Health and Social Care Update February 2014

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 you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

Care	Mental Health
Clinical Risk/Health and Safety	Primary Care
Commissioning	Procurement
Employment/HR	Public Health
Finance	Regulation
Foundation Trusts	General
Inquests

Care

Publications/Guidance
Social care funding – Industry and government statement of intent. The Care and Support Minister, Norman Lamb, and the Director General of the ABI, Otto Thoresen, have signed a joint Statement of Intent committing to work together to help people get the information they need to plan and make decisions about how to pay for their long term care, and create the right conditions for a larger market of financial products that will give people more choice. The commitment results from the planned reforms under the Care Bill that aim to provide greater certainty about what people will be expected to pay for their long term care and therefore provide greater opportunity for a new market of care products to emerge.
DH has also published the results of an Industry review of financial care products that identifies opportunities for development of financial products to help people pay for care.

Measuring people’s experiences of integrated care; an options appraisal and a recommended set of questions. Picker Institute Europe has published two linked research reports describing how patients’, service users’ and carers’ perspectives can be used to measure integration within and between health and social care services. Both were commissioned by the DH and completed in partnership with charity coalition National Voices and other industry leading experts. The reports describe a robust and efficient approach to measuring people’s experiences of integrated care, and provide valuable resources for those evaluating local and national initiatives.

NHS waiting times for elective care in England. This report highlights the increasing challenge to the NHS of sustaining the 18-week waiting time standard for elective care and the importance for trusts of having reliable performance information and shared good practice. This report concludes that value for money is being undermined by the problems with the completeness, consistency and accuracy of patient waiting time data; and by inconsistencies in the way that patient referrals to hospitals are managed.

If you wish to discuss any clinical risk or health and safety issues please contact  Stuart Marchant .

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Clinical Risk/Health and Safety

Publications/Guidance
Healthcare associated infections (HCAIs) - litigation and reputation. This research finds that two thirds of Britons would sue a hospital if they contracted a serious HCAI while undergoing treatment. It suggests that the reputational/litigation risk to hospitals with higher HCAI rates, and the possible consequential loss of patient volumes, is an incentive to focus on reducing HCAIs.

Pathology quality assurance review report. A need for transparency, better safety checks on testing, consistency and standardisation of processes and procedures are some of the recommendations made to NHS England in a review into pathology services.

Confidentiality clauses and special severance payments: thirty-sixth report of session 2013-14. This Public Accounts Committee report concludes that 'gagging' clauses could be used to stop whistleblowers speaking out about patient care and child safety. It also raises concerns about the use of compromise agreements and special severance payments to terminate employment in the public sector.

NHS safe staffing: not just a number. This analysis highlights the risks to patient care when hospital ward staffing falls short of the roster. Despite developments in electronic rostering, hospitals have resisted using automated systems to track their staff. Recent unannounced hospital inspections have found serious staff shortfalls against rosters. This report highlights the potential benefits of implementing robust systems to track the deployment of hospital staff in real time, to patients, to the workforce, and to hospital management.

The Francis report: one year on - the response of acute trusts in England. This report explores how acute trusts are responding to the Francis Inquiry report, one year on from Robert Francis QC’s original report into the failings in Mid Staffordshire hospitals. It finds that many of the themes from the Francis Inquiry Report, including the importance of openness, adequate staffing levels and a patient-centred culture, have resonated with leaders of the hospitals responding to the survey and interviews. Four in five of the hospitals responding to the online survey said they were taking new steps in response to the report, and an even greater proportion said they already had work underway on many of the relevant recommendations when the report was published.

Regulating quality and safety of health and social care: international experiences. Taking a range of six countries, this report reviews the regulatory mechanisms that have been implemented to ensure that essential standards of care are applied and are being adhered to, and considers the range of policy instruments used to encourage and ensure continuous quality improvement. It looks at Australia, England, Finland, Germany, the Netherlands and the USA. It is intended to inform policy thinking for the Department of Health and others in developing the regulation of safety and quality of health and social care in England. It was prepared as part of the project 'An "On-call" Facility for International Healthcare Comparisons' funded by the Department of Health in England through its Policy Research Programme.

National Patient Safety Alerting System (NPSAS). A new alerting system launched by NHS England will ensure warnings of potential risks to the safety of patients can be developed much more quickly and be rapidly disseminated right across the NHS. The new National Patient Safety Alerting System (NPSAS) will ensure warnings of emerging risks can be rapidly issued following their identification by the NHS England Patient Safety Domain. As part of the new process, by April 2014 NHS England will also begin publishing monthly data on trusts who fail to confirm they have complied with the required actions of an alert within the set timeframe.

Maternity services in England: Fortieth Report of Session 2013-14: Report, together with formal minutes, oral and written evidence. A Committee of Public Accounts report on maternity services in England concludes that despite an overall increase in the number of midwives there is still a shortage of 2,300 that are required to meet current birth rates and that there is confusion around the Department of Health's policy for maternity services, what it wants to achieve and who is accountable for delivery.

Management of HIV infected healthcare workers performing exposure prone procedures. PHE publishes interim guidance on policy implementation and interim paper-based occupational health register.

Leading the information revolution in cancer intelligence: why the National Lung Cancer Audit is the key to transforming lung cancer outcomes. This report analyses the importance of the National Lung Cancer Audit, which was launched in 1994 and captures up to date information on almost every lung cancer case in the UK. It compares clinical practice at hospitals across the country, helping to identify problem areas and drive up standards of care for the disease, which kills 35,000 people every year. This report credits the audit with increasing the number of patients who receive radiotherapy, increasing the number of patients who have surgery, increasing the number of patients who have chemotherapy and increasing the number of patients who see a nurse specialist.

Registration of stillbirth - Commons Library Standard Note. A House of Commons Library Standard Note discusses the registration of stillborn babies.

Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae. This toolkit provides practical advice for clinicians, and staff at the frontline in an acute care setting (a similar toolkit is being prepared for the non-acute care setting). It also provides some basic public health risk assessment tools and advice and information for the patient.

Bevan Brittan Events
Clinical risk claims and complaints forum. 17 April 2014 : Timings TBC . Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. This regular seminar addresses a variety of clinical risk and complaints related issues. Further information about the exact topics that will be discussed in this session will be provided closer to the date of the seminar.

Bevan Brittan Articles
Duty of Candour. Robert Francis QC made a series of recommendations concerning openness, transparency and candour. In response, the Government has, to date, introduced the National Health Service and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. Regulations 16 to 18 required from 1 April 2013 the duty of candour to take effect in contractual form by way of being included in the NHS Standard Contract 2013/14, and is mirrored in the subsequent 2014/15 contract.

If you wish to discuss any clinical risk or health and safety issues please contact Joanna Lloyd or Stuart Marchant .

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Commissioning

Publications/Guidance
'Any town' toolkit. This toolkit uses high level health system modelling and allows CCGs to map how interventions could improve local health services and close the financial gap. It is an additional guide to help commissioners with their five-year strategic plans, showing how a typical CCG could achieve financial balance over the strategic period up to 2018/19. Using 2013/14 as a baseline, ‘Any town’ uses detailed data including population size and disease prevalence, to predict what a typical health system’s quality and financial baseline may look like in 2018/19.

Taking the lead: How clinical commissioning groups are changing the face of the NHS. NHS Clinical Commissioners has published a suite of 16 CCGs’ success stories which illustrate how CCGs are working with local government, the voluntary sector and others to improve services.

Clinical commissioning group funding. The House of Commons Library has compiled a research note on CCG funding in England.  

Consultations
Consultation on the Clinical Commissioning Group Outcomes Indicator Set (CCG OIS). NICE is seeking views on proposed new indicators for the CCG OIS. The indicators have been mapped against the five domains of the NHS Outcomes Framework. The consultation closes on 3 March 2014.

Bevan Brittan Articles
CCGs responsible for Special Educational Needs commissioning. CCGs will have a duty to carry out Special Educational Needs (SEN) commissioning from September 2014. The guidance "Everyone Counts: planning for patients 2014/15" states that CCGs will need to work closely with local authorities and schools to meet the wider pledge for better health outcomes for children and young people. We look at the extent and nature of this duty for CCGs.

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

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Employment/HR

Publications/Guidance
Confidentiality clauses and special severance payments: thirty-sixth report of session 2013-14. This Public Accounts Committee report concludes that 'gagging' clauses could be used to stop whistleblowers speaking out about patient care and child safety. It also raises concerns about the use of compromise agreements and special severance payments to terminate employment in the public sector.

NHS safe staffing: not just a number. This analysis highlights the risks to patient care when hospital ward staffing falls short of the roster. Despite developments in electronic rostering, hospitals have resisted using automated systems to track their staff. Recent unannounced hospital inspections have found serious staff shortfalls against rosters. This report highlights the potential benefits of implementing robust systems to track the deployment of hospital staff in real time, to patients, to the workforce, and to hospital management.

NHS Pay Review Body: review for 2014/15 - written evidence from Health Education England. This document contains HEE's evidence as contribution to the development of pay policy. It provides information on HEE's role, remit and current activities.

Staff care: how to engage staff in the NHS and why it matters. This report shows that the way healthcare staff feel about their work has a direct impact on the quality of patient care as well as on an organisation’s efficiency and financial performance. It argues that it is not only necessary for healthcare providers to encourage staff engagement but to accelerate it. 

Appointing a new accountable officer to a clinical commissioning group. This guidance from NHS England supports CCGs who wish to appoint a new accountable officer to the role on both an interim and substantive basis. NHS England has a statutory responsibility to oversee and assure the appointment process. The guidance sets out the roles and responsibilities of area and regional teams in this process. The guidance also reminds CCGs of best practice in appointing to senior roles, including chairs and chief finance officers.

Information management and quality assurance guidanceGuidance on information management for medical revalidation in England and quality assurance of medical appraisers has been updated. Both documents include minor revisions to improve clarity and bring them up to date. However, the principles and messages of each document are otherwise consistent with previous versions.

NHS Bursary Scheme rules. The DH has published new editions of the documents that set out the rules and administrative arrangements for the payment of NHS bursaries to students who are considering work in the NHS and have accepted a place on an eligible course. The NHS Bursary Scheme rules ensure the bursaries are paid fairly and consistently. There are two sets of rules: one for students who started their course before 1 September 2012 and one for those who started on or after that date. These editions replace previous editions.

Equality counts: equality information for CQC in 2013. This report sets out how the CQC have promoted equality and tackled inequality both for people who use health and social care services and for its staff.

Consultations
Language controls for doctors: proposed changes to the Medical Act 1983. The DH has published the outcome of the consultation on giving more power to the General Medical Council (GMC) to act if there are concerns about a doctor’s English language capability. The majority of the 54 responses supported the proposed changes .
See also the draft Medical Act 1983 (Amendment) (Knowledge of English) Order 2014 which makes amendments to the Medical Act 1983 to give the GMC the power to refuse a licence to practise in circumstances where the medical practitioner is unable to demonstrate the necessary knowledge of English, and to create a new fitness to practise category of impairment, relating to having the necessary knowledge of English.

National consultation on a NHS bands 1-4 workforce strategy. The staff in bands 1-4 make up around 40 per cent of the NHS’s workforce, and are responsible for an estimated 60 per cent of direct patient contact but receive only around 5 per cent of the training budget. HEE wants to know what people think are the barriers and challenges for this part of the workforce, and how these can be overcome. All the feedback collected will be analysed to create a bands 1-4 national strategy - “The Talent for Care”. The closing date for feedback is 24th March 2014.

News
NHS trusts failing to support staff health and mental wellbeing. NHS trusts in England need to do more to support the health and mental wellbeing of their staff, an audit of NICE workplace guidance has revealed. There is clear evidence to show that the health of NHS staff influences productivity and the quality of care delivered to patients. The recent Keogh Review of 14 trusts with high levels of patient mortality found that these trusts had high rates of staff sickness absence, particularly among doctors and nurses. 

Bevan Brittan Articles
Key employment law developments: what to expect in 2014. The New Year promises to be as eventful as ever in relation to employment law developments. Hot on the heels of the new TUPE Regulations coming into force this month, from April onwards we will see a raft of new measures coming into force over the course of the year. We are also anticipating some key decisions to be published by the appeal courts. Bevan Brittan's Head of Employment & Pensions, Julian Hoskins, takes you through the highlights of the year ahead.

Employment status: Agency workers. Mike Smith reports on a case which considered the question of whether agency workers can only be deemed to be employees of end-user clients if it 'necessary' to do so. The Employment Appeal Tribunal reviewed recent case law on this issue, and confirmed the principles which should be applied when determining employment status.

Employment news round-up. Despite the gloomy time of year, there are at least three reasons to be cheerful today: 'Blue Monday' (20 January) is out of the way, January is very nearly over, and Bevan Brittan's first News Round-Up of 2014 is here. And, as if is not enough, this is a special 'New Year New TUPE' edition, in which Sarah Lamont looks at what the 2014 TUPE regulations will mean for you, alongside other recent developments in the world of employment law.

If you wish to discuss any employment issues or any of the items raised in this sectin please contact Julian Hoskins or James Gutteridge.

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Finance

Publications/Guidance
'Any town' toolkit. This toolkit uses high level health system modelling and allows CCGs to map how interventions could improve local health services and close the financial gap. It is an additional guide to help commissioners with their five-year strategic plans, showing how a typical CCG could achieve financial balance over the strategic period up to 2018/19. Using 2013/14 as a baseline, ‘Any town’ uses detailed data including population size and disease prevalence, to predict what a typical health system’s quality and financial baseline may look like in 2018/19.

NHS finance – the fundamentals post 2012 reforms. This is part of a series of briefings which is written and structured for foundation trust governors. The aim of this briefing is to enable governors to navigate around the financial reports provided to governors and identify the key information within these reports.

Clinical commissioning group funding. The House of Commons Library has compiled a research note on CCG funding in England.

The NHS England planning guidance for 2014/15 - 2018/19. The Healthcare Financial Management Association (HFMA) has produced a summary of the latest planning framework from NHS England, Everyone Counts: Planning for Patients 2014/15 to 2018/19, with particular reference to the financial aspects of the framework. The framework requires CCGs to produce five-year plans, including detailed financial and operational plans for the first two years, that cover five areas: strategic; operational; financial; direct commissioning; and the Better Care Fund (previously known as the Integration Transformation Fund). The first submission of plans is due by 14 February and, following the signing of contracts (deadline 28 February), the final two-year plans and draft five-year plans by 4 April. The final five-year plans are due by 20 June.

Making best use of the Better Care Fund: spending to save?This evidence summary briefing offers an evidence-based guide to aid the discussions between clinical commissioning groups, local authorities and health and wellbeing boards. It presents evidence from The King’s Fund and others in a number of different areas – for example, primary prevention; self-care; case management – and emphasises that this evidence must be interpreted and used with a sound understanding of the key local challenges and the underlying issues that need to be addressed.

NHS co-payments: How popular are they among health users? This report from the Patients Association discusses the results of a survey of patients on the use of co-payments and top-up fees in the NHS.

NHS Bursary Scheme rules. The DH has published new editions of the documents that set out the rules and administrative arrangements for the payment of NHS bursaries to students who are considering work in the NHS and have accepted a place on an eligible course. The NHS Bursary Scheme rules ensure the bursaries are paid fairly and consistently. There are two sets of rules: one for students who started their course before 1 September 2012 and one for those who started on or after that date. These editions replace previous editions.

If you require further information about any of the items raised in this section please contact David Owens.

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Foundation Trusts

Publications/Guidance
Governance reviews: consultation document. This draft guidance represents a starting point for NHS foundation trusts to structure reviews of their governance. It is designed to support NHS foundation trusts in gaining assurance that they are well led and, therefore, to help them to continue to meet patients’ needs and expectations in challenging circumstances. The consultation closes on 7 March 2014. 

Consultations
 Your help needed: guidance for governors on representing the interests of the trust members and the public. The mini guide will be accessibly written, and designed to help governors understand how they might go about representing the interests of trust members and the public in a meaningful and practical way. It will seek to help trust boards and staff to understand how they can support governors to do this.

Consultation on our revised approach to risk assessing NHS foundation trust transactions. Monitor are  seeking views on proposals to update Monitor's approach to risk assessing transactions undertaken by NHS foundation trusts, and proposals for good practice guidance on transactions.

Arrangements to support NHS foundation trusts contemplating mergers. In this letter from David Bennett we are seeking your views on our proposed new approach to help facilitate a smoother and swifter path for mergers, which will benefit patients.

If you wish to discuss any issues relating to foundation trusts please contact Vincent Buscemi.

Back to topIInquestsNews
Coroners' death warnings go online. The Chief Coroner's Office has announced that, from January 14, 2014, "preventing future deaths" reports drawn up by coroners for the benefit of individuals, organisations or public bodies will be available to the public online via the Judiciary website. The Crime and Justice Transparency Sector Panel has welcomed the move to increase transparency.

If you wish to discuss any issues around inquests please contact Joanna Lloyd

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Mental Health

Bevan Brittan Training - If you would like to know about our free lunch time training sessions just ask Claire Bentley. You can attend in our London, Bristol or Birmingham office.

Publications/Guidance
Preventing suicide in England: one year on first annual report on the cross-government outcomes strategy to save lives This report summarises the developments on the suicide prevention strategy for England at national level. It identifies key research studies and their findings, and is accompanied by a report of statistical information on suicides. It sets out the key initiatives that local areas can take to prevent suicides. It also highlights the importance of responsive and high quality care for people who self-harm.

Anxiety quality standard. The National Institute for Health and Care Excellence (NICE) has issued standards to improve the quality of care and support for children, young people and adults with anxiety disorders.

Service transformation: lessons from mental health. Mental health services have undergone radical transformation in the past 30 years. A community-based care model has largely replaced the acute and long-term care provided in large institutions. Similar change – from hospital to community-based alternatives – is a long-standing policy objective for physical health care in the United Kingdom. How far the two can be compared has been remarkably under-explored. This paper seeks to correct this by examining the transformation of mental health services in England and the relevance to current policy. Drawing on workshops with those involved in the changes and a review of published literature, the paper explores the context and factors that enabled change to happen in mental health. It includes 10 lessons for service transformation based on these experiences.

A joint inspection of the treatment of offenders with learning disabilities within the criminal justice system – phase 1 from arrest to sentence. This is a report of a joint inspection into people with learning disabilities within the criminal justice system. It found that the needs of many people with learning disabilities are going unnoticed when they are arrested by police, go to court and are sentenced. It makes recommendations for greater partnership working between the justice and health system in order to support the assessment and treatment of offenders with learning disabilities.

Mental Health Act 2012/13. The Care Quality Commission has published a report on the experiences of patients who received care under the Mental Health Act in 2012/13.

Mental health: the key facts and trends The factsheet gives an overview of the major trends and challenges facing mental health services today. Compiled from a wide range of sources, the factsheet sets out data in a range of areas relating to investment in servicestrends in morbidity; suicide and homicide rates; service activity; use of mental health legislation; mental health of children and young people; service user experience; inequalities experienced by people with mental health problems; and workforce and staff satisfaction.

London mental health: the invisible costs of mental ill health. The report investigates the scope and scale of mental ill health in London, to highlight the wider impacts beyond those to health and social care. These wider impacts result in around £26 billion each year in total economic and social costs to London and impact every facet of the community.

Policing and mental health guide. Mind and Victim Support have launched a police and mental health good practice guide. Police and Mental Health: How to get it right locally is endorsed by the Association of Chief Police Officers (ACPO) and the Police Federation. It is aimed at frontline officers and gives practical advice on supporting people with mental health problems. The guide follows the publication of the At risk, yet dismissed report in October, by Victim Support and Mind, which revealed that people with mental health problems are up to ten times more likely to become victims of crime than the general population, and far less likely to report fair and respectful treatment by police. Police and Mental Health showcases examples of good practice where police forces have worked with other local services and service users to ensure the best possible support for people with mental health problems

Autism quality standard. The provision of services for people with autism is varied across England and this quality standard is designed to standardise and improve the care and management of autism. It covers autism in children, young people and adults, including both health and social care services.

Transparency in the Court of Protection. The President of the Court of Protection has issued guidance on transparency, effective from February 3, 2014, which will increase the number of Court of Protection judgments available for publication.

Mental health: priorities for change. The Department of Health has set out 25 priorities for changing how mental health services are provided. The document set out how changes in local service planning and delivery will make a difference to the lives of people with mental health problems in the next two or three years.

Preventing suicide in England: one year on. First annual report on the cross-government outcomes strategy to save lives. This report summarises the developments on the suicide prevention strategy for England at national level. It identifies key research studies and their findings, and is accompanied by a report of statistical information on suicides. It sets out the key actions that local areas can take to prevent suicides and also highlights the importance of responsive and high quality care for people who self-harm.

Deprivation of Liberty Safeguards 2012/13. The CQC have published the findings from their fourth annual report on the use of the Deprivation of Liberty Safeguards in care homes and hospitals throughout 2012/13. A new approach to regulation including more checks on the use of Deprivation of Liberty Safeguards (DoLS) will become a routine part of hospital and care home inspection. The new strategy, outlined in this fourth annual report into the use of the Mental Capacity Act (MCA), put forward by the Quality Care Commission (QCC), aims to raise standards and put people first. The MCA sets out the balance between respect for rights to liberty and independence for vulnerable persons in order to protect them when they lack the capacity to make decisions.
The QCC has expressed concern that MCA is still not understood and implemented consistently across health and social care services.
Findings for 2012/13 include:
people subjected to restraint and possible deprivation of liberty without legal protection in care homes and hospitals
people's experiences of the DoLS are mixed
an increase in the number of applications for the use of DoLS of people aged over 85
varying application rates by region--reasons unknown
two thirds of care homes and hospitals fail to notify CQC of the outcome of DoLS applications. Expectations and recommendations
better communication, consultation and sharing of information with the person directly affected by the DoLS
notification rates to be improved by care homes and hospitals
local authorities and health services to increase awareness and understanding of DoLS
NHS England to include the use of DoLS in the standard contract for providers.

News
Brain-damaged woman has the right to have sex. The Times reports that senior judges have upheld a Court of Protection ruling that a woman who was brain-damaged after an operation retained capacity to make decisions about sexual relations after her mother sought an order to stop her having sex with her former lover. The woman was said to lack the capacity to consent to sex as she could not weigh up the risk, however Lord Justice Leveson ruled that the woman's weakness of perception does not "tell in favour of a lack of capacity to consent to sexual relations, any more than it does in a person of full capacity". See IM v LM [2014] EWCA Civ 37.

Hundreds of children 'detained in police cells'. The BBC reports that more than 300 youngsters suspected to have mental health problems, including a child aged 10, were held in police cells during 2013. The teenagers were assessed in cells, rather than in medical facilities, with some teenagers being detained for more than 24 hours.

Bevan Brittan Articles
The scope of the court of protection and potential judicial review proceedings. The Court of Protection has two primary powers of most relevance in cases concerning residence; firstly, to make a determination that the person lacks capacity to make decisions about his/her (i) residence and (ii) care and treatment needs. Secondly, to make declarations as to the person's best interests with regards to his/her (i) residence and (ii) care and treatment needs. The Court of Protection can also authorise any deprivation of liberty, which it considers is in the person's best interests.

If you wish to discuss any of the items raised in the above section please contact Simon Lindsay or Stuart Marchant.

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Primary Care

Publications/Guidance
Outcomes from visits to general practitioners and primary healthcare providers. This report highlights the positive approaches GP practices are adopting to look after people’s data. It summarises 24 advisory visits undertaken by the ICO at GP surgeries across England in the past year. The visits found surgeries tended to have good data protection policies and awareness of issues, including the need for adequate security and patient confidentiality. Practices also tended to have procedures in place around the practical aspects of data handling, including disposal of confidential papers.

Consultations
Discussion document following Monitor's call for evidence on GP servicesThis document summarises the issues that have been raised following a call for evidence on general practice services sector in England. Feedback from respondents fell broadly into three themes: variations on access and quality; the ability of new or existing providers of GP services to develop the scope of their offer to the NHS; and providers' ability and incentives to work together to benefit patients. Monitor are still welcoming comments on this strand of work and you can contact them at gpservices@monitor.gov.uk  

If you wish to discuss any queries you may have around primary care please contact David Owens.

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Procurement

Legislation
New Public Procurement Directives. On 15 January 2014 the European Parliament voted to adopt three new Directives that replace the existing Public Sector and Utilities Directives and introducing a new Directive covering the procurement of works concessions and service concessions. It is likely that the Directives will come into effect in March 2014, following formal signature and publication requirements. Member States will have 24 months to implement the Directives but it is likely that implementation will happen sooner in the UK.
Bevan Brittan has produced a summary of the Procurement Directives following the vote - please click here to request a copy.

If you wish to discuss any queries you may have around procurement please contact Matthew Mo.

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Public Health

Publications/Guidance
NHS and LA reforms factsheet 5: Supply of medicines for public health commissioned services – A factsheet for local authorities. NHS Prescription Services has published a new factsheet on the supply of medicines for public health commissioned services specifically for local authorities.

Ring-fenced public health grant. Public Health England and the LGA have outlined the agreed arrangements for providing a year-end Preliminary Statement of Assurance to demonstrate that the ring-fenced public health grant has been spent on eligible expenditure. This letter to local authority chief executives sets out the process for returning Preliminary Statements of Assurance for the 2013/14 financial year. It includes a Statement of Assurance to be completed and returned to Public Health England by 6 May 2014.

Public health transformation nine months on – Bedding in and reaching out. This resource commissioned by the LGA and PHE describes how public health in a number of councils has started to use the opportunities of a local government setting to improve health and wellbeing, since the formal transfer to local government in April 2013.

The views of public health teams working in local authorities: Year 1. This report from a survey of public health professionals working in local authorities finds that the majority believe health decisions are being made based on politics rather than evidence. In addition it was apparent that the public health workforce perceives that budgets which are meant to be reserved for public health initiatives are not being ring-fenced in practice. Nearly three quarters of respondents also suggested that financial restrictions are impacting upon their team’s ability to deliver health improvement initiatives. The report raises concerns and highlights the cultural shift being experienced by public health teams, with over 80% of respondents suggesting additional influencing skills would help them demonstrate their effectiveness within this new environment.

News
NHS and LA reforms factsheet 5: Supply of medicines for public health commissioned services – A factsheet for local authorities. NHS Prescription Services has published a new factsheet on the supply of medicines for public health commissioned services specifically for local authorities.

Ring-fenced public health grant. Public Health England and the LGA have outlined the agreed arrangements for providing a year-end Preliminary Statement of Assurance to demonstrate that the ring-fenced public health grant has been spent on eligible expenditure. This letter to local authority chief executives sets out the process for returning Preliminary Statements of Assurance for the 2013/14 financial year. It includes a Statement of Assurance to be completed and returned to Public Health England by 6 May 2014.

If you wish to discuss any queries you may have around public health please contact Olwen Dutton.

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Regulation

Publications/Guidance
2013 accountability hearing with the Care Quality Commission. The Care Quality Commission (CQC) is now better able to protect patients and the public, according to MPs on the House of Commons Health Committee. Their report, '2013 accountability hearing with the Care Quality Commission', says the CQC had formerly been a case study in how not to run a regulator, but essential reforms implemented by the new management are now turning it around. It now has a renewed sense of purpose and understands it exists to ensure care providers meet basic standards, and to intervene when they do not.

Equality counts: equality information for CQC in 2013. This report sets out how the CQC have promoted equality and tackled inequality both for people who use health and social care services and for its staff.

Consultations
Introducing fundamental standards – Proposals to change CQC registration regulations. Seeks views on proposed new basic requirements that all health and adult social care providers registered with the Care Quality Commission (CQC) should meet, and the standard of care and service that patients or care service users should expect. The fundamental standards will make it clear that there are some standards of safety and quality that should always be met. They will be used as part of the CQC’s inspections and regulation of care providers, and the CQC will be able to hold providers to account if they are not being met, including through the courts where appropriate. The consultation closes on 4 April 2014.

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

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General

Publications/Guidance
NHS waiting times for elective care in England. The NAO has identified inconsistencies in the way trusts measure waiting time and errors in the time recorded.

Topics for new NICE quality standards and guidance to improve the quality of social care – Summary of consultation responses and outcomes. In February 2013 the Government consulted on future topics for National Institute for Health and Clinical Excellence guidance and standards in social care. NICE quality standards are a set of statements designed to improve and measure improvements within a particular area of care. This report lists the topics that arose from the consultation and the DH's decision for each. The first set of five topics will be formally referred to NICE in January 2014, who will then add them to their social care work plan.

Global atlas of palliative care. This report shows that over 20 million people require palliative care at the end of life and the great majority suffer from non communicable diseases.

State of the Nation's waistline – Obesity in the UK: Analysis and expectations. The National Obesity Forum has produced a report on obesity in the UK, which warns that the health costs of obesity are rising faster than previous estimates suggest.

Sustainable, resilient, healthy people & places: A sustainable development strategy for the NHS, public health and social care system. The NHS Sustainable Development Unit has published its strategy that sets out how it plans to continually improve health and wellbeing and deliver high quality care when necessary, now and for future generations, within available financial, social and environmental resources. The strategy describes the opportunities to reduce the NHS's environmental impacts, improve the natural environment, increase readiness for changing times and climates and strengthen social cohesion. It also explores how this can be taken forward as a system and outlines specific areas of focus that can be used to guide action.

Wellbeing - why it matters to health policy. These documents contain evidence on why wellbeing matters to health throughout someone’s life, and what policy makers can do about it.

Hospital discharge: the patient, carer and doctor perspective. This document contains a checklist to help support patients with the hospital discharge process. The list of questions aims to be suitable for the majority of patients. It also includes stories from patients about their experiences and the perspectives of doctors on their care journey.

Implications for the NHS of inward and outward medical tourism: a policy and economic analysis using literature review and mixed-methods approaches. The study examined the implications of inward and outward flows of private patients for the NHS across a range of specialties and services. It found that the past decade has seen an increase in both inward and outward medical travel. Europe is both a key source of travellers to the UK and a destination for UK residents who travel for medical treatment and the study found that the economic implications of medical tourism for the NHS are not uniform.

Legislation
Care Bill impact assessments. The Government has published a series of impact assessments alongside the Care Bill that look at the problems that the Bill aims to address, the policy objectves and options that have been considered, and that compare the costs, benefits and impact of the options. There is also a summary of the 11 impact assessments. The Care Bill is currently before the Commons Committee.

News
Trusts face new emergency department standard
NHS England is looking to develop accident and emergency standards that are “far more meaningful” than the current target of treating, admitting or discharging 95 per cent of patients within four hours, it has been disclosed.

Bevan Brittan Articles
Competition Commission publishes provisional remedies following Private Healthcare Market investigation. We have previously reported on the Competition Commission's investigations into the private health market and the provisional findings published in August last year which identified features of the markets for the supply of private healthcare services that resulted in an adverse effect on competition. Click here to view.

If you wish to discuss any of the items raised in this section please contact Claire Bentley.

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