Health and Social Care Update - November 2017

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

07/11/2017

Claire Bentley

Claire Bentley

Associate

Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.

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Training Events

Mental Health

Acute and emergency care

Primary Care

Children

Procurement

Clinical Risk/Patient Safety

Providers

Commissioning

Public Health

Employment/HR

Regulation

Finance

Social care

Independent Healthcare

General 

Information sharing/data

 

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Bevan Brittan Free Training Events

Court of Protection Seminars

In November, Bevan Brittan's specialist Court of Protection team is hosting practical update sessions in Birmingham 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 – 13.00. Registration for all sessions will open at 09:30 and lunch will be available.

  • 8 November – Birmingham
  • 9 November – Leeds

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

Employment law seminars : the highlights of 2017 & key changes on the horizon.

Bristol - 5 December
Leeds - 6 December
Birmingham - 7 December
London - 14 December

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:-

  •  21.11.17. Understanding fatal accident claims: practical guidance and an update on where are we now and where the law may be heading. These are common and often, relatively high value claims in  NHSR’s portfolio.

  •  05.12.17. 2017 In review – After Montgomery and a general procedural update. To stay up to date on the very live issue of consent cases, and wider civil practice issues. A review of how Montgomery is being put into practice.

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

What do the numbers say about emergency readmissions to hospital? This briefing analyses emergency readmissions data from hospital trusts across England from the past five years. It aims to help hospital trusts' boards, managers and clinicians identify risk and learn from occasions when things have gone wrong.

What happens when people leave hospital and other care settings? This briefing shares what over 2,000 people told local Healthwatch about their experiences of being discharged. Whilst many initiatives have been introduced since Healthwatch first reported on this issue in 2015, it finds that there is still significant room for improvement.

Help for NHS to recover costs of care from visitors and migrants: Example letter – advice to doctors and dentists. Updated template letter to doctors and dentists about patient's eligibility for free NHS secondary care treatment under National Health Service (Charges to Overseas Visitors) Regulations 2015.

Consultations

Modernising radiotherapy services in England - Consultation on proposed service specification. NHS England is seeking feedback on a new specification for adult radiotherapy services, which sets out how modernised services should be organised across England so that patients can access sustainable, high-quality and safe treatment. It also describes the benefits of doing things differently, and why the changes are needed. The closing date for comments is 18 December 2017.

News

Welsh Government invests £8.2m in new ambulance vehicles. Announces £8.2 funding that will enable the Welsh Ambulance Service to purchase: 18 emergency ambulances; 67 non emergency patient transport service vehicles; and five specialist Hazardous Area Response Team (HART) vehicles, to replace the existing fleet.

Many people experience good urgent and emergency care but some report waits and want better information when they are discharged

How operating theatres are wasting two hours a day. The BBC reports that a new NHS Improvement study shows that NHS hospitals could carry out 280,000 more non-emergency operations a year by organising operating theatre schedules better. 

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

Criminal Injuries Compensation Authority issues new guidance on child sexual abuse compensation. The Criminal Injuries Compensation Authority has altered its guidelines on the impact of grooming to ensure victims of child sexual abuse are not denied compensation on the mistaken grounds that they consented to a relationship, following criticism by a coalition of charities, which warned that sexually abused children as young as 12 were being denied payments even if their attackers had been convicted and imprisoned.

Review of children and young people's mental health services: phase one report This report confirms many of the issues raised in the Five year forward view for mental health and comments on the difficulties children and young people face in accessing appropriate support for their mental health concerns from a system that is fragmented and where services vary in quality.

Children's mental health care in England. This report sets out the views, perspectives and experiences of children with mental health needs and gives anonymous first-hand accounts of children in England aged 17 and under who have experienced mental health illnesses. It highlights the discrepancy and inequalities between children's and adults' mental health services and makes recommendation to transform provision and improve access to services. An accompanying evidence review uses qualitative research to explore the limited awareness of mental health issues in young people, focusing on their perception of mental health.

Children and young people's mental health - the role of education: Government Response to the First Joint Report of the Education and Health Committees of Session 2016-17 - First Joint Special Report of Session 2017-19. Sets out the Government's response to the first joint Education and Health Committees report of the 2017-19 Session which made recommendations with respect to the role of education in the mental health of children and young persons. An Ofsted response to a relevant recommendation of the report is also appended.

Consultations

Consultation on the revised statutory guidance for local authorities on the care of unaccompanied asylum seeking and trafficked children Government response. A publication by the Department for Education (DfE) summarises responses to its March 2017 consultation on revised statutory guidance for local authorities on the care of unaccompanied asylum seeking and trafficked children. The DfE will review the guidance in 2020 but it will only be revised if it is considered no longer fit for purpose.

Working Together to Safeguard Children: changes to statutory guidance. This consultation seeks views on significant revisions to ‘Working Together to Safeguard Children’ – the statutory guidance which sets out what is expected of organisations, individually and jointly, to safeguard and promote the welfare of children. These revisions are being made largely to reflect the legislative changes introduced through the Children and Social Work Act 2017.

Cases

Re P (Human Fertilisation and Embryology Act 2008) (No.2) [2017] EWHC 2532 (Fam). Issues of legal parentage arising from anomalies in forms consenting to assisted reproduction could not be resolved without obtaining a court order. A declaration of status granted by a court put the child's legal relationship with the parent beyond future dispute. Following the grant of declarations of parentage in cases where there were anomalies in consent forms signed by prospective parents, the court gave guidance as to the steps to be taken in such cases.

News

NHS doctors to ask all patients over 16 years old about their sexual orientation. NHS England has been criticised due to privacy concerns over its announcement that it is to require all NHS doctors and nurses in England to ask every patient from the age of 16 to declare their sexual orientation by April 2019 to fulfil its legal duties under the Equality Act 2006 to provide equality for homosexual people. 

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

Guidance note one: Giving evidence at court - NHSR

Guidance note two: Being a witness in a clinical negligence claim - NHSR

People like us? Understanding complaints about paramedics and social workers. This new research carried out by the University of Surrey sets out to improve understanding of the reasons for the disproportionately high number and nature of complaints to the HCPC about two professions - paramedics from across the UK, and social workers in England. Both these professions show a higher rate of referral than other professions regulated by HCPC. It also considers what preventative action could be taken to address the issues and themes brought out in the report.

NHS Injury Cost Recovery scheme. Guidance on the application of the NHS Injury Cost Recovery scheme for 2017 to 2018.

Managing babies born on the threshold of survival (Circular WHC/2017/043). This guidance sets out what Welsh Health Boards need to do to care for babies born alive before 24 weeks of gestation, whilst also supporting their families and ensuring they are fully involved in making decisions about their care and treatment.

News

PPO first as insurer agrees to cover future cost of mesothelioma treatment. Solicitors for a man suffering from mesothelioma have claimed a first by securing an agreement with the defendant insurers to cover the future costs of his cancer treatment, no matter the amount or length.

Government accepts Jackson’s call for CJC to seek industry agreement on low-value clin neg claims.

Mothers fight for the truth over stillbirths.

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:-

  • 21.11.17. Understanding fatal accident claims: practical guidance and an update on where are we now and where the law may be heading. These are common and often, relatively high value claims in  NHSR’s portfolio.

  • 05.12.17. 2017 In review – After Montgomery and a general procedural update. To stay up to date on the very live issue of consent cases, and wider civil practice issues. A review of how Montgomery is being put into practice.

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 

Sustainability and transformation partnerships: Developing robust governance arrangements. New ways of partnership working with health, local government, primary care, private and third sector bodies lead to the need for new principles-based governance arrangements that also need to be future-proof. The approach needs to be tailored to fit the size and complexity of the partnership in question. The HFMA’s Governance and Audit Committee has developed a diagnostic tool which on completion, can underpin board / governing body / audit committee discussions by highlighting where robust arrangements are already in place and also where more work is required. 

Working with other health and care partners – a suggested checklist for LPCs. This Pharmaceutical Services Negotiating Committee briefing, which is aimed at LPC Chief Officers and members, provides a suggested checklist for developing relationships with other health and care partners including Sustainability and Transformation Partnerships (STPs), aspirant Accountable Care Systems (ACSs) and Accountable Care Organisations (ACOs), CCG staff and members and GPs. The briefing is an updated version of one previously published in 2013 and it draws upon recent feedback and advice from LPC Chief Officers collated by PSNC.

Commissioning for quality and innovation: enhanced supportive care data tool. This updated version of the tool should be used to collect baseline data and return data relevant to each quarter's payment trigger within the enhanced supportive care (for advanced cancer patients) commissioning for quality and innovation national goal.

News

CCGs demand patients lose weight or face indefinite wait for surgery. People in Hertfordshire who smoke or are obese face indefinite waits for routine surgery unless they quit smoking or lose weight, commissioners have decided as they try to save £68m this financial year.

2017-19 NHS Standard Contract consultation. NHS England is seeking views on proposals for in-year National Variations to the NHS Standard Contract 2017/18 and 2018/19 (Full Length) and to the NHS Standard Contract 2017/18 and 2018/19 (Shorter Form). It has also published the associated Technical Guidance in draft form. The National Variation is required because of recently announced changes to ambulance response standards. The closing date for comments is 10 November 2017. 

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

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Employment/HR

Publications/guidance

Falling number of nurses in the NHS paints a worrying picture. This King's Fund blog by Richard Murray considers the implications for the NHS of the latest NHS workforce statistics.

Rising pressure: the NHS workforce challenge. A report from the Health Foundation analyses trends in the NHS workforce. It focuses on two pressure points: the impact of the removal of the NHS bursary on student nurse numbers, and staff retention.

Expansion of the International GP Recruitment Programme. NHS England is expanding the International GP Recruitment Programme, which is part of the General Practice Forward View (GPFV) commitment to strengthen the primary care workforce. It is scaling up targeted international recruitment to a total of 2,000 overseas doctors over the next three years.

A guide for overseas doctors: Living and working the UK for GPs and their families. This web-based resource, developed by the RCGP in partnership with the NHS, GMC and the BMA, offers constructive advice and practical support to doctors, bringing together relevant information and showcasing the UK as a great place to work as a GP.

News

Jeremy Hunt announces salary supplement for trainee GPs. The Health Secretary has announced a package of measures to strengthen general practice. This includes a new government-backed scheme – the Targeted Enhanced Recruitment Scheme – which will offer a one-off payment of £20,000 to attract trainees to work in areas of the country where training places have been unfilled for a number of years.

Bevan Brittan Events

Employment law update: the highlights of 2017 & key changes on the horizon.
Bristol - 5 December
Leeds - 6 December
Birmingham - 7 December
London - 14 December

Bevan Brittan Updates

Bevan Brittan's employment law report for October 2017

1. New data protection regime: five key points for HR
2. Too much information?
3. 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

Lifting the cap: the fiscal and economic impact of lifting the NHS pay cap This briefing examines the fiscal and economic impact of two alternative scenarios for NHS pay over the next two years: increasing pay in line with Consumer Price Index inflation, and a ‘catch-up’ rate of increasing NHS pay in line with private sector earnings plus one per cent.

Fraud costs NHS England £1.25bn. Fraud, bribery and corruption is costing the NHS in England £1.25 billion a year, according to the NHS Counter Fraud Authority, which was formally launched on 1 November 2017. The Authority has promised to look at new ways of fighting fake prescription claims and other fraudulent practices.

Personal asset protection guarantee This white paper deals with the question of how the cost of long-term care should be divided between the state and those individuals with care needs who have the resources to pay for themselves. Under the personal asset protection guarantee, individuals are guaranteed to keep about three-quarters of their personal assets in the event of their needing residential care in their old age.

WannaCry cyber attack and the NHS. This NAO report investigates the NHS’s response to the cyber attack that affected it in May 2017 and the impact on health services.

Reducing agency spend through a collaborative mobile app. This case study describes how Royal Surrey County Hospital NHS Foundation Trust has maximised the take up of bank shifts through development of a mobile app allowing clinicians to self-select shifts.

NHS private patient income predicted to grow every year to 2020. Income from private patient work carried out by NHS run units will grow by more than 5 per cent in each of the next three calendar years, researchers have predicted.

Help for NHS to recover costs of care from visitors and migrants: Example letter – advice to doctors and dentists. Updated template letter to doctors and dentists about patient's eligibility for free NHS secondary care treatment under National Health Service (Charges to Overseas Visitors) Regulations 2015.

Towards an effective NHS payment system: Eight principles. The Health Foundation and NHS Providers have investigated how current payment systems impact on those providing care to patients by considering what works well, what problems they encounter. This report identifies eight guiding principles that a payment system should meet if it is to support providers in delivering high quality care. These principles reflect the views of those responsible for providing care to patients, and are presented with the aim of informing future evolutions of the payment system that support the provision of high quality services.

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

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Independent Healthcare

Publications/Guidance

NHS private patient income predicted to grow every year to 2020. Income from private patient work carried out by NHS run units will grow by more than 5 per cent in each of the next three calendar years, researchers have predicted. 

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

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Information Sharing/data

Publications/Guidance

The non-executive director's guide to NHS data: Part one. This briefing is the first in a new series of guides that aims to highlight how data can be used to drive improvement, provide effective oversight and support the transformation of care. This briefing is aimed at non-executive directors in the acute care sector and examines activity in both primary and secondary care settings and considers the role of data sharing in bringing about efficiency savings.

2017/18 data security and protection requirements This document sets out what all health and care organisations will be expected to do to demonstrate that they are putting into practice the ten data security standards recommended by the National Data Guardian.

WannaCry cyber attack and the NHS. This NAO report investigates the NHS’s response to the cyber attack that affected it in May 2017 and the impact on health services. 

Bevan Brittan Updates

Careful what you say* : information sharing and competition law (*) and, if in doubt, say nothing and leave. 

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

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Mental Health

Publications/Guidance

Code of practice: Mental Health Act 1983. Shows professionals how to carry out their responsibilities under the Mental Health Act 1983, and provide high quality and safe care.

Government Interim response to the Law Commission report on Mental Capacity and Deprivation of Liberty: Written statement - HCWS202 In a written statement the Department of Health states that the Government has made its interim response to the Law Commission's report on Mental Capacity and Deprivation of Liberty. The Government is considering the report and will engage with stakeholders to understand how the changes proposed can be implemented. It will provide its final response to the House of Commons in Spring 2018.

Improving healthcare access for people with learning disabilities This suite of guidance outlines how social care staff can help people with learning disabilities get better access to medical services. It provides practical tips as well as links to further information and useful resources.

Review of children and young people's mental health services: phase one report This report confirms many of the issues raised in the Five year forward view for mental health and comments on the difficulties children and young people face in accessing appropriate support for their mental health concerns from a system that is fragmented and where services vary in quality.

Guidance for the implementation of changes to police powers and places of safety provisions in the Mental Health Act 1983. A Department of Health and Home Office document provides guidance to police forces, mental health services, clinical commissioning groups and ambulance services on the practical application of changes to provisions in the Mental Health Act 1983, made by the Policing and Crime Act 2017, on police powers and places of safety.

Thriving at work: the Stephenson/Farmer review of mental health and employers. This report outlines the result of an independent review of mental health and employers. It sets out what employers can do to better support all employees, including those with mental health problems to remain in and thrive at work. It includes a detailed analysis that explores the cost of poor mental health to UK businesses and the economy as a whole.

Deprivation of Liberty Safeguards. This House of Commons Library briefing explains what Deprivation of Liberty Safeguards (DoLS) are, their purpose and the process which is followed in order to authorise a deprivation of liberty. The paper outlines the Law Commission's recommendations for an overhaul of the DoLS process.

Beyond Places of Safety – Grant application guidance. Information on a new £15m grant scheme to improve support services for those needing urgent and emergency mental healthcare. This includes conditions such as psychosis, bipolar disorder, and personality disorders that could cause people to be a risk to themselves or others. The scheme is now open to receive bids from Crisis Care Concordat leads. The closing date for final bids is 21 January 2018.

Of primary importance: Commissioning mental health services in primary care. This report from NHS Clinical Commissioners highlights projects where CCGs and their partners are delivering better care for patients, working across the boundaries between physical and mental health, as well as health and social care, while at the same time reducing pressure on GPs and hospitals.

Children's mental health care in England. This report sets out the views, perspectives and experiences of children with mental health needs and gives anonymous first-hand accounts of children in England aged 17 and under who have experienced mental health illnesses. It highlights the discrepancy and inequalities between children's and adults' mental health services and makes recommendation to transform provision and improve access to services. An accompanying evidence review uses qualitative research to explore the limited awareness of mental health issues in young people, focusing on their perception of mental health.

Children and young people's mental health - the role of education: Government Response to the First Joint Report of the Education and Health Committees of Session 2016-17 - First Joint Special Report of Session 2017-19. Sets out the Government's response to the first joint Education and Health Committees report of the 2017-19 Session which made recommendations with respect to the role of education in the mental health of children and young persons. An Ofsted response to a relevant recommendation of the report is also appended.

Dementia-friendly dentistry. These Good Practice Guidelines enable dental professionals to understand dementia and its implications for dental practice, and adapt their patient management and clinical decisions accordingly.

Legislation

The Court of Protection Rules 2017. These Rules revoke the Court of Protection Rules 2007, as amended, and replace them with a consolidated set of rules governing practice and procedure in the Court of Protection, which has the jurisdiction to make decisions regarding individuals who lack capacity to make such decisions themselves. The new rules are arranged in Parts with separately numbered rules within each Part, following the model of the Civil Procedure Rules, Family Procedure Rules and Criminal Procedure Rules. They also adopt a different order from the 2007 Rules, which was piloted over 2016-17 by a practice direction under the 2007 Rules (the Practice Direction - Case Management Pilot), and introduce some new rules which were also piloted in that practice direction.

Consultations

Learning disabilities and behaviour that challenges: service design and delivery. NICE is seeking views on draft guidance about how services should work for people with a learning disability and behaviour that challenges - i.e. it is harmful to the person or others around them, which can include hitting or kicking, and if it stops them from being able achieve things in their daily life, such as making friends. The draft guidance advises that local authorities and NHS bodies should provide specialist community care for people with learning disabilities who behave in a way that challenges to avoid admissions to psychiatric wards or residential homes. The closing date for comments is 20 November 2017.

Cases

In the matter of D [2017] EWCA Civ 1695. The Court of Appeal has allowed the appeal by Birmingham City Council  against the judgment of Keehan J in which he held that parents could not consent to the confinement of their 16 or 17 year old children. See Hannah Taylor's article below

PL v Sutton Clinical Commissioning Group & Anor [2017] EWCOP 22​. The Patient's son (with the support of the rest of the family) was seeking a declaration that it was not in his mother’s best interests that CANH should be continued, with the inevitable and foreseeable consequence that she would shortly thereafter die. The court concluded that it was not in her best interests; it followed that the discontinuance of the CANH treatment was therefore lawful.

Salford Royal NHS Foundation Trust v Mrs P & Anor (Rev 1) [2017] EWCOP 23 ​The Salford Royal NHS Foundation Trust was seeking a declaration that it was in the Patient’s (who is in a Minimally Conscious State (MCS)) best interests to receive clinical treatment including clinically assisted artificial nutrition and hydration (CANH). The application was refused.

The Hospital Trust v V & Ors [2017] EWCOP 20. The issue in this case was whether it was in the best interests of the vulnerable and sexually unaware Patient to administer contraception. The court held that it was.

Tinsley v Manchester City Council [2017] EWCA Civ 1704 A person who had been released from compulsorily detention under the Mental Health Act 1983 s.3 but still required "after-care services" was entitled to require his local authority to provide such services under s.117 at any time before he had exhausted sums reflecting the costs of care awarded to him in a judgment against a negligent tortfeasor.

News

Number of Deprivation of Liberty Safeguards applications up 11 per cent. The number of Deprivation of Liberty Safeguards2(DoLS) applications submitted in 2016/17 increased to 217,000, compared with 196,000 the previous year

New £15 million programme to help train one million in mental health first aid. Announces a new £15m programme that will see up to 1m people trained in basic mental health first aid skills. The programme will improve personal resilience and help people recognise and respond effectively to signs of mental illness in others. The campaign, designed and delivered by Public Health England (PHE), will help people assess their own mental wellbeing and learn techniques to reduce stress.

Bevan Brittan Updates

Children - which decision counts? - This article has been updated to take account of the Court of Appeal's decision In the matter of D (A Child) [2017] EWCA Civ 1695 (Court of Appeal) (31 October 2017).

Case Summary: SCC v MSA [2017] EWCOP 18. Court of Protection case summary

Charlie Gard: The paramount importance of a child's best interests

Introduction to CTO Recall: Part 1 Community Treatment Orders (CTOs) remain one of the more controversial elements of the Mental Health Act 1983 (as Amended by the 2007 Act, "MHA"). 

Bevan Brittan Events

Court of Protection Seminars

In October and November, Bevan Brittan's specialist Court of Protection team is hosting practical update sessions in Birmingham 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 – 13.00. Registration for all sessions will open at 09:30 and lunch will be available.

  • 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:-

  •  21.11.17. Understanding fatal accident claims: practical guidance and an update on where are we now and where the law may be heading. These are common and often, relatively high value claims in  NHSR’s portfolio.

  •  05.12.17. 2017 In review – After Montgomery and a general procedural update. To stay up to date on the very live issue of consent cases, and wider civil practice issues. A review of how Montgomery is being put into practice.

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:-
.Changes to s135/136.
.Nomination of deputies for s5

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

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Primary Care

Publications/Guidance

Improving access for all: reducing inequalities in access to general practice services. NHS England has produced a practical resource that aims to promote understanding of groups in the community who are experiencing barriers in accessing services and help to address those barriers as improvements in access to general practice services are implemented.

Expansion of the International GP Recruitment Programme. NHS England is expanding the International GP Recruitment Programme, which is part of the General Practice Forward View (GPFV) commitment to strengthen the primary care workforce. It is scaling up targeted international recruitment to a total of 2,000 overseas doctors over the next three years.

A guide for overseas doctors: Living and working the UK for GPs and their families. This web-based resource, developed by the RCGP in partnership with the NHS, GMC and the BMA, offers constructive advice and practical support to doctors, bringing together relevant information and showcasing the UK as a great place to work as a GP.

Indemnity in general practice: Developing a more affordable and stable future. The Secretary of State for Health has announced that the DH is planning the development of a state-backed indemnity scheme for general practice in England, subject to further work on relevant issues. This paper outlines the current assumptions on key areas. It marks the start of detailed work with GP representatives and others.

2017/18 General Medical Services (GMS) contract: Guidance for GMS contract 2017/18. Detailed guidance on changes to the GMS contract in England for 2017/18. There is also a summary of the agreement.
See also: 
. General Medical Services Statement of Financial Entitlements (Amendment) Directions 2017 
. General Medical Services Statement of Financial Entitlements (Payment in Respect of Indemnity Fees) Directions 2017 
. Primary Medical Services (Directed Enhanced Services) Directions 2017.

Supporting routine frailty identification and frailty through the GP Contract 2017/2018. Updated guidance for general practices to support implementation of the new frailty requirements in the 20127/18 GP contract. It provides an explanation as to why routine frailty identification is included, what a general practice is required to do, with signposting to further support.

Legislation

National Health Service (General Dental Services Contracts and Personal Dental Services Agreements) (Wales) (Amendment) Regulations 2017 (SI 2017/1040 (W.269)). These regulations, which come into force in Wales on 1 December 2017, amend SI 2006/490 (W.59) and SI 2006/489 (W.58) that set out a framework for Wales for general dental services contracts and personal dental services agreements. The amendments allow for electronic submission of information to the Local Health Board.

News

Clinical Pharmacists helping to transform the NHS workforce. HEE reports that GP practices are now invited to apply for funding in the second phase of the successful Clinical Pharmacist in General Practice Scheme that helps recruit, train and develop clinical pharmacists. HEE is managing the implementation of the education and training programme which will be delivered by the Centre for Pharmacy Postgraduate Education. The NHS England led scheme sees clinical pharmacists working as clinicians within general practice teams to help patients manage long-term conditions and multiple medications.

Jeremy Hunt announces salary supplement for trainee GPs. The Health Secretary has announced a package of measures to strengthen general practice. This includes a new government-backed scheme – the Targeted Enhanced Recruitment Scheme – which will offer a one-off payment of £20,000 to attract trainees to work in areas of the country where training places have been unfilled for a number of years.

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

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Procurement

Bevan Brittan Events

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

14 November - London 

15 November - Leeds

16 November - Bristol 

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

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Providers

Publications/Guidance

Towards an effective NHS payment system: Eight principles. The Health Foundation and NHS Providers have investigated how current payment systems impact on those providing care to patients by considering what works well, what problems they encounter. This report identifies eight guiding principles that a payment system should meet if it is to support providers in delivering high quality care. These principles reflect the views of those responsible for providing care to patients, and are presented with the aim of informing future evolutions of the payment system that support the provision of high quality services.

Public health: everyone's business? This report uses interviews with health leaders from a range of trusts and other parts of the service to help gain a better understanding of NHS providers’ role in shaping and delivering public health and care.

Making the case for quality improvement: lessons for NHS boards and leaders. This King's Fund report outline 10 lessons for NHS leaders, to provide a starting point for leaders seeking to embed quality improvement in their work.

Guidance on implementing the Overseas Visitor Charging Regulations. Updated guidance for NHS bodies who need to charge overseas visitors for NHS hospital treatment, under the NHS (Charges to Overseas Visitors) Regulations 2015. The guidance incorporates changes that come into effect from 21 August and 23 October 2017 under SI 2017/756.

Partnerships for improvement: ingredients for success. The Health Foundation commissioned the Health Services Management Centre at the University of Birmingham to look at a range of current organisational partnerships, to find out about what makes for successful partnerships between providers at an organisational level. The report focuses on five different partnering arrangements, as well as interviews with national leaders, and draws learning to help inform and guide policymakers and providers. This briefing summarises the main findings of the research report and what providers and policymakers can learn.

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

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Public Health

Publications/Guidance

Public health: everyone’s business? This report from NHS Providers uses 12 interviews with NHS trust leaders, as well as academics, system leaders, local government representatives, and those with strategic responsibility for delivery and commissioning, to help gain a better understanding of NHS providers’ role in shaping and delivering public health and care.

Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings. Updated PHE guidance that reflects the changing epidemiology, evidence and feedback on implementation in practice.

Tobacco control policy overview. The Government’s new tobacco control plan was published in 2017. The plan seeks to reduce smoking overall and target inequalities in smoking rates – smoking accounts for almost half the difference in life expectancy between the richest and poorest in society. This Commons Library briefing paper provides a summary on the tobacco control plan, tobacco control policies and smoking cessation services.

Legislation

General Dental Council (Continuing Professional Development) (Dentists and Dental Care Professionals) Rules Order of Council 2017 (SI 2017/966). This Order, which comes into force on 1 January 2018, approves the General Dental Council (Continuing Professional Development) (Dentists and Dental Care Professionals) Rules 2017 that are set out in the Schedule. The rules relate to the CPD of registered dentists and dental care professionals (excluding visiting dentists and visiting dental care professionals from relevant European States).

Public Health (Wales) Act 2017 (Commencement) (Amendment) Order 2017 (SI 2017/967 (W.249) (C.90)). This Order amends Art.3 of the original Commencement Order (SI 2017/949) that brought into force on 1 January 2018 provisions of the 2017 Act relating to the intimate piercing of children (Part 5 and s.4 for the purposes of Part 5). These provisions will now be brought into force at a later date by a separate commencement order. 

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

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Regulation

Publications/guidance

State of Care. State of Care is the annual assessment of health and social care in England by the CQC. The report looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care.

People like us? Understanding complaints about paramedics and social workers. This new research carried out by the University of Surrey sets out to improve understanding of the reasons for the disproportionately high number and nature of complaints to the Health & Care Professions Council (HCPC) about two professions - paramedics from across the UK, and social workers in England. Both these professions show a higher rate of referral than other professions regulated by HCPC. It also considers what preventative action could be taken to address the issues and themes brought out in the report.

Analysis report on the consultation on revalidation for pharmacy professionals: What we did. The General Pharmaceutical Council has published a report which highlights that there was overall support for the proposals for revalidation for pharmacy professionals among respondents to a consultation that it held earlier this year. The majority of respondents agreed that the new requirements were clear and easy to understand, and would help to provide greater assurance that pharmacy professionals were continuing to meet the standards for pharmacy professionals and were keeping their skills and knowledge up to date.

NHS England’s National Report to Ministers on the Responsible Officer Regulations and Medical Revalidation. At the end of the fourth year of implementation of medical revalidation, the National Report 2016/17 (formerly the Senior Responsible Owner’s Report), provides evidence of a steadily improving picture of engagement.

Putting the public at the heart of our work. The Care Quality Commission has published a new strategy for how they will engage with the public to help make them an even stronger regulator that is always on the side of people using care services.

Care Quality Commission – Regulating health and social care. This NAO report on the CQC finds that the Commission has improved as an organisation. Value for money is getting better and the Commission can secure further improvement, if it continues its current direction of travel. Its main challenge now is to develop its digital systems and capabilities to support its move to a more intelligence driven and risk based approach to regulation.

Consultations

Promoting professionalism, reforming regulation. This consultation takes forward the Government's commitment to legislate to reform and rationalise the current system of regulation of healthcare professions. It seeks views on the reforms needed to help maximise public protection while supporting workforce development. The proposals aim to design a flexible model of professional regulation that secures public trust, fosters professionalism and improves clinical practice, while also being adaptable to future developments in healthcare. The closing date for comments is 23 January 2018.

The regulation of medical associate professions in the UK. This consultation seeks views on the regulation of medical associate professions in the UK, including physician associates, physicians’ assistants, surgical care practitioners and advanced critical care practitioners. The closing date for comments is 22 December 2017.

Regulation of nursing associates in England. Seeks views on amendments to the Nursing and Midwifery Order 2001, to regulate nursing associates in England. It is intended that aspects and regulatory functions of the legislation will apply to the nursing associate profession in the same way as for nurses and midwives. In amending the legislation, the regulatory framework for nursing associates will be similar to that of nurses and midwives, except where it is necessary to accommodate specific differences in the nursing associate profession. The closing date for comments is 26 December 2017.

Updating our expectations of newly qualified doctors in the UK: reviewing the Outcomes for Graduates. The GMC has launched a consultation on the knowledge, skills and professional behaviours needed by newly-qualified doctors in order to help shape the future development of undergraduate medical education. It has issued a revised draft of its Outcomes for Graduates that set out what doctors must know and be able to do by the time they graduate from medical school, which has been updated to better reflect modern medical education and practice. The closing date for comments is 10 January 2018.

Cases

General Medical Council v Stone 2017] EWHC 2534 (Admin). The court ruled that the GMC Medical Practitioners Tribunal had erred by imposing the sanction of suspension on a GP who had engaged in an improper sexual and emotional relationship with a vulnerable patient for over two and a half years. Given the gravity, duration and extent of the GP's misconduct, erasure was the only appropriate sanction.

Oyesanya v General Medical Council (Unreported, Admin Ct). The court held that the GMC's Fitness to Practise Panel had incorrectly ruled that a consultant's fitness to practise was impaired by reason of the way he communicated with his colleague. It therefore remitted all the other allegations, namely of misprescribing drugs and failing to arrange a scan, relating to whether his fitness to practise was impaired, back to the panel.

Bevan Brittan Events

Health Technology and Transformation - The Regulatory Framework. As health and social care shifts the focus towards population health, quality of life and outcomes, technology is becoming a vital and more prominent requirement of change. However, whether provided to consumers or for use by health and social care professionals, technological solutions need to comply with regulatory standards so as to ensure patient safety and protect sensitive personal data.
London - 27 November

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 health care and adult social care in England 2016/17. CQC has published its annual assessment of health and social care in England that looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care. It states that this year’s report shows that the quality of care has been maintained despite some very real challenges. Most people are receiving good, safe care and many services that were previously rated inadequate have recognised the inspection findings, made the necessary changes and improved. The fact that quality has been maintained in the toughest climate most can remember is testament to the hard work and dedication of staff and leaders. However, it warns that as the system continues to struggle with increasingly complex demand, access and cost, future quality is precarious.

Whole-system transformation needs whole-system engagement. This King's Fund blog is the first of three drawing on experiences shared during a visit by leaders of the health system in Canterbury, New Zealand. Chris Ham focuses on how Canterbury’s leaders began transforming care and the results they delivered.
See also: "You need a whole system to work for the whole system to work" in which David Meates, Chief Executive of the Canterbury District Health Board, explains how organisations within the Canterbury health system have moved from playing the ‘blame game’ to working together to provide the best possible care for the local population; and Sustainable primary care provides a platform for system change: Vince Barry, Chief Executive of Pegasus Health, looks at how building sustainable primary care creates a platform for change.

Health and Wellbeing Fund 2017-18: Social prescribing, additional guidance. DH is inviting applications to set up a new social prescribing scheme or to support the expansion of an existing scheme. This document contains additional information for voluntary, community and social enterprise (VCSE) sector organisations on the fund.

Personal social services adult social care survey, England – 2016-17. Sets out findings from NHS Digital's Adult Social Care Survey 2016-17 that is conducted by councils with adult social services responsibilities. It shows that overall, 64.7% of service users were extremely or very satisfied with the care and support services they received. Also, 70.1% of people receiving social services care feel "as safe as they want", while 86.4% of service users reported that the care and support services they receive has helped them in feeling safe, up 1.0 percentage point from 2015-16.

Prevention in action: How prevention and integration are being understood and prioritised locally in England. This British Red Cross report finds that local authorities in England must do more in their areas to provide services that prevent, reduce or delay the need for care and support. The report also identifies shortcomings in plans for integrating health and social care.

Responding to risks or priorities in an area: Cornwall and London Borough of Sutton – Overview. CQC has published a report on how health and social care services in Cornwall and Sutton work together to respond to risk and provide joined-up care to the people in these two areas.

Health and social care integration. This Commons Library briefing paper analyses recent policy and debate on the integration of NHS-provided healthcare and local authority-provided social care in the UK. This has been a key policy priority for successive Governments, with the aim of improving patient care and saving money for the NHS and local authorities. It includes an October 2017 update with information on the proposed review of local authorities' Better Care Fund allocations, for those not meeting targets on delayed transfers of care.
See also the briefing papers on Adult Social Care Funding (England) that examines the key funding pressures facing adult social care services in England and evidence of the impacts of these pressures on social care and health services; and Social care: Conservative manifesto's commitments on the means-test including the £100,000 limit (England) that considers the Conservative Party’s commitments to reform the social care means-test, including the new £100,000 means-test limit and compares the proposals to the current position, exploring their possible implications.

The role of care homes in end of life care. The National End of Life Care Intelligence Network has published two briefings covering "Care home bed provision and potential end of life care need in people aged 75 or older in England" and "Place and cause of death for permanent and temporary residents of care homes".

Personalised health and care 2020: patient, carers and service user vision. Brief plain English summary of how the Government’s and national health and care organisations’ current portfolio of programmes will enable health and social care services to deliver for people in England through improved use of information technology. It describes what will be different as the national health and care organisations support local services to introduce the changes planned by the National Information Board.

What happens when people leave hospital and other care settings? This briefing shares what over 2,000 people told local Healthwatch about their experiences of being discharged. Whilst many initiatives have been introduced since Healthwatch first reported on this issue in 2015, it finds that there is still significant room for improvement.

Cases

R (Davey) v Oxfordshire CC [2017] EWCA Civ 1308 (CA). D, a severely disabled man, appealed against the refusal of his application for judicial review of the Council's decision pursuant to the Care Act 2014 to reduce his personal budget for care from £1,651pw to £950pw. The High Court held that the Council's approach of seeking to develop independence and reducing anxiety by providing for D to spend more time alone was not unlawful. There was no legal error which warranted interfering with the Council's decision. The Court of Appeal held, dismissing D's appeal, that the very significant reduction in D's personal budget had been reached at the end of a lawful process. 

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

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General

Publications/Guidance

National cancer waiting times monitoring data set. NHS England is planning changes to the cancer waiting times (CWT) system and dataset, which will come into effect from April 2018. The changes are part of a programme of work to implement the new 28 day faster diagnosis standard by 2020. The CWT system enables CCGs to monitor and manage pathways of care for cancer patients. An information standards notice, published under s.250 of the Health and Social Care Act 2012, sets out the forthcoming changes, and an updated guidance document for CWT standards will be published later this year.

Modern slavery victims to receive longer period of support. The Home Office has announced measures to improve the identification and support for victims of human trafficking and modern slavery, including reforms to the National Referral Mechanism, which will see the minimum period of "move-on" support for victims increased, the establishment of places of safety, as well as up to 6 months of "drop-in" services. The Government will also roll out nationally the provision of Independent Child Trafficking Advocates.

NHS Indicators: England, October 2017. This Commons Library briefing paper provides a summary of data on demand for and performance of NHS services in England, as well as information on the supply of beds and staff. In each case more information is available, either from NHS England, from more detailed Library briefings, or both. Links to further publications are provided.

How does the NHS in England work? An alternative guide. This King's Fund animation is a whistle-stop tour of how the NHS works in 2017 and how it is changing.
See also new NHS organograms that explain how providers are regulated and commissioned, and how the money flows.

Reconfiguration of NHS services (England). This House of Commons Library briefing looks at recent policy developments and trends regarding NHS service reconfiguration, the involvement of the public and local authorities in the reconfiguration process, and some of the major drivers of change.

Making the case for quality improvement: lessons for NHS boards and leaders. This King's Fund report states that at a time of significant financial and operational pressure, local and national NHS leaders need to focus on improving quality and delivering better-value care.

Maintaining reciprocal health care for patients after Brexit. This briefing considers a post-Brexit scenario in which reciprocal health care arrangements no longer exist and estimates the cost of this at £500 million a year. It warns that travel insurance could become unaffordable for British citizens with pre-existing health conditions and that additional pressure could be placed on an already stretched health service if British people abroad could no longer access reciprocal health care.

The impact of homelessness on health: a guide for local authorities This report warns that that the rising number of older homeless people will create significant extra pressures for councils, for example in providing housing and social care. The report aims to support local authorities in protecting and improving their population’s health and wellbeing, and reducing health inequalities, by tackling homelessness and its causes.

The state of hospice services in England: 2014 to 2017. This report presents findings from CQC's hospice inspection programme and finds that hospice care across England has the highest percentage of health and social care services that are rated outstanding (25 per cent), and a further 70 per cent are rated good. The inspections found that hospice leaders and frontline staff displayed a strong commitment to providing truly person-centred, compassionate care and support to people using their services, and their loved ones.

NHS pressures: future trends This analysis of NHS admissions and waiting times data estimates that emergency department attendances could increase to 24 million between October 2017 and September 2018. During this period, the analysis also projects that the number of patients failing to be treated within four hours of arrival at hospital could rise by 370,000.

News 

'NHS Airbnb' could have launched as early as December 

EHRC calls for "right to equality" after Brexit. The Equality and Human Rights Commission (EHRC) is calling on the Government to enshrine a "constitutional right to equality" in UK law to ensure anti-discrimination laws are not depleted after Brexit. The EHRC said the UK will "lose the safety net" of EU law and that people could be in a weaker position against employers or the state. It also wants the EU Charter of Fundamental Rights to be retained after Brexit.

Medical examiners and death certification. In March 2016 the DH consulted on proposed changes to the death certification process, which would include the introduction of independent medical examiners who will confirm cause of all deaths that do not need to be investigated by a coroner. The DH Parliamentary Under-Secretary of State, Lord O'Shaughnessy, has now confirmed that the Government’s response to the consultation will be published shortly and the system will be introduced no later than April 2019.

Bevan Brittan Updates

Identifying modern slavery – The role of the healthcare professional. In September 2017, 11 people were jailed for up to 15 years for exploiting at least 18 victims of modern slavery, including one for 26 years. Men, women, and children are trafficked for exploitation in the UK every year and forced to work in prostitution, domestic roles, or manual labour.

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

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