Health and Social Care Update - December 2016

Policy and law relevant to those involved in health and social care work.

06/12/2016

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

Information sharing/data protection

Care

Inquests

Children

Mental Health

Clinical Risk/Patient Safety

Primary Care

Commissioning

Procurement

Employment/HR

Public Health

Finance

Regulation

Foundation Trusts

General

 

Training 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 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:-
Human Rights Act claims update - 12 December 12.30pm - 1.30pm.

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Care

Publications/guidance

Winter pressure in accident and emergency departments. This Commons Health Committee report concludes that the Government urgently needs to address the underfunding of adult social care to relieve pressure on A&E departments. It finds that for major emergency departments in 2015, only 88 per cent of patients were admitted, transferred or discharged within four hours, short of the 95 per cent standard set by the Government. It also finds that the current level of variation in meeting the four hour waiting time standard is also due to differences in the way that trusts manage flows within hospitals.

Further guidance on managing complaints and incidents within homecare services. The Royal Pharmaceutical Society has published new guidance that provides detailed practical advice on how reporting and learning systems should operate in homecare services in order to meet the requirements of patients, carers, regulators and other stakeholders.

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. A note of the changes can be found here.

Adult social care funding: 2016 state of the nation report. This report looks at the state of funding for adult social care and current pressures. It contains a series of short essays by senior figures in the care sector offering personal views and expert perspectives.

Don't be left in the dark – Adult social care. Simple overview for councillors and the public on local authorities' adult social care services and how eligibility assessment works.

Taking integration of health and care forward. London Councils has set out a list of "integration asks" to Government to help smooth the path towards further health and social care integration in London. The proposals include strengthening the role of Health and Wellbeing Boards so they can control CCG budget spending, seeking continued support for health devolution, bringing forward Better Care Fund budget allocations for 2018/19 and investing in the financial sustainability of adult social care.

Transforming social care through the use of information and technology. This LGA report highlights the emerging role of technology in transforming social care services and enabling care and health integration. It includes case studies of the introduction and use of technology to deliver improved outcomes for social care service users and, in the context of integration, patients. It also showcases the current and future roles of technology in facilitating demand management, delivering cost efficiencies, and mitigating against systemic risks.

Ombudsman’s annual review highlights concerns about quality of homecare. The Local Government Ombudsman (LGO) has seen a 25 per cent rise in complaints about the home care received by some of the most vulnerable people in England over the past year.

Fitness to practise annual report 2016. This report highlights the HCPC's work in considering allegations about the fitness to practise of registered health and care workers. In 2015/16, HCPC's register increased and the numbers of fitness to practise concerns decreased and the proportion of registered workers remains low with less than one per cent being subjects of investigation.

The Autumn Statement – Joint statement on health and social care. The King’s Fund, Nuffield Trust and the Health Foundation are urging the Government to address the critical state of social care in its forthcoming Autumn Statement. The briefing calls on the Government to recognise the immediate funding pressures facing the sector by bringing forward to next year funding from the Better Care Fund which is planned to reach £1.5bn in 2019/20. It also makes it clear that the NHS funding settlement will need to be revisited in future financial statements.

Investing in social care This report argues that the social care funding crisis could be eased by the use of £2.4 billion in unallocated business rates. The report also highlights the inequality in service provision in England for older people in deprived areas, and emphasises how an increase in social care funding can help to improve care and ease pressures on the system.

Creating the five year forward view for social care. This paper from the SIE explores the potential for scaling up some of the most promising examples of care and support services, using data from Birmingham City Council, to see what their impact would be on outcomes and costs. It aims to start a series of national and local discussions which re-imagine how we can lead good lives, in good places for people with support needs, building on well-evidenced innovative models from across the UK.

The adult social care sector and workforce. These nine regional reports and infographics use data from the National Minimum Data Set for Social Care and gives a picture of the adult social care workforce across England. The reports include data on a profile of the ageing population; the size of the adult social care workforce; an outline of recruitment and retention issues; pay rates; qualification levels; and demographic profiles of the workforce.

Further guidance on managing complaints and incidents within home care services. As home care is often a shared care arrangement involving multiple organisations, it is important the processes that allow the sharing, reporting and learning from complaints are in place and integrated between all parties involved. This ensures that complaints are received, recorded, investigated, acted upon and reviewed in order to support patient care. This guidance provides detailed practical advice on how reporting and learning systems should operate in home care services in order to meet the requirements of patients, carers, regulators and other stakeholders.

The damage: Care in crisis. This report from Unison presents the findings of a survey of more than 1,000 staff across the UK working in homecare, residential support and day services, and looking after those with chronic health conditions such as dementia. The report highlights the scale of spending cuts to social care and the impact on care workers, older people needing care and their families

Delivering adult social care in challenging times. The County Councils Network has published a report that outlines the issues and funding pressures facing county authorities in delivering adult social care. The results of a survey of Directors of Adult Social Care reveals that 88 per cent believe their budgets to be at a 'severe' or 'critical' level, and 12 per cent report their current funding levels as 'manageable'. The report argues that social care pressures are most acute in county areas due to the fastest-growing elderly populations and the proportionately reduced funding in county authorities.

Making personal budgets dementia friendly – A guide for local authorities. The Alzheimer's Society has developed a dementia friendly personal budget charter that local authorities can sign up to in order to show their commitment to working towards making the personal budgets system more accessible and dementia friendly. This guide assists local authorities in implementing the recommendations.

Review of Adult Social Care complaints 2015/16. The LGO looks at all types of complaints about adult social care, regardless of whether the local authority is involved. This latest annual report analyses complaints from 2015-2016, and the trends and patterns that the organisation has observed. During the year the LGO received a 6% increase in complaints and enquiries about all areas of Adult Social Care, with a 25% increase in complaints and enquiries about home care. The LGO upheld 58% of all cases investigated in detail. The report also provides data for every English local authority and registrable independent care provider about which it has received a complaint.

Adult social care market shaping This guidance is aimed at people who buy social care services, including local authority and clinical commissioning group commissioners, as well as personal budget holders and people who fund their own care, care service providers and potential investors in the care sector. It aims to help people and organisations understand adult social care market shaping and how to take action.

Quick guides for social care. NICE has published two more guides in its series that presents key information for social care topics in a simple format:
Better home care for older people: A quick guide for people who arrange their own home care 
Improving oral health for adults in care homes: A quick guide for care home managers

Information on visiting rights in care homes. This document published by the CQC gives information about certain regulations that protect care home residents and those who visit them, such as their partners, family and friends. It also highlights issues for care home providers to consider about meeting the needs of those who use their services.

News

Quarter of people do not need to be admitted to hospital, new research reveals. The LGA's Autumn Statement submission to Government warns social care for the elderly and disabled could be facing a potential funding gap of at least £2.6 billion by the end of the decade. It argues that new research shows that up to one in four people admitted to hospital do not need to be there and could be looked after elsewhere if better use was made of services available to treat people in the community.

Care workers jailed for "cruel and tasteless" bullying of the elderly. In what is believed to be one of the first cases to be prosecuted under the Care Act 2014 implemented in 2015, two care workers, Shauna Higgin and Victoria Johnson, who admitted wilful neglect or ill treatment of elderly residents during December 2015, following the publication of pictures by a whistleblower, have been handed down prison sentences of 12 and 13 months respectively by Judge Andrew Lowcock at the Manchester Crown Court.

Poor care exposed by Panorama at Morleigh Group homes. An undercover investigation has exposed shocking levels of neglect at two care homes in Cornwall. Hidden camera footage filmed by BBC Panorama reporters recorded vulnerable people left unattended, including one left on a bedpan for 40 minutes, an out-of-date prescription supplement relabelled for use by another resident and the threat of morphine being used to silence a resident.

Britain sleepwalking into care crisis.

Government agrees to extend legal protections for whistleblowers in children’s social care sector. Announces that the Government has agreed an amendment to the Children and Social Work Bill which will mean people applying for roles relating to children’s social care functions in local authorities will have legal protection to ensure they are not treated unfairly because they have previously made protected disclosures about their organisation.

12% of care homes are at risk of going insolvent in the next three years

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

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Children

Publications/guidance

Supporting public health – Children, young people and families: Early years high impact areas guidance. Updated PHE guidance for local authorities and providers on commissioning and delivering children's public health services. The updated documents cover the six areas where health visitors have the highest impact on the health and wellbeing of children aged 0 - 5 years.  

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:-
Human Rights Act claims update - 12 December 12.30pm - 1.30pm.

Publications/Guidance

NHS injury cost recovery scheme 2016 to 2017: guidance on the application of the NHS injury cost recovery scheme. This guidance is primarily for NHS trusts and NHS foundation trusts who provide treatment for injuries whose costs are recoverable under the NHS injury cost recovery scheme (ICR). It sets out the circumstances where costs can be recovered and the process under which this is undertaken, as well as giving some guidance on how ICR payments should be recorded in annual accounts.

Consent: supported decision-making: a guide to good practice. 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. Traditionally clinical practice in the NHS has considered that it is up to doctors to decide what risks to communicate to patients. Recent case law has changed and doctors are now obliged to ensure that patients are aware of any and all risks that an individual patient might consider significant. This guidance is aimed at doctors and surgeons to help them understand this shift in the law, as well as giving them the tools to assist in improving their practice. 

WHO recommendations on antenatal care for a positive pregnancy experience. This guidance contains a series of recommendations to improve the quality of antenatal care in order to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience. The recommendations include increasing the number of contacts a pregnant woman has with health providers from four to eight throughout pregnancy, and outlines the aspects of care and advice that pregnant women should receive.

Breast screening: clinical guidelines for screening assessment. NHSBSP Publication No 49: clinical guidelines for healthcare professionals screening women for breast cancer.

Cases

Clearway Drainage Systems v Miles Smith. The judge at first instance refused the claimant’s application for relief from sanctions after witness statements were served two months late. The Court of Appeal upheld this decision.

TUI UK Limited v Tickell & Others [2016] EWHC 2741 (QB) It had not been disproportionate for a master to allow 144 hours of inter-fee earner discussions overall on the individual bills of 205 claimants in assessing overall base costs. The bills were clear that paralegals had carried out the vast majority of the work. t Iwas unrealistic to suggest that no inter-fee earner discussions should have occurred.

Kumudu Kumari Rupasinghe (suing on her own behalf & as administratrix of the estate of Rohan Rupasinghe Deceased) v West Hertfordshire Hospitals NHS Trust [2016] EWHC 2848. In a claim for damages under the Fatal Accidents Act 1976, the court rejected heads of claim for earnings dependency based on a plea that, as a result of her husband's death, the claimant had had to give up her job and accept less valuable employment elsewhere. That claim was in reality one for loss of earnings and was not attributable to the need to replace a service that the husband had formerly been providing. 

Spire Healthcare Ltd v Brooke [2016] EWHC 2828 (QB). The court construed s.10(4) of the Limitation Act 1980, determining that an interim payment did not trigger the start of the two-year period for commencing contribution proceedings.

Watts v Secretary of State for Health [2016] EWHC 2835 (QB). A claimant had failed to establish that her right shoulder had been damaged at her birth as a consequence of a midwife's extensive pulling or traction to free her shoulder, which had become obstructed while she was being born.

News

Workload strain compromises patient safety, finds survey. A BMA survey of GPs in England highlights the alarming impact spiralling levels of demand are having on GPs, many of whom are increasingly unable to cope. Based on more than 5,000 responses, the survey found that 84 per cent of GPs report that unchecked and growing workload pressures are undermining their ability to provide safe and quality care. Of this figure, 57 per cent described their daily workloads as 'unmanageable' with a further 27 per cent saying that excessive pressures are directly impacting standards.

Experts worry about rise of "hired gun". According to a survey by expert witness training company Bond Solon and The Times newspaper, 46% of the 779 experts polled had come across a counterpart they considered to be a "hired gun", someone willing to give an opinion that helps the side paying them. Just over a quarter of those surveyed said they had considered giving up expert work, with pay levels the main concern, followed by time constraints, the risk of being sued for negligence, and the risk of disciplinary proceedings by their professional body.

Shaken baby evidence doctor reinstated. A doctor struck off the medical register for the evidence she gave in so-called "shaken baby" cases, has been reinstated. Clive Stafford Smith, founder of the campaign group Reprieve,, has issued a warning to expert witnesses about giving minority views following a decision by the High Court to continue a ban preventing Dr Waney Squier from giving medical evidence, despite allowing her to resume practice and assist in coroners' courts. See Squier v General Medical Council [2016] EWHC 2739 (Admin) below.

Six maternity pilot sites to shape midwifery supervision and help improve maternity services. NHS England has announced six maternity pilot sites to drive the design of new approaches to midwifery supervision, helping to improve quality of care for women and their babies. The pilot sites will pioneer a new model of midwifery supervision in England ahead of legislative changes due in Spring next year. The aim is to support midwives across all aspects of their role leading to improvements in maternity experiences and the quality of care in all parts of the health system. This includes improvements to the overall work experience, increased job satisfaction, reduced sickness, and better staff development. In addition to announcing the pilot sites, one site will be working with an independent maternity provider to test how the model can be deployed for independent midwives working across large geographical areas.

Hospital fined after dementia patient's death. Norfolk and Suffolk NHS Foundation Trust has been fined £366,000 and ordered to pay costs of £12,888.48 after safety failings led to the death of a patient suffering from dementia. An investigation by the Health Safety Executive (HSE) found that the hospital did not have sufficient policies or procedures in place for managing the safety of its patients.

NHSLA set to launch formal mediation panel for injury and costs claims. The NHS Litigation Authority (NHSLA) has begun a procurement process seeking to appoint two, or possibly three, providers of mediation services to a new mediation panel, which will mediate claims for personal injury (PI) and clinical negligence claims, as well as claims on legal costs. The announcement follows a successful pilot of a mediation service for fatal and elderly care claims. The NHS paid out more than £1.4 billion to patients and legal representatives in 2015-16.

NHS Litigation Authority appoints Dr Mike Durkin as associate non-executive director in bid to improve patient safety.

Call for assistant nurse role rethink. The creation of new nursing assistant posts should be scrapped and money invested in "real nurses", experts say after research suggested the use of lower skilled posts was a risk. Rollout of the new nursing associate roles starts in England in December. Research in the BMJ Quality and Safety journal linked the use of junior care roles to higher death rates.

Reducing infections in the NHS. The Health Secretary Jeremy Hunt has launched new plans to halve the number of gram-negative bloodstream infections by 2020. Alongside the plan to reduce E. coli rates, an additional £60m will be allocated to the Getting It Right First Time programme, which seeks to improve patient experience by replicating the work of the best clinicians across the health service, including cutting infection rates resulting from surgery. The programme will now be expanded to another 18 surgical specialties, building on the initial investment of £2.5m.

David Sellu trial: Doctor's conviction over patient's death quashed. David Sellu, a surgeon who served a jail sentence over the death of a patient at a private hospital has won an appeal against his conviction.

Amendment to the Policing and Crime Bill. The Government has accepted an amendment to the Policing and Crime Bill to remove deaths under Schedule A1 authorisations (and where the person is subject to a relevant order of the Court of Protection) from the definition of "state detention" for purposes of the Coroners and Justice Act 2009. This would mean that there would be no mandatory inquest where a person dies in a care home or hospital under a DOLS authorisation (or where a person dies subject to an order made by the Court of Protection which has the effect of authorising the deprivation of their liberty). The record of the debate can be found here.

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 

Commissioning and delivering enhanced seven-day NHS services. This paper from NHS Confederation seeks to get behind the debate and explore the evidence for and against the extension to seven-day services. It analyses what is already known about seven-day provision from the work of NHS national bodies, NHS organisations and others, and explores the evidence about a case for an enhanced seven-day NHS.

NHS Standard Contract 2017/18 and 2018/19 technical guidance. Revised guidance that outlines the changes made to the 2016/17 Contracts, provides general guidance on contracting, and outlines the key topics in the Contracts. It also includes a summary guide to completing the contracts. Section 3 contains a summary of the changes have made to the contracts. There is also a Summary of key changes made in response to consultation feedback.
All the documents relating to the NHS Standard Contracts 2017/18 are on the NHS England website.

Health and Justice commissioning intentions for 2017/18. This document outlines the priorities for the commissioning of services in secure and detained settings in England. It also sets out those priorities for liaison and diversion services, sexual assault referral centres and major national programmes (such as, smoke free prisons, the Health and Justice Information System, children and young people mental health transformation work stream and substance misuse services). The intentions are intended to support commissioners, providers and the management of the secure and detained estate, to make preparations for health care services in 2017/2018 and have been developed to support NHS England’s overarching strategy, the Health and Justice Strategic Direction: 2016-2020.

Armed Forces and their families commissioning intentions - 2017/18 to 2018/19. This document provides notice to healthcare providers and gives information to other commissioners of healthcare services about changes and planned developments in the commissioning and delivery of services for the Armed Forces and their families registered with a Defence Medical Services (DMS) practice by NHS England. Together with planning guidance, the NHS contract, National Tariff system and CQUIN guidance they form a plan to be reflected in contracts, developments, service reviews and procurement opportunities for the two years from 2017/18 to 2018/19. The prime purpose of these intentions is to enable healthcare providers to make early preparations, to engage with clinical leads and to make changes that benefit patients, with improved outcomes. These intentions should inform providers’ plans at all levels. These intentions also set out other planned changes related to the healthcare of the Armed Forces community that CCGs will wish to be aware of

Alliance contracting, prime contracting and outcome based contracting: What can the NHS learn from elsewhere? A literature review. The Policy Research Unit on Commissioning and Healthcare System gas published the attached report as part of its research on new models of contracting in the NHS, commissioned by the DH. The report summarises the findings of a literature review of the available evidence concerning the characteristics of these new contractual models and their implementation in other sectors. The available evidence is considered in order to draw out the lessons which may be learnt to aid the implementation of these models in the English NHS.

Procedures for clinical commissioning groups to apply for constitution change, merger or dissolution. This guidance outlines the test that will be applied to any CCGs who submit proposals to merge or combine their managements. It makes clear that there remains a general presumption against mergers unless they can be shown to release staff and resources to support local STP implementation whilst cutting administrative costs. The guidance includes a list of eleven criteria that CCGs will have to meet for a formal merger, as well as prior approval of mergers of senior management.

Contract management standards. The Crown Commercial Services has issued updated contract management standards for use by government departments and wider public sector organisations for the management of their contracts.

PSNC Briefing 058/16: Imposition for 2016/17 and 2017/18 – Frequently Asked Questions. Following the announcement of the imposition for community pharmacy funding for 2016/17 and 2017/18, PSNC has been asked a number of questions both by contractors and the pharmacy press. This document sets out its responses to these questions and may be of interest to contractors and LPCs.

Long Term Conditions financial modelling tool. This simulation allows CCGs to test the financial impact of person-centred care interventions for people living with multiple long term conditions. It enables health systems to test out ideas in advance in order to support a more robust business case for financial decision-making. The simulation has been approved by NHS England following user testing and academic review and it is free to use.

NHS Urgent medicine supply advanced service pilot. This pilot was announced as part of the DH's imposition of a two-year funding package on community pharmacy and is being commissioned as an Advanced Service. Funding from the Pharmacy Integration Fund is being used to test and evaluate the service in order to inform possible future commissioning, i.e. the funding for the service is not from the main community pharmacy contractual framework (CPCF) funding. This service specification sets out information about provision of the service, including the funding for the service.

Outcomes-based commissioning – How Social Enterprise Mark CIC accreditation can help. Social Enterprises Mark is a social enterprise accreditation scheme, enabling organisations to prove they are in business to create benefits for people and the planet. It has published resources and advice for public sector commissioners on how to embed an outcomes based approach to their procurement of public services.

Testing times to come? An evaluation of pathology capacity across the UK. Cancer Research UK commissioned this research to understand the pressures facing pathology services across the UK and to identify solutions to address these issues. It finds that pathology services in the UK are struggling to cope with the increasing number of patient samples that need to be tested. The report makes recommendations to ensure pathology services are maximising efficiency, workforce is optimised, and that pathology is future proofed for changes in technology, research and molecular diagnostics.

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.

Bevan Brittan Updates

New NHS framework for assuring major. Publication of the 'Integrated Support and Assurance Process (ISAP) - An introduction to assuring novel and complex contracts' 

Bevan Brittan Events

Health and social care integration: where next? This interactive seminar is an opportunity for health bodies and local authorities to come together and share experience of their projects to integrate health and social care, obtain an update on current policy and practice on integration and the future of Better Care Fund and Vanguard projects as well as understand current issues in commissioning and procurement in both health and local government.
London 13 December 09:30
Leeds 14 December 09:30

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

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Employment/HR

Publications/Guidance

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.

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.

NHS terms and conditions of service handbook. NHS Employers have launched the terms and conditions of service handbook for Agenda for Change staff in an interactive format that aims to make it easier to find information.

News

Social worker who used Facebook to communicate with service user suspended. A conduct panel found a social worker should have known it was inappropriate to communicate with a service user on Facebook messenger.

New nursing degree apprenticeship. The Health Secretary has announced a new apprenticeship role of nursing associate who will work alongside healthcare support workers to deliver hands on care. People who complete the nursing associate apprenticeship will be able to count that training towards a nursing degree.

More doctors and nurses to become leaders of the future. The Health Secretary has announced new measures to bring in the sharpest graduates and aspiring leaders and turn them into chief executives of the same standard as the best in the NHS and the private sector. Working with world class universities (Yale University this year) the government is creating a new programme to prepare and support doctors and nurses with the highest potential for leadership. The first students will enrol in September 2017. 

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 news round-up, November 2016. Julian Hoskins on the latest employment law news in brief for November 2016.

Inappropriate final written warnings. Jodie Sinclair looks at how employment tribunals (and, by extension, employers) should deal with dismissal following a manifestly inappropriate final written warning.

'Manager' vs 'technology platform'. What does Uber's recent defeat at employment tribunal mean for the modern economy and the 'Uberization' of work? 

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

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Finance 

Publications and Guidance

What if the NHS had to balance its books like local government? In this latest essay in the King's Fund's 'What if?' series, Lord Kerslake asks what would happen if NHS organisations had to balance their books each year, with no bail outs from central government. This is the reality for local authorities, which are required to spend within their means. He considers what it would mean for health and care if NHS organisations had to do the same.

Long Term Conditions financial modelling tool. This simulation allows CCGs to test the financial impact of person-centred care interventions for people living with multiple long term conditions. It enables health systems to test out ideas in advance in order to support a more robust business case for financial decision-making. The simulation has been approved by NHS England following user testing and academic review and it is free to use.

NHS efficiency map. HFMA and NHS Improvement have updated and revised the NHS Efficiency Map. This is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency.

The Autumn Statement: joint statement on health and social care. This briefing, produced in partnership with the Health Foundation and the Nuffield Trust, analyses the state of health and social care finances and concludes that the cuts and rising demand will leave adult social care facing a £1.9 billion funding gap next year. The three organisations conclude that despite mounting pressures on the NHS, finding money to plug this gap is the most urgent priority. The joint statement also warns that the planned increase in the Department of Health's budget between 2015/16 and 2020/21 will not be enough to meet rising demand for services, maintain standards of NHS care and deliver the changes to services set out in the NHS Five Year Forward View.

Financial sustainability of the NHS. The National Audit Office finds that the financial performance of NHS bodies worsened considerably in 2015-16 and this trend is not sustainable, and that financial problems were endemic.

The financial sustainability of the NHS in England. This House of Commons Library briefing provides background on the current funding settlement for the NHS in England, the financial and operational performance of the health service, and measures being taken to ensure its future sustainability, including Sustainability of Transformation Plans. The briefing also provides background on the Department of Health’s Annual Report and Accounts for 2015/16 and ongoing Select Committee scrutiny of NHS funding.

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.

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

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Foundation Trusts 

Bevan Brittan Updates

New NHS framework for assuring major. Publication of the 'Integrated Support and Assurance Process (ISAP) - An introduction to assuring novel and complex contracts'

If you wish to discuss any issue in relation to foundation trusts please contact Vincent Buscemi.

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Information Sharing/Data Protection 

News

NHS using Google technology to treat patients. The NHS has deepened its relationship with Google after Royal Free London Foundation Trust announced the most significant deal to date between the health service and the tech giant’s artificial intelligence arm, DeepMind.

GP patient records system “in chaos”, warns new BMA survey.

‘Sensitive’ data lost after social worker left court bundle on car roof and drove off. Ealing council has been warned over data protection failings after a social worker left a court bundle containing "sensitive" information on the roof of her car and drove off.  

Bevan Brittan Updates

ICO guidance on GDPR. Government (finally) confirms GDPR will apply to UK and the ICO's guidance notes will be published soon

If you wish to discuss any issue relating to information sharing please contact Jane Bennett or Adam Kendall

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Inquests

Publications/guidance

Amendment to the Policing and Crime Bill. The Government has accepted an amendment to the Policing and Crime Bill to remove deaths under Schedule A1 authorisations (and where the person is subject to a relevant order of the Court of Protection) from the definition of "state detention" for purposes of the Coroners and Justice Act 2009. This would mean that there would be no mandatory inquest where a person dies in a care home or hospital under a DOLS authorisation (or where a person dies subject to an order made by the Court of Protection which has the effect of authorising the deprivation of their liberty). The record of the debate can be found here.

News

Government to scrap Deprivation of Liberty Safeguards inquests duty.  

If you wish to discuss any issue relating to inquests 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 open to health and social care professionals 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:-

  • Human Rights Act claims update - 12 December 12.30pm - 1.30pm.

Publications/Guidance

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study Pain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. This study reviews the literature and explores staff and carer views to identify robust methods for identifying, assessing and managing pain.

Survey on Mental Health Act. This survey is from the Mental Health Alliance, a coalition of more than 75 organisations from across the mental health spectrum and beyond that work together to advocate for fair implementation of the Mental Health Act in England and Wales. Rethink Mental Illness are members of the Alliance and have been commissioned to develop this survey.

Mental health five year forward view dashboard This dashboard brings together data from across the broad range of mental health services. This aims to provide a resource to track improvement at the CCG level and allow areas to understand where they need to target their efforts to improve services locally. The dashboard not only includes statistics from mental health services but also metrics on employment, housing and justice relating to people with mental health

The Mental Welfare Commission for Scotland has published a good practice guide on supported decision-making. Although the guidance is Scotland specific, it is equally useful to health and social care staff in other jurisdictions, individuals with mental disabilities, their families and those who work with them

Mental Capacity and Ordinary Residence. This guidance note from 39 Essex Chambers sets out the key considerations to be applied when assessing the ordinary residence of a person who is mentally incapable of forming a settled intention where to live.

The forensic mental health social work: capabilities framework This framework sets out progression and developments for forensic mental health social workers. It builds on the capabilities set out in the framework for social workers and it outlines pathways for post-qualifying progression and development for social workers practising within forensic mental health settings.

Judicial Deprivation of Liberty Authorisations. This guide from 39 Essex Chambers provides updated guidance as to the process for applying for judicial authorisation of deprivation of liberty, including the requirements set down in the revised COP DOL10 form into force on 1 December 2016.

Health and Justice commissioning intentions for 2017/18. This document outlines the priorities for the commissioning of services in secure and detained settings in England. It also sets out those priorities for liaison and diversion services, sexual assault referral centres and major national programmes (such as, smoke free prisons, the Health and Justice Information System, children and young people mental health transformation work stream and substance misuse services). The intentions are intended to support commissioners, providers and the management of the secure and detained estate, to make preparations for health care services in 2017/2018 and have been developed to support NHS England’s overarching strategy, the Health and Justice Strategic Direction: 2016-2020. 

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.

Better equipped, better care: improving mental health training for GPs and practice nurses. The data collected for this report shows that 46 per cent of trainee GPs undertook a training placement in a mental health setting. The report calls on the government to ensure all GPs and practice nurses receive structured mental health training that is comprehensive, relevant and supports their ongoing development.

Dementia 2020 citizens' engagement programme: toolkit for engaging people with dementia and carers. This toolkit, aimed at dementia groups and networks, provides guidance and helpful tips about facilitating discussions with people with dementia and carers effectively and sensitively.

Community mental health survey 2016. Provides information on the experiences of people who have received community mental health services.

Best practice for perinatal mental health care: the economic case. A report by the London School of Economics examines the economic case for investing in early interventions that reflect best practice in England.

CCGs 2015/16 assessment for maternity and mental health The newly published ratings on mental health and maternity services have been published by NHS England on the My NHS website. The data highlights areas that are performing well and also helps to identify where improvements can be made. The ratings can be broken down by CCG and can help CCGs to self-assess more effectively and target areas in need of improvement.

The Local Government Association MCA/DOLS resources page has been updated  to include a number of  useful guides.

Time to Deliver. The Education Policy Institute’s Independent Commission on Children and Young People’s Mental Health has released a new report, Time to Deliver, which calls for a new ‘Prime Minister’s Challenge’ on children and young people’s mental health. The report represents the culmination of the Commission’s work over the last year, reflecting on progress made in transforming services following the government’s investment of £1.4bn, announced in 2015. Based on its comprehensive research, Time to Deliver sets out a number of new findings, and proposes a series of recommendations which it urges the government to adopt through the Challenge. This includes an ambitious programme of changes covering research and prevention, early intervention and improving access to quality services.

Strength in numbers. Banks must give more help to mental health carers. Half of mental health carers know someone else’s PIN number, research by the Money and Mental Health Policy Institute has revealed. This, the research finds, is due to a lack of support by the banks which leaves carers using risky workarounds to help those for whom they care. A report from the Institute sets out the scale of the problem, the financial harm being caused by banks’ failure to act, and proposals for change—which include developing a strategic approach to carer and family access to information and improving the Power of Attorney system.

Information on visiting rights in care homes. This document published by the CQC gives information about certain regulations that protect care home residents and those who visit them, such as their partners, family and friends. It also highlights issues for care home providers to consider about meeting the needs of those who use their services.

Monitoring the Mental Health Act in 2015/16. The annual report from the CQC on the use of the Mental Health Act (MHA) looks at how providers are caring for patients, and whether patient’s rights are being protected. It identifies four areas for change: 

  • Providers must demonstrate stronger leadership making sure they can train and support their staff on the revised Code of Practice and how patients should be involved in their care from admission and onwards;
  • Commissioners should consider how to ensure the best approach to commissioning, procuring and delivering services locally that is based on the needs of people who use services;
  • The Department of Health and national agencies should work together to focus on early intervention to reduce detention rates; and
  • The experiences and views of detained patients should be a routine part of local MHA monitoring.

News

Deprivation of liberty cases in children’s services ‘storm waiting to happen'. Head of ADCS policy committee warns children’s services are not testing their compliance with the law on deprivation of liberty enough.

DoH starts listening programme for dementia sufferers. A new listening programme has been started by the Department of Health to better understand the experiences of people with dementia and their carers. The programme, focused only in England, will include different ways of gathering views and experiences, both in person and online.

NHS England sets out steps to improve mental health care for pregnant women and new mums and help those attending A&E in crisis

Woman with learning disability should have caesarean, judge rules. After specialist court hearing, judge says a planned caesarean is in best interests of woman who cannot be identified

Government to scrap Deprivation of Liberty Safeguards inquests duty

Events

Elderly clients: A medical and legal update. - Bristol Civil Justice Centre. 6 December As well as being an excellent training event, it will be a fantastic opportunity to meet COP Court staff and network with wider professionals in the South West region. The event will be followed by drinks at Totos Wine Bar from 6pm which is kindly being sponsored by Guildhall Chambers.

Bevan Brittan Updates

Bevan Brittan Mental Health Extranet.  If you are a health and social care professional working for the NHS or local government and would like access to the Bevan Brittan Mental Health Extranet contact Claire Bentley

Facilitating the participation of P in the Court of Protection. Charles J has issued guidance for consideration by practitioners and others representing P in the Court of Protection. For a summary of the guidance and to  join the conversation about this guidance click here to go to the Bevan Brittan Mental Health Extranet. If you are a health and social care professional working for the NHS or local government and would like access to the Bevan Brittan Mental Health Extranet contact Claire Bentley

A local authority v X [2016] EWCOP 44. The Court of Protection indicates concern at the prospect of incurring further legal expenditure of public funds on some "abstract determination of capacity if, realistically there is no choice in the way forward for this particular patient in his circumstances." To join the conversation and to read a summary of the implications about this case click here to go to the Bevan Brittan Mental Health Extranet. If you are a health and social care professional working for the NHS or local government and would like access to the Bevan Brittan Mental Health Extranet contact Claire Bentley

An NHS Trust v HN [2016] EWCOP 43. For a discussion of this case from Will Pickles click here. If you are a health and social care professional working for the NHS or local government and would like access to the Bevan Brittan Mental Health Extranet contact Claire Bentley

The Law Commission - final report and draft bill delayed until March 2017. Final report of its review of the law of mental capacity and deprivation of liberty and draft bill. If you are a health and social care professional working for the NHS or local government and would like access to the Bevan Brittan Mental Health Extranet contact Claire Bentley

If you wish to discuss any issue relating to mental health please contact Simon Lindsay or Stuart Marchant

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Primary Care

Publications/guidance

Physical health of people in prison - NICE guideline NG57. This guideline covers assessing, diagnosing and managing physical health problems of people in prison. It aims to improve health and wellbeing in the prison population by promoting more coordinated care and more effective approaches to prescribing, dispensing and supervising medicines. Note that recommendations on ongoing mental health care will be included in NICE’s guideline on mental health of adults in contact with the criminal justice system, due to be published in February 2017.

Helping people look after themselves: a guide on self-care. This report calls for a new culture of care to reduce the pressures on doctors and hospitals. It highlights the role that GPs can play in educating the public on self-care and how patients can treat themselves without visiting the doctor or manage long-term conditions by taking preventative measures to stay fit.

General practitioner recruitment and retention: an evidence synthesis. This report presents an evidence synthesis on GP recruitment, retention and re-employment. It finds that overall the published evidence focuses primarily on attracting GPs to rural areas. However the literature does provide some useful insights to factors that may support the development of specific strategies for the recruitment and retention of GPs. The report suggests that medical students should be exposed to successful GP role models and general practice and that supporting intrinsic motivational factors and career determinants can influence recruitment.

Estates and technology transformation fund schemes 2016/17. The recipients of the NHS England estates and technology transformation fund have now been announced. Nearly 300 GP schemes have been earmarked for investment to improve premises and IT infrastructure and to expand the range of services for patients. 

By choice - not by chance: supporting medical students towards future careers in general practice This report, commissioned in partnership with the Medical Schools Council, investigates how general practice is taught in medical schools and makes recommendations for HEE and other key partners. It emphasises the need to tackle long held views about general practice which is often perceived as a less valued career and that change is key to making sure that the future GP workforce is assured.

Tips and mythbusters for GP practices.  Here he clears up some common myths about our inspections of GP and out-of-hours services and shares agreed guidance to best practice.

The digital patient: transforming primary care? This report argues that digital technology for patients and staff in primary care holds great potential for the NHS but that the impact of this new digital capability is far from certain. It reviews the evidence on digital technology and its impact on patients and finds that patient-facing technology is already showing promise, particularly for people with long-term conditions. The report warns that policy-makers and politicians should avoid assuming that self-care enabling technology will produce significant savings, at least in the short term.

Choice in the presence of experts: the role of general practitioners in patients' hospital care This paper presents an analysis of patients' hospital choice for elective medical procedures when their choice set is pre-selected by a GP. The study found that patients defer to GPs when assessing hospital quality and tangible attributes such as hospital amenities and that GPs, in turn, as patients' agents present choice options based on quality, but as agents of health authorities also consider their financial implications.

Freedom to speak up in primary care: guidance to primary care providers on supporting whistleblowing in the NHS This guidance aims to make it easier for primary care staff to raise their concerns so that action can be taken and improvements made. The guidance has been produced following recommendations from the Freedom to Speak Up review which suggested that guidelines be adapted for primary care where smaller work settings can present challenges around anonymity and conflicts with employers.

General Practitioners Council (GPC) monitoring of Primary Care Support England (PCSE) performance This report warns that the GP patient record system in England is "in chaos" following a survey of 281 GP practices which has revealed widespread problems with the delivery of back office services by Capita. In September 2015, Capita were awarded an outsourced contract from NHS England to deliver administrative support services to GP practices and the survey of practices reveals the performance of Capita in delivering these services so far.

Integrated care for older people with frailty: innovative approaches in practice. A new joint report from the Royal College of GPs and the British Geriatrics Society has been published showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Access to NHS Dental Services: What people told local Healthwatch. This report about people's experiences of NHS dentistry summarises the findings from 31 local Healthwatch reports and highlights three key areas that require particular attention. Most people surveyed said that they were able to book an NHS dental appointment when they needed one and they were satisfied with their NHS dental care.

News

Forty 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 40 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 such as cuts and grazes , lower back pain, terminal cancer, prostate conditions, and small wrist fractures or ‘buckle fractures’ in children. At the heart of the Choosing Wisely initiative is a call to both doctors and patients to have a fully informed conversation about the risks and benefits of treatments and procedures.  

Workload strain compromises patient safety, finds survey. A BMA survey of GPs in England highlights the alarming impact spiralling levels of demand are having on GPs, many of whom are increasingly unable to cope. Based on more than 5,000 responses, the survey found that 84 per cent of GPs report that unchecked and growing workload pressures are undermining their ability to provide safe and quality care. Of this figure, 57 per cent described their daily workloads as 'unmanageable' with a further 27 per cent saying that excessive pressures are directly impacting standards.

Digital technology can transform patients’ lives, but impact on the NHS is uncertain, experts find

GP patient records system “in chaos”, warns new BMA survey.

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

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Procurement 

Publications/Guidance

NHS Standard Contract 2017/18 and 2018/19 technical guidance. Revised guidance that outlines the changes made to the 2016/17 Contracts, provides general guidance on contracting, and outlines the key topics in the Contracts. It also includes a summary guide to completing the contracts. Section 3 contains a summary of the changes have made to the contracts. There is also a Summary of key changes made in response to consultation feedback. All the documents relating to the NHS Standard Contracts 2017/18 are on the NHS England website.

Health and Justice commissioning intentions for 2017/18. This document outlines the priorities for the commissioning of services in secure and detained settings in England. It also sets out those priorities for liaison and diversion services, sexual assault referral centres and major national programmes (such as, smoke free prisons, the Health and Justice Information System, children and young people mental health transformation work stream and substance misuse services). The intentions are intended to support commissioners, providers and the management of the secure and detained estate, to make preparations for health care services in 2017/2018 and have been developed to support NHS England’s overarching strategy, the Health and Justice Strategic Direction: 2016-2020.

Armed Forces and their families commissioning intentions - 2017/18 to 2018/19. This document provides notice to healthcare providers and gives information to other commissioners of healthcare services about changes and planned developments in the commissioning and delivery of services for the Armed Forces and their families registered with a Defence Medical Services (DMS) practice by NHS England. Together with planning guidance, the NHS contract, National Tariff system and CQUIN guidance they form a plan to be reflected in contracts, developments, service reviews and procurement opportunities for the two years from 2017/18 to 2018/19. The prime purpose of these intentions is to enable healthcare providers to make early preparations, to engage with clinical leads and to make changes that benefit patients, with improved outcomes. These intentions should inform providers’ plans at all levels. These intentions also set out other planned changes related to the healthcare of the Armed Forces community that CCGs will wish to be aware of.

PSNC Briefing 058/16: Imposition for 2016/17 and 2017/18 – Frequently Asked Questions. Following the announcement of the imposition for community pharmacy funding for 2016/17 and 2017/18, PSNC has been asked a number of questions both by contractors and the pharmacy press. This document sets out its responses to these questions and may be of interest to contractors and LPCs.

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.

Bevan Brittan Services 

Do your internal documents need updating? Bevan Brittan's nationally renowned procurement team can draft a suite of procurement documents for you at a fixed fee.

Bevan Brittan Events

Health and social care integration: where next? This interactive seminar is an opportunity for health bodies and local authorities to come together and share experience of their projects to integrate health and social care, obtain an update on current policy and practice on integration and the future of Better Care Fund and Vanguard projects as well as understand current issues in commissioning and procurement in both health and local government.
London 13 December 09:30
Leeds 14 December 09:30 

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

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Public Health

Publications/Guidance

Police and Public Health – Innovation in practice: an overview of collaboration across England. This document highlights case studies of initiatives between police and public health from across the country. It was developed to stimulate discussion and sharing of good practice at the October 2016 Police and Public Health Summit with a view to developing a national consensus statement on policing and public health.

Supporting public health – Children, young people and families: Early years high impact areas guidance. Updated PHE guidance for local authorities and providers on commissioning and delivering children's public health services. The updated documents cover the six areas where health visitors have the highest impact on the health and wellbeing of children aged 0 - 5 years. 

Building capacity: Realising the potential of community pharmacy assets for improving the public’s health. This report from the Royal Society for Public Health identifies a number of opportunities and challenges for community pharmacy teams to further support the public’s health. It provides a snapshot of the extent to which pharmacy teams are supporting the public’s health, the opportunities and challenges they may face and what can be done to address the challenges.

Changing risk behaviours and promoting cognitive health in older adults: An evidence-based resource for local authorities and commissioners. This resource helps local authorities and CCGs to identify what types of interventions they should focus on to help the uptake and maintenance of healthy behaviours and promote cognitive health among older adults living in the community. It is also intended for providers of lifestyle behaviour change programmes to support the development of evidence-informed prevention packages for older adults.

News

Screening newborns for muscle wasting condition not recommended. Public Health England reports that the UK National Screening Committee has found that babies should not be screened for Duchenne muscular dystrophy as the current test is simply not reliable enough. Babies would be identified as having the condition when they don’t and the test also misses babies who go on to develop the disease. 

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

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Regulation

Publications/Guidance

Ophthalmology Common Clinical Competency Framework. The Royal College of Ophthalmologists has launched a Clinical Competency Framework that provides standards of knowledge and skill required for non-medical eye healthcare professionals to deliver patient care. The Framework covers four clinical areas: acute and emergency eye care, cataract assessment, glaucoma and medical retina.

Consultations

Consultation on the transposition of the revised Mutual Recognition of Professional Qualifications (MRPQ) Directive 2005/36/EC: Amendments to health and care regulators’ legislation: government response. In December 2015, the Government sought views on legislation needed to introduce changes set out in the Mutual Recognition of Professional Qualifications (MPRQ) Directive. This document sets out the results of that consultation. The Government expects to lay the regulations in Parliament to come into force by the end of November. It will continue to work with key stakeholders such as the regulatory bodies to ensure that the changes are implemented appropriately.

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.  

Cases

Squier v General Medical Council [2016] EWHC 2739 (Admin). The court reviewed factual findings made and relied upon by the Medical Practitioners Tribunal when striking off a consultant neuropathologist for impaired fitness to practise because of her conduct as an expert witness and found that the decision was significantly flawed. It also commented that in long, complex cases, or in those which focused on the preparation and giving of expert evidence, it was preferable for the tribunal to be chaired by a lawyer with judicial experience.
Clive Stafford Smith, founder of the campaign group Reprieve, has issued a warning to expert witnesses about giving minority views following the High Court's decision to continue a ban preventing Dr Waney Squier from giving medical evidence, despite allowing her to resume practice and assist in coroners' courts.

Wisniewska v Nursing Midwifery Council [2016] EWHC 2672 (Admin). The court has allowed an appeal brought by a nurse appeal against the NMC's decision to impose a striking off order, consequent upon its finding that her fitness to practise was impaired. It held that where the only options for sanction were striking off or suspension, it was critical for the panel to evaluate the available mitigation not only when considering striking off but also when evaluating the proportionality of a suspension. The panel's conclusion that there was an absence of any evidence of remediation was wrong. The illogicality in its reasoning undermined the reliability of its findings and rendered the decision on sanction unreliable. Whilst not seeking to trivialise the nurse's dishonesty, applying the principal of proportionality the maximum period of suspension was appropriate, namely 12 months' suspension from the register.

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

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General

Publications/Guidance

What if NHS leaders were more representative of their patients? This essay is the latest in 'The NHS if' series, which explores hypothetical scenarios and their impact on the future of health and care. In this paper, Vijaya Nath considers how the priorities, culture and ways of working in the NHS would be different if its leadership teams were as diverse as the populations they serve.

Choosing wisely. As part of the Choosing Wisely campaign, AoMRC has outlined a list of 40 treatments and procedures that have limited clinical value or impact. The campaign calls for doctors and patients to have a fully informed conversation about the risks and benefits of treatments and procedures.

Policy changes to implement the NHS five year forward view: a progress report. Two years on from the publication of the NHS Five Year Forward View, the King's Fund assesses how much progress has been made and what still needs to be done to align policies with the plan. Its report argues that most progress in implementing the Forward View has been made in the new care models programme, in work on sustainability and transformation plans, and in plans to devolve more responsibility to public sector leaders in Greater Manchester. But with two out of the five years covered by the Forward View already elapsed, much remains to be done to align national policies with the improvements in care it is seeking to bring about. The report warns that the absence of ring-fenced funding for investing in new services could jeopardise plans to improve patient care outlined in the NHS Forward View.

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. 

Data Provision Notice for the FGM Enhanced Dataset. DH launched the FGM Prevention Programme in 2014, in partnership with NHS England. The programme highlighted the need for information to support the commissioning of services, as the scope and needs of the patients are little understood. This aggregate data will be used by NHS England with partner agencies, to inform FGM prevention strategies, and support the commissioning of services for women and girls with FGM.

2016 international health policy survey of adults. This survey of eleven countries compares patients' experiences with their country's health care system - comparing access to care, quality and affordability - as well as their self-reported health and wellbeing. The study compared patients from Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States.

Leading my life my way: young disabled people's experiences of using services to live independent lives This report finds that young disabled people are experiencing poor quality care and support planning, a lack of information and advice tailored to their specific needs and expectations. The report calls for the government to look beyond funding support for the basics in social care to ensure that young disabled people are supported and enabled to live independent lives.

GMC briefs peers on potential impact of Brexit. Leaving the EU could have a significant impact on the UK healthcare system and medical regulation, according to the General Medical Council (GMC) in a briefing given to peers on the move could affect healthcare in the UK. The GMC said the full scale of the impact will depend on whether free movement is maintained, and whether the UK government decides to retain the European professional mobility framework.

Urgent and emergency care pilot reports. CQC has published reports of two pilots which explore what the quality of urgent and emergency care could look like, based on two local areas. The reports on the pilots focus on UEC systems in South Warwickshire and in Airedale, Wharfedale, Craven & Bradford. In each area they looked at the contribution of the services that support people with urgent and emergency care needs, including NHS 111, A&E departments, ambulance services, GP practices, GP out of hours services and care homes – and how well they worked together for the benefit of the local population.

Cases

Re JS (Disposal of body) sub nom JS v (1) M (2) F [2016] EWHC 2859 (Fam). The court made a prospective order to resolve a dispute between the parents of a 14-year-old terminally ill girl who wanted her body to be frozen by cryonic preservation after her death.

NHS Foundation Trust v (1) T (2) T [2016] EWHC 2980 (Fam) Order provides that, notwithstanding the absence of parental consent, it is lawful and in T's best interests that he receives blood or blood products should the same be clinically indicated in the opinion of the treating doctors. The Order will record that such treatment will only be given after consultation with the parents and that blood products or blood will only be used if there is no clinically appropriate alternative.

NHS Foundation Trust v T [2016] EWHC 2980 (Fam). The Family Division, in the exercise of its inherent jurisdiction, ordered that, notwithstanding the absence of parental consent, it was lawful and in a child's best interests that he received blood or blood products should they be clinically indicated by the treating doctors. It was necessary for the court to make the decision instead of the parents, as such treatment caused them problems because they belonged to the Jehovah's Witness faith.

Secretary of State for the Home Department v Her Majesty's Senior Coroner for Surrey [2016] EWHC 3001 (Admin). The Administrative Court granted an application permitting non-disclosure of documents on the ground that disclosure would damage the public interest. In granting the application, the court held that it had jurisdiction to consider an application for public interest immunity, and that it was appropriate to exercise it, in a case where the defendant coroner had asked for disclosure of sensitive material, and the Secretary of State had refused to disclose that material because disclosure could have damaged national security.

News

Dying boy's parents lose palliative care court fight. The Family Division of the High Court has said that a terminally ill boy should be moved to a palliative care regime proposed by specialists despite his parents' objections.  

CPS considers whether plastic surgeons should face female mutilation charges. The Crown Prosecution Service (CPS) is considering whether to prosecute three cases where doctors carried out cosmetic genital surgery on adult women, two in London and one in Cheshire, under the Female Genital Mutilation Act 2003. The women reportedly paid privately for the surgery.

What it takes to be a CEO in the NHS. Sir Robert Naylor’s retirement speech opens up on lessons he learned while serving as UCLH foundation trust chief executive for the past 16 years – and speaks about the next chapter of his career

NHS using Google technology to treat patients. The NHS has deepened its relationship with Google after Royal Free London Foundation Trust announced the most significant deal to date between the health service and the tech giant’s artificial intelligence arm, DeepMind.

SCC raises NHS surveillance camera concerns. Expanding the list of relevant authorities in the Protection of Freedoms Act 2012 (PFA 2012) to include the National Health Service (NHS) is one of the issues raised in a letter sent by the Surveillance Camera Commissioner (SCC) to the Minister for Policing and the Fire Service, Brandon Lewis. The letter was issued following a meeting to discuss the SCC’s review of the surveillance camera code of practice and the current consultation on a draft national surveillance camera strategy.

Proof of ID may be needed for NHS care, says health chief. The BBC reports that patients could have to show two forms of identification to get some NHS care. Chris Wormald, permanent secretary at the DH, has told the Public Accounts Committee that it was a controversial move but already happened in some NHS trusts, and the NHS has "a lot further to go" in reclaiming money for treating foreign visitors.

GP patient records system “in chaos”, warns new BMA survey.

Tory MP calls for debate on introducing NHS charges. Conservative MP Sir Edward Leigh, who sits on the Public Accounts Commission, has called for an 'honest debate' about introducing charges for NHS treatment, arguing that such charges would help the health service focus on 'the essentials'.

Major teaching hospital has 100 patients waiting more than a year. The £1bn turnover trust had agreed with NHS England that it would start hitting the target by April 2017 but admitted it might not be able to do this without sending some patients to independent sector providers.

‘Sensitive’ data lost after social worker left court bundle on car roof and drove off. Ealing council has been warned over data protection failings after a social worker left a court bundle containing "sensitive" information on the roof of her car and drove off.

New £112 million investment in clinical research facilities. Announces funding from the National Institute for Health Research (NIHR) for specialist research nurses and new facilities to support clinical research and trials. The funding will be given to 23 NHS organisations over the next 5 years and will pay for specialist research nurses and technical staff, as well as providing cutting-edge facilities to support clinical research and trials.

Government launches £60 million call for global health research. The DH is inviting UK universities to apply for funding for research to benefit people’s health in low and middle-income countries. The National Institute for Health Research (NIHR), which will award the funds, is particularly keen to see proposals that consider areas currently under-researched. These include non-communicable diseases, mental health, tobacco control, road safety, surgery, and health and applied social or economic research. The funding is available for successful universities looking to expand their existing global health work, or for new entrants to the field. The closing date for applications is 26 January 2017.

NHS England Chief Executive Simon Stevens welcomes eight health innovations joining NHS Accelerator. NHS England has revealed eight health innovations set to join year two of the NHS Innovation Accelerator, a scheme designed to help with the adoption of promising new treatments and technologies. Each of the innovations are evidence-based and cost-saving and focus on providing solutions to key challenges facing the NHS, including better prevention of ill health, improved management of long term conditions and early intervention into diseases.

NHS trust doubles its money from foreign patient checks. Figures from a pilot scheme at the Peterborough and Stamford Hospitals NHS Foundation Trust, which introduced identity checks for all non-urgent treatment in 2013, have supported the Government's plans to introduce passport checks before medical treatment to recover monies owed from abroad. The NHS trust reports that the policy had enabled it to increase the amount recovered from overseas patients by £145,000.

Court rules that NHS must consider funding HIV prevention pills.NHS England has lost its appeal over a High Court ruling that it has the legal power to commission PrEP, a “game-changing” preventative HIV/Aids drug.

Quarter of people do not need to be admitted to hospital, new research reveals Up to one in four people admitted to hospital could be looked after adequately at home, according to new research commissioned by the Local Government Association (LGA). It believes treating more people in their homes would save the health system money and ease the pressure on local councils.

NHS to use private firms to beat the winter crisis. The Telegraph reports that NHS trusts have been told to take a series of measures to dramatically reduce bed occupancy levels in an attempt to ensure that wards can cope as pressures mount. These include hand over swathes of operations to the private sector and discharging thousands of patients in a bid to reduce record levels of crowding, while managers have been banned from declaring "black alerts". 

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