and education, and strengthening leadership at the political, organisational, clinical and community levels. Other points in the ‘toolbox’ include effective and high-quality education and training; strengthening measurement methods, including incident reporting, and exploring new digital solutions. However, the authors warn that interventions implemented to reduce avoidable patient harm must be engineered with the whole system in mind, and empower patients and staff to become more involved in preventing harm and improving care. 

News

Healthcare Safety Investigation Branch (HSIB) Expert Advisory Group. On 16 July 2015 the Governments published its response to three inquiries into patient safety: the Morecambe Bay Investigation, Robert Francis’ report into whistleblowing (Freedom to Speak Up) and the Public Administration Select Committee report on clinical incidents. In particular, the Government response, Learning not blaming, set out plans for an Independent Patient Safety Investigation Service to be established and in place from 1 April 2016. Launching this report, on 16 July 2015, the Secretary of State also gave a speech setting out his ambition for the NHS to become the world’s largest learning organisation. Following feedback from the group and others, the function’s name was changed to the Healthcare Safety Investigation Branch (HSIB).

The Care Quality Commission is to review data security in the NHS, as national data guardian Dame Fiona Caldicott starts to develop new security standards and rules on how patient information is shared after it was revealed that the NHS is particularly vulnerable to cyber attacks due to the vast difference in its cybersecurity across each of its 40,000 hospitals, GPs' surgeries and care homes.

Minister hints at flexibility over £250k clinical negligence costs limit. The Government has suggested that it may be prepared to be flexible about the upper limit for fixed costs in clinical negligence cases. Speaking during a Westminster Hall debate on 9 March 2016, Health Minister Ben Gummer stated that the proposed upper limit of £250,000 was not arbitrary, but chosen based on the original intentions of Lord Justice Jackson's review of civil litigation costs in 2010.

New league launched to encourage openness in the NHS. Monitor and the NHS Trust Development Authority have launched "Learning from mistakes league" – a league table identifying levels of openness and transparency within NHS trusts and foundation trusts. The league table has been drawn together by giving providers scores based on the fairness and effectiveness of procedures for reporting errors, near misses and incidents; staff confidence and security in reporting unsafe clinical practice and the percentage of staff who feel able to contribute towards improvements at their trust. NHS Improvement will work with providers at the bottom of the league to assist them with improving their openness and transparency.  

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

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Commissioning

Publications/Guidance

Commissioning for Quality and Innovation (CQUIN): Guidance for 2016/17. This document sets out the CQUIN scheme for 2016/17. The CQUIN scheme is intended to deliver clinical quality improvements and drive transformational change. The 2016/17 scheme introduces two new indicators: one improving the health and wellbeing of NHS staff and the other focusing on 62 day cancer waiting times. 

Consultations

Specialised Services clinical commissioning policies and service specification – 7th Wave. NHS England is seeking views on a proposed number of new products for specialised services, including service specifications and clinical commissioning policies. There has already been extensive engagement on these national specifications and policies, as they have been developed with the support and input of lead clinicians and patient and public representatives. Please note this is one of several public consultations on a proposed number of new draft products for specialised services. The consultation closes on 10 April 2016.

Bevan Brittan Events

Taking stock of NHS governance after the 2013 reforms: Public procurement, competition and conflicts of interest in NHS commissioning. 23 June 2016 09:00. University of Bristol Law School, with the generous sponsorship of PolicyBristol and Bevan Brittan, and supported by the Elizabeth Blackwell Institute for Health Research. This event has two main objectives. First, it intends to bring together CCGs, NHS Trusts, legal practitioners and academics, so that we can collectively take stock of this aspect of the new NHS governance framework almost 3 years after its adoption.

Commissioners' Light Touch Regime - Bristol. 18 April 2016 13:30. The aim of this interactive seminar is to help commissioners of healthcare services get to grips with the new rules which are coming into force within April. Attending will help you understand the way the new regime applies and how to navigate the new rules. There will be a focus on practical advice and the management of the risks for NHS procurement of health care.

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

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Employment/HR

Bevan Brittan Events

Junior doctors' banding claims - Birmingham. 04 May 2016 09:30. Although there is a lot of uncertainty about the introduction of the new junior doctors' contract in 2016, NHS Trusts are continuing to face an increasing number of banding appeals and claims arising from non-compliant rotas. The BMA is supporting more and more claims and many Trusts are defending proceedings issued in the Employment Tribunal or the civil courts. 

Junior Doctors' banding claims - Bristol. 12 May 2016 09:30. Although there is a lot of uncertainty about the introduction of the new junior doctors' contract in 2016, NHS Trusts are continuing to face an increasing number of banding appeals and claims arising from non-compliant rotas. The BMA is supporting more and more claims and many Trusts are defending proceedings issued in the Employment Tribunal or the civil courts.

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

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Finance

Publications and Guidance

Sustainability and financial performance of acute hospital trusts. This Commons Public Accounts Committee report finds that the financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable. In its investigation of the acute hospital sector, the report argues that the government has not acted quickly enough to keep acute hospital trusts in financial balance and that there is not a feasible plan in place yet for closing the funding gap. The other aspects of the acute sector's management that is highlighted as damaging were: government efficiency targets; data used to estimate potential cost savings to trusts; attempts to control agency spending; and the lack of incentive for joined-up health services.

Guidance on overseas visitors hospital charging regulations. Guidance on making and recovering charges for NHS hospital treatment from overseas visitors not exempt from charge.

Help for NHS to recover costs of care from visitors and migrants. Documents include template letters, posters and guidance to help NHS trusts manage overseas visitors and migrant charging.

Support for NHS providers to improve finances. NHS providers will have help with improving their finances, Monitor has announced. Among the help providers will receive is 'on site' improvement expertise from early April 2016, designed to strengthen the way they identify, plan and undertake financial improvement.

A perfect storm: an impossible climate for NHS providers finances? This report examines the financial performance of the NHS in England. The main focus is on the finances of NHS providers and the financial position of the commissioners of care (NHS England and clinical commissioning groups).

Guidance on the local procurement of external auditors for NHS trusts and CCGs. Under the Local Audit and Accountability Act 2014, NHS trusts and CCGs must select and appoint their own auditors and directly manage their contracts for the audits for the financial year starting on 1 April 2017. This guidance is to assist NHS trusts and CCGs with their initial audit appointments. It sets out the legal requirements, National Audit Office’s code of audit practice and auditor’s eligibility, a core specification for audit services, and advice on options for procurement and use of frameworks.

If you wish to discuss any issues raised in this section please contact Claire Bentley.

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Information Sharing

Publications/Guidance

The one-way mirror: public attitudes to commercial access to health data. This report, carried out by Ipsos MORI, has revealed that just over 50 per cent of the public are in favour of patient records being used by commercial organisations as long as there is a clear public benefit and appropriate safeguards in place. It also emphasises how unaware many people are about how patient data is already used within the NHS, let alone by others such as academic researchers, charities and commercial organisations.

A quick guide to sharing patient information for urgent and emergency care. This guide is designed to support frontline providers and commissioners collaborating in urgent and emergency care networks (UECNs) to confidently share information, and enable the delivery of ‘safer, faster and better’ urgent and emergency care and to deliver best practice.  

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 are a client and 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

Bringing together physical and mental health: A new frontier for integrated care. Until now, most efforts to promote integrated care have focused on bridging the gaps between health and social care or between primary and secondary care. But the NHS Five Year Forward View has highlighted a third dimension – bringing together physical and mental health. This report from The King's Fund makes a compelling case for this 'new frontier' for integration. It gives service users’ perspectives on what integrated care would look like and highlights 10 areas that offer some of the biggest opportunities for improving quality and controlling costs.

Key facts and trends in mental health: 2016 update. The Mental Health Network (MHN) has published the fourth edition of its factsheet on key statistics and trends in mental health.

Preventing deaths in detention of adults with mental health conditions: progress review. An Equality and Human Rights Commission follow-up report to its 2015 inquiry into non-natural deaths of adults with mental health conditions who were detained in prisons, police custody or psychiatric hospitals between 2010-13 examines the steps taken to act on the Commission's recommendations. The report acknowledges that some improvements have been made in police custody, hospitals and prisons; however, progress is patchy and safety in prisons is a significant concern.  

Legislation

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2016 (SI 2016/293). These regulations, which come into force on 1 April 2016, amend SI 2012/2996 relating to the functioning and commissioning responsibilities of NHS England and CCGs. In particular, they amend CCG responsibility for the provision of aftercare services under s.117 of the Mental Health Act 1983 by omitting reg.14(2)(a) of the 2012 Regulations, so that CCG responsibility is determined in accordance with s.117(3) of the 1983 Act. See also the Explanatory Memorandum.  

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

Publications/guidance

An opportunity to improve – General practice complaint handling across England: a thematic review. This report from the Parliamentary and Health Service Ombudsman pools evidence from its casework with intelligence gathered by the Care Quality Commission, NHS England and Healthwatch England to review how well GP practices in England are handling concerns and complaints when things go wrong. It shows that whilst more than half of GP practices are handling complaints well others are falling short, leading to lost opportunities to improve patient care. Where GP surgeries handled complaints well, patients reported satisfaction that their GP made complaining simple and easy, and the practice took their complaints seriously. The report also sets out areas where GPs should improve their complaint handling. Its recommendations emphasise that change can only come if everyone works together and focuses on how GP practices should be supported to develop a listening and learning culture.

RCGP Guide to supporting information for appraisal and revalidation. These updated guidelines aim to reduce the overall administrative burden for GPs and to put more emphasis on the quality than quantity. It reduces inconsistencies in interpretation of requirements and simplifies and streamlines the appraisal and revalidation process.

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

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Procurement

Guidance

Guidance on the local procurement of external auditors for NHS trusts and CCGs. Under the Local Audit and Accountability Act 2014, NHS trusts and CCGs must select and appoint their own auditors and directly manage their contracts for the audits for the financial year starting on 1 April 2017. This guidance is to assist NHS trusts and CCGs with their initial audit appointments. It sets out the legal requirements, National Audit Office’s code of audit practice and auditor’s eligibility, a core specification for audit services, and advice on options for procurement and use of frameworks.

Legislation

Concession Contracts Regulations 2016 (SI 2016/273). These regulations, which come into force on 18 April 2016, implement the new Concession Contracts Directive 2014/23, which provides rules for the award of concession contracts above certain thresholds by public authorities and utilities. They regulations also implement the Remedies Directives 89/665 and 92/13 so far as they apply to remedies and review procedures for the procurement of concession contracts. Together with the Public Contracts Regulations 2015 (SI 2015/102) and the Utilities Contracts Regulations 2016 (SI 2016/274), they form a package of measures to improve public procurement processes.
See also the Crown Commercial Service's Procurement Policy Note 02/16 that announces the new regulations and explains when they come into force.

Bevan Brittan Publications

New procurement regulations published - Emily Heard. The Government has published the Concession Contracts Regulations 2016 and the Utilities Contracts Regulations 2016, implementing the Concession Contracts Directive 2014/23 and the Utilities Contracts Directive 2014/25 respectively

Classification of NHS bodies for the purposes of the EU procurement rules: Are CCGs sub-central authorities? - Emily Heard. The correct classification of contracting authorities under the EU procurement rules is important for two main reasons.

Bevan Brittan Events

Procurement Update - Bristol. 18 April 2016 09:30.
Procurement Update - London morning session. 19 April 2016 09:00
Procurement Update - London afternoon. 19 April 2016 14:00
Procurement Update - Leeds. 20 April 2016 09:30
Procurement Update - Birmingham. 21 April 2016 09:30
Our Procurement team will cover legislative and policy developments as well as looking at recent EU and UK court cases and how these affect procurement in practice. 

If you wish to discuss any queries you may have around procurement please contact Emily Heard  

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Public Health

Publications/Guidance

Healthy weight, healthy futures: Local government action to tackle childhood obesity. The transfer of responsibility for public health in 2013 to councils has sparked a surge in innovative programmes and some are featured in these case studies. From working with children who are obese and overweight to encouraging children to cut their consumption of sugary drinks, local authorities are showing how child obesity can be tackled.

Health matters: midlife approaches to reduce dementia risk. This resource for health professionals and local authorities makes the case for action in midlife to promote healthy lifestyles that can reduce the risk of dementia. 

If you wish to discuss any queries you may have around public health please contact Claire Bentley.  

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General

Publications/Guidance

Guidance for doctors treating transgender patients. The first report of the House of Commons Women and Equalities Committee  highlighted significant concerns about doctors’ lack of awareness and consideration in treating transgender patients. These web pages aim to help doctors see how the principles of Good medical practice apply in relation to trans patients and also to explain doctors’ duties under the Equality Act 2010 and other legislation.

Get well soon: Reimagining place-based health. This report from NLGN argues that the NHS must construct a 15 year plan to shift money out of hospitals and into investment in communities. It demonstrates that the health service in its current form is not sustainable, and sets out a new plan for shifting the system to focus on preventing illness, shorten stays in hospitals and help people live independently for longer. A new 15 year plan would need to overcome the short term operational and political pressures that prevent a focus on transformation. It would build on the Five Year Forward View to create a longer-term blueprint for a future system for health and wellbeing that is fit for purpose.

The structure of the NHS in England. Major reforms to the structure of the health service in England were introduced by the Health and Social Care Act 2012, with a large number of new organisations established on 1 April 2013. This Commons Library briefing provides an overview of the funding and accountability relationships under the new system, and an introduction to the roles of key organisations. This briefing also highlights some of the key health policy issues for the current Parliament, including patient safety, funding, and the integration of health and social care.

Consultations

Consultation: Introduction of medical examiners and reforms to death certification in England and Wales – Policy and draft regulations. The DH is consulting on proposed reforms to the death certification process which will introduce a unified system of scrutiny by independent medical examiners of all deaths that are not investigated by a coroner. The purpose of the reforms is to strengthen safeguards for the public. The consultation closes on 15 June 2016.

News

NHS England announces £55 million cash boost to end hospital referrals by second class post. NHS England has set aside £55m to reward GPs and hospitals that switch to making referrals digitally by 2018, calling time on the practice of referring patients to hospital by second class post. NHS England and NHS Improvement also plan to consult on a proposal that by 2018 NHS commissioners and providers will no longer be paid for referrals made by paper.

NHS England launches national programme to combat antibiotic overusage.

NHS charges from April 2016.  

Bevan Brittan Events

Vanguards & Accountable Care Organisations: A Practical Insight. 27 April 2016 09:30. Michael Boyd. This practical session is aimed at organisations which are considering establishing an ACO or who may be affected by an ACO which is being set up.

If you wish to discuss any issues raised in this section please contact Claire Bentley.