Health and Social Care Update - April 2017

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

05/04/2017

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.

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Training Events

Primary Care

Acute and emergency care

Procurement

Clinical Risk/Patient Safety

Providers

Commissioning

Public Health

Employment/HR

Regulation 

Finance

Social care

Information sharing/data 

General

Mental Health

 

If someone forwarded you this email you can sign up for your own free copy here delivered directly to your inbox.

Training Events

Webinars

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:-

  • Clinical Negligence Liability Update - 18th April. How recent decisions impact on cases going forward and key issues to look out for. If you would like to attend this free webinar just ask Claire Bentley.
  • Mental Health and Mental Capacity Acts Update - 2nd May. A look at recent court decisions from a mental health management and possible claim perspective. If you would like to attend this free webinar just ask Claire Bentley.

Seminars

Digital health: law and risk management in health tech and telemedicine - 4 May 2017.

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 15 May
Leeds 16 May
. London 17 May
. Bristol 18 May

If you wish to discuss any queries you may have around training please contact Claire Bentley

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Acute and emergency care

Publications/guidance

Enhancing junior doctors' working lives. This report highlighting the progress made by Health Education England (HEE) to enhance juniors doctors’ working lives. The junior doctors’ contract dispute highlighted a number of issues involving their training and working environment. Common concerns involved issues that sat outside the contract itself and included: lack of timely information about rotations and on-call duties; different interpretations of the many rules around flexibility in training; and the rising costs of developing as a professional. This report updates the work undertaken by HEE and partners on these initiatives and proposes next steps for further action.

What's going on in A&E? The key questions answered. This updated King's Fund analysis looks at how A&E waiting times have changed over the past few years and explores the complex causes of the problems in A&E, which reflect wider pressures on the NHS and social care.

Hospital winter pressures: How did NHS trusts perform in 2016/17? This NHS analysis examines the performance of the NHS over the three peak winter months covering 1 December 2016 to 26 February 2017. The briefing summarises the trends week-by-week, and includes recommendations for future action by health system leaders. It finds that the number of temporary beds opened to cope with demand in busiest part of winter was equivalent to eight additional hospitals. The figures show a system running hot and it reiterates calls for a formal review of winter pressures.

Bevan Brittan Updates 

When should doctors report gunshot, knife wounds and other violent injuries? The GMC has published explanatory guidance setting out what to do when a patient presents with a  gunshot or knife wound.  Claire Bentley explains.

If you wish to discuss any queries you may have around acute and emergency care please contact Claire Bentley.

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Clinical Risk/Patient Safety

Publications/Guidance

Learning from deaths in the NHS: national guidance. Sets out a framework to help standardise and improve how NHS providers identify, report, investigate and learn from deaths.

Damages Act 1996: The Discount Rate - Review of the Legal Framework. A response by the Ministry of Justice to its consultation on the legal framework surrounding the calculation of the discount rate includes a summary of responses received, highlighting the diverging views from respondents on whether the current legal parameters were appropriate, and noting the limited support for the greater encouragement of periodical payments.

Ogden tables: actuarial compensation tables for injury and death. On 27 February the Lord Chancellor announced that under the provisions of Section 1 of the Damages Act 1996 the prescribed discount rate to be taken into account by the courts when assessing lump sum damages awards for personal injury would be lowered from 2.5% to -0.75% with effect from 20 March 2017. As the tables of multipliers in the current 7th edition of the Ogden Tables are not tabulated at a discount rate of -0.75% supplementary tables have been issued which provide multipliers at the current tabulated discount rates together with multipliers calculated at a rate of -0.75%. The new multipliers have been calculated using the same mortality rates and other assumptions underlying the tables in the 7th edition. The other tables of factors in the explanatory notes to the 7th edition have not been revised at this time.  

Consultations

Fixed recoverable costs for clinical negligence claims. Seeks views on proposal for a mandatory system of fixed recoverable costs for lower value clinical negligence claims in England and Wales.

The Personal Injury Discount Rate: How it should be set in future. A Ministry of Justice consultation seeks views on what principles should guide how the personal injury discount rate is set, how often the rate should be set, and who should set it. It also considers whether sufficient use is being made of periodical payments orders. Comments by 11 May 2017.

Rapid resolution and redress scheme for severe birth injury consultation. This consultation seeks views on the proposed investigations into severe avoidable birth injury and the support and compensation scheme. The rapid resolution and redress scheme aims to introduce a system of consistent and independent investigations for all instances where there may be severe avoidable birth injury, along with access to ongoing support and compensation for eligible babies through an administrative scheme. This consultation closes on 26 May 2016.  

News

CQC alerts independent ambulance providers to 'emerging patient safety concerns' The Care Quality Commission (CQC) is calling on independent ambulance services in England to ensure they care for their patients safely after its inspections to date have found significant concerns.

Government PI reforms will hand insurers windfall of up to £700m, say economists. A report by Capital Economics (CE) suggests that insurers will see profits increase by £700million as a result of the Government's personal injury (PI) reforms proposed in the Prisons and Courts Bill 2016. In its report, CE questioned the Government's basis for the reforms, saying there was "little evidence" PI claims and fraud had substantially increased premiums, and described as "implausibly high" a projection that insurers would pass on 85% of the £1.3 billion in savings as lower premiums.

Girl's damages nearly tripled in first settlement under new discount rate.
Under what is believed to be the first case following the 20 March 2017 change to the discount rate, the High Court awarded a girl an increase of over £5 million on her capitalised settlement. In LMS v East Lancashire Hospitals NHS Trust, the High Court approved the agreed quantum settlement on the basis that the claimant, who has cerebral palsy, was to recover 50% of the full value of her claim calculated at the new minus 0.75% rate. The capitalised value of the award at the new rate was £9,296,673.

Defence union accuses Truss of legal error in setting new discount rate.
The Medical and Dental Defence Union of Scotland (MDDUS) has criticised the Lord Chancellor's decision to reduce the discount rate to -0.75%, suggesting she has erred legally in both the process and substance of her decision. MDDUS chief executive Chris Kenny said the reform would drive up the size and number of claims and asked for Ms Truss to show her reasoning in greater detail. Responding to the new rate, the Association of British Insurers said premiums would go up in waves over the next year in line with renewal trends. 

Bevan Brittan Training

Webinars

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:-

  • Clinical Negligence Liability Update - 18th April. How recent decisions impact on cases going forward and key issues to look out for. If you would like to attend this free webinar just ask Claire Bentley.
  • Mental Health and Mental Capacity Acts Update - 2nd May. A look at recent court decisions from a mental health management and possible claim perspective. If you would like to attend this free webinar just ask Claire Bentley.

Seminars

Digital health: law and risk management in health tech and telemedicine - 4 May 2017.

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 

Clinical commissioning group guidance on senior appointments, including accountable officers. Updated CCG guidance on policy and procedures for appointing a new accountable officer to a CCG, and a new appointment pro forma. It acknowledges the changes that have taken place within NHS England since October 2015, and updated roles and responsibilities for CCGs and NHS England when appointing new AOs. 

Delegated commissioning case studies. NHS England has produced a series of case studies to show how CCGs are using delegated commissioning to improve care for local people. They show how CCGs are: using delegated commissioning to develop out of hospital services; improving the quality of general practice services through quality contracts and benchmarking; engaging their members in the development of primary medical services; and building the foundations for a more sustainable primary care system through workforce and estates reviews; they also show how delegated commissioning is supporting the development of STPs and new care models.

Cost-effective commissioning of end of life care. These resources bring together existing evidence in palliative and end of life care, describe the wider policy context, and outline some of the key initiatives supporting the end of life care in England. The economic tool helps to inform commissioners in their decision-making for end of life care services. It explores the trade-offs between shifting end of life care out of secondary services and describes interventions that might be deployed to achieve such savings. Where evidence of the effectiveness (for example in reducing the use of acute care beds) of specific interventions is available, the tool allows users to model the impact of these interventions on their local data, to provide an estimate of the Return on Investment associated with that intervention.

Legislation

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No.2) Regulations 2017 (SI 2017/322). These regulations, which come into force on 1 April 2017, amend reg.20 of the Standing Rules (SI 2012/2996) so as to decrease the rates for NHS funded nursing care payable by the relevant body (NHS England or a CCG).

News

NHS England to issue new guidance on low value prescription items. Announces that NHS England will be leading a review of low value prescription items from April 2017 and introducing new guidance for CCGs, with a view to substantially saving NHS expenditure in this area. It follows extensive work by NHS Clinical Commissioners which identified significant areas where potential savings can be made, up to potentially £400m per year. NHS England will work with clinicians and clinical commissioning groups to develop guidelines initially around a set of 10 medicines which are ineffective, unnecessary, inappropriate for prescription on the NHS, or indeed unsafe, and that together cost the NHS £128m per year.

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

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Employment/HR

Publications/Guidance

Enhancing junior doctors' working lives. This report highlighting the progress made by Health Education England (HEE) to enhance juniors doctors’ working lives. The junior doctors’ contract dispute highlighted a number of issues involving their training and working environment. Common concerns involved issues that sat outside the contract itself and included: lack of timely information about rotations and on-call duties; different interpretations of the many rules around flexibility in training; and the rising costs of developing as a professional. This report updates the work undertaken by HEE and partners on these initiatives and proposes next steps for further action.

Review body on doctors’ and dentists’ remuneration - forty-fifth report 2017 This report sets out the Review Body on Doctors’ and Dentists’ Remuneration's (DDRB) analysis of evidence given by relevant organisations and makes proposals for doctors’ and dentists’ pay and associated issues in England, Wales and Northern Ireland. In this report the DDRB provides independent advice on the pay of doctors and dentists in the NHS to the: Prime Minister, Secretary of State for Health, First Minister of Scotland, First Minister of Wales and First Minister and Deputy First Minister of Northern Ireland. 

Adapting for the future: a plan for improving the flexibility of UK postgraduate medical training Following a review of medical training, the GMC have responded to recommendations that greater flexibility in training paths for doctors is required. The recommendations outlined in this report cover the organisation of specialities curriculums, focusing on outcomes rather than time spent in training and reducing the burden of the GMC's approval system and UK legislation to enable a more agile training system.

Consultations

The National Health Service Pension Scheme (Amendment) Regulations 2017: consultation response. Summarises and responds to points raised in the December 2016 consultation that sought views on changes to the NHS Pension Scheme, including the rules, to support the development of NHS England's new models of care. The proposed amendments to the NHS Pension Scheme were either supported by respondents or received no comment. The measures permitting scheme access for independent providers of NHS services using an approved sub-contract were well received, with calls to include other contract types. Contracting arrangements for NHS England’s new care models continue to evolve and are likely to be ready for use later this year. Accordingly, Scheme amendments to accommodate multi-specialty community provider contracts are withdrawn in favour of bringing forward a suite of changes that accommodate both multi-specialty community provider and primary and acute care system arrangements from October 2017. The National Health Service Pension Scheme and Additional Voluntary Contributions (Amendment) Regulations 2017 (SI 2017/275) have been updated as described in the document and come into force on 1 April 2017.  

Bevan Brittan Updates

Employment Eye March 2017 including:-
Headscarves tied in knots
Spring forward
Employment news round up 

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

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Finance 

Publications and Guidance

Understanding NHS financial pressures. This report by the King's Fund examines the impact of NHS financial pressures on patient care across four different parts of the health system. 

Spring 2017 budget. The Chancellor of the Exchequer delivered his Spring Budget to Parliament on 8 March 2017. Amongst the announcements in the Budget were: an additional £2bn for social care over the next three years; £100m of capital investment for A&E improvements; and £325m over the next three years to implement STPs.

A year of plenty? An analysis of NHS finances and consultant productivity. The NHS is facing unprecedented financial pressures two and a half years after the publication of the Five Year Forward View. This report by the Health Foundation analyses the finances of NHS providers and the consultant productivity of acute NHS hospitals, drawing on their annual accounts from 2009/10 to 2015/16 and linking this to wider NHS data. The analyses show that NHS providers saw relatively little of the income growth for the NHS as a whole, and that productivity for consultants and the wider workforce in acute hospitals has been falling.

How healthcare is funded. The NHS is experiencing the longest and most severe slowdown in funding in its history. This has raised questions about the sustainability of its funding model. This article explains the main models used to finance health care: taxation, private health insurance and social health insurance. It outlines how each model works in its purest form, while recognising that most countries typically pay for health care using a combination of methods. 

The long-term sustainability of the NHS and adult social care. The Lords Select Committee on the Long-term Sustainability of the NHS has published a report that slams the 'short-sightedness' of successive governments for failing to plan effectively for the long-term future of the health service and adult social care. It finds that there is a shocking lack of long-term strategic planning in the NHS, which stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions. it recommends that to solve this, there is a new Office for Health and Care Sustainability that is independent of government and is able to identify clearly the healthcare needs of a changing and ageing population and the staffing and funding the NHS will require to meet those needs. We also need to recognise the NHS will need more money.

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

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Information sharing/data

Bevan Brittan Updates

When should doctors report gunshot, knife wounds and other violent injuries? The GMC has published explanatory guidance setting out what to do when a patient presents with a  gunshot or knife wound.  

Patients' fitness to drive and reporting concerns to the DVLA/ DVA. The General Medical Council has published revised guidance on confidentiality for all doctors practising in the UK. 

If you wish to discuss any issues raised in this section please contact Jane Bennett

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Mental Health

Publications/Guidance

Improving integrated care management in mental health. NHS LA case story. Better joint working and specialist help benefits patients, families and the NHS

New data reveals suicide prevalence in England by occupation. The Office for National Statistics analysis reveals which professions have the highest risk of suicide. The analysis, commissioned by Public Health England (PHE), presents national suicide rates broken down by occupation for the first time.

Mental capacity and deprivation of liberty. The Law Commission has published its final report following its review of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). The review found that the law is still failing to deliver Article 5 safeguards to many people who lack capacity to consent to their care or treatment and are being deprived of their liberty. The official figures show a significant backlog of cases referred for authorisation under the DoLS, with the legal timescales for DoLS assessments being routinely breached and a significant number of cases not being assessed at all. It also received evidence of significant delays in reviews and renewals of DoLS authorisations, and that many NHS bodies and local authorities were not even considering deprivation of liberty cases outside hospital and care home settings or involving 16 and 17 year olds. The final report, with a draft Mental Capacity (Amendment) Bill, recommends that the DoLS be repealed with pressing urgency and sets out a replacement scheme for the DoLS – called the Liberty Protection Safeguards. In addition the draft Bill makes wider reforms to the Mental Capacity Act which ensure greater safeguards for persons before they are deprived of their liberty.

Local support for people with a learning disability. This report from the NAO looks at progress with the DH and NHS England's Transforming Care programme that aimed to move people out of mental health hospitals more quickly. The NAO finds that good progress has been made by the DH and NHS England in setting up a programme to close hospital beds for people with a learning disability, but the programme is not yet on track to achieve value for money.

Practice Direction B - Fixed Costs in the Court of Protection. A Courts and Tribunals Judiciary Practice Direction sets out the fixed costs that may be claimed by solicitors and public authorities acting in Court of Protection proceedings and the fixed amounts of remuneration that may be claimed by solicitors and office holders in public authorities appointed to act as a deputy for individuals who lack mental capacity.

Peer support and children’s and young people’s mental health – Analysis of call for evidence activities. In February 2016 the DfE sought views on the most effective support methods to help improve the mental health of children and young people. This paper summarises and presents the findings from a range of activities undertaken by DfE to develop understanding, including support available within schools, in community settings and online.

Mental health of adults in contact with the criminal justice system. This guideline covers assessing, diagnosing and managing mental health problems in adults (aged 18 and over) who are in contact with the criminal justice system. It aims to improve mental health and wellbeing in this population by establishing principles for assessment and management, and promoting more coordinated care planning and service organisation across the criminal justice system.

Improving integrated care management in mental health. NHS LA case story. Better joint working and specialist help benefits patients, families and the NHS.

Chief Coroner Guidance No 16 A. To accompany the coming into force of the change to the definition of "state detention" introduced by the Policing and Crime Act 2017 on 3 April, the Chief Coroner has issued new guidance. This guidance makes it clear that where a death occurs on or after 3 April 2017 any person subject to a DoL is no longer ‘in state detention’ for the purposes of the Coroners and Justice Act 2009. Such a death should be treated like any other death outside the context of state detention. It only needs to be reported to the coroner if one or more of the other requisite conditions are met. However the guidance also makes clear that where there is a concern about the death, such as a concern about care or treatment before death, or where the medical cause of death is uncertain, the coroner will investigate thoroughly in the usual way.

Consultations

Safe, sustainable and productive staffing in mental health services. NHS Improvement has published draft improvement resource to help standardise safe, sustainable and productive staffing decisions in mental health services. The document aims to make the link between the decisions on staffing that boards and clinical teams take and the needs of people who use mental health services. It is practical and pulls together existing guidance and approaches used to help make staffing decisions. The deadline for comments on the draft is 28 April 2017.

Bevan Brittan Mental Health Extranet

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.

Issues that are currently being discussed on our forum are:-

1. New Court of Appeal Judgments: PJ and YZ
2. Policing and Crime Act 2017 - impact on s135 and s136 Mental Health Act 1983
3. Where a death occurs on or after 3rd April 2017 any person subject to a DoL is no longer ‘in state detention'
4. Effective Integrated Working for patients with vulnerabilities
5. How mental health is diagnosed and treated within the criminal justice system.
6. Landmark Judgment - Role of the Court of Protection where there is a dispute between the providers or funders of health or social care services for a person who lacks the capacity to make decisions for himself and members of his family about what should be provided for him.
7. New data reveals suicide prevalence in England by occupation
8. Law Commission’s Mental Capacity and Deprivation of Liberty Report

Bevan Brittan Training

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:-

  • Clinical Negligence Liability Update - 18th April. How recent decisions impact on cases going forward and key issues to look out for. If you would like to attend this free webinar just ask Claire Bentley.
  • Mental Health and Mental Capacity Acts Update - 2nd May. A look at recent court decisions from a mental health management and possible claim perspective. If you would like to attend this free webinar just ask Claire Bentley.

Bevan Brittan Updates

Commissioning and the Court of Protection - the Supreme Court's decision in N v ACGG [2017] UKSC 22. The Supreme Court's judgment means that the risk of having funding decisions routinely challenged in the Court of Protection has abated.

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

Safe, sustainable and productive staffing in district nursing services. MHS Improvement has published a draft improvement resource to help standardise safe, sustainable and productive staffing decisions in the district nursing service. The resource outlines a systematic approach for identifying the organisational, managerial and contextual factors that support safe staffing. It includes recommendations for monitoring and taking action, if insufficient members of staff are available to meet patients’ needs.

GP services in Wales: The perspective of older people. This report from the Older People's Commissioner for Wales finds that there are significant and unacceptable variations in older people’s experiences of accessing and using GP services in Wales, with particular issues around the appointments booking process, the accessibility of GP surgeries and the surgery environment, the time available for appointments, communication and privacy. Whilst a number of those surveyed spoke in positive terms about their GP services, many others shared concerns and highlighted a range of issues that can create unnecessary challenges and barriers.

The General Practice Nursing Workforce Development Plan: Recognise, reform, rethink. This Health Education England report contains recommendations to improve the recruitment, retention and return of general practice nurses (GPNs). It sets out some clear guidance and steps that can be taken to improve GPN recruitment and retention, and encourage nurses to return to the profession by setting out how best to respond to the current and anticipated workforce challenges at both strategic and local levels.

Implementing the 2017/18 GP contract: Changes to Personal Medical Services and Alternative Provider Medical Services contracts. Following the changes agreed to the GMS contract for 2017/18, this document sets out the approach to the funding changes that NHS England will apply to PMS and APMS contracts.

International GP Recruitment Programme. The General Practice Forward View (GPFV) includes a commitment to deliver a major international recruitment drive to attract at least 500 appropriately trained and qualified GPs from overseas by 2020. NHS England has published information on the International GP Recruitment Programme that will formally commence on April 1 2017. In advance of this, NHS England has provided funding to four international recruitment schemes that have helped test approaches and develop plans for the national roll-out of the programme from April 2017. 

Implementing the 2017/18 GP contract: Changes to Personal Medical Services and Alternative Provider Medical Services contracts. Following the changes agreed to the GMS contract for 2017/18, this document sets out the approach to the funding changes that NHS England will apply to PMS and APMS contracts.  

News

Welsh Government and GPC Wales agree changes to the GP contract for 2017/18. The Welsh Health Secretary Vaughan Gething has announced changes to the GP contract for 2017/18 that will result in investment in general medical service increasing by approximately £27m. This includes an uplift of 2.7% for GP pay and expenses for 2017/18. The investment also includes provision for new enhanced services covering care homes; warfarin management , diabetes and the delivery of secondary care initiated phlebotomy test.  

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

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Procurement

Publications

Procurement transparency guidance. This updated document provides guidance to all NHS foundation and non-foundation trusts on the actions to take to increase openness and clarity about NHS procurement. Under the NHS Standard Contract, all NHS Foundation Trusts and NHS trusts must comply with the guidance and requirements contained within this document. Independent sector providers of NHS healthcare may also wish to consider the benefits of adopting the guidance in this document.

Crown Commercial Service. The Commons Public Accounts Committee has published a report that examines the Crown Commercial Service (CCS), established in 2014 with the aim of centralising £13.4bn of central government spending and to carry out direct buying services on behalf of all departments. It concludes the creation of CCS was poorly executed and progress in centralising procurement has been slow, with CCS only managing £2.5bn of spend on behalf of seven departments instead of the £13bn, on behalf of all 17 departments, predicted in 2014.  

Bevan Brittan Updates

Bevan Brittan's Byte Size Procurement Updates – The Selection Questionnaire. We have published the final three articles in our "SQ Bytes" series that looks at the Selection Questionnaire (SQ) issued by the Crown Commercial Service (CCS):

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

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Providers

Publications/Guidance

Next steps on the NHS Five Year Forward View. This document reviews the progress made since the launch of the NHS Five Year Forward View in October 2014 and sets out a series of practical and realistic steps for the NHS to deliver a better, more joined-up and more responsive NHS in England.

Mission impossible? The task for NHS providers in 2017/18. NHS Providers has published a detailed analysis that shows that what is currently being asked of NHS trusts in the coming financial year is well beyond reach. The report sets out how greater realism, flexibility and support are needed if trusts are to deliver in 2017/18. The report presents a detailed assessment of the demands that are being placed on NHS trusts through the NHS planning guidance. These are compared against next year’s significantly lower funding increases, revealing a currently unbridgeable gap.

NHS efficiency map. Updated 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. Aimed at NHS finance directors and their teams and other NHS staff with an interest in the delivery of CIPs, the purpose of the NHS efficiency map is to highlight existing resources on eliminating waste, increasing efficiency and at the same time improving quality and safety. The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. The map highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency.

Hospital winter pressures: how did NHS trusts perform in 2016/17? This briefing examines the performance of the NHS over the three peak winter months covering December 2016 to February 2017. The analysis finds that the number of temporary beds opened to cope with demand on A&E units in the busiest part of this winter was equivalent to eight additional hospitals. The briefing calls for a formal review of how the NHS manages winter pressures, with a focus on the ring-fencing of winter funding and the impact of cancelling non-urgent operations.

News

Fees scheme for registered providers 2017/18 now published by CQC. CQC have now published their final fees scheme which sets out their annual charges to providers that will be in place from April 2017.

Section 29A warning notices for NHS trusts and NHS foundation trusts. CQC can serve a warning notice under section 29A of the Health and Social Care Act 2008 when they identify concerns across either the whole or part of an NHS trust or NHS foundation trust and decide that there is a need for significant improvements in the quality of healthcare.

Changes in regulatory fees for providers confirmed. The Care Quality Commission (CQC) has outlined the fees that providers of health and adult social care in England will be charged from April 2017 to recover the costs of their regulation. This press release summarises the main changes. See the Fees Scheme 2017/18 for full details. 

If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.

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Public Health

Publications/Guidance

Review of mandation for the universal health visiting service. The DH commissioned this review of the 5 mandated universal health checks, from pregnancy to age 2 and a half, as set out in Healthy Child Programme (0 to 5), following the transfer of commissioning of public health services for children aged 0 to 5 years to local authorities in October 2015. The review considered the: impact of this transfer; support for existing and continued regulation; evidence of service transformation; and risks to sustainability from a range of perspectives using data from different sources. The review found widespread support for the regulation of these services to continue and for future arrangements to be considered alongside other regulated public health services.

School nurse toolkit: Evaluation of behaviour change interventions. This PHE toolkit aims to guide school nurses through evaluations and provides guidance on how to implement results to promote learning, make improvements and demonstrate the impact of interventions.

Public health in local government – A model for public sector reform. The transfer of public health to local government, despite a number of challenges, has resulted in a number of positive improvements to the function. It is also having a wider impact on the way local government operates in its place-shaping role. This paper from the ADPH identifies ten reasons for this success and describes how this is relevant to wider public sector reform.

NHS public health functions agreement 2017 to 2018. Sets out the arrangements under which the Secretary of State delegates responsibility to NHS England for certain public health services (known as Section 7A services).

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

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Regulation

Publications/Guidance

Medical devices regulations: Compliance and enforcement. Updated information on the Medicines and Healthcare products Regulatory Agency's enforcement duties and how to report a non-compliant medical device.

CQC’s Equality Objectives for 2017-19. CQC is legally required under the Equality Act 2010 to set equality objectives at least every four years; however, it has chosen to set objectives every two years, to reflect the pace of development of CQC and its regulatory model, and because it is ambitious to work for change on equality. These new objectives focus on its regulatory role in improving equality. Through its inspections, CQC will check that providers make person-centred care work for everyone, from all equality groups.

News

Changes in regulatory fees for providers confirmed. The Care Quality Commission (CQC) has outlined the fees that providers of health and adult social care in England will be charged from April 2017 to recover the costs of their regulation. This press release summarises the main changes. See the Fees Scheme 2017/18 for full details.

Update of RPS Professional Standards for Hospital Pharmacy Services. Announces that the Royal Pharmaceutical Society is updating its standards for hospital pharmacy services across Great Britain (GB) that support the development of safe, quality services that put patients and their needs first. Supportive, enabling and professionally challenging the standards give a broad framework to be used by Chief Pharmacists, Directors of Pharmacy and their teams to develop and improve services, and to shape future services and pharmacy roles in order to deliver quality patient care. It is expected that the standards update will be completed before the end of 2017.

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

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Social Care

Publications/Guidance

Total transformation of care and support: Creating the five year forward view for social care – How transformed and integrated health and care could improve outcomes and cost-effectiveness. This paper explores the potential for scaling up the most promising examples of care, support and community health services, using data from Birmingham City Council, to see what their impact would be on outcomes and costs. Originally published in November 2016, it has been updated to include additional models.

The social care funding gap – Implications for local health care reform. This Health Foundation briefing offers an analysis of the size of the gap in adult social care funding in England – revealed as at least £2bn in 2017/18. This puts unacceptable pressure on vulnerable and older people and their families, and risks unravelling the plans to put the NHS and care services on a more sustainable footing. The research has used the social care gap estimates in many of the Sustainability and Transformation Plans (STPs) to produce an estimate of the national funding gap which is based on detailed local analysis.

Social work: Essential to integration. This document explains the critical contribution that social workers make to integrated services, how social work is essential to the whole system and the necessity of support to ensure integration succeeds in providing the services people need. It also includes ‘top tips’ for directors of adult social services and for principal social workers to assist in progressing the integration agenda. It has been produced to support and inform local and regional health and social care integration initiatives.

Responding to domestic abuse: a resource for health professionals. This resource looks at how health professionals can support adults and young people over 16 who are experiencing domestic abuse, and dependent children in their households. It will help health staff to identify potential victims, initiate sensitive routine enquiry and respond effectively to disclosures of abuse. Commissioners will gain insight into services to support people experiencing domestic violence and abuse, and the importance of joined-up local strategic planning.

Integration and Better Care Fund Policy Framework 2017 to 2019. Guidance for those responsible for delivering the Better Care Fund at a local level (such as CCGs, local authorities and health and wellbeing boards) and NHS England. It sets out the background to the integration of health, social care and other public services and provides an overview of related policy initiatives and legislation. It includes the policy framework for the implementation of the statutory Better Care Fund in 2017-19, and sets out proposals for going beyond the BCF towards further integration by 2020. Whilst there will now be no separate process for integration plans, the DH will provide a set of resources, integration models and indicators for integration to help local areas towards our shared goal of person-centred, coordinated care.

Adult social care. The Commons Communities and Local Government Committee has published a report which says that the Government needs to urgently review how social care is funded in the long term and address serious threats to social care provision. The report finds inadequate funding very seriously affects the quantity and quality of adult social care provision, impacting on those receiving care, the NHS, care staff, carers and providers. The report sets out a number of recommendations relating to the monitoring of care services, care commissioning, and the care workforce. The Committee welcomes the Chancellor's commitment to provide an additional £2bn for social care over the next three years but finds this falls short of the amount required to close the social care funding gap. The Committee believes expenditure on adult social care will need to rise as a proportion of total public expenditure and recommends an urgent review of how to fund social care in the long-term.

Paying for it – The human cost of cut-price care. This LGiU report looks at the human side of a care market on the brink of failure with stories from across the care system, and at why care is priced so low and how people in the system end up paying for cut-price care. it highlights how care providers are increasingly less willing to provide care under current commissioning arrangements because they simply cannot afford to do so. Some care providers are handing back contracts while other providers are simply choosing not to bid on uneconomic contracts, and some big providers are exiting the market altogether. It argues that we need radical reform in the way that we pay for and purchase care. The care market is on the point of collapse, and recent stop-gap funding will not address either the financial shortfall or the systemic market problems.

Self care: Everybody's talking about it. This discussion paper from Regional Voices explore the extent to which the recognition of the contribution of the voluntary and community sector (VCS) at policy level is replicated at a local level in the commissioning of VCS organisations across the East Midlands and East regions by CCGs. It focuses on 'self-care support' for people living with long term conditions. There is also an accompanying briefing paper on increasing the understanding amongst commissioners of the contribution the VCS make as enablers of self-care.

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

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General

Publications/Guidance

NHS women on boards: 50:50 by 2020. This report examines the steps the NHS needs to take to reach the target of equal gender representation on boards by 2020. It summarises demographic data from 452 organisations, including arms-length bodies, NHS trusts and clinical commissioning groups. It has been published in conjunction with NHS Improvement.

Review body on doctors’ and dentists’ remuneration - forty-fifth report 2017 This report sets out the Review Body on Doctors’ and Dentists’ Remuneration's (DDRB) analysis of evidence given by relevant organisations and makes proposals for doctors’ and dentists’ pay and associated issues in England, Wales and Northern Ireland. In this report the DDRB provides independent advice on the pay of doctors and dentists in the NHS to the: Prime Minister, Secretary of State for Health, First Minister of Scotland, First Minister of Wales and First Minister and Deputy First Minister of Northern Ireland.

Next steps on the NHS Five Year Forward View. This document reviews the progress made since the launch of the NHS Five Year Forward View in October 2014 and sets out a series of practical and realistic steps for the NHS to deliver a better, more joined-up and more responsive NHS in England.

NHS Property and Estates: Why the estate matters for patients. This independent report by Sir Robert Naylor examines how the NHS can make the best use of its estate to support NHS England’s Five Year Forward View. It highlights the opportunities available to support sustainability and transformation plans (STPs) and optimise the use of NHS land and buildings. The Government is already acting on some of the recommendations by: creating a new NHS property body; making a £325m capital investment over the next 3 years to develop local STPs; and developing an incentive scheme to guarantee that proceeds of sales are available for reinvestment. The Government will consider a further multi-year capital programme in the autumn.

Public satisfaction with the NHS in 2016: Results and trends from the British Social Attitudes survey. Since 1983, NatCen Social Research’s British Social Attitudes (BSA) survey has asked members of the public – rather than only patients – about their views on, and feelings towards, the NHS and health and care issues generally. The latest survey was carried out between July and October 2016 and asked a nationally representative sample of nearly 3,000 people about their satisfaction with the NHS overall, and of nearly 1,000 people about their satisfaction with individual NHS services. This report summarises the headline results. More detail from the survey will be published by NatCen in summer 2017.

A guide to employing reservists in the NHS. This guidance, produced in partnership with Health Education England and the Ministry of Defence, brings together key information to help managers understand the role of reservists and how to support them.

The Government's mandate to NHS England for 2017-18. This mandate sets direction for the NHS, and helps to ensure that the NHS is accountable to Parliament and the public. It reaffirms the Government’s commitment to an NHS that provides the best care and support to today’s patients, and also safeguards the service for future generations. Building on the previous multi-year mandate, which came into effect on 1 April 2016 and set long term objectives and goals to 2020, this mandate focuses on the same seven high-level objectives. It sets out the main aims in each area for the financial year 2017/18 to achieve the 2020 goals. The accompanying Financial Directions set out certain additional expenditure controls to which NHS England must adhere. These stem from budgetary controls that HM Treasury applies to the DH.

Care of dying adults in the last days of life. This guidance calls for health care professionals to ask adults in the final days of life about their religious or spiritual beliefs. In response to estimates that three out of four deaths are anticipated by medical staff, it provides guidance to help health care professionals identify patients who are nearing death in order to allow the patient and those close to them prepare accordingly.

Latest experimental statistics about female genital mutilation published.

Dying from inequality: socio-economic disadvantage and suicidal behaviour. This report links higher risk of suicide, with inequality calls for greater awareness of the risks of suicide and for direct support to those with unstable employment, insecure housing, low income or in areas of socio-economic deprivation.

Cases

Scheme to help patients with the cost of travel for medical appointments extended. The Welsh Government has announced the extension of the Healthcare Travel Costs Scheme (HTCS) to help eligible patients with the cost of travelling to non-urgent medical appointments. It has also announced plans for a pilot to explore the benefits of providing overnight accommodation for patients who would be eligible to travel by non-emergency patient transport for regular periods of treatment.

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

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