08/03/2017
Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.
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Training Events
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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. Lunchtime training sessions coming up are:-
. Ex turpi causa in clinical negligence and personal injury
. Ophthalmology – an overview of the anatomy and case examples for when things go wrong.
Seminar: Procurement Update. Our Procurement team will cover legislative and policy developments as well as looking at recent EU and UK court cases and how these affect procurement in practice.
. Birmingham 15 May
. Leeds 16 May
. London 17 May
. Bristol 18 May
If you wish to discuss any queries you may have around training please contact Claire Bentley
Acute and emergency care
Publications/guidance
The state of care in NHS acute hospitals: 2014 to 2016 This report outlines the findings from CQC's first round of acute and specialist hospital trust inspections. It shows variation in the quality of hospital services but also highlights those hospital trusts that have been able to make practical changes to the way they deliver care, and are seeing improvements to patient care as a result. The analysis shows variation both in the quality of care between hospitals and between individual core services within the same hospital. While the majority of hospital services are delivering good quality care and looking after patients well, inspections have also uncovered pockets of poor care even in good hospitals.
Winter insight: NHS 111. An analysis by the Nuffield Trust of how NHS 111 has fared, especially over the winter period. It finds that the service seems to steer people away from emergency services, though there is great variability across England. In some areas, NHS 111 is likely too risk averse, as it is connecting more people to the ambulance service than sending people to A&E – which is the reverse of the usual pattern of NHS use.
Shifting the balance of care: Great expectations. This Nuffield Trust research draws on an extensive literature review to assess the realism of the narrative that moving care out of hospital will save money. It explores five key areas: elective care, urgent and emergency care, admission avoidance and easier discharge, at risk populations, and self-care. Moving care out of hospital is at the heart of the NHS’s national and local plans to solve its financial problems, but the review suggests that the 44 local plans will struggle to reduce overall numbers of patients requiring hospital treatment unless they are given additional money and staff to develop new services.
How is the NHS performing? March 2017 This quarter's quarterly monitoring report finds that sicker patients are the main reason for A&E winter pressures. Despite the recent media focus on access to GPs, our latest survey of finance directors finds that the rising number of patients with complex health needs is the key factor behind the increasing pressures on A&E departments. The survey also highlights the huge effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of CCGs paid for extra resources in primary care.
Warning signs – Challenges to delivering the Cancer Strategy for England by 2020. This report from Macmillan Cancer Support sets out the challenges faced by a health service under pressure as it seeks to transform cancer services so it can meet increased demand in the coming decades. It finds that 64% of people recently diagnosed with cancer in England have experienced mental health problems such as anxiety and depression while waiting for their treatment to start. The charity warns that treatment delays have a 'profoundly negative impact' on the mental and physical wellbeing of people with cancer.
The London Quality Standards: A case study in changing clinical care. This Nuffield Trust report evaluates the introduction of the London Quality Standards (LQS) to improve acute and emergency care in London hospitals. The LQS set out a range of minimum requirements, including regular consultant review during out-of-hours and at the weekends. Several formed the basis for the Seven Day Services Standards which the NHS is now committed to rolling out across England. The evaluation found that the introduction of the LQS worked well in making people aware of shortcomings in care, and drove real change in how people worked. The initial statistical analysis did not show any evidence that they achieved consistent improvement in patient outcomes. The most important factor in making the standards a reality was a bottom-up effort from clinicians. The study saw some deficiencies in hospitals’ ability to manage complex changes, and evidence of a deep disconnect between frontline staff and top managers. The use of reconfiguration as a “stick” to drive the standards demotivated staff, and eventually came to be seen as an empty threat.
London Major Trauma System: Management of elderly major trauma patients. The Trauma Audit Research Network (TARN) data highlights that major trauma patients in the England and Wales are becoming more elderly, and that low level falls are a leading cause of severe injury. The pan London elderly trauma group has now produced clinical guidance for the management of elderly trauma patients within Major Trauma Centres and Trauma Units. It summarises the work of the group and aims to improve recognition of injury, clinical management, outcomes and the patient and family experience. Clinical commissioning standards for the care of this group of patients have been proposed within the guidelines, for discussion with the National Clinical Reference group and other key stakeholders.
What's behind delayed transfers of care? The Chief Executive of the Nuffield Trust Nigel Edwards explores what the data tells us about delayed transfers of care and busts some myths about how to prevent them.
NHS treatment for overseas patients. This Public Accounts Committee report says that health chiefs must take urgent action to recover more money from NHS patients visiting from overseas. The Committee calls on the Department of Health to improve systems for cost recovery and "do more to promote public confidence that the money due to the NHS is being recovered, and that the system is fair to taxpayers and to patients who are entitled to free care". The report states: "If the NHS does not recover the cost of treating patients who are not entitled to free care, then there is less money available to treat other people and even more pressure on NHS finances."
Overseas visitor and migrant NHS cost recovery programme: formative evaluation – final report. Ipsos MORI was commissioned to undertake a formative evaluation of the Overseas Visitor and Migrant NHS Cost Recovery Programme, which aimed to increase the revenues available to the NHS by introducing more effective practices to recover costs from visitors and migrants ineligible for free healthcare. This report sets out the final results of the evaluation.
Consultations
Making a fair contribution: Government response to the consultation on the extension of charging overseas visitors and migrants using the NHS in England. Sets out the Government's response to the December 2015 consultation on proposals to further extend charging for overseas visitors and migrants who use the NHS. It announces that the Government will proceed with the extension of charging overseas visitors for most NHS services which they can currently access for free, although this will be taken in a staged approach. From April 2017, all hospitals must establish whether patients are eligible for free treatment, and charge upfront those who are not eligible, for any non-urgent, planned care. The new measures will also require hospitals and NHS bodies to identify and flag a patient’s chargeable status so that other parts of the NHS can more easily recoup costs from overseas visitors wherever charges apply. In the case of A&E and ambulance services, the Government is still considering the points raised by respondents and exploring the feasibility of implementing the proposals; it will therefore respond on those points later in the year.
News
Green light for highly successful blue light model. The Welsh Health Secretary Vaughan Gething has given the go-ahead for a new model of emergency ambulance services to be implemented with immediate effect, following a successful pilot. it follows a positive independent evaluation of the model commissioned by the Emergency Ambulance Services Committee (EASC). The clinical response model moves away from historic time-based targets for all but the most immediately life-threatening or ‘Red’ calls. It places a greater focus on patient outcomes, prioritising those in most need of an urgent response.
If you wish to discuss any queries you may have around acute and emergency care please contact Claire Bentley.
Children
Publications/Guidance
Improving outcomes for children and families in the early years: a key role for health visiting services. The LGA has published case studies that demonstrate examples of innovation in the delivery of health visiting since its move into local government. it also highlights that there have also been challenges. Concerns have been raised that in some areas health visitor posts are being cut as a consequence of the reductions to local government funding. The cuts to local authority public health budgets make it more important than ever for health visitors and commissioners to work together to monitor and evaluate the impact of the service.
Tackling child sexual exploitation: Progress report The Home Office have published a new report which provides an update on the action and next steps the government is taking to deal with child sexual exploitation. The report outlines the government’s main objectives and the progress made in tackling child sexual exploitation since the report ‘Tackling child sexual exploitation’ was published in March 2015.
Ofsted launches new social care common inspection framework. Announces that a new social care common inspection framework will take effect in April 2017. Three principles will link all inspections of children’s social care providers: to focus on the things that matter most to children’s lives; to be consistent in its expectations of providers; and to prioritise its work where improvement is needed most. The framework has been tailored to reflect and address each distinct type of children’s social care provider. See also The social care common inspection framework: questions and answers.
Consultations
Proposals to implement standards for congenital heart disease services for children and adults in England. NHS England is seeking views on proposals to implement national service standards at every hospital that provides congenital heart disease (CHD) services. The effect of the proposals, if implemented, will be that some hospitals will carry out more CHD surgery and catheter procedures, while others, which do not meet the relevant standards, will stop doing this work. The aim of this public consultation is to provide information about the proposals, and the potential impact they may have, if implemented, on the delivery of services. The closing date for comments is 5 June 2017.
Cases
Great Ormond Street Hospital for Children Foundation NHS Trust v NO and others. [2017] EWHC 241 (Fam) The Curt declared that it would be in the best interests of an eight-month-old girl not to receive or have given invasive or aggressive treatment in the form of cardiopulmonary resuscitation, inotropes, intubation and mechanical ventilation, and not to have the insertion of intra-osseous needles, central venous lines and further chest drains, despite her parents' opposition. It was not in the child's best interests to carry out the intervention and invasive treatments sought by her parents.
News
Children's hospital trust first to be rated outstanding. England’s chief inspector of hospitals rated Birmingham Children’s Hospital Foundation Trust as outstanding following an inspection by the CQC in May 2016.
Bevan Brittan Updates
Providing end of life care for children with life limiting conditions.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah.
Clinical Risk/Patient Safety
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. Lunchtime training sessions coming up are:-
. Ex turpi causa in clinical negligence and personal injury
. Ophthalmology – an overview of the anatomy and case examples for when things go wrong
Publications/Guidance
State of maternity services report 2016. This annual report examines the statistics and figures around maternity services in order to identify emerging issues and trends. This year's report identifies a demographic change in both patients and workforce. The number of midwives under 50 has fallen and the report highlights concerns around a future shortfall of midwives in the UK's workforce.
New analysis links 30,000 excess deaths in 2015 to cuts in health and social care. Researchers exploring why there has been a substantial increase in mortality in England and Wales in 2015 conclude that failures in the health and social care system linked to disinvestment are likely to be the main cause. There were 30,000 excess deaths in 2015, representing the largest increase in deaths in the post-war period. The excess deaths, which included a large spike in January that year, were largely in the older population who are most dependent on health and social care.
Never Events Provisional 2016/17 data: 1 April to 30 December 2016. A provisional summary of never events that have been reported as occurring between 1 April and 31 December 2016.
Cases
Rezek-Clarke -v- Moorfields Eye Hospital NHS Foundation Trust [2017] EWHC B5 Master Simons upheld a decision to assess costs, claimed at £72,320.85 to £24,604.40. The ruling said that the original figure for a low value medical negligence claim of this type was disproportionate and did not "bear any reasonable relationship to the sums in issue in the proceedings".
Haywood v University Hospitals of North Midlands NHS Trust [2017] EWHC 335 (QB). The Court held that the defendant had been negligent to discharge the claimant from hospital without first having carried out further tests to exclude the risk of post-operative infection. There had been a breach of duty on the defendant's part and the claimant's stroke, and its continuing consequences, had been caused by that breach of duty.
Webster (A child & protected party, by his mother & litigation friend, Heather Butler) v Burton Hospitals NHS Foundation Trust [2017] EWCA Civ 62 CA In the light of Montgomery, the judge was mistaken in his approach to the nature of a doctor's duty to advise a patient in respect of treatment when finding that a failure by a consultant to properly advise an expectant mother of the risks and uncertainties of different treatments had not caused a prenatal brain injury to her child resulting in cerebral palsy.
EXP v Charles Simon Barker [2017] EWCA Civ 63. A judge was correct in finding that a consultant neuroradiologist had negligently failed to identify an aneurysm in the course of his review of a brain scan. In addition, the judge had been entitled to find that the independence and objectivity of the consultant's expert witness had been undermined by a failure to disclose that they had previously worked together and had a close connection.
Kearns v Delta Steeplejacks [2017] EWHC 149 (QB). A former steeplejack suffered from a respiratory disability of 60%, of which 20% arose from his exposure to asbestos in the course of his employment. This had caused diffuse pleural thickening in his right lung. The defendant employer was liable for 39% of his time exposure to asbestos, and consequently had to pay 39% of the total damages awarded of £40,300.
Re SL (Permission to Vaccinate); Barnet LBC v AL [2017] EWHC 125 (Fam). The local authority and the mother disagreed as to whether a baby who was subject to an interim care order should have vaccinations. The court made a declaration under its inherent jurisdiction that it was in the child's best interests for the local authority to arrange for the baby to receive them.
Consultations
Rapid resolution and redress scheme for severe birth injury. A new rapid resolution and redress scheme (RRR)—a voluntary administrative compensation scheme for families affected by birth injuries—is being put forward by the Department of Health (DH). The scheme aims to introduce a system of consistent and independent investigations for all instances where there may be severe avoidable birth injury, and would include ongoing support and compensation for eligible babies. Views are sought by DH on the RRR scheme by 26 May 2017.
Fixed recoverable costs for clinical negligence claims The Department of Health has launched a consultation into fixed recoverable costs in clinical negligence claims. The consultation closes at 11.45pm on 1st May 2017.
Proposals to implement standards for congenital heart disease services for children and adults in England. NHS England is seeking views on proposals to implement national service standards at every hospital that provides congenital heart disease (CHD) services. The effect of the proposals, if implemented, will be that some hospitals will carry out more CHD surgery and catheter procedures, while others, which do not meet the relevant standards, will stop doing this work. The aim of this public consultation is to provide information about the proposals, and the potential impact they may have, if implemented, on the delivery of services. The closing date for comments is 5 June 2017.
News
National Kitchen Table Week March 27 - April 2. Share knowledge on keeping patients safer.
NHS standing on 'burning platform' as current model is not fit for future Professor Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, has warned that patient safety is inadequate at four out of five hospital trusts, where 81% of non-specialist trusts were found to require improvements in safety.
New discount rate for personal injury claims announced
Chancellor meets insurance sector leaders to discuss personal injury discount rate
Bevan Brittan Updates
Brachial plexus injury not negligent – High Court decision runs against the trend
When is it negligent not to obtain a second opinion?
Data Protection Act – Guidance for Trusts
If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Catherine Radford or Penelope Radcliffe.
Commissioning
Publications/Guidance
Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed? The wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning.
Enabling social action – Guidance. The Government and the new Economics Foundation have developed resources for commissioners and other public sector leaders to help them embed social action in commissioning. These publications provide resources, ideas and case studies on how to embed social action into existing services, develop new programmes and create the conditions for social action. There is also a video about Staffordshire CC’s ambition to develop a social action strategy, that describes procurement and commissioning practice from different perspectives. It includes examples of innovative approaches using social action including delivering youth services.
NHS Standard Contract 2017/18 and 2018/19 - Shorter-form interactive version. The NHS shorter-form contract 2017/18 to 2018/19 has been published in interactive pdf form for use as a training tool. The pdf should help commissioners and providers to understand how to use the contract. It links the text from the shorter-form contract particulars, service conditions and general conditions with the relevant definitions and text from the NHS standard contract technical guidance.
Pharmacy Quality Payments: Quality criteria guidance. This guidance provides information to contractors on how to claim quality payments, provide further clarification on gateway criteria and to provide information for contractors to help them demonstrate that they meet any of the eight quality payment criteria.
Professional standards for optimising medicines for people in secure environments. The Royal Pharmaceutical Society has published new professional standards for optimising medicines for people in secure environments, including immigration removal centres, prisons and other places of residential detention. The standards support the commissioning and development of safe, quality services that put patients and their needs first when optimising medicines for people in secure environments.
Documents to support participation. NHS England has published a set of documents to strengthen patient and public participation in the services that it is responsible for commissioning. The latest frameworks cover:
. Armed forces commissioning;
. Health and justice commissioning;
. Public health commissioning; and
. Specialised commissioning.
If you wish to discuss the issue of commissioning please contact David Owens.
Employment/HR
Publications/Guidance
Managing conflicts of interest in the NHS: guidance for staff and organisations This guidance aims to strengthen the management of conflicts of interest within the NHS and to ensure transparent and accountable health care. The guidance permits NHS staff to receive small tokens or gifts, but will require them to decline anything that could be seen to affect their professional judgement. It will also be standard practice for NHS commitments to take precedence over private practice, and for any member of staff - clinical or non-clinical - to declare outside employment and the details of where and when this takes place.
Changes to apprenticeships: what employers need to know. The Government has published rules and guidance that set out how levy paying employers can fund apprenticeships. This guide offers advice, hints and tips, as well as key information around the introduction of the apprenticeship levy and how to make the most of the changes which will come into effect from April 2017.
TUC analysis details risk to NHS and social care in England from loss of EU workers. The TUC has published analysis that provides a regional breakdown of where NHS and adult social care services are most reliant on workers from the EU. The TUC says that the government’s refusal to confirm that EU workers can stay is putting NHS patients at risk, along with older and disabled people who use social care.
Race in the workplace: the MacGregor-Smith review This independent review considers the issues affecting black and minority ethnic (BME) groups in the workplace. It sets out recommendations for employers in the public and private sectors to improve diversity within their organisations. The governments response is published alongside the report.
Tackling cyberbulling in the NHS: what you need to know This briefing explores how the NHS currently tackles cyberbulling through examining results of a study conducted by the charity All Rise Say No To Cyber Abuse. As the use of online communication tools continues to increase, it is important that organisations across the NHS include cyberbullying in their most relevant HR policy. To help trusts with this, NHS Employers have created an adaptable template cyberbullying policy for use on a local level.
Against the odds: experiences from the NHS front line This report brings together the experiences of doctors working in NHS hospitals between December 2016 and January 2017. In the report, they explain in their own words what an overstretched NHS looks like in practice.
If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.
Finance
Publications and Guidance
Financial sustainability of the NHS This report argues for a united effort from the Department of Health, NHS England and No. 10 in order to restore financial stability to the NHS. The report also highlights concerns that the focus on action to restore financial stability is affecting patients’ access to services and their experience of care, and warns of the potentially damaging consequences of "repeated raids" on investment funds to meet day-to-day spending. The committee makes recommendations for the urgent need for a recovery plan targeting NHS bodies and health economies in severe financial difficulty, and that the government should publish its assessment of whether there is capacity in the NHS to deliver everything that they are expected to within agreed timeframes.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
Information sharing/data
Publications/Guidance
Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children. Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.
Update on NHS Shared Business Services patient correspondence incident This letter from the Department of Health provides an update to the Chair of the Public Accounts Committee at her request to have regular updates provided on the misplacing of patient records. The letter outlines the costs of further clinical investigation so far and how many cases have required further clinical review.
Consultation
Views sought on ICO guidance on consent in the GDPR. This draft guidance on consent explains the ICO's recommended approach to compliance and what counts as valid consent. It also provides practical help to decide when to rely on consent, and when to look at alternatives.
News
NHS data loss: 500 patients may have suffered serious harm. NHS England is investigating 537 ‘live cases’ resulting from failure to deliver 500,000 documents over five-year period
Bevan Brittan Updates
Data Protection Act – Guidance for Trusts
If you wish to discuss any issues raised in this section please contact Jane Bennett.
Mental Health
Would you like to access the Bevan Brittan Mental Health Extranet? - It is a secure online resource containing a discussion forum, knowledge bank and information about training events. If you would like access please contact Claire Bentley. Issues that are currently being discussed on our forum are:-
Policing and Crime Act 2017 - impact on s135 and s136 Mental Health Act 1983
Duty on Local Authorities to make applications to the court of Protection for authorisation of a private deprivation of liberty
s136 - the root of the problem?
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.
Publications/Guidance
Five year forward view for mental health: one year on This report marks the anniversary of the publication of the Five year forward view for mental health. It highlights the progress made in the first year of the programme, and takes a look at the achievements that need to be built upon next year and beyond.
Fatherhood: the impact of fathers on children’s mental health explores the research available on this topic and highlights the distinct role fathers can play in nurturing good mental health in their children.
The Participation of P in Welfare Cases in the Court of Protection This report considers what a ‘human rights model of participation’ looks like. It assesses key features of participation in the Court of Protection against this model, focusing on cases about health, welfare and deprivation of liberty. They then look at the same issues for the Mental Health Tribunals in England and Wales, to see whether this offers a better approach.
Perinatal Mental Health toolkit. The RCGP, in partnership with NHS England, has produced a toolkit to assist members of the primary care team to deliver the highest quality care to women with mental health problems in the perinatal period. As well as offering a diverse collection of resources, the Perinatal Mental Health Toolkit gives details of additional learning for individual practitioners. It also provides resources for those concerned about their own mental health issues.
Working together to address obesity in adult mental health secure units This review summarises the latest evidence on obesity in secure mental health units. It examines the evidence on the prevalence and impact of obesity in secure settings, and an investigation of potential interventions.
Warning signs – Challenges to delivering the Cancer Strategy for England by 2020. This report from Macmillan Cancer Support sets out the challenges faced by a health service under pressure as it seeks to transform cancer services so it can meet increased demand in the coming decades. It finds that 64% of people recently diagnosed with cancer in England have experienced mental health problems such as anxiety and depression while waiting for their treatment to start. The charity warns that treatment delays have a 'profoundly negative impact' on the mental and physical wellbeing of people with cancer.
Professional standards for optimising medicines for people in secure environments. The Royal Pharmaceutical Society has published new professional standards for optimising medicines for people in secure environments, including immigration removal centres, prisons and other places of residential detention. The standards support the commissioning and development of safe, quality services that put patients and their needs first when optimising medicines for people in secure environments.
Preventing prison suicides: staff perspective This report is the last in a series stemming from a year-long investigation into suicide in prisons by the Centre for Mental Health and the Howard League for Penal Reform. This report is based on interviews with health care staff working in prisons and those reviewing clinical care following suicide deaths. It finds that distress, self-harm and suicide attempts are too often seen as manipulative rather than signs of need and vulnerability among prisoners. The report highlights the need for a culture change in prisons to prevent people from losing their lives through suicide.
Transforming care – Model service specifications. NHS England has published three model service specifications to provide additional detail for commissioners to implement the national service model for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition. Each specification aims to help commissioners review and meet the needs of their local population, giving people the best quality care and quality of life. It builds on the Transforming Care programme’s national service model, published in October 2015.
Consultations
New service specifications for Adult Medium and Low Secure Mental Health Services NHS England has launched a consultation on the two new service specifications (and two separate appendices) for the Adult Secure Low and Medium Mental Health Services.
News
Trust chiefs must sign off CCG mental health spending.
Bevan Brittan Updates
Women at risk: A gender gap in the provision of mental health services?
Court of Protection Case Management Pilot. The case management pilot is a scheme which has been in place since 1 September 2016 in the Court of Protection.
The role of the 'IMCA' within the health service – what do you need to know? Decision-making regarding patient care.
If you wish to discuss any of the items raised in the above section please contact Simon Lindsay or Stuart Marchant.
Primary Care
Publications/guidance
Reducing hospital admissions by improving continuity of care in general practice. This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62–82 years. The research found that there were fewer hospital admissions for certain conditions when the patient saw the same GP more consistently. Patients who saw their usual GP two or more times out of every ten were associated with six per cent fewer avoidable hospital admissions.
Understanding GP attitudes to cancer preventing drugs. A study by Cancer Research UK concludes that GPs want more support when offering drugs that lower the risk of certain cancers. It finds that GPs are more comfortable to discuss drugs, and more willing to prescribe or recommend drugs when they are supported by secondary care clinicians.
Delivery of the 2017/18 NHS e-Referral Service CQUIN: Supporting guidance. Guidance on meeting the requirements of the NHS e-Referral Service CQUIN, which aims to support referrers, such as GPs, in being able to refer their patients electronically to the full range of outpatient services available and for their patients to always be able to book an appointment. The Quality Premium is an incentive payment to encourage CCGs to work with their GPs, hospitals and other providers, to increase the number of patients who can be referred electronically through the NHS e-Referral Service and have the ability to book an appointment. The incentive will help ensure that hospitals and other providers are encouraged to make the necessary outpatient services and appointments available on the NHS e-Referral Service.
Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children. Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.
Summary of 2017/18 GMS contract negotiations. NHS Employers and the British Medical Association have agreed a new GP contract for 2017/18. The deal involves investment of £238.7m and focuses on improvement in patient care. This document summarises the key changes to the GMS contract in England for 2017/18.
What is social prescribing? This King's Fund article looks at social prescribing, whereby GPs, nurses and other primary care professionals refer people to a range of local, non-clinical services. These are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports. The article considers whether social prescribing works and looks at how it fits in with wider health and care policy.
Primary care guidance: diagnosing and managing infections. GPs and other health professionals in primary care can use this series of quick reference guides for diagnosis of infectious disease including knowing when to use the microbiology laboratory and how to understand results. They also provide guidance on appropriate use of antibiotics and antifungals.
If you wish to discuss any queries you may have around primary care please contact David Owens.
Procurement
Publications
Procurement Policy Note 01/17: Update to Transparency Principles. This PPN advises that the principles on The Transparency of Suppliers and Government to the Public have been clarified following feedback. The principles require public procurers proactively to disclose contract and related information that may previously have been withheld on grounds of commercial confidentiality. It applies to all Central Government Departments, their Executive Agencies and Non Departmental Public Bodies. It replaces PPN 13/15.
Enabling social action – Guidance. The Government and the new Economics Foundation have developed resources for commissioners and other public sector leaders to help them embed social action in commissioning. These publications provide resources, ideas and case studies on how to embed social action into existing services, develop new programmes and create the conditions for social action. There is also a video about Staffordshire CC’s ambition to develop a social action strategy, that describes procurement and commissioning practice from different perspectives. It includes examples of innovative approaches using social action including delivering youth services.
Bevan Brittan Updates
Leaving the EU and the lawfulness of evaluation criteria. The controversial advertisement for contractors, issued by the Department for International Trade.
Byte Size Procurement Updates – The Selection Questionnaire ("SQ") Byte 4 – Changing the SQ
Byte Size Procurement Updates – The Selection Questionnaire ("SQ") Byte 3 – Using the SQ
Byte Size Procurement Updates – The Selection Questionnaire ("SQ") Byte 2 – Scope and coverage
Byte Size Procurement Updates – The Selection Questionnaire ("SQ") Byte 1 - Overview
If you wish to discuss any queries you may have around procurement please contact Emily Heard.
Providers
Publications/Guidance
NHS Standard Contract 2017/18 and 2018/19 - Shorter-form interactive version. The NHS shorter-form contract 2017/18 to 2018/19 has been published in interactive pdf form for use as a training tool. The pdf should help commissioners and providers to understand how to use the contract. It links the text from the shorter-form contract particulars, service conditions and general conditions with the relevant definitions and text from the NHS standard contract technical guidance.
Quarterly performance of the provider sector as at 31 December 2016 This publication brings together data on the performance of NHS providers over quarter three of 2016/17. It finds that the demand for emergency treatment, coupled with a significant reduction in bed availablility has led to providers collectively underperforming against several key health care standards. This sustained focus on providing emergency care has led to a loss of income for providers with a deficit of £886m reported at the end of the quarter.
Care of dying adults in the last days of life: Quality standard QS144. This NICE quality standard covers the clinical care of adults (aged 18 and over) who are dying, during the last 2 to 3 days of life. It describes high-quality care in priority areas for improvement. It does not cover care before the last few days of life, such as palliative care or ‘end of life care’ (often defined as care during the last year or so of a progressive disease), or care after death. These are included in NICE’s quality standard for end of life care for adults.
Consultations
Proposals to implement standards for congenital heart disease services for children and adults in England. NHS England is seeking views on proposals to implement national service standards at every hospital that provides congenital heart disease (CHD) services. The effect of the proposals, if implemented, will be that some hospitals will carry out more CHD surgery and catheter procedures, while others, which do not meet the relevant standards, will stop doing this work. The aim of this public consultation is to provide information about the proposals, and the potential impact they may have, if implemented, on the delivery of services. The closing date for comments is 5 June 2017.
Legislation
National Health Service (Direct Payments) (Amendment) Regulations 2017 (SI 2017/219). These regulations, which come into force on 1 April 2017, make minor amendments to the Direct Payments Regulations 2013 (SI 2013/1617) which govern the rules for the making of direct payments for health care to secure the provision of certain health services under the National Health Service Act 2006. They allow a third party to hold a direct payment on behalf of an individual patient or representative of a patient and provide administrative support while the patient or representative maintains responsibility, both for ensuring that it is spent according to the patient’s care plan and for all contractual arrangements entered into to secure the provision of services by way of a personal health budget. They also clarify the policy intention that an individual who is a spouse, family member or friend of the recipient of a personal health budget and who also lives in the same household as the recipient can only receive payment for providing care where it is necessary to meet the recipient’s needs.
News
Innovating for improvement. The Health Foundation's Innovating for Improvement programme aims to improve health care delivery and/or the way people manage their own health care through the redesign of processes, practices and services. It supports clinical teams to develop their innovative ideas and approaches, put them into practice and gather evidence about how their innovation improves quality. It is inviting applications for a share of £1.5m funding for up to 20 teams to test and develop innovative ideas to improve health care delivery in the UK. The deadline for applications is 28 March 2017.
If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.
Public Health
Publications/Guidance
Improving outcomes for children and families in the early years: a key role for health visiting services. The LGA has published case studies that demonstrate examples of innovation in the delivery of health visiting since its move into local government. it also highlights that there have also been challenges. Concerns have been raised that in some areas health visitor posts are being cut as a consequence of the reductions to local government funding. The cuts to local authority public health budgets make it more important than ever for health visitors and commissioners to work together to monitor and evaluate the impact of the service.
Digital-first public health: Public Health England's digital strategy. Explains how PHE will make best use of digital to meet the needs of its users and fulfil its remit to protect and promote health and reduce inequalities. PHE will take a digital-first approach to lead the development of new models of public health within the public health system, working with partners including national government, local government, the NHS, the voluntary and community sector, industry, the scientific and academic community and global public health partners. The strategy sets a common approach for PHE's digital work, including principles, clear roles and responsibilities, and standards for digital development. It describes the current state of digital within PHE and its plans for 2017/18.
Consultations
Consolidated standards for NHS Breast Screening Programme. PHE is seeking views on draft consolidated national standards for the Breast Screening Programme (BSP), which aims to support health professionals and commissioners in providing a high quality breast screening programme. The standards provide a defined set of measures that providers have to meet to ensure local programmes are safe and effective. The consultation closes on 27 February 2017.
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/Guidance
Joint statement from the GMC and AoMRC on the development of the Medical Register to record doctors’ scope of practice. The Academy of Medical Royal Colleges is working with the GMC to undertake exploratory work looking at enhancing the GMC’s Medical Register by recording doctors’ scope of practice.
SAS doctor development: Summary of resources and further work. The BMA, HEE, the Academy of Medical Royal Colleges (AoMRC) and NHS Employers have published new guidance on the development of specialty and associate specialist (SAS) doctors in the NHS in England. The guide aims to help to ensure that this important group of doctors remain fit to practice and develop in their careers. It describes actions that can be taken to ensure best practice is applied in the development of SAS doctors and dentists, as well as how different groups can work together to ensure the principles are consistently applied.
Conflicts of interest in the NHS – Guidance for staff and organisations. Guidance for the management of conflicts of interest in the NHS, with common principles and rules for managing conflicts of interest, simple advice to staff and organisations about what to do in common situations, and support for good judgement about how interests should be approached and managed. It applies to CCGs, NHS Trusts and NHS FTs, and NHS England. The principles of this guidance will be included in a revised version of the statutory guidance for CCGs issued by NHS England pursuant to its powers under s.14O and s.14Z8 NHS Act 2006; NHS Trusts and NHS Foundation Trusts must have regard to this guidance through its incorporation into the NHS Standard Contract pursuant to General Condition 27. Other bodies involved in the provision of NHS services (e.g. independent and private sector organisations, general practices, social enterprises, community pharmacies, community dental practices) are invited to consider implementing this guidance as a means to effectively manage conflicts of interest and provide safeguards for their staff.
Consultations
Securing the licence to practise - introducing a Medical Licensing Assessment. The GMC is seeking views on plans to establish a UK-wide Medical Licensing Assessment (MLA). This would create a single, objective demonstration that those who obtain registration with a licence to practise medicine in the UK can meet a common threshold for safe practice. The consultation is open until 30 April 2017.
Legislation
Medical Devices (Fees Amendment) Regulations 2017 (SI 2017/207). These regulations, which come into force on 1 April 2017, amend Part VI of the Medical Devices regulations 2002 (SI 2002/618) that sets out the fees that are payable under the scheme for regulating the placing on the market and putting into service of medical devices in the United Kingdom.
Registration of Private Dentistry (Wales) Regulations 2017 (SI 2017/201 (W.56)). These regulations, which come into force in Wales on 1 April 2017, are made under Part 2 the Care Standards Act 2000, which provides for the registration and inspection of establishments and agencies by the Welsh Ministers. They provide for the registration of private dental practices.
Private Dentistry (Wales) Regulations 2017 (SI 2017/202 (W.57)). These regulations, which come into force on 1 April 2017, apply in relation to persons who carry on or manage the provision of private dental services by a dentist, or relevant professional services by a dental care professional, otherwise than for the purposes of the National Health Service (Wales) Act 2006 in Wales. The regulations replace the Private Dentistry (Wales) Regulations 2008 which regulated individual dentists and they make provision in relation to private dental practices which are required to register under Part 2 of the Act.
News
Government considers the introduction of one super-regulator for all healthcare professions. The Government is considering the biggest health regulation reform for more than a century following the findings of a public inquiry into the neglect of patients at the Mid Staffordshire trust where regulators were criticised for being too fragmented to spot emerging problems. Proposals being considered include merging the General Medical Council and the Nursing and Midwifery Council alone, or to merge all nine healthcare regulators.
If you wish to discuss any queries you may have around public health please contact Stuart Marchant.
Social Care
Publications/Guidance
Shifting the balance of care: great expectations. This report reviews the evidence around care closer to home and finds that whilst it results in improved patient experience, it fails to save money for the NHS. The report warns that the drive to move care into the community, as outlined in STPs, requires greater funding and resourcing in order to reduce the demand on acute services.
Care in a post-Brexit climate – How to raise standards and meet workforce challenges. This IPPR report explores the drivers of inadequate standards of care in the UK, including chronic underinvestment, the reliance on a low paid, poorly trained workforce and high levels of staff turnover. It also sets out a vision for a more relational, personalised care system, delivered by a more highly skilled and well-resourced workforce.
Health and care of older people in England 2017. This Age UK briefing looks at how the system of health and care is working for older people in this country at the moment. It highlights the immense challenges facing older people needing support. It demonstrates the impact of the failure to provide support on their health and wellbeing, as well as the NHS, and how the social care crisis is also creating a significant burden for other forms of support.
TUC analysis details risk to NHS and social care in England from loss of EU workers. The TUC has published analysis that provides a regional breakdown of where NHS and adult social care services are most reliant on workers from the EU. The TUC says that the government’s refusal to confirm that EU workers can stay is putting NHS patients at risk, along with older and disabled people who use social care.
Older people's experiences of sight loss in care homes This report calls for greater visual awareness training in order to support people with sight loss living in care homes. It presents the findings of a study carried out in seven care homes, and found that greater support for this group of people helped to reduce the impact of sight loss and social isolation.
Adult social care: market shaping. Updated guidance on creating personalised, high quality, sustainable care solutions using a range of care providers and support organisations. The guidance is aimed at people who buy social care services, including local authority and clinical commissioning group commissioners, as well as personal budget holders and people who fund their own care, care service providers and potential investors in the care sector.
Social care – Charging for care and support (LAC(DH)(2017)1). This DH circular advises local authorities of the social care charging arrangements for 2017 to 2018.
Health and social care integration. This NAO report finds that the Better Care Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or hospital activity. It warns that progress with integration of health and social care has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities. As a result, the Government’s plan for integrated health and social care services across England by 2020 is at significant risk. The report also found that NHS England’s ambition to save £900m through introducing seven new care models may be optimistic – the new care models are as yet unproven and their impact is still being evaluated. In addition, the NAO found no compelling evidence to show that integration in England leads to sustainable financial savings or reduced acute hospital activity.
Health and social care integration (England) This briefing paper analyses recent policy and debate on the integration of NHS-provided healthcare and local authority-provided social care. As health and social care are both devolved policy areas, this briefing focuses on integration in England.
Brexit and health and social care: Secretary of State for Health's evidence. This document provides a brief overview of the evidence given at the session with the Secretary State for Health which took place on 24 January 2017. It discusses the Department of Health's involvement with Brexit negotiations and the impact on resourcing to the NHS.
If you wish to discuss any queries you may have around public health please contact Stuart Marchant.
General
Publications/Guidance
State of the health system: beds in the NHS. This paper presents NHS bed data from across the UK and it examines the causes and consequences of bed pressures within the health system. The report finds that in England, average bed availability has decreased over the past thirty years, with mental health beds seeing a large decline. It also finds that over the past five years, average bed occupancy rates have increased, even in areas like day beds where the number of beds has increased but the demand has also increased.
Delivering sustainability and transformation plans. The King’s Fund has published a report into sustainability and transformation plans (STPs) in which it concludes STPs offer the ‘best hope for the NHS and its partners to sustain services and transform the delivery of health and care’. The King’s Fund has also said the proposals in STPs now need to be developed into credible plans.
Work in progress. Towards a leaner, smarter public-sector workforce. This Reform paper evaluates recent governments’ approaches to workforce design across the NHS, education, central and local government and the police. It finds that the current workforce is a legacy of past approaches. It is built around siloed attitudes of yesterday’s governments and fails to embrace technology and new ways of working to meet users’ needs in the most effective ways. A traditionalist mentality fails to cultivate a culture of change: mistakes are covered up, risk-aversion is rife and leaders have not built the workforce around the needs of users. It concludes that a new approach is needed, where public services deliver outcomes that matter to users, and meet expectations of interacting via technology.
Sustainable development in the health and care system: Health check 2017. This report is the first in a series of annual publications from the Sustainable Development Unit (SDU) that looks at the progress of sustainable development across the health and care system. It shows the extent to which environmental, social and financial aspects of sustainability are applied to the NHS, public health and social care system. It finds that overall, organisations are cutting their carbon footprint and saving money through reducing energy use, but having less success in addressing water use and the increased costs from waste disposal. Progress in sustainable approaches to commissioning, procurement and across the social care sector is more difficult to measure and more needs to be done in this area. Sustainable development is increasingly becoming a core part of work. More organisations have board approved Sustainable Development Management Plans (SDMPs) and are reporting annually on their work.
Healthcare social media toolkit. This toolkit aims to support the health care sector in utilising social media effectively and efficiently. It includes guidance on strategy and content creation, downloadable templates and resources, and advice on how to encourage team members in using social media.
If you wish to discuss any issues raised in this section please contact Claire Bentley.
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