West Midlands Corporate Governance Network, May 2018, Birmingham, Browne Jacobson.

1. West Midlands Corporate Governance Network
May 2018

2. West Midlands Corporate
Governance Network
18 May 2018

3. CCG Mergers and Joint Working
Gerard Hanratty
Partner

4. Merger process & timetable
• NHS England guidance – November 2016
• CCGs have legal right to apply for a merger
• Engage at an early stage with NHS England DCOs
• Single application by all CCGs to NHS England Regional Director
• Must demonstrate how 11 tests are met
• Involve member practices and stakeholders (e.g. LA, Healthwatch)
• Public consultation?
• Timescale – apply by 31 July for merger on 1 April following year

5. Merger - factors to be considered
• Co-terminosity with local authorities
• New CCG to remain clinically led
• Financial management and controls
• Arrangements with other CCGs
• Arrangements for commissioning support
• Strategic purpose – more logical footprint for delivery of local STP?
• Prior collaboration
• Leadership support from STP / GBs
• Is the proposal future proofed?
• Ability to engage with local communities
• Optimisation of administrative resources

6. The Commissioner legal Can
do’s….
• Share and/or delegate commissioning (and associated)
functions
 Internal Committee or Individual
 Another CCG
 NHS England
 Local Authority or Combined Authority or s.75 (sometimes)
• Create Joint Committees
• Get other’s to support management of functions
• Create regional and place governance systems
• Share senior appointments with CCGs and LAs

7. … and legal Can not's
• Delegate any function to a provider organisation
• Delegate any function under a s.75 arrangement to
a joint committee for joint decision making
• Have local politicians on the governing body
• Share senior appointments with providers (? –
consider what conflict arises)
• Ignore choice and competition
• Politics – changing picture…………

8. Questions and Thank You
Gerard Hanratty -
Gerard.hanratty@brownejacobson.com
DD: 0330 O452159 / Mob: 07921 685815

9. Section 75 arrangements
Rachel Whitaker

10. Section 75 arrangements
• Section 75 NHS Act 2006:
– allows “prescribed bodies” (local authorities and
NHS bodies) to enter into “prescribed arrangements”
for “prescribed functions” if the arrangements are
likely to lead to an improvement in the way those
functions are exercised; and
– for regulations (NHS Bodies and Local Authorities
Partnership Arrangements Regulations 2000) to be
made in connection with the provision of those
arrangements.

11. Section 75 arrangements
• Powers permit:
– the creation of pooled funds;
– the exercise of NHS Functions by local authorities
and Health Related Functions by NHS bodies, (NHS
trust, NHS FT, a CCG or NHSE); and
– the provision of staff, goods or services and the
making of payments between the two partners in
connection with the above.

12. Section 75 arrangements
• Although section 75 and the Regulations are
permissive and allow for maximum flexibility, the
Regulations require that section 75 agreements
include specific content e.g. contributions to be
made to any pooled fund, host and aims and
outcomes.
• Powers can be used together or separately – for
example can have one partner commissioning
services for both – but separate budgets.

13. Why so topical?
• Better Care Fund arrangements
• The integration agenda

14. What makes a good section 75
agreement
• Trust and a common understanding of the aims and
objectives of what the partners want to achieve
• Clear written agreement – which actually reflects
the common understanding of the parties
• Clarity of roles and responsibilities
• Clarity regarding financial contributions and what’s
covered and what’s not
• Robust and transparent monitoring

15. Risks of section 75 agreements
• Different cultures and accountability structures
• Differing agendas
• Lack of common understanding
• Poor planning for failed initiatives

16. Risks cont…
• Use of any pooled fund
• Overspends/underspends
• Staffing arrangements:
– TUPE
– Secondments

17. Risks cont…
• Clear governance arrangements
• Clear and measurable KPIs
• Clear underpinning contracting arrangements

18. Any questions?
Rachel Whitaker -
Rachel.whitaker@brownejacobson.com
0115 976 6538 / 07920 257152

19. The Integrated Support and
Assurance Process (ISAP)
Jonathan Hayden
18 May 2018
www.bjhealthlawyers.com

20. Content
• What is the ISAP and what is its purpose?
• To whom and when may the ISAP apply?
• 4 key checkpoints
• Timeframe of the ISAP process
• Key Lines of Enquiry (KLOEs)
• Overview of checkpoints
• Handy tips

21. What is the ISAP?
• ISAP is the joint NHS England and NHS Improvement
assurance process for novel and complex contracts
• Introductory guidance published in November 2016
and final guidance issued in Summer 2017
• Three parts to guidance:
– A) Introduction to the ISAP
– B) Questions and submissions at each ISAP stage
– C) Guidance for providers that are looking to bid

22. The Purpose of the ISAP
• The guidance has been developed partly in
response to the collapsed contract commissioned
by the Cambridgeshire and Peterborough CCG with
Uniting Care Partnership in 2015
• Identified 7 key lessons:
1. The service design needs to be right from the outset
2. Cost information that legacy providers share with
commissioners must be transparent

23. The Purpose of the ISAP
3. Commercial skills and awareness will be needed
4. Commissioners need to be clear on the role of
external advisors and ensure that sufficient expertise is
provided. The advice from different external advisers
needs to be corroborated and the proposal should be
consistent with the advice given
5. Appropriate terms should be agreed at the start of
the procurement process
6. Contract award and/or commencement of service
delivery should be delayed if issues are unresolved

24. The Purpose of the ISAP
7. NHS Improvement and NHS England should scrutinise
the arrangements for these complex contracts through
an integrated process.
• The ISAP has two overall purposes:
o to support the work of local commissioners and providers
in creating successful and safe schemes, and
o to provide a means of assurance that this has happened.

25. To whom does the ISAP apply?
• The ISAP applies to commissioners procuring novel
and complex contracts
– CCGs
– NHS England
• Also relevant for providers as it will affect
procurement processes in which they are involved,
and NHSI’s transaction review will form part of
ISAP for relevant transactions

26. When may the ISAP apply
It should be considered for all complex procurements –
eg:
• where contract forms, risk sharing arrangements, or
the calculation of the contract value are taking an
approach previously unused in that locality
• potential providers are proposing to create legal
entities involving new organisational forms
• services are being integrated along a care pathway
• population-based payments / significant outcome-
based payments are being used

27. When may the ISAP apply
Factors to be considered:
• Contract value (proportion of commissioners’
allocation)
• Contract length
• “Commissioner quality”
• Degree of performance-based income
but ISAP will only apply where there’s a procurement, so
alliancing arrangements likely to fall outside

28. Procurement lifecycle and ISAP
checkpoints (NHSE/NHSI diagram)

29. The 4 Key Checkpoints
Early
Engagement
• EE meeting takes place while a commissioner is developing a
strategy which involves the commissioning of a complex contract
Check point
1
• Checkpoint 1 takes place just before formal competitive
procurement or other selection process begins
Check point
2
• Checkpoint 2 takes place when the Preferred bidder is identified
but before contract is signed
Check point
3
• Checkpoint 3 takes place before service commencement

30. ISAP checkpoint timescales
Early
engagement
1week
Check point 1
1 month
Check point 3
1 month
Check point 2
3 months

31. Key Lines of Enquiry (KLOEs)

32. Governance arrangements
• At each check point, submissions from commissioner(s)
must first be assured by their respective governing
bodies
• Expected that commissioners will seek from
independent providers assurance that all submissions
have been agreed by their board
• Decision whether to procure / award still for local
commissioners (views of NHSE/NHSI are “key
consideration” and commissioners must take actions
required in checkpoints outcomes before proceeding)

33. Key Lines of Enquiry (KLOEs)
• Lots of useful information in Part B of the ISAP
guidance (51 pages!)
• The guidance summarises for each stage:
– Aim of that stage
– Timings
– Potential Sources of evidence
– Output / areas of focus
• KLOEs will affect commissioners (and NHS providers
in checkpoint 2 and 3)

34. Early engagement
• Aim – determine if ISAP applies; understand
arrangements, procurement timetable, agree ISAP
timetable for checkpoints and confirm sources of
evidence etc
• Timing – when commissioner(s) developing strategy
and before any engagement PIN has been issued
• Sources of evidence – prospectus, business case or
similar document; draft “engagement PIN” (if any);
explanation of intended process, timeline etc

35. Checkpoint 1
• Aim – establish if good strategic solution for local
economy; determine that necessary preparatory work
has been completed
• Timing – before formal competitive procurement or
other selection process
• Sources of evidence – about fifteen items listed! – eg
business case; financial model/analysis; description of
gain/loss share or outcome arrangements, procurement
plan; draft contract; ITT; reassurance that lawyers
engaged who have advised on all relevant matters etc

36. Checkpoint 2
• Aim – establish if final contract terms agreed and
whether procurement process followed; ensure
commissioner and provider have capacity to deliver
• Timing – when preferred bidder identified, but before
contract signed
• Sources of evidence – builds on CP1 plus others – eg
final contract set; evaluation report; summary of
external expert advice; updated risk register and
contingency plan; system financial model; summary of
key legal advice on compliance with procurement law

37. Checkpoint 3
• Aim – establish if any changes since contract awarded;
mobilisation plans successfully implemented; ensure
provider and commissioner ready for service delivery
• Timing – just prior to service commencement
• Sources of evidence – builds on CP2 plus others – eg
contract management plan; summary of key legal
advice on mobilisation/implementation; evidence of
clinical oversight and sign-off that services safe to go
live; licensing documents; minutes of governing body /
programme board meetings; risk register etc

38. Handy tips
• Speak to NHS England before the Early Engagement
• If in doubt whether ISAP applies, speak to NHSE
• Know who the regional/centrals contacts are
• Keep an open dialogue with NHS England
throughout the process
• Get sign off on your project timelines at an early
stage

39. Any questions?
Jonathan Hayden -
Jonathan.Hayden@brownejacobson.com
0121 237 4551 / 07825 616292

40. NHSE consultation on ACO
contract: update
Catherine Fawlk
18 May 2018

41. Background
• 12 week public consultation announced 25 January
2018
• Not started yet
• Suggested originally that it would start in Spring
2018 and would coincide with the timings of the
Health Select Committee’s inquiry into the
introduction of STPs

42. Consultation
• Will cover how:
– contract fits within the NHS as a whole;
– existing statutory duties of NHS commissioners and
providers would be performed under it (including
how this would work with existing governance
arrangements); and
– public accountability and patient choice would be
preserved.

43. Consultation – cont’d
• Will also:
– explain what ACOs are and are not;
– cover the terms of the contract; and
– why the contract is being proposed.

44. Update on legal challenges - 999
Call for the NHS
• Claim was that use of Whole Population Annual
Payment (a block payment mechanism) in ACO
contract is unlawful as:
– not made at national price nor in accordance with
national tariff;
– doesn’t relate to an individual treatment episode;
– encourages the price competition banished by the
Health and Social Care Act 2012.

45. Outcome of the challenge
• The High Court looked closely at national tariff and
ruled on 15 May 2018 that the use of the Whole
Population Annual Payment in ACO contract was
lawful and compatible with national tariff.
• Campaign group have said they intend to appeal
and have 21 days to decide whether to do so.

46. Update on legal challenges -
JR4NHS
• Claim alleges consultation held in Sept-Nov 2017 on
changes to regulations to allow GPs to suspend
their GP contracts for example, pre-empts
lawfulness of future consultation on ACOs and ACO
contract.
• To be heard 23-24 May.

47. Any questions?
Catherine Fawlk -
Catherine.fawlk@brownejacobson.com
0330 045 2439 / 07458 008816

48. GDPR Update
Gerard Hanratty
Partner

49. Where are we at?
• 7 days to go!!!
• Institute of Directors - 6 in 10 company directors
feel their organisation is fully compliant (poll of
700 UK bosses)
• Spiceworks (IT platform) – survey indicated 61% of
UK organisations, 46% of rest of Europe and 25% in
USA expected to be compliant by 25 May
• New guidance still being issued by ICO
• Everyone still working to be compliant

50. More ICO Guidance….
• Consent (22 March 2018)
– Sets high standard for consent
– Consent must be unambiguous and involve a clear
affirmative action (opt-in)
– Pre-ticked opt-in boxes banned
– Should not be part of a precondition of signing up,
but should be separate
• Right to be informed
– Checklists

51. And some more
• Regulatory Action Policy
– Consultation closing on 28 June
– Objectives of regulatory action
– Assessment Reports
– Enforcement Notices
– Penalty Notices
– Representations in writing and orally
– Fixed penalties – micro, small and medium
organisations

52. A salutary tale…
• Michelle Harrison – receptionist at Milton Keynes
University Hospital NHS FT
• Inappropriately accessed patient records of her ex-
partner and a woman who claimed MH then used
the information to harass her and complained to
Trust
• Trust informed ICO
• Guilty plea to two offences - £300 fine and £30
victim surcharge

53. Key Steps (1)
1. Information audit – develop Article 30 record of
processing activities, and keep this under review
2. Update policies and privacy notices
3. Ensure processes are in place to comply with data
subjects rights
4. Ensure processes are in place to secure
confidentiality of communications
5. Consider level of resource required – keep this
under regular review

54. Key Steps (2)
6. Consider whether any DPIAs are required and
take steps to complete them
7. Ensure processes are in place to be involved
properly and in a timely manner in data
processing activities
8. Consider the issue of any conflicts as and when
they arise and whether this requires
amendment to your existing role

55. Key Steps (3)
9. Publicise yourself and your role to the
organisation
10. Notify the ICO of your appointment and contact
details
11. Keep a regular eye on the development of
matters relating to the GDPR, particularly in
the period following implementation

56. Questions and Thank YouQuestions and Thank You
Gerard Hanratty -
Gerard.hanratty@brownejacobson.com
DD: 0330 O452159 / Mob: 07921 685815

57. Employment Update -
Protection of Whistleblowers in
the NHS
Helen Badger, Partner

58. Existing protection for
whistleblowers – quick recap
• Public Interest Disclosure Act 1998 – inserts
provisions into the Employment Rights Act 1996
• 2 levels of protection
– dismissal
– detriment
• Who is protected?
– Employees
– Workers
– Not applicants

59. Existing protection for
whistleblowers – quick recap
• Protection only available where the disclosure is
qualifying and protected
• Qualifying disclosure:
– Disclosure of information
– Relevant failure
– Reasonable belief
– Public interest
• Protected disclosure – identity of body to whom
disclosure made

60. Reform of whistleblowing law
• Protection for NHS workers following Sir Robert
Francis review
• Employment Rights Act 1996 (NHS Recruitment-
Protected Disclosure) Regulations
• Prohibit discrimination by certain NHS employers
(including CCG’s) in the recruitment of an
applicant on grounds that they appear to have
made a protected disclosure.

61. Employment Rights Act 1996 (NHS
Recruitment-Protected Disclosure)
Regulations
• An "applicant" - an individual who applies to an NHS
employer for:
– a contract of employment,
– a contract to do work personally,
– or an appointment to an office or post (section
49B(2), ERA 1996).

62. Discrimination under the new
regulations
• An NHS employer "discriminates" against an
applicant if:
– they refuse their application or
– in some other way treat them less favourably than
they treat or would treat other applicants in relation
to the same contract, office or post
– because “it appears to the NHS employer that the
applicant has made a protected disclosure”.

63. Remedies
• Complaint to an employment tribunal within three
months of the date of the alleged discrimination:
– from date decision is communicated
– from date by which it would have been reasonable
to act if deliberate omission
• Uncapped compensation
• Declaration
• Recommendations – additional penalties if these
are not complied with

64. Vicarious liability
• Organisations liable for actions of employees
and/or agents
• In the case of agents - employer will be liable for
where it has authorised an agent's conduct
• Employer has a defence where it can establish that
it took all reasonable steps to prevent the
discrimination

65. Action for breach of statutory
duty
• Applicant is entitled to bring a separate claim in
the County Court or the High Court for breach of
statutory duty
• Applicant can seek to restrain or prevent
discriminatory conduct
• Applicant cannot bring an action in the County
Court and the ET in relation to the same conduct

66. What does this mean for NHS
employers?
• Currently, employers only liable for acts against
existing or former employees – not applicants
• New Regulations mean that applicants are now
protected as well.
• Burden of proof on NHS employer rather than
applicant;
• Employer must prove that there has not been
discrimination

67. What does this mean for NHS
employers?
• Problems may arise where an applicant has a
reputation for being difficult/troublemaker
• Important to follow recruitment best practice:
– setting clear and specific criteria
– recording and following interview scoring
– record reasons why an application has been
rejected.

68. What does this mean for NHS
employers?
• Statutory duty
– potential for injunction proceedings to restrain or
prevent a discriminatory recruitment process
– unclear exactly how the right will work in practice.
– unlikely a court would order an NHS employer to
select a particular candidate.
– BUT court could order an NHS employer to
reconsider a recruitment decision which will cause
delay

69. Questions and Thank YouQuestions and Thank You
Helen Badger – helen.badger@brownejacobson.com
DD: 0330 0452159 / Mob: 07921 685815

70. s.117 aftercare and
commissioning for mental
health inpatient stays
18 May 2018
Neil Ward
Partner

71. What we will cover
A “whistle-stop tour” through the following:
• S.117 – what is it? – Key points
• s.117 responsibility & the 2016 changes
• Mental Health Inpatient responsibility
• Dispute resolution

72. S.117 Mental Health Act 1983
Duty found within s.117 itself:
“It shall be the duty of the clinical commissioning
group and of the local social services authority to
provide or arrange for the provision of, in co-operation
with relevant voluntary agencies, after-care services
for any person to whom this section applies until such
time as the clinical commissioning group … and the
local social services authority are satisfied that the
person concerned is no longer in need of such services”

73. S.117 After-care – key points
• Key purpose is to ensure services to reduce risk of readmission to
hospital – defined in s.117(6) as follows:
“after-care services”, in relation to a person, means services
which have both of the following purposes—
(a) meeting a need arising from or related to the person's
mental disorder; and
(b) reducing the risk of a deterioration of the person's mental
condition (and, accordingly, reducing the risk of the person
requiring admission to a hospital again for treatment for
mental disorder).

74. S.117 After-care – key points
• Triggered when patient “ceases to be detained” and “leaves
hospital” – can therefore include patients on CTO and s.17
leave
• A patient on a day trip under s.17 probably doesn’t qualify; a
patient on a month trial of home care on s.17 probably does.
• Not means-tested – a patient with a multi-million pound
personal injury settlement is just as entitled to s.117 after-
care as any other eligible patient.

75. S.117 After-care – key points
• Broad definition of “services” - can include healthcare,
nursing, social care, housing, through to spiritual and
cultural needs
• Can also be about more than meeting immediate needs –
support in regaining/enhancing skills to cope with life
outside hospital.
• Services that are not provided under s.117 are: storage of
property, housing pets, household bills, food, holidays etc.

76. S.117 After-care – key points
• Nationality, immigration status or ‘no recourse to
public funds’ has no relevance to s.117 entitlement
– these services are available regardless.
• Entitlement lasts “until no longer required”.
• Must be provided for CTO patients for the duration
of the CTO (but that doesn’t necessarily mean it’s
no longer required when the CTO ends)

77. S.117 Relationship with CHC & other funding
• Free-standing duty, distinct from Care Act funding, CHC etc.
• Para 120 National Framework for NHS CHC:
“Where a patient is eligible for services under section 117 these should be
provided under section 117 and not under NHS continuing healthcare.”
• However, a patient may still have other significant needs (e.g. for physical
healthcare) that may entitle them to other types of funding concurrently.
• Be careful not to apply CHC domains or Care Act eligibility criteria or means testing
etc. that may apply to other funding streams – these aren’t relevant to s.117.
• Bear in mind the responsible CCG / LA for s.117 may well be different to the CCG /
LA required to provide other services.

78. Responsible Commissioner – the law
• The NHS Act 2006 (as amended by Health and Social Care Act
2012)
• National Health Service Commissioning Board and Clinical
Commissioning Groups (Responsibilities and Standing Rules)
Regulations 2012 (the “Standing Rules”)
• National Health Service (Clinical Commissioning Groups
(disapplication of responsibility) regulations 2013 (the “2013
Regs”)
• Who Pays – NHS England Guidance (August 2013, revised
2016)
• The “Standing Rules” regulations 2016

79. Starting point – which CCG?
• Depends on the services – eg emergency services are
the based on location
• General rule for everything else:
– The relevant CCG will be the one where Pt is
registered with a member GP practice OR
– If unregistered – the CCG where Pt is “usually
resident”
• But this is subject to exceptions, two of which apply to
mental health inpatient and s.117 responsibility…

80. S117 – responsible commissioner?
• 3 periods of time, if P is discharged:-
• prior to April 2013;
– RC to be determined by where P was “resident” at the
time of the detention;
• between April 2013 and March 2016 (Standing Rules, 2012);
– RC determined by “usual rule” – ie where P registered
with GP, or if not registered where P “usually resident”;
(ie changes on moving GPs) – but NB local authority
constant
• from 1 April 2016 onwards (Standing Rules, 2016)
– where P was “ordinarily resident” at time of detention

81. “Ordinary residence at the time
of detention”
N.B. different from “residence” and different from “usual residence”
The concept of “ordinary residence” aligns the responsible CCG and
local authority, but may not make things less contentious – it has
been subject to many disputes over the years.
Generally defined as a place which P has “adopted voluntarily and for
settled purposes as part of the regular order of his life for the time
being, whether of short or long duration” (the ‘Shah’ test)

82. How have we ended up with 3 sets of rules?
• Pre 2013, there was confusion that responsibility for some care (GP
registration / residence now) was different to CCG responsibility
for aftercare (based on residence at detention) – the law changed
in 2013 to align the two.
• This resulted in more confusion as it would often mean the
responsible LA staying the same while the CCG moves around. It
created a strong incentive to place “out of area”, and disincentive
to commission appropriate services in area.
• The April 2016 rule was meant to put that particular ‘cat back in
the bag’, but we are still seeing a lot of disputes and uncertainty.

83. Transitional provisions – 2016 only
• No definite guide at all to whether the post April
2013 rules applied to those discharged pre April
2013
• However, there are transitional provisions for
implementation of the 2016 rules – which mean
that the “music stops” with the CCG responsible
immediately before 1 April 2016

84. Impact of a fresh detention?
• Transitional provisions in the 2016 Regs say –
• Reg 5 - Where, immediately before these Regulations come into
force, a clinical commissioning group has responsibility to arrange
for the provision of after-care services for a person under section
117(2) of the 1983 Act by virtue of paragraphs (1) and (2)(a) of
regulation 14 of the principal Regulations, responsibility shall
remain with that clinical commissioning group—
(a) for as long as that person needs after-care; or
(b) until that person is detained under a provision referred to in
section 117(1) of the 1983 Act

85. Who pays guidance 2013 para 34
• “It is the duty of the CCG and local social services
authority to commission after-care for those
persons discharged from hospital following
detention under section 117 of the Mental Health
Act. The responsible CCG should be established by
the usual means (see paragraph 1 [ie GP
registration / failing which “usual residence”])”.
• Was correct between April 2013 and April 2016 –
but now inconsistent with the 2016 Regulations

86. Who pays addendum 2016
• Can only be found on ADASS website!
• “’Who Pays’ amendment to the section on ‘persons
detained under the Mental Health Act 1983’” (i.e. it
should replace that bit of Who Pays 2013)
• Explicitly to support correction of the responsible
commissioner back to the pre 2013 position – to avoid –
– Confusion & disputes
– Incentives to pass patients on to other areas
– Disincentive to invest in suitable local services
– Discontinuity of care

87. Who pays addendum 2016
• “… However, if a patient who is resident in one area
(CCG A) is discharged to another area (CCG B), it is
then the responsibility of the CCG in the area where
the patient moves (CCG B) to jointly work with CCG A,
who will retain responsibility to pay for their aftercare
under s.117…”.
• “from 1 April 2016… the legacy/originating CCG
continues to be responsible in most cases”
• Potentially misleading wording – key is where patient
was ordinarily resident at the time of the detention

88. Guidance v Statute / Regulations
• Urge caution - Who Pays / Addendum both clearly
contradict the statutory provisions in a number of
cases – and where there is a difference of
outcome, the legislation and regulations take
precedence.
• We are hopeful that new guidance may be
released shortly, but in the meantime advise
caution in relying on Who Pays unquestioningly.

89. MHA inpatient commissioning
• Standing Rules 2012 Reg 4 – a CCG is ALSO responsible
for those patients listed in … Schedule 1 para 2
• (j) - Every “qualifying patient” within the meaning of
MHA s130C and “liable to be detained” under MHA …in
that CCG’s area
• Liable to be detained includes pts detained and eg on
s17 leave and conditional discharges (but not CTO)
• NB includes all care (save ambulance and A&E) not just
the mental health treatment

90. MHA inpatient commissioning
• So the responsible commissioner for mental health
inpatient is the ‘local’ CCG where the inpatient unit is
located
• Still not widely understood or followed in practice
• Quite possibly because contrast Who Pays (2013) para
33 (and addendum) which suggest responsibility for
inpatient stay is usually determined by GP registration –
again the law and the guidance seem contradictory.

91. How can we help?
• Advice on responsible commissioner and disputes
• Advice / review of commissioning policies
• Advice on approach to JPOCs / s117 splits
• Audit of CHC eligibility decision making
• Court of Protection
• “Mediation” or joint instruction to adjudicate
responsible commissioner disputes

92. Questions and Thank YouQuestions and Thank You
Neil Ward – neil.ward@brownejacobson.com
DD: 0121 237 3927 / Mob: 07500 041236