In this seminar experts in different fields of law give a practical update on recent developments tailored specifically to in-house lawyers or general counsel working within the independent health and social care sector. The seminar covered:
- TUPE - does TUPE apply in short term/caretaker arrangements?
- inquests
- new care models update – MCP, PACS and EHCH frameworks and joint commissioning issues.
Chris Ham: capitated budgets - a flexible way to enable new models of careThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, looks at how high performing integrated systems are using capitated budgets and shares examples of eight PCTs who are commissioning integrated care in an innovative way.
Can strategic purchasing of health services from the private sector drive val...Rebekah McKay-Smith
Can strategic purchasing of health services from the private sector drive value for money? Evidence from the Results Based Financing programme in Malawi
David Buck on improving the allocation of health resources in England The King's Fund
David Buck, Senior Fellow in Public Health and Inequalities at The King’s Fund, explains how health resources are allocated in the English NHS, and how improvements to the process could be made to support a more coherent health and care system.
This document summarizes key points of a new 5-year GP contract framework agreement in the UK. It covers addressing workforce shortages through recruitment and retention programs, solving indemnity costs by establishing a new clinical negligence scheme, improving quality measures, establishing primary care networks to integrate services, investing in digital technologies, and guaranteeing funding stability over 5 years. The agreement aims to improve health outcomes, care quality for patients with multiple conditions, and long-term sustainability of the NHS.
Population Level Commissioning for the Future
Wednesday 3 December 2014, 1pm – 1.45pm
Dr Abraham George
Assistant Director/Consultant in Public Health
Kent County Council
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
The document discusses the development of Primary Care Networks (PCNs) in accordance with the NHS Long Term Plan. Key points include:
- The Plan mandates a redesign of primary care services around PCNs to be established nationwide by July 2019.
- Systems like STPs must submit PCN strategies to NHSE for approval by Autumn 2019 outlining how general practice and community services will be supported and integrated through PCNs.
- Guidance provides expectations for PCNs over the next 5 years regarding service delivery, populations health management, workforce development and digital transformation. Systems must ensure adequate support for PCNs to achieve targets.
LTC year of care commissioning early implementer sites workshop held on 1 December 2014. Featuring Dr Martin McShane, Rob Meaker and Renata Drinkwater.
This document discusses leveraging managed long-term services and supports (MLTSS) to accomplish system objectives. It provides examples from Kansas, Tennessee, and Texas of how MLTSS programs in these states aim to increase access to home and community-based services (HCBS), improve care coordination and quality, and balance long-term care spending between institutional and HCBS. Key levers discussed include capitated rate-setting, performance measures, quality incentives, and flexibility for managed care organizations. Challenges and opportunities for further strengthening MLTSS are also presented.
Chris Ham: capitated budgets - a flexible way to enable new models of careThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, looks at how high performing integrated systems are using capitated budgets and shares examples of eight PCTs who are commissioning integrated care in an innovative way.
Can strategic purchasing of health services from the private sector drive val...Rebekah McKay-Smith
Can strategic purchasing of health services from the private sector drive value for money? Evidence from the Results Based Financing programme in Malawi
David Buck on improving the allocation of health resources in England The King's Fund
David Buck, Senior Fellow in Public Health and Inequalities at The King’s Fund, explains how health resources are allocated in the English NHS, and how improvements to the process could be made to support a more coherent health and care system.
This document summarizes key points of a new 5-year GP contract framework agreement in the UK. It covers addressing workforce shortages through recruitment and retention programs, solving indemnity costs by establishing a new clinical negligence scheme, improving quality measures, establishing primary care networks to integrate services, investing in digital technologies, and guaranteeing funding stability over 5 years. The agreement aims to improve health outcomes, care quality for patients with multiple conditions, and long-term sustainability of the NHS.
Population Level Commissioning for the Future
Wednesday 3 December 2014, 1pm – 1.45pm
Dr Abraham George
Assistant Director/Consultant in Public Health
Kent County Council
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
The document discusses the development of Primary Care Networks (PCNs) in accordance with the NHS Long Term Plan. Key points include:
- The Plan mandates a redesign of primary care services around PCNs to be established nationwide by July 2019.
- Systems like STPs must submit PCN strategies to NHSE for approval by Autumn 2019 outlining how general practice and community services will be supported and integrated through PCNs.
- Guidance provides expectations for PCNs over the next 5 years regarding service delivery, populations health management, workforce development and digital transformation. Systems must ensure adequate support for PCNs to achieve targets.
LTC year of care commissioning early implementer sites workshop held on 1 December 2014. Featuring Dr Martin McShane, Rob Meaker and Renata Drinkwater.
This document discusses leveraging managed long-term services and supports (MLTSS) to accomplish system objectives. It provides examples from Kansas, Tennessee, and Texas of how MLTSS programs in these states aim to increase access to home and community-based services (HCBS), improve care coordination and quality, and balance long-term care spending between institutional and HCBS. Key levers discussed include capitated rate-setting, performance measures, quality incentives, and flexibility for managed care organizations. Challenges and opportunities for further strengthening MLTSS are also presented.
A Global Perspective of Intensification in relation to food security and clim...Sri Lmb
Prof. Norman Uphoff
Professor of Government and International Agriculture
Cornell University, Ithaca, NY 14853
* Director, Cornell Institute for Public Affairs (CIPA), and
* Senior Advisor, SRI International Network and Resources Center (SRI-Rice), Cornell International Institute for Food, Agriculture and Development (CIIFAD)
Powerstruct is an electrical contracting company with over 16 years of experience in Australia. It pledges to maintain high ethical standards, appropriate behavior, and accountability. It prides itself on quality work, safety, teamwork, prosperity, integrity, and protecting the environment. Powerstruct aims to be the top choice for electrical projects through its experienced staff and a focus on its core values.
http://www.scenic.com/ | Think you know everything about the Grand Canyon? You might be surprised. Here are some of the most fascinating facts you may not have known about this iconic travel destination.
Soliciting contributions from large crowds has been proven to deliver better results than from experts alone, and has also saved time and money for businesses. Learn why crowdsourcing is so valuable to businesses, the various types of crowdsourcing, who is doing it right and what these businesses have in common. Full webinar at:
How to leverage social media data for crowdsourcing business insights
SMK Profita Bandung didirikan pada tahun 1975 oleh guru-guru SMEA II Bandung Filial Pajagalan untuk menampung jumlah siswa SMP dan SLTP yang sangat besar pada tahun 1974. Sekolah ini berdiri di bawah yayasan Pendidikan Ekonomi Bandung dan berlokasi di Jalan Pajagalan No. 67 Bandung.
So You Think You Can Tweet....in Multiple Languagescenter4edupunx
Global Education Conference Session 2015
The ISTE Games & Simulations Network, ISTE Mobile Learning Network and ISTE Global Collaboration Network are collaborating on a scheduled multilingual tweetchat that anyone can join. Come learn what we learned from putting on a 30 minute synchronous and 24 hour slow tweetchat that went out in 3 languages but grew to 8 languages. We will also discuss the threefold purpose of the #globalgamechat. Its purpose is to 1) have educators sharing information in the language of their choice 2) broaden the discussion of games for change, social action and global understanding 3) give educators and their students an opportunity to participate in a multilingual event.
Link to GlobalEdCon Session Proposal (full URL with http://): http://www.globaleducationconference.com/forum/topics/so-you-think-you-can-tweet-in-multiple-languages
Other Websites / URLs Associated with Your Session: ISTE Games and Simulations Network ISTE Global Collaboration Network ISTE Mobile Learning Network Global tweetchat https://globaltweetchat.wordpress.com/ Games for Change as a Resource (ISTE Metagame Book Club) https://sites.google.com/site/metagamebookclub/games-for-change-recap
Of giant ferns and tiny prayer temples - Marianne EsdersMarianne Esders
The document provides notes from the author's learning walk through Dzongu, Sikkim from January 28th to February 4th, 2015. Some key details include:
- The author thanks their guides who made the journey possible and shares that the goal was a "Shodh Yatra", meaning a journey for knowledge, creativity, and innovation.
- During their walk, the author encounters giant ferns and tiny prayer temples, experiences the local culture and cuisine, and gains a deeper appreciation for the natural environment and harmonious way of life of the Lepcha people who live there.
- The author is struck by the vast biodiversity of the region and the deep knowledge that even young children possess
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
Deel communicatiebudget FOD Justitie ging naar hotelThierry Debels
Via een parlementaire vraag krijgen we inzicht in de uitgaven voor communicatie van de FOF Justitie .
De meeste facturen slaan uiteraard op drukkerijen.
Maar voor het jaar 2015 valt ook een substantiële betaling aan Hostelaria Unida op. Het gaat om een bedrag van 21.631,25 euro.
Volgens het Staatsblad en juridische databases gaat het om een hotel.
De vraag is dan uiteraard waarom een grote uitgave voor een hotel in het communicatiebudget van de FOD Justitie terechtkomt.
The document discusses the development and testing of a Child Well Being Assessment tool in South Africa. It was adapted from the Core Status Index to assess children's well-being across 8 domains on a quarterly basis. The tool aims to provide a standardized way to monitor children, identify their needs, and ensure resources are appropriately allocated. Over 100 youth facilitators and CCF members have been trained on the tool. Testing is underway and focus groups will provide feedback before it is rolled out more widely. The tool is intended to guide interventions and evaluate the impact of services in moving children from vulnerability to greater well-being.
This document outlines 6 habits to help you make a difference at work: 1) Be the first to arrive each day and get things done to set a good example, 2) Be known for something specific like turning around struggling employees, 3) Create your own side projects to stand out, 4) Back up your opinions with effort by helping fix problems, 5) Show some personal interests to help others identify you, 6) Work harder than others as nothing substitutes hard work and it's an easy way to stand out.
A hitchhiker’s guide to neuroevolution in ErlangThoughtworks
The document discusses artificial neural networks and how they can be trained using a perceptron learning algorithm. It provides an example of training a perceptron to perform the logical AND operation. Over multiple epochs, the perceptron's weights are adjusted based on its errors to correctly output a 1 only when both the x1 and x2 inputs are 1.
Lanita Lasenberry is a radiologic technologist seeking new opportunities. She has over 5 years of experience in radiography and has worked in various clinical settings. She holds an Associate's degree in Radiography as well as a Bachelor's degree in Psychology/Criminal Justice. Her objective is to leverage her skills and experience to optimize the patient experience.
This document discusses different aspects of archives including definitions, publishing, modes of archiving information, and the relationship between archives and personal and social identity. It explores how the structure of publishing can change our experiences and consequences of archiving. Specifically, it examines how digital archives are more efficient but require external tools for retrieval and how archives can shape narratives and fill gaps in historical records.
Lisa Solis has over 15 years of experience in accounts receivable, banking, and photography. She has a background in accounts receivable, billing, and customer service from her time at Forum Energy Technologies. She also has experience as a teller and in customer service and operations from her roles at Chocolate Bayou Credit Union, Communicators Federal Credit Union, and as a photographer at Sears Portrait Studio. She is proficient in Microsoft Office programs and other accounting software.
Modern Relationships Between Physicians, Hospitals, and Long-Term Care Provid...PYA, P.C.
PYA Consulting Manager Aaron Elias co-presented “Modern Relationships Between Physicians, Hospitals, and Long-Term Care Providers in a Time of Risk-Based Contracting,” along with Jeanna Palmer Gunville, a shareholder at Polsinelli.
CMS Emergency Preparedness Rule -- Cyber Annex for EOPDavid Sweigert
The CMS Emergency Preparedness Rule establishes consistent emergency preparedness requirements for 17 Medicare and Medicaid providers. It aims to address gaps, establish consistency, and encourage coordination across healthcare entities. The rule requires these providers to develop an emergency plan, policies/procedures, training/testing program, and communication plan based on a risk assessment. It establishes minimum standards while requirements vary by provider type. The rule is effective November 15, 2016 and must be implemented by November 15, 2017.
A Global Perspective of Intensification in relation to food security and clim...Sri Lmb
Prof. Norman Uphoff
Professor of Government and International Agriculture
Cornell University, Ithaca, NY 14853
* Director, Cornell Institute for Public Affairs (CIPA), and
* Senior Advisor, SRI International Network and Resources Center (SRI-Rice), Cornell International Institute for Food, Agriculture and Development (CIIFAD)
Powerstruct is an electrical contracting company with over 16 years of experience in Australia. It pledges to maintain high ethical standards, appropriate behavior, and accountability. It prides itself on quality work, safety, teamwork, prosperity, integrity, and protecting the environment. Powerstruct aims to be the top choice for electrical projects through its experienced staff and a focus on its core values.
http://www.scenic.com/ | Think you know everything about the Grand Canyon? You might be surprised. Here are some of the most fascinating facts you may not have known about this iconic travel destination.
Soliciting contributions from large crowds has been proven to deliver better results than from experts alone, and has also saved time and money for businesses. Learn why crowdsourcing is so valuable to businesses, the various types of crowdsourcing, who is doing it right and what these businesses have in common. Full webinar at:
How to leverage social media data for crowdsourcing business insights
SMK Profita Bandung didirikan pada tahun 1975 oleh guru-guru SMEA II Bandung Filial Pajagalan untuk menampung jumlah siswa SMP dan SLTP yang sangat besar pada tahun 1974. Sekolah ini berdiri di bawah yayasan Pendidikan Ekonomi Bandung dan berlokasi di Jalan Pajagalan No. 67 Bandung.
So You Think You Can Tweet....in Multiple Languagescenter4edupunx
Global Education Conference Session 2015
The ISTE Games & Simulations Network, ISTE Mobile Learning Network and ISTE Global Collaboration Network are collaborating on a scheduled multilingual tweetchat that anyone can join. Come learn what we learned from putting on a 30 minute synchronous and 24 hour slow tweetchat that went out in 3 languages but grew to 8 languages. We will also discuss the threefold purpose of the #globalgamechat. Its purpose is to 1) have educators sharing information in the language of their choice 2) broaden the discussion of games for change, social action and global understanding 3) give educators and their students an opportunity to participate in a multilingual event.
Link to GlobalEdCon Session Proposal (full URL with http://): http://www.globaleducationconference.com/forum/topics/so-you-think-you-can-tweet-in-multiple-languages
Other Websites / URLs Associated with Your Session: ISTE Games and Simulations Network ISTE Global Collaboration Network ISTE Mobile Learning Network Global tweetchat https://globaltweetchat.wordpress.com/ Games for Change as a Resource (ISTE Metagame Book Club) https://sites.google.com/site/metagamebookclub/games-for-change-recap
Of giant ferns and tiny prayer temples - Marianne EsdersMarianne Esders
The document provides notes from the author's learning walk through Dzongu, Sikkim from January 28th to February 4th, 2015. Some key details include:
- The author thanks their guides who made the journey possible and shares that the goal was a "Shodh Yatra", meaning a journey for knowledge, creativity, and innovation.
- During their walk, the author encounters giant ferns and tiny prayer temples, experiences the local culture and cuisine, and gains a deeper appreciation for the natural environment and harmonious way of life of the Lepcha people who live there.
- The author is struck by the vast biodiversity of the region and the deep knowledge that even young children possess
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
Deel communicatiebudget FOD Justitie ging naar hotelThierry Debels
Via een parlementaire vraag krijgen we inzicht in de uitgaven voor communicatie van de FOF Justitie .
De meeste facturen slaan uiteraard op drukkerijen.
Maar voor het jaar 2015 valt ook een substantiële betaling aan Hostelaria Unida op. Het gaat om een bedrag van 21.631,25 euro.
Volgens het Staatsblad en juridische databases gaat het om een hotel.
De vraag is dan uiteraard waarom een grote uitgave voor een hotel in het communicatiebudget van de FOD Justitie terechtkomt.
The document discusses the development and testing of a Child Well Being Assessment tool in South Africa. It was adapted from the Core Status Index to assess children's well-being across 8 domains on a quarterly basis. The tool aims to provide a standardized way to monitor children, identify their needs, and ensure resources are appropriately allocated. Over 100 youth facilitators and CCF members have been trained on the tool. Testing is underway and focus groups will provide feedback before it is rolled out more widely. The tool is intended to guide interventions and evaluate the impact of services in moving children from vulnerability to greater well-being.
This document outlines 6 habits to help you make a difference at work: 1) Be the first to arrive each day and get things done to set a good example, 2) Be known for something specific like turning around struggling employees, 3) Create your own side projects to stand out, 4) Back up your opinions with effort by helping fix problems, 5) Show some personal interests to help others identify you, 6) Work harder than others as nothing substitutes hard work and it's an easy way to stand out.
A hitchhiker’s guide to neuroevolution in ErlangThoughtworks
The document discusses artificial neural networks and how they can be trained using a perceptron learning algorithm. It provides an example of training a perceptron to perform the logical AND operation. Over multiple epochs, the perceptron's weights are adjusted based on its errors to correctly output a 1 only when both the x1 and x2 inputs are 1.
Lanita Lasenberry is a radiologic technologist seeking new opportunities. She has over 5 years of experience in radiography and has worked in various clinical settings. She holds an Associate's degree in Radiography as well as a Bachelor's degree in Psychology/Criminal Justice. Her objective is to leverage her skills and experience to optimize the patient experience.
This document discusses different aspects of archives including definitions, publishing, modes of archiving information, and the relationship between archives and personal and social identity. It explores how the structure of publishing can change our experiences and consequences of archiving. Specifically, it examines how digital archives are more efficient but require external tools for retrieval and how archives can shape narratives and fill gaps in historical records.
Lisa Solis has over 15 years of experience in accounts receivable, banking, and photography. She has a background in accounts receivable, billing, and customer service from her time at Forum Energy Technologies. She also has experience as a teller and in customer service and operations from her roles at Chocolate Bayou Credit Union, Communicators Federal Credit Union, and as a photographer at Sears Portrait Studio. She is proficient in Microsoft Office programs and other accounting software.
Modern Relationships Between Physicians, Hospitals, and Long-Term Care Provid...PYA, P.C.
PYA Consulting Manager Aaron Elias co-presented “Modern Relationships Between Physicians, Hospitals, and Long-Term Care Providers in a Time of Risk-Based Contracting,” along with Jeanna Palmer Gunville, a shareholder at Polsinelli.
CMS Emergency Preparedness Rule -- Cyber Annex for EOPDavid Sweigert
The CMS Emergency Preparedness Rule establishes consistent emergency preparedness requirements for 17 Medicare and Medicaid providers. It aims to address gaps, establish consistency, and encourage coordination across healthcare entities. The rule requires these providers to develop an emergency plan, policies/procedures, training/testing program, and communication plan based on a risk assessment. It establishes minimum standards while requirements vary by provider type. The rule is effective November 15, 2016 and must be implemented by November 15, 2017.
The 5 Year Forward View document outlines several new models of care to transform healthcare services in England:
1. Multispecialty Community Providers that would serve as the focal point for a wide range of care in the community, potentially employing consultants and taking over community hospitals.
2. Primary and Acute Care Systems that integrate primary care, hospital, mental health, and community services under one organization with a delegated capitated budget.
3. Urgent and Emergency Care Networks that integrate A&E, GP out-of-hours care, urgent care centers, NHS 111, and ambulance services.
Transforming Primary Care through the development of Primary Care Networks – ...NHS England
The document discusses transforming primary care in the UK through the establishment of primary care networks (PCNs). It notes that the changing health needs of the population are putting pressure on the health system, with an aging population and rise in chronic conditions. While services are fragmented, the NHS Long Term Plan aims to develop integrated care systems with PCNs as the foundation. PCNs will comprise groupings of clinicians serving populations of 30,000 to 50,000 people, in order to provide proactive, accessible, and coordinated primary and community care at scale. The plan provides funding for PCNs to expand multidisciplinary teams.
The impact of New Models of Care on a Health Economy’s Digital StrategyHIMSS UK
This document discusses the key digital implications of new models of care on a health economy's digital strategy. It presents a case study of the Croydon Accountable Provider Alliance (APA) in the UK. The three key digital implications discussed are:
1) Organizational form and governance - The new model of care requires a shared governance structure and independent project management to achieve digital ambitions.
2) Interoperability - The model requires a fully interoperable electronic health record that can be shared across providers and with patients. Options for integration platforms are considered.
3) Analytics - A culture of data-driven decision making is needed. Joint business intelligence services and a focus on population health analytics can improve
1. Community Care Teams and the Patient-Centered Medical Home (PCMH) model can be enhanced by including mental health and substance use services and care coordination to create a Person-Centered Healthcare Home (PCHH).
2. Community Care of North Carolina uses Community Care Networks (CCNs) that are public-private partnerships providing coordinated care through medical homes. Preliminary results show improved care for patients with chronic conditions and cost savings.
3. CCNs employ care managers who work with medical homes to coordinate care for high-risk patients through activities like patient education and addressing barriers to care.
Greater Manchester's visionary approach to integrated care
Delivered by the Greater Manchester Health and Social Care Partnership
Day Two, Pop-up University 8, 16.00
This document introduces a new framework for community mental health services in England. It aims to address fragmentation and barriers in current services by developing integrated, place-based models of care centered around the needs of individuals. The framework seeks to improve access to appropriate care, support people in their communities, and reduce inequalities. It outlines a new structure for community mental health teams and functions to deliver more coordinated, personalised services closer to home. The framework will guide local collaboration between health, social care and community partners to implement new models of care.
Andrew Taylor: Competition in the NHS: progress and prospectsNuffield Trust
This document summarizes Andrew Taylor's presentation on competition in the NHS. It discusses progress on patient choice in acute elective care and primary care, as well as competitive tendering. It also examines issues around NHS mergers, identifying possible benefits, and the impact of vertical integration on patient choice and competition. Finally, it discusses the potential for a third party access regime in the NHS to promote further competition.
UCLP is considering its role and focus as Academic Health Science Networks (AHSNs) are launched across England. It has made progress in recent projects but seeks members' views on its future direction. Options discussed include:
1) Maintaining its current geography and partners or expanding further north to include Anglia Ruskin Health Partnership and Hertfordshire
2) Balancing the benefits of increased scale with additional logistical challenges of more partners
3) Continuing to focus on research, education, project delivery, and improving healthcare across both AHSC and AHSN functions
Members' input will help shape UCLP's evolving role in an "AHSN world".
This week the UK Department of health issued guidance to CCGs and other healthcare commissioners requiring them to produce local strategies for the primary and community care estate by December 2015. We take a critical look at the guidance, flag up pitfalls and other issues to be considered, offer professional advice on how to fulfil the requirement and suggest ways of delivering and exceeding expectation.
BILD Event – 21 March 2018 : Transforming care - Sharing solutions that make ...NHS England
Cost pressures, funding flows, issues and solutions
Alan Lotinga from Care and Safeguarding Limited explores the financial principles and funding flows behind the Transforming Care Programme and gives tips on good practice.
Chris Ham on making integrated care happen at scale and paceThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, highlights the 16 lessons needed to make a reality of integrated care, drawing on work by the Fund and others to provide examples of good practice.
The document discusses opportunities around accountable care organizations (ACOs) and bundled payments under healthcare reform legislation. It outlines proposed ACO pilots that would test payment models to reduce costs and improve outcomes. It also discusses proposals for bundled payment pilots for post-acute care services beginning in 2011. Key questions are raised around which providers can participate in ACOs, what organizational structures and partnerships may look like, and how providers can position themselves for these new models.
How will Sustainability and Transformation Plans (STPs) help deliver the Five Year Forward View?
Matthew Swindells and Simon Enright, NHS England, and Julia Ross, North West Surrey CCG
Day One, Pop-up University 7, 10.00
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Integrated care strategies: A snapshot in progressJoyOkunnu
(1) This document provides an overview of emerging themes from the first iterations of integrated care strategies published by integrated care systems in the UK. (2) It analyzes 35 strategies and finds common priority areas like healthy aging, mental health, and reducing health inequalities. (3) The document also provides case studies on community engagement approaches taken by different integrated care partnerships.
Similar to Independent healthcare in-house lawyers forum (20)
Employment law update - Browne Jacobson Exeter - 06 February 2020Browne Jacobson LLP
These seminars are aimed at anyone who deals with employment law on a day to day basis, including HR Managers and HR Directors.
At these events we will present an overview of what we consider to be the most significant developments in 2019, and what they teach us about managing your workforce – together with our practical tips.
You will also hear about what is coming up in 2020, and how you can get ready for what will be another busy year in employment law.
This document discusses school exclusions and provides guidance on the topic. It begins with an overview of the exclusions landscape and key documents related to exclusions. It then outlines prospective changes being made to exclusions policy, including recommendations from the Timpson Review. The exclusions process is explained as a multi-stage process involving the head teacher's decision, governing board review, and potential independent review panel. Finally, tips are provided to avoid common pitfalls in the exclusions process related to issues like SEND, documentation, and timelines.
Procurement workshop training slides - Birmingham sessionBrowne Jacobson LLP
Managing procurement risks and challenges aims to increase understanding of procurement processes and risks, and knowledge of risk mitigation strategies. The document outlines several procurement stages and associated risks, including pre-market engagement, selection, tendering, contract award, and modifications. Key risks include challenges from bidders, non-compliance with regulations, undisclosed evaluation criteria, and substantial contract changes. Mitigation strategies include transparency, equal treatment of bidders, thorough documentation, and compliance with regulations.
Local authority acquisition and disposal of land - July 2019Browne Jacobson LLP
Ongoing austerity requires authorities to “sweat their assets” and land holdings are a significant focus for the generation of revenue and capital. These slides cover commercial and public law considerations in relation to:
- Powers to acquire land
- Powers to invest through land acquisition including investment purchases
- Potential barriers to disposal
- Powers to appropriate land
- Planning permission
- Powers to dispose of land
- Pre-conditions relating to disposal of land
- A capital receipt or a revenue stream
- Development vehicles and options
- Who do you need to be able to satisfy as to the legality of land transactions
Your employees, their future employers, and your intellectual property - July...Browne Jacobson LLP
Innovation and creativity is driven by your people. How do you as a business encourage innovation, capture the relevant IP assets and reward your innovators? What happens when a key individual leaves the business – how do you ensure that your R&D crown jewels remain legitimately protected? In a market of ever increasing competitive collaboration, setting up the right strategy to ensure the appropriate safeguards are in place and are communicated to your employees is important.
At this Public Sector Planning Club we reviewed:
- Recent developments in planning law, including cases and guidance
- Consideration of the use of planning conditions, including the appropriate use of pre-commencement conditions
- The powers available for stopping up and diverting highways, when these may be used, and points to consider
Browne Jacobson, Deloitte and DoctorLink are pleased to invite you to our first joint health tech seminar with leading industry thought leaders. This will be a practical session, sharing experience from across the NHS and beyond to inform options on how to improve services, break down silos and focus on population health outcomes.
This event is exclusively for Commissioners, GPs, and Policymakers keen to understand how new integrated care systems and models of care can meet the needs of their local population and can be implemented pragmatically and affordably to drive improvement goals and achieve better health, better care and better value.
Education Law Conference Manchester - Monday 10 June 2019Browne Jacobson LLP
1. Implement a clear, well-publicized complaints procedure that outlines appropriate steps and timelines.
2. Address social media issues promptly by controlling the narrative and responding diplomatically or ignoring depending on the circumstances.
3. Understand when the law can help, such as the Protection from Harassment Act for addressing vexatious complaints.
4. Escalate complaints appropriately and clarify the desired outcome to resolve issues efficiently. Stand back when complaints are really about private disputes rather than the school.
Designed to inform, challenge and enliven your perspectives, our packed agenda was designed to provide innovative ideas and fresh perspectives. With a headline session on the management of transgender children needs within a school setting, we aim to provide you with the advice and guidance that the sector currently lacks.
Other topics included:
learning from child death inquests
good governance – so much more than compliance
managing difficult parents and their complaints.
The IICSA has a number of investigative streams, and one of its areas of focus is Accountability and Reparations. It has already recommended that the Government sets up a Payment Scheme for former Child Migrants, and the Government has acted upon it.
Is a redress scheme the way forward for abuse claims? How might it impact your organisation? We are helping more and more organisations explore the pros and cons of redress schemes so that they can decide whether a scheme is right for them and what the longer term impacts might be.
Our Birmingham Claims Club event will cover the following:
- Civil Liability Act 2018
- Freedom of Information Act requests - including 'Information Law, why is it relevant?'
- Brexit and local government
Our London Claims Club event will cover the following:
- Civil Liability Act 2018
- Freedom of Information Act requests - including 'Information Law, why is it relevant?'
- Brexit and local government
Our Admin and Public Law seminar, chaired by Sir Robert Devereux, former Permanent Secretary for the Department for Work and Pensions was held on Thursday 4 April, covering the following topics:
- 'wearing two hats' - managing the legal risks of conflicts of interest and allegations of pre-determination/bias
- information law update session - freedom of information (FOI) cases, General Data Protection Regulation (GDPR)
- case law update
- judicial review - tactics for dealing with judicial review and case law
In this webinar recording, Selina Hinchliffe, Alex Kynoch, Nick Smee and Helen Jones hold a panel discussion covering some of the key state aid concepts and how this impacts ownership and licensing of intellectual property, both from a commercial partner, public body and university perspective.
Whilst you’ve been distracted with Brexit and what that means for your business, you’ve probably missed some significant changes in the law. In our March forum we covered:
- contract changes (what they mean to your supply chain, customers and suppliers)
- data protection (the challenges of becoming a 'third country')
- legal privilege and internal investigations (practical tips following SFO V ENRC)
- employment law (changes to employment law you need to be aware of)
- banking - your banking covenants (what to be aware of - particularly in the event of a downturn ahead)
- property (end of lease issues for business owners).
For further training and resources visit our webpage - https://www.brownejacobson.com/sectors-and-services/sectors/in-house-legal
Every business, and every in house lawyer, will at some point be involved with an enquiry, an investigation, or potential litigation. During litigation, documents – including emails, attendance notes and reports – which are relevant to the litigation may have to be disclosed if they are not privileged.
So businesses need to know how it can assess litigation risk or conduct an enquiry without creating documents that it then has to produce and which may be detrimental to its position. The law on this issue has recently been considered by the Court of Appeal in two key cases: WH Holding Ltd v E20 Stadium LLP and SFO v Eurasian Natural Resources Corp Ltd.
In this webinar recording, our experts Mark Daniels and Helen Simm provide you with the key information you need to identify these issues when they arise and to know how you can best protect your position.
We are all waiting with bated breath for the Supreme Court decision in CN & GN, a case which will have a huge practical impact on service providers. Previously the Court of Appeal was dismayed about the damages claims, that had been litigated with little regard to, or understanding of, the law and reality of social care practice. Some of the team involved in the case discus what might happen next, and analyse the practical effect for you of the Supreme Court judgment.
Whilst that judgment has been awaited many claims have been on ice, but to fill that gap we are seeing many of our clients being affected by:
- pressure to consider Redress Schemes
- the Independent Inquiry into Child Sexual Abuse
- claims being brought directly against them as fostering agencies
- claims under the Human Rights Act
- issues following the implementation of GDPR.
For further information and training visit our webpage - https://www.brownejacobson.com/insurance
In this practical session we explored the legal duties of directors and the difficulties which they may face. The session focussed on individuals who are directors for public sector companies, including their role, obligations and competing interests which may arise.
At our February planning club we covered the following topics:
- planning performance agreements
- expert evidence in planning inquiries
- certificates of lawful use.
For further information and training visit our webpage - https://www.brownejacobson.com/sectors-and-services/sectors/public-sector
Mental health, capacity and deprivation of liberty case law update, February ...Browne Jacobson LLP
Rebecca Fitzpatrick looks at some of the most recent leading cases in relation to the Mental Health Act and Deprivation of Liberty, including the Supreme Court’s important decisions of 'MM' and 'PJ' which consider the interaction between the Mental Health Act and deprivation of liberty in the community. Rebecca also covered the subsequent case of 'AB' which focuses on the role of the High Court’s inherent jurisdiction in these types of cases, and the recent final report from the Mental Health Act independent review chaired by Professor Sir Simon Wessely.
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
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Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
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Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
2. New models of care update
Jonathan Hayden and Peter Ware
3. Three “framework” documents
• Multi-specialty Community Provider (MCP)
emerging care model and contract framework –
published end July 2016
• Integrated Primary and Acute Care Systems (PACS)
care model and business model – published
September 2016
• Enhanced Health in Care Homes (EHCH) framework
– released September 2016 (alongside the PACS
one)
4. Three “framework” documents
• Frameworks are lengthy documents (about 110
pages in total)
• These slides/notes are only extracts/summaries
from the “frameworks”
• Although not summarised below, the frameworks
contain lots of useful examples of work and
activities being undertaken by the vanguards
5. MCP framework
• MCP framework aims to define what being an MCP
means by assembling features from the 14 MCP
vanguards into a common framework
• Noted that the care model will evolve and
framework may be adopted / adapted
• Framework is not definitive policy on
commissioning and contracting for an MCP
6. MCP framework
• MCP combines the delivery of primary care and
community-based health and care services
• Place-based model of care and serves the whole
population
• MCP covers the registered lists of the participating
primary medical practices plus any unregistered
population
• All 14 vanguards serve a minimum population of at
least c100,000 (some much larger)
7. MCP framework
• Framework describes how the MCP care model operates
at four levels:
– Whole population level
– Urgent care needs
– Ongoing care needs
– Highest needs and costs
• “As long as it has sufficient decision-making rights to
deploy that budget flexibly, the MCP can reshape the
local care delivery system around what really works
best for different groups of patients”
8. MCP framework
• Related sections on
– Reducing future demand
– Creating accessible and responsive urgent care (see
the eight commissioning standards on p13)
– Integrating primary and community based care for
people with ongoing needs (inc links to Enhanced
Health in Care Homes, Integrated Personal
Commissioning)
– Implementing the “extentivist” care model
9. MCP framework
• Ten “essential jobs in creating an MCP” are
outlined in the framework (p7)
• Summary of key differences between an MCP and a
PACS
– Scope – PACS also provides most / all hospital
services
– Scale – Min MCP population likely to be 100k,
whereas PACS likely to be 250k
10. MCP framework
• Framework explains how a MCP should (for
example):
– Take account of the JSNA
– Create integrated datasets drawn from
interoperable health and care records
– Use actuarial approaches to model risk profiles of
populations
– Rely on high quality business intelligence systems
11. MCP framework
• A MCP should (continued…)
– Stratify risk, segment the population and understand
sub-groups with the greatest needs
– Adopt / adapt the NHS Rightcare method of
understanding unwarranted variations in outcomes
etc.
– Use and join-up data safely
12. MCP framework
• Acknowledgement that “an MCP may start off as a
loose coalition, but sooner or later it has to be
established on a sound legal footing under
contract”
• Three broad visions emerging:
– Virtual
– Partially integrated
– Fully integrated
13. MCP framework
• Virtual
– Individual providers and commissioning contracts are
bound together by an alliance agreement
• Partially integrated
– Contract covers all services other than primary
medical, supported by contractual arrangements
between the MCP and GPs to achieve operational
integration
14. MCP framework
• Fully integrated
– Single whole population budget across all primary
medical and community care services
• MCP contract being developed to cover the
partially integrated and fully integrated options
15. MCP framework
• MCP contract
– Streamlined hybrid of the NHS Standard Contract
and a contract for primary medical services
– Threefold aims when developing the contract:
i) increase flexibility for the provider, ii) focus
better on outcomes, and iii) to simplify
– Contract duration could be 10-15 years, probably
with early break option
– Contract will provide for some ongoing adaptation
16. MCP framework
• MCP contract
– Payment comprising three parts: i) whole population
budget, ii) performance element replacing CQUIN
and QOF, iii) gain/risk share for acute activity
– Could (in theory at least) be held by range of
entities
– GPs wont be compelled to leave GMS, PMS etc.
• NHSE is working with six MCP sites to shape and
develop the contract
17. MCP framework
• Organisational form
– Capable of bearing financial risk
– Clear governance and accountability arrangements
– NHSI and CQC considering approach to oversight
– Issues being explored:
Pensions
Insurance / CNST
VAT
18. MCP framework
• MCP’s relationship with GPs / primary medical
providers could take various forms:
– Partners/shareholders
– Subcontractors
– Employees
• Considering option to “suspend” GMS/PMS
contracts for participating practices
19. MCP framework
• Role of commissioner
– Acknowledgement that “the new models of
accountable care will move the boundary between
what is commissioning and what is provision”
• Managing conflicts of interests
• Consultation
• Procurement
20. PACS framework
• MCPs and PACS are similar but different in scope
and scale
• PACS may, in particular, have links with an Acute
Care Collaboration model
• Similar to MCPs there are four levels at which the
PACS will operate: population, urgent care,
ongoing care needs, and complex health needs
21. PACS framework
• Core elements of the PACS care model
– Prevention and population health management
Building shared care records and business intelligence
systems
Tailoring services based on population segmentation
Better population health through community
engagement
Supporting self-care and patient activation
Linking people to community assets and other public
services
22. PACS framework
• Urgent care needs – integrated access and crisis
response teams
– Proactive approach to urgent care
– Joined-up crisis response services
– Integrated access to unplanned, urgent and
emergency care services
23. PACS framework
• Ongoing care needs – enhanced primary and
community care
– Scaled up and enhanced primary and community
care teams
– Multi-disciplinary teams for service users with
complex needs
– Integrated access to specialist advice and treatment
– Ongoing care in the community, enabled by
technology
24. PACS framework
• Highest care needs – coordinated community-based
and inpatient care
– Better care for patients with complex needs and
high costs
– A new model of coordinated in-patient care
– Rapid discharge and re-integration into community
based care
25. PACS framework
• Options for commissioning and providing a PACS
– Noted that the challenges are similar to those for
MCPs, but the scale of scope of a PACS may bring
distinct challenges
– Unlike an MCP, a PACS will include acute services
and tertiary / specialised services could also be in
scope
26. PACS framework
• Role of commissioners
– Similar to MCPs, it is noted that a PACS may
“redefine the roles of commissioner and provider”
– NHSE is “working with a number of vanguards to
establish which activities must always remain with
the CCG (or other commissioners) and which
activities an MCP or PACS would perform under
contract”
– Commissioners will retain a strategic role
• Consultation, procurement etc.
27. PACS framework
• Three broad versions of a PACS (similar to MCPs)
– Virtual – alliance arrangement overlaying
“traditional” contracts
– Partially-integrated – all services other than primary
medical are procured under a single contract, with
the provider required to work with primary care
providers
– Fully-integrated – single whole-population budget for
the full range of services in scope
28. PACS framework
• Organisational form
– Options are, in theory, the same as for an MCP
– Subject to NHSE / CQC joint assurance process
• Like for MCPs, pensions, clinical negligence cover,
VAT etc. are all relevant issues for PACS (there’s
also mention of investigation of how parent
company guarantees may be used)
29. PACS framework
• PACS’ relationship with GPs / primary medical
providers (same as for MCPs)
– Partners/shareholders
– Subcontractors
– Employees
• PACS contract – substantially similar to the MCP
contract, but reflecting any learnings from the MCP
contract, so to be developed later - “by Summer
2017”
30. PACS framework
• PACS contract “will be of longer duration than
those that are typically offered to NHS providers at
present but with an initial early break-point”
• Specification will be a mix of national/mandated
and local service requirements
• Fully-integrated PACS will receive a single budget:
whole population budget (incl performance
element replacing QOF and CQUIN) but unlikely
that PACS need same risk/gain share as for MCPs
31. EHCH framework
• EHCH to be a core element of the MCP and PACS
models
• Model aims to overcome barriers:
– Care
– Financial
– Organisational
32. EHCH framework
• EHCH model seeks to overcome these challenges by
ensuring:
– Access to enhanced primary care and specialist
services
– Alignment of budgets and incentives
– Working environment optimised for integrated teams
– People maintain independence as far as possible
– Health and social care commissioned in a
coordinated manner
33. EHCH framework
• EHCH vanguards identified the following as critical
to success:
– Person-centered care
– Co-production e.g. with local government, the
community and voluntary and care homes sectors
– Focus on quality as the driving factor for change
– Strong leadership and joint shared vision (and
recognising cultural differences between
organisations)
34. EHCH framework
• Footprint of an EHCH?
“… all of the care homes (residential and nursing) that
are situated in the planning footprint that chooses to
implement the EHCH model, be it a sustainability and
transformation plan (STP) area, a clinical
commissioning group (CCG), a local authority or an MCP
or PACS”
35. EHCH framework
• The EHCH framework “draws on both the ‘I
statements’ (published by the ‘Think Local, Act
Personal’ (TLAP) partnership that spans the health
and social care sector) and the ’My Home Life’
initiative (that promotes quality of life and delivers
positive change in care homes for older people)”
36. EHCH framework
• The EHCH framework describes
– Seven core care elements of the EHCH model and
how they can be commissioned to deliver joined-up
services
– The fully mature EHCH model
37. EHCH framework
• Seven care elements (and 18 sub-elements):
– enhanced primary care support
– multi-disciplinary (MDT) support including coordinated
health and social care
– re-ablement and rehabilitation
– high quality end-of-life care and dementia care
– joined-up commissioning and collaboration between
health and social care
– workforce development
– data, IT and technology
38. EHCH framework
• The Framework also includes a useful table highlighting
for each care element and sub-element whether it is
“core” or “enhanced” and the indicative pace of
implementation (starting from <1 year, and up to 1-5
years)
• Self-assessment framework to be released to help local
areas assess themselves against the framework
• At Annex 2 there are some “low cost, high impact
ideas” – e.g. using NHS secure mail
39. EHCH framework
• Organisational form
“Unlike with MCPs and PACSs, however, implementing the
EHCH care model does not involve the creation of a single
lead provider; nor are we expecting care home providers to
merge with an MCP or a PACS in a new organisational form.
Rather, care home providers may, if they wish, enter into a
formal agreement with an MCP or PACS, or existing
commissioners and providers, to formalise their
commitment to whole-system, partnership working.”
40. Procurement
• Procurement
– The guidance for MCPs makes it clear that there are
procurement obligations in particular:
Public Contracts Regulations 2015 – “the Light Touch
Regime”; and
the National Health Service (Procurement, Patient
Choice and Competition) (No. 2) Regulations 2013.
– Note new guidance from DH on interaction between
the two.
41. Joint commissioning
• Clear focus in the frameworks on the need for
coordinated health and social care commissioning
• Useful to have high-level understanding of s75
partnership arrangements and scope for joint
commissioning
42. Legislative Background
• National Health Service Act 2006
– Local authorities and NHS bodies can enter into
partnerships
– Must lead to an improvement in the way their
functions are exercised
• Health and Social Care Act 2012
– Duty to consider Joint Health and Well-being
strategy
– Duty to encourage integrated working
43. Prescribed Functions
• Set out in the NHS Bodies and Local Authorities
(Partnerships, Care Trusts, Public Health and Local
Healthwatch) Regulations 2012:
– NHS functions (Regulation 5)
e.g. health services, after care for people leaving
hospital with mental health conditions
– Local authority functions (Regulation 6)
e.g. social services and community care, youth
services
44. Typical Partnerships
• Typical partnership services include:
– Domiciliary care services
– Mental health services
– Community rehabilitation services
– Drug and alcohol treatment services
45. Conditions to Section 75
arrangements
• The power to enter into section 75 agreements is
conditional on the following:
– Arrangements likely to lead to improvement in the
way functions exercised
– Partners have jointly consulted people affected by
arrangements
46. Powers permit:
• NHS Act provides flexibility to:
– Form a pooled budget
– Lead commissioning
– Integrated provision
47. Practical issues
• Charging for services
– Where NHS lead, agree procedure for income
collection
– Local authority may still want to collect charges
– LA can delegate function to NHS Body
– RISK when LA contribution to pooled fund dependent
on income from service users (DoH’s Integrated Care
Network guidance)
• Arrangements for VAT
48. Practical issues
• Consultation
– Must ensure obligations to consult are discharged
– If NHS Trust enters into pooled fund, consent from
relevant CCG is required
– Service users must understand changes
49. Practical issues
• Transfers of Staff
– TUPE may apply
– Indemnity prior to transfer date
– Alternative to TUPE- secondments of staff
– Pension- Fair Deal Policy and Best Value Authorities
Staff Transfers Direction 2007
50. Practical issues
• Accountability and governance
– Retained responsibility
– Management and monitoring essential
– Risks appropriately apportioned to partners
– Take responsibility for management of partnership
– Joint Committee
– Complaint handling
– Information Sharing Protocol
51. Practical issues
• Procurement
– Does the procurement regime apply to S75
arrangements?
– Public Contract Regulations 2015- Light Touch
Regime
– the National Health Service (Procurement, Patient Choice
and Competition) (No. 2) Regulations 2013
– Responsibility for process/ deal with challenges who
is responsible?
53. Contact us…
Jonathan Hayden
E: jonathan.hayden@brownejacobson.com
T: 0121 237 4551
Peter Ware
E: peter.ware@brownejacobson.com
T: 0115 976 6242
54. Does TUPE apply in short
term/caretaker arrangements?
Gemma Steele, Browne Jacobson
55. Brief Recap – what is TUPE?
TUPE applies to a "relevant transfer", which means either or both of the following:
• Business Transfer - A transfer of a business, undertaking or part of a business or undertaking
where there is a transfer of an economic entity that retains its identity. This involves three
elements:
– an economic entity;
– a transfer of that economic entity; and
– the economic entity retaining its identity following the transfer.
• Service provision change - A client engaging a contractor to do work on its behalf, reassigning
such a contract or bringing the work "in-house". This can, therefore, encompass an initial (or
first generation) outsourcing, a subsequent (or second generation) outsourcing or an in-
sourcing. However, the supply of goods and "one-off buying-in of services" are excluded.
Activities carried on after a change in service provider must be "fundamentally or essentially
the same" as those carried on before it.
56. What is a service provision change?
3 conditions must be met:
• Organised grouping of resources which must have, as
its principal purpose, the provision of services to a
particular client
• Not a single specific or task of a short term duration
• Not wholly or mainly the supply of goods
57. 2014 Regs: service provision change
Transfers on or after 31 January 2014:
• Activities: “fundamentally or essentially the
same”
• Change reflects existing case law on the
meaning of ‘activities’
58. Caretaker arrangements
• If an APMS or GMS contract is terminated at short notice, a
caretaker provider is often appointed as an interim measure whilst
the commissioner undertakes a full procurement exercise
• A caretaker arrangement enables continuity of care for the
patients to be maintained ahead of a more permanent solution and
is often where timescales mean that patient consultation is not
possible.
• Caretaker arrangements can be anything from three months to one
year depending on the size of the list and the extent of the
procurement exercise.
• But will TUPE apply?
59. Is it a service provision change?
Yes - The activities (the GMS/APMS contract) ceases
to be carried out by a contractor (the old provider)
on a client's (the commissioner’s) behalf and are
reassigned to a subsequent contractor (the caretaker
provider) to carry out on the client's (the
commissioner’s) behalf.
60. Short term exemption?
In order for there to be a service provision change,
the client (commissioner) must intend that the
relevant activities will, following the service
provision change, be carried out by the transferee
(caretaker provider) other than in connection with a
single specific event or task of short-term duration
(regulation 3(3)(a)(ii)).
61. Case law
In Robert Sage t/a Prestige Nursing Care v
O'Connell and others UKEAT/0336/12, the EAT held
that for this exemption to apply, a client
(commissioner) must have more than a "hope and
wish" that a particular event or task will be short-
term. The Employment Tribunal will focus on client's
intention at the time of a transfer and whether is
intended to be short term.
62. ICTS UK Ltd v Mahdi and others
UKEAT/0133/15
• Subsequent events can be relevant in deciding
whether it was intended that the task be short
term, and should be taken into account.
• Although the intention was short term security of a
vacant site pending building work, by the time of
the ET no planning permission had been granted for
any major building project at the site and no
building work had taken place. The ET were
entitled to take these factors into account.
63. What does this mean for
caretaker arrangement?
• The client's (the commissioner’s) intention as to whether the task
will genuinely be of short term nature is crucial. So, for example,
if it is envisaged that the APMS/GMS contract will ultimately be
awarded to the caretaker provider following a full procurement
exercise, it is going to be very hard to convince an Employment
Tribunal that the caretaker arrangement was genuinely intended
to be of a short term nature.
• Each case is very dependent on its facts and legal advice should be
sought on the particular circumstances.
• However, recent case law proves that it would be dangerous to
assume TUPE never applies in a caretaker scenario.
• Indemnities!
65. Inquests and private health:
why should I care?
Andrew Peel, Browne Jacobson LLP
2 November 2016
66. Introduction
• 1. Powers of the Coroner
• 2. Employment
• 3. System failure v system error
• 4. The CQC
• 5. PFDs
• 6. How can PFDs be avoided?
• 7. Insurers
• 8. Other investigations
• 9. Financial impact
• 10. DoLS and inquests
• 11. Legal support during the inquest
• 12. Questions
67. What the Coroner can’t do
• The Coroner cannot apportion blame
• Fact finding exercise
– It is not a trial / purpose is not to apportion blame but…
– It may feel like it during the inquest…!
68. What the Coroner can do
Upon reporting of a death the Coroner can:
- Certify the death as due to natural causes without a post-mortem
- Certify as due to natural causes after a post-mortem
- Initiate an investigation into the death
When must the Coroner investigate a death?
- Death is violent or unnatural including death due to self harm
- The cause is unknown
- Death in custody or state detention
Discontinuance of investigation
- Where post mortem reveals cause of death
69. What the Coroner can do (2)
• Consider four key questions
- Who the deceased was?
- How, when and where the deceased
died?
• Make people PIPs (Properly Interested Persons)
- Interest in outcome of inquest
- Ask questions
- Where an employee is named as a PIP or a witness, care providers should
consider how they can support the member of staff
70. What the Coroner can do (3)
• Summons witnesses
- In most instances, the Coroner will request witness’ voluntary attendance
the inquest, although witnesses can be compelled by way of a formal
summons
- Failure to attend after receiving a formal summons is a criminal offence
• Order disclosure of documentation
- Coroner gives notice of request for disclosure
- Powers of the Coroner to require evidence to be given or produced
(documents of other items of inspection)
- Sanction is financial rather than imprisonable (max £1,000)
71. What the Coroner can do (4)
• Prevention of Future Deaths (PFD)
- Mandatory where the evidence gives rise to a concern that circumstances
exist which create a risk that other deaths will occur in the future
- Can be issued at the inquest or any other point during the investigation
- Not just the person who receives the PFD who sees it:
- Chief Coroner
- All interested persons
- Anyone the Coroner feels may find it useful – CQC
- Published on the internet
- Annual report to Parliament
So there are clear reputational issues
72. Is it this simple?
No it is not – There are further far reaching implications
• The Coroner can summons senior persons e.g. CEO, Chief Nurse etc. to
explain what happened
• Can refer the matter to the Crown Prosecution Service
• Relationship with other investigations
• Refer persons to the GMC/NMC
• Insurance
• Financial implications
73. Employment
• Duties to assist employees during the process
- Support
- Ensure that only those who need to give evidence are involved
• Referral of staff to professional regulatory bodies such as the GMC/NMC
• Internal conduct and disciplinary issues
• Impact on wider organisation HR issues e.g. investigation of working
practices
• If a staff member has left ensure the Coroner
knows as soon as possible
74. System failure v human error
• Root Cause Analysis (RCA) /Serious Untoward Incident (SUI) report will
be requested by Coroner, as well as investigations statements/
recordings
- Staff engagement in the process is crucial
- Purpose of RCA is to monitor and improve quality of healthcare
- RCA ‘sets the tone’ / may guide scope of inquest (and any litigation!)
• Consultants as independent contractors
• Conflicts of interests
- Early identification of actual / potential conflicts
of interest between individual and organisation
75. System failure v human error (2)
• Support individuals
- Support from HR
- Support from defence union
- Maintain a good relationship to lower to risk of hostile evidence against
organisation’s systems
- Exclude from inquest preparation
• Importance of witness evidence
- Statements taken as part of an investigation are disclosable
- Ensure care is taken with the statements particularly as they are likely to
be contemporaneous
- There can be difficulties later if a statement is made in preparation for
the inquest which differs to that made for the investigation report
76. The CQC
• Attention from the CQC – Serious!
• Requirement to be notified of death
• Can be made a PIP
• Unannounced inspections
• Fines / conditions imposed on registration
• CQC’s 5 key questions:
safe, effective, caring, responsive, well led?
77. PFDs
• The Coroner can’t tell organisations what to do
• Is the ‘obvious’ solution that is sought by the Coroner, in fact, workable in
practice?
• CQC may seek to enforce actions in a way that the Coroner cannot
• FOI requests. Can a pattern be established across organisations?
78. So how can a PFD be avoided?
• Conduct a thorough investigation at an early stage
• Produce a clear and relevant RCA report and disclose to Coroner
• Ensure scope of RCA is wide enough
• Clear action plan that has been monitored/completed
• Specific organisational lesson-learning evidence
- The right witness is vital
- From a senior doctor/ nurse/director explaining the investigation and
what processes have changed
- Support with evidence
• Ensure witnesses are aware of the new policies / procedures!
• Co-operate with other PIPs
• Coroner may opt to write to organisation for reassurance where need for
PDF is uncertain
79. Insurers
• Notification – once inquest has been called - does this count as an
intimation of a claim?
• PFD reports – on notice of ‘issue’ at the organisation
• Liaise with Insurers to understand whether representation at the inquest
will be covered
• Do admissions of liability in RCA report require Insurer's approval ?
80. Other investigations
The Coroner can refer the matter to other organisations, including:
• Crown Prosecution Service – Corporate Manslaughter/Gross Negligence
Manslaughter
• Health and Safety Executive
• Fire Authority
• GMC/NMC/Other professional bodies
81. Financial impact
• Scope of the inquests, PIPs, duration and jury all increase overall costs
• Performance at inquests will impact on proceeding with civil claim
- Inquests as ‘fishing expeditions’ especially Article
2 inquests
- Transcript of inquest can be used in civil claim
- Conclusions at inquests are not determinable of the outcome of a civil
action but can be very persuasive
• Publicity & reputational damage
- Anyone, including the press can attend
Court
82. Financial impact (2)
• Insurers – increased premiums and reluctance to refer policyholders
• CQC fine
- Failure to comply with regulations about quality and safety (Health and
Social Care Act) – Unlimited fine
• Health & Safety Executive fines
• Corporate Manslaughter fine – Unlimited
• Potential recovery of family’s costs of attending inquest from the
organisation
83. DoLS & inquests
• Duty for inquest to be carried out into death of anyone under a
Deprivation of Liberty Safeguard
• Anyone who dies whilst subject to a DoL are considered having died in
‘state detention’
• Chief Coroner in his 2015-2016 annual report revealed that Coroners held
inquests for 7,183 people who died whilst under a DoL in 2015
• Following the Cheshire West ruling, the Law Commission is reviewing DoLS
and is due to present its recommendations later this year
84. Legal support during the inquest
• RCA investigation and report writing
• Obtaining the best evidence from staff, both statements and oral
• Witness management – is the most appropriate person giving evidence?
• Strategy to ensure protection of organisation from early stage
• Privilege
• Management of sensitive organisation
- Inquest v claim disclosure issues
• Legal representations during inquest
- Control the scope, questions asked, information delivered by witnesses
• Submissions on conclusion
- Some Coroners ask advocates to submit drafts for narrative conclusions
• Response to PFD report
• Staff training after the inquest