Health and Social Care update

Legal intelligence for professionals in health and social care

This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

Care	Governance
Children	Health and Safety
Clinical Management	Healthcare Associated Infection
Clinical Research	Inquests
Commissioning	Mental Health
Data Protection	Primary Care Trust
Employment/HR	Regulation
Finance	General

Care

Publications/Guidance
Management of health and safety in care homes 2009-10. This circular provides guidance for visiting staff on inspecting the management of health and safety in care homes in 2009-10.

End of life care - nineteenth report of session 2008/09. This report examines the scale and quality of end of life care, the current and future approach to commissioning and funding of services, and the capability and capacity of NHS and social care staff to provide such care.

The new registration system for health and adult social care. From April 2010, a new system of regulation for health and adult social care in England comes into force for the NHS. This will require all providers of certain health and adult social care activities to register with the Care Quality Commission in order to provide services. The Department of Health is now consulting on the draft regulations. This briefing summarises the main proposals and their implications for providers of NHS care and its commissioners.

Balanced decision-making for people who use care services. This circular provides advice to health and safety regulators who are involved in the regulation of social care activities. The circular explains the priorities that local authority social services departments and social care providers have with regard to supporting adults and older people who need care and support to live with dignity and independence within the community, whilst ensuring risks are identified and managed. The general principles of risk management will also apply to the health care sector.

Elderly population across Europe past, present and future. People in virtually every country in the world are living longer. This briefing looks at how the population is ageing in the largest EU member states and in the EU overall and discusses the implications for health care.

Indicators for quality improvement. High Quality Care For All defined quality in the NHS as safe and effective care of which the patient's whole experience is positive. Lord Darzi set out commitments for making quality the organising principle of the NHS alongside a vision that all NHS staff will measure what they do as a basis for improving quality. In response to this the Department of Health and The NHS Information Centre, in partnership with professionals across the NHS, have identified an initial, but evolving, set of indicators to describe the quality of a broad range of services.

Demonstrating how to deliver stroke care for adults in the community. This updated version of circular LAC(DH)(2008)2 gives information about the scope and purpose of funding which the DH introduced last year for all adult social services authorities to demonstrate how to deliver stroke care for adults in the community.

Consultations
Care Quality Commission: Consultation on new registration standards. All regulated health and adult social care providers will be required by law to register with the Care Quality Commission from April 2010. This consultation seeks views on whether the CQC's guidance appropriately reflects the new registration standards and what should rightly be expected of a safe, quality care service. The consultation closes on 24 August 2009.

News
CQC to enquire into Take Care Now. Announces that the Care Quality Commission is to investigate Take Care Now, a healthcare provider, and its provision of out-of-hours services commissioned by the NHS, after a patient, David Gray, was accidentally given a lethal overdose of painkillers by a German doctor providing out-of-hours NHS care. The inquiry will include the circumstances surrounding the death of Mr Gray, 70, in 2008. The German doctor, Daniel Ubani, has been given a nine-month suspended sentence in Germany for negligence over Mr Gray's death.

Contract awarded to develop Patient Reported Outcome Measures. The DH has announced that a contract has been awarded to the Royal College of Surgeons and the London School of Hygiene & Tropical Medicine to look at how PROMs, which support the NHS to collect patient feedback on the success of their operations, can best be used to stimulate improvements in the quality of care patients receive.

If you wish to discuss any of the items raised in this section please contact Neil Grant.

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Children

Publications/Guidance
The protection of children in England: action plan - the Government's response to Lord Laming. This document sets out the Government's response to Lord Laming's recommendations on child protection. It outlines how all of central Government will work together with local government and front-line services to drive forward reform of child protection services across England. The action plan commits to greater openness and public scrutiny of local child protection arrangements, as well as more investment in training and support for front line social workers. The reforms will be driven forward by a new cross-Government delivery unit working alongside Sir Roger Singleton, the new Chief Adviser on the Safety of Children. The action plan includes:

• a Chief Adviser’s Expert Group that will work with Government to establish a cross‑Government National Safeguarding Delivery Unit (NSDU) to give strong, co-ordinated national leadership across the system;
• working with NHS Chief Executives to clarify accountabilities and management arrangements and to develop new statutory targets and their indicators;
• working on systems, guidance and training arrangements to help A&E departments identify and deal appropriately with children at risk;
• revised Working Together to Safeguard Children guidance, including revised Chapter 8 on Serious Case reviews;
• amending the Performers List Regulations to ensure that primary care contractors cannot be included in a performers list unless they have had a Vetting and Barring Scheme check. By the terms of their contract, GPs will need to ensure that any staff they engage to carry out regulated activity have had similar checks;
• training for the children's health workforce on safeguarding and child protection issues;
• overhaul of the Integrated Children's System (ICS) and simplification of national requirements on record-keeping; and
• a £58m six-point plan to transform the social work profession, including new university courses and a professional development programme;
• in addition, the MoJ has appointed Francis Plowden to conduct a review of court fees, and to establish whether or not court fees act as a deterrent when local authorities decide whether or not to commence care proceedings. He is expected to report by mid September 2009.

British Medical Association: Child protection - a tool kit for doctors. The aim of this tool kit is to provide a brief and accessible guide to doctors' responsibilities in child protection cases in England and Wales. The guidance, the first of its kind to deal specifically with the role of doctors in protecting children at risk of abuse, also recommends examinations of children without parental consent where considered necessary. The Child Protection Tool Kit also states doctors treating children at risk should obtain notes and records of previous medical consultations to increase awareness of suspicious incidents and injuries a child may have suffered. Although the guidelines have been welcomed by doctors there are concerns the changes could lead to parents failing to seek medical attention for fear of prosecution or having children removed for their care.

DCSF: Understanding parents' information needs and experiences where professional concerns about non-accidental injury were not substantiated. This research focuses on the role of paediatricians in relation to the information needs of parents when abuse is considered as a possible cause of non-accidental injury.

Review of the involvement and action taken by health bodies in relation to the case of Baby P. This report details the findings of an investigation of the health services involved in the case of Baby P carried out by the Healthcare Commission at the request of the Secretary of State for Health. The report focuses on North Middlesex University Hospital NHS Trust, Haringey Teaching PCT and Great Ormond Street Hospital for Children NHS Trust as they provided the majority of Baby P's NHS care. He also attended on one occasion the Whittington Hospital NHS Trust, so the report looks at child protection procedures in place there as well. The CQC highlights improvements at these Trusts since Baby P's death, including measures to ensure that medical staff have a child's background medical notes when treating or assessing them; steps have also been taken to ensure that a social worker is present at child protection assessments. But the report says more work still needs to be done in areas like: ensuring sufficient staffing levels; improving attendance of healthcare staff at child protection case conferences; and addressing communication problems, particularly when making referrals.

Parental experience of services for disabled children. Sets out the main findings from a national sample survey of parents of disabled children in England conducted during January - March 2009 that measured parental experience of services for disabled children as part of the Aiming High for Disabled Children programme. On average, parents rated the services for their disabled child as 59 out of 100, providing the Government and local areas with the first ever tangible base point from which to track progress or changes in perceptions and experience in future years on services for disabled children, covering health, education and social care. In June the Government will publish the breakdown of this national score and each local area’s score using the five core offer standards, information, transparency, assessment, participation and feedback, against the three services areas of education, health and social care. By the end of June a report will be published for each local area involved in this first survey with more detail on their results.

Consultations
DCSF: Promoting the health and wellbeing of looked after children - revised statutory guidance. Seeks views on revised guidance to PCTs, SHAs and local authorities on the exercise of their functions in relation to co-operation to promote the well-being of children and young people, and the making of arrangements to safeguard and promote the welfare of children. The guidance is issued under s.10 of the Children Act 2004. Comments are required by 3 August 2009.

Handling allegations of abuse made against adults who work with children and young people. Seeks views on draft guidance that sets out the statutory framework and underlying principles of handling allegations of abuse for those involved in dealing with allegations. It covers practical issues surrounding exercising professional judgement along with information sharing and record keeping. The practice guidance is supplementary to the guidance contained in Appendix 5 of Working Together to Safeguard Children and Chapter 5 of Safeguarding Children and Safer Recruitment in Education. Comments are required by 7 August 2009.

News
Safer together: Child Safety Week 2009. This is a free resource pack on Child Safety Week for all those working with children, young people or families. Child Safety Week is 22 to 28 June 2009.

If you wish to discuss any of the items raised in this section please contact Penelope Radcliffe or Tracey Lucas.

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Clinical Management

Publications/Guidance
Heatwave plan for England 2009. The Plan's purpose is to enhance resilience in the event of a heatwave. It is an important component of overall emergency planning; and will become increasingly relevant in adapting to the impact of climate change. Additional guidance this year is provided for the role of SHAs and Government Offices at Regional Level for each of the heatwave levels, from one to four. This provides clarity about governance and risk management.

Guidance notes for midwives on swine flu. This guidance describes the differences between seasonal, swine and avian influenza, including information on symptoms, avoiding infection, and what advice to give women and their families.

Pandemic flu: Managing demand and capacity in health care organisations. The aim of the guidance is to support NHS and social care organisations to build on their existing preparedness plans and enable clinicians to work within an ethical framework during a pandemic, when there may be a significant increase in demand for care.  

If you wish to discuss any of the items raised in this section please contact Jackie Linehan.

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Clinical Research

News
The Chief Scientific Officer has announced that 10 NHS healthcare scientists have been awarded research fellowships worth a total of over £1m for projects that will lead to improvements in patient care.

If you wish to discuss any of the items raised in this section please contact Tracey Lucas.

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Commissioning

Publications/Guidance
Deed of variation for 2008 NHS standard acute contract. This suite of documents is for those commissioners and providers who entered into the acute services contract that was published in December 2007, who are now working to a document that does not reflect changes brought about by the operating framework for 2009/10. The standard deed of variation is designed to vary those existing acute services contacts by incorporating the significant elements of the 2009/10 standard NHS contract for acute services brought about by the operating framework.

The engagement cycle: a new way of thinking about patient and public engagement (PPE) in world class commissioning. The engagement cycle is a way of approaching patient engagement when commissioning services. It highlights who needs to do what to engage people at each stage of the commissioning cycle. It can be used to facilitate improvements in world class commissioning, particularly concerning Competency Three - engaging with patients and the public.

Local Pharmaceutical Services model contract. This document is a model contract offered by the DH as a template for a Local Pharmaceutical Services (LPS) scheme for use by PCTs considering commissioning LPS services. It reflects the mandatory terms for any LPS contract.

The new registration system for health and adult social care. From April 2010, a new system of regulation for health and adult social care in England comes into force for the NHS. This will require all providers of certain health and adult social care activities to register with the Care Quality Commission in order to provide services. The Department of Health is now consulting on the draft regulations. This briefing summarises the main proposals and their implications for providers of NHS care and its commissioners.

Necessity - not nicety: a new commercial operating model for the NHS and Department of Health. This report outlines how the new commercial operating model will further enhance commercial and procurement skills across the NHS in helping to deliver high quality and personalised care for patients.

News
CQC to enquire into Take Care Now. Announces that the Care Quality Commission is to investigate Take Care Now, a healthcare provider, and its provision of out-of-hours services commissioned by the NHS, after a patient, David Gray, was accidentally given a lethal overdose by a German doctor providing out-of-hours NHS care. The inquiry will include the circumstances surrounding the death of Mr Gray, 70, in 2008. The German doctor, Daniel Ubani, has been given a nine-month suspended sentence in Germany for negligence over Mr Gray's death.

If you wish to discuss any of the items raised in this section please contact David Owens.

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Data Protection

News
Reforming the medical statement. The DWP is seeking views on the design of a new medical "fit note" to replace the current "sick note" and help more people stay in work rather than drift into long term sickness. The fit note will help people get advice about staying in work, and if they can't work what their employers can do to help them return to work sooner. The new system, which will be computer-generated in GP surgeries, is expected to be rolled out in Spring 2010. The introduction of the fit note forms part of the Government's response (Cm.7492) to Dame Carol Black's report into the health of Britain's working age population. Comments are required by 19 August 2009.

If you wish to discuss any of the items raised in this section please contact James Cassidy .

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Employment/HR

Publications/Guidance 
Pandemic flu guidance reminder. Guidance on the key human resource issues that would arise in the event of an outbreak of pandemic flu can be found at It covers preparations for a pandemic and what to do if a pandemic does occur.

Local employment partnerships briefing. NHS Employers have produced a new briefing to support employers to maximise employment opportunities for active jobseekers and vulnerable groups in the local community through signing up to the local employment partnership (LEP) initiative. The briefing outlines what a LEP is and the benefits of these partnerships for employers, as well as providing practical tips on how to successfully implement the initiative within your organisation. The publication can be viewed at

Recruiting from overseas - advice for employers. A Beginners Guide to International Recruitment, which will be helpful for employers looking to recruit from overseas to fill vacancies.

Health Innovation and Education Clusters - guide for applications. The Department of Health has published a guide for applications to create Health Innovation and Education Clusters (HIECs). HIECs will be partnerships between NHS organisations, the higher education sector, industry, and other private and public sector organisations to support the spread and adoption of innovation locally and strengthen professional education and training.

Immigration status and recruitment - FAQs published. NHS Employers has published a series of FAQs for employers and a legal briefing  about the Osborne Clarke Services v Purohit Employment Appeal Tribunal case. In the light of this case NHS Employers are planning to change the NHS Jobs application form and are advising employers not to use a number of pre-application and filter questions as part of their recruitment process.

New sexual boundaries guidance. New guidance on sexual boundaries between healthcare professionals and patients is now available. The Council for Healthcare Regulatory Excellence (CHRE) publication gives patients and carers a reference guide on topics including why sexual boundaries are important and the patient's role, and healthcare professionals' responsibilities, in this area. The guidance documents can be found at. 

European Working Time Directive derogation. This letter from Flora Goldhill, Director, Workforce Capacity Analysis and HR, provides an update on the implementation of the European Working Time Directive due to be introduced by 1 August 2009.

Cases
The case of Rose Gibb v Maidstone & Tunbridge Wells NHS Trust continues to attract the attention of the press. Ms Gibb, was refused permission to appeal the High Court’s decision that Maidstone and Tunbridge Wells NHS Trust had gone beyond its powers in offering her a sum of £175,000 in addition to her notice pay of £75,000, as part of a compromise agreement and she was therefore not entitled to receive this sum. However she has now made an application for leave to appeal direct to the Court of Appeal. The Court of Appeal will consider whether to allow her appeal in July. It has also been reported that Ms Gibb will be asking an Employment Tribunal to hear her claim for unfair dismissal, even though it is technically outside the three month time limit for filing such a claim.

The Employment Appeal Tribunal has recently ruled in the case of Carl v University of Sheffield that part-time employees pursuing damages for alleged unfavourable treatment against them because of their status must identify an appropriate full-time comparator. If they do not do so then their claim will fail and they will not be allowed to rely on a hypothetical comparator. In this case Mrs Carl, a part time teacher at Sheffield University claimed she had been treated less favourably than a named comparator who was paid for preparation time while she was not. The EAT however pointed out that her comparators role (that of a full time teacher in a different department) was not even broadly similar to her own. Mrs Carl’s comparator had two MA’s, was preparing for a PhD and had skills way beyond her own, Mrs Carl had a BEd qualification and taught to A Level standard whereas her comparator lectured up to PhD level .

Consultations
Reforming the medical statement. The DWP is seeking views on the design of a new medical "fit note" to replace the current "sick note" and help more people stay in work rather than drift into long term sickness. The fit note will help people get advice about staying in work, and if they can't work what their employers can do to help them return to work sooner. The new system, which will be computer-generated in GP surgeries, is expected to be rolled out in Spring 2010. The introduction of the fit note forms part of the Government's response (Cm.7492) to Dame Carol Black's report into the health of Britain's working age population. Comments are required by 19 August 2009.

News
The DH Chief Scientific Officer has issued a statement on UK-wide Modernising Scientific Careers that sets out progress following the closure of the consultation on The Future of the Healthcare Science Workforce - Modernising Scientific Careers: The Next Steps, which set out more comprehensive proposals to transform the future training and career pathways of the healthcare science workforce.

GMC Licence to Practise: advice to employers. The General Medical Council (GMC) is writing to trust chief executives, human resource directors and medical directors to advise them of the options exercise for doctors considering applying for the License to Practice. Legal or contractual issues will require most doctors in NHS organisations to hold a licence so the decision should be easy, however it will depend on their professional situation and the particular activities they undertake.

Whistleblowing update. The Royal College of Nursing and recent media stories have highlighted issues about whistleblowing in the NHS. NHS Employers supports NHS organisations to promote a climate of openness and dialogue in which staff feel free to raise concerns in a reasonable and responsible way, without fear of victimisation.

Bevan Brittan Updates
Swine flu: contingency planning now may save your bacon.  There has been much in the press over recent weeks about the new swine influenza strain, known as influenza A(H1N1) and the potential threat to the UK.  Sarah Lamont explores how an outbreak could affect your legal rights and responsibilities towards staff, customers and local and central government agencies and what you can do to prepare for a potential pandemic.

Stress – react and assist or pay up!  In the recent unreported, but widely covered in the press, case of Connor v Surrey County Council the High Court provided a timely reminder that in addition to statutory duties under health and safety legislation, employers are under a common law duty to take reasonable care for the health and safety of employees in the workplace. If they fail to do this the consequences can be far reaching and expensive. Chloe Edwards take a closer look at this case and its implications for employers.

Local Government Pension Scheme (LGPS) - Update. Following a press release from the Government's Actuary Department (GAD) and the publication of a draft FSA Code of Practice, our pensions expert Christine Johnson provides a Local Government Pension Scheme update.

News Round Up. Anne Palmer reports on the latest developments in employment law including the publication of the long awaited draft Equality Bill, an update on progress of the ‘Stringer’ decision, a final decision (we hope!) on the much debated future of the working time opt out, clarification of when tips can be used to top up wages and a summary of an intriguing case concerning what amounts to a religious belief.  

If you wish to discuss any of the items raised in this section please contact Sarah Michael.

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Finance

Publications/Guidance
Health Committee - Fourth Report: Top-up fees. In recent years the NHS has been criticised both for not funding certain drugs and for withdrawing treatment for patients who chose to purchase privately additional drugs which the NHS refused to fund. Following Professor Richard's report, 'Improving access to medicines for NHS patients', the Department of Health's instruction that NHS trusts should immediately cease the practice of withdrawing funding for NHS patients who had purchased additional treatment was generally welcomed. However some of the evidence in this report raised concerns about the risks of potential disadvantages to NHS patients including the formation of a "two-tier" system.

GP training practices £100m capital programme guidance. The DH has been allocated £100m for 2009/10 to advance the upgrading of up to 600 GP surgeries to training practices with the aim of creating opportunities for small firms and targeting funding on those areas that have historically had a lower provision of doctors. This guidance sets out how the funding will be allocated and who has responsibility for ensuring the capital upgrading of the relevant practices takes place.

NHS reference costs 2007-08. The main purpose of this document is to provide a basis for comparison within (and outside) the NHS between organisations, going down to the level of individual treatments. The document also provides details on NHS expenditure in the 2007/8 financial year.

Financial management in the NHS: report on the summarised accounts 2007-08: 22nd report of session 2008-09. This report, containing formal minutes and oral and written evidence, examines NHS accounts for the 2007/8 period. A surplus of almost £1.7bn is reported, which represents almost 2% of available resources. This surplus represents funding that was made available by Parliament for healthcare in 2007/8, but that was not used. The Committee outline how this surplus was achieved, its impact and financial challenges facing the NHS in the future.

Prompt payment code. This Dear Colleague letter explains the Prompt Payment Code, which is a payment initiative to tackle the crucial issue of late payment and to help small businesses. All SHAs, PCTs, NHS trusts and NHS foundation trusts should be adopting the principles incorporated within the Prompt Payment Code.  

If you wish to discuss any of the items raised in this section please contact Claire Bentley

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Governance

Publications/Guidance
Taking it on trust: A review of how boards of NHS trusts and foundation trusts get their assurance. This report from the Audit Commission reviews the rigour with which boards of NHS trusts and foundation trusts operate the governance structures and processes to assure themselves that their organisation is operating effectively and meeting their strategic objectives. It finds that:

• board assurance processes are generally in place to guard against risks but must be rigorously applied;
• board members are not always challenging enough; and
• the data received by boards is not always relevant, timely or fit for purpose.
  
  

It includes recommendations for Government and Trusts as well as questions for board members to ask themselves about their current arrangements.

If you wish to discuss any of the items raised in this section please contact Tracey Lucas.

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Health and Safety

Publications/Guidance
Reducing deaths from blood clots in hospitals. Blood clots, or venous thromboembolism (VTE), are a major risk to hospitalised patients. VTE leads to pain, swelling and potential death. While the full scale of the problem is not known, it is estimated that hospital-associated VTE leads to about 40,000 deaths in England per year, 25,000 of which may be preventable through proper risk management and care. This is about five times as many healthcare-associated deaths as from methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile combined. This briefing sets out the strong quality and financial imperative for hospitals to prioritise VTE prevention.

Indicators for Quality Improvement (IQI). The DH and the NHS Information Centre has published a list of more than 200 indicators of high quality care in the NHS to help clinicians drive up the quality of care they deliver to patients. The Indicators for Quality Improvement will help measure the quality of care clinicians deliver, highlight areas for improvement and track the changes they implement. They span the three dimensions of high quality care: patient safety, effectiveness of care and patient experience. Clinicians can choose from the list the indicators that are most relevant to their work. The indicators are a key outcome from Lord Darzi's report 'High Quality Care for All' in which he noted that high performing teams already measure the quality of care they deliver and benchmark their work against their peers. Over the next three to five years the list will be further developed to improve depth of coverage across all care pathways and quality dimensions.

Management of health and safety in care homes 2009-10. This circular provides guidance for visiting staff on inspecting the management of health and safety in care homes in 2009-10.

Balanced decision-making for people who use care services. This circular provides advice to health and safety regulators who are involved in the regulation of social care activities. The circular explains the priorities that local authority social services departments and social care providers have with regard to supporting adults and older people who need care and support to live with dignity and independence within the community, whilst ensuring risks are identified and managed. The general principles of risk management will also apply to the health care sector.

If you wish to discuss any of the items raised in this section please contact Adam Kendall.

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Healthcare Associated Infection

News
New care regulator commends NHS progress on infection control. The Care Quality Commission has commended the majority of NHS trusts for improving infection control, stating that infection rates are falling and that many hospitals are continuing to strengthen systems for protecting patients. In the latest measure to drive improvement, it has registered for the first time 388 NHS trusts to provide care after carrying out an assessment of whether they meet government regulations for managing infection. Trusts had to declare whether they were compliant with the regulations and cross-checked this with other performance information, including patient and staff surveys, findings from the Healthcare Commission's hygiene inspections, trusts' declarations against core standards for infection control, and rates of MRSA and C. difficile infection.

If you wish to discuss any of the items raised in this section please contact Sian Morgan.

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Inquests

Publications/Guidance
R (O'Connor) v HM Coroner for Avon; Visser (Intervener) [2009] EWHC 854 (Admin) (Admin Ct). The court held that the coroner had proceeded on a material misdirection of the law in viewing the test for unlawful killing to be objective and for considering the defence of insanity as not relevant to his verdict. Further, with regard to insanity, the differences between a coroner's inquest and a criminal trial necessitated a different standard of proof. Insanity, properly raised, had to be disproved to the criminal standard to sustain a verdict of unlawful killing.

Amendments to the Coroners and Justice Bill: Written ministerial statement by Jack Straw. This written ministerial statement to Parliament discusses amendments to the Coroners and Justice Bill.

If you wish to discuss any of the items raised in this section please contact Joanna Lloyd.

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Mental Health

Publications/Guidance
Healthy mind, healthy body: how liaison psychiatry services can transform quality and productivity in acute settings. This briefing looks at opportunities to improve quality and efficiency in acute services by focusing on the needs of the significant number of patients who also have mental health problems complicating their care and discharge. It sets out some good practice examples together with academic evidence to build a business case for liaison psychiatry services.

Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system. This independent review was commissioned to examine the extent to which offenders with mental health problems or learning disabilities could, in appropriate cases, be diverted from prison to other services and the barriers to such diversion. The review has kept a broad remit and incorporated the range of mental health problems and learning disabilities across the whole of the criminal justice system, and made recommendations to government including the organisation of effective liaison and diversion arrangements and the services needed to support them. The Government's response to the report is also available in which it is announced that a Health and Criminal National Programme Board will be set up to oversee the implementation of recommendations.

Access to justice: a review of the existing evidence of the experiences of adults with mental health problems. A report by KM Research and Consultancy Ltd for the Ministry of Justice summarises international research evidence on the experiences of adults with mental health problems in the justice system. It recommends working towards more integrated criminal justice and mental health systems; developing strategic guidelines for integrating the goals of ensuring justice is done and providing effective treatment; and providing further training and awareness-raising to challenge prejudicial attitudes amongst civil and criminal legal service providers.

Consultations
A better future: a consultation on a future strategy for adults with autistic spectrum conditions. Seeks views on on a future strategy to support adults with autistic spectrum conditions to live full and inclusive lives with access to the right care and support. The consultation considers five key themes for delivering change – health, social inclusion, choice and control, awareness raising and training, and access to training and employment. The consultation closes on 15 September 2009.

News
Self-advocacy champion gets top learning disabilities job. Announces that Scott Watkin has been appointed as the DH's new Co-National Director for Learning Disabilities. He will lead work on making the Department's learning disability strategy, Valuing People Now, a reality, working jointly with Anne Williams, the current National Director.

Bevan Brittan Booklets

• Bevan Brittan has produced a Deprivation of Liberty Safeguards booklet which sets out the key points in relation to DOLS. If you would like a copy please contact Lisa Selby.
• Bevan Brittan has produced a Mental Capacity Act booklet which sets out the key points in relation to Mental Capacity Act. If you would like a copy please contact Lisa Selby.
• Bevan Brittan has produced a Supervised Community Treatment flowchart card which sets out the key points in relation to Supervised Community Treatment. If you would like a copy please contact Lisa Selby.
• Bevan Brittan has produced a Community Treatment Order booklet which sets out the key points in relation to Community Treatment Orders. If you would like a copy please contact Lisa Selby.

If you wish to discuss any of the items raised in this section please contact Simon Lindsay.

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Primary Care Trust

Publications/Guidance
PCT performance - quick guides. The Quick Guides have been created as an aid to improving PCT performance against a series of Annual Health Check targets. The Commissioning Performance Directorate has worked with PCTs and clinicians to condense existing guidance into a practical and user friendly guide covering the essential issues to improve performance.

Joint documents promote pharmacy to the NHS. These documents, 10 High Impact Changes in PCT Commissioning Practice and 5 High Impact Changes for SHAs are part of a strategy to promote the role of pharmacists to commissioners, managers, general practitioners and others in primary care. They also seek to influence the commissioning of pharmacy services by PCTs under World Class Commissioning and the integration of pharmacy into Practice Based Commissioning (PBC).

Primary care service framework: Gypsies and travellers. The focus of this service framework is Romany Gypsy, Roma and Irish traveller communities; however, the principles it contains may be applied to develop services (or consult local people on developing services) for other traveller groups. The purpose of this framework is to equip PCT commissioners with the necessary background knowledge, service and implementation details to work with providers and practitioners to deliver accessible primary care services, over and above mainstream services, for gypsy and traveller communities and to improve gypsy and traveller health and quality of life by providing effective, appropriate, ongoing support.

Primary care service framework: Alcohol. This service framework is for adult patients who are drinking to hazardous and harmful or dependent levels. The document has been updated to include recent policy changes and is supported by a range of enhanced tools to support implementation. A complementary suite of resources and supportive notes is also available.

Low back pain: Early management of persistent non-specific low back pain. The National Institute for Health and Clinical Excellence has published guidance recommending that GPs offer patients acupuncture for back pain, as well as other treatments including osteopathy and chiropracty. It is the first time NICE has endorsed the use of alternative therapies on the NHS.

Urgent care: a practical guide to transforming same day care in general practice. The Primary Care Foundation was commissioned by the Department of Health to undertake this review of urgent care in general practice. The Department’s Next Stage Review (known as the Darzi report) in July 2008 pledged: ‘Every member of the public should be able to expect integrated local services that provide access to urgent care, 24 hours a day and 365 days a year.’ This project explores the practical steps that GPs and their staff are taking to improve patient care and reduce pressure on the wider healthcare system.

Reviews on primary care information for the public. The Health Management Services Centre (HMSC) recently completed a series of evidence reviews exploring the provision of public information about the quality of primary care services. Each review addresses a specific question including: what information about the quality of primary care services do patients and the public want; which information formats are most accessible and effective; and how can information be presented to empower patients to make an informed choice of primary care provider?

If you wish to discuss any of the items raised in this section please contact David Owens.

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Regulation

Publications/Guidance
Mid Staffordshire NHS Foundation Trust. The DH has published the reports of the independent reviews by Sir George Alberti and Dr David Colin Thomé that were commissioned in response to the Healthcare Commission's investigation into the failings at Mid Staffordshire NHS FT. The Alberti Review looked at the procedures for emergency admissions and treatment, and progress against the recommendation of the March Healthcare Commission report, while Dr Colin Thomé reviewed commissioning arrangements. The Health Secretary's response accepts all the reports' recommendations and makes it clear that greater priority must be given to patients' views. Monitor has also agreed to the recommendations.

The role of Responsible Officer - response to the consultation on Responsible Officers and their duties relating to the medical profession. The White Paper 'Trust, Assurance and Safety' set out an ambitious programme for the reform of professional regulation, including the creation of responsible officers. The DH consulted on the roles and responsibilities of responsible officers in Autumn 2008, to inform the development of draft regulations setting out the detail of responsible officers. This document sets out the DH's formal response to the consultation and provides a full analysis of responses.

Monitor: Corporate Plan 2009-12. Sets out Monitor's strategy and objectives for 2009-10 and 2011-12. It will publish separate one year business plans at the beginning of 2010-11 and 2011-12.

Cases
Southall v General Medical Council [2009] EWHC 1155 (Admin) (Admin Ct). The court held that the GMC Fitness to Practise Panel had been entitled to find a consultant paediatrician guilty of serious professional misconduct following his interview of a patient's mother at which he accused her of murdering her first son who had been found to have committed suicide.

Dzikowski v General Medical Council [2009] EWHC 1090 (Admin) (Admin Ct). The court held that where a consultant psychiatrist specialising in the treatment of drug addicts had acted in breach of conditions imposed in relation to his prescribing practices, including writing a prescription for methadone in direct contravention of those conditions, he had demonstrated a deep-seated attitudinal problem in refusing to believe himself constrained in the treatment of his patients and the GMC's Fitness to Practise Panel had been entitled to erase his name from the medical register.

News
Ambulance services are rated highly in their response to non-urgent calls, survey shows. The Care Quality Commission has published the findings of a national survey targeted specifically at people whose conditions were assessed by ambulance call handlers as Category C, defined as non-urgent or non-life-threatening, which are given a lower priority by the ambulance services, behind conditions that are immediately life-threatening (Category A) or require urgent attention (Category B). They show that most of those who responded to the survey had a positive experience of the way they were looked after by the emergency ambulance service.

If you wish to discuss any of the items raised in this section please contact Neil Grant.

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General

Publications/Guidance
Report of the National Patient Choice Survey, England - December 2008. This report gives the final results of around 76,000 responses to the 16th national Patient Choice Survey commissioned to assess the implementation of choice at PCT level. The series of surveys, conducted by Ipsos MORI on behalf of the Department of Health, monitor patient awareness of choice and recall of having been offered a choice of hospital for their first outpatient appointment.

Survey of adult in-patients 2008. This national survey of the views of adult in-patients asked about the experiences of people who have been admitted to hospital overnight or for longer. The questions in the survey cover the issues that patients consider important in their care and would like to be included in national assessments. The survey offers an insight into their experiences and uses this information in the assessment of NHS trusts.

Draft guidance on provisions to deal with nuisance or disturbance behaviour on NHS premises in England. This consultation seeks comment on draft guidance that will be issued to support use of the power of removal by NHS bodies in England to deal with anyone causing a nuisance or disturbance on NHS premises. The consultation closes on 4 August 2009.

Tackling health inequalities: 10 years on. This report reviews developments in health inequalities over the last 10 years. It covers developments across government on the wider social determinants of health and the role of the NHS.

Government response to the Health Select Committee report on health inequalities. This document sets out the Government's response to the conclusions and recommendations made by the House of Commons Select Committee report on health inequalities, which was published on 15 March 2009.

Understanding what matters: A guide to using patient feedback to transform care. The guide sets out best practice for collecting, analysing and using patient feedback to transform services. It also includes examples of how the NHS is already using feedback from patients to get results.

Sustainable food: a guide for hospitals. This guide describes why the sustainability of food is important; provides guidance on what hospitals can do to improve the sustainability of the food they provide to patients, staff and visitors; and advises on how hospitals can assure the sustainability of their food service provision.

Uptake of NICE approved cancer drugs 2007/2008. This letter from Professor Mike Richards, National Cancer Director, outlines the findings on the usage of NICE approved cancer drugs in 2007/8.

The NHS Constitution: All you need to know about how the NHS Constitution affects you as a provider or commissioner of NHS care. This leaflet is aimed at NHS staff. It gives background information about the NHS Constitution, and explains those parts that are most relevant to NHS staff.

Healthy hospitals, healthy planet, healthy people: addressing climate change in health care settings. This paper begins to define a framework for analysing and addressing the health sector's climate footprint - including identifying seven aspects of a climate-friendly hospital. It also draws on a series of examples from around the world that demonstrate that the health sector is indeed already beginning to provide leadership in this area.

Cases
Whiston v London SHA [2009] EWHC 956 (QB) (QBD). The court held that a person who suffered cerebral palsy after experiencing hypoxia around the time of his birth was entitled to proceed with his claim for damages against the health authority as he only acquired the relevant knowledge, namely that his disability might be attributable to acts or omissions by medical staff, many years later and his claim was then brought within the statutory limitation period.

Consultations
Department of Health formal response to the Cooperation and Competition Panel consultation. The Cooperation and Competition Panel, chaired by Lord Carter of Coles, was established to help ensure NHS-funded services support the delivery of high quality care for patients and value for money for taxpayers. It opened for referrals on 30 January 2009. The Panel has been consulting on its draft operating guidelines, which outline how it will do business with the NHS. The aim of this consultation was to seek the views from interested parties on whether the four guidance documents covering procurement disputes, appeals on advertising, anticompetitive conduct and mergers were clear, comprehensible and analytically sound. This document sets out the DH's formal response to the Panel's consultation. The Secretary of State has strongly welcomed the consultative and iterative approach the Panel has taken to develop the guidelines. He is confident the Panel, in making its recommendations, will help ensure that cooperation and competition in the NHS supports the objective of delivering high quality care for all.

The RCN Policy Unit is in the process of conducting an extensive RCN wide consultation aimed at identifying what the prevailing attitudes are amongst members towards assisted suicide, such that the views of nurses can be considered as part of the public debate. In order to support and encourage a comprehensive internal debate, opinions will be sought from country/regional boards, branches, forums and individuals.

News
Work begins to eliminate mixed sex accommodation in NHS. Reports on progress on projects financed by the £100m Privacy and Dignity Fund, which enables all SHAs to carry out improvements to ensure that men and women will not have to share sleeping areas, bathrooms or toilets when admitted to hospital and that their privacy and dignity is upheld whenever possible. This letter updates on progress in respect of delivering same-sex accommodation and confirms further action required in the coming months, for completion by 30 June 2009.

If you wish to discuss any of the items raised in this section please contact Claire Bentley.

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