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.

Training Events

Health and Safety

Care

Inquests

Children

Mental Health

Clinical Risk/Patient Safety

Primary Care

Commissioning

Procurement

Employment/HR

Public Health

Finance

Regulation

Foundation Trusts

General

 

Training Events

Court of Protection Seminar - This session will focus on practical issues that practitioners, commissioners and providers encounter in matters engaging the Court of Protection; covering relevant legislation, guidance and case law and their impact on managing incapable patients.
Bristol - Wednesday 23 November 2016, 09:30
Birmingham - Thursday 24 November 2016, 09:30
London - Tuesday 29 November 2016, 09:30
Leeds - Tuesday 29 November 2016, 09:30  

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, 09:15
London - Tuesday 15 November 2016, 09:15
Birmingham - Wednesday 16 November 2016, 09:15

Employment law update: the highlights of 2016 & key changes on the horizon. As the seismic events of 23 June 2016 continue to bed down and the detail of our exit from the EU comes into focus, we will take you on a whistle-stop tour of the headline developments in workforce law and practice over 2016. Almost needless to say, we will be taking a look at what 'Brexit means Brexit' means for your workforce. And in other developments, we will walk you through key changes that have emerged over the past year, including new social media / employee monitoring case law, the ever-expanding scope of the whistleblowing agenda, pay issues - including the 'living wage' and gender pay gap reporting - and the increasing regulation of employers' use of overseas workers. Then it is out with the crystal ball to look at forthcoming changes and important cases to look out for in 2017.
Birmingham - Tuesday 6 December 09:30
Bristol - Wednesday 7 December 09:30
Leeds - Thursday 8 December 09:30
London - Wednesday 14 December 09:30

Procurement Update - Our Procurement team will cover legislative and policy developments as well as looking at recent EU and UK court cases and how these affect procurement in practice.
Birmingham - 7 November 13:00
Leeds - 8 November 09:30
London - 9 November 09:00
London - 9 November 13:00
Bristol - 10 November 09:00 

Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If you are a client and would like to come along and join our team at these sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office. If you are unable to get to one of our offices you can also sign up to watch the training sessions remotely via our webinar facility. Lunchtime training sessions coming up are:-
Mental Health Act and Mental Capacity Act update - 14 November 12.30pm - 1.30pm
Human Rights Act claims update - 12 December 12.30pm - 1.30pm.

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Care

Publications/guidance

Guidance: Needs assessments on hospital discharge. The CQC has issued guidance following some concerns that care home providers will not readmit people after periods in hospital without conducting full, in person assessments of need. It clarifies the legal requirements around this and offers some best practice guidance.

Care and support statutory guidance. The statutory guidance on Part 1 of the 2014 Act has been updated to make clearer how s.75 of the 2006 Act and the Care Act work together.

The state of health care and adult social care in England 2015/16. This annual assessment of the quality of health and adult social care in England has found that most health and adult social care services in England are providing people with safe, high quality and compassionate care - but with pressures rising on demand, access and cost, this report raises concerns about how long this can last. The report also highlights the impact of the fragility of the adult social care market on those who rely on these services and on the performance of NHS care.

The Homecare Deficit 2016: A report on the funding of older people’s homecare across the United Kingdom. UK Homecare Association's report demonstrates the funding gap between what councils pay for homecare and the costs of services which must meet the National Living Wage. It reveals that the average price councils paid for homecare in the UK in April 2016 was just £14.58 per hour, compared to UKHCA's Minimum Price for Homecare of £16.70 per hour. It argues that the rates that so many councils are paying independent and voluntary homecare providers illustrate the root cause of instability of local homecare markets and unacceptably low pay and conditions of the homecare workforce supplying care through contracts with councils and Health and Social Care Trusts.

LGA and ADASS on expectations for the continuation of BCF fund from 2017. The LGA and ADASS support the intentions of the Better Care Fund (BCF) to drive local integration of health and social care through the transfer of NHS resource to local authorities to protect vital adult social care services. This statement lists how they expect the BCF to be significantly improved from 2017.

Harnessing social action to support older people. This research report from Nuffield Trust presents the findings of its evaluation of seven social action projects funded by the Cabinet Office, NHS England, Monitor, NHS Trust Development Authority and the Association of Directors of Adult Social Services. The projects fell into three broad categories: community-based support, supporting discharge from hospital wards, and supporting individuals in A&E department to avoid admissions. Between them, the projects offered a wide range of services to older people – both direct (for example help with shopping or providing transport) and indirect (linking with other services).

The Enhanced Health in Care Homes care model. This briefing summarises NHS England's framework document for enhanced health in care homes which outlines various evidence-based interventions designed to be delivered within or around a care home in a co-ordinated manner in order to make the biggest difference to care home residents. 

The framework for enhanced health in care homes. This framework document lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of in reach services. It sets out seven key components and 18 sub-components which define the care homes model, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

The state of the adult social care sector and workforce in England, 2016. This report presents a comprehensive overview of the adult social care sector, which continues to grow and employs an estimated 1.55m jobs.

Pressure points: Carers and the NHS. This report by Carers UK examines the role of carers in reducing emergency admissions and delayed transfers of care from hospital. The research looked at carers’ experiences of using emergency services like 999 or going to A&E and their reasons for turning to hospital rather than to a community health service. It also asked carers about what could have made a difference to preventing an emergency care admission or supporting them to care effectively at home without damaging their own health in the process.

Moving from the margins: the challenges of building integrated local services. Collaborate and Turning Point have produced a discussion paper that presents seven key insights for building integrated public services. Its overriding message is that local integrated services should be at the heart of strategies for social renewal and public service reform. The report’s seven insights range from the need to shift the narrative from austerity to one of social challenges in a place, to the value of building system infrastructure that enables collaboration. The combination of the current political, economic, and social context coupled with the presentation of credible model of community-led integrated care, makes a compelling argument for these to be taken seriously.

Growing older in the UK: A series of expert-authored briefing papers on ageing and health. This series of briefing papers explores a range of topics relevant to supporting and improving people’s health and wellbeing as they grow older in the UK. They highlight the increasing demand and inadequate resources facing the UK’s health and social care system.

News

Quarter of people do not need to be admitted to hospital, new research reveals

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

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Children

Publications/guidance

NICE guideline NG55: Harmful sexual behaviour among children and young people. This guideline covers children and young people who display harmful sexual behaviour, including those on remand or serving community or custodial sentences. It aims to ensure these problems don’t escalate and possibly lead to them being charged with a sexual offence. It also aims to ensure no-one is unnecessarily referred to specialist services.  

Children in need of help or protection. The Department for Education recognised since 2010 that child protection services are not good enough but its subsequent response has not yet resulted in better outcomes. Spending on children’s social work, including on child protection, varies widely across England and is not related to quality. Neither the DfE nor authorities understand why spending varies. 

News

Boy being brought up as a girl removed from mother's care. Mr Justice Hayden has removed from his mother's care a 7-year-old boy who was living as a girl, saying the woman had caused her son "emotional harm" and criticising social services for failing to act on concerns about the boy's treatment. Hayden J said the women had been convinced that the boy "perceived himself as a girl". In a related story, the Sunday Times reports on a family challenging a local authority for backing their daughter's attempt to take a boy's name as a step towards changing her gender.

Funding for children and young people’s mental health. Claire Murdoch, National Mental Health Director, NHS England, has written to CCG Clinical Leaders and Accountable Officers advising of an additional £25m in funding for children and young people's mental health services which has been made available for CCGs in 2016/17. This is additional to the £149m already allocated to CCGs for these services in the same period.

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 Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If you are a client and would like to come along and join our team at these sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office. If you are unable to get to one of our offices you can also sign up to watch the training sessions remotely via our webinar facility. Lunchtime training sessions coming up are:-
Mental Health Act and Mental Capacity Act update - 14 November 12.30pm - 1.30pm
Human Rights Act claims update - 12 December 12.30pm - 1.30pm.

Publications/Guidance

Choosing Wisely UK launched – 40 treatments that bring little or no benefit to patients. The Academy of Medical Royal colleges has launched its Choosing Wisely campaign, with a list of forty treatments and procedures that are of little or no benefit to patients. The list, which has been drawn up by the Academy’s member royal colleges and faculties includes advice to both patients and doctors for treating health related issues.

The state of medical education and practice in the UK report: 2016. The overview highlights a growing pressure on doctors, a ‘dangerous level of alienation’ felt by doctors in training and the impact which struggling healthcare services are having on doctors’ education and training.

Creating Supportive Environments Tackling behaviours that undermine a culture of safety An interim report by the Academy of Medical Royal Colleges’ Trainee Doctors’ Group (ATDG) that explores bullying and undermining within the medical workforce in the UK. It looks at current efforts to tackle problems and what further work is required.

Consent: Supported Decision-Making. The RCS has developed guidance on consent that sets out the principles for working with patients through a process of supported decision-making, and a series of podcasts that illustrate those principles in practice.

PHSO review: quality of NHS complaints investigations: government response to the committee’s first report of session 2016–17. In May 2016, the Public Administration and Constitutional Affairs Committee investigated the way in which NHS complaints are handled and made recommendations for the creation of the Healthcare Safety Investigation Branch (HSIB). This response from the government outlines the action currently being taken to improve the quality of NHS complaint handling.

Safer maternity care. The Safer Maternity Care action plan is part of the national ambition to halve rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or shortly after birth, by 2030. This action plan outlines the Department of Health's national ambition to halve rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or shortly after birth, by 2030. The plan sets out the various measures that will be used to make NHS maternity services safer, such as: a £250,000 maternity safety innovation fund, published maternity ratings for CCGs to enable benchmarking and a new national quality improvement programme.

Agency, bank and overtime spending in maternity units in England in 2015. This report is the result of FOI requests sent to all NHS trusts in England with maternity services and it found that in 2015, the NHS spent over £72 million on agency, overtime and bank midwives which is equivalent to the cost of over 3000 full-time midwives. The report highlights the need for improvement on workforce strategy within the NHS to ensure a more efficient use of resources and it also calls for the government to reconsider proposed plans to abolish nursing bursaries.

Report on the Clinical Negligence Scheme for Trusts (CNST) Consultation. This report sets out the feedback the NHS LA received, how they intend to use that to improve the CNST, the steps that they will take and when.

Follow-up to PHSO report on unsafe discharge from hospital. The Commons Public Administration and Constitutional Affairs Committee has published a report looking at the work already carried out by the PHSO (Parliamentary and Health Service Ombudsman) which highlighted harrowing cases that illustrated the human costs of poor discharge, causing suffering and distress for patients, and anguish for their carers and relatives. The Committee found that the discharge failures identified by the PHSO report are not isolated incidents but rather examples of problems that patients, relatives and carers are experiencing more widely. Despite increased attention to the issue, it remains a persistent problem. It concludes that the incidence of unsafe discharge from NHS hospitals is unacceptably high as a result of political maladministration.

Creating supportive environments: tackling behaviours that undermine a culture of safety. This report explores bullying and undermining within the medical workforce in the UK. It looks at current efforts to tackle problems and what further work is required.

User feedback in maternity services. This report looks at what maternity services are doing locally to collect, analyse and act on user feedback. It describes the challenges of adopting the different approaches and highlights the features of organisations that are successful in user feedback activities.

Joint whistleblowing guidance. HEE and the BMA have issued joint guidance on the new whistleblowing protection announced for doctors in training. This follows HEE’s recent letter to employers with the detailed Terms of Agreement that provides junior doctors in England with legal protection if they are subjected to detrimental treatment by HEE as a result of whistleblowing.

Cases

Smith v Lancashire Teaching Hospitals NHS Trust and Another [2016] EWHC 2208 (QB). In this case the court stressed that the difference in treatment between cohabitees and people who are married or in a civil partnership could not be justified and that consideration should be given to reforming the law. However, the judge also found that the fact that the Fatal Accidents Act 1976 slA(2)(a) excluded cohabitees from receiving damages for bereavement did not directly engage, or fall within the ambit of ECHR Art 8.

Valerie Elsie May Merrix v Heart of England NHS Foundation Trust  (Birmingham) (District Judge Lumb) 13/10/2016 A costs judge's powers at a detailed assessment were not fettered by the costs budgeting regime under CPR Pt 3 save for the point that the budgeted figures should not be exceeded unless good reason could be shown. Parties to litigation are under a duty to co-operate and narrow the issues. Costs budgets should be produced by the parties where the difference was so negligible that it would not be worth the trim or trouble of a detailed assessment. (Our understanding is that permission to appeal this decision was given.)

Consultations

Providing a 'safe space' in healthcare safety investigations. Seeks views on creating a balanced 'safe space' to allow NHS staff to speak up about incidents without the fear of being punished.See also "Providing a 'safe space' in healthcare safety investigations: Written statement - HLWS194"

News

Department of Health's first ever ratings find three in four maternity services are failing. The Telegraph reports that for the first time, the Department of Health has rated every clinical commissioning group in England and Wales in an effort to improve NHS maternity care, and found that three quarters of all NHS maternity services are failing patients.

Ambulance patients face long A&E delays. Thousands of patients taken to hospital by ambulance face long delays before being seen by accident and emergency staff, figures for England show.

Joshua Titcombe death: Midwife Lindsey Biggs struck off.

Second round of funding aims to improve maternity services through patient feedback.

The NHS partners with Twitter to help shed light on what it means to work or be a patient in the NHS. A pioneering new initiative to lift the lid on the NHS through the voices of the people on its frontline has gone live with the launch of the @NHS Twitter account.

Government “set to limit” clinical negligence fixed costs to cases worth up to £25,000. The DH is set to rein in its plans for fixed recoverable costs in clinical negligence cases and introduce them just for claims worth up to just £25,000.

Breast implant register is launched to safeguard patients. A register of patients in England with breast and other cosmetic implants has been set up to allow them to be traced in the event of any safety concerns.

Fast-track compensation for birth injuries to improve NHS safety. Under proposals to encourage NHS health professionals to admit mistakes and improve safety, parents whose babies are harmed during labour are to get fast-track compensation without the need to go to court. The Secretary of State for Health will announce that the NHS will from now on automatically investigate and pay out even if negligence is not proven. He will promise a "rapid resolution and redress" scheme, putting the onus on the NHS to look into errors and offer compensation.

Clinical negligence lawyers back greater use of mediation. Clinical negligence lawyers have lent their support to the increased use of mediation in resolving disputes, following an invitation by the NHS Litigation Authority (NHSLA) to provide its mediation services. The NHSLA has set a deadline of November 2016 for mediation procurement in a bid to put a stop to "compensation culture".

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

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

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Commissioning

Publications/Guidance

The Public Contracts Regulation 2015 and NHS commissioners. The Public Contract Regulations 2015 require commissioners to act in a transparent way when taking procurement decisions and, in particular, advertising when awarding a contract for services above a value of €750,000. This DH briefing summarises requirements for NHS commissioners and those supporting them with their procurement of healthcare services.

The future of commissioning. This paper sets out NHS Clinical Commissioners' vision for the future of clinical commissioning. It considers that in the future it is unlikely that there will be one single model of clinical commissioning, but at the heart sits the clinical leadership, expertise and local knowledge of the communities they serve and this must not be lost. The attached paper also calls on national bodies and policy-makers to support the local models of strategic commissioning that are emerging.

The Social Value difference in health and care commissioning. This short report details the difference social value can make in health and care commissioning, and shares learning for other commissioning authorities to make the most of social value. It presents the initial findings from SEUK's Health and Social Value Programme, a three-year programme bringing together local CCGs, local authorities, Health and Wellbeing Boards and VCSE organisations in 12 areas across England.
There is also a 12 step approach for commissioners looking to make the most of social value.

Technical Guidance Annex B: Information on Quality Premium. Updated section of the technical guidance for NHS planning 2017/18 and 2018/19 gives information on the Quality Premium (QP) scheme, which rewards CCGs for improvements in the quality of the services they commission. The scheme also incentivises CCGs to improve patient health outcomes and reduce inequalities in health outcomes and improve access to services.

Crown Commercial Service newsletter for NHS trusts. Provide NHS trusts with the latest information to help them achieve best value and make savings for the taxpayer when buying commonly required goods and services.

New care models: emerging innovations in governance and organisational form. The 23 vanguard sites chosen to develop the multispecialty community provider (MCP) and primary and acute care system (PACS) new care models have been working to pool budgets and integrate services more closely. Some are continuing to use informal partnerships, but others are opting for more formal governance arrangements. Commissioners are grappling with how to contract for the new systems, while providers are exploring how to work together within emerging partnerships, how to allocate funding, and how to share risk and rewards. This report looks at the different approaches being taken by MCP and PACS vanguards to contracting, governance and other organisational infrastructure.

Patient Reported Outcome Measures. NHS England is asking commissioners to familiarise themselves with a range of insight tools including national surveys and feedback data using a series of short guides.

Managing Conflicts of Interest: Internal Audit Framework for CCGs. The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake the audit, NHS England has published this template audit framework.

Making difficult decisions: Commissioning healthcare in changing times. NHS Clinical Commissioners has launched a new publication to support CCGs in making difficult decisions about prioritisation of resources and changes to local services. It sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes, drawing on both academic research and practical insight from commissioners, patient groups and NHS England.

Consultations

Consultation on commissioning policies. This consultation seeks views on commissioning policies that describe how NHS England will make decisions on funding for treatments that are not currently routinely commissioned. The consultation aims to ensure that the policies help NHS England make effective, sustainable and fair uses of finite resources. The closing date for feedback is 15 January 2017.

News

More CCGs urged to apply for 'delegated' status NHS England is encouraging CCGs working under other arrangements to apply for full delegation from April 2017.

NHS England involvement hub. NHS England has created a new involvement hub to provide a one-stop shop for tools, resources, best practice and training linked to patient and public participation. The site is for healthcare commissioners who want further information about participation and patients and the public who want to get involved in the NHS. NHS England is keen to find out about new training, best practice and resources developed by CCGs that could be shared with others via the new site. 

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

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Employment/HR

Publications/Guidance

In the red: student nurse debt. This research highlights risks to the future nursing supply in England as it finds that half of nurses are aged 45 or over and are within ten years of being eligible for early retirement. In comparison, a decade ago just a third of the nursing workforce was aged 45 or over. The report calls on the government to scrap the pay cap for NHS staff to help to alleviate the retention crisis.

Unheeded warnings: health care in crisis: the UK nursing labour market review 2016. This report finds that two thirds of NHS students have had to take on work on top of their studies in order to supplement their income. The proportion of medical and health students taking on extra jobs has risen from 61 per cent to 68 per cent in the last decade and 64 per cent of those surveyed say that working these extra hours is affecting their ability to study.

Cohort study of 2006 medical graduates: tenth report. The BMA Cohort Doctor report is a ten year study of 430 doctors who, nine years post-graduation, are mostly progressing through specialty training or are working as qualified GPs. This report provides an insight into career choice and working environments in terms of workplace morale, work related stress and work-life balance. It finds that almost half of doctors are looking to move overseas as their current experience of being a doctor is worse than they expected when they graduated.

Agency, bank and overtime spending in maternity units in England in 2015. In January 2016 the RCM sent an FOI request to all the NHS trusts in England that have maternity units to ask them how much they have spent on agency and bank staff and overtime for every month in 2015, and also about the numbers of hours of staff time this equated to. The findings show that while bank and overtime spending are much better value for money than agency spending, it is clear that organisations are far too reliant on temporary staffing. NHS organisations need to develop a total workforce strategy to ensure that they have the appropriate numbers of staff; to ensure that they are retaining their existing staff and to ensure they are recruiting enough staff to deal with the increased demand on the service and replace staff who leave.

A mandate from the government to Health Education England: 2016 to 2017. Sets out the Government's objectives for HEE to provide healthcare education and training. 

Creating supportive environments: tackling behaviours that undermine a culture of safety. This report explores bullying and undermining within the medical workforce in the UK. It looks at current efforts to tackle problems and what further work is required.

Joint whistleblowing guidance. HEE and the BMA have issued joint guidance on the new whistleblowing protection announced for doctors in training. This follows HEE’s recent letter to employers with the detailed Terms of Agreement that provides junior doctors in England with legal protection if they are subjected to detrimental treatment by HEE as a result of whistleblowing.

Doctors around the world to face competency tests Doctors will face competency checks throughout the world following a landmark decision by the General Assembly of the International Association of Medical Regulatory Authorities (IAMRA). A resolution passed at the IAMRA meeting in Melbourne will encourage regulators from around the world to ensure doctors can demonstrate competence throughout their careers.

Personal safety when working alone: guidance for members working in health and social care This guide has been developed for RCN members who work alone. It also contains a checklist for RCN safety representatives who work on negotiating improvements to workplace safety for members and nurse managers who manage lone working staff.

The state of medical education and practice in the UK 2016. This annual report explores how the medical profession has changed and reviews the education and practice of doctors in the UK. This year's report raises concerns that the health system and staff working within it are struggling to cope with a range of issues such as the increased pressure on health and social care services. The report outlines the response that the GMC will take to these increased pressures on doctors by taking a lighter touch on regulation.

HR and social media in the NHS: The essential guide for HR directors and managers. NHS Employers' briefing to help organisations with integrating social media. It covers key areas such as HR policy, staff engagement and recruitment.

UNISON evidence to NHS Pay Review Body 2017-18. This submission of evidence to the NHS Pay Review Body outlines the findings of UNISON's annual pay survey which seeks the views, experiences and strength of feeling on pay across NHS staff in the UK. This year's survey received over 21,000 responses and the results highlighted the increased pressures on personal finances with 67 per cent of respondents reporting that they have had to seek financial help from friends and family or make substantial changes to their living standards within the past year.

News

Health Education England announces training places for over 2,000 Nursing Associates. HEE has announced the eleven partnership sites that will trial the new nursing associate role. The new role aims to bridge the gap between health and care support workers who have a care certificate and graduate registered nurses. It has been developed to enable nurses to focus on the more advanced elements of their jobs, and to offer improved career pathway opportunities to emerging talent.

Doctors who relocate abroad after training could face fines. Under controversial plans to tackle the NHS recruitment crisis, junior doctors will face fines if they relocate outside the UK after finishing training.

Up to 1,500 extra medical training places announced. The Health Secretary has announced that from September 2018, the Government will fund up to 1,500 additional student places through medical school each year. Students will be able to apply for the extra places from next year in order to take them up from the academic year 2018/19. The Health Secretary also pledged to reform the current cap on the total number of places that medical schools can offer, which is set at just over 6,000 p.a. The Government will consult on how these proposals can be implemented. It will also explore ways to ensure graduates provide a return on taxpayer investment to the NHS through, for example, a minimum period of NHS service.

The new English / Welsh language fluency requirements for 'customer facing' public sector workers will be in place from 21 November 2016. In addition, public authorities must ensure that they have in place an appropriate complaints procedure for members of the public who believe that the English language requirements have been breached. There is a supporting Code of Practice, which is here and which explains the appropriate ways in which public authorities can set a standard of spoken English or Welsh; and provides options for remedial action where employees do not meet the necessary standard for English or Welsh.

Bevan Brittan Events

Employment law update: the highlights of 2016 & key changes on the horizon. As the seismic events of 23 June 2016 continue to bed down and the detail of our exit from the EU comes into focus, we will take you on a whistle-stop tour of the headline developments in workforce law and practice over 2016. Almost needless to say, we will be taking a look at what 'Brexit means Brexit' means for your workforce. And in other developments, we will walk you through key changes that have emerged over the past year, including new social media / employee monitoring case law, the ever-expanding scope of the whistleblowing agenda, pay issues - including the 'living wage' and gender pay gap reporting - and the increasing regulation of employers' use of overseas workers. Then it is out with the crystal ball to look at forthcoming changes and important cases to look out for in 2017.
Birmingham - Tuesday 6 December 09:30
Bristol - Wednesday 7 December 09:30
Leeds - Thursday 8 December 09:30
London - Wednesday 14 December 09:30

Bevan Brittan Updates

Employment law news round-up, October 2016 - The latest employment law news in brief for October 2016.

Policing social media: when does virtual communication amount to a criminal offence? - New CPS guidance and what it means for employers.

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

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Finance 

Publications and Guidance

Agency, bank and overtime spending in maternity units in England in 2015. In January 2016 the RCM sent an FOI request to all the NHS trusts in England that have maternity units to ask them how much they have spent on agency and bank staff and overtime for every month in 2015, and also about the numbers of hours of staff time this equated to. The findings show that while bank and overtime spending are much better value for money than agency spending, it is clear that organisations are far too reliant on temporary staffing. NHS organisations need to develop a total workforce strategy to ensure that they have the appropriate numbers of staff; to ensure that they are retaining their existing staff and to ensure they are recruiting enough staff to deal with the increased demand on the service and replace staff who leave.

Enhancing the NHS through international engagement. Brings together the experience and best practice of healthcare exporters from within and beyond the NHS. It aims to provide NHS organisations which have limited international experience with an overview of the key things to consider to maximise the chance of success (and minimise risk) when beginning their export journey. NHS organisations can draw on this information to get on the right track for generating a successful and sustainable international revenue stream, which can be used for innovation and improvement in UK patient care.

News

New figures reveal running cost of NHS estate. NHS Digital has released figures detailing the costs of building, maintaining and servicing parts of the NHS estate - from how much is spent on feeding patients, to how many car parking spaces hospitals have.

Threat to name NHS trusts over high agency spending. NHS bosses are threatening to "name and shame" trusts in England as they try to crack down on agency spending.

Doctors who relocate abroad after training could face fines. Under controversial plans to tackle the NHS recruitment crisis, junior doctors will face fines if they relocate outside the UK after finishing training.

AI predicts results of ECtHR cases. 14 Scientists at University College London have devised software that is able to weigh up legal evidence and moral questions, and which has successfully predicted the result in hundreds of real-life cases. The artificial intelligence (AI) "judge" has reached the same verdicts as judges at the ECtHR in 79% of cases involving torture, degrading treatment and privacy. The algorithm, which looked at 584 cases, could be useful for identifying patterns in cases and identifying which cases are most likely to be violations of the ECHR, researchers said.

Boy being brought up as a girl removed from mother's care. Mr Justice Hayden has removed from his mother's care a 7-year-old boy who was living as a girl, saying the woman had caused her son "emotional harm" and criticising social services for failing to act on concerns about the boy's treatment. Hayden J said the women had been convinced that the boy "perceived himself as a girl". In a related story, the Sunday Times reports on a family challenging a local authority for backing their daughter's attempt to take a boy's name as a step towards changing her gender.

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

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Foundation Trusts 

Publications/Guidance

Options for structuring foundation groups Guidance for NHS foundation trusts considering forming a foundation group and for any providers who are considering participating. 

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

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Health and Safety 

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, 09:15
London - Tuesday 15 November 2016, 09:15
Birmingham - Wednesday 16 November 2016, 09:15 

If you wish to discuss any issues raised in this section please contact Adam Kendall

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Inquests

Bevan Brittan Updates

Inquest Law: Admitted Failings in Article 2 Hearings. R (on the application of Teresa Tainton) v HM Senior Coroner for Preston and West Lancashire [2016] EWHC 1396 (Admin).

If you wish to discuss any issues raised in this section please contact Claire Leonard or  Annette Parker

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Mental Health

Would you like to access the Bevan Brittan Mental Health Extranet? - It is a secure online resource containing a discussion forum, knowledge bank and information about training events. If you would like access please contact Claire Bentley. Items that are currently being discussed on our forum are:- 

Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If you are a client and would like to come along and join our team at these sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office. If you are unable to get to one of our offices you can also sign up to watch the training sessions remotely via our webinar facility. Lunchtime training sessions coming up are:-
Mental Health Act and Mental Capacity Act update - 14 November 12.30pm - 1.30pm
Human Rights Act claims update - 12 December 12.30pm - 1.30pm.

Publications/Guidance

Improving the physical health of adults with severe mental illness: essential actions This report, written in partnership with various royal medical colleges and Public Health England, sets out the essential actions to improve the physical health of adults with severe mental illness (SMI) across the NHS. The report makes practical recommendations for changes that will help adults with SMI to receive the same standards of physical healthcare as the general population and reduce the risk of premature death.

Rapid review of evidence of the impact on health outcomes of NHS commissioned health services for people in secure and detained settings. This rapid review of evidence of the impact on health outcomes of NHS commissioned health services demonstrates that there have been significant improvements in the quality of health care in prison settings. The review will inform future health interventions and prioritisation in England where there are further improvements to be made.

Is mental health crisis care in crisis? This briefing, by the Mental Health Network, explores the gap between the policy rhetoric around mental health crisis care and reporting on the ground.

Hidden in plain sight: the unmet mental health needs of older people According to this report, the current availability of mental health services does not meet the increasingly high demand from an ageing population. It also found that over a third of mental health trusts in England have no policies for providing integrated care for people over 65 with both mental and physical health needs.

Speech by Mr Justice Baker: A matter of life or death. Text of a speech by Mr Justice Baker on the role of the Court of Protection,  analysis of Bland and whether judges are the right people to decide such issues.

I am whole: a report investigating the stigma faced by young people experiencing mental health difficulties The report examines the stigma faced by young people experiencing mental health difficulties. The research looks at the prevalence of this stigma, who is experiencing it and how they are doing so, the impact of this stigma, and the potential solutions that the young people themselves have identified.

Together for Mental Health: Delivery plan: 2016-19. The Welsh Government's 10-year strategy for improving mental health and wellbeing and improving the care and treatment of people using mental health services their carers and their families was published in 2012. This delivery plan is the second of three plans which sets out the actions to ensure the strategy is implemented.

Sussex Partnership NHS Foundation Trust. Publication of thematic homicide review. A mental health trust underestimated the risk posed by its patients and sometimes did not act on threats to kill, a review of 10 killings over eight years has found.

Commitments to increase mental health funding not reaching the front line. Promised increases in funding for mental health services have not materialised in many areas of the country, according to a new analysis by The King’s Fund.

Inequalities in mental health, cognitive impairment and dementia among older people. This report focuses on inequalities in the experience and prevalence of poor mental health, cognitive impairment and dementia and the impact of social isolation, lack of mental stimulation and physical activity, before and after retirement, and in later life. If finds that these issues can exacerbate the risks of poor mental health, cognitive impairment and dementia in later life and are experienced disproportionately by people in lower socio economic groups. It also provides a brief summary of life course social determinants that increase the risk of poor mental health, early onset of cognitive decline and the symptoms of dementia.

Out of area placements in mental health services for adults in acute inpatient care. The government has set a national ambition to eliminate inappropriate out of area placements (OAPs) in mental health services for adults in acute inpatient care by 2020 to 2021. This guidance is aimed at providers, commissioners and users of local adult inpatient acute mental health services in England. It is intended to support providers and commissioners in accurately monitoring and reducing their use of OAPs and to help providers submit accurate information on OAPs to national data collections.

Family court statistics quarterly: April to June 2016. There are PDF and Excel files. The PDF contains a brief summary of stats for the quarter and the Excel file has more detailed stats since 2008. You can access the spreadsheet from the link. You need to go into tables 17 and 18 for the CoP figures.

Two Pilot Practice Directions launched in Court of Protection: Case Management & s.49 Reports. The pilot Practice Directions were published in advance of two pilots commencing in the Court of Protection (CoP), one in relation to case management and one specifically in relation to section 49 reports. The pilots commenced on 1 September 2016, though the pilot Practice Directions were initially published in draft in March to allow practitioners to prepare for a significant change in case management practice.

National confidential inquiry into suicide and homicide by people with mental illness This report presents findings relating to people who died by suicide in 2004-2014. It found that over 200 suicide deaths per year now occur in patients under mental health crisis teams, three times as many as in in-patients.

Providers of surety bonds for deputies: new Practice Note from the OPG. ​The OPG has updated its Practice Note 03/2012 relating to surety bond providers for deputies who have been appointed by the Court of Protection to manage the property and affairs of the Patient.

Mental Capacity Act 2005, Deprivation of Liberty Safeguards (England), Annual Report 2015-16. The latest annual report from NHS Digital on Deprivation of Liberty Safeguards applications shows that 105,055 applications were completed in England in 2015-16, up from 62,645 in 2014-15. In comparison that figure stood at 13,404 in 2013-14.

World Alzheimer Report 2016 calls for global transformation in healthcare for people with dementia. 

Consultations

Mental health of adults in contact with the criminal justice system: draft guidance This draft guidance seeks to improve the assessment, treatment and prevention of mental health problems in adults. When the guideline is finalised, it will apply to anyone who comes into contact with the English criminal justice system, including time spent serving a community or prison sentence, and any probationary periods. It highlights the need for all staff working within the criminal justice system to receive training to recognise and respond to mental health problems. Comments and feedback are currently being sought on this draft guidance until 18 November 2016.

News

Funding for children and young people’s mental health. Claire Murdoch, National Mental Health Director, NHS England, has written to CCG Clinical Leaders and Accountable Officers advising of an additional £25m in funding for children and young people's mental health services which has been made available for CCGs in 2016/17. This is additional to the £149m already allocated to CCGs for these services in the same period.

Increase in the number of people dying with dementia. PHE reports that the proportion of people dying with a recorded dementia diagnosis has more than doubled since 2001. It has launched a range of products which examine the deaths of people recorded with dementia between 2012 and 2014. The reports draw on national data to see if there have been changes in dementia deaths over time, who the people dying with dementia are, where they die and the cause of their death. The findings suggest that people who live in more deprived areas die with dementia at a younger age than those who live in more affluent areas. There are also considerable differences between the place of death for people who have dementia and the general population: people with dementia are considerably more likely to die in hospitals and care homes and less likely to die at home or in end of life care settings such as hospices. 

Bevan Brittan Events

Court of Protection Seminar - This session will focus on practical issues that practitioners, commissioners and providers encounter in matters engaging the Court of Protection; covering relevant legislation, guidance and case law and their impact on managing incapable patients.
Bristol - Wednesday 23 November 2016, 09:30
Birmingham - Thursday 24 November 2016, 09:30
London - Tuesday 29 November 2016, 09:30
Leeds - Tuesday 29 November 2016, 09:30  

Bevan Brittan Updates

Suicides of Mental Health Patients in the Community Reflects Increasing Reliance on Crisis Teams. The number of suicides by mental health patients in the UK has risen in recent years, mainly as a result of increases in England, however at the same time the rate of suicide by mental health patients appears to have fallen overall.

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

The Government Response to the House of Commons Health Select Committee Report on Primary Care. Sets out the Government's response to the Health Select Committee's April 2016 report. It explains the measures which have been put in place to support primary care and improve patients’ access to services. These include: increasing funding for primary medical care by £2.4 billion per year by the end of the financial year 2020 to 2021; increasing the growth rate in the number of GPs, through offering new incentives; a new practice resilience programme to support struggling practices; local Sustainability and transformation plans to address workload and workforce issues; and trying new models of care, through multi-speciality provider vanguards and GP Access Fund sites.

RCGP Mythbusters – Addressing common misunderstandings about appraisal and revalidation. A new guide aimed at ‘busting the myths’ around the requirements for revalidation and appraisal as applied to GPs is launched by the Royal College of General Practitioners.

Integrated primary and acute care systems (PACS) – Describing the care model and the business model. This framework document uses the learning from the nine PACS vanguards to support local health and care systems planning to implement a PACS model. It outlines the next steps required to set up the model, including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services. See also NHS England's news item Two local vanguard leaders explain what it means to be an integrated primary and acute care system (PACS), in which two members of the South Somerset Symphony Programme vanguard (Paul Mears, Chief Executive of Yeovil Hospital, and Dr Berge Balian, GP and Symphony Programme Board Chair) take a look at what the proposals could mean.

News

Inquiry call over NHS health provider's finances. Labour MP Emma Reynolds is demanding that the Health Secretary investigates how a private firm running dozens of GP surgeries and NHS walk-in centres is handling its finances.

Winter indemnity scheme for GPs – 2016. Announces that NHS England’s 2016 winter indemnity scheme for GPs will run until 31 March 2017. The scheme is designed to meet the costs of personal professional indemnity for any additional out of hours work undertaken by GPs this winter to enable the freedom to work additional sessions without having to pay additional subscriptions to their medical defence organisation.

NHS England announces major boost for general practice. Announces that a £19.5m NHS GP Health service will be introduced in January 2017, aimed at improving access to mental health support for general practitioners and trainee GPs, while the Induction and Refresher scheme will be revamped to speed up the time it takes for GPs to return to practice in England.

Extended access to general practice: A guide to completing the extended access survey. Provides GP practice staff with information to assist them in submitting data to NHS England about their practice’s offer to patients of enhanced access to appointments.

What if people had to pay £10 to see a GP? This King's Fund essay considers whether charging people to visit a GP would raise funds for the NHS or add to the care burden by having a negative impact on people's health.  

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

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Procurement

Bevan Brittan Events

Procurement Update - Our Procurement team will cover legislative and policy developments as well as looking at recent EU and UK court cases and how these affect procurement in practice.

Birmingham - 7 November 13:00
Leeds - 8 November 09:30
London - 9 November 09:00
London - 9 November 13:00
Bristol - 10 November 09:00  

Bevan Brittan Updates

Lifting the automatic suspension - What's money got to do with it? 

If you wish to discuss any queries you may have around public health please contact Emily Heard.  

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Public Health

Publications/Guidance

Improving eye health through community optical practice: a briefing for councils. LGA, Optical Confederation and Local Optical Committee Support Unit (LOCSU) briefing for councillors, senior council officers and commissioners of services, which describes the essential role that community optics can play in helping to improve eye health specifically, as well as general health and wellbeing. 

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

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Regulation

Publications/Guidance

RCGP Mythbusters – Addressing common misunderstandings about appraisal and revalidation. A new guide aimed at ‘busting the myths’ around the requirements for revalidation and appraisal as applied to GPs is launched by the Royal College of General Practitioners.

Continuing professional development audit report 2013-2015 The report shows that in this period, 8,164 registrants, across all 16 professions regulated by the HCPC, were randomly selected to submit CPD profiles. Nearly 81 per cent of these met the CPD standards with most accepted after their first assessment. It also supports recent research findings which indicate that 90 per cent of respondents said they understood the standards ‘well’ or ‘completely’ and 69 per cent agreed that the current standards encouraged them to reflect and think critically about their practice.

Doctors around the world to face competency tests Doctors will face competency checks throughout the world following a landmark decision by the General Assembly of the International Association of Medical Regulatory Authorities (IAMRA). A resolution passed at the IAMRA meeting in Melbourne will encourage regulators from around the world to ensure doctors can demonstrate competence throughout their careers.

The state of medical education and practice in the UK 2016. This annual report explores how the medical profession has changed and reviews the education and practice of doctors in the UK. This year's report raises concerns that the health system and staff working within it are struggling to cope with a range of issues such as the increased pressure on health and social care services. The report outlines the response that the GMC will take to these increased pressures on doctors by taking a lighter touch on regulation.

Consultations

Modernising fitness to practise: changes to the Fitness to Practise Rules 2004. This consultation seeks feedback on proposed changes to the NMC's fitness to practise processes. The proposed changes will allow the NMC to give advice, issue warnings and recommend undertakings. The consultation closes on 19 December 2016.  

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

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General

Publications/Guidance

Recovering the cost of NHS treatment for overseas patients. The Government’s ambition of recovering up to £500m a year by 2017/18 from overseas visitors who are not entitled to free NHS hospital treatment will be missed under the current charging rules, the National Audit Office (NAO) has concluded. In 2015/16, £289m was charged for treating overseas visitors, with £164m generated by the new immigration health surcharge for students and temporary migrants from outside the European Economic Area (EEA). Overall, the NAO found significant variation in the amount of overseas visitor income that trusts identify.

Understanding patient flow in hospitals. A briefing from Nuffield Trust warns that the NHS can no longer find enough bed space to move patients through hospitals quickly and meet key A&E targets - and that its practice of counting patients at midnight means that the true scale of the squeeze is being missed.

TalkCPR: Improving patient-practitioner communication. A nationwide campaign in Wales has sought to improve dialogue between patients and healthcare practitioners on the issue of do not attempt cardiopulmonary resuscitation (DNACPR) orders among patients with a terminal illness.

Building a successful NHS workforce: The added value of specialist hospitals in England. This report from the Federation of Specialist Hospitals sets out recommendations on how the NHS can make the best use of staff to ensure they can deliver the care patients need now and into the future. It contains case studies that: demonstrate clinical excellence such as the Getting It Right First Time Project which has realised £60-90m of savings; drive innovation in the NHS such as new clinical pathways at the Royal Brompton for children on long-term ventilation; bring services closer to home using the satellite model of Moorfields Eye Hospital; and a number of exciting new training programmes for NHS clinicians.

Priorities for health and social care in the negotiations on the UK's withdrawal from the European Union. House of Commons Health Select Committee Inquiry Evidence from the Academy of Medical Royal Colleges.

Hospital productivity growth in the English NHS 2008/09 to 2013/14. This report examines the extent to which NHS hospital trusts make better of their resources over time by increasing the number of patients they treat and the services that they deliver for the same or fewer inputs. The report finds that current methods of measuring productivity aren't appropriate for individual hospital trusts and that a new approach is needed.

Accelerated access review: final report. This report sets out recommendations on how patients could get quicker access to innovative new diagnostic tools, treatments, and medical technologies. It argues that streamlined processes could bring forward patient access to drugs by up to four years and patients will benefit from quicker access to medical technologies too. The report will help the NHS to provide the best care to patients, use funds more effectively, and create the conditions to help the life sciences industry continue to thrive.

Personal safety when working alone: guidance for members working in health and social care This guide has been developed for RCN members who work alone. It also contains a checklist for RCN safety representatives who work on negotiating improvements to workplace safety for members and nurse managers who manage lone working staff.

Brexit means Brexit, but how will it impact the NHS? This infographic from the NHS European Office explains some of the possible implications of Brexit on the NHS. It looks briefly at six possible areas of impact, including finance, workforce and research, and asks what should be the NHS' main priorities as the UK prepares to leave the European Union. 

News

WHO to change definition of fertility to give single men the right to start family. The World Health Organisation (WHO) is to announce that single men and women without medical issues will be classed as infertile, if they do not have children but want to become a parent. Legal experts state that the move, which dramatically changes the definition of infertility, may force a law change in the UK, allowing the introduction of commercial surrogacy.

Superbug rife at factories that supply the NHS with drugs. Following an investigation by campaign group Changing Markets, which found high levels of antibiotic-resistant bacteria outside pharmaceutical factories in India, the Department of Health has announced that it is to consider changing the rules relating to companies supplying the NHS with antibiotics.

EMA allows public access to clinical reports. The European Medicines Agency (EMA) has provided open access to clinical reports for new medicines for human use, authorised in the EU. This allows every citizen, including researchers and academics, to access clinical reports submitted by pharmaceutical companies to EMA in the context of marketing-authorisation applications. The clinical reports will be made available at EMA's 'clinical data website'. The EMA has declared this move to improve transparency and innovation in the pharmaceutical industry. 

Bevan Brittan Updates

Inquest Law: Admitted Failings in Article 2 Hearings. R (on the application of Teresa Tainton) v HM Senior Coroner for Preston and West Lancashire [2016] EWHC 1396 (Admin)

Use of CCTV in Care Packages in the Community. The use of CCTV in packages of care in the community represents a serious risk issue for commissioners, providers and care co-ordinators. 

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

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