Health adviserHealth advis rINSIGHT, FORESIGHT AND PRACTICAL SOLUTIONS / Issue 18

HAPPY 70TH BIRTHDAY, NHS!A look back at how the National Health Service has evolved

INTERVIEW: ROB BEHRENSThe Ombudsman who is revolutionising the complaints process

NHS ESTATE STRATEGYHow the NHS is reacting to the Naylor Report

A NEW WAY OF THINKING

MENTAL HEALTH

Health Adviser is a DAC Beachcroft publication.

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DAC Beachcroft LLP is a limited liability partnership registered in England and Wales (registered number OC317852) which is regulated by the Solicitors Regulation Authority. We use the word ‘partner’ to refer to a member of the LLP, or an employee or consultant with equivalent standing and qualifications. A list of the names of our members is available for inspection at our registered office, 100 Fetter Lane London EC4A 1BN. The information contained in this magazine is for general information only based on English law. The contents of this magazine do not constitute legal or other professional advice. Readers should seek appropriate legal guidance before coming to any decision or either taking or refraining from taking any legal action. If you have a specific legal question, you should address it to one of our lawyers by contacting the relevant partner identified in this magazine, or on our website www.dacbeachcroft.com.

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C O N T E N T S

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16 Changing landscapes With a new NHS estate strategy underway, we look at what this will mean in practice and what impact these proposals might have.

20 Permission to speak There are around 500 Freedom to Speak Up Guardians helping staff raise concerns, but how are these ‘whistleblowers’ perceived?

22 In practice What lessons can the health sector learn from the collapse of Carillion?

04 Executive agenda Our latest patient safety report; Confed18; and the future of social care.

06 NHS 70th anniversary reflections A look back at the NHS, and some of the contributions made by DAC Beachcroft, that have helped shape it.

COVER STORY

08 Mental health: A new way of thinking Can collaborative working and new technology help ease the burden on the mental health sector?

12 Interview: Rob Behrens The Parliamentary and Health Service Ombudsman on how he wants to change its role when it comes to complaints.

08It’s been a testing time for the health and social care sector, as it endures an array of pressures in relation to resourcing, integration and the expectation of service users. Yet, in the face of these challenges, health and care professionals across the public and independent sector continue to provide the best care possible, with patient safety at the forefront.

This effort should be celebrated this year as 2018 heralds the NHS’ 70th birthday. And so, in this timely edition of Health Adviser we highlight some of DAC Beachcroft’s contributions to the development of the health service. We have gathered the thoughts of former NHS managers and a highly respected chronicler about how far the NHS has come in the last 70 years and the legislative landmarks that have shaped it.

Looking ahead, we examine how the NHS continues to be shaped, including a new NHS estate strategy, which aims to evolve how trusts use their estates for maximum benefit and what this means in practice. We also take a look at how mental health services in particular are enduring huge pressures; with the latest reports revealing shortages of cash, beds and staff, as well as patients being treated miles from home. We look at whether collaborative working and new technology can help.

And finally, with now some 500 Freedom to Speak Up Guardians, Champions or Ambassadors working across the NHS and independent sectors in England to help staff raise concerns when things are going wrong, we review whether they are perceived as critical friends or enemies within.

Welcome

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3DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawuk

Nigel Montgomery Head of Health and Partner

www.dacbeachcroft.com/health

2@healthlawuk

The Accelerated Access Review, published in 2016 and commissioned by the

Government in 2014, set several recommendations to increase the speed and uptake of innovative medicines, medical technologies and diagnostics.

Stretched budgets and lack of real-world data to assess innovations are just two reasons why the health service often struggles to adapt new technologies that can transform patient care. The Accelerated Access Review is a step towards addressing these issues.

In response, the Government has made pledges, including the introduction of an Accelerated Access Pathway – a new, streamlined route to market that opened in April 2018 to bring forward patient access to a select number of transformative products. These products will be selected by the Accelerated Access Collaborative, which brings together representatives from national organisations such as NICE, NHS England as well as patients, industry and clinicians with a core objective of encouraging the uptake of affordably priced innovation within the NHS.

As Chair of the Health Tech Alliance, I know the scale of transformative innovation being developed by this country’s MedTech industry and our members welcome these initiatives. We hope that more products are chosen as part of the Pathway and that the Government will continue to support innovations past the point of adoption, so that they are then successfully diffused throughout the health service. The Alliance is actively engaging with senior stakeholders to ensure that innovative products, proven to be cost-saving and to improve patient care, are taken up by the health service at pace.

NEWS

Executive agendaEmerging issues for the health sector

Our latest research piece, ‘Patient Safety: From board to ward’, aims at helping boards across the health and social care sector identify their most useful data channels in understanding and managing patient safety in their organisations. This original piece of research received responses from C-suite members in the NHS, independent health, independent social care and the third sector.

The results are now available in the report and illustrate the value senior leaders and boards place on the various types of data they receive. It recognises the plethora of data that is utilised and its impact on improving patient safety; a top concern for health and care providers and one that boards must tackle successfully if they are to deliver care effectively.

The research surveyed how these senior leaders receive, review and manage the outcomes of data on patient safety

in their organisations and has been compiled into a report that focuses on four key areas:1. how patient safety ethos is beginning to influence board policy 2. in what ways the information and data is being used 3. the consistency with which learnings from the data is

received at board level4. how it is being used to drive safety and engagement

A key outcome of the report highlights the need for more consistency and collaboration across health and care organisations, with recommendations from our experts around sharing intelligence, acquainting organisations across the health and social care sector with best practice in identifying the most useful data channels and, crucially, managing the flow of learning from board level to the point of delivering care in order to effect change.

DAC Beachcroft is attending the NHS Confederation conference, or Confed18, on 13 and 14 June. This year Confed18 is celebrating health and social care’s past and looking at how it may be shaped in the future by focusing on six strands: digital; transformation; integration; efficiency and productivity; workforce and leadership.

The event will provide delegates with an opportunity to strengthen professional relationships, showcase innovations, and provide insight into the current and future direction of health and social care in the UK.

With a theme that celebrates the past and looks to the future, DAC Beachcroft will be at stand 99

at Confed18. We will be exploring the future of the NHS whilst also celebrating its past milestones and achievements; from the inception of the NHS in 1948 (see page 6), the introduction of the NHS Constitution in 2009, to a look at new models of care and MedTech.

We look forward to hearing your memories and considerations for the future and to sharing these findings in 2018.

For more information visit www.dacbeachcroft.com/nhs70

In May, a number of our experts working in social care attended LaingBuisson’s Social Care Conference. The conference explored the future of social care and how providers, stakeholders and investors can make the care home, homecare, supported living, specialist care and housing with care markets work for them.

The event consisted of in-depth sessions with some of the biggest investors in the care sector working with delegates, including our Partners Jonny Landau (Healthcare Regulatory) and James Reed (Corporate), to examine specific issues affecting residential care, homecare and supported living, as well as discussing the latest technological development, staffing considerations and asset management.

This was a great opportunity for our experts to work with key individuals in social care to shape the future of investment in this area and understand where the opportunities exist.

Dame Barbara Hakin, Chair of the Health Tech Alliance, an informal coalition of MedTech companies, says that the Accelerated Access Review is just the start.

Platform

For more information on our expertise in independent health and social care, please email jlandau@dacbeachcroft.com or jreed@dacbeachcroft.com

If you would like a copy, or if you’d like to discuss the report’s findings further with one of our experts, please contact Charlotte Boston by emailing cboston@dacbeachcroft.com. Alternatively, you can view the report in full here: www.dacbeachcroft.com/patient-safety ii

Patient safety report

The future of social care

NHS Confederation

5DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawukwww.dacbeachcroft.com/health

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NHS 70TH ANNIVERSARY

To discuss the issues raised in this article, please contact Nigel Montgomery on +44 (0)117 918 2321 or nmontgomery@dacbeachcroft.com

Nigel Montgomery, Head of Health and Partner, DAC Beachcroft

“A s we salute the NHS turning 70, an institution we have worked with since its foundation in 1948, it

seems fitting to reflect on key events. “Since DAC Beachcroft’s work with the

first acquisition of a trust by a foundation trust, we have also helped around a third of Primary Care Trusts (PCTs) with their Transforming Community Services programmes and transition into Clinical Commissioning Groups (CCGs).

“It was satisfying to help streamline the processes, and even more so now we continue to work on the changing nature of collaboration and commissioning between health and social care and developing new care pathways.

“Over the last two decades we have seen much more collaboration and innovative thinking across the system.

Legislatively, it can be hard to work as one, but organisations are finding ways to come together and we are seeing many positive changes.

“However, the NHS has never been as politicised as it is now. Nor has it ever been under the current intensity of regulatory scrutiny across quality, safety and financial rigour.

“As the NHS evolves (and continues to do so) we change with it, adapting with our clients. Key structural changes have of course been driven by legislation, enacting key policy decisions; however, a significant driver within recent transformation has been locally motivated innovation and cultural change, particularly in new models of care and within the patient safety agenda.

“In patient safety, for example, the Francis recommendations were a landmark; though in some ways the legislation that followed – such as the regulatory duty of candour – felt at the time like a hammer to crack a nut. A few years in, and many of us

There were other long-lasting effects of the 1974 reorganisation. Former NHS Chief Executive and now Chair of the NHS Retirement Fellowship, John Rostill, says the NHS gaining responsibility for public health and local authorities for social care was “probably a compromise and that’s never a good way of developing a policy. Commissioners ended up on the back foot and Cinderella services were left behind.”

The introduction of the internal market and the purchaser/provider split at the end of the 1980s was another seismic time.

“It saved the NHS from right wing reforms,” adds Jarrold. “Without it Mrs Thatcher would have let the NHS be privatised.”

Change in cultureThe Griffiths report of the early 1980s was also a key milestone. The report ended ‘consensus management’ and introduced general management in the NHS, resulting in a massive cultural change.

“It was the biggest change of all,” says Thornton.

can see that the pressure created by placing candour within a regulated framework, perhaps hastened progress in achieving the cultural changes sought on safety.

“Alongside this the NHS has learned lessons from working with patients and families. We have seen these reflections, taken from both distressing and rewarding times, inform and develop how health leaders approach their services in 2018 and the way they work to improve safety and the overall patient experience in NHS services. Mapped alongside the strategic changes to care pathways, partnering structures in establishing new working relationships, changes in funding, and policy shifts within (for example) mental health services and digital health opportunities to increase access to NHS services, the NHS’s pathway of continuous evolution continues.

“We are truly proud to have been a part of the NHS and its outstanding journey over the past 70 years and look forward to the next 70.”

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But it is widely agreed that the overriding approach of central command and control has remained since 1974.

Jarrold notes that other attempts at giving the NHS further freedoms, through the establishment of trusts and later foundation trusts, have eventually seen them “whittled away”.

The Lansley reforms of the 2012 Health and Social Care Act had no effect in changing this [see box] and are widely seen at best as ineffectual and at worst damaging to the service. But it is widely acknowledged that there is little appetite or legislative time for further reformation.

“The change work that is being done now is place based. It makes enormous sense and is being done without regulation or legislation, but it also needs adequate funding; you can only work with what you have,” says Farrar.

NHS 70th anniversary reflectionsWith the NHS celebrating its 70th anniversary, DAC Beachcroft’s Nigel Montgomery highlights some of the company’s contributions to the development of the health service.

Emma Dent speaks to former NHS managers and a highly respected chronicler about how far the NHS has come in the last 70 years, as well as the legislative landmarks that have shaped it.

The NHS historian Nick Timmins is a Senior Fellow at the Institute for Government and the King’s Fund, as well as a Senior Associate at the Nuffield Trust. A former public policy commentator and Editor at the Financial Times, Timmins has over 40 years’ experience of writing about health and social care.

“Meddling with the NHS is a particularly English disease,” says Timmins. “The culture of the NHS is often a combination of the current circumstances and the personality of the Health Secretary, whether they are strategic or more interested in the minutiae.”

The first reorganisation of the NHS in 1974, which included the introduction of regional and area health authorities, was fundamental.

“It put population health at the centre of services,” says Timmins. “But its layers of bureaucracy gummed up the machinery and ‘consensus management’ led to lowest common denominator decisions.”

The ‘internal’ market, or “the high-water mark of dividing purchasers from providers” as Timmins puts it, introduced in the early 1990s, was also groundbreaking. “And the [Blair era] targets were a very effective way of reducing waiting times.”

However, Timmins plays down the importance of the Lansley reforms. “Now it’s all about localisation. And how successful was he [Lansley] in ending micro-management of the NHS and depoliticising the NHS, when there is not a country in the world where health is not a political issue?”

What former NHS Senior Chief Executives have to say:Talking to those who have held senior roles in the NHS during many of the last 70 years, it is clear that both cultural and legislation changes have impacted the NHS.

“While legislation can result in structural changes, it can be difficult to value what you are trying to achieve,” says Consultant and Chair of the PwC public sector health board Mike Farrar, whose previous roles include Head of Primary Care at Department of Health and heading the NHS Confederation. “When the politics align with what the politicians intend, the NHS can continue with what it needs to do, but when regulations are stacked against it, it will struggle.”

Government interventionYet it was not until the reorganisation of the NHS in 1974 that it “occurred to Governments that they could interfere in the NHS,” says Ken Jarrold, Chair of Northumberland, Tyne and Wear NHS Foundation Trust and who spent three years as the Director of Human Resources and Deputy to the Chief Executive of the NHS in England.

“Before 1974, the Government’s role was simply to provide,” says Jarrold.

“The introduction of health authorities created a direct chain of command for the first time,” agrees Stephen Thornton, a former head of health authorities, the NHS Confederation and the Health Foundation.

7DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawukwww.dacbeachcroft.com/health

6#NHS70

MENTAL HEALTH

NHS Providers, which represents acute hospitals, mental health services and other providers, predicts that the vacancy rate in

mental health nursing will rise to 18% this year. In December 2016, it revealed the mental health nursing vacancy rate stood at 14.2% with seven out of the top ten highest reported vacancy rates across the NHS in England, in mental health trusts.

And as of July last year, 13% of mental health consultant posts were vacant. Indeed, the Royal College of Psychiatrists is calling for child and adolescent psychiatrists to be added to the national shortage occupation list in order to recruit more doctors from abroad. If not, it says the Government’s Children and Young People’s Mental Health Green Paper target of a four-week wait to see a consultant will remain an aspiration.

These gaps in support and provision in the system are reflected in a CQC report, published in January 2018, which raised concern at the rise in detentions under the Mental Health Act. The CQC explained this was influenced by these gaps, including a lack of beds to admit patients voluntarily in the early stages of illness.

Many experts seek the answer through integration – the key to developing effective and efficient mental health services. However, DAC Beachcroft Partner Gill Weatherill

suggests this also brings risks, particularly against a backdrop of these funding and resource pressures.

“We are increasingly seeing incidents and deaths in circumstances where there is a lack of understanding or agreement between services regarding organisational responsibility,” says Weatherill. “Coroners are repeatedly using terms such as the ‘jigsaw’ of services and the risk of individuals falling between the ‘cracks’.”

In addition, Weatherill says the outsourcing of services such as drug and alcohol support or counselling to new or non-traditional providers means that patients may have a care pathway that involves input from a myriad providers. “While that can bring benefits it also brings risks and requires clearly thought out governance processes to ensure accountability and safe patient care.”

The problems within the system were highlighted in January in separate reports by the Kings Fund and The Royal College of Psychiatrists, revealing that while mental health funding has increased it still lags behind acute trusts.

Coroners are repeatedly using terms such as the ‘jigsaw’ of services and the risk of individuals falling between the ‘cracks’.

Mental health services are enduring huge pressures in an increasingly stretched NHS. Reports have revealed shortages of cash, beds and staff, as well as patients being treated miles from home. Mark Gould asks where is the money going and can collaborative working and new technology help?

A new way of thinking

MENTAL HEALTH

9@healthlawukDAC BEACHCROFT / HEALTH ADVISER / ISSUE 18www.dacbeachcroft.com/health

8@healthlawuk#MentalHealth

severe mental health problems, leading to improved quality of life.”

Nadkarni’s Trust was one of the pioneers for Street Triage, an initiative where mental health nurses accompany police officers as they attend to incidents in their local communities. “The scheme has reduced the need for certain

MENTAL HEALTH

the previous financial year. She says CCGs should pass this money on to mental health trusts and other providers to iron out the funding gap.

Burn feels that the 2012 Health and Social Care Act meant less cash for hospital mental healthcare. “Mental health trusts are now only part of the picture – mental health funding is also distributed through GPs, local councils, private providers and the voluntary sector.”

While spending by commissioners is monitored by NHS England’s mental health statistics ‘Dashboard’, Burn says “there is no regular publication of high-quality data for those other

Youth take a liking to Kooth Elaine Bousfield, a community worker and therapist who works with young people and adults with mental health needs, set up XenZone in 2001 "because I really felt the internet was going to change the way we deliver care".

Now XenZone's Kooth online emotional wellbeing, counselling and support service for children and young people is being commissioned by 40% of CCGs in England.

“Digital is able to reach young people at scale – last year we had over 55,000 Cyp (children and young people) and we have a ready-made system in place with case notes, outcomes (goal-based and session-by-session) and also peer support and self-help content channels,” says Bousfield.

“It’s all about easy access and early intervention. Buying a Kooth service is massively economical as well. It costs less than the price of one hospital admission.”

Easy and anonymousLogging onto Kooth is simple. First, potential users enter their geographical location to check their CCG is commissioning the service. Users can stay anonymous at the point of entry and only need enter year of birth, ethnicity and gender. They can access an online one-to-one chatroom, live discussion forums and get one-to-one confidential help from a British Association of Counselling and Psychotherapy accredited counsellor or one of the emotional

wellbeing practitioners, who can assess levels of need and suggest referral options.

Kooth offers a range of interventions including information and advice through peer-to-peer support, self-help resources, drop-in counselling sessions, regular structured face-to-face or online counselling and therapy, and liaising with other services.

“We aim for a 15-minute wait for a counsellor with a maximum of one hour says Bousfield.

“While users wait they can read self-help materials co-produced by other young people, join live moderated peer-to-peer support forums and access a goal-based journal.”

Topics covered on the website include bullying, relationships, self-harm, eating disorders, and a range of topics and issues affecting young people.

Digital approachBousfield says there has been a “sea-change in the way digital applications play a role in care”.

“It’s been hard work. We started Kooth off in 2004 with one PCT (Primary Care Trust), and expanded into Cheshire and Merseyside. We build relationships. We are continuously collaborating with local authorities, CCGs, foundation trusts, charities and other organisations to provide an early intervention solution with clear escalation and de-escalation pathways.”

The idea for Kooth was clinically and not technology led and arose from an online therapy service for adult males. “We realised that 35% of the traffic was coming from under-18s,” says Bousfield.

Bousfield hopes that greater integration between health and social care under the umbrella of Accountable Care Organisations will mean they are better placed to look at mental health needs in a strategic way.

She says the focus must remain on health inequalities and understanding more the determinants of poor mental health. But she also feels that just as the e-book has not replaced the printed word, online help “must go hand in hand with good bricks and mortar services”.

As more companies jump on the online or app-based health bandwagon she feels the market will become glutted and that it will need accreditation and regulation to separate those that have been using clinical input, from those that have not.

“You can't have health apps that are developed technically because they can and might make lots of money – instead we need to work with the NHS and ask the question what can we do to make life easier and services more accessible and safe?”

And the name Kooth? “We had all sorts of names and that was the one young people liked. They didn’t want a name with the world counselling in it. It plays on uncouth, it rhymes with youth and it’s an old Scottish word for ‘wise’.”

organisations”. The College is calling for comprehensive spending data to be published regularly by all providers of publicly-funded mental health services.

Integration, prevention and early accessDr Rajesh Nadkarni, the Medical Director of Northumberland, Tyne and Wear NHS Foundation Trust, a mental health trust providing a wide range of hospital and outpatient services, says it is vital that mental health receives the funding to meet some of the aspirations of the Mental Health Five Year Forward View. “The key themes are all about integration, prevention and early access, to avoid expensive hospitalisation.”

According to Nadkarni, particular attention is being paid to children’s mental health, new mothers, the elderly and people with long-term conditions. “If we deliver appropriate mental health care in the first year after pregnancy and birth, the outcomes are much better for the mother, the child and society. Likewise, if we deliver timely integrated care (dealing with mental and physical needs) for people with long-term conditions like diabetes or COPD, they are less likely to develop additional physical complications, or other more

detentions under the Mental Health Act, which police would have otherwise used for those suspected of suffering from a mental health issue, and led to more appropriate identification of services for those presenting in crisis to the police – again, it’s all about integration and partnership.”

To discuss the issues raised in this article, please contact Gill Weatherill on 0191 4044045 or gweatherill@dacbeachcroft.com

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Funding gapThe Kings Fund Fellow in Health Policy, Helen Gilburt, revealed that since 2012, funding for mental health trusts has increased by just 5.6% compared with 16.8% for acute hospitals.

Gilburt’s analysis of CQC inspection reports for mental health trusts identified an increased risk of suicide and self-harm as a result of problems with beds and staffing in more than half of trusts. Some trusts highlighted reliance on bank and agency staff, as well as ‘substitution’ of staff, for example healthcare assistants replacing registered nurses.

While the majority of Clinical Commissioning Groups (CCGs) have met their commitments to raise spending on mental health, Gilburt says the overall spending gap between mental health trusts and acute and specialist trusts has widened because national funding has focused on relieving pressure on acute hospitals. “Unless funding grows more quickly, mental health providers may end up implementing improvements to some services at the expense of others.”

Professor Wendy Burn, the President of the Royal College of Psychiatrists, says this is already happening. According to Burn, Health Secretary Jeremy Hunt made much of the extra £575 million spent by CCGs last year compared with

Unless funding grows more quickly, mental health providers may end up implementing improvements to some services at the expense of others.

If we deliver appropriate mental health care in the first year after pregnancy and birth, the outcomes are much better for the mother, the child and society.

11DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawukwww.dacbeachcroft.com/health

10#MentalHealth

When it comes to the delicate and complex issue of complaints made to the NHS, diplomacy is vital, tempered with honest, plain talking.

Straight talking is clearly a strength of the Parliamentary and Health Service Ombudsman (PHSO), Rob Behrens, who despite being in the post for just over a year has already implemented several changes.

“It’s been a tough, character-building experience,” says Behrens. It’s an honest assessment about the challenge he faced when taking on leadership of the body that independently and impartially makes final decisions on complaints that have not been resolved by the NHS in England, UK government departments, and other UK public organisations.

Behrens’ predecessor, Dame Julie Mellor, had previously resigned and Behrens says: “I joined an organisation that had lost its two senior leaders, where staff morale was low, where the office had lost contact with colleagues in the Ombudsman world and other key stakeholders, where too many complainants were unhappy with their experience, and where we were confronted with a 24% budget cut over three years.”

In partnership with his Chief Executive Amanda Campbell, progress has been made.

“We have devoted an enormous amount of time on engaging with staff on a daily basis, individually and collectively. We have invested hugely in staff

INTERVIEW

Rob Behrens, Parliamentary and Health Service Ombudsman, tells Adrian O’Dowd how he wants to enhance the role of Ombudsman as a last resort for unresolved complaints by shortening the process time, being more transparent, and promoting what he considers to be a ‘national asset’.

Problem solver

training and development. We have clarified our core role as an independent Ombudsman service, with morale improving significantly.

“We are now more of an open-faced organisation. We have open meetings, launched Radio Ombudsman – a regular podcast featuring conversations on various topics – and have reconnected with the Ombudsman world.”

A new user-friendly, more effective case handling process for complainants has also been introduced. It puts them at the forefront of the process to ensure better communication.

Experience into practiceBehrens came with considerable experience of investigating allegations of public service failure. Previous roles include Complaints Commissioner at the Bar Standards Board and Independent Adjudicator for Higher Education (Office of the Independent Adjudicator) in England and Wales.

With the Ombudsman office currently in the middle of a three-year budget reduction of 24%, Behrens has faced some tough decisions.

Staff numbers have been cut by 13% as a cost saving measure, he says, adding: “We have moved our operations to Manchester saving a huge amount of money on releasing property in London. We have reduced our staffing by 60, which has been painful but necessary, and now we are in a strong position to deliver the required spending cuts.”

We are now more of an open-faced organisation. We have open meetings, launched Radio Ombudsman – a regular podcast featuring conversations on various topics – and have reconnected with the Ombudsman world.

13DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawukwww.dacbeachcroft.com/health

12#PHSOstrategy

Asked what he has found most rewarding during his first year in office, Behrens says: “Closing cases that have been unresolved for too long and also meeting bereaved and distressed complainants and listening to their experience.”

He is also proud of publishing two insight reports – one on anorexia and one on general mental health provision.

“When I joined, it was an organisation in transition, which was not performing well. It wasn’t clear what its core role was anymore. My aim was to create an organisation that reflects the Ombudsman DNA – meaning being independent of bodies in jurisdictions, but also of complainants.”

Strategic goalsBehrens’ plans for the future are encapsulated by a new strategy. “The strategy is necessary because there was a lack of clarity in the organisation about the relative status of complaint handling on the one hand, and doing insight work on the other.

“The core role of the Ombudsman service is to resolve complaints as effectively as possible. Out of that come the insight reports building on the experience of handling complaints.

“The strategic plan addresses that. We want to introduce techniques that are

used in other Ombudsman services like early resolution of cases, or mediation.

“That will shorten the time it takes to resolve a complaint, but also we have to be more transparent in all that we do. Over a period of time, we will publish summaries of everything that we adjudicate on in the course of a year.”

Behrens is determined that more complaints should and could be dealt with locally before they reach his office. “We get around 120,000 calls a year from people asking for help and we get 30,000 complaints. Many of these should be resolved on the frontline in the health service and public administration.

“Complaint handlers, particularly in the health service but also more widely, are desperate for status, for support, for recognition and for help in developing more effective methods in dealing with complaints.

“We will work with bodies in jurisdiction to help them resolve complaints more effectively. It’s very difficult for them [complaint handlers] in a culture that gives primacy to professional clinicians. Challenging clinicians in a constructive way is a skill and they need support and advice about how to do that.”

The work of the Ombudsman office must maintain a balance between recognising the good work that the NHS does and ensuring that mistakes are dealt with appropriately, Behrens explains.

“When you go out and visit nurses on wards and talk to clinicians and patients, you realise what a magnificent achievement the NHS is.

“But there is no doubt that this is a service under extreme pressure. We have an increasingly elderly population, an under-resourced sector as far as mental health is concerned (see page 8), and we have historic problems of resourcing professional posts in particular areas of the NHS.

“These are big issues and it means there are detriments to individuals and things that need to be done better. But we must do it in a way that doesn’t undermine the morale of the good people who are providing a public service.”

Rise in complaintsIn 2016-17, the Ombudsman service handled 31,444 complaints and investigated 4,239 cases. During 2016, it completed 835 investigations into potential avoidable deaths in the NHS in England, of which 368 were fully or partly upheld.

The office’s workload appears to be growing and in September of last year, NHS Digital data showed that the number of written complaints about the NHS increased by 4.9% (208,400) on the previous year. Behrens believes this trend could continue.

“The demographics mean that it’s likely there will be a rise in complaints over a period of time. What worries me is that there are sectors of users in the health service who don’t complain as much as they might do, such as older people or people with mental health challenges.

“We found that too many people feel they will be victimised when they are elderly if they make a complaint.”

Work is also needed to improve the public’s knowledge and perception of the Ombudsman office. “Only around 22% of the public in surveys are aware of the existence of the National Ombudsman,” says Behrens.

Last resort“I have a responsibility to promote the role of the Ombudsman, explaining very carefully to people that we are not there to be their champions, but to impartially investigate their complaint with empathy.

“We have to work with those bodies [local NHS organisations] to make sure

that they can resolve as many cases as they possibly can, but in terms of good practice, it is a national asset to have a last resort for complainants who can come to us if they have exhausted the frontline service and don’t get the remedy they think they deserve. There should always be that opportunity for people.”

The Government’s plans for a single Public Service Ombudsman (PSO) role, that would combine the current local government and social care Ombudsman office with his role, is welcomed by Behrens.

“Even before I came here, I argued in favour of it,” he says. “I am disappointed that the implementation of the legislation has been put on hold. It may be a number of years before we actually get it.

“We need it because it’s not sensible to separate health and social care in the way that it is currently. We have very close and cordial links with the local government Ombudsman, but we need a new, joined-up institution that can effectively deal with those cases holistically.

“We need new powers for the Ombudsman. Around the world, most Ombudsmen have the right in exceptional circumstances to look at cases or issues where there hasn’t been a specific complaint. We should have that power.”

Self-confidence at the Ombudsman office appears to be returning.

INTERVIEW

We found that too many people feel they will be victimised when they are elderly if they make a complaint.

Complaint handlers, particularly in the health service but also more widely, are desperate for status, for support, for recognition and for help in developing more effective methods in dealing with complaints.

BiographyRob Behrens, CBE is the Parliamentary and Health Service Ombudsman, Chair of ENOHE, the European Network of Ombudsmen in Higher Education, and a Visiting Professor at University College London. Previously Behrens has served as Independent Adjudicator for higher education in England and Wales and Complaints Commissioner to the Bar Standards Board of England and Wales. Behrens’ earlier career in the Civil Service included three years as Secretary to the Committee on Standards in Public Life and notable work on the South African transformation from apartheid – a role for which he was thanked personally by Nelson Mandela.

The 2016-17 Ombudsman in numbers:

31,444 complaints handled

+4.9% increase on previous year in number of written complaints

22% of surveyed public who are aware of its existence

4,239 cases investigated

835 investigations into potential avoidable deaths in the NHS in England (368 fully or partly upheld)

The Ombudsman’s Annual

Report and Accounts 2016-17

15DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawukwww.dacbeachcroft.com/health

14#PHSOstrategy

Changing landscapes

In the 56 years since the 1962 Hospital Plan for England, NHS infrastructure has hardly changed, despite the shifting political and social landscape.

In the past couple of years – especially with the impetus of the Five Year Forward View – the Government has commissioned successive investigations to see how the estate can be evolved; and indeed how these changes can potentially generate both revenue and useful social purpose. The most recent, produced by Sir Robert Naylor and published in March 2017, received its response from the Department of Health and Social Care this January. But what does this mean in practice?

Call and responseThe Naylor report set out to develop a new NHS estate strategy supporting the delivery of specific Department of Health and Social Care (DHSC) targets to release

£2 billion of assets for reinvestment, and to deliver land for 26,000 new homes. It makes 17 recommendations falling into three categories: 1) Improving capability and capacity, to

support national strategic planning and local delivery

2) Encouraging and incentivising local action

3) Funding and National Planning The Government response to the

Naylor report, published in January 2018, sets out its own detailed programme of actions (see box), to be overseen by a new NHS Property Board. One key principle is allowing NHS organisations to retain receipts from land sales, as long as they are reinvested in the NHS estate to deliver local priorities and Sustainability and Transformation Plan (STP) strategies. There will be support for the NHS in developing its surplus land for homes for

NHS ESTATES

A new NHS estate strategy is underway. Radhika Holmström asks what will this mean in practice and examines the impact these proposals might have.

17@healthlawukDAC BEACHCROFT / HEALTH ADVISER / ISSUE 18www.dacbeachcroft.com/health

16#NHSestates

its own staff as well as housing for sale, and to realise £3.3 billion of additional capital from the disposal of surplus land, holding trusts to account against locally developed and agreed targets.

New drivers, new vehiclesOne of the key debates arising from these new developments is how organisations can be incentivised and enabled to work together, explains DAC Beachcroft Partner Anne Crofts. “We’re looking at how best to bring together public sector organisations to optimise the value of their estates, whether for new housing projects, new community facilities for health and social care, or other similar uses.”

Crofts continues: “One of the issues we are looking at is how closely different bodies can come together to create new entities, for instance, limited liability partnerships, to create the vehicles that can optimise the development of assets

However, not everyone is convinced that this will achieve the intended result. The New Economics Foundation warned, in a report also published this January, that four out of five such homes will be out of reach of a nurse on an average salary. In London, across all areas, none of the homes for sale will be affordable to NHS key workers, including nurses and midwives. The NHS Confederation has also argued against the Naylor and Government proposals, suggesting that instead of private development, land should be released using seed money from the NHS Homes Fund, which could also be used to fund other developments.

“There’s also public debate as to what amounts to privatisation and what doesn’t,” says Crofts. “We’re acting for a number of NHS trusts that have set up their own subsidiaries to provide estates and facilities services. That’s known as insourcing (setting up their own vehicles through which to provide the service); it gives some commercial flexibilities, but remains wholly owned by the NHS parent. There is some public consternation about this as being a ‘first step to privatisation’ but the intention is generally to establish a vehicle that enables greater commercial efficiencies while remaining within the NHS, with appropriate governance and controls, and in a context where everyone is demanded to make efficiencies.

“These are also potentially appropriate vehicles for greater collaboration between public sector organisations at scale. The alternative is often seen as complete outsourcing of the service to the private sector; is this a more appropriate middle ground?”

Instead, Crofts suggests we need a proper debate on the best model for

or indeed third-party investment. Even in the NHS not all organisations have the legal powers to make such investment. That can mean you have to fall back onto contractual arrangements, and the governance of those can become unwieldy. Local authorities are further down the line in terms of these deals and have more of a track record. Therefore one possibility is to bring local authorities, private sector and NHS organisations together to tackle the political and legal issues involved.”

Notes and queriesOne of the most urgent questions – especially in London – is whether the plans will also result in affordable housing for NHS employees. The intention is that in those areas where affordable housing can be developed, NHS staff should be offered a right of first refusal.

collaborating with the private sector. “It’s inconceivable that the private sector will cease to have a role, but what should that relationship look like? And what is acceptable in terms of returns to the private sector?”

Key coordinatesWider collaboration in the public sector also poses some challenges, Crofts adds. “There are some legal hurdles. Local authorities and NHS bodies still operate under separate legislative regimes. The Government Response to Naylor has confirmed that NHS trusts will be able to benefit from sales of surplus land (Foundation Trusts are legally entitled to retain proceeds), and these can be reinvested in line with STP plans but, so far, there’s very little detail as to how this is to be applied in practice. What does that look like, if the trusts who are disposing of this land are not going to benefit directly? How will that be applied? There is still a lot of detail to be worked out and we need to see individual STP plans.”

Crofts points to the loss of contract management and commercial management skills, especially with the fragmentation of structures over the past ten years, a skills gap that is also highlighted in the

Naylor Report and the Government Response. “We no longer have strategic health authorities, CCGs are quite small, and commissioning and provision are now separate. Estates strategy and skill sets are similarly fragmented. The Report points to plans to make resources available, but it has to be acknowledged that there has been this loss that may take time to redress.”

Crofts concludes that part of the solution is probably to work across the

NHS ESTATES

The Naylor report plans in summary• Build capability and capacity in strategic estates planning and management

across the system, including: – an NHS Property Board – a strategic estates planning service – training, development and specialist support and guidance

• Invest in estates transformation and align it with wider sustainability and transformation, including:– £3.9 billion of additional capital by 2022/23– a pipeline of capital investment projects – reviewing the rules on NHS trusts' use of capital funding

• Enable local NHS organisations and STPs to take a more strategic approach to estates planning and management, including:– allowing NHS organisations to retain receipts from land sales – encouraging participation in the One Public Estate programme – supporting the NHS to develop surplus land for NHS staff and other

residential housing– supporting the NHS to realise £3.3 billion of additional capital from the disposal

of surplus land

One Public EstateOne of the Government recommendations is that STPs and NHS providers be encouraged to work with local Government and other public sector organisations as part of the One Public Estate (OPE) programme.

The vast majority of local authorities in England have signed up to this programme, which is delivered in partnership by the Cabinet Office Government Property Unit (GPU) and the Local Government Association (LGA). It provides practical and technical support and funding to councils to deliver ‘ambitious property-focused programmes’ in collaboration with central Government and other public sector partners. The intention is that through OPE, land for 25,000 new homes will be released by 2020; and the programme also plans to create 44,000 new jobs and deliver £615 million in capital receipts for public services, in addition to cutting running costs by £158 million.

“It’s an excellent idea, which I think could be used more widely by other public bodies,” says Dean Parrett, Senior Associate at DAC Beachcroft. “A lot of these other bodies have surplus land, and this is a good way to meet the Government’s aim of developing extra housing.”

The Royal Surrey County Hospital NHS Foundation Trust is one body that has achieved notable success in this area in partnership with social housing and local authorities, because land swaps have enabled the Trust to free up its own site for development with a housing association. Parrett adds: “We have, for example, another two neighbouring hospital trusts that are exploring the option of combining forces to put neighbouring surplus land up for developing housing, both for staff and for the wider public. Part of the land is owned by one Trust and part by another, but combining the two will maximise its use. It also means they will be able to generate the maximum receipt.”

To discuss the issues raised in this article, please contact Anne Crofts on +44 (0)20 7894 6531 or acrofts@dacbeachcroft.com

i

Anne CroftsWe’re acting for a number of NHS trusts that have set up their own subsidiaries to provide estates and facilities services.

different boundaries dividing the sectors, and within those sectors, different types of organisation. “It could be that creating these new vehicles, which help collaboration and coordination, acts as a catalyst for developing new centres of excellence.”

19DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawukwww.dacbeachcroft.com/health

18#NHSestates

FREEDOM TO SPEAK UP GUARDIANS

The establishment of a network of Freedom to Speak Up Guardians across the NHS was one of the key recommendations of

Sir Robert Francis’ Freedom to Speak Up review. It was precipitated by the findings of his earlier investigation into the failings at Mid-Staffordshire hospitals.

According to the annual report of the National Guardian's Office, published in October last year, nearly 4,000 members of NHS staff have spoken to their Freedom to Speak Up Guardians, raising over 1,000 patient safety issues.

Corinne Slingo, Partner at DAC Beachcroft, says that whilst the Guardian is a nationally recognised role, each organisation is approaching the job, and the way it is delivered, slightly differently.

“Within larger NHS organisations in particular, we have seen some blurring of lines between this important role and the other routes to raise concerns, including within HR processes. This can prove challenging to navigate, but that is more about the Guardian being clear on the scope (and limits) of the role than a problem with the role itself, and should be easy to resolve.”

Slingo feels that the ‘ultimate test’ is whether the role shows a demonstrable shift in culture and delivers an associated impact on patient safety. “Realistically the Guardian role remains but one of a selection of patient safety initiatives and cultural game changers introduced post Francis, which collectively are improving patient safety culture across the sector,” she concludes.

Understanding the role“Am I a friend or trouble maker? I was picked because I was seen as a person of trust and integrity who may not be the bringer of the best news.” So says Dr Judith Graham, the Deputy Director of Organisational Development at Rotherham, Doncaster and South Humber NHS Foundation Trust, the trust’s Freedom to Speak Up Guardian.

She describes the complexities of interactions where a concern has been raised. “Some people get defensive, feeling they are being accused of being a failure as a manager, asking ‘why did my staff come to you not me?’ It’s important to offer support to those who are being complained about as well as those who make the complaint.

There are now some 500 Freedom to Speak Up Guardians, Champions or Ambassadors working across the NHS and independent sectors in England to help staff raise concerns when things are going wrong. Mark Gould asks, are they perceived as critical friends or enemies within?

“Some parts of the NHS feel ashamed that there is a need for Guardians, that it’s not a good thing to admit, and engaging more means more conflict. But is that a bad thing if it is managed well?”

Graham stresses she does not want to build a power base. “We always tell people there are many ways of raising concerns; managers, unions, the Care Quality Commission (CQC), and Guardians are one part of that suite.”

When deemed necessary, Graham works to ascertain any immediate patient safety concerns. “If there is a nursing issue the Director of Nursing would look into it under the guise of a mock CQC inspection, if we need to maintain confidentiality. If not, we work with the complainant and their manager in an open and transparent way to gain a resolution.”

Concerns fall into two categories: patient safety, and staff bullying. “People seem happier raising patient safety concerns with managers, and come to us with bullying. They can raise concerns anonymously or confidentially, or they can be raised completely openly.”

Graham continues: “It’s made clear to complainants that, as a result of an issue being raised, their own competence could be questioned depending on what the complaint is about – and that could have repercussions. All we want all of the time is for any concerns to be raised so we can act on them immediately and provide the best care possible for our patients and staff.”

Graham says that a background as a Mental Health Nurse helps when dealing with traumatic situations. The trust suggested her for the Guardian role and she was appointed after an interview process.

She hopes the system helps put staff at ease about raising concerns. “People need to feel confident to talk so I have recruited Guardian Advocates who come from all sorts of grades, disciplines, ages and genders. If the complainant doesn’t want to talk to me, they can speak to someone else that they do feel more comfortable with.”

Dealing with actual concerns makes up just 5 to 10% of Graham’s work. “The rest is being a visible leader, championing the ability of others to raise concerns and breeding a safety culture. I walk about the trust, I wear the Guardian lanyard, there are posters and banners about Guardians across the sites.”

Graham has had training around legal and HR issues and more is being developed by the National Guardian’s Office.

“Some people come to see me because they have a concern, others come because they don’t want to see their line manager as they may be ashamed that they are not coping or working well enough,” says Graham. “My role is to either support them through this or for one of my Freedom to Speak Up advocates to offer them the necessary support.”

Independent approachTracy Ruthven has been the Freedom to Speak Up Guardian at Rainbows Hospice for Children and Young People in Leicestershire for over a year while holding down a full-time job in clinical audit. She is not employed by Rainbows but knows the hospice professionally and was approached to take on the role.

“I hope I was seen as a safe pair of hands, who understands the organisation but is not part of it. I think that is a good thing, it keeps me independent and hopefully staff find that helpful.”

The National Guardian’s Office doesn’t train non-NHS bodies such as Rainbows, which is a charity, so Ruthven has linked up with local NHS Guardians to swap information and share good practice.

“This is a relatively small organisation and I haven’t encountered any legal or HR obstacles so far. The fact that it is so small

means I have direct access to the Board of Trustees when needed.”

She will not reveal the actual number of cases for concern she has received, although she says it’s “relatively small”, which she feels might be a consequence of this being a hospice.

Each month, Ruthven lets Rainbows know she is coming and spends the day walking around meeting people.

“Sometimes I am approached for a direct chat and sometimes asked for a private meeting. Should a safeguarding issue be raised, we have to move that forward in a more formal way with senior management.”

Rainbows has also appointed two members of staff as Freedom to Speak Up Champions who can feed back concerns to Ruthven. The organisation has its own established systems for monitoring its services and for raising issues.

That said, Ruthven feels the Guardian concept adds a valuable additional dimension and says she has developed the mantra “we will walk with you to get to resolution.” “That means that where someone raises an issue they have to maintain ownership. They can’t just leave it with us and walk away. If that’s made clear it tends to mean that malicious complaints are avoided.”

Ruthven feels it’s ‘an honour’ to be a Guardian. “It’s brilliant to see concerns raised in a way that people are happy with the outcome. I think the Guardian movement is a force for good. It has much more positive connotations than the whistleblowing label, which I think frightened people off.”

Corinne Slingo Whilst the Guardian is a nationally recognised role, each organisation is approaching the job, and the way it is delivered, slightly differently.

To discuss the issues raised in this article, please contact Corinne Slingo on +44 (0)117 918 2152 or cslingo@dacbeachcroft.com

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www.dacbeachcroft.com/health

20#FreedomToSpeak

Permission to speakI hope I was seen as a safe pair

of hands, who understands the organisation but is not part of it.

21DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawuk

NHS organisations are all required to consider the efficiency of their contracting arrangements in line with

the Carter Report recommendations. The collapse of Carillion in January this year brought the issue of contractor financial viability into sharp focus and, although NHS contractor insolvency has been a relatively rare occurrence, Carillion has caused many organisations to question the risks of outsourcing support services and what their options are if a contractor goes bust.

Firstly, where a supplier ceases to be able to provide services, the contract remains relevant and needs to be reviewed to understand the contracting authority's rights in this situation; including whether it will automatically terminate due to the triggering of an insolvency event, or whether the authority has proactively to notify the special manager of its intentions and/or to exercise step-in rights.

Where a service provider, as part of a larger consortium under a PFI scheme (such as Carillion was), collapses, then the responsibility for their replacement will principally be governed by the PFI Contractor’s relationship with them through the FM Contract (and associated parent company guarantee). However,

under the terms of the Project Agreement with the PFI Contractor, consent to any appointed replacement is likely to be required. It’s therefore sensible to enquire of your PFI Contractor what steps they have in place for this.

In the wake of the Carillion collapse, a number of their employees were members of a workplace ‘defined contribution’ pension plan, which wasn’t affected by the firm’s liquidation. Most (around 28,000 employees) belonged to one of Carillion’s 13 ‘final salary’ pension schemes, which are very likely to pass into the Pension Protection Fund (PPF) – in this instance this will happen automatically following the appointment of Insolvency Practitioners without NHS trusts having to take any steps. Former members who have already retired, will continue to receive 100% of benefits due, whilst staff who retired early or are still working will end up getting around 90% of what they are due, subject to an annual cap.

In an insolvency situation, the rules applying to the application of TUPE and, to an extent procurement, can be relaxed in certain circumstances to facilitate the transfer. In relation to TUPE, these relaxations may not apply where an insourcing or recontracting occurs. In any event, the key issue for NHS bodies is likely to be around preserving service continuity,

and this is likely to mean respecting employees’ existing terms and conditions.

Some NHS trusts are considering whether bringing services back in house can be a more cost effective option in the longer term, or trusts may decide to establish a shared service with other public sector organisations including through subsidiary companies with shared ownership across multiple NHS organisations/STP footprints. These models potentially provide the trusts with opportunities to benefit from greater commercial flexibilities for the relevant teams. Subsidiary companies can offer the governance model of a separate entity, whilst retaining the benefits of NHS ownership.

The collapse of Carillion has forced all industries to take a look at how they outsource, including the health sector. NHS bodies should be prepared in case a contractor goes bust.

Anne Crofts, Partner, Commercial Health

To discuss the issues raised in this article, please contact Anne Crofts on +44 (0)20 7894 6531 or acrofts@dacbeachcroft.com

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…the key issue for NHS bodies is likely to be around preserving service continuity, and this is likely to mean respecting employees’ existing terms and conditions.

IN PRACTICE

www.dacbeachcroft.com/health

22@healthlawuk

Meet the expertsDAC Beachcroft is one of the largest health commercial law firms in the country, advising public and private healthcare providers and NHS commissioners. With one of the UK’s most experienced and forward-thinking health advice and clinical risk teams, we offer a comprehensive, integrated legal service from a business perspective to healthcare providers and commissioners. The following are some of our experts quoted in this issue. For details of our other health specialists, visit www.dacbeachcroft.com/health

Nigel Montgomery Sector Head of Health; Partner, Healthcare & Clinical Risk Specialist areas Clinical negligence, health and social care, NHS medical law, private clients and Trusts, risk management

Nigel acts on behalf of public and private sector clients in the UK and Ireland, advising on risk and claims. He has long experience of handling clinical negligence claims and

particular expertise in cases involving multiple claimants.

+44 (0)117 918 2321 / nmontgomery@dacbeachcroft.com

Anne Crofts

Partner, Commercial HealthSpecialist areas Commercial law, NHS restructuring, governance, procurement, joint ventures and PPP, data protection and privacy

Anne advises public and private sector clients on commercial contracting, specialising in the health sector, particularly major procurements, joint ventures and partnering, shared services and restructuring. Anne also advises on R&D and is an expert in data protection of health informatics.

+44 (0)20 7894 6531 / acrofts@dacbeachcroft.com

Jonny LandauPartner, Healthcare Regulatory Specialist areas Healthcare regulatory, inquests, safeguarding investigations, commissioning advice

and conflict resolution, criminal and regulatory investigations, Tribunal appeals

Jonny specialises in advising health and social care providers in connection with regulatory investigations and has particular expertise in CQC, inquests and commissioning. He has significant expertise in relation to care homes.

+44 (0)117 918 2753 / jlandau@dacbeachcroft.com

Charlotte BurnettPartner, Commercial Health Specialist areas Commercial law, contracting, integration projects and primary care

Charlotte advises health sector organisations on a wide range of commercial and contracting issues. She specialises in integration within the NHS and between the NHS and independent providers. She is an expert in primary care, advising national and local NHS organisations on major national primary care policies, strategy, procurements, commissioning arrangements and disputes.

+44 (0)113 251 4785 / ckburnett@dacbeachcroft.com

Gill WeatherillPartner, Healthcare Regulatory Specialist areas Healthcare & regulatory law, mental health, capacity, consent and deprivation of liberty, clinical governance and patient safety,

inquests, information governance

Gill advises health and social care providers on the legal and regulatory framework governing the delivery of safe patient care. She has particular expertise in the areas of mental health law, capacity and consent, inquests, patient safety and information governance; and represents healthcare bodies in complex Court of Protection, High Court, and Tribunal proceedings.

+44 (0)191 404 4045 / gweatherill@dacbeachcroft.com

Dean ParrettSenior Associate, Real EstateSpecialist areas Real estate, development, health and public sector

Dean has wide experience in all aspects of real estate and advises health sector clients on matters such as landlord & tenant, development, sales, acquisitions, LIFT schemes, PFI and rationalisation.

+44 (0)20 7894 6057 / dparrett@dacbeachcroft.com

Corinne SlingoPartner, Healthcare Regulatory and Public Law Specialist areas Healthcare & regulatory law, clinical governance, regulator relationship, Serious Untoward

Incident management, board assurance and risk, inquests, information governance

Corinne advises on healthcare and regulatory law, from patient care/consent to statutory powers and regulator relationships, particularly CQC. Her work includes advocacy in inquests, judicial review, risk assessment and governance. She also assists with capacity issues, consent and ethical dilemmas.

+44 (0)117 918 2152 / cslingo@dacbeachcroft.com

23DAC BEACHCROFT / HEALTH ADVISER / ISSUE 18 @healthlawuk

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