06/01/2020

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

Finance

Knowledge Transfer

Inquests

Acute and emergency care

Mental Health

Children

Primary Care

Clinical Risk/Patient Safety

Providers

Commissioning

Public Health

Digital Health

Regulation

Employment/HR

Social Care

 

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 

Bevan Brittan Events

Patient Safety: Proactive and Reactive Seminars
21.01.20 - London
22.01.20 - Leeds
29.01.20 - Birmingham

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 your organisation is a Bevan Brittan client you can sign up to watch the training sessions remotely via our webinar facility.

If you would like to receive the programme for 2020 just ask Claire Bentley.  

Knowledge Transfer

Training. In addition to our free training programme for 2019, 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.  

Liberty Protection Safeguards - If you are interested in being sent updates about this important area please contact Claire Bentley

Back to top 

Acute and emergency care

Publications and guidance

Fifth patient report of the National Emergency Laparotomy Audit (NELA): December 2017 to November 2018 Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, the report analyses the care received by close to 25,000 emergency bowel surgery patients treated in NHS hospitals in England and Wales between December 2017 and November 2018. Among the findings is that time to antibiotics in patients with sepsis remains poor, with 80.6 per cent not receiving antibiotics within one hour. The report is the fifth report of NELA and offers a series of recommendations to reduce variation in the care of patients undergoing emergency bowel surgery.

News

Emergency waiting times reveal strain on England’s NHS. Signs of unsustainable strain in England’s National Health Service emerged as data showed the worst ever performance against a key emergency treatment target and a sharp rise in the number of patients stuck on trolleys for lack of a hospital bed.

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 

Better for women: improving the health and wellbeing of girls and women Too often, women are struggling to get the right information they need about their health, to book routine appointments and to get their basic health needs met. Health services miss opportunities to ask the right questions, prevent illness and ensure the best outcomes for girls and women. This report identifies simple and cost-effective solutions to prevent girls and women falling through the cracks of our health systems.

Connecting up the care: supporting London’s children exposed to domestic abuse, parental mental ill-health and parental substance abuse Early neglect and trauma on children can have substantial negative outcomes later on in life. These potentially traumatic events are called adverse childhood experiences (ACEs). This report from the London Assembly Health Committee examines three ACEs that commonly co-occur (domestic violence and abuse, parental mental ill-health, and parental alcohol and drug misuse) to assess how access to and support from services could be improved.

Child death review data collection: submitting data How child death overview panels (CDOPs) should submit information for the Local Safeguarding Children Board (LSCB1) data collection.

Children and young people's experiences of care. The Care Quality Commission has published results of our 2018 children and young people's patient experience survey which reached 33,179 children and young people.

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

Back to top 

Clinical Risk

Publications/Guidance 

Hospital mergers increase death and harm’? Not so fast… In February 2019 the Competition and Markets Authority (CMA) published a working paper on the impact of hospital competition on rates of patient harm in the English NHS. The Health Foundation examined the central conclusion of the CMA paper – that the research provides ‘further empirical evidence that competition ultimately benefits patients’ – finding that this cannot be substantiated from the analysis. This working paper outlines how more rigorous and well-designed research is needed to measure the impact of competition on the quality of care. 

Implementing the recommendations of the Neonatal Critical Care Transformation Review. This action plan to implement the recommendations of the Neonatal Critical Care Transformation Review sets out how the NHS will further improve neonatal care with the support of funding set out in the NHS long-term plan. The recommendations are grouped under the following themes: aligning capacity; developing the expert neonatal workforce; enhancing the experience of families; and making it happen. For each theme, the report summarises the evidence for the change, who needs to do what by when to inform regional commissioning planning processes and decision-making, and what support is available.

Saving lives, improving mothers’ care: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17 This is the sixth annual report produced for the Maternal, Newborn and Infant Clinical Outcome Review Programme, run by the MBRRACE-UK collaboration. The authors analysed 2.3 million pregnancies from 2015-2017 in the UK and Ireland. During that three-year period, 209 women in the UK and Ireland died during their pregnancies or up to six weeks afterwards from pregnancy-related causes. This is equivalent to just over 9 women per 100,000. The leading cause of maternal deaths in the UK is still cardiovascular disease, including heart attacks, heart failure and heart rhythm problems, and there has been no reduction in maternal deaths from heart-related causes for more than 15 years.

National Neonatal Audit Programme (NNAP): 2019 annual report on 2018 data This report highlights the key findings and recommendations from the analysis of the data provided by neonatal units on the admissions of babies for neonatal care in England, Scotland and Wales in 2018. The National Neonatal Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

Paediatric Intensive Care Audit Network annual report 2019: summary report This is the sixteenth annual PICA Net clinical audit report summarising paediatric critical care that took place in the United Kingdom and Republic of Ireland between 2016 and 2018. PICANet continues to provide key information to monitor the quality of care and clinical outcomes in relation to agreed standards, and inform national policy in paediatric critical care.

National Vascular Registry: 2019 annual report This is the seventh annual report since the National Vascular Registry was launched in 2013. It contains comparative information on five major interventions for vascular disease: lower limb bypass; lower limb angioplasty/stenting; major lower limb amputation; carotid endarterectomy; and repair of aortic aneurysms, including elective infra-renal, ruptured infra-renal, and more complex aneurysms.

National Diabetes Audit 2017-18: report 2a – complications and mortality This report from the National Diabetes Audit covers complications of diabetes. The report has been divided into three main sections: cardiovascular complications; diabetes-specific complications; and mortality. Each section aims to address overall rates, time trends, geographical variation and hospital utilisation.

Data on Written Complaints in the NHS 2019-20 Quarter 2  This quarterly collection is a count of written complaints made by (or on behalf of) patients. Data are collected via the KO41a and are for complaints about NHS Hospital and Community Health Services (HCHS) in England.

Bevan Brittan Events

Patient Safety: Proactive and Reactive Seminars
21.01.20 - London
22.01.20 - Leeds
29.01.20 - Birmingham

Bevan Brittan 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 your organisation is a Bevan Brittan client, you can sign up to watch the training sessions remotely via our webinar facility. If you would like to receive more information about the webinars just ask Claire Bentley. 

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

Back to top 

Commissioning   

Publications/Guidance 

RightCare and Imperial Health College Partners have developed a high impact intervention tool to help commissioners to measure the value of identifying and treating patients with atrial fibrillation. The tool can help weigh the effectiveness of screening and treatment-based options. Health systems can use this tool to manage atrial fibrillation in their population to reduce the risk of strokes.

Collaborative commissioning for sexual health, reproductive health and HIV: a review of 4 areas In 2016, Public Health England (PHE) and partner agencies undertook a survey of sexual health, reproductive health and HIV commissioning, and published an accompanying action plan. One of the key actions was to support two pilot areas in developing collaborative approaches. PHE has undertaken an evaluation of these two areas and two other areas that had adopted a collaborative approach to commissioning. This review provides a summary of the evaluation and the existing frameworks that can support collaborative working. The slide set details the methodology and findings from this qualitative evaluation.

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

Back to top

Digital Health

Publications/guidance

Getting started with NHS login: the patient journey This guide for health and care staff will help you to help patients access health and social care services that use NHS login.

News

NHS staff have to remember 15 different logins under 'outdated' IT system. The Health and Social Care Secretary has announced £40 million of funding to overhaul NHS computer systems. The work will include the creation of a new unified login system to make it easier for staff to access the multiple systems needed to carry out daily tasks.

AI 'outperforms' doctors diagnosing breast cancer. A new study has found that artificial intelligence is more accurate than doctors at diagnosing breast cancer from mammograms.

 

If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.

Back to top 

Employment/HR  

Publications/guidance

Whistleblowing disclosures report. The General Medical Council (GMC) has joined with seven other healthcare professional regulators to publish an annual report on whistleblowing disclosures. The report covers the 12 months from April 2018 to March 2019 and shows that the GMC received 35 whistleblowing disclosures during that period. This was an increase on the previous year when 23 concerns were raised.

Junior doctors 2018 contract refresh guidance This guidance, published in partnership with the British Medical Association, aims to support employers to appoint and develop flexible training champions. The champion will play a strategic role in promoting and improving existing support for less than full-time trainee doctors and dentists, advocating for them where necessary. The ultimate intention behind the introduction of the role was to create a shift in culture within the NHS, to give trainees more flexibility, and to offer them support as they carry out their training and other commitments they may have.

Improving joy at work: electronic self-rostering After hearing from staff that offering flexibility and choice of shifts would improve their work-life balance, the Royal Free London NHS Foundation Trust introduced an electronic self-rostering system. It provided support and training to members of staff to help utilise the system to its fullest potential. The trust has seen a reduction in both vacancy and turnover rates since the introduction, alongside comments from staff expressing its benefit to their work-life balance.

The state of medical education and practice in the UK: 2019 This report highlights changing approaches to work-life balance and career development that impact on UK health services’ ability to plan for patient demand. Against a backdrop of rising workloads and the need to recruit and retain a sustainable medical workforce, the report finds doctors moving away from traditional career and training paths. Among notable trends is the rise in the number of doctors choosing to spend time working as a locum, practising medicine abroad, or even taking a year out, rather than going straight into specialty or GP training after the completion of their initial training.

People performance management toolkit: communications pack NHS Employers has refreshed the communications pack for its people performance management (PPM) toolkit. The pack contains key messages for HR and internal comms teams to help promote the toolkit with managers in their organisations. It is one of NHS Employers' most popular resources and includes practical support for both new and experienced managers, including tips on where to start with line management, how to work with both underperforming and exceptional staff and advice on how to give constructive feedback. It also features a number of different management scenarios and can help identify solutions to the challenges most relevant to staff.

Falling short: the NHS workforce challenge This report analyses the changes in the size and composition of the NHS workforce in England in the context of long-term trends, policy priorities and future projected need. It builds on previous reports to provide analysis of longer-term trends and insights into the changing NHS staff profile. It focuses specifically on the NHS workforce issues that have been identified in recent years: nursing shortages, and shortages of staff in general practice and primary care.

Bevan Brittan Updates

Paying Tax on Pension Savings – the NHS Pension Scheme and Beyond

If you wish to discuss any employment issues generally please contact Jodie Sinclair, Alastair Currie or James Gutteridge.

Back to top 

Finance 

Publications/Guidance

The 2019 voluntary scheme for branded medicines pricing and access: payment percentage for 2020 The 2019 voluntary scheme for branded medicines pricing and access is an agreement between the Department of Health and Social Care and the Association of the British Pharmaceutical Industry on getting the best value and most effective medicines into use more quickly. The voluntary scheme payment percentage for 2020 will be 5.9 per cent. This document sets out how the level was calculated.

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

Back to top

Inquests  

Publications/guidance

Overview report of what is known about the deaths of people on post custody supervision following release from prison. The report, by Dr Jake Phillips of Sheffield Hallam University and Rebecca Roberts of INQUEST, highlights the lack of visibility and policy attention given to this growing problem and calls for immediate action to ensure greater scrutiny, learning and prevention.

News

Coroner warns NHS England of the underappreciated side effects of clozapine. Katharine Stamp died whilst detained under the Mental Health Act as a result of sudden cardiac arrhythmia due to hypoxia. Hypoxia was the result of a combination of physical health factors including aspiration pneumonia and probable sleep apnoea which was linked to obesity, smoking and the effects of clozapine on her respiratory system. The Coroner returned a narrative conclusion. He said the side effects of Clozapine "may be rare but they are important," adding that he would write to NHS England "so that awareness is raised". The Coroner has written to NHS England by way of a Prevention of Future Deaths Report and has noted that the side-effects of clozapine, with specific reference to smoking and pneumonia, are under-appreciated. He has noted that the British National Formulary does not currently provide sufficient clarity to prescribers about these side-effects.

Dispute arises after MoJ official denies legal aid to bereaved relatives who have resorted to crowdfunding for inquest representation. Internal Ministry of Justice documents revealing an official denying legal aid to any bereaved crowdfunding relatives have opened up a dispute over who pays for representation at inquests. Email trails obtained by the charity Inquest highlight conflict over the MOJ’s refusal to pay automatically for representation in cases where state agencies have been involved in a death.

The NHS 111 helpline for urgent medical care is facing calls for an investigation after poor decision-making was linked to more than 20 deaths. Since 2014, Coroners have written 15 Prevention of Future Death Reports involving NHS 111. There have been five other cases where inquests heard of missed chances to save lives by NHS 111 staff; two other cases are continuing and one was subject to an NHS England investigation. The latest coroner’s report issued to prevent further deaths was published in November. It concerned Myla Deviren, 2, from Peterborough, who died from an intestinal blockage in August 2015. Myla’s mother Natalie, 31, spoke for 40 minutes to NHS 111, describing symptoms from sickness to a lack of lip colour, and was finally assured by an out-of-hours nurse that it was gastroenteritis. Hours later Myla was found unconscious, taken to hospital and pronounced dead.

If you wish to discuss any queries you may have around inquests please contact Toby De Mellow.

Back to top

Mental Health 

Cases

Z, Re [2019] EWCOP 55 An application by JK, the son of Z, for access to various court documents and expert reports relating to declarations made in November 2018. JK was not a party to those proceedings (even though he could have been) and Morgan J had found that Z lacked capacity to manage his property and financial affairs. Application refused.

A Local Health Board v JK [2019] EWHC 67 (Fam) The court considered an application by a local health board in relation to a 55-year-old prisoner with autism who had been detained under the Mental Health Act 1983 s.48 and was refusing to eat. It was asked to consider possible future treatment options, and in particular whether it would be lawful to force feed him pursuant to s.63.

News

Death review backlog still growing despite NHSE commitment. A backlog of thousands of deaths of people with learning disabilities awaiting official review has grown further, despite NHS England committing in spring last year to “address” the buildup. 

Outrage at NHSE decision to delay new medication reviews. People with learning disabilities or autism will continue to suffer “serious side-effects” amid further delays to a national programme aimed at stopping overuse of medicines to control their behaviour, a former national clinical director has warned.

Bevan Brittan Updates

Case Summary: JK v A Local Health Board [2019] EWHC 67 (Fam) - Hannah Taylor

Bevan Brittan Events

Patient Safety: Proactive and Reactive Seminars
21.01.20 - London
22.01.20 - Leeds
29.01.20 - Birmingham

Bevan Brittan Mental Health Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If your organisation is a Bevan Brittan client you can sign up to watch the training sessions remotely via our webinar facility.

How can we help?

Fixed fee training packages. We have devised a two-part fixed fee training package to ensure mental health professionals are up to speed with their duties and to enable key managers to proactively manage caseloads. We regularly deliver these sessions to provider and commissioner organisations, including their partner agencies. If you would like more information click here.

Early Intervention Scheme and Triage. Our EIS allows us to help commissioners, providers and care co-ordinators identify packages of care and treatment interventions, for people who lack capacity, that need an appropriate legal framework. If you would like more information click here.

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 Hannah TaylorSimon Lindsay or Stuart Marchant

Back to top 

Primary Care  

Publications/guidance

National general practice profiles: 2019 annual update Public Health England has published national general practice profiles. These are designed to support GPs, clinical commissioning groups (CCGs) and local authorities to commission effective, appropriate healthcare services for their local populations.

Five tips for successfully leading a primary care network Drawing on their work with emerging PCNs, Tricia Boyle and Beccy Baird offer five suggestions that could support those involved in developing these new networks.

If you wish to discuss any issues involving primary care please contact Vincent Buscemi.

Back to top   

Providers 

Publications/Guidance  

Opportunities to embed sexual and reproductive healthcare services into new models of care: a practical guide for commissioners and service providers More than 50 strategies and operational plans were reviewed for this audit, with results showing that few areas have explicitly recognised the opportunity to embed sexual and reproductive health care services in their plans. Other areas of sexual and reproductive health such as psychosexual services and menopause were not present in the majority of plans.

A place to work: system approaches to workforce challenges in the NHS This briefing examines how trusts are working with their staff and local partners to enable the workforce to adapt to new ways of collaborative working.

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

Back to top 

Public Health 

Publications/guidance

Immunisations: applying All Our Health This guidance contains examples to help health and care professionals make interventions to promote the benefits and increase uptake of immunisations.

NHS public health functions agreement 2019-20: public health functions to be exercised by NHS England This agreement sets out the arrangements under which the Secretary of State delegates responsibility to NHS England for certain public health services. The services currently commissioned in this way are: national immunisation programmes; national population screening programmes; Child Health Information Services; public health services for adults and children in secure and detained settings in England; and sexual assault services.

News

Tens of thousands unaware they have deadly hepatitis C infection Report estimates that around two-thirds of people living with hepatitis C may not realise they have the virus, with PHE urging those at risk to get tested.

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

Back to top 

Regulation 

Publications/Guidance

Whistleblowing disclosures report. The General Medical Council (GMC) has joined with seven other healthcare professional regulators to publish an annual report on whistleblowing disclosures. The report covers the 12 months from April 2018 to March 2019 and shows that the GMC received 35 whistleblowing disclosures during that period. This was an increase on the previous year when 23 concerns were raised.

Bevan Brittan Updates

CQC Registration of Agencies- Carlton Sadler

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

Back to top

Social Care  

Publications/Guidance  

Children and young people's experiences of care. The Care Quality Commission has published results of our 2018 children and young people's patient experience survey which reached 33,179 children and young people.  

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

Back to top