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

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

Training Events

Inquests

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 

Information sharing/data

 

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

Bevan Brittan Free Training Events

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

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:-

  • Tuesday 16 January 12.30 - 2pm Fatal Accidents Claims Update
  • Tuesday 30 January 12.30 - 2pm Sussex Community NHS FT –v- Price, and a review of bed-blocking.

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.

Back to top

Acute and emergency care

Publications/guidance

Meeting the quality challenge: sharing examples of best practice from clinical leaders in emergency departments. This report provides practical examples of positive action that some trusts are taking to help meet the challenges of managing capacity and demand. The examples cover a range of areas including ambulance arrivals, initial patient assessments, staffing, managing deteriorating patients and specialist referrals.

Does hospital competition improve efficiency? The effect of the patient choice reform in England. This paper from the Centre for Health Economics investigates the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, cancelled elective operations, proportion of untouched meals) and costs (cleaning services costs, laundry and linen costs, reference cost index for overall and elective activity). The findings suggest that increased competition had mixed effects on efficiency.

Addressing ambulance handover delays. This letter and guidance sets out the main points from recent guidance documents and separates them into actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

Patient care deteriorating as NHS heads into winter on a knife edge. The King’s Fund’s latest quarterly monitoring report shows that a seven-year squeeze on NHS and social care budgets is taking a significant toll on patient care. Analysis for the report suggests that the NHS is heading into winter on a knife edge with performance worse than at this time last year against a number of key indicators.

Integrated urgent care / NHS 111 career framework and competency based job descriptions: Skills for Health Levels 2-7. Sets out a newly developed career framework, with associated competency based job descriptions for roles at Skills for Health Levels 2 to 7, operating within the Integrated Urgent Care/ NHS 111 call centre service. It forms part of the wider Integrated Urgent Care/NHS 111 Workforce Blueprint specified within the National Service Specification for Integrated Urgent Care Services.

Safe, sustainable and productive staffing: An improvement resource for urgent and emergency care. Draft guidance to help providers of NHS-commissioned services, boards and executive directors support their urgent and emergency care professionals in implementing safe staffing for urgent and emergency care settings. It describes the principles for safe urgent and emergency care nurse staffing to ensure service users receive high quality, safe care appropriate to their needs and wishes.

News

Most children and young people report good experiences of hospital care. The results of the CQC's 2016 children and young people’s survey show that the majority of children and young people who stayed in hospital overnight or were seen as a day case patient were happy with the care they received.

Revealed: Lack of Treasury funding delays consultant contract to 2019. The HSJ reports that a new contract for senior doctors in England will be delayed until 2019 due to a lack of transition funding from the Treasury.

New rules on blood donation come into force. Announces that changes to the rules on blood donation in England came into force on 28 November 2017. The new rules will allow more people to donate blood, without affecting the safety of the blood supply. 

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

Back to top

Children

Publications/guidance

Care of unaccompanied migrant children and child victims of modern slavery. Statutory guidance for LAs and professionals who support unaccompanied migrant children, who may be victims, or potential victims, of modern slavery. Statutory guidance for LAs and professionals who support unaccompanied migrant children, who may be victims, or potential victims, of modern slavery.

Transforming children and young people's mental health provision: a Green Paper. This Green Paper outlines the government's proposals to improve mental health support for children and young people in England. The measures include: encouraging schools and colleges to designate a mental health lead; setting up mental health support teams to work in schools; and piloting a four-week waiting time target for children and young people's mental health services. Views and feedback are being sought on these proposals until 2 March 2018.

Online mental health support for young people This report aims to provide insight into the efficacy of online counselling for children and young people. It focuses exclusively on Kooth online counselling and includes user data along with feedback from Kooth users and commissioners. It finds Kooth online counselling is popular and effective in increasing access to care and providing choice. The anonymous nature of the service was found to be a big benefit for children and young people.

Commissioning children's palliative care in England: 2017 edition. This report highlights that only a third of CCGs in England are implementing NICE clinical guidance to the prioritisation of palliative care for babies, children and young people. It finds that while 93 per cent of CCGs commission community children's nursing services, only 67 per cent provide this service out of hours and at weekends.

News

Most children and young people report good experiences of hospital care. The results of the CQC's 2016 children and young people’s survey show that the majority of children and young people who stayed in hospital overnight or were seen as a day case patient were happy with the care they received.

Children should get flu vaccination to protect grandparents at Christmas. With less than a month until Christmas, the NHS has appealed to parents to take up the free flu vaccination for children to curb infection over the holiday season when family get-togethers spread the infection, putting grandparents and other vulnerable relatives at risk.

Bevan Brittan Updates

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

Back to top

Clinical Risk/Patient Safety

Publications/Guidance

NHSR Guidance note three - Being a witness - non- clinical revised.

NHSR Guidance note four - Limitation including extension requests. Members will often receive requests from claimant solicitors to voluntarily agree an extension of limitation to allow investigations to be completed. This guidance sets out the relevant law and provides some practical tips for all such requests.

NHSR Guidance note five - How claims are valued. This note focuses on how claims are valued. The general principle is that damages are paid to a claimant with the aim of restoring them (as far as possible) to the position they would have been in but for the negligence.

NHSR guidance - An inspector calls. What happens when the police come into our hospitals.

NHSR Guidance Inquests - What lies beneath?

NHSR Guidance - the role of the Coroner and Inquest process

The NHSR document 'Organisational Chart and Administrative Bases' has been updated.

Safer maternity care: progress and next steps. Reports on progress and next steps with implementation of the Safer Maternity Care action plan, and sets out additional measures for further and quicker improvement. It sets out additional measures for further and quicker improvement, including: improving rigour and quality of investigations into term stillbirths, neonatal and maternal deaths, and serious brain injuries, and learning from the investigations; more support for maternity and neonatal training; looking into giving coroners powers to conduct investigations into stillbirths; aiming to reduce the national rate of pre-term births from 8% to 6%; and bringing forward from 2030 to 2025 the ambition to halve rates of stillbirths, neonatal and maternal deaths, and brain injuries occurring during or soon after birth.

Clinical correspondence handling at NHS Shared Business Services. The Public Accounts Committee examined NHS SBS's failure to identify and rectify the problem of misdirected clinical correspondence. Until April 2016, NHS England contracted NHS SBS to make sure that misdirected clinical correspondence was sent on to the correct GP in the East Midlands, South West and North East London. The Committee found that the failures in the handling of sensitive clinical data by NHS SBS were staggering. Even as the Committee was looking into problems dating back at least three years, NHS England was uncovering more mishandled correspondence. It was deeply unimpressed by the lack of grip NHS England continued to have on the handling of clinical correspondence, and dismayed to be informed of a further backlog of 162,000 items which need to be assessed. NHS England must obtain positive assurance from every GP reviewing correspondence that they have completed their checks and whether they have identified any cases where patients may have been harmed.

MBRRACE-UK Perinatal Confidential Enquiry: term, singleton, intrapartum stillbirth and intrapartum-related neonatal death. This report finds that the rate of term, singleton, intrapartum stillbirth and intrapartum-related neonatal death has more than halved since these deaths were last reviewed nationally in 1993. It concludes that despite the fall in the mortality rate these deaths remain an important group for concern because, in the vast majority of cases, the mother was directly receiving maternity care when the baby died or when the event in labour or birth occurred which led to the baby’s death.

The investigation of stillbirth. This briefing discusses the way that stillbirth is investigated at present and the government announcement about independent investigations in future.

Managing the costs of clinical negligence in hospital trusts: Fifth Report of Session 2017-19.  A Public Accounts Committee report on managing the costs of clinical negligence in NHS trusts notes that the annual cost for trusts has quadrupled over the last decade, from £0.4 billion in 2006-07 to £1.6 billion in 2016/17. The Committee adds that despite long-standing concerns about these predictable rising costs, the Government has been disappointingly slow and complacent in its response. It concludes that the Government needs to take bolder and more coordinated action to prevent the risk of clinical negligence claims spiralling out of control.

Pre-legislative scrutiny: draft personal injury discount rate clause: Third Report of Session 2017-19. A Justice Committee report on its pre-legislative scrutiny of the draft personal injury discount rate clause welcomes the Government's commitment to the principle of full compensation for claimants, but recommends that it clarifies what it means by this, given that lump-sum awards will nearly always either under or over-compensate individual claimants. It advises caution in considering evidence of claimants' behaviour to set the discount rate arguing the risk they accept may be driven by the rate itself.

The law and practicalities of Before-the-Event (BTE) Insurance – An information study. A comprehensive report by an expert working group of the Civil Justice Council on before the event (BTE) legal expenses insurance looks at the role BTE insurance plays in enhancing access to justice. It sets out a comprehensive range of information, interviews, case studies and analysis with the aim of informing policy makers developing BTE services and consumers purchasing them.

National maternity and perinatal audit. Clinical report 2017. This audit compares the care that maternity units provide to women across England, Scotland and Wales, based on data about 696,738 births in NHS maternity services between 1 April 2015 and 31 March 2016. It identifies priorities for improvement, where unexplained variation in outcomes for women and babies exists. It also identifies good practice, and detects gaps in policy and guidelines. Increasing pressures on the service from societal and behavioural factors are also highlighted, which have implications for outcomes, policy and service provision.

Cases

Spearman v Royal United Bath Hospitals NHS Foundation Trust [2017] EWHC 3027 (QB). The Defendant owed a duty to take reasonable steps to ensure that the premises were reasonably safe for him as a vulnerable patient who was confused and mentally unstable at the time that he was in the Emergency Department of the hospital.

TW (A Child) v Royal Bolton Hospital NHS Foundation Trust 2017 EWHC. An examination of the problems caused by “missing” witnesses and a failure to take contemporaneous statements.

Mohammed v The Home Office [2017] EWHC 3051 (QB) Mr Edward Peperall QC (sitting as a Deputy High Court Judge) considered the appropriate award for interest and additional damages when a claimant had beaten their own Part 36 offer.

Jacqueline Smith (suing in her own right & as the surviving partner of John Bulloch Deceased) v (1) Lancashire Teaching Hospitals NHS Foundation Trust (2) Lancashire Care NHS Foundation Trust (3) Secretary of State for Justice (2017). The Fatal Accidents Act 1976 s.1A was incompatible with ECHR art.14, read in conjunction with art.8, to the extent that it excluded cohabitees of over two years from its scheme for bereavement damages. The court considered the correct test for determining whether the scheme was within the ambit of art.8, so as to engage art.14.

Meadows v Hafshah [2017] EWHC 2990 (QB). A doctor who was negligent in failing to determine that a woman was a carrier for haemophilia was liable for losses incurred by that woman in raising a child to whom she had later given birth and who suffered from both haemophilia and autism. Although the autism was unrelated to the haemophilia, both conditions were a natural consequence of a pregnancy that would not have continued but for the negligence. Thus, the scope of the doctor's duty extended to preventing the child's birth and all its consequences. 

Consultations

A rapid resolution and redress scheme for severe avoidable birth injury: Government summary consultation response. A Department of Health document details the responses received to its consultation on proposed investigations into severe avoidable birth injury and the support and compensation scheme. 

News

Woman awarded £9m damages for care of son who 'should not have been born'. High court rules in favour of Omodele Meadows, who says she would have terminated her pregnancy if she had known child would have haemophilia - see case report above.

New hot-tubbing and 'costs of costs management' rules come into force. Variations to PD 35 with respect to how concurrent expert evidence is dealt with by judges came into force in the week commencing 20 November 2017 together with a new provision clarifying the way in which the costs of costs management should be calculated.

Bereavement damages. Looks at Smith v Lancashire Teaching Hospitals NHS Foundation Trust (CA) that the denial of bereavement damages to an unmarried woman after her partner died as a result of negligence, on the ground that the award was only paid out to spouses and civil partners, breached her rights under ECHR arts 8 and 14 on the grounds of her non-marital status and right to respect for family life. See case report above.

MPs urge "complacent" government to consider mandatory mediation to cut clinical negligence costs. MPs on the public accounts committee (PAC) have criticised the Government as "slow and complacent" with respect to the increasing costs of clinical negligence saying that it had not assessed the impact of reforms on the numbers of such claims. They recommended that mandatory mediation should be considered in certain circumstances of claim.

Legal advice privilege: a search for clarity? Since 2004 the leading authority on legal advice privilege has been the much criticised Court of Appeal decision in Three Rivers (No 5) [2003] EWCA Civ 474, which gave a restrictive interpretation as to who is the ‘client’ in the corporate context. Several recent court decisions have confirmed this narrow approach and may suggest a trend towards yet further erosion in the ability to claim both legal advice and litigation privilege. 

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:-

  • Tuesday 16 January 12.30 - 2pm Fatal Accidents Claims Update
  • Tuesday 30 January 12.30 - 2pm Sussex Community NHS FT –v- Price, and a review of bed-blocking

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

Back to top

Commissioning

Publications/Guidance 

Challenging Health Inequalities: Support for CCGs. This guide has been created to help identify areas of variation in emergency admissions in more and less deprived CCGs and to promote a discussion where variation occurs.

Supporting change in your NHS: The non-executive community in transformational change. This NHS Clinical Commissioners publication, produced jointly with NHS England and NHS Improvement, summarises discussions held at two events earlier this year that brought together more than 200 CCG lay members and trust non-executive directors (NEDs). Hosted by NHS England in collaboration with NHSCC and NHS Improvement, these events focused on how lay members and NEDs can contribute to the integration and transformation of their local health communities. The publication looks at attendees’ perspectives on the lay member and NED role; insights on current system change; and views on the next steps for lay members, NEDs and health and care organisations.

Checklist for professional development of CCG lay members. Guidance from NHS Clinical Commissioners to help CCGs support the professional development of their lay members. It is the final checklist in the series on the lay member role, and follows on from the two published earlier this year to support CCGs with lay member recruitment and induction and training.

Technical requirements for 2017/18 contract changes (version 3). This updated document includes the national diabetes audit (NDA), mental health (MH) Read codes for the dementia data collection and the GMS PMS (primary medical services) data collection.

Funding for local groups of NHS organisations (Sustainability and Transformation Partnerships). Sets out the first 12 schemes due to benefit from £2.6bn government investment in local groups of NHS organisations (Sustainability and Transformation Partnerships), as announced in the Autumn Budget 2017, to deliver transformation schemes and improve their ability to meet demand for local services.

CCG improvement and assessment framework 2017/18. The updated CCG Improvement and Assessment framework (CCG IAF) describes the CCG annual performance assessment and the metrics that will inform that assessment for 2017/18. The framework for 2017/18 is broadly similar to the previous year’s, which it replaces, enabling improvement in key areas to be tracked over time. The technical annex provides the detail of the construction and purpose of each of the indicators in the Framework. The detail is provided in a mostly standardised form, with slight differences for the small number of indicators which require more judgement and moderation in their construction.

Legislation

Alternative Provider Medical Services (Amendment) Directions 2017. Amend direction 14 of the 2016 APMS Directions regarding the mandatory terms of an APMS contract under which essential services are to be provided.

General Medical Services Statement of Financial Entitlement (Amendment No.2) Directions 2017. Amends the GMS FE Directions 2013. 

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

Back to top

Employment/HR

Publications/guidance

Training environments 2017: key findings from the national training surveys This report outlines the findings of an annual survey of trainee doctors and trainers about the quality of UK medical training and training environments. The report warns that medical education and training is too reliant on the goodwill and sacrifices made by senior colleagues who act as trainers. The report also highlights the challenges faced by trainees who report that heavy workloads threaten the time that they have for training.

Improving lives: the future of work, health and disability . This policy paper sets out how the Government will work with employers, charities, health care providers and local authorities to break down employment barriers for disabled people and people with health conditions over the next ten years. The actions outlined for health services focus on ensuring that health professionals are ready to talk about health barriers to work, timely access to appropriate treatments, and effective occupational health services accessible by all in work.

Agency, bank and overtime spending in UK maternity units in 2016. The findings from this survey show that while bank and overtime spending are much better value for money than agency spending, it is clear that organisations are far too reliant on temporary staffing. NHS organisations need to develop a total workforce strategy to ensure that they have the appropriate numbers of staff; to ensure that they are retaining their existing staff and to ensure they are recruiting enough staff to deal with the increased demand on the service and replace staff who leave.

Consultations

Good practice in creating positive staff experience and compassionate workplaces: A call for contributions. NHS England, in partnership with Hope 4 the Community (CIC), is developing a guide to commissioning for positive staff experience and creating compassionate workplaces. It is inviting instances of exemplary practice to support the creation of a compassionate workplace and positive staff experience, to help it to generate an in-depth picture of exemplary practice to support compassionate workplaces and how this is developed, maintained, measured and reported to support positive staff experience. The deadline for submissions is 20 December 2017.

News

Medical training too reliant on doctors' goodwill, says GMC. Education and training for doctors is too reliant on the goodwill and sacrifices made by senior colleagues who act as trainers, the General Medical Council (GMC) warns.

Bevan Brittan Updates

Employment Eye. Bevan Brittan's employment law report for November 2017

Bevan Brittan Events

Employment law update: the highlights of 2017 & key changes on the horizon.
London - 14 December

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

Back to top 

Finance 

Publications and Guidance

Autumn Budget 2017: NHS spending The Autumn Budget 2017 included £6.3 billion of new funding for the NHS in England, including £2.8 billion over the next three years for day-to-day services and £3.5 billion of capital investment by 2022/23. This document sets out the background to NHS spending and details of the government’s policy. Autumn Budget Kings Fund response.

Consultations

Consultation: reporting and rating NHS trusts’ use of resources. The Care Quality Commission and NHS Improvement are consulting on plans to fully implement the process that both organisations will use to report on how NHS non-specialist acute trusts are using their resources to provide high-quality, efficient and sustainable care. They are seeking views on their proposed approach to working together, and the closing date for comments is 10 January 2018.

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

Back to top   

Independent Healthcare

Publications/Guidance

Ian Paterson: Independent inquiry into breast surgeon. An independent inquiry is to be held into the malpractice of breast surgeon Ian Paterson, who carried out hundreds of botched operations.

Care homes market study. The CMA has published its final findings following an extensive review of whether the residential care homes sector is working well for older people and their families. The year-long market study found that the current system for providing care is not sustainable. As a result, the CMA is taking direct action under consumer protection law, and has also made a range of recommendations to government and others.

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

Back to top   

Information Sharing/data

Publications/Guidance

The future of public service identity: blockchain This report explores how blockchain technology could be used for public services identity management, shifting the ownership of personal data from government to citizens. It argues that the current government identity management model is inefficient and inconvenient.

Guide to the General Data Protection Regulation (GDPR). An Information Commissioner's Office guide to the General Data Protection Regulations (GDPR) explains the provisions of the GDPR to help organisations comply with its requirements. It is for those who have day-to-day responsibility for data protection. The ICO has also published tools to help organisations prepare for the GDPR including "12 steps to take now" and a checklist.

Sharing data in line with patients' reasonable expectations. The National Data Guardian has been looking at the circumstances under which health and care data may be shared, and the role that patients’ reasonable expectations play in shaping these circumstances. Part of this work has been examining how implied consent is used within health and care settings to share patient data and support individual care. The two reports cover two events examining this, and the importance of understanding patient expectations.

Consultations

Consultation on revised Freedom of Information Code of Practice. The Cabinet Office is seeking views on a draft revised FOI Code of Practice that provides best practice guidance to public authorities on how to fulfil their functions under Part I of the FOI Act 2000. It has been revised and updated in light of the Independent Commission on Freedom of Information’s report. The closing date for comments is 2 February 2018. 

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

Back to top   

Inquests

Publications/Guidance

Chief Coroner Guidance No. 26 - Organ Donation. Judiciary guidance for coroners on the law and procedures to be followed when dealing with post mortem organ and tissue donation, with a view to providing greater consistency of approach across all of England and Wales. The guidance also aims to assist the NHS Blood & Transplant, clinical leads in organ donation, eye banks, transplant surgeons, intensive care physicians and police officers with a clear understanding of the relevant law and procedure and the role of the coroner.

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

Back to top 

Mental Health

Publications/Guidance

Community mental health survey 2017. Findings have been published by the Care Quality Commission from the latest survey on patient experience of community mental health services.

Mental health and fair trial A JUSTICE report on mental health and fair trials argues that the criminal justice system in England and Wales is failing defendants with mental health issues and calls for the introduction of specialist prosecutors to review charging decisions where suspects have such issues and an amendment to the defence of insanity. JUSTICE argues that if mental health issues are not addressed the fair trial rights of defendants could be undermined.

Transforming children and young people's mental health provision: a Green Paper. This Green Paper outlines the government's proposals to improve mental health support for children and young people in England. The measures include: encouraging schools and colleges to designate a mental health lead; setting up mental health support teams to work in schools; and piloting a four-week waiting time target for children and young people's mental health services. Views and feedback are being sought on these proposals until 2 March 2018.

Online mental health support for young people This report aims to provide insight into the efficacy of online counselling for children and young people. It focuses exclusively on Kooth online counselling and includes user data along with feedback from Kooth users and commissioners. It finds Kooth online counselling is popular and effective in increasing access to care and providing choice. The anonymous nature of the service was found to be a big benefit for children and young people.

Safeguarding Adults, Annual Report, England 2016/17. NHS England has published a report presenting information about adult safeguarding enquiries during the 2016/17 financial year. It provides details of how many safeguarding concerns were raised during the year, how many safeguarding enquiries were started and how many were completed within that year under s.42 of the Care Act 2014.

Commencement of amendments to the Mental Health Act 1983: letter from Claire Murdoch, Tim Kendall and Ruth May. Informs CCG and providers of the changes in law to s.135 and s.136 of the Mental Health Act 1983 through the Policing and Crime Act 2017 which will come into effect on 11 December 2017.

Census 2017: workforce figures for consultants and specialty doctor psychiatrists. This report outlines the findings of this year's census of psychiatric workforce across England, Scotland, Northern Ireland and Wales. It finds that there is an ongoing rise in the reported number of vacant or unfilled consultant posts across the UK and an increase in the use of locum specialty doctors.

Prevent mental health guidance and e-learning package. Prevent is a government initiative to safeguard vulnerable people from being radicalised to support terrorism or become terrorists. This guidance and e-learning course aims to support NHS providers and staff to exercise their statutory and professional duties to safeguard vulnerable adults, children and young people at risk of radicalisation.

Improving mental health support for our children and young people. Expert Working Group final report.

Consultations

Reducing the need for restraint and restrictive intervention: Children and young people with learning disabilities, autistic spectrum disorder and mental health difficulties: Draft guidance for consultation. A joint DH and DfE consultation seeks views on draft guidance on reducing the need for restraint and restrictive intervention for children and young people. The guidance applies to health and care settings and special educational settings. Comments by 24 January 2018.

Cases

Spearman v Royal United Bath Hospitals NHS Foundation Trust [2017] EWHC 3027 (QB). The Defendant owed a duty to take reasonable steps to ensure that the premises were reasonably safe for him as a vulnerable patient who was confused and mentally unstable at the time that he was in the Emergency Department of the hospital.

R (on the application of OK) (Applicant) v First-Tier Tribunal (Respondent) & Gambian Fairview (Interested Party) (2017) [2017] UKUT 22 (AAC) A patient who lacked the capacity to make an application to the First-tier Tribunal was not deprived of his Convention rights. The rights of such a person were protected by various statutory provisions.

News

Mental health services: Children and young people: Written question - HL2991. In response to a written question about: when the Green Paper on children and young people's mental health will be published; and whether plans are in place to assess differences in mental health treatment depending on geographical location, the Department of Health stated that: it planned to publish the Green Paper by the end of 2018; and the Paper would include provisions to improve services irrespective of geographical location.

Bevan Brittan Updates

Bevan Brittan Events

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:-

  • Tuesday 16 January 12.30 - 2pm Fatal Accidents Claims Update
  • Tuesday 30 January 12.30 - 2pm Sussex Community NHS FT –v- Price, and a review of bed-blocking.

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.

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

Back to top

Primary Care

Publications/Guidance

Indemnity in General Practice: Developing a more affordable and stable future. The DH is seeking to put in place a more stable and more affordable system of indemnity for general practice in England. This updated information marks the start of detailed work with GP representatives and others. It outlines current assumptions on key areas. As policy thinking develops, these positions may change.

Primary medical care policy and guidance manual. Provides commissioners of primary care services the context, information and tools to safely commission and contract manage primary medical care contracts.

Destination GP: medical students’ experiences and perceptions of general practice. The Destination GP project aimed to build the evidence base on medical students' perceptions of general practice, and how and where they are exposed to misconceptions and negative views. Based on these findings, this report sets out a series of recommendations where further work is needed to tackle the spread of misconceptions and negativity surrounding general practice.

News

NHS Choices to trial improved Find a Pharmacy service. Announces that the NHS Choices website will shortly start to trial an improved search service that will allow website visitors to find the nearest pharmacy to them which is open at the time of the search.

GP online consultation systems fund. Gives details of the £45m fund that has been created to contribute towards the costs for practices to purchase online consultation systems, improving access and making best use of clinicians’ time. The funding is part of the General Practice Development Programme building capacity for improvement through free training, spreading innovations from around to country using the 10 High Impact Actions and funding for new ways of working.

GP contract negotiations Scotland 2017/18. Announces a proposed Scotland-only GP contract that aims to make general practice sustainable for the future. The contract provides for an expanded multidisciplinary team to work with GP practices to provide direct access to services for patients, allowing GPs to concentrate on being expert medical generalists. It also allows practices to transfer some additional services to health boards without losing funding. Other proposals include a change to the funding formula and additional resources to provide more support for practices for higher workload; however, the income of every practice would be protected under the new contract. The contract lays the groundwork for guaranteed GP income and direct reimbursement of expenses in the future, and provides funding to reduce the risks to GP partners of providing their own premises.

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

Back to top 

Providers

Publications/Guidance

Some assembly required: implementing new models of care. The Health Foundation has captured some of the experiences of those working on the vanguard sites of the new care models programme in England. Drawing on the experiences of those leading the vanguard sites of the new care models programme, this report sets out 10 lessons for those seeking to systematically make improvements across local health and care services for those patients who are in most need of joined up care.

Making a reality of the Accelerated Access Review: improving patient access to breakthrough treatments. Announces a new fast-track route into the NHS for breakthrough medicines and technologies that will speed up the time it takes for patients to benefit from ground-breaking products for conditions such as cancer, dementia and diabetes. The new Accelerated Access Collaborative will develop an accelerated access pathway to bring breakthrough products to market and then to patients as quickly as possible, with £86m government funding to support innovators and the NHS in overcoming barriers to getting new, innovative technologies to patients quickly.

Legislation

Hospital (Parking Charges and Business Rates) Bill. This Private Member's Bill has been introduced into the House of Commons by Peter Bone MP and has received its 1st Reading. The Bill prohibits charging for car parking at NHS Hospitals for patients and visitors and provides for NHS Hospitals to be exempt from business rates.

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

Back to top

Public Health

Publications/Guidance

Reaching out: Influencing the wider determinants of health. Research published by the New Local Government Network (NLGN) calls for public health to be more fully recognised as contributing to the UK’s growth potential. The research found that, while public health teams have integrated well with people-focused services in local authorities, there are weaker connections with economic development teams and Local Enterprise Partnerships (LEPs). It recommends that central government should invest £65m into Health and Wellbeing Boards, to support a 5-year 'upstream prevention' programme, which could fund pilots within their area that address the wider determinants of health.

Health and social care needs assessments of the older prison population: a guidance document. This document provides evidence-based guidance on how to carry out a health and social care needs assessment of older people in prisons. Commissioners of prison health care services and social care services can use this to understand the needs of older people in prisons and commission and deliver services that meet their needs.

Calling time – Addressing ageism and age discrimination in alcohol policy, practice and research. This report from think-tank the International Longevity Centre finds that ageism and age discrimination in alcohol policy, practice and research is denying older people the treatment they need to recover from harmful drinking. It calls on UK governments to develop alcohol strategies that recognise that older adults’ needs may be different to those of younger people.

Review of Public Health England's data collection and data management functions. This report outlines the findings of an independent review into Public Health England's data management activities and makes recommendations on whether these activities might be better managed by NHS Digital. A high-level implementation plan accompanies the review and outlines how the recommendations will by jointly implemented by the Department of Health, Public Health England and NHS Digital.

Healthy Child Record Standard. The Professional Records Standards Body (PRSB) has published a draft information standard that spells out what information on screening tests, immunisations and developmental milestones should be accessible to ensure that children receive appropriate care. The standards for child health records support the Healthy Child Programme and its prevention agenda, by improving health and wellbeing and empowering parents in their children's care and development.

Public health in Europe during the austerity years. This report explores the relationship between austerity policies and public health across Europe. It indicates that progress on a number of key health indicators has stalled, including life expectancy and mortality rates. It also finds that levels of subjective health have fallen among young people aged 15–24 across Europe, and in all age groups in the UK.

Localised community outbreaks of influenza in the out of season period: Letters to clinical commissioning groups. Letter from NHS England to CCGs on a template procedure to facilitate the NHS response to localised community outbreaks of influenza.

The efficacy of public health spending. This briefing examines the spending on, access to and cost-effectiveness of four areas of public health spending in the UK: smoking, physical health, obesity and alcohol. 

News

PHE announces areas for IPS alcohol and drug dependency trial. Announces the seven local authority areas that have been selected to take part in a randomised controlled trial of individual placement and support (IPS) for people in or dependent on either drugs, alcohol or both in community treatment services. The IPS-AD trial is being funded by the joint DWP, and DH Work and Health Unit.

Children should get flu vaccination to protect grandparents at Christmas. With less than a month until Christmas, the NHS has appealed to parents to take up the free flu vaccination for children to curb infection over the holiday season when family get-togethers spread the infection, putting grandparents and other vulnerable relatives at risk. 

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

Back to top

Regulation

Publications/guidance

Multi-professional framework for advanced clinical practice in England. Health Education England (HEE), in partnership with NHS Improvement and NHS England, has launched a new national framework that sets out a vision for the further development of Advanced Clinical Practitioners (ACPs). ACPs enhance capacity and capability within multi-professional teams by supporting existing and more established roles. They also help to improve clinical continuity, provide more patient-focused care, and help to provide safe, accessible and high-quality care for patients. The framework provides national definition and framework of what Advanced Clinical Practice is and what the requirements for entry are.

Substance misuse services This CQC briefing looks at the quality and safety of clinics offering residential services for people withdrawing from drugs or alcohol. It presents the concerns identified during inspections and also gives an example of good practice and a number of actions and recommendations. 

Cases

McDermott v Health and Care Professions Council [2017] EWHC 2899 (Admin). The court held that a physiotherapist who had been found to lack competence should not have been suspended where he had made real improvement in his most recent post and complied with conditions imposed on him. A conditions of practice order would be imposed in place of the suspension. 

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

Back to top

Social Care

Publications/Guidance

Adult social care outcomes framework 2017/18: 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.

Review of adult social care complaints 2016/17. The latest annual report from the Local Government & Social Care Ombudsman shows that in 2016/17 they upheld 63% of adult social care investigations last year. Councils and care providers acted on more than 1,300 recommendations to put things right where the LGSCO had identified failings – an 11% increase on the previous year. In all but one case, councils and care providers acted positively to implement the recommendations. This report highlights how an individual complaint can result in improving care services for others. These cases demonstrate the power that one person speaking up can have in changing services for the better for everyone.

Managing transfers of care frequently asked questions. The LGA is working with councils and the social care sector to identify solutions to effectively manage patient discharge from hospital to home. These FAQs includes appendices on: DTOC expectations for councils; delayed transfers of care measures; and understanding and making use of the data available.

Care homes market study. The CMA has published its final findings following an extensive review of whether the residential care homes sector is working well for older people and their families. The year-long market study found that the current system for providing care is not sustainable. As a result, the CMA is taking direct action under consumer protection law, and has also made a range of recommendations to government and others.

Half of care homes failing in parts of England. Analysis of CQC data by Which? finds that more than half of care home places in some parts of England are in facilities rated as ‘inadequate’ or ‘requiring improvement’. The research shows that almost nine in 10 council areas across England could see a shortfall in care home places by 2022. It also raises questions around whether some councils will be able to continue to meet their statutory duty to offer local authority-funded individuals at least one suitable care home place that will meet the prospective resident’s needs.

Room to improve – The role of home adaptations in improving later life. This report from the Centre for Ageing Better finds that making small changes to older people’s homes, such as installing handrails, ramps and level-access showers, alongside carrying out simple home repairs, could play a significant role in relieving pressure on the NHS and social care and reduce costs by millions of pounds each year. It argues that making these kinds of small changes to homes earlier, alongside repairs to homes, should be a greater priority for local services, and could help to avoid or delay use of NHS and social care.

Speak up. Healthwatch's latest annual report to Parliament highlights the top issues that people have spoken to Healthwatch about in the last financial year. The report finds that whilst many people are getting the support they need, there is great variation in the availability and quality of services across the country.

Moving more, ageing well. This report from UKactive examines to harness opportunities across three different environments - the home, the community and residential care - and the broader health and social care system to get more older people, more active, more often.

Will the cap fit? What the Government should consider before introducing a cap on social care costs. According to new analysis, 90 per cent of self-funders will not benefit if the cap on care costs, currently set at £72,000, is implemented. Set at this level, it will take a typical pensioner over six years to reach the cap, which is double the average life expectancy for someone in residential or nursing care. It proposes an 'all-inclusive cap' set at £100,000 which would benefit up to four times as many people and within two to three years.

LGA budget submission: autumn 2017 This briefing argues that pressure is being placed on council budgets as a result of the rising demand for adult social care and children’s services. It estimates that for every £1 of council tax collected in 2019/20, 56p will be spent on social care, leaving less funding available for other public services.

Saving social care: a fair funding settlement for the future. This report examines four options for the future of social care funding: means testing the Winter Fuel Payment, scrapping the triple lock on the State Pension, increasing National Insurance contributions and an increase in inheritance tax. It estimates that a rise in National Insurance contributions by 1 per cent would immediately raise up to £5 billion towards social care funding. When compared with other options for filling the funding gap, it tested as the most progressive and politically achievable option.

Consultations

Knowledge and skills statement for social work supervisors in adult social care. Seeks views on the knowledge and skills statement for adult social work supervisors, to make sure it covers the key skills and knowledge needed to support high quality, reflective social work practice. The consultation closes on 26 January 2018.

News

Government to set out proposals to reform care and support. The First Secretary and Minister for the Cabinet Office Damian Green has announced that the Government will publish a green paper on care and support for older people by Summer 2018. The paper will set out plans for how government proposes to improve care and support for older people and tackle the challenge of an ageing population. 

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

Back to top

General

Publications/Guidance

Autumn Budget 2017: NHS spending The Autumn Budget 2017 included £6.3 billion of new funding for the NHS in England, including £2.8 billion over the next three years for day-to-day services and £3.5 billion of capital investment by 2022/23. This document sets out the background to NHS spending and details of the government’s policy. Autumn Budget Kings Fund response.

The Government's response to an incompatibility in the Human Fertilisation and Embryology Act 2008. Command paper and remedial order to allow a single person to obtain a parental order following a surrogacy arrangement.

Government response to the House of Commons Health Committee report Brexit and health and social care - people & process. Sets out the Government’s response to the report on the impact of Brexit on health and social care that was published by the Commons Health Committee in April 2017, chaired by Dr Sarah Wollaston MP. It identifies the main policy areas that are affected by the UK’s withdrawal from the EU for which DH has the lead within Government, as the health and care workforce, medicines regulation and the supply chain, reciprocal healthcare and public health

A tale of two cities This report shares the findings of research that took place over a year in three different communities in a city in the North of England. The findings present community perspectives on what inequality is and identifies pathways to new solutions for strengthening community responses to tackling inequality.

Health and social care needs assessments of the older prison population: A guidance document.  A Public Health England document provides evidence-based guidance on how to carry out a health and social care needs assessment of older people in prisons. Commissioners of prison healthcare and social care services can use the guidance to understand the needs of older people in prisons and commission and deliver services that meet their needs.

Safeguarding Adults, Annual Report, England 2016/17. NHS England has published a report presenting information about adult safeguarding enquiries during the 2016/17 financial year. It provides details of how many safeguarding concerns were raised during the year, how many safeguarding enquiries were started and how many were completed within that year under s.42 of the Care Act 2014.

Embedding a culture of quality improvement. This King's Fund report explores the factors that have helped organisations to launch a quality improvement strategy and sustain a focus on quality improvement. Drawing on a roundtable event attended by senior local and national NHS leaders, semi-structured interviews and a literature review, it identifies three common themes for successfully launching a quality improvement strategy: having a clear rationale; ensuring staff are ready for change; and understanding the implications for the organisation’s leadership team in terms of style and role.

Health matters: preventing infections and reducing antimicrobial resistance This professional resource outlines the importance of infection prevention and control and how it can contribute to reducing antimicrobial resistance.

Consultations 

A consultation covering changes to simplify arrangements for research in the NHS and associated changes to the terms of the NHS Standard Contract. NHS England is seeking views on simplifying and standardising the process for getting research projects up and running in the NHS. It proposes 12 actions that will cut bureaucracy, improve its data infrastructure, apply leading technologies and support the adoption of proven and affordable innovations. The consultation closes on 1 February 2018.

Consultation: reporting and rating NHS trusts’ use of resources. The Care Quality Commission and NHS Improvement are consulting on plans to fully implement the process that both organisations will use to report on how NHS non-specialist acute trusts are using their resources to provide high-quality, efficient and sustainable care. They are seeking views on their proposed approach to working together, and the closing date for comments is 10 January 2018.

Good practice in creating positive staff experience and compassionate workplaces: A call for contributions. NHS England, in partnership with Hope 4 the Community (CIC), is developing a guide to commissioning for positive staff experience and creating compassionate workplaces. It is inviting instances of exemplary practice to support the creation of a compassionate workplace and positive staff experience, to help it to generate an in-depth picture of exemplary practice to support compassionate workplaces and how this is developed, maintained, measured and reported to support positive staff experience. The deadline for submissions is 20 December 2017.

Consultation on revised Freedom of Information Code of Practice. The Cabinet Office is seeking views on a draft revised FOI Code of Practice that provides best practice guidance to public authorities on how to fulfil their functions under Part I of the FOI Act 2000. It has been revised and updated in light of the Independent Commission on Freedom of Information’s report. The closing date for comments is 2 February 2018.

Consultation report: The use and promotion of complementary and alternative medicine: making decisions about charitable status. A Charity Commission report presents an overview of the responses received to its March 2017 consultation on the charitable status of complementary and alternative medicines. The review is ongoing and the outcome of the consultation is expected during the first half of 2018.

News

Review into harassment and intimidation near abortion clinics. Home Secretary Amber Rudd has ordered an in-depth assessment of protests outside family planning clinics, following concerns about the tactics used by some demonstrators, before considering what action can be taken to protect those using or working in abortion clinics. The Government has stated that this could include "bolstering existing or creating new police and civil powers".

Medical training too reliant on doctors' goodwill, says GMC. Education and training for doctors is too reliant on the goodwill and sacrifices made by senior colleagues who act as trainers, the General Medical Council (GMC) warns.

Most children and young people report good experiences of hospital care. The results of the 2016 children and young people’s survey published show that the majority of children and young people who stayed in hospital overnight or were seen as a day case patient were happy with the care they received

Doctors call for updated law on egg freezing. The British Fertility Society has urged the Government to change the law on freezing eggs in order to avoid thousands of women having their eggs needlessly destroyed, adding that the current 10-year limit on storing eggs for women wishing to preserve their fertility was "arbitrary" and failed to take into account new technology. 

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

Back to top