11/07/2018

Bevan Brittan provides high quality, comprehensive advice to the NHS and independent healthcare sector. This update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, both in the NHS and independent sector which have been published in the last month.  

If someone forwarded you this email you can sign up for your own free copy here delivered directly to your inbox.  

Training Events

Inquests

Acute and emergency care

Mental Health

Children

Primary Care

Clinical Risk/Patient Safety

Providers

Commissioning

Public Health

Employment/HR

Regulation

Finance

Social care

Independent Healthcare

General

Information sharing/data

 

 

If someone forwarded you this email you can sign up for your own free copy here delivered directly to your inbox.   

Bevan Brittan Free Training Events 

Key topics for Social Care Providers. We have specialist insight into the challenges and opportunities for the sector arising from political policy, funding and financing, innovation, new models of care, workforce issues and regulation. We have invited industry experts to join us in reviewing and debating current issues for social care providers. Please register your interest in attending by clicking on the following links: 

Annual Mental Health Seminar - SAVE THE DATE  

Please register your interest in attending by clicking on the following links: 

Court of Protections Seminars - SAVE THE DATE  

Please register your interest in attending by clicking on the following links: 

Clinical Risk Webinars
Bevan Brittan Clinical Risk/Medical Law Training -
These are internal hour long lunch time training sessions that are attended by our team of solicitors. You can sign up to watch the training sessions remotely via our webinar facility.  Just ask Claire Bentley.  

The  lunchtime training session coming up is:- 

In addition to our free training programme, we also provide bespoke knowledge transfer sessions on a range of healthcare law topics. If you wish to discuss any queries you may have around training or webinars please contact Claire Bentley.  

Back to top 

 

Acute and emergency care

Publications/guidance 

Inpatient survey. The results of the 2017 inpatient survey, involving every NHS acute trust in the country, reveal what over 70,000 adults who had stayed in hospital for at least one night during July last year said about the care they received.

Horizontal or vertical: which way to integrate? Approaches to community services integration and consequences for emergency hospital activity. The Transforming Community Services policy required primary care trusts to decide how they organised the community health services they delivered; vertically integrate with an acute trust, horizontally integrate with a mental health trust, or set up a stand-alone community trust or Community Interest Company? This report explores the impact this choice had on the level and growth in emergency hospital use in older people and considers the wider implications for the NHS as it develops new models of care and integrated care systems.

When tragedy strikes: reflections on the NHS response to the Manchester Arena bombing and Grenfell Tower fire To support NHS organisations with planning for major incidents, the NHS Confederation has conducted a series of interviews to capture the learning from the health service’s response to events of 2017. Interviews were held with Lord Bob Kerslake, Chair of The Kerslake Arena Review, Dr John Green, Clinical Director of the Grenfell Tower NHS Mental Health Response, and Professor Chris Moran, National Clinical Director for Trauma, at NHS England. The interviews reflect on key aspects of the responses by emergency, mental health, acute and community services, drawing out key issues for executive and non-executive health care leaders to consider.

System under strain: Why demand pressures are more than a winter phenomenon. This report from the NHS Confederation shows how increasing year-on-year demand, coupled with flat funding, is not just a winter phenomenon affecting accident and emergency departments. The report highlights how demand and funding pressures are placing strain on all parts of the health and care system throughout the year. The membership body is calling on NHS England and NHS Improvement to capitalise on the opportunities presented by their recently revealed plans for greater collaboration.

Clinical guidance: Onward referral. The Academy of Medical Royal Colleges has published guidelines on the best practice on onward referrals, with clear principles for how to avoid unnecessary doubling up of referrals and helping patients move more easily though the care system.

How CQC monitors, inspects and regulates urgent care services. This guidance has been updated. to include:
• Updates to the provider information request so that CQC can better understand the care and the service  provided.
• Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means CQC will not always consider all five key questions on each inspection.
• More information on follow-up inspections.

Reducing emergency admissions: Forty-Fourth Report of Session 2017-19. A Committee of Public Accounts report warns hospitals, GPs, community services and social care need to work together more effectively to reduce emergency admissions. It states NHS England needs to deliver on its five-year plan to move care into the community and out of hospitals. The report highlights the consequences of the Government's failure to properly fund and coordinate preventive health care and social care.

News

'Red bags' to be rolled out across England’s care homes getting patients home from hospital quicker. Reports on an initiative that helps care home residents who have been admitted to hospital be discharged more quickly. Red bags containing key paperwork, medication and personal items are handed to ambulance crews by carers and then travel with patients to hospital where they are handed to the doctor. The bags provide hospital staff with quick, up-to-date information and medication requirements for the patient. avoiding unnecessary phone calls.  

Bevan Brittan Updates 

Gross Negligence Manslaughter in Healthcare – killing our opportunity to learn lessons? This update looks at the case of Dr Bawa-Garba and the Williams review. 

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

Back to top 

 

Children 

Publications/Guidance 

Children’s public health 0 to 5 years: national reporting This guidance provides local authority analysts with the technical detail they need to submit aggregate data to the central system. 

News 

Improved mental health support for children in care. Announces £240,000 funding to support up to 10 pilots across the country to trial new high quality mental health assessments, which ensure young people are assessed at the right time, with a focus on their individual needs as they enter care. The Anna Freud Centre will work with Action for Children, Child Outcomes Research Consortium, Research in Practice and NSPCC to deliver up to 10 local pilots over two years. The pilot areas will also benefit from a share of £650,000 to deliver the scheme. The programme will look at which professionals should be involved in the assessment and develop best practice that ensures the child’s unique needs are at the centre of the process. In addition, consortium led by SQW, an economic development and social research organisation, has been awarded £150,000 to carry out an independent evaluation to look at the effectiveness and impact of the pilots.   

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

Back to top  

 

Clinical Risk/Patient Safety 

Publications/Guidance 

Learning from safety incidents. These 'Learning from safety incidents' resources from CQC briefly describes a critical issue - what happened, what CQC and the provider have done about it, and the steps you can take to avoid it happening in your service.

GMC signs up to joint approach to addressing concerns raised by doctors. The General Medical Council (GMC) has signed up to a joint statement with other organisations on a commitment to address issues around exception reporting, the process by which trainee doctors in England report concerns they have about impacts of working in under-resourced environments.

Williams review into gross negligence manslaughter in healthcare. The review makes recommendations to support a more just and learning culture in the healthcare system. It covers:
• the process for investigating gross negligence manslaughter
• reflective practice of healthcare professionals
• the regulation of healthcare professionals.
This rapid policy review into gross negligence manslaughter in healthcare was chaired by Professor Sir Norman Williams. The review was set up to look at the wider patient safety impact of concerns among healthcare professionals that simple errors could result in prosecution for gross negligence manslaughter, even if they happen in the context of broader organisation and system failings.

Clinical correspondence handling in the NHS. This report finds that the NHS has wasted nearly £2.5 million pounds reviewing the handling of misdirected clinical correspondence. It reports that NHS England is still assessing almost 2,000 cases to determine whether there has been harm to patients and has so far identified two incidents where expert consultant review has concluded that patient harm cannot be ruled out.

Gosport War Memorial Hospital: The Report of the Gosport Independent Panel. The Gosport Independent Panel's report concludes that up to 650 patients died from lethal doses of opiate painkillers given "without medical justification" over a 12 year period at the Gosport War Memorial Hospital in Hampshire. It found evidence in 456 cases, but taking into account missing records it states "at least another 200 patients were similarly affected". The Secretary of State for Health and Social Care made an oral statement to Parliament on the report on 20 June 2018. 

Cases 

Shalaby v London North West Healthcare NHS Trust [2018] EWCA Civ 1323. The Court of Appeal held  that a defendant is not automatically entitled to indemnity costs if a claimant fails to beat a Part 36 offer. 

Duce v Worcestershire Acute Hospitals NHS Trust Court of Appeal [2018] EWCA Civ 1307. An NHS trust had not breached its duty of care by failing to warn a patient of the risk of developing chronic post-surgical pain following a total abdominal hysterectomy and bilateral salpingo-oophorectomy. 

News 

Boards told they are failing on infection control. NHS trust boards have been told to do more on infection risks after an analysis by NHS Improvement found many were not receiving detailed information. Less than half of the 134 acute providers examined by NHSI had presented an annual infection prevention and control report to the board, despite this being a requirement under the Health and Social Care Act 2008. 

Webinars   

Bevan Brittan Clinical Risk/Medical Law Training - These are internal hour long lunch time training sessions that are attended by our team of solicitors. You can sign up to watch the training sessions remotely via our webinar facility.  Just ask Claire Bentley. 

Bevan Brittan Updates 

Gross Negligence Manslaughter in Healthcare – killing our opportunity to learn lessons? This update looks at the case of Dr Bawa-Garba and the Williams review. 

If you wish to discuss any clinical risk or patient safety issues please contact Joanna Lloyd, Catherine Radford or Penelope Radcliffe.  

Back to top  

Commissioning   

Publications/Guidance 

Risk and reward sharing for NHS Integrated Care Systems. Risk and reward sharing is a key feature of the policy agenda for Accountable Care Organisations in the US and Integrated Care Systems in England. It is a simple and attractive concept, offering a commissioner the opportunity to co-opt and incentivise a provider to moderate growth in healthcare demand by sharing in the savings or cost over-runs. Risk and reward sharing can be seen as an end in itself, or as step in the journey towards capitated budgets and the full transfer of financial risk to providers. This publication discusses how, if the NHS is to make best use of risk and reward sharing, then it must be aware of the complexities and hazards inherent in these arrangements as well as the potential benefits.  

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

Back to top  

Employment/HR  

Publications/guidance 

Start Well: Stay Well - a new model to support new starters This case study explores how the Cambridge University Hospitals NHS Foundation Trust designed the Start Well: Stay Well model to ensure new starters feel part of the team from the start of their employment journey, and that they continue to be engaged throughout their time with the trust.  

Mind the gap: women and leadership in the NHS. Is there a glass ceiling for women in health and care? If so, what should be done about it?

The gender pay gap: what now? In this new blog Deborah Ward explores some of the factors behind the gender pay gap in the health and care sector, and what can be done to address them. 

Double or quits: calculating how many more medical students we need. This policy brief outlines new calculations for the number of doctors needed, and sets out key issues facing workforce planning in the UK that affect the current supply, future service demand and predicted losses in the workforce. 

Cases

The Employment Appeal Tribunal has published its decision in the keenly awaited case of Flowers v East of England Ambulance Trust, and has decided that clause 13.9 of Agenda for Change means that there is a contractual entitlement to voluntary overtime pay being included in holiday pay, as long as there is a regular pattern of work. 

Bevan Brittan Insights 

Employment Eye June 2018  

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

Back to top 

Finance 

Publications/guidance 

Risk and reward sharing for NHS integrated care systems. This report outlines approaches to risk and reward sharing as they might apply to integrated care systems in the NHS. It is designed for those involved in establishing NHS integrated care systems, particularly NHS directors of finance, directors of strategy and their teams.  

How is the NHS performing? : June 2018 quarterly monitoring report. A survey of NHS trust finance directors and CCG finance leads carried out for the report asked them to identify their top three priorities for additional funding. According to those surveyed for the report, new funding must focus on services outside hospital including social care and community health services. 

Taking the value-based agenda forward: The five essential components of value-based approaches to health and care. This paper from the NHS Confederation explores how to spread the adoption of value-based healthcare across all parts of the system and ensure that we maximise the benefits for those who use NHS and wider services.

Better health and care for all: A 10-point plan for the 2020s. This final report of the Lord Darzi Review puts forward a 10-point plan to achieve a bold and long-term funding and reform plan that will secure the NHS and social care for the future. It also sets out a 10-point offer to the public on what the health and care system will be able to offer if this plan for investment and reform is adopted. 

Making the money work in the health and care system. The HFMA has worked in conjunction with PwC to explore how financial flows could be redesigned to find a better way to make money work in the health and care system. The research sets out why change is necessary and proposes a number of radical financial reforms so that benefits to patients are maximised and resources are put to their most effective use.    

Investigation into NHS spending on generic medicines in primary care This investigation focuses on primary care, where most spending on generic medicines is incurred, and it sets out the facts in relation to NHS spending on generic medicines, and the 2017-18 increase in spending on certain generic medicines. It also describes possible causes of the price increases in the market for generic medicines and how the Department of Health and Social Care and its arm’s-length bodies responded to the price increases. 

Upfront charging operational framework to support identification and charging of overseas visitors. This document supplements the existing guidance on implementing the overseas visitor charging regulations. It sets out a framework on the practical steps and key considerations necessary for providers to implement cost recovery and meet the legal requirement to charge upfront. It ensures that the most vulnerable always have access to care, whenever they need it, and that urgent treatment is never denied. 

If you wish to discuss any queries you may have around finance please contact Claire Bentley.   

Back to top 

Independent Healthcare  

Publications/Guidance  

How CQC monitors, inspects and regulates independent healthcare services. The guidance for providers will apply to all independent healthcare services with the exception of:
• Independent doctors and clinics providing acute and primary care, including online.
• Providers of community healthcare and/or mental healthcare (typically community interest companies (CICs)) that deliver multiple services to people in a specific geographical area, similar to an NHS trust.   

Memorandum of Understanding agreements with health insurers. These agreements represent a public commitment from the health insurers to share information with CQC about the quality and safety of independent healthcare services. They will use this information to improve how it monitors quality and safety in these services, as part of maintaining an effective regulatory system, to ensure people are provided with safe, effective, compassionate, high-quality care. 

Bevan Brittan Updates 

Gross Negligence Manslaughter in Healthcare – killing our opportunity to learn lessons? This update looks at the case of Dr Bawa-Garba and the Williams review. 

If you wish to discuss any queries you may have around independent healthcare please contact Vincent Buscemi or Debbie Rookes.    

Back to top

Information sharing/data  

Publications/Guidance  

Legal requirements to provide information about health service products: Consultation response. Summarises the responses to the DHSC's consultation on proposed legal requirements to provide information about health service products. It states that the majority of respondents disagreed with the proposal to end the three existing voluntary agreements for quarterly information provision and introduce regulations requiring all manufacturers, importers and wholesalers of unbranded generic medicines and special medicinal products to provide certain information every quarter about their sales and purchases. It also notes that respondents favoured quarterly provision of information because the burden would increase significantly with monthly provision.  

If you wish to discuss any queries you may have around information sharing please contact Jane Bennett.  

Back to top

Inquests 

Consultations 

Introduction of Medical Examiners and reforms to death certification in England and Wales: Government response to consultation. Sets out the Government’s analysis of responses received to, and addresses the issues raised in, its March 2018 consultation on proposed changes to the death certification process in England and Wales. It states that through a phased roll-out from April 2019, medical examiners will be introduced to the death certification process to confirm the cause of all deaths that do not need to be investigated by a coroner. The new system will also ensure that the bereaved will be involved in the process of death certification and offer them an opportunity to raise any concerns. There have been 7 pilot sites and the feedback so far has been positive. 

Cases

R (on the application of Gerard Joseph Parkinson) (Claimant) v HM Senior Coroner for Kent (Defendant) & (1) Dartford & Gravesham NHS Trust (2) Sameer Hijazi (Interested Parties) [2018] EWHC 1501 (Admin)  The coroner had not misapplied the law in holding that the enhanced investigative duty under the ECHR art.2 did not arise in relation to the death of an elderly lady at the accident and emergency department of a hospital. The coroner was entitled to find that there was no systemic failure on the part of the hospital authorities. This case provides a helpful summary of the relevant principles on Article 2. In particular, it restates the crucial distinction between cases of mere error or medical negligence and those where there is a systemic failure triggering Article 2. The coroner's conclusion that the cause of death was bronchopneumonia combined possibly with right lung pulmonary thrombi was not irrational, and his decision not to make a prevention of death report was reasonable. 

Events 

Clinical Risk Webinars - These are internal hour long lunch time training sessions that are attended by our team of solicitors. You can sign up to watch the training sessions remotely via our webinar facility.  Just ask Claire Bentley.  

Bevan Brittan Updates 

Gross Negligence Manslaughter in Healthcare – killing our opportunity to learn lessons? This update looks at the case of Dr Bawa-Garba and the Williams review. 

If you wish to discuss any issues raised in this section please contact Debbie Rookes or Will Pickles

Back to top

Mental Health 

Publications/Guidance 

When tragedy strikes: reflections on the NHS response to the Manchester Arena bombing and Grenfell Tower fire To support NHS organisations with planning for major incidents, the NHS Confederation has conducted a series of interviews to capture the learning from the health service’s response to events of 2017. Interviews were held with Lord Bob Kerslake, Chair of The Kerslake Arena Review, Dr John Green, Clinical Director of the Grenfell Tower NHS Mental Health Response, and Professor Chris Moran, National Clinical Director for Trauma, at NHS England. The interviews reflect on key aspects of the responses by emergency, mental health, acute and community services, drawing out key issues for executive and non-executive health care leaders to consider. 

The Right to Freedom and Safety: Reform of the Deprivation of Liberty Safeguards: Seventh Report of Session 2017-19. A Joint Committee on Human Rights report examines the Law Commission's proposals to reform the Deprivation of Liberty Safeguards scheme and states that the current system is broken and that urgent action is needed. The Committee recommends that legislation is brought forward to implement the Law Commission's Liberty Protection Safeguards which would authorise the specific arrangements that give rise to the deprivation of liberty, but in a lighter touch way than the current scheme. 

Principles for full investigation of serious incidents involving patients under the care of mental health and intellectual disability provider organisations Serious incidents can occur that put patients, carers, family members, friends, staff, members of the public, or the provider organisation at risk or cause them harm. Learning from serious incidents is essential, and a culture of openness should be present in every organisation. However, despite healthcare providers being under greater pressure to investigate and learn from serious incidents, there is a lack of evidence about how we can learn from such incidents. In addition, the threshold for what is classed as a serious incident varies between organisations, which can make comparing methods of investigation and learning challenging. Moreover, the quality of the investigations varies and there is also variation in the way that patients and families or carers are engaged in the process.

This could cost lives: a frontline view on the funding of supported housing This report is based on a survey of 117 staff members who work in supported housing services for people with mental illness. It reveals that 84 per cent of those surveyed believe that the government’s new funding proposals would mean their service would probably close.

Ask Listen Do: Top tips for families and carers. This booklet is designed to help families, parents and carers of those with a learning disability and autistic people to give feedback, raise concerns and make complaints across education, health and social care.

The Improving Access to Psychological Therapies Manual. This manual is for all commissioners, providers and clinicians of services that deliver psychological therapies. It serves as an essential manual for IAPT services, describing the IAPT model in detail and how to deliver it, with a focus on the importance of providing NICE-recommended care.

Mental Health Act 1983: patient information leaflets. DHSC has published information leaflets for patients who have been brought to hospital by a police officer under s.135 or s.136 of the Mental Health Act. The leaflets explain to the person: why they are in hospital; what to expect during this section; their rights; and what could happen afterwards.

Learning disability: applying All Our Health. PHE has published evidence and guidance to help healthcare professionals to improve the health and wellbeing of people with learning disabilities.

Mental health, human rights and standards of care. This report assesses the quality of institutional care for adults with psychosocial and intellectual disabilities in the WHO European region. Out of all the quality ratings made, only 25 per cent showed compliance with international standards, suggesting that long-term institutional care in the region has room for improvement. 

Consultations 

Post-traumatic stress disorder (update): Draft guidance consultation. NICE is seeking views on updated guidance that gives recommendations on preventing and managing post-traumatic stress disorder (PTSD). It advises that adults who are at risk of PTSD should be offered individualised cognitive-behavioural therapy within a month of experiencing a stressful event; children can be considered for group therapy after shared trauma to reduce the risk of developing PTSD. The consultation closes on 23 July 2018.   

News 

Improved mental health support for children in care. Announces £240,000 funding to support up to 10 pilots across the country to trial new high quality mental health assessments, which ensure young people are assessed at the right time, with a focus on their individual needs as they enter care. The Anna Freud Centre will work with Action for Children, Child Outcomes Research Consortium, Research in Practice and NSPCC to deliver up to 10 local pilots over two years. The pilot areas will also benefit from a share of £650,000 to deliver the scheme. The programme will look at which professionals should be involved in the assessment and develop best practice that ensures the child’s unique needs are at the centre of the process. In addition, consortium led by SQW, an economic development and social research organisation, has been awarded £150,000 to carry out an independent evaluation to look at the effectiveness and impact of the pilots.  

Bevan Brittan Events 

SAVE THE DATE – BEVAN BRITTAN'S ANNUAL MENTAL HEALTH SEMINARS AND ANNUAL COURT OF PROTECTION SEMINARS  

Back by popular demand, we are very pleased to announce that we will be running our free annual Mental Health seminars in October and annual Court of Protection Seminars in November. We have some dates to save in your diaries and will offer more detail about the content of the sessions nearer the event. 

Mental Health Seminar - SAVE THE DATE  

Please register your interest in attending by clicking on the following links: 

Court of Protections Seminars - SAVE THE DATE  

Please register your interest in attending by clicking on the following links: 

Bevan Brittan Mental Health Extranet 

Would you like to access the Bevan Brittan Mental Health Extranet? - It is a secure online resource containing a discussion forum, knowledge bank and information about training events. If you would like access please contact Claire Bentley.   

Bevan Brittan Updates 

Gross Negligence Manslaughter in Healthcare – killing our opportunity to learn lessons? This update looks at the case of Dr Bawa-Garba and the Williams review. 

If you wish to discuss any mental health issues please contact Hannah TaylorSimon Lindsay or Stuart Marchant.  

Back to top 

Primary Care  

Publications/Guidance  

Horizontal or vertical: which way to integrate? Approaches to community services integration and consequences for emergency hospital activity. The Transforming Community Services policy required primary care trusts to decide how they organised the community health services they delivered; vertically integrate with an acute trust, horizontally integrate with a mental health trust, or set up a stand-alone community trust or Community Interest Company? This report explores the impact this choice had on the level and growth in emergency hospital use in older people and considers the wider implications for the NHS as it develops new models of care and integrated care systems.   

Driving improvement: Case studies from 10 GP practices draws on interviews with a broad group of staff from ten practices – nine of which were originally rated as inadequate and, through dedicated effort, improved to an overall rating of good on their last inspection. The tenth practice improved from a rating of requires improvement to outstanding.

Investigation into NHS spending on generic medicines in primary care This investigation focuses on primary care, where most spending on generic medicines is incurred, and it sets out the facts in relation to NHS spending on generic medicines, and the 2017-18 increase in spending on certain generic medicines. It also describes possible causes of the price increases in the market for generic medicines and how the Department of Health and Social Care and its arm’s-length bodies responded to the price increases.

The state of care in urgent primary care services: findings from CQC’s programme of comprehensive inspections in England This report finds that urgent care centres, NHS 111 services and GP out-of-hours services play a vital role in England’s healthcare system. It highlights that effective urgent primary care benefits not only patients but the wider healthcare system, by easing pressure on other services. It finds that while the majority of care is rated good or outstanding, voluntary sector groups have raised concerns that there is a lack of public information about which services to contact and when, and that people require guidance to overcome an historic reliance on accident and emergency.

Dental contract reform: prototypes. DHSC has published information about the Dental Prototype Agreement Scheme, along with supporting documents. The 76 practices currently taking part in the scheme are testing new ways of providing NHS dental care with an increased emphasis on preventing future dental disease.

General Practice Forward View snapshot infographic. NHS England has published an infographic that illustrates some of the key areas of progress, two years into the implementation of the General Practice Forward View programme.

Local General Practitioners Retention Fund: Guidance for NHS England regional and local office teams. Sets out the availability of new funding in 2018/19 to further support delivery of the commitment set out in the General Practice Forward View (GPFV) to ensure an additional 5,000 extra doctors working in general practice by 2020. At least £7m of additional funding is being made available during 2018/19 to facilitate the establishment of local schemes and initiatives that enable local GPs to stay in the workforce, through promoting new ways of working and offering additional support.

How CQC monitors, inspects and regulates urgent care services. This guidance has been updated. to include:
• Updates to the provider information request so that CQC can better understand the care and the service provided.
• Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means CQC will not always consider all five key questions on each inspection.
• More information on follow-up inspections.

Innovative models of general practice. This King's Fund report looks at innovative models of general practice from the UK and other countries and identifies key design features it believes will be important in designing effective GP services in the future. The report sets out five attributes that underpin general practice: person-centred, holistic care; access; co-ordination; continuity and community focus. Models that focus on access at the expense of other attributes may not provide the most effective and comprehensive care for patients. Alongside the report, the King's Fund has published An alternative day in the life of a GP based on the experiences of GPs it met in researching Innovative models of general practice. It gives a typical day in the life of a GP contrasted with an alternative day in the life of a GP within an innovative model of general practice.   

If you wish to discuss any primary care issues please contact Vincent Buscemi.  

Back to top 

Providers  

Publications/guidance 

System under strain: why demand pressures are more than a winter phenomenon. This report shows that increases in demand for health care services are not restricted to particular parts of the service and specific times of the year. It describes ways in which increasing demand in one part of the system can affect the performance of other NHS services. It outlines how some NHS and social care providers have adapted their services to enable patients and service users to access care more efficiently.

Leadership of allied health professions in trusts: what exists and what matters. This NHS Improvement report shares the findings from a project it commissioned to evaluate current leadership arrangements for allied health professions (AHPs). It was developed to provide an evidence-based approach to reviewing and improving AHP leadership in provider organisations.

Upfront charging operational framework to support identification and charging of overseas visitors. This document supplements the existing guidance on implementing the overseas visitor charging regulations. It sets out a framework on the practical steps and key considerations necessary for providers to implement cost recovery and meet the legal requirement to charge upfront. It ensures that the most vulnerable always have access to care, whenever they need it, and that urgent treatment is never denied. 

News  

How to check the identity of a CQC inspector. CQC have been made aware that a small number of providers have been contacted by people posing as CQC inspectors or claiming to be affiliated to CQC. If you are unsure about the identity of an inspector, or any contact via phone or email from someone claiming to represent CQC, please contact CQC enquiries team on 03000 616161. 

Bevan Brittan Events 

Key topics for Social Care Providers. We have specialist insight into the challenges and opportunities for the sector arising from political policy, funding and financing, innovation, new models of care, workforce issues and regulation. We have invited industry experts to join us in reviewing and debating current issues for social care providers. Please register your interest in attending by clicking on the following links: 

If you wish to discuss any queries you may have around providers please contact Vincent Buscemi.    

Back to top  

Public Health 

Publications/Guidance  

Children’s public health 0 to 5 years: national reporting This guidance provides local authority analysts with the technical detail they need to submit aggregate data to the central system.

That age old question This report reveals that ageist views are held across the generations, and that an ageing society is viewed by many as a challenge rather than an opportunity. It makes a number of recommendations aimed at addressing some of the key drivers and negative consequences of societal ageism, including a suggestion that health care professionals should be trained on the effects of ageism in clinical and care settings.

The Prioritisation Framework: making the most of your budget. Public Health England has published a flexible tool to help local authorities make transparent, evidence-based spending decisions across public health programmes. The Prioritisation Framework is designed to help local authorities conduct a systematic prioritisation exercise, by greatly reducing the burden and complexity of the task.

The role of cities in improving population health: international insights. Drawing on international case studies, this King's Fund report explores the role of cities in improving population health and the conditions needed for success. It is based on 50 interviews with leaders from 14 cities and includes an extended case study on London that examines the lessons the city might learn from elsewhere. The research found that although there is wide variation between cities in terms of governance arrangements, powers and resources, there are also some common themes. One is that improving population health depends on co-ordinated action at multiple levels, which requires effective leadership, robust governance, and adequate investment in central programme management.

Tobacco control plan – Delivery plan 2017 to 2022. This DHSC delivery plan will monitor how the aims of the Tobacco Control Plan for England are being met, through inter-departmental collaboration and local partnerships, with a cross-government oversight body to provide governance. It sets out specific milestones and what is expected at national and local levels. It also sets out a number of areas where the Government is encouraging local areas to work collaboratively to address smoking.

Survey reveals women experience severe reproductive health issues A new Public Health England (PHE) survey reveals that 31% of women experience severe reproductive health problems, but under half seek help. 

News 

Dementia risk now included as part of NHS Health Check. Announces that Healthcare professionals in GP surgeries and the community will soon give advice on dementia risk to patients as part of the NHS Health Check.

New data reveals 420,000 cases of STIs diagnosed in 2017. Public Health England figures show there were 420,000 cases of sexually transmitted infections diagnosed in 2017, with cases of syphilis continuing to rise.   

If you wish to discuss any queries you may have around public health please contact Claire Bentley.  

Back to top 

Regulation  

Publications/Guidance 

The state of care in urgent primary care services: findings from CQC’s programme of comprehensive inspections in England This report finds that urgent care centres, NHS 111 services and GP out-of-hours services play a vital role in England’s healthcare system. It highlights that effective urgent primary care benefits not only patients but the wider healthcare system, by easing pressure on other services. It finds that while the majority of care is rated good or outstanding, voluntary sector groups have raised concerns that there is a lack of public information about which services to contact and when, and that people require guidance to overcome an historic reliance on accident and emergency. 

How CQC monitors, inspects and regulates urgent care services. This guidance has been updated. to include:
• Updates to the provider information request so that CQC can better understand the care and the service provided.
• Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means CQC will not always consider all five key questions on each inspection.
• More information on follow-up inspections. 

Consultations 

Rebalancing medicines legislation and pharmacy regulation: Two draft Section 60 Orders: seeks views on proposals for two draft Orders which would amend current pharmacy legislation on dispensing errors and clarify how registered pharmacies are governed: the Pharmacy (Preparation and Dispensing Errors – Hospitals and Other Pharmacy Services) Order 2018 and the Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc) Order 2018. The first draft Order seeks to extend defences that already exist for pharmacy professionals working at or from registered pharmacies in the case of accidental preparation and dispensing errors. It would cover pharmacy professionals working in hospitals and other relevant pharmacy services. The second draft Order seeks to clarify and strengthen the arrangements of registered pharmacies concerning how they are governed. Specifically, it makes the roles of responsible pharmacists and superintendent pharmacists clear in primary legislation. The consultation closes on 11 September 2018.    

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

Back to top 

Social Care  

Publications/Guidance  

Long-term funding of adult social care. This joint report from the Commons Health & Social Care and Housing, Communities & Local Government Committees calls for a sustainable funding solution for adult social care. It describes the social care system as "under very great and unsustainable strain". Ahead of the Government’s Green Paper, now expected in the Autumn, it highlights the urgent need to plug a funding gap estimated at up to £2.5bn in the next financial year, before introducing wider funding reforms at both a local and national level to raise extra revenue with a long-term aspiration of providing social care free at the point of delivery. It recommends that a ‘Social Care Premium’ be introduced, either as an additional element of National Insurance or with the premium paid into a dedicated not-for-profit social insurance fund that people would be confident could only be used for social care. It also recommends extending free personal care to people deemed to have 'critical' needs. Extra funds will also need to be raised to extend the care to those with moderate needs as well as those with substantial and critical needs and to provide sufficient resources to ensure the stability of the workforce and financial viability of care providers. It calls for reform of council tax valuations and bands and for local authorities to be able to use new funding from additional business rates retention in 2020 to fund social care rather than as a replacement of grants from the Government.

Ideas for the NHS long-term plan from the Centre for Ageing Better. This paper sets out the case for why NHS England should make some bold commitments to healthy ageing in its long-term plan and suggests some ideas for actions it could take and some areas for action with others.

A healthier Wales: our plan for health and social care. Sets out the Welsh Government’s long-term plan for the future of health and social care in Wales. The aim is to see a shift from healthcare which focuses on treating people when they become unwell, to one that provides services which support people to stay well, lead healthier lifestyles and live independently for as long as possible. There will also be more focus on seamless services, which are designed to fit around the individual. Information will be shared between services and providers, allowing a smoother patient experience; this will also allow those with the greatest need to be treated first and make the most effective use of resources. There is a £100m Transformation Fund to support the implementation of the plan, with funding for resources to speed up the process, including the development of new integrated prevention services and activities in the community.

Digital change in health and social care The use of digital technology in health and social care can improve quality, efficiency and patient experience as well as supporting more integrated care and improving the health of a population.

What the NHS needs to see from the Social Care Green Paper. This briefing lays out ten key issues that the NHS Confederation and its members ask the Government to consider in the Social Care Green Paper and when reshaping the care system.

ADASS Budget Survey 2018. The annual ADASS Budget Survey is the authoritative analysis of the state of adult social care finances in England. The results of this survey explore directors of adult social services’ views of how councils are making incredibly difficult decisions in relation to the growing numbers of people requiring care and support with increasingly complex needs and with higher costs, where funding simply isn’t keeping pace. The data sets out the concerns of councils in making increasingly difficult choices and their attempts to minimise the impact on people made vulnerable by their circumstances, with care and support needs, and their carers. It highlights how social care funding directly affects the lives and life chances of people needing care and support and their families, the workforce, care providers and the NHS.

IPC and Personal Health Budget Support and Development Programme: Learning and next steps. This report from charity National Voices describes the role that the voluntary, community and social enterprise sector has to play in delivering personalised care, and shows what needs to happen at a local level to realise this potential. It sets out how personal health budgets are enabling people to make new choices and share responsibility for their own health and wellbeing, while helping them to be active citizens.

Behind the headlines: the battle to get care at home. This report from Age UK reveals that 3m hours of home care services have been lost since 2015 due to Central Government cuts. It includes real-life stories illustrating the appalling human consequences of councils struggling to meet the growing need for home care.

Breaking down barriers to better health and care. Guidance from NHS England on how NHS organisations and local councils in England are moving from fragmented services to local partnerships and integrated care systems in order to meet the health needs of the population.

UK care home providers for the elderly – Consumer law advice on the charging of fees after death. Advice for care home providers on their responsibilities under consumer law following the death of a resident. It sets out the CMA’s views on the application of Part 2 of the Consumer Rights Act 2015 in relation to unfair contract terms and the Consumer Protection from Unfair Trading Regulations 2008 in relation to unfair business practices.

Review of Adult Social Care Relative Needs Formulae. The research proposes a new formula to be used within the local government finance settlement. It will be considered as part of the Government’s review of local authorities’ relative needs and resources, which is led by the Ministry of Housing, Communities and Local Government.  

News 

'Red bags' to be rolled out across England’s care homes getting patients home from hospital quicker. Reports on an initiative that helps care home residents who have been admitted to hospital be discharged more quickly. Red bags containing key paperwork, medication and personal items are handed to ambulance crews by carers and then travel with patients to hospital where they are handed to the doctor. The bags provide hospital staff with quick, up-to-date information and medication requirements for the patient. avoiding unnecessary phone calls. 

NHS launches plan to improve patient care by cutting long hospital stays. Simon Stevens and Ian Dalton, the Chief Executives of NHS England and NHS Improvement, have set out plans which will help to free up thousands of hospital beds and ease pressures next winter. The NHS, working with local authorities, aims to reduce the number of long staying patients by around a quarter. Trusts will be supported by extended GP access and a focus on avoiding unnecessary hospital admissions including more support for care home staff to prevent residents being admitted. There will also be regional emergency care intensive support teams charged with helping to deliver the 25% ambition. 

Bevan Brittan Events 

Key topics for Social Care Providers. We have specialist insight into the challenges and opportunities for the sector arising from political policy, funding and financing, innovation, new models of care, workforce issues and regulation. We have invited industry experts to join us in reviewing and debating current issues for social care providers. Please register your interest in attending by clicking on the following links: 

If you wish to discuss any queries you may have around social care please contact Stuart Marchant

Back to top

General  

Publications/Guidance  

Integrated care: organisations, partnerships and systems. The Commons Health and Social Care Committee say that the Government and the NHS must improve how they communicate NHS reforms to the public. It finds that there are many examples of NHS and care services coming together to deliver better care and this kind of integration has been happening at local level for some time. However, further integration of services, and the organisations planning and delivering them, is too often hampered by current legislation. Rather than threatening the integrity of the NHS, reforms to better join-up the organisation of services, including health and social care, present an opportunity to row back the NHS-internal market. However, government and national bodies have yet to explain the case for change clearly and persuasively. There has also been a failure to consistently engage with local leaders in the design of service changes. Overuse of jargon and poor communication confuses both health professionals and the public alike, and changing acronyms, titles and terminology have allowed misunderstanding to fester and suspicion of the underlying purpose of reform.

Government response to the House of Lords EU Committee, 13th report of session 2017 to 2019 – Brexit: reciprocal healthcare. This report welcome the House of Lords European Union Committee’s report (March 2018) which recognised the importance of reciprocal healthcare to UK (and EU) residents and state pensioners when they visit or retire to, the EU (or UK). The report notes and welcomes the progress in negotiations for the Withdrawal Agreement and Implementation Period and identifies outstanding issues for negotiations on the future relationship. It states that the Government has pushed strongly for the inclusion of onward movement rights for anyone within scope of the Withdrawal Agreement during the first phase of negotiations, but the EU was not ready to include them at that stage. It also pushed for wider EHIC rights for all. It continues to seek an agreement with the EU that protects the reciprocal healthcare entitlements of state pensioners including those not covered by the terms of the Withdrawal Agreement, and also to fully protect rights under the EHIC and S2 schemes.  

Legal requirements to provide information about health service products: Consultation response. Summarises the responses to the DHSC's consultation on proposed legal requirements to provide information about health service products. It states that the majority of respondents disagreed with the proposal to end the three existing voluntary agreements for quarterly information provision and introduce regulations requiring all manufacturers, importers and wholesalers of unbranded generic medicines and special medicinal products to provide certain information every quarter about their sales and purchases. It also notes that respondents favoured quarterly provision of information because the burden would increase significantly with monthly provision.

Our international health service This report looks at the possible implications of Brexit on the NHS workforce. It finds that more than a quarter of NHS doctors – including almost half in some vital specialities – and almost one in six nurses, are from overseas. It finds signs that the NHS is finding it increasingly difficult to attract the clinical staff it needs from the EU, which could add significant new pressures to the NHS in the future. 

Prison healthcare inquiry. The inquiry will explore the effectiveness of prisons and prison healthcare services in meeting the physical and mental health, and social care, needs of prisoners. The oral evidence has now been published. 

If you wish to discuss any issues raised in this section please contact Claire Bentley.  

Back to top