Health and Care Update - July 2024

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	Independent Health
Acute and emergency care	Information Sharing/data
Children/young people	Inquests and Inquiries
Clinical Risk/Patient Safety	Mental Health
Digital Health	Primary Care
Employment/HR	Prison Health
Finance	Social Care
Health Inequalities	General

 

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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. 

Local Authorities and Health & Safety: The Cornerstones of Success - 2 July 12pm

Civil Procedure Rules, Part 36 offers and recent decisions in 2024 - 9 July 12.30pm

Sexual Relations, Equality and the Court of Protection - 25 July 12.30pm

Medico legal issues arising for Pre-Term Babies - 30 July 12.30pm

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

Accident and emergency waiting times. The current A&E standard states that 95% of people arriving at an A&E department should be admitted to hospital, transferred to a more appropriate care setting, or discharged home within four hours. But is this standard being met?

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

Babies in care proceedings: What do we know about parents with learning disabilities or difficulties? A Nuffield Family Justice Observatory report finds that 34% of parents who are at risk of having their babies removed from their care have learning disabilities or difficulties, which are often not identified until their cases reach court. The report makes recommendations including: that children's social workers screen for and, where indicated, organise a more in-depth assessment of a parent's learning needs as a core part of any early assessment work; that local authorities incorporate and nurture learning disabilities expertise within child and family social work teams undertaking child in need and child protection work; and that senior leaders of the judiciary, bar and solicitors improve the rollout of vulnerable witness training for all advocates working in care proceedings.

Key principles for ensuring continuous health records of adopted children. Letter from Professor Simon Kenny, Dr Amanda Doyle and Dr Claire Fuller about the managing of health records when a child is adopted. 

Child protection statistics. NSPCC Learning has updated its factsheet on children who are the subject of a child protection plan or on a child protection register for the United Kingdom. The factsheet for the nation of Wales has also been updated to include the latest statistics. Each factsheet sets out: the number of children who are the subject of a child protection plan or on a child protection register; the reasons children are the subject of a plan or on a register; and the age and gender of children who are the subject of a plan or on a register.

Keeping children safe in education. NSPCC Learning has created a summary of the proposed changes to the Department for Education’s statutory guidance for schools in England, Keeping children safe in education 2024 (KCSIE). KCSIE 2024 is currently for information only. Once the final version is published, it will come into force in September 2024. The proposed changes include: amendments to the definition of safeguarding in line with Working together to safeguard children 2023; additional information about early help; and information on data protection.

Reverse the trend: reducing type 2 diabetes in young people. This report reveals a 40% rise in type 2 diabetes diagnoses in younger people between 2016–17 and 2022–23. There are now almost 168,000 people under 40 in the UK who live with type 2 diabetes, an increase of more than 47,000 since 2016–17. Diabetes UK is calling on all political parties to commit to tackling the alarming rise in cases of type 2 diabetes among this age group.

The voice of the child: learning from case reviews. Summary of learning for improved practice around the voice of the child 

The Suspected Inflicted Head Injury Service (SIHIS) for children pilot: Information for Legal Practitioners. A Department for Education document provides information to spread awareness across the legal profession of the new pilot for the Suspected Inflicted Head Injury Service (SIHIS) for children. Funding has been awarded to Manchester University NHS Foundation Trust, Birmingham Children's Hospital, and Sheffield Children's NHS Foundation Trust to implement the pilots and test the impact of the new SIHIS. The aim of the pilot is to create sustainable cross-system changes that reduce family court delays through testing the impact of this approach in a trial. The SIHIS will focus on improving the clarity, quality and timeliness of medical assessments that are presented to family courts to support the judiciary in making decisions with regards to suspected abusive head/spine trauma. The pilot is limited to head/spine trauma as this pilot is to act as proof-of-concept, to establish the value of such a system. This pilot will cover children aged between 0 to eight years old presenting with a head injury thought possibly to have been inflicted in nature and will end on 31 March 2025.

News

Places in council-run children’s homes in England fall by third as private firms take over. The Guardian has published a news story on children’s homes in England. An Observer analysis of government data shows a decline in the number of places in council-run children’s homes and an increased reliance on privately run provision. The article highlights some concerns about the decline in the number of council-managed residential children’s homes, such as children needing to be placed further away from their families. 

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

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Clinical Risk / Patient Safety

Publications/Guidance 

The Thirlwall Inquiry Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues: prepared by the Thirlwall Inquiry Legal Team. The Thirlwall Inquiry has published a review of implementation of recommendations from previous inquires into healthcare issues, which will inform Part C of the Inquiry's investigative phase. The Table collates recommendations from 30 inquiries over the course of 30 years that have taken place in England and Wales and which relate to events in hospitals and other healthcare settings, or safeguarding of vulnerable individuals. It details the extent to which these recommendations have been implemented in order to explore whether they have made a difference. Analysing the progress, it found across 30 inquiries just 302 out of more than 1,400 key recommendations had been adopted. It indicates the NHS and Government have failed to implement a single recommendation from the Jimmy Savile Inquiry.

Corridor care: unsafe, undignified, unacceptable. This report reveals that more than 1 in 3 (37%) nursing staff working in typical hospital settings delivered care in inappropriate settings, such as corridors, on their last shift. The report shares the results of a survey of almost 11,000 frontline nursing staff across the UK. The report calls for mandatory national reporting of patients being cared for in corridors, to reveal the extent of hospital overcrowding, as part of a plan to eradicate the practice.

World Health Organization (WHO) global report on patient safety. This aims to provide a foundational understanding of the current state of patient safety across the world, aligned with the Global Patient Safety Action Plan 2021-2030. It contains insights and information beneficial to healthcare professionals, policy-makers, patients and patient safety advocates, researchers. 

AvMA's Response to Ministry of Justice consultation Reforming the Law of Apologies in England and Wales. Responding to a Ministry of Justice consultation on how to improve the law of apologies and encourage organisations to apologise more, Action against Medical Accidents (AvMA) agrees that a meaningful apology can help to de-escalate a very emotionally charged situation but states that an apology on its own is unlikely to avoid litigation. It argues that there are other factors which are equally if not more important to patients. It is AvMA's view that the duty of candour in healthcare is generally still poorly understood, not uniformly embedded in the culture of every trust in England and is not routinely applied.

News 

NHS computer issues linked to patient harm

Hospitals harm hundreds of patients a year by misidentification.

Bevan Brittan Events

Civil Procedure Rules, Part 36 offers and recent decisions in 2024 - 9 July 12.30pm

Medico legal issues arising for Pre-Term Babies - 30 July 12.30pm

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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Digital Health

Publications/guidance

Transparency for Machine Learning-Enabled Medical Devices: Guiding Principles. A Medicines and Healthcare products Regulatory Agency publication provides guiding principles on the transparency of machine learning medical devices. These include: relevant audiences; placement of information; timing; and methods used to support transparency.

 A new national purpose: harnessing data for health. This report describes how large health and biomedical data sets, artificial intelligence and advances in biotechnology can improve and innovate health care, prevent disease and help people live longer, healthier lives. It looks at the challenges this could bring and suggests ways these challenges can be overcome. 

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

Summary of existing guidance on the deployment of medical associate professions in NHS healthcare settings. This document is a summary of existing guidance on the deployment of MAPs to support organisations employing MAPs in NHS settings. It brings together information previously shared that describes the common expectations of how organisations providing NHS care should deploy MAPs, specifically the:
1. actions needed to ensure clarity of competencies and responsibilities
2. safeguards in place to ensure patient safety
3. support and development that MAPs should have

NHS Employers updates guidance on use of settlement agreements and confidentiality clauses. NHS Employers has updated its guidance for employers on the use of settlement agreements and confidentiality clauses when resolving a workplace dispute or ending an employment contract. The guidance includes the latest information on legislative requirements, good practice examples on the freedom to speak up, guidance on Mutually Agreed Resignation Schemes, information on board members and the NHS England Fit and Proper Person Test Framework and links to further resources.  

Employer’s guidance to right to work checks. The Home Office has updated its Employer’s guide to right to work checks document for recent changes, including to remove follow up checks for persons with pre-settled status (PSS) under the European Settlement Scheme (EUSS) and to clarify the position on the right to work for asylum claimant Application Registration Card (ARC) holders after Statement of Changes in Immigration Rules HC 590. The guidance is yet to reflect a key change to made in HC 590, notably the expansion of the supplementary work conditions for Health and Care workers, and as such it has not clarified to whom the change should apply.

Bevan Brittan Events 

Our Mid-Year Employment Law Update. In this session, our team of expert employment lawyers looked at some of the key issues of the year so far. They also explored the next wave of changes, and what they might mean for your organisation.

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, Oonagh Sharma, James Gutteridge or Andrew Uttley.

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Finance  

Publications/guidance

The state of NHS finances 2024/25. This report examines the financial challenge facing NHS organisations in 2024/25 and finds that the main challenge facing NHS leaders and their staff is how they balance their books while protecting patient safety, given many organisations are having to achieve significant efficiency savings. The survey of NHS leaders carried out by the NHS Confederation shows that many NHS organisations are having to meet high efficiency targets of 5% and beyond, with some as high as 11%. This is the tightest financial position NHS organisations have faced in years.

How much funding does the NHS need over the next decade? This long read projects a potential £38 billion shortfall in the funding needed to improve the NHS by the end of the next parliament. With the pledges made by both the main political parties so far falling a long way short of this, the analysis raises questions about the trade-offs facing the next government in balancing the funding needed by the NHS, pressures on other public services, and levels of taxation. 

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Health Inequalities 

Publications/Guidance

United against health inequalities: moving in the right direction. This report shares the results of a recent NHS Provider member survey and provides an update on the progress members have made in tackling health inequalities in the past three years.

How do the last five years measure up on levelling up? Five years ago, then prime minister Boris Johnson made ‘levelling up’ a central plank of the Conservative Party’s bid for re-election, with a manifesto pledge to ‘level up every part of the UK’. In 2022, the government published a thorough and ambitious White Paper setting out 12 levelling up ‘missions’ to achieve by 2030, as well as specific metrics by which they would be measured. This report examines early progress towards those 12 missions, where possible using the headline metrics identified in the White Paper.  

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 

Publications/Guidance

More money, more choice, more of the private sector: can the next government repeat the feat of the 2000s and cut waiting times? NHS waiting times are a central issue of the 2024 election campaign. Proposed solutions – more money, more staff, more use of the independent sector and strengthening patient choice – are mostly shared between the two main parties. More money, more choice and more private sector provision helped reduce median waiting times (under old measures) from 12 weeks to 5 weeks in the decade following the 1997 election. This long read analyses the data to assess whether this is possible again. 

News

Data breach threats. Private healthcare providers have been warned to wake up to escalating data breach threats from organised criminals using a vast range of tactics on the unwary.

Two new private mental health hospitals to open

New crackdown on ICSs that ‘discourage’ referrals to private hospitals. NHS England will begin monitoring and benchmarking systems on the extent to which patients are given the option to be treated by a private provider.

More sick children go private as others face NHS waits.

For more information contact Tim Hodgetts or Julie Charlton 

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Information sharing/data 

Publications/Guidance

Key principles for ensuring continuous health records of adopted children. Letter from Professor Simon Kenny, Dr Amanda Doyle and Dr Claire Fuller about the managing of health records when a child is adopted. 

News

Data breach threats. Private healthcare providers have been warned to wake up to escalating data breach threats from organised criminals using a vast range of tactics on the unwary.

For more information contact Jane Bennett. 

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Inquests and Inquiries  

Publications/Guidance

The Thirlwall Inquiry Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues: prepared by the Thirlwall Inquiry Legal Team. The Thirlwall Inquiry has published a review of implementation of recommendations from previous inquires into healthcare issues, which will inform Part C of the Inquiry's investigative phase. The Table collates recommendations from 30 inquiries over the course of 30 years that have taken place in England and Wales and which relate to events in hospitals and other healthcare settings, or safeguarding of vulnerable individuals. It details the extent to which these recommendations have been implemented in order to explore whether they have made a difference. Analysing the progress, it found across 30 inquiries just 302 out of more than 1,400 key recommendations had been adopted. It indicates the NHS and Government have failed to implement a single recommendation from the Jimmy Savile Inquiry. 

Receiving the new medical certificate of cause of death (MCCD). Department of Health and Social Care guidance explains reforms to death certification and the introduction of medical examiners, which will commence on 9 September 2024. As part of the changes, a new medical certificate of cause of death (MCCD) will replace the existing certificate.

Voicing Loss: A research and policy project on the role of bereaved people in coroners’ investigations and inquests. The research examined the role of bereaved people in coroners’ investigations and inquests, as defined in law and policy and as experienced in practice. It also explored ways in which the inclusion and participation of bereaved people in the process can be better supported.

Frazer Williams: Prevention of future deaths report. The coroner expressed concerns about:

• inequity within the system of the treatment of a person with mental illness in the prison setting compared to an individual in the community; 
• a lack of NHS guidance, and joint guidance with HMPPS, on the identification, management, and treatment of someone with self neglect in the prison setting; 
• a lack of a national directory detailing the facilities and provision of healthcare at individual prisons; and,
• a lack of national guidance for healthcare teams working in prisons around the handover of healthcare.  

Bevan Brittan Updates

2023 statistics on Prevention of Future Death reports released

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

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Mental Health 

Cases

 AB v CD (By The Official Solicitor) & Anor [2024] EWCOP 32.  Consolidated proceedings involving an annual review of the continued deprivation of liberty of CD (in operation since 2019) and health and welfare application by his mother, AB

A Local Authority v ZX [2024] EWCOP 30 Decision regarding ZX's capacity to engage in sexual activity.

Newcastle City Council v LM [2023] EWCOP 69. Final hearing as to capacity over several areas, habitual residence and LM's best interests concerning her current placement and care plan.

Bevan Brittan Events

Sexual Relations, Equality and the Court of Protection - 25 July 12.30pm 

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 or Hannah Taylor. 

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Primary Care 

Publications/Guidance 

Receiving the new medical certificate of cause of death (MCCD). Department of Health and Social Care guidance explains reforms to death certification and the introduction of medical examiners, which will commence on 9 September 2024. As part of the changes, a new medical certificate of cause of death (MCCD) will replace the existing certificate. GP practices are advised to ensure they receive new medical certificates of cause of death (MCCDs) from DHSC in July.

Delivering a general practice estate that is fit for purpose. GPs often work in buildings that are too cramped, too old and too inflexible for a modern health service – with a quarter of GPs’ buildings built before the NHS was founded. This report warns that the next government will need to urgently address the crumbling general practice estate. 

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

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Prison Health

Publications/Guidance 

Voting whilst in prison. Prison Reform Trust guidance provides updated information about the rights and restrictions to vote whilst in prison. It explains which categories of prisoner are eligible to vote, how they can vote, and provides links to government guidance and relevant legislation.

Frazer Williams: Prevention of future deaths report. The coroner expressed concerns about:

• inequity within the system of the treatment of a person with mental illness in the prison setting compared to an individual in the community; 
• a lack of NHS guidance, and joint guidance with HMPPS, on the identification, management, and treatment of someone with self neglect in the prison setting; 
• a lack of a national directory detailing the facilities and provision of healthcare at individual prisons; and,
• a lack of national guidance for healthcare teams working in prisons around the handover of healthcare.  

Race to the top: A PPN report on race and ethnicity in prisons. A Prison Reform Trust report, following consultation by the Prisoner Policy Network (PPN) on how ethnicity impacts prisoners' time in prison and on racial equality and discrimination in the system, concludes that an urgent reprioritisation of equalities and diversity work is needed by the Ministry of Justice and HM Prison and Probation Service (HMPPS). The report recommends: creating a knowledge exchange mechanism for sending officers from prisons in rural, less diverse areas to places where there is a greater collective and organisational understanding of how to work with people from various ethnic, racial and cultural backgrounds; HMPPS should create a good practice guide on racial literacy/structural racism; and improving the food budget in prisons so that the variety of food offered can be increased.

If you wish to discuss any issues in prison health then please contact Joanne Easterbrook or Julie Charlton 

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Social Care  

Publications/Guidance 

Social care. Unlike NHS services, social care is not free at the point of use. Find out who is eligible for publicly funded social care, how many people have requested support, and how many people's needs are not being met in this updated nutshell.

Care Quality Commission assessments for adult social care: must know guide for lead members. Local Government Association guidance provides background on the Care Quality Commission (CQC) assessment process for lead members following the December 2021 White Paper "People at the Heart of Care" when it was announced that the CQC would independently review and assess local authority performance in delivering their adult social care duties under the Care Act 2014 Pt 1. The guide includes information on the background, the process and how to prepare for the assessment. 

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

Using plain language in health information – a quick guide. The Patient Information Forum has published an update to its quick guide to using plain language in health information. The guide includes data on literacy challenges, top tips for writing in plain language, and advice on use of word economy and active language. It also offers advice on communicating risks and benefits and the use of artificial intelligence in the production of health information.

Waiting times. Waiting times consistently rank as one of the public’s main concerns with the NHS and have a big impact on patient experience. Explore the latest data for waiting times for elective care, and how waiting times for different services have an impact on patients.

How likely is a general election to transform health and social care? Nicholas Timmins looks back at the last three big political transitions to ask, how fast might things change for health and social care?

What health and care need from the next government. The fourth briefing in this series looks at waiting times for health care – the biggest cause for public dissatisfaction with the NHS and a central battleground of this general election. It suggests seven tests that must be met, which should be put to politicians as they battle to convince the public they have the answers.

Productivity in the NHS and health care sector. Productivity is one way people measure the performance of a sector – it compares the growth in the quantity of outputs to the growth in the quantity of inputs. This explainer looks at what productivity is and how different bodies measure health care productivity in England in different ways.  

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

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