Health and Social Care Update - June 2016

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

04/07/2016

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

Procurement

Employment/HR

Providers

Finance

Public Health

Foundation Trusts

Regulation 

Health and Safety

General

 

Care

Publications/guidance

“Hiding who I am”: The reality of end of life care for LGBT people. This report from the terminal illness charity, Marie Curie, looks at the barriers that prevent lesbian, gay, bisexual and trans (LGBT) people from accessing end of life care and highlights their real-life experiences. It finds that nearly three-quarters (74%) of LGBT people are not confident that health and social care services provide sensitive end of life care for their needs. As a result, they often delay accessing the care they need and are more likely to experience unmanaged symptoms and pain at the end of their lives.

Home care for older people: quality standard. This new quality standard highlights how social care providers can help older people maintain their independence for as long as possible. It encourages providers to take a more personalised approach to home care planning and advises that family and carers should also be involved in the decision making process.

Stepping up to the place: The key to successful health and care integration. Bringing together health and social care has been a constant and dominant policy theme for many decades, and many places around the country are already demonstrating the potential to do things differently. This report from the NHS Confederation describes what a fully integrated, transformed system should look like based on the evidence.

Personal budgets in social care. This reports warns that stronger measures are needed to safeguard the interests of adults receiving personal budgets for social care. The committee calls on the Department of Health to set out clearly to local authorities and providers 'what high-quality and proportionate support looks like' and how much it costs, and recommends a range of analytical and other measures to safeguard users' interests and the social care market.

The right medicine - Improving care in care homes. This report from the Royal Pharmaceutical Society suggests that pharmacist led medicine reviews in care homes can not only improve safety for elderly care home residents but also save the NHS money by preventing avoidable hospital admissions. 

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.

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.

Personal budgets in social care. This reports warns that stronger measures are needed to safeguard the interests of adults receiving personal budgets for social care. The committee calls on the Department of Health to set out clearly to local authorities and providers 'what high-quality and proportionate support looks like' and how much it costs, and recommends a range of analytical and other measures to safeguard users' interests and the social care market.

A different ending: Addressing inequalities in end of life care. People from certain groups in society sometimes experience poorer quality care at the end of their lives because providers do not always understand or fully consider their needs.

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.

Consultations

Adult social care inquiry. The Commons CLG Committee has launched an inquiry into the financial sustainability of local authority adult social care and the quality of care provided. The deadline for written submissions is 19 August 2016.

News

Ombudsman issues first dual jurisdiction report following complaint of neglect at Oxfordshire care home. A complaint about the neglect of an elderly woman at an Oxfordshire care home has led the Local Government Ombudsman to issue its first joint investigation report into a care home and local authority.

Bevan Brittan Updates

Bevan Brittan supports Provider in First CQC Health and Safety Prosecution. Sarah Knight represented St Anne's Community Services.

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

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Children

Publications/guidance

Alan Wood Independent Review of LSCBs. Review into the role that local safeguarding children boards (LSCBs) play in protecting and safeguarding children. 

Review of evidence on children and young people's mental health. A report by the Centre for Mental Health finds that children and young people with mental health problems typically don’t get treatment for 10 years.

Children and young people's mental health - policy, services, funding and education. This briefing provides an overview of mental health service provision for children and young people in England. It looks at key government policies on children and young people's mental health, government inquires, and school interventions. 

How safe are our children? 2016. This report from the NSPCC sets out 20 different indicators. Each indicator looks at the question of 'how safe are our children?' from a different perspective. They also include historic data, to help track progress over time. 

Concluding observations on the fifth periodic report of the United Kingdom of Great Britain and Northern Ireland. The report recommends the introduction of ‘a statutory obligation at national and devolved levels to systematically conduct a child rights impact assessment when developing laws and policies affecting children, including in international development cooperation’. The report raises serious concerns about ‘the effects that recent fiscal policies and allocation of resources have had in contributing to inequality in children’s enjoyment of their rights, disproportionately affecting children in disadvantaged situations’.

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

Epilepsy in pregnancy. This RCOG guideline summarises the evidence on maternal and fetal outcomes in women with epilepsy (WWE). It provides recommendations on the care of WWE during the prepregnancy, antepartum, intrapartum and postpartum periods.

Preventing maternal mortality: it's ok to ask. This animation was produced in conjunction with the Royal College of Physicians and Surgeons of Glasgow and it aims to help doctors assess unwell pregnant or post-partum women. The video is accompanied by a poster which highlights the main causes of maternal death and provides doctors and midwives with advice for assessing pregnant and post-partum women who are feeling unwell.

MHRA research on protecting public health. Following concerns raised about the safety of implanting polypropylene into patients in order to treat pelvic floor conditions, a review from the Medicines and Healthcare products Regulatory Agency (MHRA) has led to the publication of a paper, written by four members of the MHRA device division, in the International Urogynecology Journal. MHRA says this work has never before been undertaken in such a thorough and systematic way, and presents all of the relevant data together in one place for the first time.

The National Clinical Assessment Service (NCAS) provides independent expert advice to healthcare organisations on the effective management and resolution of concerns raised about the practice of doctors, dentists and pharmacists (practitioners).

Each baby counts: key messages from 2015. The first annual report from the Royal College of Obstetricians and Gynaecologists’ Each Baby Counts initiative concludes that the quality of local investigations into cases of stillbirth, early neonatal death and severe brain injury occurring as a result of incidents during term labour must improve. Each Baby Counts is a national quality improvement programme, launched in October 2014, aiming to halve the number of these tragic events by 2020. This project will bring together the lessons learned from a review of all local investigations in order to improve the quality of care in labour across the UK.

2015 adult inpatient survey. This survey provides information on the experiences of people admitted to an acute or acute specialist NHS hospital in England in 2015. The results indicate that there have been small, but statistically significant improvements in a number of areas, compared with previous surveys. This includes patients’ perceptions of the quality of communication between medical professionals and patients, the standards of hospital cleanliness, the availability of help to eat when needed, the number of nurses on duty and being involved in decisions about their care and treatment.

Consultations

Medical Examiners: Chief Coroner's response to consultation. In response to the Department of Health's consultation on medical examiners, the Chief Coroner welcomes the proposed implementation of the medical examiner system. It sets out how the system should benefit the work of coroners, specifically relating to: a reduction in referrals; the statutory criteria for referrals; and medical advice for the coroner.

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.

News

Proportion of women giving birth recorded as smokers falls to lowest level since series began in 2006/07.

Research finds quarter of stillbirth inquiries are inadequate. The Royal College of Obstetricians and Gynaecologists has found that inadequate investigations are regularly being carried out into the circumstances surrounding the births of stillborn babies, children who die at less than a week old, and those who suffer brain injuries during labour, and that reviews often exclude parents.

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.

Bevan Brittan Articles/Journal Articles

HSIB: A step along the path towards safer care. There has been considerable interest in the Healthcare Safety Investigation Branch (HSIB), which came into being on 1 April this year.

Blowing the Whistle in the NHS. In April 2016, the final version of an overarching whistleblowing policy which should be adopted by all NHS organisations was published by NHS Improvement in conjunction with NHS England.

Bevan Brittan Events

Dealing with Complaints - This practical training day will focus on best practice and guidance for front-line staff of the NHS and healthcare organisations to investigate and manage claims, complex complaints and adverse incidents.
London. Tuesday 18 October 2016, 09:30 
Bristol Wednesday 19 October 2016, 09:30 
Birmingham. Tuesday 01 November 2016, 09:30

If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Stuart Marchant, Catherine Radford or Penelope Radcliffe

Bevan Brittan Training

On Wednesday 8 June, we held a training seminar on Causation, Consent and Candour. If you are a Bevan Brittan client and are interested in receiving a recording of the sessions please contact Claire Bentley

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

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Commissioning

Publications/Guidance

The role of the nurse on the CCG governing body. The NHSCC Nurses Forum has released a report highlighting how the role of nurses on a CCG’s governing body has changed over time. 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, usually quality, going far beyond the legal requirement for a registered nurse to sit on their governing body. The report makes recommendations for national organisations and CCGs themselves on how they can support the commissioning nurse to be as effective as possible; it also has case studies illustrating 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.

What makes a top clinical commissioning leader? This report by NHSCC and Hunter Healthcare sets out how current leaders can be supported, and a future generation inspired and encouraged to take up a role in commissioning. It highlights how both clinical and managerial leaders are integral to the success of a CCG, bringing different strengths to the organisation and its ability to deliver more for patients. For example, clinical leaders bring a working knowledge of their local healthcare system and are able to draw on their clinical expertise to make a credible case for change, whereas leaders with a professional managerial background tend to have clearer insight into operational and financial details. It also identifies qualities that make a top clinical commissioning leader including resilience, openness, emotional intelligence and being good communicators, with excellent listening skills and the ability to instil clarity of purpose.

NHS contracting for the provision of third party pharmacy out-patient dispensing services and service provider access to CMU framework agreement prices - Guidance. This guidance sets out the responsibilities of NHS trusts and chief pharmacists involved in outsourcing outpatient pharmacy provisions. The document includes a template letter to help make sure a consistent message is sent to pharmaceutical manufacturers and suppliers about these arrangements.

GMS contract changes 2016/17. Summarises the key changes to the GMS contract in England for 2016/17.

Technical requirements for 2016/17 GMS contract changes. Sets out the detailed technical requirements for commissioners and practices that hold a GMS contract and for all practices offering enhanced services (ESs) and vaccination programmes nationally.

CCG Improvement and Assessment Framework 2016/17 technical annex. This document provides technical guidance for the 2016/17 CCG Improvement and Assessment Framework that includes a set of 60 indicators across 29 areas. This Technical Annex provides the detail of the construction and purpose of each of the indicators in the Framework.  

Commissioning for Value: Comprehensive data packs to support CCGs and NHS England in the regions NHS England is committed to giving CCGs and NHS England in the regions practical support in gathering data, evidence and tools to help them transform the way care is delivered for their patients and populations.  

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

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Employment/HR

Guidance

A survey of staffing levels of medical clinical academics in UK medical schools as at 31 July 2015. The Medical Schools Council has published its 14th survey of clinical academic staffing levels in UK medical schools, with analysis by academic grade, source of funding, specialty, region, gender and ethnicity. Medical clinical academics are doctors who, in addition to treating patients in the NHS, are responsible for educating the doctors of the future and for carrying out research into all aspects of health and disease. The survey shows a decline in the numbers of medical clinical academic staff in contrast to the increase in consultants across the NHS over the past five years; it also shows that the proportion of women in clinical academia is increasing and the workforce is ageing.

NHS staff health & wellbeing: CQUIN Supplementary guidance. NHS England has published guidance offering financial incentives to improve the health and wellbeing of NHS staff in England. It outlines the need for the NHS to improve its offer as an employer to look after the health and wellbeing of its staff, highlighting the reasons for taking action and drawing on the emerging evidence within the NHS Healthy Workforce Programme, whilst also providing specific clarification and support to help introduce the measures in the Health & Wellbeing CQUIN.

New care models and staff engagement: All aboard. This NHS Confederation publication brings together the experiences of four vanguards which are placing staff at the centre of new care models. It draws out a set of principles for ensuring staff are at the heart of decisions about new models of care.

Tackling bullying and harassment in the NHS - new resources launched. NHS Employers has launched new resources to support NHS organisations to develop cultures where staff are free from the fear of intimidating behaviour. These include a webpage containing practical tools, evidence and support for tackling bullying, and an infographic that shows the impact of bullying and harassment in the NHS.

Supplying the demand for doctors: The need to end the rationing of medical training places. This paper by Civitas Health Researcher Ed Stubbs proposes that instead of Health Education England (HEE) making upfront payments for the training of its medics (via bursaries, fifth year tuition fees and clinical placement fees), medical students should be required to take out a loan from the Student Loans Company to cover the total cost of their training, thus transferring the NHS’s immediate training costs to an asset on the DBIS’s balance sheet. Stubbs also points out that another problematic element of current recruitment practices is that foreign students are given their placement fees, the same as any UK national student. These fees come out of the NHS’s training budget, meaning the NHS is paying up to £12m per year for overseas students to study here with no guarantee that they will stay beyond the end of their studies. The proposed placement fee loan would ensure that such students either remain and work for the NHS after graduation or fully pay back their placement fees if they wish to return home.

Managing the supply of NHS clinical staff in England. This report calls for an urgent review of NHS clinical staffing in England, raising concerns about supply, budgeting, agency costs and leadership. It highlights that undersupply could lead to longer waiting times for patients and outlines concerns regarding the leadership provided by the Department of Health.

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.

News 

GMC proposes to reduce fitness to practise stress. Draft proposals aimed at reducing the stress and impact the General Medical Council (GMC) fitness to practise process can have on doctors were discussed at a recent workshop. The GMC has issued a report on the issues raised during the workshop. The proposals will now be finalised and implemented in due course.

Brexit 'will make NHS staff shortages worse.'

Bevan Brittan Articles

Brexit – the implications for employment law. On 23 June, the UK voted to leave the European Union. A very different future is emerging for politics, finance and governance in the UK.

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

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Finance

Publications and Guidance

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. 

Indicative 2020/21 STP funding including transformation. NHS England has published indicative figures for how much each part of England could see its NHS budget grow by 2020, and the funding available for transformation. This will help local NHS and care leaders develop their Sustainability & Transformation plans (STPs), showing how the NHS Five Year Forward View will be implemented locally, using the growing funding envelope available to each area. NHS England also announced that it would invest around £112m (2016/17) in the vanguard projects which are leading the way and road testing new models of care in different parts of the county.

Personal budgets in social care. This reports warns that stronger measures are needed to safeguard the interests of adults receiving personal budgets for social care. The committee calls on the Department of Health to set out clearly to local authorities and providers 'what high-quality and proportionate support looks like' and how much it costs, and recommends a range of analytical and other measures to safeguard users' interests and the social care market.

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

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Foundation Trusts

Publications/Guidance

Have your say: Single Oversight Framework consultation. NHS Improvement approach to overseeing and supporting NHS trusts and foundation trusts.

If you wish to discuss any issues raised in this section please contact Vincent Buscemi

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Health and Safety

News

Safety watchdog inspections find NHS failing to comply with sharps laws. A sample of NHS organisations has found more than 80% to be breaching sharps regulations, according to the national watchdog for work-related health and safety.

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 Publications

Bevan Brittan supports Provider in First CQC Health and Safety Prosecution. Sarah Knight represented St Anne's Community Services.

Bevan Brittan Events

Health & Safety Update. A number of recent developments mean that the potential impact of health and safety breaches is greater than ever before. Bevan Brittan is at the forefront of advising organisations in the UK to minimise your exposure from a financial, commercial and reputational perspective. This seminar provides a fantastic opportunity to ensure you are up to date with the law, to receive practical tips to help you achieve compliance, an interesting selection of break-out sessions to opt-in to, and a chance to share experiences with other colleagues.
Bristol. Wednesday 02 November 2016, 09:30
London. Tuesday 15 November 2016, 09:30
Birmingham - Wednesday 16 November 2016, 09:30

If you wish to discuss any issues raised in this section please contact Sarah Knight or Debbie Rookes

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Information Sharing

Publications/Guidance 

Patients recording NHS staff in health and social care settings. This short guide has been developed to provide advice to Local Security Management Specialists (LSMSs) to enable them to support and advise NHS staff on covert and overt recording by patients.

Bevan Brittan Articles

Brexit: The impact on Data Protection. The General Data Protection Regulation ('GDPR') will be coming into force across the European Union on 25 May 2018. The aim of the GDPR is to ensure that the fundamental right to protect personal data will be guaranteed across the EU. 

Bevan Brittan Events

General Data Protection Regulation: What you need to know. Our specialist Information Law team is running this event to assist clients to understand what the new General Data Protection Regulation means for them, and what they can do now to prepare.
27 September - London
28 September - Bristol
4 October - Birmingham
5 October - Leeds

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

Capacity and consent decision-making tool from GMC. The General Medical Council has launched a new tool for doctors and other healthcare professionals.

Review of evidence on children and young people's mental health. A report by the Centre for Mental Health finds that children and young people with mental health problems typically don’t get treatment for 10 years.

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.

Better mental health for all: a public health approach to mental health improvement. This report focuses on what can be done individually and collectively to enhance the mental health of individuals, families and communities by using a public health approach. It is intended as a resource for public health practitioners to support the development of knowledge and skills in public mental health. It presents the latter from the perspective of those working within public health, giving valuable interdisciplinary perspectives that focus on achieving health gains across the population.

Children and young people's mental health - policy, services, funding and education. This briefing provides an overview of mental health service provision for children and young people in England. It looks at key government policies on children and young people's mental health, government inquires, and school interventions.  

News

Councils seek judicial review over funding of Deprivation of Liberty Safeguards. Four local authorities, led by Liverpool City Council, have lodged a claim for judicial review against the Department of Health over funding for deprivation of liberty safeguards. They are seeking additional funding to address the rise in referrals following the Supreme Court's decision in Cheshire West and Chester Council v P.

Children wait ten years for mental health support, says review from Centre for Mental Health.

Bevan Brittan Articles

Brexit – Certainly Uncertain. Are the rights and freedoms of individuals who lack capacity safe after the referendum?

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

Building better participation. This set of resources aims to help all GP practice patient participation groups (PPGs) to work effectively. The guidance and accompanying tools, commissioned by NHS England, will help all PPGs - whether they are long-standing or recently formed - to reflect on what they do, how they work, and how they might become even more effective. 

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).

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

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Procurement

Publications /Guidance

Procurement policy note 04/16 Concession contracts threshold. Informs contracting authorities and utilities that the threshold for concession contracts is £4,104,394 (€5,225,000) with effect from 18 April 2016.

Procurement Policy Note 05/16: Open book contract management. This PPN assists in enabling open book contract management (OBCM) to be used in a fair way depending on the risk level and complexity of the contract. This will ensure it is used on those contracts where the additional cost is justified by the level of benefits and risk. It states that organisations should begin assessing their contract portfolios by no later than 24 June 2016, and mobilising resources to begin implementing OBCM by no later than 24 July 2016. There is also guidance on OBCM. See also Government contracts to be open to public for the first time: Cabinet Office announcement of a series of concrete commitments to maintain the UK’s position as the most transparent governments ever. The UK Open Government National Action Plan 2016-18 (NAP) sets out 13 commitments on transparency, anti-corruption and open government. These include commitment to the Open Contracting Data Standard (OCDS) for contracts administered by a central purchasing authority, the Crown Commercial Service – this means that the whole process of awarding public sector contracts will be visible to the public for the first time by October 2016. It will be piloted by HS2.  

CMA: Detecting and deterring bid-rigging. Bid-rigging is a serious type of anti-competitive activity that can drive up the prices of contracts for vital goods or services and deny purchasers from getting true value for money. The CMA has issued an open letter to procurement and supply professionals on how to detect and deter bid-rigging. It provides information on tools and advice to help purchasers detect suspicious activity and avoid becoming victims of bid-rigging. 

NAO: Government commercial and contracting – An overview of the NAO's work. This overview of the NAO’s work on the Government’s management of contracting examines subjects including the Government’s commercial capability, accountability and transparency, and its management of contracted-out service delivery. The NAO and the Public Accounts Committee have acknowledged improvements in the Government’s management of contracts in recent years. But there is much more to be done for government contracting to be effective, meet expected public service standards and provide better value for money for the taxpayer. This overview also looks at areas for improvement including greater transparency of suppliers’ performance, cost and revenue.

Cases

Kent Community Health NHS Foundation Trust v NHS Swale CCG and NHS Dartford, Gravesham & Swanley CCG [2016] EWHC 1393 (TCC). KCH was the incumbent provider of adult community services in North Kent. Following a re-procurement the defendant CCGs awarded the contract to Virgin Care. KCH issued proceedings which triggered the automatic suspension on contract-making under the Public Contracts Regulations (PCR). The CCGs applied to lift the automatic suspension. The questions for the court were whether damages would be an adequate remedy for KCH and whether the balance of convenience favoured lifting or maintaining the suspension, the parties having agreed for the purposes of the application that there was a serious issue to be tried (the American Cyanamid test). The court held, granting the application and lifting the suspension, that damages would be an adequate remedy for the Trust and that this question should not be approached any differently in respect of a non-profit public sector contractor than a profit-making private contractor. That analysis appears to conflict with a Coulson J's general statement to the contrary in the case of Bristol Missing Link. The court further held that the balance of convenience did not weigh substantially in favour of maintaining or lifting the suspension but that the status quo favoured lifting it. A dispute arose as to what the status quo was. KCH argued that as it was the incumbent provider the status quo favoured maintaining the suspension. The CCGs argued that KCH's contract had come to an end so the status quo was to allow it to enter into the contract with Virgin. The court preferred the CCGs' argument.

Bevan Brittan Articles

Procurement and trade rules post Brexit. We are waking to a very different future for politics, finance and governance in the UK.

Procurement Bytes: Dynamic Purchasing Systems (DPS) Byes 1, 2 & 3. We have published a series of three articles that look at practical issues in setting up and running Dynamic Purchasing Systems (DPS).

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

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Providers

Publications/Guidance

The chief executive's tale: views from the front line of the NHS. This report, published in partnership with NHS Providers, draws on the views and experiences of twelve 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. It concludes that 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.

Bevan Brittan Events

South West Healthcare Sector Drinks Reception. Tuesday 04 October 2016, 17:00. Bevan Brittan and Clydesdale Yorkshire Bank invite you to a free event giving providers and professional advisers in the sector an opportunity to discuss the current challenges and opportunities and to network in an informal setting.

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

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Public Health

Publications/Guidance

MHRA research on protecting public health. Following concerns raised about the safety of implanting polypropylene into patients in order to treat pelvic floor conditions, a review from the Medicines and Healthcare products Regulatory Agency (MHRA) has led to the publication of a paper, written by four members of the MHRA device division, in the International Urogynecology Journal. MHRA says this work has never before been undertaken in such a thorough and systematic way, and presents all of the relevant data together in one place for the first time.  

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.

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

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Regulation

Publications/guidance

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. 

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

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General

Publications/Guidance

Misuse of social media to harass, intimidate or threaten NHS staff. This short guidance document aims to help Local Security Management Specialists (LSMSs) support and advise NHS staff in cases where social media has been misused to harass, intimidate or threaten them.

Patients recording NHS staff in health and social care settings. This short guide has been developed to provide advice to Local Security Management Specialists (LSMSs) to enable them to support and advise NHS staff on covert and overt recording by patients.

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.

2015 adult inpatient survey. This survey provides information on the experiences of people admitted to an acute or acute specialist NHS hospital in England in 2015. The results indicate that there have been small, but statistically significant improvements in a number of areas, compared with previous surveys. This includes patients’ perceptions of the quality of communication between medical professionals and patients, the standards of hospital cleanliness, the availability of help to eat when needed, the number of nurses on duty and being involved in decisions about their care and treatment.

Patients benefiting from advanced brain tumour treatment set to double. NHS England has announced the award of new contracts for stereotactic radiosurgery and radiotherapy (SRS/SRT), specialist forms of radiotherapy that can be used to treat patients with intracranial conditions, such as benign and malignant brain tumours. Providers will start delivering SRS/SRT services during 2016 and work swiftly towards a significantly expanded service. As part of the Cancer Strategy, further improvements to radiotherapy access and quality will be the subject of a separate Radiotherapy Services Review. The Review will produce a plan for a modern national radiotherapy network by September, with a revised radiotherapy service specification by the end of the year.

NHS Chief launches new fast track funding so NHS patients get treatment innovations faster. In his keynote speech to around 1,000 NHS leaders at the NHS Confederation Conference in Manchester, Simon Stevens has announced the launch of a new programme to fast-track cutting-edge innovations from across the globe to the NHS frontline. This will accelerate uptake of new medtech devices and apps for patients with diabetes, heart conditions, asthma, sleep disorders, and other chronic health conditions, and many other areas such as infertility and pregnancy, obesity reduction and weight management, and common mental health disorders.  

Six principles for engaging people and communities: putting them into practice. The six principles were developed by the People and Communities Board, one of the Five Year Forward View programme boards, in conjunction with the new models of care vanguards sites, to give practical support to services as they deliver the ‘new relationship with people and communities’ set out in the Five Year Forward View. This new paper sets out why the principles are important, and offers case studies and key questions to help local leaders put them into practice.

Map of technology and data in health and care. The King's Fund has published an interactive map that brings together case studies from across England and the rest of world, highlighting some of the places that are experimenting with and implementing new technologies to achieve better health outcomes or more efficient care. There are also links to each case study.

Supplying the demand for doctors: The need to end the rationing of medical training places. This paper by Civitas Health Researcher Ed Stubbs proposes that instead of Health Education England (HEE) making upfront payments for the training of its medics (via bursaries, fifth year tuition fees and clinical placement fees), medical students should be required to take out a loan from the Student Loans Company to cover the total cost of their training, thus transferring the NHS’s immediate training costs to an asset on the DBIS’s balance sheet. Stubbs also points out that another problematic element of current recruitment practices is that foreign students are given their placement fees, the same as any UK national student. These fees come out of the NHS’s training budget, meaning the NHS is paying up to £12m per year for overseas students to study here with no guarantee that they will stay beyond the end of their studies. The proposed placement fee loan would ensure that such students either remain and work for the NHS after graduation or fully pay back their placement fees if they wish to return home.

The Department of Health's agencies and partner organisations. Provides important information about the 14 agencies and public bodies that the DH works with.

Devolution: What does it mean from an NHS England perspective? NHS England has published information on how it will assess proposals for devolution of NHS England functions and how the devolution agenda links with the sustainability and transformation planning process. It sets out overarching models of devolution of NHS England functions in terms of the current legislative framework, and provides further information on how NHS England will assess proposals for devolution of its functions and how the devolution agenda links with the Sustainability and Transformation Planning (STP) process.

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.

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.  

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. 

Bevan Brittan Articles

A Quick Guide to Developing a Legionella Investigation Protocol

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

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