Health and Care Update - October 2023

Bevan Brittan provides high quality, comprehensive advice to the NHS, independent healthcare sector and local authorities. 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, independent sector and local authorities which have been published in the last month. 

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Training Events	Health Inequalities
Acute and emergency care	Independent Health
Children/young people	Information Sharing
Clinical Risk/Patient Safety	Inquests and Inquiries
Covid	Mental Health
Digital Health	Primary Care
Employment/HR	Regulation
Finance	Social Care

 

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Bevan Brittan Free Training Events 

There is no charge for any of the events listed below

Webinars  
These are internal hour long lunch time training sessions.  You can sign up to watch the training sessions remotely via our webinar facility. Please contact Claire Bentley. 

Shared decision making and consent. 10 October 12.30pm. Daniel Morris, a partner at Bevan Brittan, will look at the following in this session:

• Consent in tele-medicine/telecare;
• Consent between clinic and consultant;
• Digital medicine/ delivery of remote and digital care;
• Whether initial assessment should have been in person, and;
• Remote consultations pre and post pandemic.
• How we can help

Inquests - Differing Perspectives. Join us on Wednesday 18 October at 11am for our webinar chaired by Joanna Lloyd, Partner, Bevan Brittan focusing on the Inquest Process viewed from different perspectives.

Inquest Update. Join us for this 1-hour session on 31 October at 12.30pm with Sarah Christie-Brown, Dr Peter Ellis and Bramble Badenach-Nicolson from Hailsham Chambers to consider:

• Key case law and important updates from the past 12 months relating to inquests;
• Recent developments in causation for coronial conclusions; and
• Disclosure requirements in inquests. 

Please note that registration for each webinar will close one hour before the webinar starts, so please do ensure you have booked your place in advance to guarantee attendance.  

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Acute and emergency care

Publications/guidance

GIRFT issues six measures to help improve acute hospital flow in winter. Guidance setting out six vital steps acute hospitals should take to improve flow during the winter months is available to download, in a collaboration between GIRFT and the Society for Acute Medicine (SAM). The detailed guidance has been developed based on the views of acute physicians currently working in a range of clinical settings across England, to help hospitals manage their acute medical take.
The six steps cover the key priorities for improving flow: Protecting Same Day Emergency Care (SDEC) capacity and function; best practice for ward rounds and handover; measures for pharmacy services; availability and access to diagnostics; workforce optimisation; and provision and access to Allied Health Professionals (AHPs) and acute frailty services.

Unlocking the power of health beyond the hospital: supporting communities to prosper. This report explores how investment in community care can improve system productivity as it relates to spend. It finds that acute health care spending between 2020/21 and 2021/22 grew faster than any other form of NHS spending, despite performance continuing to be challenged with pressure on A&E, beds and discharges. It concludes that responding to these pressures requires a more holistic understanding of system productivity.

Reducing misogyny and improving sexual safety in the ambulance service: what we know. The AACE and Office of the Chief Allied Health Professions Officer (CAHPO) have launched three publications aimed at reducing misogyny and improving sexual safety in the ambulance service. This document outlines information gathered during the ‘discovery phase’ of the Reducing Misogyny and Improving Sexual Safety in the Ambulance Service workstream.

Reducing misogyny and improving sexual safety in the ambulance service: consensus statement. This consensus statement sets the AACE and CAHPO's shared commitment to lead meaningful reduction of misogyny and improvement of sexual safety across the ambulance sector, focusing on reducing harm caused by themes of misogyny through a learning approach to change, removing barriers to speaking up, accessing support, and embedding a culture of respect, understanding and safety.

Reducing misogyny and improving sexual safety in the ambulance service: next steps. This document sets out the recommendations for action to reduce misogyny and improve sexual safety in the ambulance service. It takes forward the commitments made in the consensus statement, which are based on findings from reviewing the available evidence and engaging with stakeholders.

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

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Children and young people 

Publications/Guidance 

A 10 step guide to sharing information to safeguard children. Information Commissioner's Office (ICO) guidance sets out data protection considerations when sharing personal information for child safeguarding purposes. It covers: developing clear and secure policies and systems for sharing information; sharing information using the right lawful basis; and sharing information in an emergency. The ICO emphasises that organisations will not get in trouble if they share information to protect children and young people at risk of serious harm. It will also develop guidance on sharing information to safeguard children aimed at specific sectors across the UK, recognising the different legislative and policy landscapes.

Policy briefing: Care experience, ethnicity and youth justice involvement - key trends and policy implications. Using Ministry of Justice (MoJ) and Department for Education (DfE) data, the research finds that: care-experienced children are disproportionately likely to have youth justice involvement compared without, with some ethnic minority groups being even more likely to have such involvement; typically, care-experienced children have much more youth justice involvement than non-care-experienced children, with some ethnic minority groups having even higher levels of involvement; and custodial sentences are twice as common among Black and Mixed ethnicity care-experienced children compared to White care-experienced children.

Children's Social Care: Stable Homes, Built on Love: Government Consultation Response. In response to the consultation on children's social care, the Department for Education details the steps already begun following the publication of, "Stable Home, Built on Love", and how delivery will continue over the next 18 months. The Government states: it remains committed to publishing a national kinship care strategy by the end of 2023; it will take forward legislative reforms and guidance changes to remove the local connection requirement for care leavers seeking to access social housing; it will develop pathfinders on an incremental basis; and consult on pre-legislative proposals on extending strengthened corporate parenting responsibilities to government departments and relevant public bodies for children in care and care leavers.

This Secure care pathway review found that availability and access to the right kind of educational, legal, health and community support is essential in preventing young people going into or returning to a secure care setting.

The good childhood report 2023. In this year’s survey, nearly one-third of children aged 10 to 17 expressed unhappiness in at least one of ten areas of their lives. While 74 per cent were optimistic about their personal futures, less than 40 per cent felt positive about the future of their country and the world. Notably, 14.5 per cent of respondents were dissatisfied with school, the highest among the surveyed aspects. Children worried about family finances reported higher overall unhappiness, particularly regarding their homes, money, possessions and personal choices. Among future concerns, having enough money topped the list, followed by finding employment and academic success. In societal issues, rising prices and environmental concerns were prominent worries among the surveyed children.

Kinship carers in England. An overview of policy relating to kinship carers in England

Securing our healthy future: prevention is better than cure. This paper (supported by the 24 members of the AoMRC) lays out the importance of prioritising child health in political decision-making. It outlines 10 key actions for the UK government to take to prioritise child health. These include creating a Cabinet-level Minister for Children and Young People and preventive measures in childhood to achieve healthy weight, enhance oral health, improve low vaccination uptake, implement clean air policies and support child mental health services. The paper was written by the Royal College of Paediatrics and Child Health and the Faculty of Public Health to support government engagement on putting children back on the policy agenda.

Reforming children's social care: Public Services Committee inquiry - In Focus. A House of Lords Library In Focus article on the Government's children's social care reform strategy, set out in "Stable homes, built on love", outlines the provisions of the strategy and the Public Services Committee's response, which set out recommendations on kinship care, fostering and regional care cooperatives. It also outlines the Government's response to the Committee's recommendations and its actions with respect to the national workload action group, the child and family social worker apprenticeship employer support fund and its expert advisory group on standards of care. Other responses to the strategy are summarised, including from the Local Government Association, OFSTED and Children England. It also notes developments with respect to the family network pilots and the families first for children pathfinder programme.

Specification 29 Section 7A: public health services for children and adults in secure and detained settings in England, 2023-2024. An NHS England publication, aimed at commissioners and providers of Secure and Detained Settings, including the Children and Young People Secure Estate (CYPSE), and Immigration Removal Centres (IRCs), seeks to reduce the health gap between people in secure and detained estates and the wider population, to meet the legal duty that NHS England have to the service commissioning requirement for the equivalent of services in the community.

Homicide: Murder, manslaughter, infanticide and causing or allowing the death or serious injury of a child or vulnerable adult. Updated Crown Prosecution Service (CPS) prosecution guidance: outlines the relevant law for homicide offences which prosecutors may charge; advises on adding an alternative count of manslaughter on an indictment alleging murder; sets out the importance of considering murder or manslaughter in cases of suicide, in particular in a domestic abuse context; gives advice on how prosecutors should approach the procedural and evidential provisions where "causing or allowing offence the death of a child or vulnerable adult" is charged alongside murder and manslaughter; and advises on how prosecutors should approach the public interest considerations when dealing with "mercy killings" and suicide pacts.

Child maintenance: Support for victims of domestic abuse. This briefing outlines support available for victims and survivors of domestic abuse when applying for child maintenance through the Child Maintenance Service.

Bevan Brittan Updates

Secretary of State for Justice announcement: Jade's law

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

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Clinical Risk / Patient Safety

Publications/Guidance 

Quality and safety of maternity care (England). This House of Commons Library briefing details Government and NHS policies on the quality and safety of maternity care in England.

Martha’s Rule: a new policy to amplify patient voice and improve safety in hospitals. Martha Mills died aged 13 in the summer of 2021 and the inquest into her death heard that she would likely have survived the sepsis that killed her had consultants made a decision to move her to intensive care sooner. This report is a response to a call from Martha Mills’ parents to rebalance the power between patients and medics to improve patient safety. It outlines evidence that shows that failing to properly listen to patients and their families contributes to safety problems in the NHS, along with public awareness among citizens that the NHS can feel unresponsive at times.

20th annual report 2023: surgical data to 31 December 2022. The NJR’s purpose is to record patient information and provide data on the performance and longevity of replacement joint implants, the surgical outcomes for the hospitals where these operations are carried out, and on the performance outcomes of the surgeons who conduct the procedures. This annual report summarises the work of NJR and shares analysis of data, visually in tables and graphs, for procedures across each of the joints, as well as implant and hospital.

Consultations

Fixed recoverable costs in lower damages clinical negligence claims – a supplementary consultation on disbursements. A supplementary consultation on disbursements within the fixed recoverable costs scheme for clinical negligence claims up to a value of £25,000 in England and Wales. This consultation closes on 27 October 2023.

Fixed recoverable costs in lower value clinical negligence claims. Consultation Outcome.

News

Secretary of State oral statement on Lucy Letby statutory inquiry. The independent statutory inquiry into events at the Countess of Chester Hospital, following the conviction of the neonatal nurse Lucy Letby of the murder of seven babies and the attempted murders of six others, will: have the power to compel witnesses to give evidence under oath; and examine the case's wider circumstances, including the NHS Trust's response to clinicians who raised the alarm, and the conduct of the wider NHS and its regulators. It will be led by Lady Justice Thirlwall. The families affected will help to shape the inquiry's terms of reference, which will be finalised in a couple of weeks so the inquiry can start the consultation as soon as possible.

Using NHS data to improve healthcare. Professor Sir Chris Whitty writes for The Times on how using data effectively and safely can improve patient care and bolster research

Government to introduce legal costs cap to support victims. Legal costs will be capped in lower damages clinical negligence claims to support victims, speed up justice and protect taxpayers and NHS England cash.

Government considers minimum service levels in hospitals during strikes. The government is considering introducing regulations that would require some doctors and nurses to work during strikes, to protect patient safety.

New GIRFT review into pancreatic cancer services. GIRFT has appointed a team of five specialist clinicians to lead a national review into services for pancreatic cancer patients in England. The workstream supports the delivery of the Optimal Care Pathway, a Pancreatic Cancer UK-led initiative which brought together 300 health professionals and people affected to agree on how standards of diagnosis, treatment and care of those with pancreatic cancer and their families can be improved.
GIRFT's review will involve data-driven deep dives at all specialist centres and their referring hospitals in England, identifying their progress against the recommendations in the Optimal Care Pathway.

Principles of best practice for preoperative assessment services. GIRFT guidance outlining the principles for best practice in preoperative assessment (POA) is now available to read and download .
The preoperative assessment services guidance has been developed to support non-medical pre-assessment leads, clinicians and managers who want to embed best practice in their preoperative assessment processes and improve theatre utilisation to support elective recovery.

Data quality dashboard launched to help improve theatre productivity. A new dashboard showing the quality of theatre data submissions is now available via the Model Health System (MHS), supporting trusts and systems to improve productivity and helping to drive elective recovery.

Landmark survey seeks women’s views on reproductive health. Women in England are being encouraged to help shape reproductive health policy by sharing their experiences, as the government launches a landmark survey.

Bevan Brittan Events

Shared decision making and consent. 10 October 12.30pm. Daniel Morris, a partner at Bevan Brittan, will look at the following in this session:

• Consent in tele-medicine/telecare;
• Consent between clinic and consultant;
• Digital medicine/ delivery of remote and digital care;
• Whether initial assessment should have been in person, and;
• Remote consultations pre and post pandemic.
• How we can help

Inquests - Differing Perspectives. Please join us on Wednesday 18 October at 11am for our webinar chaired by Joanna Lloyd, Partner, Bevan Brittan focusing on the Inquest Process viewed from different perspectives.

Inquest Update. Join us for this 1-hour session on 31 October at 12.30pm with Sarah Christie-Brown, Dr Peter Ellis and Bramble Badenach-Nicolson from Hailsham Chambers to consider:

• Key case law and important updates from the past 12 months relating to inquests;
• Recent developments in causation for coronial conclusions; and
• Disclosure requirements in inquests. 

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 Joanne Easterbrook or Tim Hodgetts.

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Covid

Publications/Guidance 

Learning the lessons: the unequal impact of the Covid-19 pandemic: voices of people and communities. This report captures the findings from an engagement exercise held by National Voices about how communities and groups were affected differently by both the Covid-19 virus and the measures to control it. It finds that the pandemic response exacerbated existing, deep-rooted inequalities across the UK, and compounded the disadvantages experienced by people from minoritised communities, by disabled people and by people living with long-term conditions.

If you wish to discuss any queries you may have around Covid and Claims please contact Daniel Morris.

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Digital Health

Publications/guidance

Inclusive digital healthcare: a framework for NHS action on digital inclusion. This document builds on previous NHS Digital guidance on digital inclusion for health and social care. It should be used to help design and implement inclusive digital approaches and technologies, which are complementary to non-digital services and support.

Digital transformation in the NHS. As well as looking at the systems and innovation required for digital transformation within the NHS, this report outlines the issues around preparing the NHS workforce such as staff involvement, changing roles and training.

Digital transformation in the NHS: Government Response to the Committee's Eighth Report. A Health and Social Care Committee report sets out the Government's response to the recommendations made in its report on the ambition for digital transformation in the NHS. Stating that, overall, it largely agrees with the recommendations, it highlights current work which is already delivering on the areas highlighted to achieve digital transformation, focussing specifically on: removing legacy IT systems; fostering innovation through new developments to the NHS App; supporting digital maturity and interoperability between systems; upskilling the digital and wider health and care workforce; and ensuring this transformation is inclusive of those facing barriers to accessing digital channels.

Can the NHS manage without AI? What are the best-use cases for large language models (LLMs) and other AI in health and care? Pritesh Mistry (Fellow, Digital Technologies at The King's Fund) looks at how LLMs are developing and their potential uses in the health and care system.

Rapid evaluation report: chronic obstructive pulmonary disease virtual ward enabled by technology – South and West Hertfordshire Health and Care Partnership. This report summarises the findings of an evaluation conducted by Eastern Academic Health Science Network (AHSN) and Health Innovation Manchester (HInM), the AHSN for Greater Manchester, on behalf of the national Innovation Collaborative for digital health. It found that the virtual ward model represents a safe, effective alternative to inpatient care: improving outcomes, positively impacting patient experience and delivering cost efficiencies compared with traditional care pathways.

Towards a unified vision of nursing and midwifery documentation. This guidance sets the direction for all nursing documentation across hospitals, community and nursing homes, with a focus on digitising documentation. It is intended to help organisations implement record systems and policies that support nurses to produce good documentation that supports and evidences professional decision-making and care, while minimising time spent on producing those records.

Access denied? Socioeconomic inequalities in digital health services. This report seeks to understand how people who have lived experience of poverty and ongoing health concerns are impacted by health inequalities when interacting with patient-facing digital health services. The findings suggest a need for policy-makers, health care leaders, and digital health service designers and developers to reconsider how they use data and how they design and deploy digital health services.

Maximising the potential of digital in mental health. This report outlines the challenges, benefits and opportunities of digital mental health and explains how it can improve mental health care and population mental health.

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

A summary of NHS England’s Fit and Proper Person Test framework. NHS England published a revised Fit and Proper Person Test (FPPT) framework in response to the recommendations made by Tom Kark KC in his 2019 Review of the FPPT. The review highlighted areas that needed improvement to strengthen the existing regime. The framework is effective from 30 September 2023 and NHS organisations are expected to use it for all new board-level appointments or promotions and for annual assessments for all board members going forward from that date. This briefing aims to help organisations to prepare for the new requirements.

Sexual safety in healthcare - organisational charter. An NHS England charter commits its signatories to a zero-tolerance approach to any unwanted, inappropriate and/or harmful sexual behaviours towards its workforce by July 2024. The signatories, NHS England, NHS Employers, the Royal College of General Practitioners (RCGP) and the Royal College of Anaesthetists (RCoA), commit to principles and actions, including: actively working to eradicate sexual harassment and abuse in the workplace; promoting a culture that fosters openness and transparency, and does not tolerate unwanted, harmful and/or inappropriate sexual behaviours; providing appropriate support for those in the workforce who experience unwanted, inappropriate and/or harmful sexual behaviours; clearly communicating standards of behaviour; ensuring appropriate, specific, and clear policies are in place; and capturing and sharing data on prevalence and staff experience transparently.

Breaking the silence: addressing sexual misconduct in healthcare. This report contains the results of a survey of the surgical workforce in the UK and Republic of Ireland and their experience of sexual misconduct by colleagues. The data showed that nearly a third of women (29.9 per cent) had been sexually assaulted by a colleague, while the majority of participants (89.5 per cent of women, 81 per cent of men) said they have witnessed some form of sexual misconduct by colleagues. The report outlines how prevention of sexual misconduct is essential for staff and patient safety. It calls for education at every stage for all, and through cultural change within accountable organisations. It also demands effective sanctions for perpetrators to ensure justice and to aid workforce retention.

Waste not, want not: strategies to improve the supply of clinical staff to the NHS. For every five nurse training places, only three full-time nurses join the NHS. The rate of dropouts in the staffing pipeline from student to early-career clinician is high, with significant numbers opting out before or soon after joining the NHS, contributing to an understaffed health service under ever-greater strain. This analysis sets out the scale of NHS attrition and puts forward a 10-point plan to improve retention, including a policy proposal to gradually write off clinicians' student debt over 10 years.

Whistleblowing disclosures report 2023: Health and social care professional regulators. A Health and Care Professions Council (HCPC) report, in collaboration with eight other professional health and care regulators, details all whistleblowing concerns raised with each organisation during the financial year 2022/23. Seven whistleblowing disclosures were made to the HCPC during the financial year 2022/23. Four were made to the Policy and Standards Department and three were made to the Education Department. The aim of the report is to be transparent about how the regulators handle disclosures, highlight the action taken about these issues, and to improve collaboration across the health sector.

Whistleblowing and gagging clauses. This briefing covers legal protections for workers who whistleblow at work, as well as attempts to silence workers using settlement agreements.

The NHS Long Term Workforce Plan explained. On 30 June 2023, the NHS Long Term Workforce Plan was published, setting out the long-term strategic direction for the NHS workforce in England. So what were the main commitments outlined? Take a look at this explainer from the Kings Fund to find out more.

Registered midwife degree apprenticeship evaluation report. This report sets out the findings of an evaluation of a workforce intervention that has not yet been extensively implemented across maternity services in the NHS. It describes how the registered midwifery degree apprenticeship has the potential to increase the supply of labour in a sustainable way. It describes the benefits and costs that could be attributed to this way of educating registered midwives.

Consultations

Consultation on the proposal to remove the statutory requirement for a full employment history when appointing health and care volunteers. A Department of Health and Social Care consultation seeks comments on the proposal to remove the statutory requirement for a full employment history when appointing volunteers in health and care settings, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It asks whether the full employment history requirement poses challenges to the appointment process and whether it is necessary to inform appointment decisions. It also seeks to understand whether the remaining required pre-employment checks would be enough to ensure the suitability of volunteer applicants. Comments by 23.59 on 18 November 2023.

Oliver McGowan draft code of practice. This consultation considers the draft code and if it gives CQC registered providers the guidance needed to meet the legislative requirement to ensure all staff receive learning disability and autism training appropriate to their role.

The disclosure of industry payments to the healthcare sector. This consultation aims to seek views on the possible introduction of regulations mandating the disclosure of industry payments to the healthcare sector.

Minimum service levels in event of strike action: hospital services in England, Scotland and Wales. The DHSC is seeking views to inform decisions on the introduction of regulations on minimum service levels (MSLs) in England, Scotland and Wales, to protect patient safety in key hospital services during strike action. The proposal is that most essential and time-critical hospital services should be covered by MSL regulations. This consultation will help to inform decisions on whether hospital services should be covered and, if so, which hospital services, the appropriate minimum service levels required, and whether any health services outside hospitals should be included. This consultation closes at 11.59pm on 14 November 2023.

News

Learning Support Fund 7th edition: 2023 to 2024. Information for academic authorities and students on pre-registration healthcare programmes in the 2023 to 2024 academic year.

NHS Bursary Scheme rules 2023 to 2024. Information for students and higher education institutions about the NHS Bursary Scheme rules that apply for the academic year 2023 to 2024.

Healthcare studies more affordable as financial support increased. Government increases financial support to make healthcare studies more affordable.

NHS doctors to receive pay rise this month. Around 150,000 NHS doctors in England, including doctors in training and consultants, will start to receive their pay rise this month, backdated to April 2023.

Government considers minimum service levels in hospitals during strikes. The government is considering introducing regulations that would require some doctors and nurses to work during strikes, to protect patient safety.

Bevan Brittan Updates

NHS England Fit and Proper Person Test Framework Goes Live

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, James Gutteridge or Andrew Uttley.

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Finance  

Publications/guidance

The disclosure of industry payments to the healthcare sector. This consultation aims to seek views on the possible introduction of regulations mandating the disclosure of industry payments to the healthcare sector.

Adult social care funding pressures: estimated costs to meet growing demand and improve services in England. This long read uses four scenarios to highlight the potential funding pressures in adult social care up to 2032/33. These reflect some of the key issues that need to be addressed to meet future demand and improve adult social care.

Funding health care in England: Has the case been made for changing the NHS model? The NHS’s recent travails have led once again to claims that the model is “broken” and that the answer is to change how health care is funded. This paper examines the different ways of funding health care; how health care in England is currently being funded; the four main options that are being canvassed; new NHS charges; and the potential impact of a change to social insurance.

How finance teams are helping to reduce health inequalities. This briefing explores the work that finance teams are doing to help reduce health inequalities. There are three main ways finance staff are supporting this important agenda: allocating resources differently to support specific population needs; aligning data sets, tackling variation and reducing inefficiency; and investing in targeted projects that focus on specific groups.

NHS cost recovery - overseas visitors. Information for NHS bodies who need to make and recover hospital charges from overseas visitors.

Consultations

Disclosure of industry payments to the healthcare sector. A Department of Health and Social Care consultation seeks views on the possible introduction of regulations placing a duty on manufacturers and commercial suppliers of medicines, devices and borderline substances, to disclose details of payments and other benefits they provide to healthcare professionals and organisations. Comments by 23.59 on 16 October 2023.

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Health Inequalities 

Publications/Guidance

Inequalities in mental health care for Gypsy, Roma, and Traveller communities: identifying best practice. This report addresses the lack of mental health care provision, despite the significant need, and captures first-hand insight and good-practice examples from six effective services. These services are mainly run by voluntary Gypsy, Roma and Traveller organisations for members of these communities. It finds that, while shame, stigma and structural barriers contribute to a number of areas in which Gypsy, Roma and Traveller communities experience health inequalities, this is worsened by a lack of granular data and tailored health services. Additionally, health care professionals do not always understand the communities’ needs or lifestyles. Mental health services are especially poor for these groups, and data shows a high number of suicides.

Health inequalities: improving accountability in the NHS. This report examines current and past mechanisms and levers that enable and hinder accountability for health inequalities and analyses whether these accountability processes are sufficient to reduce health inequalities. It provides proposals to improve accountability for health inequalities across integrated care systems (ICSs). Views were gathered from senior managers in the NHS in England with experience and expertise in health inequalities. In addition, policy documents and relevant grey and academic publications were reviewed to inform the assessment of past and current accountability mechanisms.

Ethnic inequalities in mortality in England: a complex picture requiring tailored, evidence-based responses. Veena Raleigh explores the latest data from the Office for National Statistics, which shows a complex picture of ethnic inequalities in mortality in England. She examines what can be done to tackle these inequalities in her latest blog.

Targeting health inequalities: realising the potential of targets in addressing health inequalities. This report, commissioned by The Health Foundation and produced by the University of Newcastle and University of Strathclyde in partnership with Health Equity North, examines how targets have been used in the past to address health inequalities and how they could be used in the future. It is part of an area of work by The Health Foundation examining how policy-makers can take a whole-government approach to improving health.

Access denied? Socioeconomic inequalities in digital health services. This report seeks to understand how people who have lived experience of poverty and ongoing health concerns are impacted by health inequalities when interacting with patient-facing digital health services. The findings suggest a need for policy-makers, health care leaders, and digital health service designers and developers to reconsider how they use data and how they design and deploy digital health services.

Learning the lessons: the unequal impact of the Covid-19 pandemic: voices of people and communities. This report captures the findings from an engagement exercise held by National Voices about how communities and groups were affected differently by both the Covid-19 virus and the measures to control it. It finds that the pandemic response exacerbated existing, deep-rooted inequalities across the UK, and compounded the disadvantages experienced by people from minoritised communities, by disabled people and by people living with long-term conditions.

How finance teams are helping to reduce health inequalities. This briefing explores the work that finance teams are doing to help reduce health inequalities. There are three main ways finance staff are supporting this important agenda: allocating resources differently to support specific population needs; aligning data sets, tackling variation and reducing inefficiency; and investing in targeted projects that focus on specific groups.

How we can help

We have a multidisciplinary team advising NHS commissioners and providers on all aspects of tackling health inequalities, ranging from:

• advising on the new legal framework and compliance with the relevant statutory duties, particularly in the context of service reconfiguration;
• addressing workforce inequalities;
• taking action on patient safety to reduce health inequalities;
• the role of the Care Quality Commission in tackling health inequalities; and
• lessons to be learnt from the Covid-19 pandemic.

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

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Independent Health 

Consultations

Licensing of non-surgical cosmetic procedures. Views on what procedures should be in scope of the licensing scheme for non-surgical cosmetic procedures in England.

News

Cygnet Health Care Limited fined just over £1.5m in prosecution brought by the Care Quality Commission over death of young woman.

Bevan Brittan Updates

Non-surgical cosmetic licensing – the Government Consultation is open

For more information contact Tim Hodgetts, Julie Charlton or Amanda Wright- Kluger

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Information sharing/data 

Publications/guidance

A 10 step guide to sharing information to safeguard children. Information Commissioner's Office (ICO) guidance sets out data protection considerations when sharing personal information for child safeguarding purposes. It covers: developing clear and secure policies and systems for sharing information; sharing information using the right lawful basis; and sharing information in an emergency. The ICO emphasises that organisations will not get in trouble if they share information to protect children and young people at risk of serious harm. It will also develop guidance on sharing information to safeguard children aimed at specific sectors across the UK, recognising the different legislative and policy landscapes.

UKHSA data strategy. This strategy outlines how UKHSA will collaborate with diverse stakeholders within the UK and internationally to improve health outcomes through better data quality, interoperability and the overall utility of insights from health data.

Developing a data pact: the relationship between the public, their data, and the health and care system. This report shows that the relationship between patients and their data is deeply personal. Patients recognise that the potential for data use to improve care is huge. This research showed widespread support for realising this potential – if patients’ concerns are acknowledged and addressed.

Using NHS data to improve healthcare. Professor Sir Chris Whitty writes for The Times on how using data effectively and safely can improve patient care and bolster research.

DHSC email subscription privacy notice. DHSC’s data protection policy and procedures for email subscriptions.

Bevan Brittan Updates

NHS England Fit and Proper Person Test Framework Goes Live

Data Matters - September 2023

For more information contact Jane Bennett. 

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Inquests and Inquiries  

Publications/Guidance

Statutory public inquiries: the Inquiries Act 2005. A briefing paper explaining the Inquiries Act 2005, issues arising from the holding of statutory public inquiries, and summary notes on the progress of active statutory inquiries.

Secretary of State oral statement on Lucy Letby statutory inquiry. The independent statutory inquiry into events at the Countess of Chester Hospital, following the conviction of the neonatal nurse Lucy Letby of the murder of seven babies and the attempted murders of six others, will: have the power to compel witnesses to give evidence under oath; and examine the case's wider circumstances, including the NHS Trust's response to clinicians who raised the alarm, and the conduct of the wider NHS and its regulators. It will be led by Lady Justice Thirlwall. The families affected will help to shape the inquiry's terms of reference, which will be finalised in a couple of weeks so the inquiry can start the consultation as soon as possible.

News

Ian Paterson: Ten more inquests open in breast surgeon probe

Bevan Brittan Events

Inquests - Differing Perspectives. Please join us on Wednesday 18 October at 11am for our webinar chaired by Joanna Lloyd, Partner, Bevan Brittan focusing on the Inquest Process viewed from different perspectives.

Inquest Update. Join us for this 1-hour session on 31 October at 12.30pm with Sarah Christie-Brown, Dr Peter Ellis and Bramble Badenach-Nicolson from Hailsham Chambers to consider:

• Key case law and important updates from the past 12 months relating to inquests;
• Recent developments in causation for coronial conclusions; and
• Disclosure requirements in inquests.

If you wish to discuss any queries you may have around inquests, please contact Amanda Wright- Kluger, Toby De Mellow or Claire Leonard. 

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Mental Health 

Publications/Guidance

Care Act 2014: supporting implementation. Support for local authorities to carry out the implementation for part 1 of the Care Act 2014.

• Care and support statutory guidance
• List of changes made to the Care Act guidance
• DHSC’s position on the determination of ordinary residence disputes in light of the outcome of the Worcestershire case.

Practice Guidance on Procedure for handling representations from victims in the Mental Health jurisdiction of the Health, Education and Social Care Chamber. Courts and Tribunals Judiciary practice guidance revises and replaces the Practice Guidance on Procedures Concerning Handling Representations from Victims in The First-Tier Tribunal (Mental Health) dated 1 July 2011. It is issued following the decision in R. (on the application of Maher) v First-tier Tribunal (Mental Health) which concerned a claim from a mother whose son was unlawfully killed. Its intention is to implement the ruling to ensure that going forward victims' representations are considered as part of the open justice framework identified in that judgment.

Mental Capacity Act 2005, Deprivation of Liberty Safeguards, 2022-23. These official statistics provide findings for England from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1 April 2022 to 31 March 2023.

Suicide prevention strategy for England: 2023 to 2028. Our visions and aims to prevent self-harm and suicide, including the actions the government and other organisations will take to save lives.

Working together to prevent suicide in the NHS workforce: A national suicide prevention toolkit for England. A NHS England toolkit, designed to help NHS organisations reduce the risk of suicide in their workforce, aims to assist organisations to embed suicide prevention strategies in health and wellbeing policies and guide the approach to supporting those at risk of suicide within the workforce. It makes recommendations relating to strategies for suicide prevention, explains how to identity risk of suicide, and describes how to respond to warning signs and how to support staff. It also sets out case studies representing good practice.

A mentally healthier nation: towards a ten-year, cross-government plan for better prevention, equality and support. This report, published on behalf of more than 30 national charities, sets out what a long-term government mental health plan for England could look like. It calls for action to tackle poverty and racial injustice, for reforms to the benefits and justice systems, and for further investment in better and more equitable mental health services. It draws on evidence provided to the UK government’s consultation on its proposed 10-year plan to identify the actions that are necessary to protect people’s mental health, reduce mental health inequalities, and improve mental health services nationwide.

Independent Care (Education) and Treatment Reviews: views of commissioners and clinicians. This report examines the impact of Independent Care (Education) and Treatment Reviews, which are meetings intended to improve the treatment of people with a learning disability or autistic people in long-term segregation.

"It's time things change": Priorities for detention for the Department of Health and Social Care's suicide prevention strategy. A joint publication on the priorities for detention for the Department of Health and Social Care's (DHSC) suicide prevention 10-year strategy sets out the themes revealed by the Independent Advisory Panel on Deaths in Custody (IAPDC) during its engagement with experts, practitioners, and stakeholders on the causes of suicides in prison, as well as those that take place in mental health settings. The IAPDC calls for the suggested priorities highlighted in this document to be incorporated into the new suicide prevention strategy. It states that it will continue to work closely with DHSC to ensure these priorities are turned into meaningful action to drive forward a sustained reduction in the number and rate of suicides across all places of detention.

Accredited legal representatives in the Court of Protection. An updated Law Society practice note provides detailed advice on the role of an accredited legal representative (ALR) in the Court of Protection. It covers areas including: communicating with and taking instructions from a client; duties of confidentiality and disclosure; good practice in the Court of Protection; and applications under the Mental Capacity Act 2005 s.21A.

Cases

St George's University Hospitals NHS Foundation Trust v Casey [2023] EWHC 2244 (Fam) Once a court was satisfied on the balance of probabilities that, on the proper application of the 2008 Code of Practice for the Diagnosis of Death by the Academy of Medical Royal Colleges, brain stem death had occurred, there was no basis for a best interests analysis. The task of the court, where a dispute arose, was to confirm that the subject of the application was dead, declare that they had died at a particular time on a particular date and declare that the withdrawal of medical intervention was lawful.

Patricia, In the Matter Of [2023] EWCOP 42. Judgment concerning Patricia's capacity to decide on medical treatment where she is seriously ill with anorexia nervosa. A 23-year-old woman, who suffered from anorexia nervosa, lacked capacity to make decisions in relation to her future medical treatment, notwithstanding that she retained litigation capacity. However, she should have autonomy since it was not in her best interests to force-feed her against her wishes; it would be futile and would only distress her.

A NHS Trust v ST & Ors [2023] EWCOP 40. Capacity decision relating to ST a young woman dying with a progressive disease who wishes medical treatment to continue in order to seek treatment abroad. 

RK, Re (Capacity; Contact; Inherent Jurisdiction) [2023] EWCOP 37. Application by R's family for declaration and orders concerning her capacity and use of inherent jurisdiction.

University Hospitals Birmingham NHS Foundation Trust v ST.  [2023] EWCOP 40 A 19-year-old woman who had an incurable and progressively degenerative disease lacked both litigation capacity and the capacity to make her own decisions in relation to future medical treatment.

News

Power of attorney process set to go online. A Gazette notice discusses new legislation, the Powers of Attorney Act 2023, which paves the way for a fully online service for lasting power of attorney. When introduced, the changes will make the system quicker, easier to access and more secure. The legislation will also strengthen existing fraud protection by allowing checks on the identity of those applying for a lasting power of attorney. The new online system and the additional safeguards are now being developed by the Office of the Public Guardian, ahead of extensive testing. An improved paper process will also be introduced for those unable to use the internet.

Major national strategy to reduce number of tragic suicides. Government pledge to reduce England’s suicide rate within 2.5 years with launch of new National Suicide Prevention Strategy.

Bevan Brittan Events

Case Law Update – Mental Health Act 1983. 19 October 12.30pm. Join us for this 1-hour session with Rhys Hadden from Serjeants’ Inn Chambers to consider:

• key case law and important updates from the past 12 months relating to Mental Health Act 1983;
• the latest with the new Mental Health Act

How we can help

We are experts in advising commissioners, providers and care co-ordinators on the relevant legal frameworks. We deal with complex issues such as deprivation of liberty, state involvement, use of CCTV monitoring, seclusion, physical restraint and covert medication. We can help providers with queries about admission and detention, consent to treatment, forensic service users, transfers, leave, discharge planning and hearings. We can advise commissioners on all matters concerning commissioning responsibility, liability and disputes. For more information click here

If you wish to discuss any mental health issues facing your organisation please contact Simon Lindsay, Hannah Taylor or Stuart Marchant. 

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Primary Care 

Publications/Guidance 

Constituency data: GPs and GP practices. Interactive dashboard showing data on GPs in England, including patient to GP ratios, the number of GPs, and a map of GP practices

If you wish to discuss any issues in primary care then please contact  Joanne Easterbrook or Ben Lambert. 

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Regulation 

Publications/Guidance 

PSA statement responding to calls for regulation of NHS managers. Following the sentencing of former neonatal nurse Lucy Letby, the Professional Standards Authority (PSA) has offered its expertise to NHS England, which is looking again at whether non-clinical NHS Managers should be regulated. The PSA will work with the four UK Governments, NHS bodies and stakeholders to understand where the risks and issues lie and to propose solutions to protect the public.

Bevan Brittan Updates

NHS England Fit and Proper Person Test Framework Goes Live

If you wish to discuss any issues in regulation then please contact Stuart Marchant 

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Social Care  

Publications/Guidance 

Review of adult social care complaints for 2022-23. The LGSCO has urged leaders to rigorously scrutinise those services provided to people who might otherwise be hidden in society, to ensure they are performing well for those who may be unable to speak up for themselves. In particular, key complaints investigated over the last 12 months and their outcomes highlight "the battles people and their carers go through to get the care to which they are entitled, and the serious consequences when that care falls below the quality expected".

Adult social care funding pressures: estimated costs to meet growing demand and improve services in England. This long read uses four scenarios to highlight the potential funding pressures in adult social care up to 2032/33. These reflect some of the key issues that need to be addressed to meet future demand and improve adult social care. need for care and support is also increasing among both working-age adults and children. 

Adult social care and the NHS: two sides of the same coin. This report provides an overview of total capacity and national trends across the health and care sector as well as the variation across the country. It focuses on demand for and provision of state-funded social care for older people as the largest group drawing on care and support, but finds that fewer people are being supported by state-funded social care in England despite the increase in people aged 65 and over. However, the need for care and support is also increasing among both working-age adults and children.

Care for our future: the roadmap to a sustainable future for adult social care. This document from Care England (a registered charity and a representative body for small, medium and large providers of adult social care in England) sets out the sector’s priorities across three key themes – workforce, funding and integration. The roadmap issues a series of policy recommendations for the next government to implement within 100 days, two years and five years of entering office. The plan is backed by major representative groups from across the sector.

Carenomics: unlocking the economic power of care. This report from a cross-party coalition including former health and care ministers, employers and unions, makes the economic case for investing in social care, setting out the benefits this investment would have to the wider economy. Drawing on a wide range of evidence, this report emphasises the substantial return on investment that social care could deliver. Potential benefits include improving employment chances for disabled people, reducing pressure on the NHS, reducing costs for employers, levelling up for poorer areas, and building a more purposeful economy.

How we can help

For ways in which we can help with Social Care issues click here.

If you wish to discuss any queries you may have around social care please contact Siwan Griffiths.

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General 

Publications/Guidance

Government commits to updating NHS constitution to ensure privacy and dignity for women receiving care. The Government has announced it will consult on proposed updates to the NHS Constitution for England to ensure the privacy, dignity and safety of all patients is respected, and the rights of different protected characteristics of patients in certain settings are taken into account. Proposed changes will be brought forward by the end of 2023, ahead of the next routine update to the constitution and its handbook in summer 2024.

Health and care defined. The health and care policy landscape is constantly evolving, and so is the language we use to describe it. This jargon buster aims to demystify and clarify some of the concepts and terms that are frequently used in health and care policy.

UK Prison Population Statistics. This briefing paper explores prison population data for the UK from the Ministry of Justice, Scottish Government, and the Northern Ireland Department of Justice.

Support for cancer in England. House of Commons Library briefing on Government and NHS policy on cancer in England and cancer research.

Damp and mould: understanding and addressing the health risks for rented housing providers. This guidance delivers on the government’s commitment in response to the Coroner’s ‘prevention of future deaths’ report on the death of 2-year-old Awaab Ishak due to mould in the home.

The Chair of the Infected Blood Inquiry, Sir Brian Langstaff, has announced his final report will be delayed and he now expects to publish in March 2023, due to the "sheer volume and scale" of the investigation. He highlights that the Inquiry Rules 2006 include a requirement that individuals and organisations subject to explicit or significant criticism in an inquiry report must receive warning letters so that any responses can be considered by the chair before finalising the report.

Fresh plea from UK fertility regulator as monumental changes to donor anonymity law finally come to fruition. The Human Fertilisation and Embryology Authority (HFEA) has announced that changes to the donor anonymity law will mean that most people conceived from egg, sperm or embryo donations made after 1 April 2005 will be able to discover the people whose donations led to their conception. The HFEA has launched its #WhoIsMyDonor campaign to raise awareness of this landmark moment.

Handbook to the NHS Constitution for England. Information about the rights and pledges in the NHS Constitution and what these mean for NHS patients and staff.

If you would like to sign up for any of our Bevan Brittan publications click here.

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