Health and Social Care Update - May 2016

Publications, legislation, cases and other developments relevant to those involved in health and social care work.

06/06/2016

Claire Bentley

Claire Bentley

Associate

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/Patient Safety

Primary Care

Commissioning

Public Health

Employment/HR

Regulation

Finance

General

 

 

Care

Publications/guidance

New care models and prevention: an integral partnership This report, jointly published by NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association, presents five case studies to highlight how vanguards have sought to address the health and wellbeing gap and the impacts seen so far. It finds that a reduction in emergency admissions for the over-65s, fewer delayed transfers of care, and GPs able to dedicate more time to frail older patients are among some of the early achievements of pioneering prevention initiatives taking root across the country.

Discharging older patients from hospital. This NAO report finds that there are currently far too many older people in hospitals who do not need to be there and without radical action, this problem will worsen and add further financial strain to the NHS and local government. The spending watchdog estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820m. While some efforts to rectify the situation have been made, an ageing population and more older people being admitted to hospital means there needs to be a step change in performance to resolve the problem. The NAO makes a number of recommendations, including that the DH, NHS England and NHS Improvement should set out how they will break the trend of rising delays against the demographic challenge of growing numbers of older people.

A report of investigations into unsafe discharge from hospital. This report by the Parliamentary and Health Service Ombudsman draws attention to the consequences of health and social care organisations failing to manage people’s discharge from hospital. It finds that patients are being sent home alone, afraid and unable to cope and in some cases without their relatives or carers being told, resulting in devastating consequences. The report highlights cases investigated by the PHSO service where people have been discharged from hospital before they are fit to leave or without making sure they can cope on their return home.

Better care in my hands: a review of how people are involved in their care. This report describes how well people are involved in their own care and what good involvement looks like. It is based on newly analysed evidence from our national reports and inspection findings, as well as national patient surveys and a literature review. It identifies what enables people and their families to work in partnership with health and social care staff and illustrates this with good practice examples from our inspection findings.

Adult personal social services: specific revenue funding and grant allocations for 2016/17. This letter clarifies local authority specific revenue funding for the financial year 2016 to 2017, which was subject to the 2015 spending review. It provides information on funding for the second year of Care Act implementation, which comes from a range of sources, as well as allocations for parts of the Better Care Fund.

State of caring 2016. This report shows that, one year on from the implementation of the Care Act 2014, carers in England are still struggling to get the support they need to care well, maintain their own health, balance work and care, and have a life of their own outside of caring. It calls for the government, local authorities and health bodies to redouble their efforts to support England’s 5.4 million unpaid carers, arguing that squeezed public services and financial pressures are pushing carers to the brink.

Training in care for the dying must improve, says GMC. More needs to be done to prepare medical students and newly qualified doctors to provide care for the dying, according to the General Medical Council's (GMC) Chief Executive Niall Dickson. The GMC has pledged to work with medical schools to improve the palliative care training available for medical students.

A different ending: Addressing inequalities in end of life care. This CQC review finds that people from certain groups in society sometimes experience poorer quality care at the end of their lives because providers and commissioners do not always understand or fully consider their needs. The CQC looked at how dying patients are treated across various settings. In particular, it focused on end of life care for people who may be less likely to receive good care, whether because of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances. It identified examples of good practice, but found that action is needed to make sure everyone has the same access to high quality, personalised care at the end of their lives, regardless of their diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances.

Achieving outcomes based commissioning in home care: outcomes-based commissioning (OBC) is a means of procuring home care for people which focuses less on the tasks associated with addressing individual needs and more on improved overall outcomes for individuals. This report outlines the work that LGiU has completed recently in OBC for home care, introduces the CoCare app which supports outcomes-based commissioning and summarises a March roundtable hosted by LGiU. 

News

In the bag - making moving between hospital and social care better. The introduction of a 'red bag' Hospital Transfer Pathway has helped to improve and speed up the transfer between hospital and care home settings.  

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

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Children

Publications/guidance

Health matters: giving every child the best start in life This guidance for health professionals and local authorities focuses on investing in early years services from pregnancy through to two years old.  

Lightning review: access to child and adolescent mental health services
Some children’s mental health services failing children with life-threatening conditions
•28% of referrals for children’s mental health support are turned away
•14% of children with life-threatening mental health conditions are being turned away from treatment
•Children and young people on mental health waiting lists for up to 200 days
•35% of trusts restrict access to children who miss appointments Over a quarter of children (28%) who were referred for specialist mental health treatment in 2015 did not receive a service, according to new information collected by the Children’s Commissioner for England using her unique powers to request data from public bodies.

Law Society practice note on representation before Mental Health Tribunals This practice note advises on providing legal advice to clients appearing before the First Tier Tribunal (Mental Health) in England and the Mental Health Review Tribunal for Wales. It has information under the following headings: (1) Introduction; (2) The right to legal advice and representation before the tribunal; (3) Communication with the client; (4) Taking instructions; (5) Your duties towards your client; (6) Good tribunal practice; (7) Representing children and young people before the tribunal; (8) More information. It was last updated on 27/5/16 to cover recent case law including YA (see para 4.1), Care and Treatment Reviews (see para 6.2.1) and includes other more minor amendments.

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

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Clinical Risk/Patient 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

Report of the Expert Advisory Group: Healthcare Safety Investigation Branch The report makes recommendations about establishing the Healthcare Safety Investigation Branch (HSIB) as well as how to improve investigation, and learning from investigation, across the health system.

Maternity Choice and Personalisation Pioneers. In March 2016, CCGs were invited to express their interest in working with neighbouring CCGs to test ways of improving choice and personalisation for women accessing maternity services. This marked the first step of implementing some of the recommendations from the National Maternity Review: Better Births. A panel has now selected seven Maternity Choice and Personalisation Pioneers.

Response to consultation: the National Guardian for the NHS - improvement through openness. This report presents a joint response from the CQC and the National Guardian's Office to a consultation on how the National Guardian's Office should be established and run. The joint response reflects the immediate priorities and functions of the National Guardian's Office which include: providing advice and support on the role of Freedom to Speak Up Guardians; setting up a support network; and establishing a programme of engagement events for board members and guardians.

PHSO review: Quality of NHS complaints investigations. The Commons Public Administration and Constitutional Affairs Committee has published a follow-up report to a recent review by the Parliamentary and Health Service Ombudsman (PHSO) of NHS complaints investigations. it concludes that the new Healthcare Safety Investigation Branch (HSIB) will only succeed if the Government legislates to guarantee its independence and ensure that it provides a genuine 'safe space' for people to speak out about patient safety risks.

Infant Mortality and Stillbirth in the UK. A POSTnote which reviews recent data on stillbirth and infant mortality rates in the UK and examines the factors contributing to increased risk. It then looks at the policy options that may help to improve health outcomes for infants and their families.

Strategic quality improvement: an action learning approach. The King’s Fund was commissioned by Oxleas NHS Foundation Trust to work with their quality board to facilitate an assessment of its existing approaches to quality improvement and to develop a strategy for future work. This case study details the approach and philosophy behind this work, which involved working with the trust’s five directorates to develop their ability to appraise their own approach to quality improvement with a view to improving performance, achieving better clinical outcomes and building further on the trust’s capacity as a learning organisation.

Shaping the future: CQC's strategy for 2016 to 2021. This five-year strategy sets out CQC's vision and ambitions for a more targeted, responsive and collaborative approach to regulation so that more people receive high-quality care. It describes how CQC will combine learning from 22,000 comprehensive inspections with better use of intelligence from the public, providers and partners in order to focus inspections more tightly to where people may be at risk of poor care. The new strategy also aims to encourage services to innovate and collaborate to drive improvement.

A report of investigations into unsafe discharge from hospital. This report highlights cases investigated by the Ombudsman service where people have been discharged from hospital before they are fit to leave or without making sure they can cope on their return home. Last year the Parliamentary and Health Service Ombudsman saw a 36 per cent increase in discharge related investigations. These found that people’s deaths or suffering could have been prevented if hospitals carried out the right checks before discharging people.

Mothers and Babies: Reducing risk through audits and confidential enquiries across the UK (MBRRACE-UK) Perinatal mortality surveillance report: UK perinatal deaths for births from January to December 2014. This report finds that there has been slight fall in the rates of stillbirths and neonatal deaths in the UK compared with rates in 2013 which continues the downward trend in rates from 2003 onwards. However, the overall trend masks variations in rates across the UK. The effect of gestational age on perinatal mortality rates was also explored in more detail in this report. This shows that around two thirds of stillbirths and neonatal deaths were of babies born preterm indicating that initiatives to reduce stillbirth and neonatal deaths must include a focus on reducing preterm birth as well as ensuring high quality care for women whose pregnancies reach full term.

Consultations

Consultation on changes to the NHS patient survey programme The survey programme is used to collect feedback on the experiences of people using a range of NHS healthcare services. The current programme includes surveys of adult inpatients, community mental health service users, people using maternity services, outpatients, children and young people’s inpatient services and accident and emergency patients. The CQC aim in consulting on changes is to ensure that the programme has maximum impact and value, and that it remains relevant and useful for those using the survey results across the health and social care system. The consultation will run to 21 July 2016

Department of Health consultation on clinical negligence expected this summer. The Law Society advises that the DH intends to launch a consultation on the introduction of a fixed-costs regime for some clinical negligence claims in summer 2016, either in May or after the EU referendum. Responding to the DH pre-consultation in 2015, the Society argued that there should be a review of Legal Aid, Sentencing and Punishment of Offenders Act 2012 before any fixed-fee scheme was implemented.

News

Air Accident Investigation chief set for top NHS role at HSIB The existing head of the UK’s Air Accident Investigation Branch is set to become the chief investigator of the new NHS patient safety body. Keith Conradi, formerly a professional pilot, has been selected by health secretary Jeremy Hunt as his preferred candidate to lead the new Healthcare Safety Investigation Branch.

Fixed costs - Government admits defeat in bid to introduce fixed costs in clinical negligence on 1 October. The government has admitted that it will not be able to introduce fixed recoverable costs for clinical negligence cases on 1 October as planned.

Royal Berkshire NHS Foundation Trust has been fined £200,000 for safety failings in its management of the use and maintenance of trolleys. A Health and Safety Executive (HSE) investigation found there was a lack of maintenance of Anetic Aid QA3 trolleys at the hospital and a lack of training in an essential aspect of their use.

BUPA Care Homes (CFC Homes) Ltd has been fined over the inappropriate management of bedrails at one of its care homes.

Bevan Brittan Events

Annual Update Seminar: Causation, Consent and Candour. Wednesday 08 June 2016, 09:15. There has been a wealth of case law and statutory change in the last year that directly impacts on the way that NHS Trusts investigate and manage claims, complaints and adverse incidents. Montgomery provides new challenges for Trust staff who are involved in the consenting process, while Williams reinforces that the material contribution doctrine will continue to play an important role in causation in clinical negligence for the foreseeable future. Meanwhile, Trusts continue to get to grips with the requirements imposed by the statutory duty of candour, which throws up new and challenging problems in the context of litigation.

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

Follow us! Bevan Brittan's patient safety team is regularly tweeting the latest patient safety news @BBPatientSafety.

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Commissioning

Publications/Guidance

What makes a top clinical commissioning leader? This report, written in conjunction with Hunter Healthcare, finds that clarity about the future of the commissioning system, a commitment to developing GP leadership, and improved leadership programmes, have been identified as critical to supporting current and prospective clinical commissioning leaders. Through a series of interviews with both clinical and managerial CCG leaders, the report sets out how current leaders can be supported, and a future generation inspired and encouraged to take up a role in commissioning.

The role of the nurse on the CCG governing body This report highlights how the role of nurses on CCG governing body has changed over time, empowering them to make more of a difference for their local patients and populations. It reveals how many CCGs are now employing full time chief or executive nurses with responsibility for the day-to-day running of an element of the organisation, going beyond the legal requirement for a registered nurse to sit on their governing body. It illustrates the impact that commissioning nurses are making locally, such as reducing rates of smoking in pregnancy, providing a voice for practice nurses and leading local service development. Finally, the report also makes recommendations for national organisations and CCGs themselves on how they can support the commissioning nurse to be as effective as possible.

Commissioning for Value: Comprehensive data packs to support CCGs and NHS England in the regions. NHS Right Care has produced a further set of Commissioning for Value packs for CCGs to help them identify the best opportunities for improving value for their populations. The CVD, respiratory and neurological packs are personalised for each CCG and provide detailed information on the opportunities in the highest spending programmes previously covered by Commissioning for Value. They include a wider range of outcome measures and information on the most common procedures and diagnoses for the condition in question. The information in each pack is designed to support local discussions and inform a more in-depth analysis around common conditions and pathways. It should be used alongside other local intelligence and reports to ensure local health economy planning focuses on those opportunities which have the potential to provide the biggest improvements in health outcomes, resource allocation and reducing inequalities.

Performance of the NHS provider sector year ended 31 March 2016. This report outlines the operational and financial performance of NHS providers over the final quarter of 2015/16. It finds that NHS providers have risen the challenge of increasing demands for health services but further work is needed to continue improving services and increasing efficiencies. Whilst the sector made £2.9 billion in efficiency savings in 2015/16, the sector ended the financial year in deficit of £2.54 billion. 

Achieving outcomes based commissioning in home care: outcomes-based commissioning (OBC) is a means of procuring home care for people which focuses less on the tasks associated with addressing individual needs and more on improved overall outcomes for individuals. This report outlines the work that LGiU has completed recently in OBC for home care, introduces the CoCare app which supports outcomes-based commissioning and summarises a March roundtable hosted by LGiU.

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

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Employment/HR

Publications/Guidance

Training in care for the dying must improve, says GMC. More needs to be done to prepare medical students and newly qualified doctors to provide care for the dying, according to the General Medical Council's (GMC) Chief Executive Niall Dickson. The GMC has pledged to work with medical schools to improve the palliative care training available for medical students. 

Leading change, adding value: A framework for nursing, midwifery and care staff. NHS England has published a new national framework is aimed at all nursing, midwifery and care staff in England. It shows how nursing, midwifery and care staff can help close the three gaps identified in the Five Year Forward View – the health and wellbeing gap, the care and quality gap, and, the funding and efficiency gap - while retaining the well-recognised ‘6Cs’ as being central to all that they do.

NHS workforce race equality standard: 2015 data analysis report for NHS trusts. This report shows results of the experiences of BME and white staff from the staff survey 2015 at every NHS trust across England. It looked at four indicators across acute trusts, ambulance trusts, community provider trusts, and mental health and learning disability trusts. The results show a picture of variation across the health service with some trusts making progress, whilst others still have a considerable way to go.

Achieving good medical practice: guidance for medical students. This guidance is directly addressed to medical students and outlines the standards expected of them both inside and outside medical school.

Professional behaviour and fitness to practise: guidance for medical schools and their students. This document gives high-level guidance to medical schools and educators on managing processes for professionalism concerns and fitness to practise. It aims to give a consistent framework that can be adapted to local processes. This guidance will also be useful for anyone involved in student fitness to practise investigations, hearings, and decision-making. Although this guidance is mainly aimed at medical schools and universities, medical students may also find it useful, to understand how their institution deals with these issues.

Managing the supply of NHS clinical staff in England. This report raises concerns about the current extent of staffing gaps in the NHS. The Public Accounts Committee are concerned that these gaps could inhibit trusts’ ability to provide services efficiently and effectively, and could lead to longer waiting times for treatment and shortcomings in the quality of care. They also recognise the tension between the drive to reduce staff in order to meet efficiency targets and efforts to increase numbers to ensure safe levels of staffing, following Robert Francis’ report into the Mid-Staffordshire scandal.

Reshaping the workforce to deliver the care patients need. This report, commissioned by NHS Employers, argues that equipping NHS nursing, community and support staff with additional skills to deliver care is the best way to develop the capacity of the health service workforce, and will be vital to enable the NHS to cope with changed patient demand in the future. However, expanding the skills of the non-medical workforce in this way also presents big organisational challenges for NHS trusts, and will not be easy to achieve in the current financial context. Despite this, changing staffing should be considered an urgent, ‘must-do’ priority for trusts.

News

NHS Improvement – examples of seven day services already up and running in the NHS  

The Guardian on the NHS deficit and staffing costs 

The Guardian's summary of the changes agreed to the junior doctors' contract 

NHS Employers' updated junior doctors' contract page (including FAQs from the BMA) 

Student bursary cut 'may worsen NHS staff shortages'

Nuffield Trust report on how the NHS must re-shape its workforce – particularly focuses on use of support staff to fill 'medical gaps'

Bevan Brittan Articles

I spy? Can you use personal material, seized by police, in an employee investigation? Alastair Currie and Joanna Smart report on a recent high profile EAT win for the team, which looked at the issue of privacy in relation to a disciplinary investigation which relied on emails and photographs supplied by the police.

Employment Eye - News Round-Up May 2016. Sarah Lamont on the latest employment law news in brief - plus details of our next events.

20,000 reasons to review immigration status. Fines of £20,000 and a tougher approach to enforcement mean that employers need to get to grips with the new Immigration Act. 

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

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Finance

Publications and Guidance

Indicative 2020/21 Sustainability and Transformation Plans funding including transformation. This briefing outlines indicative figures for how much each part of England could see its NHS budget grow by 2020, and the funding available for transformation. This document aims to help local NHS and care leaders develop their Sustainability and Transformation Plans, showing how the NHS Five Year Forward View will be implemented locally, using the growing funding envelope available to each area.  

Adult personal social services: specific revenue funding and grant allocations for 2016/17. This letter clarifies local authority specific revenue funding for the financial year 2016 to 2017, which was subject to the 2015 spending review. It provides information on funding for the second year of Care Act implementation, which comes from a range of sources, as well as allocations for parts of the Better Care Fund. 

How is the NHS performing? Quarterly monitoring report Nearly two-thirds of NHS trust finance directors and more than half of CCG finance leads say the quality of patient care in their area has deteriorated over the past year, according to this report. It finds that only 2 per cent of trust finance directors and 12 per cent of CCG finance leads said that patient care had improved over the past 12 months. Looking back over 2015/16 as a whole, the report underlines the increasing strain the NHS is under as it struggles to manage increasing pressure on services within constrained resources.

Consultations

Changes to the DH accounting guidance for all NHS bodies. Seeks views on the content of the DH Group Accounting Manual (GAM) that applies to all NHS bodies for their annual reports and accounts for 2016 to 2017. It includes mandatory accounting guidance for all NHS bodies on completing their statutory annual report and accounts. The consultation closes on 1 July 2016.

News

NHS drops fines for trusts for missed time targets. NHS England has suspended financial sanctions for trusts that miss waiting time targets. From May, trusts receiving bailouts due to forecast budgetary deficits - three-quarters of trusts and foundation trusts - will not be subject to fines.

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

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Information Sharing

News

NHS trust fined over HIV newsletter data breach. A London NHS trust has been fined £180,000 after the email addresses of more than 700 users of an HIV service were revealed. The Information Commissioner's Office (ICO) found there had been a serious breach of the Data Protection Act, which was likely to have caused substantial distress.

NHS warned to improve data security after leaks NHS managers have been told to overhaul their computer technology, staff training and corporate governance ahead of the publication of two reports by the Care Quality Commission and Dame Fiona Caldicott, the national data guardian, amid increasing concerns over the safety of patient data. 

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

Preventing prison suicide: perspectives from the inside This report, written in conjunction with the Howard League for Penal Reform, argues that prisons need to change to enable staff to build relationships with prisoners and reduce the risk of suicide. It focuses on the views and experiences of current and former prisoners about what contributes to vulnerability and what increases or reduces their risk of suicide. Prisoners described a culture where distress was often not believed or responded to with compassion. The report concludes that change needs to happen across the system to recognise the influence of the prison environment on people’s vulnerability.

Lightning review: access to child and adolescent mental health services
Some children’s mental health services failing children with life-threatening conditions
•28% of referrals for children’s mental health support are turned away
•14% of children with life-threatening mental health conditions are being turned away from treatment
•Children and young people on mental health waiting lists for up to 200 days
•35% of trusts restrict access to children who miss appointments Over a quarter of children (28%) who were referred for specialist mental health treatment in 2015 did not receive a service, according to new information collected by the Children’s Commissioner for England using her unique powers to request data from public bodies.

Law Society practice note on representation before Mental Health Tribunals This practice note advises on providing legal advice to clients appearing before the First Tier Tribunal (Mental Health) in England and the Mental Health Review Tribunal for Wales. It has information under the following headings: (1) Introduction; (2) The right to legal advice and representation before the tribunal; (3) Communication with the client; (4) Taking instructions; (5) Your duties towards your client; (6) Good tribunal practice; (7) Representing children and young people before the tribunal; (8) More information. It was last updated on 27/5/16 to cover recent case law including YA (see para 4.1), Care and Treatment Reviews (see para 6.2.1) and includes other more minor amendments.

Reforming the Deprivation of Liberty Safeguards – emerging solutions. In July 2015 the Law Commission opened a consultation on the law of mental capacity and deprivation of liberty, seeking views on a comprehensive scheme of protective care to replace the Deprivation of Liberty Safeguards (DoLS) and proposing that the scheme be extended to domestic settings. This interim statement This interim statement updates stakeholders on the key issues that have emerged at consultation and some of the Commission's initial conclusions. It concludes that the problems with the DoLS can be resolved only by wholesale replacement of the DoLS and reform of the law. The Law Commission will now produce draft legislation and a final report.

Mental Capacity and Deprivation of Liberty Interim Statement. The Law Commission have provided an update on their current thinking in relation to the problems with the Deprivation of Liberty Safeguards. Their initial conclusion is that the problems can be resolved only by wholesale replacement of the DoLS and reform of the law.

Improving the outcomes of mental health problems among the LGBT community. In this case study Leicestershire Partnership NHS Trust share their experience of how they introduced better mental health support for the lesbian, gay, bisexual and transgender community, and improved understanding amongst local health professionals of the issues faced by them.

Improving the physical health of people with mental health problems – Actions for mental health nurses. New guidance from the DH for mental health nurses will help them to improve the physical health and wellbeing of people with mental health problems. The guidance aims to give those living with mental health problems the same access to health checks and healthcare as the rest of the population, and identifies a number of action areas to improve health outcomes.

Mental health crisis care: health based places of safety funding. This funding programme aims to increase and improve health based places of safety and continue to reduce police cells being used as an alternative. Bids for a share of the £15 million fund will be managed by the Department of Health. This guidance document sets out how local crisis care concordat groups can apply for funding to increase the capacity and number of health based places of safety.

Funding mental health at a local level: unpicking the variation. NHS Providers and the Healthcare Financial Management Association (HFMA) surveyed finance directors in mental health trusts and chief finance officers in CCGs to understand how the parity of esteem commitment is being implemented locally. The survey found that the government’s commitment to parity of esteem between mental and physical health services is being undermined by a failure to ensure funding increases reach the frontline with only half (52%) of providers reporting that they had received a real terms increase in funding of their services in 2015/16.

Improving health based places of safety: Guidance for applications for capital funding. The DH is making up to £15m in capital funding available to improve the provision, capacity and quality of health based places of safety to better support people detained under s.136 of the Mental Health Act 1983 and to prevent vulnerable people being held in police cells. This document describes the kind of projects that the Department is hoping to support, and explains how to make an application. The funding is targeted at 23 priority areas, covering 10 police forces, where the use of police cells for those experiencing mental health crises is amongst the highest.

Fix dementia care: NHS and care homes. An investigation by the Alzheimer's Society has found that almost half of care home managers feel the NHS isn’t providing residents with dementia adequate and timely access to vital services like physiotherapy, continence and mental health services. This has led to instances where people have been left bed-bound, incontinent and sedated because the health service is too slow in responding to their needs. It also revealed that one in five care homes surveyed are being wrongly charged by GP practices for services that should be free on the NHS – up to as much as £36,000 a year. The total cost of GP charges to care homes is estimated to exceed £26m a year.  

News

Inquest finds neglect by the Priory contributed to teen's accidental death. A 14-year-old girl suffered an accidental death contributed to by neglect while under the care of the Priory hospital, an inquest jury has ruled.

Mental health pilot scheme doubles numbers getting key physical health checks. NHS England announces that four mental health trusts have almost doubled the number of people getting five key physical health checks during a pilot scheme now being shared for adoption across the NHS. The two-year improvement programme used the Lester tool, a poster and electronic clinical prompt system to support clinical teams to screen and intervene for cardiovascular conditions such as diabetes and high blood pressure, as well as smoking, lifestyle and weight. The programme was independently evaluated by the Royal College of Psychiatrists Clinical Care Quality Improvement Unit.

Surgeons can perform hysterectomy on schizophrenic woman. A judge has ruled, in a Court of Protection hearing, that a woman suffering from paranoid schizophrenia lacked the capacity to make a decision about her treatment for ovarian cancer. Mr Justice MacDonald stated that a hysterectomy would be in the patient's best interests after hearing from doctors treating her that she would be unlikely to survive until the end of the year without surgery. Lawyers for the woman said that she had declined treatment and that she wished to have a child.

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

Targeted investment in recruiting returning doctors pilot for 2016. The Targeted Investment in Recruiting Returning Doctors Scheme is a pilot scheme that invests resources in GP practices which can evidence that they have historically encountered difficulty in recruiting GPs (held vacancies for a minimum of 12 months). The pilot scheme offers support to practices to promote and advertise their posts. Practices will be invited to apply for the scheme by their NHS England local team. This NHS England gives further information on the scheme.

Estates and Technology Transformation Fund (Primary Care): Guidance for CCGs – How to submit recommendations for funding. Guidance to support CCGs with their submissions for investment from the Estates and Technology Transformation Fund (ETTF). This is a multi-million pound investment to accelerate the development of infrastructure to enable the improvement and expansion of joined-up out of hospital care for patients. Additional capital will also be invested in general practice.

Outpatient services and primary care: Scoping review, sub-studies and international comparisons. This study by the National Institute for Health Research suggests that with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. The review also highlights the lack of evidence on the cost-effectiveness of these new models of care.

Securing Excellence in GP IT Services: Operating model 3rd edition (2016-18). NHS England has published a revision of the GP IT operating model for the provision of high quality GP IT support services. It outlines clear accountability and commissioning responsibilities, together with a number of enhancements to the 2014/16 model. The revised arrangements provide increased local flexibilities to enable commissioners to develop digital services that are able to respond to local needs, support emerging models of care, extended working and integration of health and care. It is aligned with and supports the delivery of local digital roadmaps, service transformation plans and the ambitions outlined within the General Practice Forward View (GPFV).

Royal College of General Practitioners (RCGP): The future of GP collaborative working. This report showcases how GPs are designing and leading innovative schemes to improve the integration of care in the best interests of patients. It highlights seven case studies spanning a wide range of services across the UK, covering different specialties, different population groups and different ways of addressing complex issues.

Comparing per patient funding levels with published Care Quality Commission (CQC) ratings of practice. The new report examined the amount of funding each GP practice in England received per patient and cross referenced this with the recent ratings given to the GP practice by the CQC. This research demonstrates a link between CQC ratings allocated to GP practices and the level of funding they receive. It found that GP practices that scored an "outstanding" or "good" rating received £152 and £140 per patient respectively; whereas those who scored "inadequate" or "needs improvement" received £128 and £111 per patient.

Understanding pressures in general practice. This King's Fund report examines how increasing demands on general practice over the past five years have led to a feeling of crisis, with the NHS finding it difficult to recruit and retain sufficient GPs who want to do full-time, patient-facing work. It looks at patient factors, system factors and supply-side issues to see what lies behind this increasing pressure on general practice. It finds that despite GPs being at the heart of the health care system, a lack of nationally available, real-time data has made their changing workload largely invisible to commissioners and policy-makers.

Medical indemnity guidance for GPs. Guidance from the BMA outlining the legal requirement for indemnity and difficulties posed by rising indemnity costs. 

News

Outstanding care highlighted as CQC publishes more GP reports. Steve Field, chief inspector of general practice at the Care Quality Commission (CQC), has said the vast majority of GP practices in England are providing a good service, with 157 practices rated outstanding. His statement follows publication of 82 more inspection reports on GP practices, of which 62 were rated good and three rated outstanding.

New BMA research demonstrates link between CQC ratings and levels of funding for GP practices. New research from the BMA has shown a link between the Care Quality Commission (CQC) ratings allocated to GP practices and the level of funding they receive. This is despite the CQC failing to take resources into account when publishing their verdicts on the performance of GP practices. The new report examined the amount of funding each GP practice in England received per patient and cross referenced this with the recent ratings given to the GP practice by the CQC. Overall, results from inspections carried out at 2,814 GP practices in 2015 were included in the research.

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

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Public Health

Publications/Guidance

A low priority? How local health and care plans overlook the needs of dying people. This report from Hospice UK explores how local Health and Wellbeing Boards (HWBs) and Clinical Commissioning Groups (CCGs) address the palliative and end of life care needs of adults and children within their planning and decision-making. It finds that: 34% of HWBs do not consider the needs of dying people in their assessments of the health and care needs of their local populations; 57% of HWBs do not include the needs of dying adults and children in their key strategies that inform local service planning, with no change since 2014. In addition, 27% of CCGs do not have a strategy for addressing end of life care for adults in their area, while 71% of CCGs do not have a strategy for supporting children and young people living with life-shortening conditions.

Placed-based services of care. This PHE guidance aims to support healthcare professionals in their role to commission and deliver integrated services to local populations.

Fit for the future – Public health people. This review of the public health workforce by Public Health England outlines recommendations to achieve a workforce that can meet future public health challenges, in order to contribute to the renewal of the DH’s national public health workforce strategy. It focuses on the capabilities and skills needed in the workforce of the future. The report outlines five important themes that underpin the response to developing a workforce for 2021 and provides a clear pathway and plan to achieve the ‘new’ workforce. 

Just what the doctor ordered – social prescribing: A guide for local authorities. "Social prescribing" is a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of non-clinical services. This LGA publication sets out how councils, with their responsibility for public health and local leadership, are ideally placed to connect people with local community services and activities so as to improve the health and wellbeing of large numbers of people.

Public health in a changing climate. This Joseph Rowntree Foundation report reviews current local strategies and actions to address climate change by public health departments and their partners. It explores barriers and opportunities for action, and identifies recommendations for local and national policy and practice.

Health matters: giving every child the best start in life This guidance for health professionals and local authorities focuses on investing in early years services from pregnancy through to two years old.

Physical inactivity: economic costs to NHS clinical commissioning groups. This report aims to further understanding of the burden of physical inactivity in terms of health and economic impact. The estimates provided here are a starting point in understanding the cost of physical inactivity in England as a result of treating adverse health outcomes. 

Consultations

Tailored review of Public Health England: call for evidence. Seeks views on PHE’s performance and effectiveness, efficiency, and governance. The closing date for comments is 24 June 2016.

Government response to the consultation Refreshing the Public Health Outcomes Framework (2015). In September 2015 the Government sought views on whether it should remove, replace or revise the existing indicators in the Public Health Outcomes Framework (PHOF). This paper sets out the results of the consultation. From April 2016 there will be 67 public health indicators which will consist of 158 indicators/sub-indicators, that will help measure the public’s health and wellbeing. Chapter 5 contains a detailed breakdown of how the indicators have changed.

News

New funding for local HIV prevention. Announces an HIV Prevention Innovation Fund for 2016 to 2017 of up to £600,000 for local prevention initiatives. Projects must have local authority endorsement in order to be eligible for the fund. Eligible projects can apply for the fund from 10 May until 15 June 2016.

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

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Regulation

News

Care Quality Commission to cut back on hospital inspections. The Care Quality Commission (CQC) will undertake fewer inspections of hospitals in England, as the NHS regulator seeks to scale back the time it spends conducting inspections and attempts to adjust to budget cuts.

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

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General

Publications/Guidance

New care models and prevention: An integral partnership. This NHS Confederation report presents five case studies to highlight how vanguards have sought to address the health and wellbeing gap and the impacts seen so far. It finds that a reduction in emergency admissions for the over-65s, fewer delayed transfers of care, and GPs able to dedicate more time to frail older patients are among some of the early achievements of pioneering prevention initiatives taking root across the country. The successes also include improved patient outcomes, increased job satisfaction for staff, and financial savings from better medicines management.

Dispensing health equality. This research report, published by Pharmacy Voice, shows that, if faced with a closure, more than one in four people who would normally seek advice first from their local pharmacy on common ailments would instead make an appointment with their GP practice. According to NHS research, this rises to as many as four in five people in areas of high deprivation such as Fleetwood in Lancashire. The Government has indicated that its proposals will lead to up to one in four local pharmacies closing. The report argues that an uplift in GP appointments is untenable in any part of the country, but especially so in those areas that find it difficult to attract GPs in the first place.

The chief executive's tale: Views from the front line of the NHS. There is a widespread perception that there is a ‘crisis of leadership’ within the NHS, illustrated in part by difficulties in recruiting and retaining chief executives in the NHS. This report, published by the King's Fund in partnership with NHS Providers, draws on the views and experiences of 12 departed or departing chief executives, or those changing jobs within health care. It aims to illuminate the realities of leadership in today’s NHS. The interviews illustrate both the positives of the job and its current difficulties. The difficulties need to be addressed if we are, first, to hold on to experienced leaders who are able to transform the NHS in an innovative way, and, second, recruit the next generation.

National Framework Agreement for Clinical Waste Services for GPs and Pharmacies. NHS England has launched a new national framework agreement for the collection and disposal of clinical waste from GP surgeries and unwanted medicines from pharmacies. NHS England is responsible for funding and arranging these services on behalf of GPs and pharmacies. This new approach will deliver a number of benefits including improved quality standards, consistency, better management of contracts and value for money. Following a procurement process, five suppliers have been chosen.
See also the Clinical Waste factsheet.

Tackling drug-resistant infections globally: final report and recommendations. This report outlines the review’s final recommendations. It first discusses the mounting problem of resistance and why action is needed to combat it and then provides an overview of the solutions that the review thinks should be implemented to curtail unnecessary use and increase the supply of new antimicrobials. It then looks at the role of public awareness campaigns, the need to improve sanitation and hygiene, reduce pollution from agriculture and the environment, improve global surveillance, introduce rapid diagnostics and vaccines, the need to increase the number of people in this area, and use of market entry rewards and an innovation fund to generate more drugs. Finally the paper examines how these solutions can be funded and looks at ways to build political consensus around them. 

NHS Five Year Forward View: Recap briefing for the Health Select Committee on technical modelling and scenarios. This technical briefing sits alongside the Five Year Forward View (FYFV) financial assessment of the NHS. It summarises the methodology used to derive the NHS funding scenarios for the period to 2020/21 described in the FYFV, and describes the subsequent Spending Review settlement and its efficiency implications.

Consultations

Reforming death certification: Introducing scrutiny by Medical Examiners – Lessons from the pilots of the reforms set out in the Coroners and Justice Act 2009. The DH is currently consulting on proposed changes to the death certification process and accompanying draft regulations. These changes include the introduction of independent medical examiners who will confirm cause of all deaths that do not need to be investigated by a coroner. They also introduce a statutory duty on registered medical practitioners to report deaths in prescribed circumstances to the coroner for investigation. This paper details the lessons learnt from pilots of the reforms. The report is based on a new system of scrutiny that has been trialled successfully in Sheffield and Gloucester and on a smaller scale in several other parts of the country. The report explores practical issues associated with the implementation of the reforms at local level. It provides more information about the medical examiner process and should help to inform responses to the consultation, which closes on 15 June 2016. 

News

Sarah-Jane Marsh, the Chief Executive of Birmingham Children’s Hospital and Birmingham Women’s Hospital, has been appointed by NHS England chief executive Simon Stevens as the Chair of the new Maternity Transformation Programme Board.

NHS (Overseas Visitors Charging) Bill. Legislation is to be introduced over the course of the next Parliamentary term to recover costs from overseas visitors who use the NHS. Proposals announced in the Queen's Speech would extend the rules on charging migrants and overseas visitors for NHS treatment, to ensure that only UK residents will get free NHS care. 

Bevan Brittan Articles

Time to clean up your act? The use of Chlorhexidine as a topical antiseptic pre-surgical skin preparation agent. This article looks at the legal implications of using a Chlorhexidine based product as a medicine, where that product does not have a marketing authorisation under the Human Medicines Regulations 2012, but where it is authorised for use as a biocidal product under the EU Biocides Regulations 528/2012.

Bevan Brittan Events

Roundtable: The Role of the Independent Sector in New Models of Care. Wednesday 22 June 2016, 16:30. This roundtable session will hear from a legal and industry perspective to provide an overview of the current state of play across the various New Models of Care both within and outside the Vanguards, and reflect on international experiences in other jurisdictions. The session will also consider the impact of the new procurement regulations in increasing the role of independent sector providers. There will also be an opportunity for networking and discussion to further explore the opportunities for the independent sector.

Seminar: Taking stock of NHS governance after the 2013 reforms: Public procurement, competition and conflicts of interest in NHS commissioning. Thursday 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.

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

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