20/10/2019

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

Housing and health

Knowledge Transfer

Inquests

Acute and emergency care

Mental Health

Brexit

Primary Care

Children

Providers

Clinical Risk/Patient Safety

Public Health

Commissioning

Regulation

Digital Health

Social Care

Employment/HR

General

Finance

 

 

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Bevan Brittan Free Training Events 

Bevan Brittan Events

Digital Health Forum: AI in healthcare -5th November 2019 London

Procurement Updates Roadshow - 4 - 7 November 2019 All offices

Healthcare Estates Breakfast Briefings - 4th December 2019 Leeds

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

Employment Law Update.  We will be covering a broad range of relevant issues including working time (holiday pay and obligations to record time); IR35; cases on whistle blowing, disability discrimination, restrictive covenants and collective bargaining; ‘just culture’; and the latest on settled status applications.
Bristol - Tuesday 3 December
Birmingham - Wednesday 4 December
London - Wednesday 11 December
Leeds - Thursday 12 December

Clinical Risk Webinars
Bevan Brittan Clinical Risk/Medical Law Training -
These are internal hour long lunch time training sessions that are attended by our team of solicitors. If your organisation is a Bevan Brittan client you can sign up to watch the training sessions remotely via our webinar facility. The next sessions coming up are:-

1. CPR and Part 36 2018/2019 update - 29th October 2019
2. A review of the challenges around providing end of life care and decisions - 12th November 2019.

If you would like to receive more information about the webinars just ask Claire Bentley.  

Knowledge Transfer

Training. In addition to our free training programme for 2019, we also provide bespoke knowledge transfer sessions on a range of healthcare law topics. If you wish to discuss any queries you may have around training or webinars please contact Claire Bentley.  

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

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Acute and emergency care

Publications and guidance

The state of health care and adult social care in England 2018/19 This year’s report considers the pressures faced by health and social care as a whole – but focuses particularly on inpatient mental health and learning disability services. While the overall quality picture for the mental health sector, which includes community mental health services, remains stable, this masks a real deterioration in some specialist inpatient services. In hospital emergency departments, performance has continued to get worse while attendances and admissions have continued to rise. The stability of the adult social care market remains a particular concern.

News

New top A&E doctor 'could support replacing target'

A&E attendances twice as high for people in the most deprived areas. There were more than twice as many attendances to accident and emergency departments in England for the 10% of the population living in the most deprived areas (3.1 million), compared with the least deprived 10% (1.5 million) in 2018/19, according to official figures released by NHS Digital.

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

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Brexit

Publications and guidance

EU reciprocal healthcare arrangements: Brexit guidance This briefing provides an overview of some of the guidance that the UK government has published on reciprocal health care after Brexit.

Exiting the EU: supplying the health and social care sectors This report reviews the Department of Health and Social Care’s (DHSC’s) preparations to make sure the UK has a steady flow of supplies for the health and social care sector when it leaves the EU. It finds that of the 12,300 medicines used in the UK, DHSC estimates that around 7,000 come from or via the EU. The report examines the progress made – working with other government departments, NHS and social care providers, and with private sector suppliers – in implementing the Continuity of Supply Programme. It sets out the DHSC’s plan and records the progress made.

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

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Children 

Publications/Guidance 

State of the nation 2019: children and young people’s wellbeing This report evaluates wellbeing in children and young people, including statistics on the wellbeing of children and young people in England. It also looks at wider indicators on their happiness with their relationships, self-reported health and experiences with school, and contains an in-depth analysis of psychological wellbeing in teenage girls.

Time to solve childhood obesity: an independent report by the Chief Medical Officer, Professor Dame Sally Davies This report calls for action across industry and the public sector to help the government reach its target of halving childhood obesity by 2030. It sets out a range of recommendations for the government, which are supported by 10 principles, and builds on the work already done by the government.

Health visiting in England: a vision for the future This report was developed in response to the government’s request for stakeholder engagement to inform its plans to refresh the health visiting model for England and the Healthy Child Programme, and takes into account the drop in numbers of health visitors over the past four years. It sets out a new model of health visiting and has a particular focus on 15 areas where health visiting can have a high impact on health outcomes.

A quality framework for children and young people in need of care and protection. The Care Inspectorate publishes an updated version of its quality framework for children and young people in need of care and protection. In particular, changes have been made to the six point scale definitions so that they align fully with the Care Inspectorate quality framework. Alongside publication of the updated framework, the Care Inspectorate has launched an interactive resource to support community planning partnerships through a joint inspection of their services for children and young people in need of care and protection.

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

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Clinical Risk

Publications/Guidance 

Health Service Safety Investigations Bill This bill establishes a new independent healthcare safety investigation body to improve patient safety. Briefing Paper: Health Service Safety Investigations Bill 2019-20 A House of Commons Library briefing paper on the Health Service Safety Investigations Bill 2019 will be produced ahead of the second reading debate. The Bill was announced in the Queen's Speech on 14 October 2019. 

Fixed recoverable costs in lower value clinical negligence claims A Civil Justice Council report on fixed recoverable costs (FRC) in lower value clinical negligence claims. It sets out recommendations as to FRC and the process improvements which are to work alongside those costs, including in relation to: the pre-issue process; cases which do not settle; FRC (standard track and light track); experts; and learning and patient safety. It also considers other recommendations which arise from the matters covered in the report.

The Early Notification scheme progress report: collaboration and improved experience for families This report provides an overview of the first year of the Early Notification scheme to drive improvements in maternity and neonatal services and to ensure better support for families whose babies suffer rare, avoidable brain injuries at birth. The report makes six recommendations to support the clinical issues identified in the research, covering topics such as the response to families when there is a poor outcome at birth and monitoring the fetal heart rate in labour.

Standing up for patient and public safety This report describes the lack of clear roles, responsibilities and accountability for workforce planning and supply in England. In reality, this means that the health and care workforce is not growing in line with the increasing population need for health and care services, and there are large numbers of vacant posts throughout the system. This impacts upon patient safety and outcomes, and leads to a challenging working environment for staff. The RCN makes the case for legislation to resolve this, alongside additional investment in the nursing workforce and a national health and care workforce strategy for England.

The National Health Service Litigation Authority (No 2) Directions 2019 Directions given to the National Health Service Litigation Authority (NHSLA). These directions allow the NHS Litigation Authority to carry out the Secretary of State’s governance and other responsibilities under the contractual arrangements entered into by the Secretary of State with the Medical and Dental Defence Union of Scotland. The NHS Litigation Authority operates under the name of NHS Resolution.

An economic evaluation of specialist counselling after baby loss. This report is an economic evaluation of the baby loss charity Petals, which provides counselling to women and their partners who have experienced the death of a baby.

Learning from avoidable brain injuries at birth. NHS Resolution has reported on the first year of its innovative scheme to drive improvements in maternity and neonatal services and to ensure that families are better supported whose babies suffer rare, but tragic, avoidable brain injuries at birth.

Delivering same-sex accommodation Updated policy on delivering same-sex accommodation for all providers of NHS-funded care to ensure the safety, privacy and dignity of patients is prioritised

NICE impact: maternity and neonatal care This report focuses on how NICE’s evidence-based guidance contributes to improvements in maternity and neonatal care. It finds that if all maternity units applied NICE’s recommendations on twin and triplet pregnancies, such as labelling the fetuses during scans so they can be told apart and monitored closely for complications, it could lead to 634 fewer emergency caesarean sections and 1,308 fewer neonatal admissions in England per year. This could mean preventing around one in ten neonatal admissions of babies from multiple births in the UK each year.

The Personal Injury Discount Rate - review and determination of the rate in Scotland by the Government Actuary The Government Actuary's Department has published its determination of the Personal Injury Discount Rate in Scotland on completion of the review of the Rate on 27 September 2019. The report has been prepared in accordance with the requirements of the Damages (Investment Returns and Periodical Payments) (Scotland) Act 2019 and the letter of engagement received from the Minister for Community Safety dated 25 June 2019.  

News

Counsel fee not fixed for claim which left protocol Senior costs judge, Master Brown, has rejected an appeal from the defendant in Dover v Finsbury Food Group Plc to restrict costs to the fixed £150 after the case dropped out of the pre-action protocol. Instead he upheld the decision of a costs officer to award £500. He held that the relevant provisions permitted recovery of counsel's fee for advising in conference as a disbursement.

The Electronic Working Pilot Scheme in the Senior Courts Costs Office comes into force on the 7th October. There are some useful links on the working of the scheme.

Child gender clinic to be sued over its "experimental" treatments. England's first NHS child gender clinic is being threatened with legal action by the mother of a 15-year-old patient and a nurse who worked at the service, over its use of "experimental" hormone-blocking treatments for children as young as 11. They have accused the Tavistock and Portman NHS Trust, which runs the gender identity development service in north London, of misleading families about the nature of the treatment.   

Bevan Brittan Updates

Medical practitioners: new duty to notify deaths - Joanna Lloyd

Bevan Brittan Events

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

Bevan Brittan Webinars   

Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If your organisation is a Bevan Brittan client, you can sign up to watch the training sessions remotely via our webinar facility. If you would like to receive more information about the webinars just ask Claire Bentley. The next sessions coming up are:-

1. CPR and Part 36 2018/2019 update - 29th October 2019
2. A review of the challenges around providing end of life care and decisions - 12th November 2019.

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

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Commissioning   

Publications/Guidance 

What is commissioning and how is it changing? Commissioning is the process by which health and care services are planned, purchased and monitored. This explainer discusses the commissioning process in more detail, the organisations involved and how it is changing.

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

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

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Digital Health

Publications/guidance

Inclusive by default As more public services are delivered digitally, there is an imperative to tackle the causes of digital exclusion. This report finds a lack of skills, motivation and the right infrastructure are some of the key factors that make digital exclusion more likely. In addition to providing alternative routes for those unable to access digital public services, it is essential that these barriers are overcome. Designing accessible services, community support and partnerships across sectors are tools that can help to make digital public services inclusive by default.

Bevan Brittan Updates

Bringing Innovation Into Healthcare: Quickening the Pace of Change - Vincent Buscemi

Bevan Brittan Events

Digital Health Forum: AI in healthcare -5th November 2019 London

Bath Digital Festival - Wednesday 23rd October

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

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Employment/HR  

Publications/guidance

Making the NHS the best place to work: support for engagement to improve our people’s experience at work This resource, developed in partnership with NHS Employers, provides extra support and examples of good practice to those organisations seeking further help with staff engagement.

Volume recruitment in the NHS: themes and recommendations This report, commissioned from Professional Psychology Ltd, outlines recommendations to help modernise recruitment practices in NHS organisations. The report focuses on volume recruitment of nurses and health care assistants (HCAs) as the largest staff groups at all NHS trusts. It includes tips on encouraging equality and diversity through recruitment processes, advice on how to run assessment centres, and recommendations on how to advertise job roles and attract the right staff.

Standing up for patient and public safety This report describes the lack of clear roles, responsibilities and accountability for workforce planning and supply in England. In reality, this means that the health and care workforce is not growing in line with the increasing population need for health and care services, and there are large numbers of vacant posts throughout the system. This impacts upon patient safety and outcomes, and leads to a challenging working environment for staff. The RCN makes the case for legislation to resolve this, alongside additional investment in the nursing workforce and a national health and care workforce strategy for England.

Caring, supportive, collaborative: doctors’ vision for change in the NHS This report draws on the experience and expertise of BMA members across all branches of medical practice in the UK. It outlines where the BMA believes changes are needed to ensure patient care is safe, to make the NHS a great place to work and to transform services for the better.

Work conversations in healthcare: how, where, when and by whom? Public Health England’s ‘work as a health outcome’ programme seeks to promote health care professionals’ understanding of the health benefits of good work and encourage them to have supportive conversations about work and health with their patients. The programme has been informed by the evidence base for Making Every Contact Count (MECC). To further understand whether or to what extent the MECC framework is transferable to this context, a comprehensive literature review with stakeholder engagement was conducted. This review presents key findings, discussions and recommendations and is intended to support policy officials in central and local government.

Developing allied health professional leaders: an interactive guide for clinicians and trust boards This is a guide to professional development opportunities and possibilities to help allied health professionals (AHPs) lead at all levels. It describes the common features of the AHP leadership journey, by combining insights and evidence from trust executives and chief AHPs. Its primary audience is aspiring AHP leaders and those with responsibility for developing the AHP workforce.

Does learning disability nursing need the maintenance grant back? David Maguire considers the impact of scrapping student nursing bursaries on the learning disability nursing workforce.

Less than full time training: the trainee perspective This report is based on the results of a survey of more than 600 trainees and highlights the benefits and challenges of working less than full time (LTFT). It found that: doctors who worked LTFT were overburdened by administrative duties, proportionally more than full-time colleagues; two-thirds of trainees are considering LTFT training in the future; too few trainees are involved in working pattern planning; LTFT training is expensive; and there is not enough information about working LTFT.

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

The state of the adult social care sector and workforce in England This report provides a comprehensive analysis of the adult social care workforce in England and the characteristics of the 1.49 million people working in it. Topics covered include: employment information, recruitment and retention, demographics, pay, qualification rates and future workforce forecasts.

Consultations

NHS Pension Scheme: increased flexibility. The Department of Health and Social Care is consulting on a new set of proposals to offer senior clinicians more control over their pensions growth, so they can continue to provide the services that patients need. Senior NHS clinicians are concerned that pension tax charges are making them retire early or change their working habits. The new proposals include a ‘flexible accrual’ option where members can choose an accrual level in 10 per cent increments and the option to ‘fine-tune’ pension growth towards the end of the scheme year, when total earnings are clearer. The closing date for comments is 1 November 2019.

News

RCN puts pressure on government to fix nurse shortages The RCN is urging patients and the public to sign a petition calling on the government to fix the nursing workforce crisis in England.

Bevan Brittan Events

Employment Law Update.  We will be covering a broad range of relevant issues including working time (holiday pay and obligations to record time); IR35; cases on whistle blowing, disability discrimination, restrictive covenants and collective bargaining; ‘just culture’; and the latest on settled status applications.
Bristol - Tuesday 3 December
Birmingham - Wednesday 4 December
London - Wednesday 11 December
Leeds - Thursday 12 December

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

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Finance 

Publications/Guidance

Tackling fraud, bribery and corruption: economic crime strategy, 2018-2021 This document provides NHS England's strategic direction regarding tackling fraud, bribery, corruption and economic crime. It estimates that economic crime costs the NHS more than £1 billion a year.

Penalty charge notices in healthcare Penalty charge notices (PCNs) are supposed to discourage people from claiming free prescriptions or dental treatment when they are not entitled to do so. This report finds that the current PCN process penalises those who fail to navigate the complex exemption criteria and neglects clear evidence of abuse by repeat offenders. It concludes that the system requires a fundamental overhaul and is not fit for purpose.

The ‘make do and mend’ health service: solving the NHS’ capital crisis. This report finds that, compared with similarly advanced economies, the NHS has had historically low levels of capital investment. The report recommends a new settlement to fund capital and support transformation totalling £5.6 billion per year – an 80 per cent uplift. It also argues that the PFI legacy must also be addressed, through a ‘right to enfranchisement’ for the NHS, which would bring those contracts that represent bad deals back into public ownership.

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

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Housing and property

Publications/guidance

Creating healthy places: perspectives from NHS England’s Healthy New Towns programme These essays highlight a number of themes, including the value of taking a place-based approach to population health, the need for specific action on health inequalities, the importance of working closely with communities and the potential to use new places as a test bed for integrated care. The report concludes that there is significant potential to improve population health through place-making and community development. It also stresses the need for the NHS to be closely involved in major housing developments and regeneration programmes in order to improve health and care outcomes.

Health matters: rough sleeping This guidance focuses on the scale of rough sleeping in England, the causes and consequences of rough sleeping (including the links with poor physical and mental health, prevention and effective interventions) and relevant calls to action.

Bevan Brittan Events

Healthcare Estates Breakfast Briefings - 4th December 2019 Leeds

If you wish to discuss any queries you may have around housing please contact Julia Jones.

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Inquests  

Publications/guidance

Notification of Deaths Regulations 2019 guidance A guidance to accompany the Notification of Deaths Regulations 2019. This guidance sets out the notification requirement, circumstances in which a notification should be made under regulation 3 and information to be provided to the senior coroner. The Notification of Deaths Regulations 2019 come into force on 1 October 2019.

Bevan Brittan Updates

Medical practitioners: new duty to notify deaths - Joanna Lloyd

If you wish to discuss any queries you may have around information sharing please contact Claire Bentley.

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Mental Health 

Publications/Guidance

Representing people who lack mental capacity. Solicitors Regulation Authority guidance to help solicitors understand their obligations to people who lack mental capacity and how to comply with them. It aims to highlight issues regarding the mental capacity of prospective and existing clients, and how these impact on the ways solicitors meet the required standards of service and client information. The guidance relates to the new "Standards and Regulations" and is effective from 25 November 2019.

Mental Health: Victims and Witnesses with Mental Health Conditions and Disorders Crown Prosecution Service guidance identifies the principles relevant to victims and witnesses with mental health conditions or disorders, namely: a mental disorder, as defined by the Mental Health Act 2007; a learning disability; a learning difficulty; Autism Spectrum Disorder; an acquired brain injury; dementia; or other mental health, cognitive or neuro-diverse conditions. It has also published "Mental Health: Suspects and Defendants with Mental Health Conditions or Disorders". Publishing the guidance, the Director of Public Prosecution Max Hill QC said out of date laws which stigmatise defendants with mental health issues need to be overhauled and called for a debate about whether the criminal justice system enables people with mental health conditions to participate fairly.

Requesting information about a guardianship order A practice note explains the Public Guardian's policy on: what information is on the register of guardianship orders; how requests for information held on the register are handled; and how requests for information not held on the register are handled.

Guidance note: Using the inherent jurisdiction in relation to adults. 39 Essex Chambers useful guidance note on the inherent jurisdiction

On the frontline: policing and mental health How are police and other services working together to support people in mental health crisis?

The community mental health framework for adults and older adults The Community Mental Health Framework describes how the Long Term Plan’s vision for a place-based community mental health model can be realised, and how community services should modernise to offer whole-person, whole-population health approaches, aligned with the new Primary Care Networks.

Deprivation of liberty safeguards: a practical guide Law Society guidance for solicitors and people working in health and social care on the law relating to deprivation of liberty safeguards (DoLS). The guidance, which sets out how to identify when a deprivation of liberty may be taking place, includes fictional case studies to explain the law following Cheshire West and Chester Council v P (SC) and a list of questions for front-line practitioners. Individual quick reference guides are published alongside the guidance and relate specifically to the identification of deprivation of liberty in a hospital setting, a psychiatric setting, a care home setting, a supported living setting, a home setting and with respect to under 18s.

The community mental health framework for adults and older adults This framework, prepared together with the National Collaborating Centre for Mental Health, describes how the NHS long-term plan’s vision for a place-based community mental health model can be realised, and how community services should modernise to offer whole-person, whole-population health approaches, aligned with the new primary care networks.

Mental Capacity (Amendment) Act 2019 A Law Society publication details its views on the Mental Capacity (Amendment) Act 2019. The Society initially opposed the amendments at Bill stage on grounds that there would be a weakening of safeguards provided under the existing Deprivation of Liberty Safeguards and they remain concerned about how the Act will affect the rights of over 300,000 people who have diminished capacity and may be subject to restrictive measures.

The Autism Act, 10 years on: a report from the All Party Parliamentary Group on Autism on understanding, services and support for autistic people and their families in England Under the landmark Autism Act, alongside other important laws like the Care Act, people with autism in England are entitled to the care and support they need. But this inquiry report, based on a survey of around 11,000 people with autism and their families, finds that not enough has been done locally and nationally to ensure that the Autism Act makes a real difference to those people throughout the country. It concludes that progress has been held up because there isn’t enough understanding of the Act’s duties on councils and the NHS and of how to implement them.

Global ministerial mental health summit 2018. Reports, news stories and speeches from the summit held in October 2018 in London.

Cases

The Hospital v JJ [2019] EWCOP 41 [2019] EWCA Civ 1558 The court held that there was reason to believe that the P lacked capacity in relation to the issues concerning his treatment and considered that it was in his best interests that he be treated in accordance with the plan that has been laid out by the Trust. The court was also satisfied that it was necessary and proportionate, and in the P's best interests to make the order that reasonable restraint can be used in order to administer treatment. See cases

Lincolnshire County Council v AB [2019] EWCOP 43 The court held that it was wholly contrary to the P's best interests for him to have sexual relations with prostitutes. Still less, was it appropriate for the court to sanction the same. See cases

Various Lasting Powers of Attorney, Re [2019] EWCOP 40 Several applications were brought by the PG where the common theme across these applications was the expression by the donor, in the Lasting Power of Attorney, of an intention that the appointed attorney use the donor's funds to benefit someone other than the donor. See cases

D (A Child) [2019] UKSC 42 It was not within the scope of the operation of parental responsibility for parents to consent to living arrangements for a 16 or 17-year-old child who lacked capacity if those arrangements would otherwise amount to a deprivation of liberty within the meaning of ECHR art.5. See cases

Various Lasting Powers of Attorney, Re [2019] EWCOP 40 Several applications were brought by the PG where the common theme across these applications was the expression by the donor, in the Lasting Power of Attorney, of an intention that the appointed attorney use the donor's funds to benefit someone other than the donor. ​See cases

JB (Capacity: Consent To Sexual Relations And Contact With Others) [2019] EWCOP 39 In relation to a person's capacity to consent to sexual relations, the "information relevant to the decision" under the Mental Capacity Act 2005 s.3(1) did not include information that, absent consent of a sexual partner, attempting sexual relations with another person was liable to breach the criminal law. See cases

Bevan Brittan Events

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

How can we help?

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

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

Bevan Brittan Mental Health Extranet 

Would you like to access the Bevan Brittan Mental Health Extranet? - It is a secure online resource containing a discussion forum, knowledge bank and information about training events. If you would like access please contact Claire Bentley.   

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

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Primary Care  

Publications/guidance

Dependence and withdrawal associated with some prescribed medicines: an evidence review This report contains the results of a public health evidence review of available data and published evidence on the problems of dependence and withdrawal associated with some prescribed medicines. It points to issues of GP prescribing and highlights how patients can experience barriers to accessing treatment services.

NHS primary medical services directions. These directions set out the legal framework under which General Practitioners (GP) operate and are paid.

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

Using online consultations in primary care: implementation toolkit This online consultation toolkit is an interactive document that provides a range of ideas and options for different professionals, including clinicians, at different points in their implementation journey.

A new approach to complex needs: Primary Care Psychological Medicine - first year evaluation The Primary Care Psychological Medicine service offers psychological interventions to people who have high levels of unexplained or persistent physical symptoms of illness. This report finds that the service has reduced the use of GP, outpatient and emergency department services in one year by more than its own staff costs. The report concludes that primary care networks could benefit from setting up similar services in local areas across the country so that fewer people miss out on the support they need close to home.

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

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Providers 

Publications/Guidance  

The state of the NHS provider sector NHS Providers is warning that a failure to present the public with the true scale of the challenges facing the NHS risks putting public faith in the health service 'on the line'. The warning follows a survey showing that the overwhelming majority (91 per cent) of trust leaders do not feel there has been enough public debate about the challenges and opportunities facing the NHS and its long-term future. This reports sets out in detail the growing pressures and difficulties trusts face, despite welcome funding pledges from the government and a new long-term plan for the NHS.

Providers deliver: better care for patients This report considers both the leadership approaches and frontline initiatives that underpin improvements in quality. Through 11 case study conversations, it considers some of the frontline work that has contributed to trusts’ improvements in Care Quality Commission ratings. The report also explores the role of trust leaders in providing an enabling, supportive environment in which this work has been possible. 

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

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Public Health 

Publications/guidance 

Individual and local area factors associated with self-reported wellbeing, perceived social cohesion and sense of attachment to one’s community: analysis of the Understanding Society Survey The findings reported here are from an analysis of data from the Understanding Society Survey (USS), which follows a large sample of people from across England over time. This study was undertaken to examine questions likely to be especially relevant for those working in the field of public health intelligence, using small area statistics to identify localities where interventions may particularly need to be targeted in order to reduce inequalities in wellbeing across England.

Public Health England strategy: 2020-25 This strategy sets out how Public Health England (PHE) will work to protect and improve the public’s health and reduce health inequalities over the next five years. It outlines PHE's role within the public health system, 10 priorities where PHE will focus particular effort, and the areas where PHE will build capability within the organisation to support delivery of its strategic objectives and wider activities.

Public Health England launches new infectious disease strategy. The new strategy addresses current and future threats to health, including antibiotic resistance and health inequalities.

News

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

Local practice: long-term sustainability through place-based health. A report by think-tank Localis calls on ministers to reverse cuts to public health funding and put a premium on preventive care budgets, targeting resources and funding to parts of the country that would benefit most from immediate help.

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

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Regulation

Publications/guidance

State of Care - CQC. Summary key points: • Some people are struggling to get access to the mental health services they need, when they need them. • There is pressure on all health and care services in England. • More and better community services are needed to help people avoid crisis situations. • The challenge for government, Parliament, commissioners, national organisations and providers is to change the way services work together so that the right services are being commissioned to deliver what people need in their local area. • Innovation is at the heart of some of the high quality care we see – sometimes this is technological and specialised, or it might be the way in which services use smarter workforce planning to meet people’s care needs.

NHS regulation and oversight: a time of transition This report outlines the findings from a survey on regulation and explores trusts' experiences of regulation over the past 12 months. It reveals that only 39 per cent of NHS trust leaders think the overall regulatory approach adopted by NHS England, NHS Improvement and the Care Quality Commission is working well. It also highlights the growing tension between the current system of regulation, which focuses on organisations, and the ambition to move towards an approach that takes system working into account.

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

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Social Care  

Publications/Guidance  

The state of health care and adult social care in England 2018/19 This year’s report considers the pressures faced by health and social care as a whole – but focuses particularly on inpatient mental health and learning disability services. While the overall quality picture for the mental health sector, which includes community mental health services, remains stable, this masks a real deterioration in some specialist inpatient services. In hospital emergency departments, performance has continued to get worse while attendances and admissions have continued to rise. The stability of the adult social care market remains a particular concern.

The state of the adult social care sector and workforce in England A report by Skills for Care provides a comprehensive analysis of the adult social care workforce in England and the characteristics of the 1.49 million people working in it.

Review of adult social care complaints 2018/19 According to this report, the Local Government and Social Care Ombudsman has found problems in nearly two out of every three adult social care complaints it has investigated in the past year. It revealed it is investigating a greater proportion of complaints than previous years – and finding fault on average in 66 per cent of cases. In some casework areas – including those about fees and charging for care – the Ombudsman has upheld 73 per cent of investigations.

Policy briefing: social care funding and mental health This briefing explores what a fair and sustainable funding settlement for social care needs to look like in order to deliver parity of esteem for mental health and sufficient funding to support people of working age as well as those in later life. It reviews the current funding and provision of mental health social work for people of working age in England. It finds that mental health social work plays a vital role in helping people to live independently and to secure their rights and dignity.

Who cares? The financialisation of adult social care According to this analysis, social care's reliance on private bed provision is growing. The report finds that the private sector now provides 84 per cent of beds for people needing residential social care, up from an estimated 82 per cent in 2015. It also finds that larger providers – particularly those funded by private equity firms – are becoming more dominant. It concludes that a growing reliance on private provision could mean lower-quality care. 

Carers action plan 2018 to 2020: 1-year progress review Sets out the progress that has been made towards fulfilling the commitments in the carers action plan 2018 to 2020.

Cases  

R v BUPA Care Homes (BNH) LTD [2019] EWCA Crim 1691. A fine imposed on a subsidiary company for an offence under the Health and Safety at Work etc. Act 1974 s.3(1) was reduced where the sentencing judge had improperly taken into account the parent company's turnover and resources when applying an uplift to the starting point reached under the Sentencing Guideline for Health and Safety Offences, Corporate Manslaughter and Food Safety and Hygiene Offences.

Bevan Brittan Updates

Care Quality Commission's State of Care report - Monica Macheng

Adult Social Care Providers EU Exit Planning Update - Monica Macheng

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

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General  

Publications/Guidance

The state of health care and adult social care in England 2018/19 This year’s report considers the pressures faced by health and social care as a whole – but focuses particularly on inpatient mental health and learning disability services. While the overall quality picture for the mental health sector, which includes community mental health services, remains stable, this masks a real deterioration in some specialist inpatient services. In hospital emergency departments, performance has continued to get worse while attendances and admissions have continued to rise. The stability of the adult social care market remains a particular concern.

Integrated care: what physicians need to know about implementing the NHS long term plan This guide outlines how doctors can best influence their local integrated care system. It highlights some best practice and case studies, which will provide food for thought as to how clinicians may approach delivering more integrated health and care.

Delivering same-sex accommodation This guidance has been updated to reflect current patient pathways, including further definition of what is and is not a mixed-sex accommodation breach and circumstances in which mixing may be justified and therefore not constitute a breach.

The national medical examiner system  A new medical examiner system is being rolled-out across England and Wales to provide greater scrutiny of deaths. NHS Improvement guidance provides details on the regional structure, the digital system and plans for funding the new system

The effectiveness and influence of the select committee system This report celebrates the 40th anniversary of the formation of Select Committees, and examines their effectiveness. It concludes that Select Committees play a crucial role in holding the government to account, but challenges lie ahead in ensuring they maintain their vital scrutiny role while expanding their reach to include a wider range of voices in their work.

Health profile for England: 2019 A Public Health England report covers: trends in mortality; trends in morbidity and behavioural risk factors; children and young people; inequalities in health; and wider determinants of health.

Structurally unsound: exploring inequalities - igniting research to better inform UK policy The UK government’s current approach to tackling inequality should urgently address the multiple levels of disadvantage that some people face, according to this report. It finds that women, working-class, ethnic minority and disabled groups often face multiple disadvantages affecting their educational outcomes, employment prospects, home ownership, health and life expectancy. The report, compiled with contributions from the Resolution Foundation, highlights lessons learned and provides recommendations for policy-makers and researchers to adopt when approaching structural inequalities.

Course corrections: how health care innovators learn from setbacks to achieve success This report examines new models for delivering and paying for health care to better serve vulnerable patients, including people with multiple chronic conditions, serious illnesses, or functional limitations, as well as those at risk of developing health problems because of their social circumstances or behavioural health conditions. It also showcases models that improve the quality of care and health outcomes while lowering costs or reducing unnecessary health care use.

Health care's climate footprint: how the health sector contributes to the global climate crisis and opportunities for action According to this report, if the global health care sector were a country it would be the fifth-largest greenhouse gas emitter on the planet. The report finds that health care’s footprint is equivalent to 4.4 per cent of global net emissions and that fossil fuel combustion makes up well over half of health care’s global climate footprint. The report makes the case for a transformation of the health care sector that aligns it with the Paris Agreement goal of limiting climate change to 1.5 degrees celsius.

Get it on time: the case for improving medication management for Parkinson’s This report highlights problems that inpatients with Parkinson's disease can face receiving their medication. These findings include: nearly two-thirds of people who have Parkinson’s don’t always get their medication on time in hospital; more than three-quarters of people with Parkinson’s who were asked reported that their health deteriorated as a result of poor medication management in hospital; and only 21 per cent of respondents said they got their medication on time without having to remind hospital staff. The report sets out recommendations that hospitals should implement to improve medication management.

The NHS’s recommendations to government and parliament for an NHS Bill The NHS long-term plan included suggested changes to the law to help implement the plan. In spring 2019, NHS staff, partner organisations and interested members of the public were invited to give their views on the proposals. This document sets out the NHS response to the views it received during engagement and sets out its recommendations to the government and parliament for an NHS Bill. This Bill could help deliver improved patient care by removing barriers and promoting collaboration between NHS organisations and their partners.

Health Infrastructure Plan: A new, strategic approach to improving our hospitals and health infrastructure.  A Department of Health and Social Care plan sets out a 5-year programme of investment in health infrastructure, including a new hospital building programme. It will deliver a long-term, rolling 5-year programme of investment in health infrastructure, including capital to: build new hospitals; modernise the primary care estate; improve mental health facilities; invest in new diagnostics and technology; and help eradicate critical safety issues in the NHS estate.

Psychological perspectives on obesity: Addressing policy, practice and research priorities. Policymakers must do more than tell people to show greater willpower if government is to crack the obesity problem, says a new report from the British Psychological Society.

A maternity pressure group has published a study on the impact of the policy of charging overseas visitors for NHS care on midwives’ practice or professional responsibilities. This study aimed to explore midwives’ experience of looking after women who had been charged, especially in relation to the impact of NHS charging on their professional practice.

Health profile for England: 2019 This report combines data and knowledge with information from other sources to give a broad picture of the health of people in England in 2019. It includes life expectancy, trends in mortality and morbidity, and inequalities in health.

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