Health and Social Care Update - August 2017

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

01/08/2017

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

Information sharing/data

Acute and emergency care

Mental Health

Children

Primary Care

Clinical Risk/Patient Safety

Providers

Commissioning

Public Health

Employment/HR

Regulation

Finance

Social care

Independent Healthcare

General 

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Bevan Brittan Free Training Events

Court of Protection Seminars -  SAVE THE DATE

In October and November, Bevan Brittan's specialist Court of Protection team is hosting practical update sessions in Bristol, Birmingham, London and Leeds. These sessions will focus on practical issues that practitioners, commissioners and providers encounter in matters engaging the Court of Protection; covering relevant legislation, guidance and case law and their impact on managing incapable patients. They will offer guidance on the sort of problems that are faced by front-line practitioners and service planners. The sessions are aimed at all those working in organisations responsible for the care of vulnerable or incapable people both as care providers or commissioners. The sessions will run from 10:00 – 15.30. Registration for all sessions will open at 09:30 and lunch will be available.

  • 31 October – Bristol
  • 7 November – London
  • 8 November – Birmingham
  • 9 November – Leeds

If you would like to register your interest in one of the above seminars click on this link.

Clinical Risk 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. The  lunchtime training sessions coming up are:-

  • Developments in managing shoulder dystocia and Erb’s Palsy cases - 12 September 2017 (12.30pm - 2pm). If you would like to attend this free lunchtime webinar just ask Claire Bentley.

  • Care claims after Reaney and other hot topics - 26 September 2017 (12.30pm - 2pm).  If you would like to attend this free lunchtime webinar just ask Claire Bentley.

Bevan Brittan training packages

In addition to our free training programme, we also provide bespoke knowledge transfer sessions on a range of healthcare law topics. If you wish to discuss any queries you may have around training or webinars please contact Claire Bentley

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Acute and emergency care

Publications/guidance

Government Response to the House of Commons Health Select Committee report on winter pressure in Accident and Emergency Departments. The report responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report. It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.

The interface between primary and secondary care: Key messages for NHS clinicians and managers. Good organisation of care across the interface between general practice and secondary care providers is crucial in ensuring that patients receive high-quality care and in making the best use of clinical time and NHS resources in both settings. This NHS England briefing document describes the key national requirements which clinicians and managers across the NHS need to be aware of.

Safe, sustainable and productive staffing in maternity services. NHS Improvement has published an improvement resource to help providers of NHS-commissioned services, boards and executive directors to support their lead maternity professionals in implementing safe staffing for maternity settings. It describes the principles for safe maternity staffing across the multiprofessional team to ensure women and their families receive joined-up care appropriate to their needs and wishes. The resource outlines a systematic approach for identifying the organisational, managerial and clinical setting factors that support safe staffing of maternity services. It makes recommendations for developing models of care, staffing, tools and monitoring, and acting on staffing issues and risk to meet women's needs.

News

NHS needs more advanced paramedics to ease A & E pressure.
Paramedics with advanced training can reduce the number of patients admitted to hospital unnecessarily, says NICE.

New ambulance service standards announced. NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time.  

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

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Children

Publications/guidance

Child sexual exploitation: prevention and intervention This report summarises the emerging evidence from the UK on the issue of child sexual exploitation. It provides practice examples to support local public health leaders to establish a public health framework for prevention and intervention. The accompanying literature search is a summary of the latest international research about effective interventions to prevent child sexual abuse and child sexual exploitation.

Facilities for child and adolescent mental health services (HBN 03-02). This guidance covers the design of child and adolescent mental health services (CAMHS) accommodation for children and young people aged up to 18 years. It provides full descriptions of rooms that are specific to CAMHS and are not contained in other health building notes (HBNs). The schedule of accommodation can be used to calculate local project-specific requirements, and the stakeholder needs and quality of life checklists can be used to assess scheme compliance.

On measuring the number of vulnerable children in England. This report looks at the scale of vulnerability among children in England. It brings together a range of information held by various government departments, agencies and others. It finds, among other things, that there are 800,000 children suffering from mental health difficulties.

News

Study finds high rate of repeat referrals in children’s services Government-commissioned research found more than half of children referred to social services were re-referred within five years.

Charlie Gard parents end legal fight for 'beautiful' baby. See also the judgment of 24 July.

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

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Clinical Risk/Patient Safety

Publications/Guidance

All metal-on-metal (MoM) hip replacements: updated advice for follow-up of patients. MHRA is updating advice provided in MDA/2012/036, to assist the early detection of soft tissue reactions in patients implanted with metal-on-metal (MoM) hip replacements (MDA/2017/018)

Annual report and accounts 2016/17. The NHS Resolution annual report and accounts include: a performance summary and analysis; accountability reports; and financial statements for the year ending 31 March 2017.

Acute Non-Invasive Ventilation: Inspiring change. Four out of five patients who need help to breathe in NHS hospitals receive less than good care, a major study has found. This NCEPOD report focuses on the quality of acute non-invasive ventilation clinical care, for patients aged 16 years or older who are admitted to hospital. The report takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and the organisational care of these patients.

The incidence and costs of inpatient falls in hospitals. NHS Improvement has published findings from a review of falls incidence and their associated costs across all NHS inpatient settings in England.

The safer management of controlled drugs. The report sets out key changes to legislation and gives an overview of prescribing data and prescribing trends for controlled drugs across England in the primary care sector. It also makes recommendations to strengthen existing arrangements.

Driving improvement: Case studies from eight NHS trusts

“The Little Voice Inside me….”. Hypoxic Ischaemic Encephalopathy (HIE) occurs when the foetal brain does not receive enough oxygen. This can lead to severe impairment or death of the baby and is of course devastating for both families and staff. Whilst there have been a number of similar cases at hospitals around the country, recommendations to improve care often focus on retraining individuals rather than addressing cultural and behavioural changes in how healthcare staff communicates between themselves and with their patients. This learning package consists of the main video as well as a series of mini-videos which each focus on a specific learning point. The aim is that the videos will enhance current methods of training in maternity and raise awareness of these issues across multidisciplinary teams to ensure the learning remains at the forefront of clinical practice and to prevent cases of avoidable HIE.

NHS Injury Costs Recovery scheme: April 2017 to March 2018. The amounts collected by the Compensation Recovery Unit and paid to the NHS.

Safe, sustainable and productive staffing in maternity services. NHS Improvement has published an improvement resource to help providers of NHS-commissioned services, boards and executive directors to support their lead maternity professionals in implementing safe staffing for maternity settings. It describes the principles for safe maternity staffing across the multi-professional team to ensure women and their families receive joined-up care appropriate to their needs and wishes. The resource outlines a systematic approach for identifying the organisational, managerial and clinical setting factors that support safe staffing of maternity services. It makes recommendations for developing models of care, staffing, tools and monitoring, and acting on staffing issues and risk to meet women's needs.

Legislation

Conscientious Objection (Medical Activities) Bill. This Private Member's Bill has been introduced into the Lords by Baroness O'Loan and received its 1st Reading. The Bill clarifies the extent to which a medical practitioner with a conscientious objection may refrain from participating in certain medical activities.

Right to Die at Home Bill. This Private Member's Bill has been introduced into the Lords by Lord Warner and received its 1st Reading. The Bill requires the Secretary of State by regulations to provide for any eligible UK resident to have an effective right to die at home or at the place that the person regards as home.

National Health Service (Quality Accounts) (Amendment) Regulations 2017 (SI 2017/744). These regulations, which come into force on 1 November 2017, amend the National Health Service (Quality Accounts) Regulations 2010. They require NHS Trusts and NHS Foundation Trusts (apart from ambulance Trusts) to report on the number of their patient deaths which have occurred during a reporting year (1 April to 31 March) as part of their Quality Accounts. The information provided in the Accounts must include the number of deaths in the reporting period which have been reviewed (whether by case record review or an investigation), how many of those deaths the Trust considers are more likely than not to be due to problems in care provided to the patient, and a description of what the Trust has learnt and the action it has taken as a result of the reviews.

Cases

Diamond v Royal Devon & Exeter NHS Foundation Trust [2017] EWHC 1495 (QB). An NHS trust had breached its duty to a patient by failing to examine her abdomen at a post-operative review appointment, and by failing to ensure that she had given informed consent before proceeding to repair an incisional hernia with a mesh. While the patient was entitled to damages for the failure to examine her abdomen, she was not entitled to damages in relation to the trust's failure to get informed consent, because even if the patient had been in a position to give informed consent, the mesh repair would still have been undertaken.

Changing expert due to ill-health. Vilca v Xstrata Ltd [2017] EWHC 1582 (QB). The decision demonstrates the court's wide discretionary powers to make, or refuse, conditional disclosure orders and the fact that an order might be "usual" does not make it "inevitable".

Shaw v Kovac & University Hospitals of Leicester NHS Trust [2017] EWCA Civ 1028. In a claim for clinical negligence, the wrongful invasion of a patient's personal autonomy by failing to obtain informed consent to treatment did not amount to a separate and free-standing cause of action, nor could it attract damages under a new head of loss. If a patient's suffering was increased by the knowledge that his personal autonomy had been invaded through want of informed consent, it could be reflected in the award of general damages for pain, suffering and loss of amenity. See useful summary of the implications from Hailsham Chambers.

Ram v Chauhan  [2017] EW Misc 12. This case demonstrates the importance of a clear written record of what was said, with the witness being given the opportunity to read the statement and change it if necessary.

News

Father sues IVF clinic over 'baby conceived without consent'. A wealthy businessman is suing a Harley Street fertility clinic for £1 million after his ex-girlfriend “forged” his signature to be able to “secretly” conceive his baby daughter by IVF, a high court heard.

Government defends timing of discount rate change. Responding to a "motion of regret" that criticised former Lord Chancellor Liz Truss for announcing a new discount rate and then starting a consultation on how it should be set in future, the Government has defended Ms Truss' actions, stating that had she not acted, she would have been "in breach of her legal obligation to maintain an appropriate rate under the current formula". Lord Hodgson of Astley Abbotts said that the "draconian" change to a rate of -0.75% had "a direct and substantial effect on the public finances".

More NHS trusts could face criminal prosecution for breaches of fundamental safety standards to act as a “deterrent”, the Care Quality Commission’s outgoing chief inspector of hospitals has warned.

Trusts with high litigation costs to come under the spotlight. NHS litigation costs are to be scrutinised by a national programme to save millions in clinical negligence pay outs and improve patient care

Betsi Cadwaladr hospital infection rates 'too high'.

Rule committee decides against revisiting budgeting limit for PI cases despite discount rate impact Underwood: major impact of new rate. The Civil Procedure Rule Committee has decided against changing the financial threshold for costs budgeting in high-value personal injury cases, despite the prospect of the new discount rate taking a significant number of claims out of the regime.

Contaminated blood scandal inquiry announced. A UK-wide inquiry will be held into the contaminated blood scandal that left at least 2,400 people dead, the prime minister has confirmed.

CQC to investigate patient deaths at NHS trusts

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. The  lunchtime training sessions coming up are:-

  • Developments in managing shoulder dystocia and Erb’s Palsy cases - 12 September 2017 (12.30pm - 2pm). If you would like to attend this free lunchtime webinar just ask Claire Bentley.

  • Care claims after Reaney and other hot topics - 26 September 2017 (12.30pm - 2pm).  If you would like to attend this free lunchtime webinar just ask Claire Bentley.

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 

Checklist for recruiting CCG lay members. NHS Clinical Commissioners have published a checklist to support CCGs with recruiting lay members. Aimed at CCG chairs, members of the CCG governing body and lay members, the checklist provides a series of questions that can be asked to start conversations about both recruitment and succession planning.

Sustainability and Transformation Plans: 5 key questions for planners. This analysis by the Centre for Health and the Public Interest identifies five key questions to ask of each of England's 44 Sustainability and Transformation Plans. Each STP has been produced by a local Sustainability and Transformation Partnership formed with the task of transforming the provision of NHS services in a given area, as part of efforts to close the NHS's unprecedented 'funding gap'. The CHPI states that the plans have been produced under extreme time pressure and in the absence of a legal basis for joint planning between the different organisations in the NHS and local government that are involved. It is crucial that the STPs receive effective scrutiny - this paper aims to set out a framework for assessing their potential impacts, based upon five questions.

Legislation

Access to Palliative Care Bill. This Private Member's Bill has bee introduced into the Lords by Baroness Finlay of Llandaff and received its 1st Reading. The Bill requires CCGs to ensure that persons in their area have access to specialist and generalist palliative care and appropriate support services.

Consultations

Gender Identity Services for Adults. NHS England has launched a 12 week consultation on specialised gender identity services for adults (aged 17+). It seeks views on two proposed service specifications: one for how Gender Identity Clinics will deliver specialised outpatient services; and another for how surgical units will deliver surgical interventions. The consultation is open until 30 September 2017.

Commissioning Toolkit Programme: Minor ailment service. As part of the Pharmaceutical Services Negotiating Committee’s work to support LPCs to get local services commissioned and to ensure services are costed correctly, it is developing template toolkits for a range of locally commissioned services. The first is for Minor Ailment Services. The closing date for comments on the draft documents is 8 August 2017.

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

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Employment/HR

Publications/guidance

2017-18 education & training placement tariffs: tariff guidance and prices from 1st April 2017. This document sets out the national tariffs for healthcare education and training placements for 2017/18; how the tariffs will be implemented; and in what circumstances the national tariffs may be varied and how to do this. The tariffs cover non-medical placements and medical undergraduate and postgraduate placements in secondary care.

NHS bursary scheme rules 2017 This guidance from NHS Business Services Authority contains information about the NHS bursary scheme, with new rules applicable for the academic year 2017 to 2018.

Survey of medical clinical academic staffing levels 2017. This report raises concerns over the falling number of clinical academic staff in UK medical schools. It finds that since 2010, the number of medical clinical academics has declined by 4.2 per cent with the reducing occurring disproportionately at the senior lecturer level. The survey results also highlight the need for a rapid expansion in the number of clinical academics in general practice to meet the growing demands for primary care.

Regional review of medical education and training in the East Midlands: 2016. This report outlines the findings of a review of medical training and education in the East Midlands. Doctors in training in the region highlighted concerns around patient safety and continuity of care due to inadequate handovers between teams. The review praises the educational governance systems in place in the region but issues around workload and resourcing meant doctors in training can struggle to fit in their learning and development activities.

Paediatric rota gaps and vacancies 2017. This report outlines the findings of an annual survey of clinical directors and workforce leads for paediatric services. It finds that almost one in five of paediatric trainee positions are currently vacant even though trainees themselves report high levels of enthusiasm for the speciality. This year's survey focused on the impact of the 2016 junior doctors' contract and 67 per cent of respondents report that the contract is having a negative impact on recruitment and retention.

News

NMC commits to further work on language test amid ‘urgency’ concerns.

Bevan Brittan Updates

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

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Finance 

Publications and Guidance

NHS financial temperature check: finance directors’ views on financial challenges facing the NHS in England. This is the seventh in the HFMA’s series of briefings setting out finance directors’ views on the financial issues facing the NHS in England. The briefing draws on the responses of 73 finance directors of trusts and foundation trusts and chief finance officers of 100 CCGs. The NHS financial temperature check provides a national picture of finance directors’ views of the financial outlook and the challenges NHS finance staff are facing.

Investigation into NHS continuing healthcare funding. NHS continuing healthcare (CHC) is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs. This report finds that the number of people assessed as eligible for CHC funding has been growing by an average of 6.4 per cent a year over the last four years. In 2015-16, almost 160,000 people received, or were assessed as eligible for, CHC funding in the year, at a cost of £3.1bn.  

News

NHS fines 22 councils for bed-blocking. One in six councils in England have been fined by the NHS for bed-blocking as the health service and local government go to war over social care funding. The NHS has fined at least 22 councils for causing delays in discharging patients and threatened 11 others with charges. The news will fuel tensions between local government and the health service, which have been pitted against each other in the battle to close a £22bn hole in health funding.

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

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Independent Healthcare

Publications/Guidance

The state of adult social care services 2014 to 2017. Presents the findings from the CQC's comprehensive programme of adult social care inspections. The report looks at what the CQC has found about the quality of care across the full range of adult social care services that it regulates. These include residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services. The report finds that while the majority of adult social care services are of a high quality and many are improving, too many people across England are receiving care in care homes and in their own home that is not good enough. Without a proper recognition of the importance of adult social care and a renewed commitment to quality, the numbers of people affected by poor care could increase and have a profound impact on their lives.

Adult social care: quality matters. The Quality Matters initiative is co-led by partners from across the adult social care sector. This report sets out a single view of quality and a commitment to improvement. The summary action plan sets out six priority areas to make progress on improving quality in the first year. 

The right to decide: towards a greater understanding of mental capacity and deprivation of liberty. This focus report from the Local Government & Social Care Ombudsman finds that vulnerable people are being forced into situations against their will because care providers are not going through the proper processes. It highlights concerns about the way some of the most vulnerable people in society are being treated when decisions are being made on behalf of people who lack mental capacity to choose how they are cared for. The report offers advice and guidance to social care professionals on how to get things right when working with people who may lack mental capacity. It also provides questions councillors can use for scrutinising their own authorities to ensure people in their area are treated properly.

Health profile for England. This report draws on population health data to give an overall picture of the health of England. It finds that life expectancy has now reached 79.5 years for men and 83.1 years for women but that much of this extra time is spent in poor health. A major theme of the report is health inequalities as the data shows that in the wealthiest areas, people enjoy nearly 20 more years in good health than those in the poorest areas.

News

Tribunal backs CQC in row over 'shaping the market'. A tribunal has backed the Care Quality Commission after a legal challenge accusing it of acting “outside of its powers” in refusing to register a new learning disability facility.

A new £65 million hospital providing more than 70 new beds for NHS patients is set to be built on the site of Birmingham's Queen Elizabeth Hospital. A new £65million hospital providing more than 70 new beds for NHS patients is set to be built on the site of Birmingham’s Queen Elizabeth Hospital. The development will also include 66 beds for private patients and will include a new radiotherapy unit and access to state-of-the-art operating theatres.

Bupa data breach affects 500,000 insurance customers. A Bupa employee inappropriately copied and removed information relating to 547,000 international health insurance plan customers, the company has said.

Father sues IVF clinic over 'baby conceived without consent'. A wealthy businessman is suing a Harley Street fertility clinic for £1 million after his ex-girlfriend “forged” his signature to be able to “secretly” conceive his baby daughter by IVF, a high court heard.  

Adult social care workforce continues to grow. New analysis from Skills for Care shows the adult social care workforce continues to grow, with 1.45m people now offering care and support in communities and services across England.

CQC Comment on Channel 4 Dispatches: Bupa Care Homes undercover.

CQC writes to care homes, hospices and independent hospitals to encourage them to review their fire safety checks

Updates and Alerts

Stuart Marchant and Amrit Sumal of Bevan Brittan LLP have written an article for the Association of Independent Healthcare Organisations on Consent and Capacity.

CQC Consultation – ‘Our next phase of regulation’. Accountability – a dramatic widening of the scope. This bulletin addresses Part 1.1 of the CQC Consultation - ‘Clarifying the definition of providers and improving the structure of registration’. Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Provider-level assessments – holding Groups to account. This bulletin addresses Part 1.3 of the CQC Consultation - ‘Provider-level assessment and rating’. Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Changes to the Fit and Proper Persons Requirement. This bulletin addresses Part 3 of the CQC Consultation - ‘Fit and Proper Persons Requirement’ Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Significant changes to the regulation of adult social care services. This bulletin addresses Part 2.2 of the CQC Consultation - ‘Adult Social Care Services’ Vincent Buscemi, Stuart Marchant, Jodie Sinclair and Carlton Sadler.

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

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Information sharing/data

Publications and Guidance

NHS trust failed to comply with data protection law in Google DeepMind trial. The Information Commissioner's Office has ruled that the Royal Free NHS Foundation did not comply with the Data Protection Act when it supplied details of 1.6m patients to Google DeepMind. The data was provided to test a system designed to diagnose acute kidney injury, but according to the ICO patients were not sufficiently warned that their information would be used for the test, and the investigation has led to the Royal Free being required to sign an undertaking establishing a correct legal basis under the Data Protection Act for future Deepmind trials.

Your data: better security, better choice, better care. This report outlines the Government's response to the Caldicott Review and the Care Quality Commission's review on data protection in the NHS. The response accepts the recommendations in both reviews and it makes commitments to the safeguarding of information with the creation of the National Data Guardian's position as a statutory position and the introduction of stronger sanctions to protect anonymised data. The response also outlines plans to strengthen cybersecurity with NHS Digital increasing the level of support provided to local organisations and a change in the NHS contract so that organisations are formally required to adopt data security standards.

Data Services for Commissioners - Commissioner Assignment Method Flow Chart 2016/17: Accompanying Guidance and Reference Tables. Through the Data services for commissioners (DSfC) programme, NHS England is developing and delivering future-state solutions to enable commissioners to legally access data necessary to fulfil their statutory duties.

News

Bupa data breach affects 500,000 insurance customers. A Bupa employee inappropriately copied and removed information relating to 547,000 international health insurance plan customers, the company has said.

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

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Mental Health

Publications/Guidance

The right to decide: towards a greater understanding of mental capacity and deprivation of liberty. This focus report from the Local Government & Social Care Ombudsman finds that vulnerable people are being forced into situations against their will because care providers are not going through the proper processes. It highlights concerns about the way some of the most vulnerable people in society are being treated when decisions are being made on behalf of people who lack mental capacity to choose how they are cared for. The report offers advice and guidance to social care professionals on how to get things right when working with people who may lack mental capacity. It also provides questions councillors can use for scrutinising their own authorities to ensure people in their area are treated properly.

Quality improvement in mental health. This report looks at how mental health organisations can implement quality improvement and outlines the benefits this can bring.

The state of care in mental health services 2014 to 2017. 68% of core services provided by NHS trusts were found to be good, with 6% rated as outstanding. Among independent services, 76% were rated as good or outstanding (72% good and 4% outstanding). Some services performed particularly well, especially community services for people with a learning disability or autism and community services for older people. In addition, services that needed to improve have made real progress when they have taken on board our findings and committed to tackle problems proactively and learn from others. However, there are a substantial minority of NHS trust and independent services that need to improve the quality of care they provide. Thirty-nine per cent of NHS trusts were rated as requires improvement as at 31 May 2017, as did 23% of independent services. And a very small number were rated as inadequate: one NHS trust and three independent services. The report identifies several areas of concern:
. Concerns about ‘locked rehabilitation wards’
. Great variation between wards in how frequently staff use restrictive practices and physical restraint to deescalate challenging behaviour
. The impact of staffing shortages
. Poor quality clinical information systems
. Commissioning of crisis care services

Court of Protection visitors and the release of their reports. An Office of the Public Guardian practice note explains who Court of Protection visitors are and their role in preparing reports. It also explains when reports can be released and who they can be released to.

Tobacco control playbook. This resource highlights the arguments and approaches that leaders in health systems across Europe have developed and used to counteract and succeed against the tobacco industry. It aims to share this knowledge to help countries learn from each other's experiences and provide an evidence base for policymakers and system leaders. In addition there is an article on Is smoking cessation beneficial for people with mental illness, and can they quit?

MH:2K Oldham: a youth-led approach to exploring mental health. From September 2016 to July 2017, Involve worked with Leaders Unlocked, to deliver a pilot project to engage young people in conversations about mental health in Oldham. It aimed to empower 14-25 year olds to identify the mental health issues that they viewed as most important; engage their peers in exploring these topics; and work with local decision-makers to make recommendations for change. The project report outlines the methodology of the pilot project and the final evaluation report presents the impacts of the project.

Psychological help for people affected by a traumatic event. NHS England has written to GPs and healthcare practitioners with practical advice to help patients who may be suffering ongoing mental health problems following the recent terror attacks in Manchester and London and the Grenfell tower block fire.

Facilities for child and adolescent mental health services (HBN 03-02). This guidance covers the design of child and adolescent mental health services (CAMHS) accommodation for children and young people aged up to 18 years. It provides full descriptions of rooms that are specific to CAMHS and are not contained in other health building notes (HBNs). The schedule of accommodation can be used to calculate local project-specific requirements, and the stakeholder needs and quality of life checklists can be used to assess scheme compliance.

Legislation

Learning Disabilities (Review of Services) Bill. This Private Member's Bill has been introduced into the Lords by Baroness Hollins and received its 1st Reading. The Bill requires the Secretary of State to undertake a public consultation reviewing the provision of comprehensive and integrated services for adults with learning disabilities.

News

Tribunal backs CQC in row over 'shaping the market'. A tribunal has backed the Care Quality Commission after a legal challenge accusing it of acting “outside of its powers” in refusing to register a new learning disability facility.

Nine lifestyle changes can reduce dementia risk, study says

'Too many' patients locked in for mental health care

Secondary school staff get mental health 'first aid' training. Announces £200,000 funding to enable teachers in secondary schools around the country to take part in a new training programme to help them identify and respond to early signs of mental health issues in children. They will receive practical advice on how to deal with issues such as depression and anxiety, suicide and psychosis, self-harm, and eating disorders. They will also be invited to become 'first aid champions', sharing their knowledge and experiences across schools and communities to raise awareness and break down stigma and discrimination. The programme will be delivered by the social enterprise organisation Mental Health First Aid (MHFA) England.

Learning disability charities face insolvency over HMRC back-pay demand. Learning disability charities have raised concerns that they face insolvency following HMRC's demand of six years of back pay for home helps due to changes to pay rates for 24-hour care following changes to government guidance on minimum wage in October 2016, which compels organisations to pay the minimum wage throughout a night shift. The charities claim that they must find an extra £400 million for the historical pay demands.  

Bevan Brittan Events

Court of Protection Seminars -  SAVE THE DATE

In October and November, Bevan Brittan's specialist Court of Protection team is hosting practical update sessions in Bristol, Birmingham, London and Leeds. These sessions will focus on practical issues that practitioners, commissioners and providers encounter in matters engaging the Court of Protection; covering relevant legislation, guidance and case law and their impact on managing incapable patients. They will offer guidance on the sort of problems that are faced by front-line practitioners and service planners. The sessions are aimed at all those working in organisations responsible for the care of vulnerable or incapable people both as care providers or commissioners. The sessions will run from 10:00 – 15.30. Registration for all sessions will open at 09:30 and lunch will be available.

  • 31 October – Bristol
  • 7 November – London
  • 8 November – Birmingham
  • 9 November – Leeds

If you would like to register your interest in one of the above seminars click on this link.

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:-

Bevan Brittan Updates

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

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Primary Care

Publications/Guidance

General Practice Resilience Programme operational guidance. The GPRP aims to deliver a menu of support that will help practices to become more sustainable and resilient, better placed to tackle the challenges they face now and into the future, and securing continuing high quality care for patients. This updated guidance describes how the GPRP will operate to deliver the commitment set out in the General Practice Forward View, including templates to support practices to self-refer or enquire about support. It provides a framework for NHS England local teams to work with key stakeholders, ensuring there is local flexibility and ownership in the implementation of the programme. The guidance sets out the criteria to ensure that support is managed consistently while also giving local teams the flexibility to meet local needs the guidance also describes the menu of support that should be secured and offered subject to locally assessed needs.

Patients Registered at a GP Practice, July 2017; Special topic - Practices which have opened or closed within the last year. Statistical information on the number of GP practices which have opened,  closed or merged within the last year. it shows that between July 2016 - June 2017, 8 GP practices opened and 202 GP practices closed or merged.

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

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Providers

Publications/Guidance

Good practice guide: Focus on improving patient flow. This NHS Improvement guide outlines areas for providers to focus on to improve the safety, efficiency and effectiveness of their urgent and emergency care programmes. Each section contains links to supporting resources that provide further detail. There is also a series of case studies that offer examples of how providers have implemented some of the principles in the guide.

The state of the NHS provider sector. This report details the results of an annual survey of NHS trust chairs and chief executives. It sets out how the provider sector is performing, the challenges trusts are facing, and the support they need as we face another five years of constrained funding and rapidly rising demand. This year's survey focuses on mental health and finds that despite government commitment to address long-standing inequalities in care for people with mental health needs, trust leaders report that the position of core mental health services is deteriorating.

Winter warning. This report from NHS Providers highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS. The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. A key factor was the sharp rise in delayed transfers of care, for patients who were ready to be discharged, often because of difficulties in lining up suitable social care. The Government’s response in the spring Budget was to use the £1bn of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts. The clear message in Winter Warning is that, in many places, this is not happening.

Bevan Brittan Updates and Alerts

CQC Consultation – ‘Our next phase of regulation’. Accountability – a dramatic widening of the scope. This bulletin addresses Part 1.1 of the CQC Consultation - ‘Clarifying the definition of providers and improving the structure of registration’. Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Provider-level assessments – holding Groups to account. This bulletin addresses Part 1.3 of the CQC Consultation - ‘Provider-level assessment and rating’. Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Changes to the Fit and Proper Persons Requirement. This bulletin addresses Part 3 of the CQC Consultation - ‘Fit and Proper Persons Requirement’ Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Significant changes to the regulation of adult social care services. This bulletin addresses Part 2.2 of the CQC Consultation - ‘Adult Social Care Services’ Vincent Buscemi, Stuart Marchant, Jodie Sinclair and Carlton Sadler.

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

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Public Health

Publications/Guidance

Meeting the public health needs of the armed forces. LGA guidance to help local authorities, local Defence Medical Services and those supporting the health needs of the armed forces community in England to support and strengthen local relationships to meet the public health needs of armed forces populations.

Spatial planning for health: evidence review. This review provides public health planners and local communities with evidence informed principles for designing healthy places.

Health and environmental impact assessment: a briefing for public health teams in England This briefing aims to help local public health teams identify when and how to contribute to environmental impact assessments. It identifies three areas where directors of public health and public health teams can act on building up knowledge and shaping future practice.

Drug strategy 2017. Sets out how the Government and its partners, at local, national and international levels, will take new action to tackle drug misuse and the harms it causes. It builds on the existing approach to preventing drug misuse, supporting people to recover from dependence and restricting the supply of drugs, with new action to: promote a smarter, partnership-based approach; enhance the balanced approach across the three existing strands (reducing demand, restricting supply and building recovery) with a fourth strand on global action; provide stronger governance for delivering the strategy, including a Home Secretary-chaired board and the introduction of a National Recovery Champion; and expand the data collected on levels of drug misuse and recovery from dependence, and develop a set of jointly-owned outcome measures to drive action across a broader range of local services.

Health and environmental impact assessment: A briefing for Public Health teams in England. Helps local public health teams identify when and how to contribute to environmental impact assessments.

Public Health Outcomes Framework: Health Equity report, focus on ethnicity. Presents analysis and commentary on inequalities for 18 indicators from the Public Health Outcomes Framework (PHOF). Public Health England is using the PHOF indicators to monitor progress to reduce health inequalities in England.

Towards a smoke-free generation: tobacco control plan for England. Outlines plans to reduce smoking in England, with the aim of creating a smoke-free generation. The objectives of the tobacco control plan are, by the end of 2022, to reduce: the number of 15 year olds who regularly smoke from 8% to 3% or less; smoking among adults in England from 15.5% to 12% or less; the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population; and the prevalence of smoking in pregnancy from 10.5% to 6% or less.

Chickens coming home to roost: local government public health budgets for 2017/18. Analysis by the King's Fund of DCLG's new data on local authorities’ planned budgets for public health in 2017/18. While the data shows that shows that councils in England are planning to spend £3.4bn on public health services in 2017/18, once inflation and changes to how budgets are calculated are factored in, on a like-for-like basis, planned public health spending is >5 per cent less in 2017/18 than it was in 2013/14. It includes graphs of: Local authority public health spending and plans 2013/14 to 2017/18, Planned local authority public health budgets 2017/18 and Percentage change in local authority planned public health budgets: 2017/18 compared to 2016/17.

Child sexual exploitation: prevention and intervention. Evidence summary and framework to support local public health leaders to prevent and intervene early in cases of child sexual exploitation.

Health profile for England. This report draws on population health data to give an overall picture of the health of England. It finds that life expectancy has now reached 79.5 years for men and 83.1 years for women but that much of this extra time is spent in poor health. A major theme of the report is health inequalities as the data shows that in the wealthiest areas, people enjoy nearly 20 more years in good health than those in the poorest areas.

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

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Regulation

Publications/Guidance

The state of adult social care services 2014 to 2017. Presents the findings from the CQC's comprehensive programme of adult social care inspections. The report looks at what the CQC has found about the quality of care across the full range of adult social care services that it regulates. These include residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services. The report finds that while the majority of adult social care services are of a high quality and many are improving, too many people across England are receiving care in care homes and in their own home that is not good enough. Without a proper recognition of the importance of adult social care and a renewed commitment to quality, the numbers of people affected by poor care could increase and have a profound impact on their lives.

Taking Revalidation Forward action plan. Sets out how the GMC and others will implement the recommendations of Sir Keith Pearson’s report, Taking Revalidation Forward. It details work the GMC and others will do to improve medical revalidation, making it a more positive and meaningful experience for doctors, responsible officers, patients and everyone involved.

News

Director referred to CQC after trust investigation. An NHS director who agreed an “irregular” payoff deal with a Morecambe Bay midwife has been referred to the Care Quality Commission by his trust following an investigation. Roger Wilson, former director of human resources and organisational development at Warrington and Halton Hospitals Foundation Trust, has been referred to the regulator under the fit and proper person regulations.

Tribunal backs CQC in row over 'shaping the market'. A tribunal has backed the Care Quality Commission after a legal challenge accusing it of acting “outside of its powers” in refusing to register a new learning disability facility.

Bevan Brittan Updates and Alerts

CQC Consultation – ‘Our next phase of regulation’. Accountability – a dramatic widening of the scope. This bulletin addresses Part 1.1 of the CQC Consultation - ‘Clarifying the definition of providers and improving the structure of registration’. Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Provider-level assessments – holding Groups to account. This bulletin addresses Part 1.3 of the CQC Consultation - ‘Provider-level assessment and rating’. Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Changes to the Fit and Proper Persons Requirement. This bulletin addresses Part 3 of the CQC Consultation - ‘Fit and Proper Persons Requirement’ Vincent Buscemi, Jodie Sinclair and Carlton Sadler.

CQC Consultation – ‘Our next phase of regulation’. Significant changes to the regulation of adult social care services. This bulletin addresses Part 2.2 of the CQC Consultation - ‘Adult Social Care Services’ Vincent Buscemi, Stuart Marchant, Jodie Sinclair and Carlton Sadler.

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

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Social Care

Publications/Guidance

The state of adult social care services 2014 to 2017. Presents the findings from the CQC's comprehensive programme of adult social care inspections. The report looks at what the CQC has found about the quality of care across the full range of adult social care services that it regulates. These include residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services. The report finds that while the majority of adult social care services are of a high quality and many are improving, too many people across England are receiving care in care homes and in their own home that is not good enough. Without a proper recognition of the importance of adult social care and a renewed commitment to quality, the numbers of people affected by poor care could increase and have a profound impact on their lives.

Strengths-based social work practice with adults. Roundtable report based on a workshop commissioned by the DH and held at the Social Care Institute for Excellence in January 2017. It looks at what ‘strengths-based social work’ with adults, individuals, families and communities means for practitioners and people using the services.

CQC annual report and accounts 2016/17. This annual report and accounts sets out what the CQC have achieved in 2016/17 and the further work they have planned to deliver the ambitions of our five-year strategy for a more targeted, responsive and collaborative approach to regulation.

State of Caring 2017. Carers are reaching ‘breaking point’ as they struggle to take even a day away from care responsibilities for years at a time, research by Carers UK has found. 4 in 10 (40%) of unpaid carers have not had a break in over one year, whilst one in four (25%) had not received a single day away from caring in five years.

The Adult Social Care Outcomes Framework 2016/17: handbook of definitions. The Adult Social Care Outcomes Framework (ASCOF) measures how well care and support services achieve the outcomes that matter most to people. This handbook of definitions sets out the technical detail of each measure, with examples to minimise confusion and inconsistency in reporting and interpretation.

Adult social care: quality matters. The Quality Matters initiative is co-led by partners from across the adult social care sector. This report sets out a single view of quality and a commitment to improvement. The summary action plan sets out six priority areas to make progress on improving quality in the first year. 

News

Adult social care workforce continues to grow. New analysis from Skills for Care shows the adult social care workforce continues to grow, with 1.45m people now offering care and support in communities and services across England.

CQC Comment on Channel 4 Dispatches: Bupa Care Homes undercover.

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

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General

Publications/Guidance

Asylum age assessments: key advice for social workers Social workers continue to be the professionals charged with carrying out formal age assessments of asylum seekers. 

Comparator report on patient access to cancer medicines in Europe revisited – a UK perspective This report shows that the UK is trailing behind the rest of Europe in the treatment of cancer. It finds that British patients have worse survival rates after five years – the international benchmark for measuring the quality of cancer care – compared to the European average in nine out of ten cancers – only exceeding the EU average in melanoma.

Draft guidance on implementing the overseas visitors hospital charging regulations. Guidance for providers of NHS secondary care on forthcoming amendments to the Charging Regulations 2015 by the draft National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 that are due to come into force on 21 August 2017 and 23 October 2017.

News 

NHS rationing plan challenged by drug companies. The Association of the British Pharmaceutical Industry is seeking judicial review of the changes that allow NHS England to delay or restrict treatments if the total cost to the health service exceeds £20 million a year. It argues that the "wrong and unnecessary" rationing of the best medicines that help more people contravenes the fundamental right to access to cost-effective medicines.

A new £65 million hospital providing more than 70 new beds for NHS patients is set to be built on the site of Birmingham's Queen Elizabeth Hospital. A new £65million hospital providing more than 70 new beds for NHS patients is set to be built on the site of Birmingham’s Queen Elizabeth Hospital. The development will also include 66 beds for private patients and will include a new radiotherapy unit and access to state-of-the-art operating theatres.

NHS found to be still using software vulnerable to hackers. Figures released by the Government have revealed that one in 20 NHS computers runs outdated software that was targeted by global hackers, while ministers admitted that they did not know how much was spent on digital security. An official inquiry is under way into the ransomware cyber attack that affected 47 hospitals in May 2017.

Government to consider introduction of new organ donation scheme to make everyone a donor. The Government has indicated that England could follow Scotland and Wales in introducing an organ donation system that would regard people as giving their consent unless they had opted out. Proposed legislation to create a new "soft opt-out" system in Scotland, where 500 people are on the waiting list for a donor organ, was announced on 28 June.

Government awards over £120 million for global health research. The DH has announced that 33 research units and groups will receive over £120m funding for global health research. It comes after an open research competition led by the National Institute for Health Research (NIHR). Following the success of this initial competition, a call for a second round of applications has also been launched today, funded by £40m from the DH Official Developmental Assistance (ODA) budget.

£86 million funding announced for new medicine and technology. The Government has announced new funding of up to £86m for UK firms to develop medical breakthroughs. The package will allow small and medium sized enterprises (SMEs) to develop and test new technologies in the NHS.

Terminally ill man in right-to-die fight.

Prison reform groups fear smoking ban will cause violent inmates.

First NHS inpatient unit fails fire safety tests.

Father sues IVF clinic over 'baby conceived without consent'. A wealthy businessman is suing a Harley Street fertility clinic for £1 million after his ex-girlfriend “forged” his signature to be able to “secretly” conceive his baby daughter by IVF, a high court heard. 
 

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

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