Health and Social Care Update June 2015

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 you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

Care	Information Sharing
Clinical Risk/Health and Safety	Mental Health
Commissioning	Primary Care
Emergency Care	Public Health
Employment/HR	Regulation
Foundation Trusts	General

Care

Publications/guidance
Care Act first-phase reforms. This NAO report scrutinises the DH's implementation of the first phase of the Care Act 2014. it finds that the DH has implemented it well, with 99 per cent of local authorities confident that they would able to carry out the Act reforms from April 2015. However, the NAO warns that the DH’s cost estimates and chosen funding mechanisms have put local authorities under increased financial risk given the uncertain level of demand for adult social care. The report finds that the DH consulted carefully on the Act, to understand the main risks and respond to sector concerns, and there is wide support for the Act. Local authorities identified two big risks: cost and, secondly, uncertain additional demand from self-funders and carers. The DH may, however, have underestimated the demand for assessments and services for carers.

'State of Support' – Local Healthwatch finances. This report outlines the funding that each local Healthwatch has received to deliver their statutory activities. The findings show that while the reasons for funding reductions are often not clear, the most significant funding reductions include those in areas where health and care budgets and services are under pressure. Healthwatch is concerned that in certain areas health and social consumers could be left without a strong voice and it has written to a number of councils where significant reductions in local Healthwatch funding have been reported. It urges those councils that have decided to impose severe cuts to outline why they have made this decision and how they will ensure the public are provided with the voice they need to influence the big decisions around how local health and care services are delivered.

Adult social care efficiency tool. This updated tool tool provides a basis for comparing spending and outcomes between councils and helps directors of adult social services and local authority financial leads to find new opportunities for improving adult social care efficiency. It identifies similar areas (or ‘statistical neighbours’) for adult social care delivery for older people and working age adults with learning disabilities. Local authorities can use it to assess their own performance, and to identify where different approaches in comparable local authorities may provide examples to learn from.

Consultations
Social care of older people with complex care needs and multiple long-term conditions. NICE is seeking views on draft guidelines on how person-centred social care and support for older people with multiple long-term conditions should be planned and delivered. It addresses how those responsible for commissioning, managing and providing care for people with multiple long-term conditions should work together to deliver safe, high-quality services that promote independence, choice and control. The consultation closes on 13 July 2015. 

News
£6m to help older people live independently in their home. The Welsh Minister for Communities and Tackling Poverty has announced £6m investment to help older people in Wales live independently in their own home. The funding supports the essential work of the Care and Repair service, which provides adaptations, such as ramps, handrails, and safety alarms, to enable older people to live safely in their own homes. It includes £2m for the Rapid Response Adaptations Programme, which provides minor adaptations to help prevent many people from having to be admitted to hospital and enable those who are in hospital to be discharged earlier.

Woman receives £27,000 following LGO investigation into care package. A woman who was left without the correct care package for over a year after she had both legs amputated has been awarded more than £27,000, following a joint investigation by the Parliamentary and Health Service Ombudsman and the Local Government Ombudsman. A dispute between Sheffield City Council and Sheffield Health and Social Care NHS Foundation Trust meant she was forced to fund her own care.

Health needs of older people: apply for business funding. Innovate UK is inviting businesses and other organisations to apply for a share of £1m funding from NHS England to develop ideas that can address challenges facing older people with multiple-morbidities and specifically in the problem areas of: Falls, Incontinence and Decline in Functional Ability. Up to 12 contracts could benefit from £100,000 phase 1 product development funding through SBRI Healthcare. This competition is open to single companies or organisations from the private, public and third sectors, including charities. The deadline for applications is noon on 11 August 2015.

Terminally ill children let down by poor end-of-life care. Research by the Royal College of Nursing has found that terminally ill children are being let down by a lack of staff, training and resources in children’s community health services. A UK-wide survey of children’s nurses found that many children are not being given the choice to die at home as there are not enough trained staff to provide 24/7 care in this setting. 

Bevan Brittan Articles
The care regulatory regime ensuring you are well-led. Meeting the quality and workforce challenges.

Travel time as "working time" If you engage workers who need to travel from home in order to carry out their work – for example, community based or care workers who drive from their homes to see patients – you will need to be aware of a new Spanish case which has suggested that time spent:

• travelling to the first appointment of the day, and
• returning from the last appointment of the day

may count as 'working time' for the purposes of the EU Working Time Directive ('the Directive'). 

The Care Act 2014: Promoting well-being, safeguarding vulnerable adults and funding The care system landscape in the UK changed with the implementation of the Care Act 2014 on 1 April 2015. It has been heralded by the Department of Health as the 'most significant reform of care and support in more than 60 years' and can be regarded as the most systematic and complete set of changes to adult social care legislation since the Beveridge Reforms of the 1940s. The Care Act places a series of new duties and responsibilities on local authorities about care and support for adults. It also creates a consistent route to establishing an entitlement to public care and support for all adults with needs for care and support. In addition, it produces the first ever entitlement to support for carers, on a similar basis.

Urgent and Emergency Care Vanguards NHS England has launched the Urgent and Emergency Care Vanguard Programme following Professor Sir Bruce Keogh's Urgent and Emergency Care Review. 

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

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Clinical Risk/Health and Safety

Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.

Publications/Guidance
Ensuring the NHS is safely staffed. England’s Chief Nursing Officer, Jane Cummings, has written to Nursing Directors, CCGs, ALBs and other stakeholders about the next steps in ensuring the NHS is safely staffed.

Openness and honesty when things go wrong: the professional duty of candour This guidance, developed in collaboration with the Nursing and Midwifery Council, sets out what is expected of every nurse, midwife and doctor practising in the UK when something goes wrong.

Public service markets: putting things right when they go wrong. Over 10m people who used public services (approximately 1 in 5) in the UK last year faced problems when using those services, according to this report by the National Audit Office. The problems ranged from fairly straightforward issues, such as types of food in care homes, to serious and life-threatening safeguarding issues. The report says that consumers find the complaints and redress system confusing, that they have to deal with many different organisations, and that they have a low awareness of which ones to turn to. It finds that system-wide improvements are inhibited by poor central leadership and that public service organisations do not make enough use of complaints to improve services and there are serious impediments to doing so.

Every complaint matters – A seven-point plan for the NHS and social care. Healthwatch has published a seven-point action plan to help ensure that the complaints system gives patients what they need and ensures the NHS and social care services can learn from their mistakes. Its analysis suggests as many as 2,000 incidents a day across the NHS are going unreported as a result, with the number likely to be much higher when users of social care are factored in.

Report on selected summaries of investigations by the Parliamentary and Health Service Ombudsman. This report contains a snapshot of summaries of the complaints the Ombudsman has investigated over a two month period (October and November 2014), during which it upheld 41 per cent of the complaints it investigated. Approximately 80 per cent of investigations are about the NHS in England as opposed to UK government departments and their agencies. During this two month period, most of the NHS investigations were about hospital trusts, followed by GP practices and then mental health trusts. 

Litigants in person: new guidelines for lawyers. These guidelines have been prepared jointly by the Bar Council, CILEx and the Law Society and offer practical advice for lawyers who face litigants in person in the civil courts and tribunals. The guidelines discuss the relationship between the client's interest and the interests of the administration of justice, and the extent to which a lawyer can properly provide assistance to a litigant in person. The guidelines also discuss the role of McKenzie Friends.

Safeguarding NHS staff from violent and aggressive patients. This updated guideline on the management of violent and aggressive behaviour in people with mental health problems covers the short-term management of violence and physically threatening behaviour in psychiatric settings, emergency and urgent care services, assertive community teams, community mental health teams and primary care.

What do people think about complaining? The results of this survey shows that just one-third of people that are unhappy after using a public service actually make a complaint, despite an overwhelming number feeling that they should.

The Health Foundation's free online resource centre has a new maternity section with tools for the delivery of safe and reliable care.
A discussion paper by Professor Cathy Warwick CBE on leadership in maternity services
Safe staffing in midwifery care: gathering data and learning lessons with Birthrate Plus
Training for managing shoulder dystocia using the PROMPT approach
How to detect maternal deterioration during both the antenatal and peripartum periods
Practical approaches to recognising domestic violence in pregnancy
Intrapartum fetal monitoring: overview, controversies and pitfalls
Video: The perinatal mental health scorecard project

Consultations
Guidance for all doctors who offer cosmetic interventions – a public consultation on our draft guidance. The draft guidance from the GMC sets out the standards that expected from doctors who practise in this area. Patients, the public and other professionals who offer cosmetic interventions may also find it a useful explanation of the standards that we expect from doctors.

MHRA survey on safety communications. A survey of healthcare professionals by the Medicines and Healthcare Products Regulatory Agency (MHRA) asks for feedback on how it communicates safety issues about medicines. The survey asks healthcare professionals about their understanding of safety communications and how effective they are perceived to be, and how professionals prefer to receive this information.

News
Clampdown on lawyers overcharging NHS in clinical negligence cases. Government plans to save NHS £80m a year by capping legal fees that in some cases run as high as 10 times the amount paid in compensation to clients.

NHS clinical negligence costs under the scalpel. The Government is to try and reduce the costs of clinical negligence claims against the NHS, through measures including fixed costs, according to a Department of Health spokeswoman, speaking after the publication of Lord Carter's Review of Operational Productivity in NHS providers.

Hospital trust failed to control legionella spread. Brighton and Sussex University Hospitals NHS Foundation Trust has been prosecuted for endangering patients through failing to control legionella. The Trust was fined £50,000 with costs of £38,705.60 after a joint investigation by the Health and Safety Executive (HSE) and Sussex Police identified a history of failing to manage the deadly waterborne bug.

Bevan Brittan Events
Duty of Candour - the Update. 08 July 2015 : 09:30 - 11:30 (registration opens at 09:15) Location: Bevan Brittan LLP, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. Carlton Sadler, will lead this update on the duty of candour.  Carlton has considerable experience arising from his involvement in the Mid Staffs Inquiry and will consider:

• Openness, Candour, and Transparency – the linked initiatives
• Candour Duties – Contractual, Statutory and Professional – the creeping threshold and inter-relationships
• Practical steps to comply with the Duties
• How CQC inspect candour. register your interest in this event

Briefing: The Care Act and Market Shaping – Implications for Care Providers. 15 July 2015 : 17:00 - 18:00 (registration will open at 16:30, the briefing will be followed by a networking drinks reception) Location: Bevan Brittan LLP, Interchange Place, Edmund Street, Birmingham , B3 2TA. The Care Act sets a new landscape for the commissioning of social care.  Whilst local authority fee pressures continue and the funding reforms may have knock-on implications for self-funded service users, the Act also presents a range of opportunities; the duties to prevent and delay needs for care and support and to promote integration with health services provide opportunities for providers at both ends of the dependency continuum.  This briefing will help providers understand the implications of local authorities' new duties and how they can best position themselves bearing in mind local authorities' roles in promoting diversity and quality in the market.  register your interest in this event

If you wish to discuss any clinical risk or health and safety issues please contact Joanna Lloyd or Stuart Marchant.

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Commissioning

Publications/Guidance
Options for integrated commissioning: Beyond Barker. The independent Commission on the Future of Health and Social Care in England, chaired by Kate Barker, recommended a new settlement based on a single ring-fenced budget and a single local commissioner. This report from The King's Fund explores the options for implementing that recommendation. It assesses evidence of past joint commissioning attempts, studies the current policy framework and local innovations in integrated budgets and commissioning, and considers which organisation is best place to take on the role of single local commissioner. The paper draws together findings from a body of work including a survey of existing joint arrangements, current evidence and examples, a seminar with pioneers of integration developments, and a national conference on integrated commissioning.

Outcome-based payment schemes – Government’s use of payment by results. This report from the NAO examines the Government's growing portfolio of payment by results (PbR) schemes where payment depends, at least in part, on the provider achieving outcomes specified by the commissioner, including welfare to work, family support, offender rehabilitation, and international aid. It finds that without a common source of shared expertise and a strong evidence base, PbR schemes may be poorly designed and implemented, and commissioners are in danger of reinventing the wheel for each new scheme. It concludes that while PbR may offer value for money, these contracts are hard to get right, which generates risk and cost for commissioners. If PbR can deliver benefits such as innovative solutions to intractable problems, then the increased risk and cost may be justified, but this requires credible evidence. Without such evidence, commissioners may be using this mechanism in circumstances to which it is ill-suited, to the detriment of value for money.

Local estates strategies: A framework for commissioners. This framework explains how CCGs and their partners can create strategic estate plans that cover primary, community and non-clinical estates. It advises that commissioners should produce high quality local estates strategies in collaboration with a wide range of local stakeholders (including the wider public estate). The formation of a Local Estates Forum (LEF) will be key to developing a sufficiently robust understanding of the available estate and aligning it to commissioning intentions to extract maximum value from NHS resources and reduce wastage.
The DH and NHS England have asked Community Health Partnerships and NHS Property Services to help unlock space and value across the NHS estate and create the infrastructure to deliver new models of care. Both organisations already offer expert strategic estates planning services to NHS commissioners and this is now being tailored to meet the challenges set out in the national blueprint, the Five Year Forward View.

Transforming our health care system: Ten priorities for commissioners. This updated King's Fund paper, originally published in March 2011, sets out how health care commissioners must shift the current emphasis on acute and episodic care towards prevention, self-care and integrated and well co-ordinated care to cope with an aging population and increased prevalence of chronic diseases. And they will need to direct resources to the patients with greatest need and redress the 'inverse care law' by which those who need the most care often receive the least.

Consultations
Is the NHS Standard Contract a barrier to commissioning VCSE organisations? Regional Voices has been told that voluntary, community and social enterprise (VCSE) organisations find the NHS Standard Contract a barrier to having their services commissioned by the NHS. Consequently NHS chief, Simon Stevens, has committed to exploring a shorter version of the NHS Standard Contract for low-value contracts. Regional Voices, with NHS England, has launched a survey to help understand specific issues which organisations have experienced in using the NHS Standard Contract. The survey closes on 27 July 2015. 

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

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Emergency Care

Publications/Guidance
The forward view into action: Registering interest to join the Urgent and Emergency Care Vanguard. NHSE is inviting expressions of interest from organisations and partnerships across England to become vanguard sites for a further new care model focusing on urgent and emergency care. The successful applicants will form the fifth group within the overall New Care Models Programme. The programme will deliberately focus on leading-edge systems that are making the strongest progress and those local health systems experiencing the very greatest operational challenges, e.g. on the A&E 4 hour standard. This document sets out the registration criteria and application process. The closing date for applications is 15 July 2015.

Time to act – Urgent care and A&E: the patient perspective. The Royal College of Emergency Medicine and the Patients Association has published a joint report on the choices, decisions and experiences of patients who accessed A&E services for urgent healthcare needs. The findings demonstrate that the NHS not only needs to ensure that patients are fully informed of services such as out-of-hours GPs, walk-in centres and the NHS 111 service, but must also ensure that these services have sufficient capacity and are available when required. Unless this issue is addressed, we will continue to see more pressure on an already overstretched A&E system.

News
Foundation trusts face challenging year as pressures mount. Monitor reports that FTs treated 10.7m emergency in-patients between April 2014 and March 2015, a 574,000 increase on the previous year. In addition, there was also a significant increase in non-emergency patients. However, this increase in demand for care, combined with an over-reliance on expensive agency staff and the need to make cost savings, is putting trusts under sustained and exceptional pressure. Overall, the 152 FTs missed a number of national waiting times targets for A&E, routine operations and some cancer treatments for the entire year. The sector also ended 2014/15 in deficit (-£349m) for the first time, in a further sign of the increased pressures upon services.

Bevan Brittan Articles
Urgent and Emergency Care Vanguards NHS England has launched the Urgent and Emergency Care Vanguard Programme following Professor Sir Bruce Keogh's Urgent and Emergency Care Review.  

If you wish to discuss the issue of emergency care please contact Claire Bentley.

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Employment/HR

Publications and Guidance
Re-tendering: NHS Pension Scheme. This guidance sets out the process for ensuring bulk transfer arrangements are in place when an NHS organisation is re-tendering for the provision of services. This will involve staff transferring back into the NHS Pension Scheme via the terms of New Fair Deal. It supplements HM Treasury’s detailed New Fair Deal guidance.
See also NHSPS and NHSPS 2015 (England and Wales) that sets out actuarial assumptions for bulk transfer calculations from or to funded schemes.

RCN lone working survey 2011. This RCN survey finds that almost half of nursing staff based in the community have been subjected to abuse during the last two years. 63% of staff have reported abuse in the last two years, but 45% of those staff said that no action was taken to address the situation. Almost half of staff (46%) said that risk assessments were carried out rarely or never, and astonishingly less than 4% said they always had adequate information about those they were due to visit. Only a third (34%) have had personal safety training, and only 13% have access to a lone worker protection device, which is worn when working alone and which can raise the alarm if the staff member feels under threat. These were launched in 2009 in England and were initially government funded but many staff have reported that they have now been withdrawn as a cost cutting measure.

Evaluating the evidence on employee engagement and its potential benefits to NHS staff: a narrative synthesis of the literature. The objective of this research was to evaluate evidence and theories of employee engagement within the NHS and the general workforce to inform policy and practice. Four research questions focused on definitions and models of engagement; the evidence of links between engagement and staff morale and performance; approaches and interventions that have the greatest potential to create and embed high levels of engagement within the NHS; and the most useful tools and resources for NHS managers in order to improve engagement.

Hospital competition improves performance. This report shows that hospital competition can improve healthcare by improving the quality of management practices. The research measured the management quality of 100 public hospitals through a management survey of clinicians and managers, and used data published by the government to assess the performance of NHS hospitals in England.

The impact of competition on management quality: Evidence from public hospitals. This report from the Centre for Economic Performance shows that hospital competition can improve healthcare by improving the quality of management practices. The research measured the management quality of 100 public hospitals through a management survey of clinicians and managers, and used data published by the government to assess the performance of NHS hospitals in England.

Ensuring the NHS is safely staffed. England’s Chief Nursing Officer, Jane Cummings, has written to Nursing Directors, CCGs, ALBs and other stakeholders about the next steps in ensuring the NHS is safely staffed.

Staff engagement outside the NHS. Whilst the NHS has a staff engagement record to be proud of, it is beneficial for NHS organisations to be aware of staff engagement strategies formed in other sectors and learn from their experiences. This briefing explores how organisations outside of the NHS have sought to develop and sustain staff engagement strategies, focusing on key sectors such as transport, finance, manufacturing and education.

West Midlands Ambulance Service NHS Trust - Improving health and wellbeing across 5,000 square miles. This case study looks at how the Ambulance Trust developed a health and wellbeing strategy with a focus on the importance of line managers. This resulted in a reduction in sickness absence of 0.64 per cent. Line managers are regularly trained and receive up-to-date health and wellbeing information. They now give health and wellbeing focused appraisals, providing staff with the opportunity to talk about their health.

News
Clampdown on staffing agencies charging NHS extortionate rates. The Department of Health has announced a number of financial control measures that will help cut NHS costs. These rules will: limit the use of expensive management consultants; set a maximum hourly rate for agency doctors and nurses; ban the use of staffing agencies that are not on approved frameworks; put a cap on total agency staff spending for each NHS trust in financial difficulty; and require approval for any consultancy contracts over £50,000.

GMC plans new unified test for doctors. Plans have been approved to develop a unified assessment for every doctor seeking to practise in the UK, the General Medical Council (GMC) has confirmed. The new assessment would replace the current Professional and Linguistic Assessments Board (PLAB) test and could potentially apply to any doctor joining the medical register. A second phase of work will involve the GMC engaging with stakeholders to identify the format, timing and content of the assessment, which has the working title of the UK Medical Licensing Assessment (UKMLA). A full public consultation will take place before the UKMLA is introduced. 

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

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Finance

Publications and Guidance
CQC to focus on efficient use of healthcare resources. The Care Quality Commission's (CQC) Chief Inspector of Hospitals is to look at the use of resources as part of his inspections of NHS hospitals, following a request from the Secretary of State for Health. The focus of the work will be on organisations' ability to deliver high quality patient care which is also efficient and sustainable, and will be developed as part of CQC's new strategy for 2016 onwards.

News
Clampdown on staffing agencies charging NHS extortionate rates. The Department of Health has announced a number of financial control measures that will help cut NHS costs. These rules will: limit the use of expensive management consultants; set a maximum hourly rate for agency doctors and nurses; ban the use of staffing agencies that are not on approved frameworks; put a cap on total agency staff spending for each NHS trust in financial difficulty; and require approval for any consultancy contracts over £50,000. 

Review of operational productivity in NHS providers. This interim report outlines the work that has been carried out by Lord Carter of Coles to review the productivity of NHS hospitals, working with a group of 22 NHS providers. His report finds that the NHS could save up to £5bn every year by 2020 by making better use of staff, using medicines more effectively and getting better value from the huge number of products it buys. The report provides interim recommendations and next steps. A full report will be published in Autumn 2015.

Payments to healthcare staff suspended from the Performers List. The DH has issued updated guidance on when NHS England should make payments to GPs, dentists and ophthalmic performers who have been suspended from the NHS Performers List.

If you wish to discuss any employment issues please contact Claire Bentley.   

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Foundation Trusts

Consultations
Consultation on changes to the risk assessment framework: June 2015. This consultation proposes a number of measures to strengthen Monitor's regulatory regime so that foundation trusts live within their means and support improvements in financial efficiency across the sector. These changes will enable Monitor to take regulatory action earlier if a foundation trust is in deficit, failing to deliver its financial plan, or not providing value for money.

News
Foundation trusts face challenging year as pressures mount. Monitor reports that FTs treated 10.7m emergency in-patients between April 2014 and March 2015, a 574,000 increase on the previous year. In addition, there was also a significant increase in non-emergency patients. However, this increase in demand for care, combined with an over-reliance on expensive agency staff and the need to make cost savings, is putting trusts under sustained and exceptional pressure. Overall, the 152 FTs missed a number of national waiting times targets for A&E, routine operations and some cancer treatments for the entire year. The sector also ended 2014/15 in deficit (-£349m) for the first time, in a further sign of the increased pressures upon services.

New measures to help NHS foundation trusts adopt best financial practice. Monitor has announced that it is strengthening its regulatory regime for NHS foundation trusts, with a package of measures that set limits on the cost of employing agency staff in hospitals from July, and reviewing any proposed consultancy contracts worth more than £50,000 with immediate effect. The new approach will automatically apply to all FTs found in breach of their licence on financial grounds.

If you wish to discuss any issues relating to foundation trusts please contact Vincent Buscemi

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Information Sharing

Publications/Guidance
Information sharing for social care employers. Government policy has outlined the importance and increasing need for information sharing between organisations at a local level. Everyone working in social care and health should see the use and safe sharing of information as part of their responsibility. This guidance developed in conjunction with Skills for Care demonstrates how employers have started to meet some of the challenges of information sharing. The guidance includes 3 short films showcasing The Centre for Excellence for Information Sharing and the Information Governance Alliance explaining how they can support social care employers to begin to explore this topic.  

If you wish to discuss any of the items raised in the above section please contact Jane Bennett.

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Mental Health

Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.

Publications/Guidance
How can and should UK society adjust to dementia? The Joseph Rowntree Foundation has published a paper that aims to stimulate debate about new ways forward in understanding, and ways to meet the needs of the growing number of people living with dementia. The publication explores the application of the social model of disability to dementia. It looks in detail at what this social model is, and where it has come from, bringing together the authors’ interests in disability and ageing, and training in disability studies and health and social geography.

Mental health crisis review – experiences of black and minority ethnic (BME) communities. The Race Equality Foundation was commissioned by the Care Quality Commission to conduct a series of interviews and focus groups with black and minority ethnic people, in specific areas, who had experience of crisis care. These areas were: Ealing, Lambeth, Northampton, Sandwell and Southampton. This report presents the results of this work and provides an insight into patient experience of mental health crisis care from a BME perspective.

Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. Avoid medication as first resort for challenging behaviour Antipsychotic mediation should only be used in particular circumstances and not as a first resort when managing behaviour that challenges in people with learning disabilities, says NICE.

Smoking cessation in secure mental health settings - Guidance for commissioners. Public Health England guidance provides advice for NHS mental health trusts to develop local action to reduce smoking prevalence and the use of tobacco in secure mental health settings.

Right here, right now – Mental health crisis care review. People undergoing a mental health crisis are not always receiving the appropriate levels of care and support, a report by the Care Quality Commission (CQC) concludes. While the CQC found instances of good care, the report highlights that care often fails to meet patients' needs, and lacks basic respect and compassion. Local providers and commissioners are advised to review their procedures and resolve any issues.

Alzheimer's Disease International Women and dementia: a global research overview. The purpose of this report is to understand the main issues affecting women in relation to dementia from an international perspective. The report examines the effect of gender on three specific groups: women living with dementia; women caring for people with dementia in a professional caring role; women undertaking an informal caregiving role for someone with dementia. It also focuses on cross-cutting issues, including factors affecting women in low and middle income countries; family structures and kinship; and the effects of migration.

News
Court of Appeal says that people without mental capacity must be involved in legal proceedings about their liberty. The Court of Appeal has stated that people who are unable to make decisions for themselves because they lack mental capacity should always be directly involved in court hearings about their personal liberty. In the unusual judgment in Re.X, the Court declined jurisdiction in the case but then set out what it views would have been if it had jurisdiction. The judgment means that streamlined procedures introduced in the Court of Protection should not prevent people who lack capacity from participating in or having legal representation at hearings which affect their liberty.

Fast track sites. NHS England has established five fast-track sites that will test new approaches to re-shaping services for people with learning disabilities and/or autism, to ensure more services are provided in the community and closer to home. The five sites (Greater Manchester and Lancashire; Cumbria and the North East; Arden; Herefordshire and Worcestershire; Nottinghamshire; and Hertfordshire) will bring together organisations across health and care that will benefit from extra technical support from NHS England. The sites will be able to access a £10m transformation fund to kickstart implementation from Autumn 2015.

Brain-injured man's family fights to continue NHS medical treatment. The family of a man said to be in a state of “low awareness” after sustaining a brain injury have launched a legal fight to prevent a health trust from halting treatment that is keeping him alive.

New Law Society scheme for vulnerable clients. The Law Society will be working with members to develop proposals for a new accreditation focusing on the protection of vulnerable clients and the Mental Capacity Act 2005. The scheme aims to enhance the knowledge and expertise of those practitioners who represent vulnerable clients in the Court of Protection, notably elderly clients and those lacking mental capacity.

If you wish to discuss any of the items raised in the above section please contact Simon Lindsay or Stuart Marchant. 

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Primary Care

Publications/Guidance
Registration requirements for GP practices collaborating to provide a greater range of services (federations). Groups of registered GP practices and primary care teams, sometimes known as federations, are increasingly collaborating, either by a formal or informal association of practices that work together to provide a greater range of services or to share knowledge. This guidance will help groups of registered providers who wish to form a federation to understand their duties and responsibilities about the registration requirements. It summarises the issues that federations should consider and provides case studies to illustrate different registration scenarios.

Improving GP services: commissioners and patient choice. This report from Monitor presents the findings of a review into how GP services are working for patients, with a specific focus on the role of choice and competition. The review drew on a variety of sources of evidence; a commissioned survey of 3,200 patients, interviews with 25 GP providers and spoke to and gathered information from NHS England, CQC and other stakeholders.

Primary care co-commissioning submission and approval process for 2015/16. Information on the application process and key dates for CCGs who wish to apply in 2015/16 to take on new delegated and joint commissioning arrangements for the majority of GP services. The deadline for applications by CCGs for fully delegated commissioning of primary care in 16/17 is 2 October 2015. For joint commissioning arrangements, there are go-live dates of 1 October 2015, 1 January 2016 and 1 April 2016.

A blueprint for building the new deal for general practice in England. Sets out the RCGP's comprehensive plan for the future of general practice. It includes five actions for the new government to consider: investment of 11% of the budget in general practice; increasing the workforce; free-up GPs time for patient care; allow time for GPs to innovate; and improve GP premises.

News
New deal for general practice. The Health Secretary Jeremy Hunt has announced the first steps in a new deal for general practice, so as to improve the quality and continuity of care for vulnerable patients and deliver better access, 7 days a week, for everyone. This includes:

• increasing the primary and community care workforce by at least 10,000, including an estimated 5,000;
• more doctors working in general practice, as well as more practice nurses, district nurses, physicians’ associates and pharmacists;
• significant improvements in the quality of primary care facilities;
• new models of care to deliver access 7 days a week;
• more support for community pharmacists;
• developing better data and metrics to assess quality in general practice; and reducing bureaucratic burdens on general practice to release more clinical time for patients.

NHS dentist access: real choice is out of reach. Research by Which? reveals that 31% per cent of NHS dentists who say they’re accepting new patients on the Government's NHS Choices are actually not, and those that are often have lengthy waits. The findings came from a mystery shop to uncover the true state of NHS dentist availability, after the consumer body's campaign to Clean Up Dental Costs revealed the difficulties that some people face when trying to find an NHS dentist.

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

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Public Health

Publications/Guidance
Public Health England: health and justice report 2014. This report details the important changes in the health and justice system and discusses the public health needs of people in prisons and other prescribed places of detention. It found that this group experienced a number of health inequalities, including suffering a higher burden of chronic illnesses, mental health and substance misuse problems than the general public. It argues that improving health in prisons can help deal with entrenched inequalities, ultimately benefiting the health of the communities to which the majority of prisoners return, while tackling substance misuse problems in prisons also helps to reduce re-offending rates.

English devolution – Local solutions for a healthy nation. This publication was commissioned by the LGA to capture the thoughts of councillors, DPHs, providers, commissioners, academics and other key opinion formers on the challenges and opportunities devolution could bring in terms of improving the public's health. It calls for more devolution to local areas, which can bring economic, political and social benefits to communities across the country.

Sexual health commissioning in local government. The LGA has published nine case studies that showcase local government experience of commissioning sexual health services since taking over this responsibility in April 2013. The studies demonstrate how commissioners have grasped the opportunities of having a local government base. They outline the steps taken to collaborate not only within and between local authorities but also with NHS England and CCGs.

Operating Model for PHE Screening Quality Assurance Service: 2015/16 to 2017/18. This document sets out the role and purpose of PHE's screening quality assurance (QA) service, providing a common approach for all NHS screening programmes.

Oral health and homelessness: Guidance for community nurses. The Queen's Nursing Institute has launched guidance for community nurses about how to support people who are homeless to improve their oral health. It covers the specific oral health risks and needs of people who are homeless and includes useful advice nurses can give to re-connect patients with community dentists, to address fears and phobias, and to give practical advice for patients about looking after their teeth.

Heatwave Plan for England. PHE and the DH have issued the latest Heatwave Plan for England that aims to prepare for, alert people to, and prevent, the major avoidable effects on health during periods of severe heat in England. It recommends a series of steps to reduce the risks to health from prolonged exposure to severe heat for: the NHS, local authorities, social care, and other public agencies; professionals working with people at risk; and individuals, local communities and voluntary groups. 

NHS public health functions (Section 7A) and co-commissioning of primary medical services. Guidance for teams co-commissioning public health with CCGs on the practical management of commissioning public health in a co-commissioning environment, where legal responsibility for Section 7A services remains with NHS England. The document is intended to support effective relationships between CCGs and integrated regional teams for public health commissioning. It also highlights the role of professional experts, including screening and immunisation leads, in providing advice to CCGs. 

If you wish to discuss any queries you may have around public health please contact Olwen Dutton.   

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 Regulation 

Publications/Guidance
Good decision making: fitness to practise hearings and sanctions guidance. The General Pharmaceutical Council has published new guidance to help the Fitness to Practise Committee decide what sanction is appropriate in particular cases. The guidance also explains how fitness to practise hearings work, how decisions are made and the sanctions which the committee can impose. It will come into effect on 20 July 2015 and will replace the indicative sanctions guidance currently used by the Fitness to Practise Committee.

 Statement on CQC's roles and responsibilities for safeguarding children and adults Following legislative changes and the introduction of our new inspection regime for health and adult social care services in England, we have updated our information on how we work with our partners to make sure people are protected from abuse, neglect and maltreatment.

News
CQC to focus on efficient use of healthcare resources. The Care Quality Commission's (CQC) Chief Inspector of Hospitals is to look at the use of resources as part of his inspections of NHS hospitals, following a request from the Secretary of State for Health. The focus of the work will be on organisations' ability to deliver high quality patient care which is also efficient and sustainable, and will be developed as part of CQC's new strategy for 2016 onwards.

Bevan Brittan Articles
The care regulatory regime ensuring you are well-led. Meeting the quality and workforce challenges.

Health and Social Care Regulatory Due Diligence Support Our team is at the forefront of major regulatory changes affecting the health and social care sector and has extensive experience of advising clients on a wide range of regulatory issues including specialist transactional due diligence. 

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

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General

Publications/Guidance
Guidance on overseas visitors hospital charging regulations. The Department of Health has revised guidance about charges for NHS hospital treatment for overseas visitors. Guidance in making and recovering charges for NHS hospital treatment from overseas visitors not exempt from charge.

Determining if a person is properly settled in the UK in order to establish if they are ordinarily resident here. The DH has published an ordinary Residence Tool to help resolve doubts about a patient’s entitlement to free NHS hospital treatment and when their ordinary residence status under the NHS (Charges to Overseas Visitors) Regulations 2015 is not immediately clear.

NHS adult hearing services in England: exploring how choice is working for patients. This report presents the findings from Monitor's research into how having a choice of NHS hearing loss services impacts patients. It sets out how the NHS could ensure that choice works better for patients.

The impact of competition on management quality: Evidence from public hospitals. This report from the Centre for Economic Performance shows that hospital competition can improve healthcare by improving the quality of management practices. The research measured the management quality of 100 public hospitals through a management survey of clinicians and managers, and used data published by the government to assess the performance of NHS hospitals in England.

Improved circulation: unleashing innovation across the NHS This report argues that one of the most important things the NHS can do to tackle the squeeze between demand and resources is to make better use of innovative technology and methods. It explores the barriers to introducing and spreading innovation in the NHS, and how to help those who develop, commission and use potentially revolutionary healthcare innovations.

How to run a country - Health and social care. The think tank reform Reform is publishing recommendations for the 2015 Spending Review. Each day it will publish analysis for each of the main areas of public spending. This report looks at reforming the NHS and social care and the challenges for this poses for public finances.

Making sense and making use of patient experience data. This report from Membership Engagement Services considers the use of patient experience data by trusts including what’s being collected, how and why, and how the results are being used to improve services. The report notes the dedication of patient experience teams, but says the sheer volume of corporate data and other pressures on them are limiting their ability to put the information to work.

Business plan for the Health and Social Care Information Centre 2015 – 2016. This plan consolidates business plans across all the HSCIC directorates.

Framework Agreement between the Department of Health and Health Education England. Describes the important elements of the working relationship between the DH and HEE. It defines how the department and HEE will work together to serve patients, the public and the taxpayer. It sets out roles, responsibilities, governance and accountability arrangements.  

Five Year Forward View: Time to deliver. NHS England has published a tool for NHS managers that looks at the progress made to date towards delivering the Five Year Forward View, and sets out the next steps that need to be taken to achieve the shared ambitions within. The paper kicks-starts a period of engagement with the NHS, patients and other partners on how to respond to the long-term challenges and close the health and wellbeing gap; the care and quality gap; and the funding and efficiency gap.

Every patient a research patient? Evaluating the current state of research in the NHS. This Cancer Research UK-commissioned report from the University of Birmingham finds that daily pressures on the NHS are having a serious impact on its ability to support world-leading research into cancer. The report, led by Hilary Brown of the Health Services Management Centre and based on interviews with clinicians, nurses and administrators involved in NHS clinical cancer research, revealed pockets of excellence in clinical research, but also showed how escalating pressures to deliver routine NHS services are squeezing out time for hospital staff to do vital research. It also highlights how financial pressures are affecting research infrastructure and the capacity of host organisations to fund additional research costs. 

News
Human rights court rules doctors can take man in seven-year coma off life support The ECtHR has ruled that French doctors can switch off the life-support system of Vincent Lambert, who has been in a coma since suffering head injuries in September 2008. Mr Lambert's parents argued that withdrawing nutrition and hydration would be in breach of arts 2 and 3 of the ECHR. The ruling will form a precedent across the continent for other cases in which families and medical staff are in dispute over how long patients in a vegetative state should be treated.

Bevan Brittan Articles
Charging overseas visitors for NHS healthcare: The new 2015 Regulations explained On 6 April 2015 the new NHS (Charges to Overseas Visitors) Regulations 2015 came into force.  In this article we explain the background to the new Regulations, the key changes implemented, and their potential effect.

Consultation and how to avoid Judicial Review In these times of austerity public bodies are having to make numerous difficult decisions relating to funding and service changes. These changes often have significant impact on individuals and as a result there is often a significant risk of challenge. Understanding recent developments in this area of the law is important to mitigate the risk of challenge.

Giving evidence in a criminal trial Attending court as a witness to give evidence in a criminal trial can seem like a daunting prospect. This guidance will provide you with a practical steer so that you know what to expect and what you should be doing.

NHS providers: meeting the efficiency challenge.  Bevan Brittan's Jodie Sinclair (Partner, Employment team) comments on Lord Carter's interim report on NHS operational productivity (published Thursday 11 June 2015).

When a patient dies in hospital – Recovery of funeral costs & dealing with personal effects This article addresses queries such as whether funeral costs can be recovered particularly where there is no next of kin, and how a Trust should go about recovering these costs. We also outline the interplay with the Treasury Solicitor in these circumstances. The article also covers what a Trust should do with the deceased's personal effects, and clarifies whether a Trust can recover funeral costs from the personal effects which the hospital holds.

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