Health and Social Care Update March 2015

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
Emergency Care	Providers
Employment/HR	Public Health
Finance	Regulation
Foundation Trusts	General

Care

Publications/Guidance
Distinctive, valued, personal – Why social care matters: The next five years. Report from ADASS outlining the developmental steps that are needed to be taken immediately after the General Election in order to ensure a safe, secure and personalised care and health system for older and disabled people.

End of life care. This Health Select Committee report looks at the state of end of life care since the independent Review of the Liverpool Care Pathway, chaired by Baroness Neuberger. The Committee found great variation in quality and practice across both acute and community settings. It makes a number of recommendations for improvement, and in particular recommends that social care should be free at the end of life.

Human rights training for Care Quality Commission staff. Care Quality Commission (CQC) staff are to receive training in equality and human rights, funded by the Equality and Human Rights Commission (EHRC) to ensure they are well equipped to identify threats and recognise good practice in hospitals, care homes and other organisations. A training programme devised by the EHRC and the British Institute of Human Rights will aim to deliver a comprehensive learning programme to inspectors and other staff members.

Older people in care homes (LGB25). This briefing summarises NICE's key recommendations for local authorities and partner organisations on the health and care of older people in care homes. It also highlights relevant quality standards. Local authorities have a key role in the integration of health and care services in their local communities. The advice and associated links provided in this briefing will help with work towards person-centred, integrated care.

The state of care in counties: The integration imperative. This report from the County All-Party Parliamentary Group, with support from the County Councils Network (CCN) and the Local Government Information Unit, identifies a unique set of challenges facing counties when it comes to providing adult social care. It puts forward a set of radical recommendations for driving forward the integration agenda in county areas. The report concludes that the success of the health and social care integration is at risk in counties from overly centralised NHS structures entrenching barriers between services. It states that there is a critical need for Health & Social Care Deals, enabling counties and their partners in health to negotiate devolved deals suited to their local challenges. The inquiry was optimistic that if barriers were removed, care services could continue to successfully transform and become more tailored towards local needs. The Inquiry found that across health and social care there were significant ambitions to innovate and do more for county residents.

Home care: Delivering personal care and practical support to older people living in their own homes. NICE is seeking views on a draft guideline for commissioners of home care in local authorities and CCGs, health and social care practitioners, providers, home care managers and home care workers. The draft guideline considers how person-centred home care should be planned and delivered. It addresses how those responsible for managing and providing home care should work together to deliver safe, high-quality home care services that promote independence. It aims to address recent concerns about the quality, reliability and consistency of home care services. While the Care Act 2014 and other legislation describe what organisations must do, this guideline focuses on ‘what works’ in terms of how to fulfil those duties, and deliver support to older people using home care and their carers. The consultation closes on 16 April 2015.

Every moment counts: a narrative for person centred coordinated care for people near the end of life. This sets out how good, coordinated – or integrated – care looks to people near the end of life and is written from their point of view. Produced by National Voices and the National Council for Palliative Care in partnership with the national clinical director for end of life care at NHS England, Dr Bee Wee, it draws on surveys, the testimonies of bereaved carers, the experience of end of life care charities and the reflections of professionals that highlighted failures in coordinating and personalising the different elements of end of life care. It outlines five themes that people say are key to coordinated care near the end of life.

What's important to me. A review of choice in End of Life care. The Choice in End of Life Care Programme Board was commissioned to provide advice to Government on improving the quality and experience of care for adults at the end of life, their carers and others who are important to them by expanding choice. Their report identifies the issues people approaching the end of life are currently facing and offers a blueprint for how greater choice in end of life care can be achieved. Their advice is focused around a 'national choice offer' – a simple expression of what should be offered to each individual who needs end of life care.

Planning for the Better Care Fund. The HC Public Accounts Committee has published a report on Planning for the Better Care Fund. It concludes that the initial planning for the Fund was deeply flawed. DH and DCLG and NHS England changed the rules in the middle of the planning phase, after failing to tell planners they needed to identify £1bn in savings. As a result, all 151 health and wellbeing boards had to submit revised plans resulting in wasted time, effort and money. Local areas are now at greater risk of not being able to implement the policy. The scale of the challenge facing local government and the NHS is growing as demand for health and care services increases. The Committee is concerned that the new focus on reducing emergency admissions and making savings will significantly increase pressure in adult social care services.

Care and support: getting ready for the cap on care costs – Funding to support implementation (LAC (DH)(2015)2). This Local Authority Circular gives advice on introducing the cap on care costs and the appeals system as part of the Care Act 2014. The note also gives advice on how local authorities might think about using the additional £146m of funding provided from April 2015 to plan and prepare for the final set of changes to fully implement the Care Act. 

Professional standards of practice and behaviour for nurses and midwives. The Code has been updated to reflect changes in contemporary professional nursing and midwifery practice and to reflect the public expectations of care.

Practical guide to engaging with health and wellbeing boards. This guide for voluntary organisations provides practical steps to follow to develop relationships with Health and Wellbeing Boards. The briefing is part of a series aimed at supporting voluntary organisations to work better with local commissioning bodies.
There is also a guide for voluntary organisations on Engaging with clinical commissioning groups.

Accessing care in 2016 and beyond: a step-by-step guide for over 65s. London Councils has developed a step by step guide for over 65s which sets out using a flow chart how the Care Act funding reforms are likely to impact whether they will qualify for support from their council or not.

CQC welcomes launch of the Care Certificate from April. The Care Quality Commission (CQC) has published information that sets out what it expects from health and social care providers ahead of the introduction of a new Care Certificate from 1 April 2015. The Care Certificate has been produced to address inconsistencies in training and competencies in the workforce.

Equal measures: equality information report for 2014. This report summarises lessons learnt about equality and diversity, both across health and social care and internally at CQC last year. It finds that while seeing some improvements, there is still too much variation in people’s access, experience and outcomes in many health and social care services. For example, the fact that more ethnic groups seem to use certain hospital services more than other groups suggests that access could be an issue. It also finds that people with dementia have poorer outcomes in hospitals than those without dementia going into hospital for the same health conditions; and, that the needs of people with visual impairment and hearing loss within care homes are sometimes overlooked.

Bevan Brittan Updates
The Care Quality Commission issues guidance for use of cameras in care settings. The use of cameras and other recording devices in care settings has been highly controversial attracting considerable media interest and debate.

If you wish to discuss any of the items above or the issue of care more generally please contact Stuart Marchant.

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Clinical Risk/Health and Safety

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
 Investigating clinical incidents in the NHS: Sixth Report of Session 2014-15: Report, together with formal minutes relating to the report. A Public Administration Select Committee report concludes there is a need for a new, permanent and simplified system for effective local clinical incident investigation conducted by trained staff, so that facts and evidence are established early, without the need to find blame, and regardless of whether a complaint has been raised. This would reduce or remove the need for costly inquiries into clinical failure.

Work and wellbeing in the NHS: why staff health matters to patient care This report shows that staff health and wellbeing in the NHS is often seen as an optional extra - as less than two thirds of trusts have a staff health and wellbeing plan in place. It says that high quality patient care relies on skilled staff who are not only physically and mentally well enough to do their jobs, but also feel valued, supported and engaged. It also states that good staff health, wellbeing and engagement can reap significant benefits for patient safety including reduced MRSA infection rates and lower patient mortality rates.

The report of the Morecambe Bay Investigation. Sets out the findings, conclusions and recommendations of the independent panel, chaired by Dr Bill Kirkup, that was established to to review the management, delivery and outcomes of care provided by the maternity and neonatal services of the University Hospitals of Morecambe Bay NHS Foundation Trust between January 2004 and June 2013. The report concludes that the maternity unit at FGH was dysfunctional and that serious failures of clinical care led to unnecessary deaths of mothers and babies. The Investigation Panel also reviewed pregnancies at other maternity units run by University Hospitals of Morecambe Bay NHS Foundation Trust. It found serious concerns over clinical practice were confined to FGH. The report makes 44 recommendations for the Trust and wider NHS, aimed at ensuring the failings are properly recognised and acted upon.

Themes and lessons learnt from NHS investigations into matters relating to Jimmy Savile. This report from Kate Lampard provides an independent oversight of the investigations at three NHS hospitals (Leeds General Infirmary, Stoke Mandeville and Broadmoor) and the DH into the associations that the late Sir Jimmy Savile OBE had with those hospitals and the Department, and allegations that Savile committed sexual abuses on the hospitals’ premises. The report summarises the findings of the reports of the NHS Savile investigations, and describes and considers the themes and issues that emerge from those findings and the further evidence gathered. It identifies lessons to be drawn by the NHS as a whole from the Savile affair and includes 14 recommendations for the NHS, the DH and wider government.

Consultations
Implementation of the recommendations, principles and actions set out in the report of the Freedom to Speak Up review. Seeks views on measures to carry out recommendations in 'Freedom to Speak Up' that will help staff feel safe to speak out on patient safety. 

Bevan Brittan Updates
Change in the law on consent to treatment On 11 March 2015 the Supreme Court handed down a unanimous judgment in potentially the most significant clinical negligence case of the last 30 years in Montgomery v Lanarkshire Health Board [2015] UKSC 11 on an appeal from the Scottish Courts. This is a binding decision on the law of consent for the lower courts in England and Wales as well as Scotland and has important urgent, ramifications for all clinicians and health bodies.

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
NHS England announces national review of maternity care. Announces details of a major review of the commissioning of NHS maternity services, as promised in the NHS Five Year Forward View. The review will assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies. It is expected to report in by the end of the year, and will be led by an external chair, supported by a diverse panel. The appointment of the chair and other review panel members will be announced shortly.

2015/16 NHS standard contract. NHS England has published the NHS Standard Contract which must be used by commissioners for all contracts for healthcare services other than primary care. It again comprises thee parts: Particulars, Service Conditions and General Conditions. The web page also links to technical guidance, National Variations, CQUIN guidance and other contract support documents. There are also Delta View comparison documents showing the changes made from the 2014/15 version of the Contract to the 2015/16 version.

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

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Emergency Care

Publications/Guidance
What's behind the A&E 'crisis'? This briefing examines the real reasons behind England's A&E 'crisis', and warns that the emphasis on the four-hour waiting time target has become disproportionate. It also makes some recommendations to policy makers on how performance management should be approached in the future.

College of Emergency Medicine. Ignoring the prescription? This paper reports the findings of a survey of 142 clinical leaders in emergency medicine across the UK. The survey was carried out in response to the unprecedented pressures over the 2014/15 winter period and reveals just how much needs to be done to address the profound challenges facing A&E services.

NHS England’s winter health check. This summary offers an overview of the system and pulls together information on waiting times in A&E, ambulance response times, daily situation reports from the NHS, and information on flu rates.

Urgent repeat medication requests: Guide for NHS 111 services. Provides details on how NHS 111 services can establish a direct referral to a pharmacy that is commissioned to provide urgent repeat medication as a local NHS service. The patient journey ensures the patient is directed to the nearest pharmacy without the need of a GPOOHs assessment and the pharmacist ensures the governance of the process is adhered to by informing the patient’s GP of any repeat supply. Commissioners of NHS 111 services and local community pharmacy services are encouraged to use this guide to inform the transformation of urgent care by shifting the burden of repeat medication requests away from GPOOHs services and other urgent care settings.

If you wish to discuss the issue of emergency care please contact Claire Bentley.

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Employment/HR

Publications and Guidance
Work and wellbeing in the NHS: why staff health matters to patient care This report shows that staff health and wellbeing in the NHS is often seen as an optional extra - as less than two thirds of trusts have a staff health and wellbeing plan in place. It says that high quality patient care relies on skilled staff who are not only physically and mentally well enough to do their jobs, but also feel valued, supported and engaged. It also states that good staff health, wellbeing and engagement can reap significant benefits for patient safety including reduced MRSA infection rates and lower patient mortality rates.

New Agenda for Change pay charts and FAQs published. Following the recent Agenda for Change (AfC) pay agreement, NHS Employers has published a new pay chart and frequently asked questions. The easy to follow chart uses a three-step process to explain the changes.

Raising the Bar – Shape of caring: A review of the future education and training of registered nurses and care assistants. This report, commissioned by Health Education England, makes 34 recommendations for the future education and training of nurses and care assistants.

Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values – A mandate from the Government to Health Education England: April 2015 to March 2016. Sets out the priority areas for Health Education England (HEE) in the delivery of its functions. The mandate looks at how the healthcare workforce can be supported through excellent education and training to deliver the very best care to patients.

Education & training tariffs: Tariff guidance for 2015-16. This document sets out: the national tariffs for healthcare education and training placements in the financial year 2015 to 2016; how the tariffs will be implemented; and in what circumstances the national tariffs may be varied and how to do this. The tariffs cover non-medical placements and medical undergraduate and postgraduate placements in secondary care.

Building a supportive environment: a review to tackle undermining and bullying in medical education and training. This report highlights and examines circumstances where bullying and undermining of doctors in training is most likely to occur. The findings come from a representative sample of 12 UK hospitals which the GMC visited. These were chosen because concerns had previously been raised through the GMC’s national survey of doctors in training and for their size, type and geographic location. In many sample sites the issues had been resolved prior to the visit subsequently resulting in examples of good practice.

NHS Bursary Scheme rules 2015. 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.

Work and wellbeing in the NHS: why staff health matters to patient care. This report by the Royal College of Physicians sets out why it is in the best interests of both patients and NHS organisations for the health, well-being and engagement of the NHS workforce to be prioritised. Building on the Future Hospital Commission’s 2013 recommendation that staff should be supported to deliver safe, compassionate care, the report offers a call to action to UK governments, NHS trusts, health boards, commissioners and medical royal colleges to take urgent action in the interest of patients, staff and services. The report shows that staff health and wellbeing in the NHS is too often seen as an optional extra - as less than two thirds of trusts have a staff health and wellbeing plan in place. It explains that investment in NHS staff is not an optional extra, but a vital investment in safe, sustainable patient care.

Consultations
Implementation of the recommendations, principles and actions set out in the report of the Freedom to Speak Up review. Seeks views on measures to carry out recommendations in 'Freedom to Speak Up' that will help staff feel safe to speak out on patient safety. 

Bevan Brittan Updates
Employment news round-up March 2015 Jodie Sinclair provides our regular monthly edit of the latest workforce law developments of which you need to be aware. This month, we cover: holiday pay and commission; private sector organisations and the 'fit and proper' test for directors; tribunal fees, 'drugs driving', the new Acas Code, immigration changes, email access for employees on long term sick leave and a recent EAT case on diabetes as a potential disability. We also provide details of our forthcoming free workshop on managing difficult grievances – there are some places still available if you wish to register your interest.

The truth about zero hours contracts. In recent months, so-called 'zero hours contracts' have attracted almost as much negative media attention as Top Gear, with the 'fracas' largely focussed on the apparent abuse of zero hours contracts by some employers, particularly the use of exclusivity clauses. As a result, the government launched two consultations and part of the resulting legislation is expected to complete its passage through Parliament by the end of this month. Sarah Maddock sorts the facts from fiction and summarises the new 'zero hours' regime. 

Bevan Brittan Events
Employment law workshop: managing difficult grievances
Bristol. 29 April 2015 : 10:00 - 12:30 (registration opens at 09:30). Location: Bevan Brittan LLP, Kings Orchard, 1 Queen Street, Bristol, BS2 0HQ.
London.13 May 2015 : 10:00 - 12:30 ( registration opens at 09:30). Location: Bevan Brittan, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF
Birmingham 14 May 2015 : 10:00 - 12:30 (registration opens at 09:30) Location: Bevan brittan LLP, Interchange Place, Edmund Street, Birmingham , B3 2TA

Our interactive case-study led employment law workshop will explore a number of scenarios and provide practical strategies for managing what are often complex, protracted and challenging grievance processes. 'Mary' – our fictional Accounts Assistant raises a myriad of issues, complaints and concerns involving her colleagues, detailed information requests, and policy and procedural considerations, which warrant a formal investigation. This session will give you an opportunity to share experience and best practice and gain insight into successfully navigating the various workforce issues to be considered, whilst maintaining effective team relationships and minimising the risk that the process does not take over and drain resources away from the team's primary service delivery tasks.

If you wish to discuss any employment issues please contact Julian Hoskins or James Gutteridge.

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Finance

Publications/Guidance
Circle's withdrawal from Hinchingbrooke Hospital. This update report from the Public Accounts Select Committee shows that, as the Committee warned in 2013, the taxpayer has been left exposed by the failure of the Hinchingbrooke franchise. The Committee is concerned that whilst this was an innovative experiment, none of those involved in the decisions has been properly held to account.

Guidance on implementing the overseas visitor hospital charging regulations 2015. Department of Health guidance provides help and advice on the implementation of the National Health Service (Charges to Overseas Visitors) Regulations 2015. It explains what should happen when an overseas visitor needs NHS treatment provided by an NHS hospital in England.

Getting better outcomes for older people using personal budgets. This report by Think Local Act Personal collates the latest information about personal budgets for older people. Drawing on research from across the sector, including data from the Health & Social Care Information Centre and the National Personal Budget Surveys, it shows that older people do experience positive benefits from having a personal budget, although these are not as marked as for other groups. The report highlights what does and doesn't work well for older people using personal budgets, recommends what can be done to improve practice and includes case studies from councils across England that are working to improve personal budget delivery.

Getting the sums right: How to sustainably finance personal health budgets. The challenges of identifying the funds for personal health budgets, and managing the financial risks to commissioners and providers, have been known for some time. This briefing shares learning on ways to identify and allocate funds for personal health budgets from within existing budgets, and manage the risk of double-running costs. It makes recommendations for commissioners, providers and national policymakers.

Developing a new approach to palliative care funding. This document presents the 2015/16 palliative care development currency. The currency is a first attempt to group specialist palliative care into packages of care that are similar in terms of resource need and clinical input. The currency is not mandatory and will be further tested and refined during 2015/1.The aim is that it will provide a meaningful tool to support service planning and commissioning.

An update on Hinchingbrooke Health Care NHS Trust. This report recommends that the Department of Health and the NHS Trust Development Authority should report to the Committee on the total cost to the taxpayer arising from the failure of the franchise, including the costs of transition arrangements and the total cost of covering the financial deficits incurred during the franchise. It also suggests that the Department of Health and the NHS Trust Development Authority should ensure that strong governance and clear accountabilities are put in place for future novel or high-risk ventures, and that there is strong and effective monitoring. 

Economic and fiscal outlook. This report sets out forecasts for the economy and the public finances over a five year horizon and assesses whether the Government is on course to hit its fiscal targets. 

If you wish to discuss any of the items in this section or any issues around finance please contact David Owens.

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Foundation Trusts

Publications/Guidance
Representing the interests of members and the public: examples and guidance for NHS foundation trusts and governors. Monitor has issued guidance to help governors represent the interests of NHS foundation trusts members and the public. This guide gives the context for governors’ work, gives examples of what governors could do to promote communication between foundation trusts, their members and the public and includes case studies of the practical experiences of foundation trusts and governors. People who are involved in helping governors to fulfil their duties may find this guide useful. Chairs and other members of foundation trust boards, membership managers and trust secretaries may wish to refer to it.

NHS foundation trusts: Planning and reporting requirements. This updated Monitor guide explains how NHS foundation trusts can meet their financial sustainability and governance requirements set out in the Risk Assessment Framework. It includes guidance documents and details of requirements for the 2015/16 annual plan review. Monitor states that it is asking only for the submission of a refreshed operational plan, covering 1 year (2015/16), which incorporates a focus on the trust’s strategic context. The timetable also includes a high-level draft plan. The deadline for full draft submissions has been extended from 27 February 2015 to 7 April, with a final submission to follow on 14 May 2015.

News
Cost of saving Mid Staffordshire NHS Trust. Sending in trust special administrators (TSAs) to identify and implement a solution to problems at Mid Staffordshire NHS Foundation Trust cost almost £19.5m over 18 months, Monitor reports. In response to a pending parliamentary question, the regulator published figures which declared it had originally budgeted £15.25m for the work, but the timescale was extended on two separate occasions.

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

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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
Mental health aftercare in England and Wales From 1 April 2015 the local authority responsible for mental health aftercare services, under section 117 of the Mental Health Act 1983 (the Act), will normally be the one where the person was ordinarily resident immediately before they were detained under the Act. This document has details about arrangements for referring disputes over ordinary residence in cases where one or more authority in dispute is in England and one or more is in Wales. These arrangements only apply where services are provided under section 117 of the Act.

Reference Guide to the Mental Health Act 1983. A new Reference Guide was published in England to coincide with the coming into force of the new Code of Practice on 1/4/15. It is a reference source for people who want to understand the main provisions of the Mental Health Act 1983 and the regulations under the Act, as amended at 1 April 2015, including by the Mental Health Act 2007, Health and Social Care Acts 2008 and 2012 and Care Act 2014. The revised reference guide complements the revised Mental Health Act Code of Practice, with the Code giving guidance on how the Act should be applied.

Care services for people with learning disabilities and challenging behaviour. Too many children and adults with learning disabilities are being kept in mental health hospitals unnecessarily because of the lack of community alternatives, according to the Public Accounts Committee. The committee expressed concern at the lack of action being taken to close hospitals and prevent people being put into institutions. However, it welcomes a new closure programme expected to be run by NHS England, setting out recommendations on how to close large mental health hospitals and develop effective transition arrangements for patients.

Draft revised statutory guidance to implement the strategy for adults with autism in England—Government response. Updated adult autism statutory guidance reviews the government's autism strategy and sets out how local authorities and NHS organisations should carry out their responsibilities to develop services which support the needs of people with autism. The revised guidance takes into account feedback received from a consultation and progress made since 2010, factoring in the advent of recent legislation such as the Care Act 2014 and the Children and Families Act 2014.

Dementia-friendly health and social care environments (HBN 08-02). Sets out design principles for dementia-friendly environments in new healthcare buildings, and in the adaptation or extension of existing facilities. The design principles, core design features and a selection of case studies provide guidance for the development of new design solutions and the adaptation or extension of existing facilities. The guide includes case studies from the Dementia Friendly Environments Programme.

Preventing deaths in detention of adults with mental health conditions. This inquiry reveals that despite many reports and recommendations, serious mistakes have gone on for far too long. The same errors are being made time and time again, leading to deaths and near misses.

Independent Mental Health Advocacy (IMHA). This suite of 12 resources includes short films, reports, at a glance summaries and tools. Some of the resources aim to raise service users’ and mental health staffs’ awareness and understanding of the IMHA role, and address equality of access. Others help advocacy providers, commissioners and mental health trusts to improve access to IMHA, to understand what a good service looks like, and how outcomes can be measured.

Future in mind: Promoting, protecting and improving our children and young people's mental health and wellbeing. The report of the Children and Young People's Mental Health and Wellbeing Taskforce makes recommendations on ways to make it easier for children, young people, parents and carers to access help and support when needed and to improve how children and young people's mental health services are organised, commissioned and provided. Recommendations include: improved access for children and young people who are particularly vulnerable; improved access to support through named points of contact in specialist mental health services and schools; and waiting time standards.

Public mental health leadership and workforce development framework. The purpose of this framework is to help develop public health leadership and workforce capability in mental health. It identifies six key ambitions, as well as some core principles for the workforce. Each ambition outlines current priorities and suggests key competencies that we need to expand and grow if mental health is to genuinely be addressed with the same energy and given the same priority as physical health, recognising that it underpins our quality of life.

The welfare of vulnerable people in police custody. Vulnerable members of society, including children and those with mental health issues, are often locked in cells and unnecessarily criminalised, a report by HM Inspectorate of Constabulary (HMIC) has found. The report says police custody is too often being used as a substitute for social and health care, and that custody can often be avoided for vulnerable adults and children if police officers take action to find other services to support these individuals.

Improving community health networks for people with severe mental illness: a case study investigation. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness to benefit health and wellbeing.

The Alzheimer’s Society has published new guidance Accessing and sharing information: acting on behalf of a person with dementia. The guidance was developed with assistance from the ICO and explains how personal information can be shared in compliance with the DPA to help manage the affairs of a person with dementia. The guidance clarifies how the DPA applies to various scenarios that a person supporting someone with dementia is likely to face. The booklet forms part of the Alzheimer’s Society Dementia Friendly Communities programme which aims to improve inclusion and quality of life for people with dementia.

Consultations
No voice unheard, no right ignored - a consultation for people with learning disabilities, autism and mental health conditions. A Department of Health consultation seeks views to strengthen rights of people with learning disabilities, autism and mental health issues to enable them to live independently. It seeks views on how people can: be supported to live independently; be assured that their views will be listened to; challenge decisions about their care; and exercise control over the support they receive with a Personal Health Budget. Comments by 29 May 2015.

Consultation on service framework for the treatment of people with a co-occurring mental health and substance misuse problem 2015. The Welsh Government is consulting on draft guidance on collaboration between services to improve care, support and treatment. The revised framework will enable people to better manage their substance misuse and mental health problems. The consultation closes on 23 April 2015.

Bevan Brittan Updates
Important Inquest Update – Deaths of Psychiatric Patients. On Friday 20 February Mr Justice Green handed down his judgment in the Administrative High Court in the case of Joanna Letts v the Lord Chancellor and the Equality and Human Rights Commission ("EHRC"). This matter was a judicial review of the criteria that the Legal Aid Agency applies to determine whether relatives should be granted legal aid for representation at inquests into deaths which may engage the duties of Article 2 of the European Convention on Human Rights. It only applies to deaths of psychiatric patients.

Bevan Brittan Events
Annual Mental Health Seminar - Click on any of the links below to register your interest
Bristol - 22 April
London - 5 May
Birmingham - 6 May

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
Exploring international acute models. Monitor has looked at international acute service line models to help inform the current thinking on potential new models of care in the NHS. The research identified 3 individual service models in use abroad that could offer benefits if used more widely by the NHS: 'risk tiers' for maternity and paediatric services, use of technology, particularly to deliver care remotely, and out-of-hours care delivered by GPs.

Building primary care in a changing Europe. This publication analyses the way how primary care is organised and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination. Relating these differences to health system outcomes the authors suggest some priority areas for reducing the gap between the ideal and current realities. 

Access to GP care. This report highlights GP shortages in London and investigates the issue of low morale and GP retention. It outlines a number of recommendations to improve access to primary care services in London such as commissioning further research into staff morale; a review of IT strategy to improve patient access; and greater collaboration between the Mayor of London and NHS England.

Fit for Work: Guidance for GPs. Fit for Work is free and helps employees stay in or return to work. It provides an occupational health assessment and general health and work advice to employees, employers and GPs. GPs can refer individuals to Fit for Work. This guidance aims to help GPs make the best use of Fit for Work and supports their patients’ return to work as quickly as appropriate.

News
Pharmacists set to work in GP surgeries in radical move to ease pressures on general practice and improve patient care. The Royal College of General Practitioners (RCGP) and the Royal Pharmaceutical Society (RPS) have come up with plans for pharmacists to work in GP surgeries, in a bid to ease current pressures in general practice and address the severe shortage of GPs. They say that the move will improve patient safety and care and, crucially, reduce waiting times for GP appointments. The proposals would see pharmacists working as part of the general practice team, much in the same way as practice nurses. They would work closely with GPs and other colleagues to resolve day to day medicine issues, particularly for patients with long term conditions and who are taking a number of different medications. They would also liaise with hospitals, community pharmacists and care homes to ensure seamless care for patients.

CQC inspectors publish reports on 95 more GP practices. The Care Quality Commission has published a further 95 reports on the quality of care provided by GP practices that have been inspected under its new approach.

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

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Procurement

Publications/Guidance
Procurement and competition rules: Can the NHS be exempted? In this briefing, The King’s Fund seeks to clarify whether a new government could extract the NHS from European Union procurement and competition rules. The briefing concludes that it is not possible to exempt the NHS from EU procurement and competition law. It does, however, suggest that the same aim could be achieved by making broader changes to policy, including bringing foundation trusts clearly back under the direct control of government.

Bevan Brittan Events
Procurement Update - Bristol 23 April 2015 : 10:00 - 13:00 (registration opens at 09:30) Location: Bevan Brittan LLP, Kings Orchard, 1 Queen Street, Bristol, BS2 0HQ
Our first round of procurement updates events for 2015, covering recent UK and EU case law and significant developments in legislation, policy and practice. We will look into recent updates of the new Procurement Directives and what they will mean in practice as well as a selection of other important topics. 

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

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Providers

Publications/Guidance
Integrated care licence condition: guidance for providers of NHS-funded services. Explains what is expected of NHS providers in relation to the integrated care licence condition and where Monitor may take action.

Protecting and promoting patients’ interests licence exemptions: Guidance for providers. This updated guidance reflects the changes regarding the nursing care licence exemption amendment regulations that were laid in Parliament in February and will come into effect on 1 April 2015. Monitor will also be updating their guidance on Commissioner Requested Services and so this section has also been updated to reflect this. NHS providers are responsible for determining if they are exempt, and for applying to Monitor for a licence if they are required to hold one. This guidance helps providers of NHS services understand whether they need a licence, or if they are exempt from the requirement to hold a licence. 

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

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Public Health

Publications/Guidance
Public health services non mandatory contract 2015-16. The DH has published an updated public health services contract which can be used by local authorities when commissioning services to deliver their new public health functions from April 2015. There is also guidance with an explanation of key contract clauses and advice on completion of the contract.

Health visitor and 0-5 transfer programme: case studies. The DH has published examples of good practice in the transformed health visitor programme, divided into the 6 high impact areas (HIAs). The stories from health visitors and service-users demonstrate the work and benefits of the transformed health visiting service. The service offers 4 levels of support depending on need, 5 universal reviews at key points in a child’s life and 6 high impact areas where health visitors make the biggest difference.

School Nurse Programme: Supporting the implementation of the new service offer – Helping school nurses to tackle child sexual exploitation. This pathway clarifies the role of the school nursing service regarding child sexual exploitation. It aims to consolidate best practice by: helping practitioners to recognise child sexual exploitation and to understand its effects on health and wellbeing; summarising the evidence base, including the types of child sexual exploitation, its prevalence and consequences; and identifying the school nurse role at different levels of service and outlining a core offer from the school nursing service.

Transfer of 0-5 children’s public health commissioning to local authorities: Finance factsheet 3: Final allocations. Explains the arrangements from October 2015 and outlines timescales for NHS area teams and local authorities in the run-up to the transfer.

Checking the health of the nation: Implementing the NHS Health Check Programme. The NHS Health Check Programme offers eligible people between the ages of 40 and 74 advice to help delay or prevent conditions such as heart disease, stroke, diabetes, kidney disease and certain types of dementia. Many local authorities now consider NHS Health Check as a core programme within their adult health improvement programmes. The NHS Health Check also provides an opportunity to identify and refer at-risk people into locally commissioned health improvement and treatment programmes. This publication from the LGA looks at how five different authorities are using innovative ways to deliver the programme.

Excess winter deaths and morbidity and the health risks associated with cold homes (NG6). This NICE guideline makes recommendations on how to reduce the risk of death and ill health associated with living in a cold home. The aim is to help meet a range of public health and other goals. The guideline is for commissioners, managers and health, social care and voluntary sector practitioners who deal with vulnerable people who may have health problems caused, or exacerbated, by living in a cold home. It will also be of interest to clinicians and others involved with at-risk groups, housing and energy suppliers. It recommends that health and social care professionals, as well as those working in the heating, plumbing and electricity industries sign post people who live in cold homes to a single-point-of-contact system for help in making their home warmer. Local health and wellbeing boards should ensure that a single-point-of-contact health and housing referral service is designed and commissioned to help vulnerable people who live in cold homes.

Living well for longer: One year on. Shows progress against the actions set out in Living Well for Longer: National support for local action which followed a call to action from the Secretary of State. The report shows that there has been improved prevention, early diagnosis and treatment of the  big killers: Cancer; Stroke; Heart disease; Lung disease and Liver disease. It also outlines the next steps for ongoing improvements across the system in reducing premature mortality.

Better health for London: Next steps. The Mayor of London, NHS England, Public Health England, London Councils and the 32 GP-led clinical commissioning groups have come together to outline how, individually and collaboratively, they will work towards London becoming the world's healthiest major city. This document sets out shared ambitions and how they will measure progress towards the 10 shared goals.

Action plan on hearing loss. NHS England and DH have produced an Action Plan to support services for deaf people and those with diminishing hearing. The plan has been developed with a number of organisations including Public Health England, hearing loss charities and those whose hearing is directly affected. Aimed at commissioners, CCGs, GPs and healthcare providers, the report identifies multiple health and social issues associated with hearing loss. It recommends ways that services for children, young people, working age and older adults living with hearing loss can be improved.

News
Meningococcal group W (MenW) immunisation advised for 14 to 18 year-olds. The Joint Committee on Vaccination and Immunisation (JCVI) has advised that immunisation for meningococcal group W (MenW) disease be offered to 14 to 18 year-olds. Whilst the number of MenW cases and overall risk remains very low, there has been an increase in prevalence, with 117 cases last year. The DH has accepted JCVI’s advice and is now planning the implementation of a combined MenACWY immunisation programme.

Parents to get complete picture of child’s development. Announces £2.2m funding for local authorities to implement their 'integrated review', bringing together assessments given by the DfE and the DH. The reviews will also be available for 2-year-olds not in settings for the first time, thanks to pilots exploring how they can be offered to all children. It is hoped the pilots will find a way to reach around 275,000 children who are not in early education settings.

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

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Regulation

Publications/Guidance
Review of decision-making in the General Medical Council's fitness to practise procedures. Decisions reached by the General Medical Council (GMC) about doctors' fitness to practise are fair and consistent, according to independent research. A GMC investigation has found decisions by GMC staff in 187 reviewed fitness to practise case files, concerning doctors who have been subject of a serious complaint, to be appropriate and in line with the guidance and criteria set out for decision-makers.

Regulations for service providers and managers. Guidance from the CQC on how providers and managers can meet two sets of regulations: the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

Monitor and the Care Quality Commission: memorandum of understanding. This memorandum of understanding sets out how Monitor and CQC will work together. It describes both organisations' respective roles, the principles followed and the agreed governance framework on joint areas of work.

Dispute Resolution Process for the 2015/16 contracting process. NHS England and the NHS Trust Development Authority (NHS TDA) have agreed a joint Dispute Resolution Process which Monitor has also contributed to. It states that it is important that all commissioners and all providers have in place between them mutually agreed contracts prior to the start of the financial year to which they relate. NHS England, NHS TDA and Monitor consider it to be a major failing of the health economy where parties do not manage to reach agreement by the national contract signature deadline of 11 March 2015.

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

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General

Publications/Guidance
Access to hospital care: is the NHS on target? This briefing examines how hospital trusts in England are performing against six national targets. The paper argues against the notion that dips in performance can be attributed to a handful of poorly performing hospital trusts, and finds there has been deterioration across the board in some measures.

Guidance on implementing the overseas visitor hospital charging regulations 2015. Department of Health guidance provides help and advice on the implementation of the National Health Service (Charges to Overseas Visitors) Regulations 2015. It explains what should happen when an overseas visitor needs NHS treatment provided by an NHS hospital in England.

Children's Commissioner commenting on “The UK’s Compliance with the UN Convention on the Rights of the Child. Commenting on a Joint Committee on Human Rights report on progress made by the Government in recognising children's rights in law and policy, the Children's Commissioner for England expresses disappointment at the Government's failure to "get to grips with child poverty", which has impacted most severely on the most disadvantaged, such as disabled children and those in single parent households.

NHS charities: Conversion to independent status – Outline guidance. In accordance with the Review of the regulation and governance of NHS Charities, published in March 2014, trustees of NHS Charities can establish a new charity independent of the Department of Health. This updated guidance for the trustees of NHS Charities explains the process for trustees considering independence. It explains variations that are dependent upon the structure of the NHS Charity, and the necessary engagement with the Department and the Charity Commission.

The efficient management of healthcare estates and facilities. DH has published guidance for NHS trusts, foundation trusts and other NHS organisations on achieving efficiency savings and reducing costs in NHS estates. It is split into two parts: Part A outlines how efficiencies in the running of land and property can be achieved, while Part B provides more detailed advice about the active management of land and buildings used for healthcare services. Addendums to the building note provide guides to: town planning for health organisations and the healthcare system in England for local planning authorities.

Realising the value: A new relationship with patients and communities. NHS England has announced that a consortium led by Nesta and the Health Foundation in partnership with Voluntary Voices (National Voices, Regional Voices, NAVCA and CSV), the Behavioural Insights Team and Newcastle University, has been selected to take forward work to empower patients and engage communities in their own health and care.

Promoting the health and wellbeing of looked-after children. This statutory guidance aims to ensure that looked-after children have access to any physical or mental health care they may need. It replaces statutory guidance on Promoting the health and wellbeing of looked-after children issued in 2009.

Equal measures - Equality information report for 2014. The CQC's latest annual equality report focuses on variation in care specifically for older people and younger people, and differences on the grounds of disability, ethnicity, religion and belief, sex, sexual orientation and gender identity. It identifies that there is still too much variation in people’s access, experience and outcomes in many health and social care services on these grounds.

NHS car-parking management: environment and sustainability (HTM 07-03). This Health Technical Memorandum helps NHS organisations identify best practice in car-park management and sustainable transport. It advises on how to deliver the DH's car-parking principles, which provide clear and consistent ground rules that will help manage car-parking provision in the NHS and help to improve the patient experience across the NHS.

Making energy work in healthcare (HTM 07-02). This Health Technical Memorandum provides guidance on managing responsible energy use within the health sector. It draws together best practice guidance and background information regarding energy use in the healthcare sector. It provides information on mandatory requirements by legislation, best practices in energy efficiency, as well as relevant case studies. It is in two parts: Part A covers policy and management, and Part B sets out procurement and energy considerations for new and existing building facilities.  

Critical condition: London’s NHS. This report from London Assembly member Dr Onkar Sahota offers a snapshot of the key issues facing frontline services in London. He argues that the crisis in emergency care services, with vital A&Es and ambulances squeezed by the knock-on effects of other failures, is a clear indicator of an NHS in trouble, and shows how problems in one part of the system inevitably trigger cascading effects across London’s healthcare. He calls for an end to fictional divisions between physical and mental health, between hospital and community care, and between public health and acute care, and for health bodies to refocus on whole person care stretching across health, social and mental care services. 

Bevan Brittan Updates
Data retention and human rights: The Supreme Court speaks The Supreme Court has overturned the Court of Appeal decisions in the cases of R (Catt) v Association of Chief Police Officers of England, Wales and Northern Ireland and R (T) v Commissioner of Police of the Metropolis. The judgment has significant implications for public bodies' data retention policies and practices.