20/10/2020
The growing impact of the Coronavirus (COVID-19) is having an unprecedented generational impact on the health and wellbeing of society across the UK and around the world. The impact is being felt in our everyday lives and is now having far reaching consequences for everyone. If you or your organisation needs advice relating to Coronavirus, Bevan Brittan has set up a COVID-19 Advisory Service which draws upon the expertise of a range of Bevan Brittan legal and regulatory teams. Please feel free to contact us.
Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.
If someone forwarded you this email you can sign up for your own free copy here delivered directly to your inbox.
If someone forwarded you this email you can sign up for your own free copy here delivered directly to your inbox.
Bevan Brittan Free Training Events
Clinical Risk Webinars
Bevan Brittan Clinical Risk/Health, Care and Regulatory Law Team Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. If your employer organisation is a Bevan Brittan client you can sign up to watch the training sessions remotely via our webinar facility.
Clinical risk webinars coming up are as follows:-
21st October 2020 12.30pm - Quantum update for clinical negligence practitioners including the recent judgment of Swift v Carpenter.
10th November 2020 12.30pm - CPR and Part 36 - a review of the year. A look at CPR changes and case decisions that will impact on handling clinical negligence cases.
24th November 2020 12.30pm - Secondary victim claims: an update on recent developments
Mental Health Webinars
8th December 2020 12.30pm- Mental Health update
Knowledge Transfer
Training. In addition to our free training programme for 2020 (ask Claire Bentley if you want a copy), 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. All these sessions are available remotely via our webinar facility.
Acute and emergency care
Publications/Guidance
Project reset in emergency medicine: patient FIRST This resource shares practical examples from emergency department staff to help trusts harness the learning from the Covid-19 pandemic. The resource focuses on five key areas: flow, infection control, reduced emergency department attendances, staffing and treatment.
If you wish to discuss any queries you may have around acute and emergency issues please contact Claire Bentley.
Children and young people
Publications/Guidance
Inquiry into the support available for young people who self-harm. This inquiry, led by the All Party Parliamentary Group on Suicide and Self-Harm Prevention and supported by Samaritans, explored the experiences of young people who self-harm in accessing support services. In particular, it examined: support services currently available in both clinical and the wider community settings (including schools); plans for improving and expanding this support; and the changes needed to ensure that support is made more effective and widely available. It concludes that young people who self-harm are often made to wait until they reach crisis point before receiving support.
The good childhood report 2020 This report finds that there has been a continued decrease in average happiness with life among 10 to 15 year olds in the UK. It discovered that 15 year olds in the UK were among the saddest and least satisfied with their lives in Europe and that the coronavirus (Covid-19) pandemic affected children’s happiness due to the lack of choice they had in life.
The whole society approach: making a giant leap on childhood health This report looks at the government's 'obesity strategy' announcement in July 2020 and considers how it could be used to address growing levels of 'health risk' faced by children. This report outlines a ‘whole society’ approach to expand ambition from obesity to all health issues; tackle the link between childhood health and issues such as marginalisation, poverty and deprivation; and ensure the full range of levers offered by a collective approach are being used.
Vulnerability in childhood: a public health report These two reports from Public Health England are aimed at local government and their partners to inform their co-ordinated approaches to reduce vulnerability and adversity in childhood. A public health informed approach looks at the factors for individual children, their families and the communities in which they live that make it more or less likely that vulnerability and adversity in childhood has a lasting impact on their lives. This holistic, multi-agency approach addresses inequality and the broader causes of vulnerability that might otherwise be overlooked.
Survey for professionals: Developing an app for children who have experienced domestic abuse. AVA would love to hear your ideas and feedback via this link to support them developing the app.
Generation Covid-19: building the case to protect young people’s future health This long read from The Health Foundation explores how as a result of necessary measures to protect health in the short term, young people in particular are now experiencing ongoing economic and social challenges that threaten their long-term health and wellbeing.
Day surgery for children and young people This publication highlights the specific needs of children and young people undergoing day surgery, outlining pre- and post-operative aspects of care and preparation, parental involvement and facilitating discharge.
State of the nation 2020: children and young people’s wellbeing This report collates published evidence on the wellbeing in children and young people over the period of March to August 2020, including statistics on the personal wellbeing of children and young people in England and the UK. It also includes a wider set of indicators on their relationships, health, education and skills, personal finance, activities, and where they live.
Coronavirus: Separated Families and Contact with Children in Care FAQs (UK) This paper provides brief information in response to some key questions regarding the impact of the Coronavirus outbreak on separated families, maintenance arrangements and access to children.
Childhood obesity This report examines the effectiveness of the government’s approach to reducing childhood obesity in England by considering the evidence base and progress so far. It focuses on children, as dealing with obesity early in life prevents future costs and obesity-related health problems. It also focuses on preventive measures rather than treatment. The report sets out: levels and trends in childhood obesity; government action to reduce childhood obesity; and local authorities’ role in reducing childhood obesity.
Childhood in the time of Covid While for some children there were certain aspects of the pandemic that brought benefits such as spending more time with their families, this report sets out how for many of the most vulnerable children the disruption of the past six months has been damaging and compounded existing inequalities. It calls for a comprehensive recovery package for children and provides a roadmap for what should be done to help children to recover from their experiences of the past six months and the ongoing crisis.
Statistics for all routine childhood vaccinations in England in 2019-20 NHS Digital has published childhood vaccination coverage statistics contains information on vaccinations measured at the ages of 12 months, 24 months and five years. There are 14 measures of vaccination coverage. At a national level, coverage has increased for 12 of these.
Guidance to parents and guardians: when you should book a coronavirus test for your child Letter from the Chief Nurse and Interim Chief Medical Officer of NHS Test and Trace on when parents and guardians should book a coronavirus (COVID-19) test for their child.
How we can help
We can assist in relation to the statutory responsibilities for children under the Coronavirus Act 2020 including decisions around:-
- commissioning and the provision of healthcare and social care;
- isolation and duties toward children in the care and those classed as vulnerable under the Coronavirus ( COVID19 );
- guidance on vulnerable children and young people;
- the delivery of EHCP plans;
- safeguarding; and,
- all aspects of educational provision including for key workers.
If you wish to discuss any queries you may have around children please contact Deborah Jeremiah.
Clinical Risk / Patient Safety
Publications/Guidance
Decision making and consent. The GMC have updated their Decision making and consent guidance, which comes into effect on 9 November 2020. The guidance will support doctors to practise shared decision making and help their patients to make healthcare decisions that are right for them. New features include:
1. a focus on taking a proportionate approach, acknowledging not every paragraph of the guidance will be relevant to every decision
2. seven key principles which summarise the guidance
3. a new section to help doctors find out what matters to patients so they can share relevant information to help them decide between viable options
4. suggestions for how other members of the healthcare team can support decision making.
Shared decision making and consent are fundamental to good medical practice. Getting this right can empower patients, which helps to improve health outcomes, patient experience and reduce complaints.
Covid-19: assessing the risk to public protection posed by a doctor as a result of concerns about their practice during the pandemic. This guidance details how to take the context created by Covid-19 into account when considering complaints about doctors. It means that, in line with the General Medical Council's normal practice, concerns about doctors will be considered in the context of the pandemic and, in certain circumstances and where there are no risks to patients or to public confidence, some issues might not put into question a doctor’s fitness to practise.
Early detection and diagnosis of cancer. This roadmap aims to unite fragmented efforts across the UK to drive progress in early detection and diagnosis of cancer.
Delivering core NHS and care services during the pandemic and beyond: Second Report of Session 2019-21. A Health and Social Care Committee report on the delivery of core NHS and case services during the coronavirus (COVID-19) outbreak and beyond details the impact and unprecedented challenge caused by COVID-19 to the provision of essential services. It calls for urgent action to assess and tackle a backlog of appointments and an unknown patient demand for all health services, specifically across cancer treatments, mental health services, dentistry services, GP services and elective surgery. The Committee says there is a compelling case for the nationwide routine testing of all NHS staff and they are yet to understand why it cannot be introduced.
Cases
Greater Manchester Fire and Rescue Service v Veevers [2020] EWHC 2550 (COMM) This was an appeal against a decision of Deputy District Judge Harris (sitting as a Regional Costs Judge in Manchester) that the costs of preparing for and attending an inquest into the death the Claimant’s son were recoverable as costs of the civil claim.
Swift v Carpenter Court of Appeal (Civil Division) [2020] EWCA Civ 1295. The Court of Appeal handed down its judgment on the issue of how the additional cost of acquiring suitable accommodation for injured claimants should be compensated. It has found that Roberts v Johnstone no longer achieves fair and reasonable compensation for an inured claimant.
News/articles
Witnesses overheard conferring during break in remote hearing. It has emerged that during a break in remote proceedings in the Technology and Construction Court (TCC), two witnesses were overheard having a private telephone conversation about the evidence being given. The conversation was overheard by the defence counsel as the microphone on one of the witnesses tablet remained switched on. Noting the "unfortunate episode" in his judgment, Russen, J reiterated the need to guard against the risk of contamination of a witness' independent recollection of events but stated that, due to the short length of the break and the call, he was satisfied the witness was not being "fed his lines".
Inquiry into maternity units in south Wales units rises to 160 cases An independent panel appointed by the Welsh Government to investigate two maternity units in south Wales where a series of concerns around staffing, processes and culture were said to be compromising care, is looking into 160 "episodes of care" involving around 150 women. Women complained they were not listened to and their concerns were not taken seriously or valued, and families reported they felt that they continued to experience emotional and physical problems and a number said they experienced post-traumatic stress disorder.
Government to draw up plans on compensation for victims of infected blood scandal. The Government has stated that it is drawing up plans to offer victims of the infected blood scandal in the 1970s and 1980s compensation, which campaigners estimate could cost more than £1 billion. Up to 25,000 patients were infected and more than 2,400 people died after being treated with blood-based drugs, mainly imported from the US, that were contaminated with HIV, hepatitis C or both.
NHS trust to be prosecuted for the first time over death of newborn baby. The Care Quality Commission has announced that an NHS trust will be prosecuted for the first time over the death of a baby and the alleged poor treatment of a mother in its care after an inquest found that the death of a seven-day-old baby at the Queen Elizabeth the Queen Mother Hospital in Margate, Kent in November 2017 had been "wholly avoidable". The East Kent Hospitals University NHS Foundation Trust is to face a criminal prosecution on two charges of failing to provide safe care and treatment.
Research and data: Taking steps to improve patient safety - Speech by Jeremy Hunt.
Bevan Brittan Updates
Accommodation claims: Swift v Carpenter. Joanne Easterbrook.
When is an admission not an admission? - Penelope Radcliffe
Maternity services in England - Samantha Minchin and Simon Lindsay
Health worker safety: A priority for patient safety - Joanna Lloyd
Bevan Brittan Events
Bevan Brittan Clinical Risk/Health, Care and Regulatory Law Team 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 our webinar programme just ask Claire Bentley.
Clinical risk webinars coming up are as follows:-
21st October 2020 12.30pm - Quantum update for clinical negligence practitioners including the recent judgment of Swift v Carpenter
10th November 2020 12.30pm - CPR and Part 36 - a review of the year. A look at CPR changes and case decisions that will impact on handling clinical negligence cases.
24th November 2020 12.30pm - Secondary victim claims: an update on recent developments
If you would like to receive the Education Lunch Programme for 2020 just ask Claire Bentley.
How we can help
We are working with clients on formulating policies and making it easier to balance treatment with finite resources. We are helping with social care policies and day to day activities such as contact and isolation, human rights issues and life/death decisions. We are working on notifications of harm and death, RIDDOR, CQC compliance, judicial review, infection control law and grappling with the new regulations and guidance. For more information click here.
If you wish to discuss any clinical risk or patient safety issues please contact Tim Hodgetts or Joanna Lloyd.
Commissioning
Publications / guidance
COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol COVID-19 guidance for commissioners and service providers for those dependent on drugs or alcohol.
If you wish to discuss the issue of commissioning please contact David Owens.
Digital Health
Publications/guidance
An uncomfortable truth: digital isn’t perfect, but neither is face to face The Covid-19 pandemic has accelerated the digital transformation in health and care, but are we oversimplifying when pitting digital services against face-to-face appointments? In this blog Pritesh Mistry highlights the need for balance to support both staff and the communities they serve.
If you wish to discuss any queries you may have around Digital Health please contact Daniel Morris.
Employment/HR
Publications/guidance
Covid-19: assessing the risk to public protection posed by a doctor as a result of concerns about their practice during the pandemic. This guidance details how to take the context created by Covid-19 into account when considering complaints about doctors. It means that, in line with the General Medical Council's normal practice, concerns about doctors will be considered in the context of the pandemic and, in certain circumstances and where there are no risks to patients or to public confidence, some issues might not put into question a doctor’s fitness to practise.
Laying foundations: attitudes and access to mental health nurse education. Mental health nurses account for more than a third of the mental health workforce in England and work across a wide range of health and care settings. However, this report finds that the pipeline of people choosing to study and qualify to become a mental health nurse is unable to meet sharply rising demand for this service. It looks at ways more people might be attracted to apply to study mental health nursing – and reasons why numbers are currently limited.
Guidance on the support of mental health social workers working in NHS, independent or integrated services. This guidance is designed to support all agencies that employ social workers. It has been produced to sit alongside the Local Government Association’s employers’ guidance and give detailed advice and support to develop the social work role across all mental health settings and organisations. It is based on the learning from the ‘social work for better mental health’ programme, working across over 70 organisations, assessing and developing their integrated arrangements. It has been updated to reflect the contribution which social work can make to mental health services during the Covid-19 epidemic.
COVID-19: how to work safely in care homes Guidance for those working in care homes providing information on how to work safely during this period of sustained transmission of COVID-19.
NHS nursing workforce. This report finds that the NHS has 40,000 nursing vacancies, with tens of thousands of nurses leaving every year and 36 per cent of the current workforce considering leaving in the next year.
Coronavirus (COVID-19) testing: guidance for employers and third-party healthcare providers Department of Health and Social Care guidance aims to help employers and third-party healthcare providers to introduce their own internal testing programmes outside of the NHS Test and Trace service. It covers: legislation, regulations and best practice; virus and antibody testing; how to interpret test results; and next steps after a positive or negative test.
Covid-19 and the health and care workforce: supporting our greatest asset This report includes key findings from a member survey of more than 250 health care leaders, which revealed that nine out of ten respondents are concerned about the long-term impact of Covid-19 on the wellbeing of their staff. It also raises concerns about workforce shortages.
So what now? Supporting students through a global pandemic and beyond This report finds that many student midwives are struggling under the weight of financial concerns, poor mental health and an unpredictable job market. It finds that 96 per cent of student midwives reported having mild or moderate mental health problems since the pandemic began. The survey shows that by the end of July just 36 per cent of students in their final year of midwifery training had been offered a job in the NHS. At the same time, midwifery educator numbers are not keeping pace with the rise in student midwife numbers, potentially leaving students less supported throughout their training.
Understanding LGBT+ employee networks and how to support them This report looks at how LGBT+ employee networks operate within the NHS. It presents a picture of what they do and some of the challenges they face. Recommendations made within the report are aimed at helping NHS organisations develop the long-term capacity for networks to flourish and add value.
The Joint Committee on Human Rights Inquiry into the human rights implications of the UK Government's Covid-19 response: Evidence from staff working in health, care and social work. In evidence to the Joint Committee on Human Rights inquiry into the human rights implications of the UK Government's coronavirus (COVID-19) response, the British Institute of Human Rights (BIHR) reveals that 76% of people working in health and care who responded to its call for evidence told BIHR that during coronavirus they were not provided with legal training or clear information about upholding human rights law. Other results include: 82% of people told BIHR that it had been harder to uphold human rights during the pandemic and 79% of people said that they were not provided with legal training or clear information about the use of emergency powers under the Coronavirus Act 2020.
Workforce race and equality standard (WRES): indicators for the NHS medical workforce The WRES was introduced in 2015 to ensure employees from black and minority ethnic backgrounds have equal access to career opportunities and receive fair treatment in the workplace. A bespoke set of WRES indicators have been developed for the NHS medical workforce. There are eleven indicators for the medical workforce. Four of the indicators reflect variation in career progression and pay, six represent medical staff perceptions of how they are treated by colleagues, employing organisations and patients, and one highlights the diversity of the councils and boards of medical institutions.
Action for equality: the time is now. According to this report, NHS leadership that more fairly represents women in senior roles is 'essential, overdue and needed now'. The Health and Care Women Leaders Network has found that while progress has been made to increase the proportion of women in leadership roles across the health service, there is much more to do to meet the NHS’s target for 50:50 representation this year, as set by the NHS regulator in 2016.
Review of the Shortage Occupation List: 2020 The MAC advises that senior care workers and nursing assistants are among the occupations that should be added to the Shortage Occupation List (SOL) to relieve pressure when freedom of movements for those born in the European Union ends. The committee has, however, warned of the stark consequences of low wages in social care, with most frontline occupations in the sector ineligible for the skilled worker route and the SOL. It has reiterated the need to make jobs more attractive to UK workers by increasing salaries rather than relying on migrants, particularly during the ongoing Covid-19 pandemic.
NHS nurse numbers increase and nursing student acceptances rise The number of nurses in the NHS in England increased by 14,199 compared to last year, and the number of doctors has risen by 9,283, figures published up until the end of June show. All professionally qualified clinical staff, paramedics and support to clinical staff are now at record levels.
The courage of compassion: Supporting nurses and midwives to deliver high-quality care. The report finds that staff stress, absenteeism and turnover in these professions have reached alarmingly high levels. This has been compounded by the Covid-19 pandemic, which has laid bare and exacerbated longer-term issues including chronic excessive workload, inadequate working conditions, staff burnout and inequalities, particularly among minority ethnic groups.
Bevan Brittan Updates
£95,000 cap on Exit Pay in the Public Sector to come into force on 4 November 2020 - Sarah Lamont
Public sector exit payments update: Regulations approved by parliament - Sarah Lamont
Covid-19 and regulation by the HSE and CQC - Samantha Minchin and Carlton Sadler
How we can help
We can offer support and advice on managing many workforce issues including flexing your workforce to respond to the pandemic, managing bank staff, redeployment, vulnerable groups, sick pay, leave options, supporting staff well-being, presenteeism, remote and home working, through FAQs, helpline or policy guidance and practical day to day advice.
If you wish to discuss any employment issues generally please contact Jodie Sinclair, Alastair Currie or James Gutteridge.
Finance
Publications/Guidance
Next steps for funding mental healthcare in England: prevention The RCPsych has identified four areas that must be fully and sustainably resourced if access to the quality of mental health services in England that has been promised by the government is to be realised. These are: infrastructure; prevention; people; and technology. This paper focuses on prevention and considers the next steps for funding mental health care in England, with a specific focus on public health and prevention, promoting resilience in social care, and budgeting for workforce growth, education and training.
Cost effectiveness analysis: health economic studies This guidance aims to explain how to use a cost effectiveness analysis to evaluate digital health products.
Health as the new wealth: the NHS’s role in economic and social recovery. This report argues that health services have a vital role to play in the wider recovery and rebuilding of local economies and communities – driving up prosperity, population health and wellbeing – in the wake of Covid-19. It highlights the links between health and growth, outlines a five-point plan for every system to build on to maximise their local impact and influence, and showcases innovative practice that is supporting lasting local change.
News
Challenge over continuing healthcare costs. Rear Admiral Philip Mathias has threatened a judicial review (JR) of the failure by NHS bosses to pay for the continuing healthcare (CHC) of patients. Under CHC rules, patients with significant health problems should have their care and nursing fees paid in full by the NHS, provided their condition is the main reason they need assistance. Rear Admiral Mathias has launched proceedings with the "intent" of changing NHS behaviour following a two year fight to recover £200,000 paid for nursing homes fees for his mother. He has launched a CrowdJustice appeal to raise funding for the initial stage of JR.
Funding boost to help healthcare suppliers improve cyber security. Hundreds of the UK's vital healthcare firms are set to benefit from government funding to boost their cyber security, Digital Infrastructure Minister Matt Warman has announced. The move comes after the National Cyber Security Centre (NCSC) identified a heightened cyber threat to the UK health sector in relation to the coronavirus (COVID-19) pandemic, with cyber crime groups attempting to steal sensitive intelligence, intellectual property and personal information from pharmaceutical companies and medical research organisations. As part of the funding, participants can receive guidance and support to get accreditation from the Government's Cyber Essentials certification.
If you wish to discuss any queries you may have around finance please contact Claire Bentley.
Inquests
Publications/Guidance
Inquests: A Conversation with the Chief Coroner of England and Wales. This session was held on Tuesday 29 September 2020 and provides a unique opportunity to gain an insight from the Chief Coroner, HHJ Mark Lucraft QC on key recent developments in coronial law.
Cases
Greater Manchester Fire and Rescue Service v Veevers [2020] EWHC 2550 (COMM) This was an appeal against a decision of Deputy District Judge Harris (sitting as a Regional Costs Judge in Manchester) that the costs of preparing for and attending an inquest into the death the Claimant’s son were recoverable as costs of the civil claim.
News
Croydon tram crash inquest postponed due to rising COVID-19 levels in London. 12 week jury inquest into the derailment, which killed seven people and also left 61 people injured, had been due to start on 12 October 2020. The Senior Coroner, Sarah Ormond-Walshe noted “I am very concerned about the jury. I do not think it is reasonable, given the increase in the Tier level for London and the infection rate in Croydon, to oblige a juror to spend the next few weeks in a room with 10 strangers”.
Bevan Brittan Updates
When is an admission not an admission? - Penelope Radcliffe
If you wish to discuss any queries you may have around inquests please contact Toby De Mellow.
Mental Health
Publications/guidance
Dementia wellbeing in the COVID-19 pandemic. This resource is primarily for clinicians working with people with dementia, but can also be used by carers and people with dementia.
Coronavirus (COVID-19): Office of the Public Guardian response. Updated guidance from the Office of the Public Guardian (OPG) explains how it is responding while affected by the coronavirus (COVID-19) pandemic. It covers: how to contact the OPG; lasting power of attorney applications (LPAs); safeguarding assessments and investigations; visits; guardianships; and protecting older people and vulnerable adults.
Coronavirus (COVID-19): looking after people who lack mental capacity Guidance for health and social care staff who are caring for, or treating, a person who lacks the relevant mental capacity.
A research paper: suicide prevention in Gypsy and Traveller communities in England This report outlines the findings of Friends Families and Travellers' research on suicide inequalities within Gypsy and Traveller communities. The papers finds that that only 5 out of 79 local suicide prevention plans in England mention Gypsy and Traveller communities, despite the fact that members of Gypsy and Traveller communities are 6 to 7 times more likely than the general population to die by suicide.
Inquiry into the support available for young people who self-harm. This inquiry, led by the All Party Parliamentary Group on Suicide and Self-Harm Prevention and supported by Samaritans, explored the experiences of young people who self-harm in accessing support services. In particular, it examined: support services currently available in both clinical and the wider community settings (including schools); plans for improving and expanding this support; and the changes needed to ensure that support is made more effective and widely available. It concludes that young people who self-harm are often made to wait until they reach crisis point before receiving support.
Pushed from pillar to post: improving the availability and quality of support after self-harm in England. This report finds that there is no consistently effective support available to people who self-harm. The research identified four key support needs for people who self-harm, which are seen as essential to providing effective care: distraction from immediate self-harm urges; emotional relief in times of stress; developing alternative coping strategies; and addressing the underlying reasons for self-harm. The report makes several recommendations for how the needs of people who self-harm can be met more effectively.
Next steps for funding mental healthcare in England: prevention The RCPsych has identified four areas that must be fully and sustainably resourced if access to the quality of mental health services in England that has been promised by the government is to be realised. These are: infrastructure; prevention; people; and technology. This paper focuses on prevention and considers the next steps for funding mental health care in England, with a specific focus on public health and prevention, promoting resilience in social care, and budgeting for workforce growth, education and training.
Decision making and consent. The GMC have updated their Decision making and consent guidance, which comes into effect on 9 November 2020. The guidance will support doctors to practise shared decision making and help their patients to make healthcare decisions that are right for them. New features include:
1. a focus on taking a proportionate approach, acknowledging not every paragraph of the guidance will be relevant to every decision
2. seven key principles which summarise the guidance
3. a new section to help doctors find out what matters to patients so they can share relevant information to help them decide between viable options
4. suggestions for how other members of the healthcare team can support decision making.
Shared decision making and consent are fundamental to good medical practice. Getting this right can empower patients, which helps to improve health outcomes, patient experience and reduce complaints.
Legislation
Mental Health Act 1983: Question for Department of Health and Social Care. In response to a written question asking what plans the Government has to reform the Mental Health Act 1983 during the 2019 Parliament, the Department of Health and Social Care (DHSC) states it has committed to publishing a white paper which will set out the Government's response to Sir Simon Wessely's independent review of the Act and pave the way for reform of it. The DHSC will publish the white paper as soon as it is possible to do so and will consult publicly on proposals and bring forward a Bill to amend the Act when parliamentary time allows.
The Mental Health (Hospital, Guardianship and Treatment) (England) (Amendment) Regulations 2020 - come into force on 1st December 2020. - These Regulations amend the Mental Health (Hospital, Guardianship and Treatment) (England) Regulations 2008 , which deal with procedural matters relating to the compulsory treatment of people with mental disorders under the Mental Health Act 1983 (c. 20). see Alex RK
LPS Update on timeline - The next significant milestone is the publication of the Code of Practice and six regulations for consultation, expected in Spring 2021. This timeline is provisional and subject to change but it is intended that full implementation will happen in April 2022.
News
Easements which weaken Mental Health Act protections to be dropped. Following recommendations made in its report, "Law under lockdown: COVID-19 measures, access to justice and vulnerable people", the Government is to drop the "easement" provisions of the Coronavirus Act 2020 which weaken Mental Health Act 1983 (MHA) protections in England. The easements, which would have allowed a single doctor to recommend detention under s.2 or s.3 of the MHA, have now been used during the coronavirus (COVID-19) pandemic.
Public Health England launches new Every Mind Matters campaign Public Health England (PHE) has launched a campaign which provides NHS-endorsed advice to help children and young people with their mental wellbeing, and equip parents and carers with the knowledge to support them. PHE survey data has revealed that two-thirds of parents say their children's behaviour has changed since the start of the pandemic, and nearly a quarter say that not knowing what action to take has prevented them supporting their children's mental wellbeing.
Bevan Brittan Updates
Case summary: A NHS Foundation Trust v MC [2020] EWCOP 33 - Ellen Lloyd
Bevan Brittan Education Lunches
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. Please contact Claire Bentley if you would like to attend any of our webinars remotely/would like to receive our education lunch programme for 2020.
Mental Health Webinars coming up are:-
8th December 2020 12.30pm - Mental Health update
If you wish to discuss any mental health issues facing your organisation please contact Hannah Taylor, Simon Lindsay or Stuart Marchant.
Primary Care
Publications/guidance
Structured medication reviews and medicines optimisation This document sets out guidance for primary care networks (PCNs) implementing the structured medication review (SMR) and medicines optimisation service, as per the requirements set out in the 2020/21 Network Contract Directed Enhanced Service (DES) Specification; which states that PCNs must have due regard to this guidance when delivering the service.
Communications toolkit for GP practices This toolkit has been developed to support general practice, Primary Care Networks and CCGs to explain to patients how they can safely access general practice during the coronavirus outbreak.
Accessing government-secured flu vaccines: guidance for GPs How GP practices in England can access the extra stock of flu vaccines this winter that the government has secured.
GP Referral to Community Pharmacist Consultation Service to be made available across England GP practices across England will be able to refer patients with minor illnesses asking for a GP appointment for a same day consultation with a community pharmacist, as part of a new referral pathway to the NHS Community Pharmacist Consultation Service (CPCS).
NICE indicator menu 2020. NICE have published new indicators for general practice on the NICE website. The NICE indicator menu includes general practice and CCG level indicators by clinical area.
COVID-19 waste management standard operating procedure. This document sets out the waste management approach for all healthcare facilities including primary care facilities and testing facilities in England and Wales during the COVID-19 outbreak.
Bevan Brittan Updates/Videos
Bevan Brittan has collaborated with NHS Resolution to produce a series of videos outlining key areas in general practice that frequently give rise to claims. Members of our clinical negligence team draw on their wealth of experience in dealing with claims to highlight the common areas of risk, provide guidance on how to mitigate or avoid these issues, and what steps to take if a complaint or a claim is received. The first three videos in this series are available to watch now. See below:-
Consent - Daniel Morris
Medical record keeping - Ben Lambert
Administrative errors - Susan Trigg
What to do if you receive a complaint or claim - Joanne Easterbrook
Common pitfalls - Helen Carrington
Other useful resources from NHS Resolution for primary care are set out below:-
1. General Practice Indemnity schemes
2. Understanding the Clinical Negligence Scheme for General Practice
3. Handling claims under the Clinical Negligence Scheme for General Practice
4. Covid-19 guidance for general practice
How we can help
We can offer support and advice on managing contractual and operational issues affecting the delivery of primary care services, including emerging legislative changes, updated guidance and policy arrangements, workforce issues and any transactional – related matters relating to vertical integrations, STPs, PCNs, etc.
If you wish to discuss any commercial, corporate or regulatory issues in primary care then please contact Vincent Buscemi.
Providers
Publications/Guidance
Providers deliver: resilient and resourceful through Covid-19 This report showcases eight examples of great ideas put into action by trusts through the dedication and ingenuity of staff. One of the main themes in the report is the value of staff empowerment, where trust leaders support ideas and approaches developed within their workforce. Other themes such as innovation and collaboration also emerge.
CQC’s impact on the quality of care: an assessment of CQC’s contribution, and suggestions for improvement. This report, written by Alliance Manchester Business School, contains an assessment of the relationship between the Care Quality Commission's (CQC) regulatory approach and improvement in the quality of health and social care. It looks at how CQC works with provider organisations and other system partners involved in health and social care. It builds on existing evidence about CQC’s impact on quality and recognises how CQC’s contribution interacts with other influencers on quality.
Update on policies for visiting arrangements in care homes. Directors of public health (DPHs) and care providers should follow this guidance to ensure policies for visiting arrangements and decisions are based on a dynamic risk assessment and minimise risk wherever possible.
Coronavirus (COVID-19) testing: guidance for employers and third-party healthcare providers Department of Health and Social Care guidance aims to help employers and third-party healthcare providers to introduce their own internal testing programmes outside of the NHS Test and Trace service. It covers: legislation, regulations and best practice; virus and antibody testing; how to interpret test results; and next steps after a positive or negative test.
COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol. COVID-19 guidance for commissioners and service providers for those dependent on drugs or alcohol.
If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.
Public Health
Publications/guidance
The future of public health: the NIHP and other public health functions This document sets out the government's plans for protecting and improving the public's health, including the creation of the National Institute for Health Protection (NIHP).
The good childhood report 2020 This report finds that there has been a continued decrease in average happiness with life among 10 to 15 year olds in the UK. It discovered that 15 year olds in the UK were among the saddest and least satisfied with their lives in Europe and that the coronavirus (Covid-19) pandemic affected children’s happiness due to the lack of choice they had in life.
The whole society approach: making a giant leap on childhood health This report looks at the government's 'obesity strategy' announcement in July 2020 and considers how it could be used to address growing levels of 'health risk' faced by children. This report outlines a ‘whole society’ approach to expand ambition from obesity to all health issues; tackle the link between childhood health and issues such as marginalisation, poverty and deprivation; and ensure the full range of levers offered by a collective approach are being used.
Vulnerability in childhood: a public health report These two reports from Public Health England are aimed at local government and their partners to inform their co-ordinated approaches to reduce vulnerability and adversity in childhood. A public health informed approach looks at the factors for individual children, their families and the communities in which they live that make it more or less likely that vulnerability and adversity in childhood has a lasting impact on their lives. This holistic, multi-agency approach addresses inequality and the broader causes of vulnerability that might otherwise be overlooked.
'It's everywhere': alcohol's public face private harm This Commission was set up by alcohol health experts and parliamentarians to examine the full extent of alcohol harm across the UK. In this, its final report, the Commission outlines recommendations for reducing harm and calls for a national strategy for alcohol.
Covid-19: guidance for those leading a nomadic way of life This guidance covers what to do if someone develops symptoms of Covid-19 when living on a traveller site, in a vehicle or on a canal boat.
Update on policies for visiting arrangements in care homes. Directors of public health (DPHs) and care providers should follow this guidance to ensure policies for visiting arrangements and decisions are based on a dynamic risk assessment and minimise risk wherever possible.
News
Public Health England launches new Every Mind Matters campaign Public Health England (PHE) has launched a campaign which provides NHS-endorsed advice to help children and young people with their mental wellbeing, and equip parents and carers with the knowledge to support them. PHE survey data has revealed that two-thirds of parents say their children's behaviour has changed since the start of the pandemic, and nearly a quarter say that not knowing what action to take has prevented them supporting their children's mental wellbeing.
If you wish to discuss any queries you may have around public health please contact Claire Bentley.
Regulation
Publications/guidance
CQC’s impact on the quality of care: an assessment of CQC’s contribution, and suggestions for improvement. This report, written by Alliance Manchester Business School, contains an assessment of the relationship between the Care Quality Commission's (CQC) regulatory approach and improvement in the quality of health and social care. It looks at how CQC works with provider organisations and other system partners involved in health and social care. It builds on existing evidence about CQC’s impact on quality and recognises how CQC’s contribution interacts with other influencers on quality.
CQC to review use of DNACPR during pandemic. The Care Quality Commission (CQC) has been instructed by the Department of Health and Social Care to review how Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were used during the coronavirus (COVID-19) pandemic. The CQC is expected to look at people's experiences in care homes, primary care and hospitals.
Rapid literature review on effective regulation: implications for the Care Quality Commission This report presents the findings of a rapid literature review on what constitutes effective regulation. The review was conducted to inform development of the Care Quality Commission’s forward strategy.
Guidance for regulators on fitness to practise hearings. Professional Standards Authority for Health and Social Care guidance on fitness to practise hearings, aimed primarily at regulators who are holding hearings, whether for fitness to practise or other matters, such as registration or restoration. It will also be relevant to accredited registers. The guidance covers key areas including public access to hearings, consensual disposal, matters to consider in determining the type of hearing, the process for determining the type of hearing, and the conduct of virtual hearings.
Whistleblowing disclosures report 2020. The annual healthcare professional regulators' report on whistleblowing disclosures covers the 12 months from April 2019 to March 2020. It reveals a marginal increase on disclosures to the General Medical Council.
News
Over £400 million pledged to remove dormitories from mental health facilities. To mark Mental Health Day the Government has announced that more than £400 million will be committed over the next four years to eradicate dormitory accommodation from mental health facilities across the UK to improve the safety, privacy and dignity of patients suffering with mental illness. It will also improve the individual care that can be given to patients, allowing them to reduce the length of their stay in the facility.
Bevan Brittan Updates
Covid-19 and regulation by the HSE and CQC - Samantha Minchin and Carlton Sadler
If you wish to discuss any queries you may have around regulation please contact Stuart Marchant.
Social Care
Publications/Guidance
A market for residential care services This report analyses the performance of the residential care market in England and makes a series of recommendations following on from the Competition and Markets Authority’s 2017 study of the care home market.
State of Care. State of Care is the CQC's annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.
Adult social care: Covid-19 winter plan This plan covers four themes: preventing and controlling the spread of infection in care settings; collaboration across health and care services; supporting people who receive social care, the workforce, and carers; and supporting the system.
Coronavirus: Adult social care key issues and sources This Commons Library briefing paper provides an overview of key issues facing the adult social care sector during the coronavirus (Covid-19) outbreak, and provides links to some of the key official guidance for the sector.
Public perceptions of health and social care in light of Covid-19 This report presents the findings of a survey commissioned by The Health Foundation and conducted by Ipsos MORI between 17 and 29 July 2020. The results highlight a significant change in the public’s perceptions towards the government’s handling of Covid-19 and the measures it has taken to tackle the outbreak so far.
NICE impact end of life care for adults. This report highlights progress made by the health and care system in implementing NICE guidance on end of life care.
End of life care: Guide for councils Local Government Association (LGA) guidance for councils in England explains how they can help people to die well and with dignity. Focusing on adults during the final 12 months of their lives, but setting out general principles which also apply to children and young people, the guide also reflects challenges posed by the coronavirus (COVID-19) pandemic. It: sets out the policy context; looks at what is meant by end of life care; includes available data; sets out the statutory framework for the role of councils; provides examples of best good practice; identifies COVID-19 issues and lessons learned; and makes recommendations.
Effective Complaint Handling for local authorities. Local Government and Social Care Ombudsman advice for local authorities sets out a practical guide to effective complaints handing, statutory complaints procedures for children's and adult social care, and monitoring and learning from complaints. Appendices to the document cover dealing with unreasonable and persistent complaints, and explain how to refer people to the Ombudsman.
Update on policies for visiting arrangements in care homes. Directors of public health (DPHs) and care providers should follow this guidance to ensure policies for visiting arrangements and decisions are based on a dynamic risk assessment and minimise risk wherever possible.
COVID-19: how to work safely in care homes Guidance for those working in care homes providing information on how to work safely during this period of sustained transmission of COVID-19.
The experience of older people instructed to shield or self-isolate during the Covid-19 pandemic A vital weapon in the fight against Covid-19 has been the shielding of clinically extremely vulnerable individuals at high risk, and instructions to clinically vulnerable people at moderate risk to stay at home and avoid face-to-face contact as far as possible. The consequences of this advice for mental health and wellbeing are not well understood. The English Longitudinal Study of Ageing (ELSA) Covid-19 Substudy provided an opportunity to evaluate the impact on mental health, quality of life, social connectedness, worries, and health-related behaviour in more than 5,800 older men and women (mean age 70 years).
Lessons and legacy from the Covid-19 pandemic in health and care This report contains key findings from a short research study undertaken in June and July to understand how technology has been an enabler in reducing the care burden and coping with the Covid-19 crisis, and to identify what should be sustained in the ‘new normal’ in the longer term. It argues that social care needs to be given the same weighting as the NHS to accelerate the move towards health and social care integration.
Fixing social care: better quality services and jobs This report argues that the Covid-19 pandemic has shown how essential social care is to society. It looks to the future and building a better system, including a demand for long-term, sustainable funding of services that provide value for money to the public purse while meeting the needs of individuals and communities. It also calls for appreciation of care workers through improved pay and working conditions.
NMC response to the Department of Health and Social Care consultation on reducing bureaucracy in the health and social care system. The response to the Department of Health and Social Care consultation on bureaucracy in the health and social care system which sought to: find out the most common bureaucratic burdens experienced by staff providing care directly, as well as managerial and administrative staff, in the NHS, public health and social care sectors; and help the Government change processes, rules and regulations, including through planned reform of professional regulation, where there are existing powers to do so in the short or medium term. The Council notes the changes they made in response to coronavirus (COVID-19), both legislative and non-legislative, provided them with the additional flexibility needed to enable them to regulate effectively during this period and to support the professionals on their register.
News
Challenge over continuing healthcare costs. Rear Admiral Philip Mathias has threatened a judicial review (JR) of the failure by NHS bosses to pay for the continuing healthcare (CHC) of patients. Under CHC rules, patients with significant health problems should have their care and nursing fees paid in full by the NHS, provided their condition is the main reason they need assistance. Rear Admiral Mathias has launched proceedings with the "intent" of changing NHS behaviour following a two year fight to recover £200,000 paid for nursing homes fees for his mother. He has launched a CrowdJustice appeal to raise funding for the initial stage of JR.
Bevan Brittan Updates
CQC has issued its State of Care report 19/20 - Carlton Sadler
DNAR notices: is blanket application possible? - George Riach
If you wish to discuss any queries you may have around social care please contact Monica Macheng or Stuart Marchant.
General
Publications/Guidance
Unequal impact? Coronavirus, disability and access to services: interim Report on temporary provisions in the Coronavirus Act: First Report of Session 2019-21. A interim report from the Women and Equalities Committee concludes that temporary Coronavirus Act 2020 provisions due to be debated in the House of Commons on 30 September 2020 could substantially restrict or curtail important, rights that disabled people rely on for their quality of life. The Report focuses on the key areas of: the replacement of local authority Care Act 2014 easement provisions with less stringent duties; changes to detention under the Mental Health Act 1983 to allow applications to be made by a single doctor; and relaxed duties and modified time limits for Education, Health and Care (EHC) plans.
COVID-19 waste management standard operating procedure. This document sets out the waste management approach for all healthcare facilities including primary care facilities and testing facilities in England and Wales during the COVID-19 outbreak.
COVID-19: guidance for health professionals. Information on COVID-19, including guidance on the assessment and management of suspected UK cases.
Early detection and diagnosis of cancer: a roadmap to the future This roadmap aims to unite fragmented efforts across the UK to drive progress in early detection and diagnosis of cancer. It articulates a shared vision, from discovery to implementation, for a long-term future where early detection and diagnosis of all cancers is a routine reality. It also highlights the current challenges impeding progress and makes recommendations for research, development, health system delivery and government policy on how to overcome these challenges.
Cancer in the UK 2020: socio-economic deprivation This report finds that there is a is clear variation between socio-economic groups in the determinants of both cancer incidence and outcomes in the UK. It also calls for urgent action to address this and reduce the disproportionate burden of cancer on those individuals from the most deprived areas.
Avoidable natural deaths in prison custody: putting things right. An Independent Advisory Panel on Deaths in Custody (IAP) report in collaboration with the Royal College of Nursing (RCN) setting out proposals to reduce the number of preventable natural deaths in prisons, including 15 recommendations. It identifies how natural deaths occurring in prison might be prevented, where possible, and end of life care managed with dignity and compassion. IAP also published "Just one Thing: Prison Safety and COVID-19" on 28 September 2020.
GENOME UK: The future of healthcare A joint Department of Health and Social Care, Department for Business, Energy and Industrial Strategy, and Office for Life Sciences publication sets out a vision to extend the UK's leadership in genomic healthcare and research. This strategy will harness genomics to offer patients personalised treatments, predict the risk of chronic diseases for vulnerable groups and enable earlier interventions.
Investigation into how government increased the number of ventilators available to the NHS in response to COVID-19 A National Audit Office report provides an account of how public money was used to increase the number of ventilators available to the NHS in response to the coronavirus (COVID-19) pandemic. It explains: what ventilators are and how they are used in treating COVID-19; the Government's objectives and performance in increasing the number of ventilators available to the NHS; how the Department of Health and Social Care purchased ventilators; and the Cabinet Office's ventilator challenge.
Making history: health visiting during Covid-19 This collection of case studies presents a window into the working lives of health visitors and families navigating the ups and downs of the Covid-19 pandemic. The case studies, family stories and creative pieces contained in the report capture the pace and scale of change as health visiting services adapted to working during 'lockdown'.
Women’s lives, women’s rights: strengthening access to contraception beyond the pandemic. The APPG SRH opened this inquiry in 2019, in response to reports of women being unable to access contraception in a way that meets their needs. Evidence submissions were reopened in May 2020 in order to examine the impact of the Covid-19 pandemic on women's access to contraception. The report finds that women in England are facing difficulty in accessing contraception, with many being bounced from service to service, which can result in more unplanned pregnancies and increased demand for maternity and abortion care. The APPG SRH states that the national reorganisation of public health is an opportunity to tackle funding and commissioning challenges in sexual and reproductive health care.
Homes, health and Covid-19. This report from the Centre for Ageing Better, written in partnership with The King's Fund, summarises the role and impact of poor-quality housing on health, particularly in the context of the Covid-19 pandemic.
Delivering core NHS and care services during the pandemic and beyond This report aims to catalogue the impact and unprecedented challenge caused by Covid-19 to the provision of essential services. It calls for urgent action to assess and tackle a backlog of appointments and an unknown patient demand for all health services, specifically across cancer treatments, mental health services, dentistry services, GP services and elective surgery. It also looks at the case made for routine testing of all NHS staff.
Resources to support infection prevention and control Resources to support communications about infection prevention and control (IPC) across all healthcare settings are available from Public Health England, including posters and a quick reference guide.
Cases
R (on the application of Christian Concern) v Secretary of State for Health and Social Care [2020] EWCA Civ 1239. The Divisional Court had not erred in refusing to grant permission to seek judicial review of the secretary of state's decision to grant a temporary approval during the COVID-19 pandemic of "the home of a pregnant woman" as a class of places for the taking of Mifepristone, one of the two drugs required for a termination of pregnancy during the first 10 weeks. The secretary of state had acted within the powers conferred by the Act.
If you wish to discuss any queries around this general topic please contact Claire Bentley.
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