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
  Complaints   Pandemic Influenza
  Employment/HR   Primary Care Trust
  Finance   Regulation
  Foundation Trusts   General
 

 

Care

Publications/Guidance
Identifying a fairer system for funding adult social care. This briefing from the Joseph Rowntree Foundation argues that analysts and commentators have paid insufficient attention to equity in adult social care. It sets out a framework for identifying a fairer system and uses this to evaluate the Green Paper ‘Shaping the future of care together’.

NHS continuing healthcare and NHS-funded nursing care: Public information booklet. Summary of information for the public on NHS continuing healthcare and NHS-funded nursing care, including details of what an individual should do if they think they may be eligible.

NHS-funded nursing care practice guide (revised) 2009. Sets out the process for determining the eligibility for NHS funded nursing care under the national framework for NHS continuing healthcare and NHS-funded nursing care. It has been revised in line with the revised national framework.

Consultations
Consultation on Care Quality Commission Strategy for 2010-15. This consultation seeks views on the Commission's five-year strategic plan.

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

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Children

Publications/Guidance
Location, location, location: making choice of place of birth a reality. This report reveals the findings of research commissioned by the National Childbirth Trust (NCT) to determine how many women have a choice of where to have their baby and whether choice has become more available in recent years. It also examines the importance of choice of place of birth, the government policies supporting it and reasons why that choice may not be available to some women. The NCT makes recommendations to stakeholders to increase the options women have when choosing where to have their baby.

Getting it right for children and families. This guide is for health visitors and their teams, provider managers, commissioners and educationalists. It sets out the contribution that health visitors and teams can make to health and wellbeing and public health.

Healthy Child Programme: pregnancy and the first five years of life. This guide for PCTs, local authorities, practice-based commissioners and providers of services in pregnancy and the first years of life highlights the key role that the Healthy Child Programme (HCP) (formerly known as the Child Health Promotion Programme) plays in improving the health and well-being of children, as part of an integrated approach to supporting children and families. It sets out the recommended standard for the delivery of the HCP and demonstrates how the programme addresses priorities for children's health and well-being. The HCP for the early life stages focuses on a universal preventative service, providing families with a programme of screening, immunisation, health and development reviews, supplemented by advice around health, wellbeing and parenting. Delivery of the HCP depends on services for children and families being fully integrated, and this guide will inform joint strategic plans to promote child health and wellbeing across all agencies.

Healthy Child Programme: the two year review. This guide is a supplement to the updated guidance on the whole HCP programme which was published in 2008. It draws together the latest evidence on the health and development of two year olds and the views of parents and practitioners, and reflects wider developments in services for children and families such as Sure Start Children's Centres and the Family Nurse Partnership programme.

Healthy Child Programme from 5 to 19 years old. Sets out the recommended framework of universal and progressive services for children and young people to promote optimal health and wellbeing. It outlines suggested roles and responsibilities for commissioners, health, education, local authority and other partners to encourage the development of high-quality services. As the Operating Framework for the NHS in England 2009/10 sets out, PCTs will want to review the transparency of their service offer in line with Healthy lives, brighter futures and local priorities, and this may include the HCP.

News
Review of NHS children's services. The Chief Executive of the NHS, David Nicholson, has commissioned Sir Ian Kennedy to explore the cultural obstacles that can stand in the way of sustained improvement in the provision of care for children and to consider what can be done to develop the NHS’ contribution to safeguarding children. For more details, see the Terms of Reference.

The new Vetting and Barring Scheme partially came into effect on 12 October 2009. From that date employers, local authorities, professional regulators and other bodies have a duty to make referrals to the Independent Safeguarding Authority where they consider a person has caused harm or posed risk of harm to children or vulnerable adults. The Scheme replaces the Protection of Vulnerable Adults (POVA) scheme and the Protection of Children Act (POCA) lists.

If you wish to discuss any of the items raised in this section please contact Penelope RadcliffeTracey Lucas or Deborah Jeremiah

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Clinical Management

Publications/Guidance
Delivering same-sex accommodation (DSSA): principles. Lists the 17 principles that have been developed to ensure each organisation delivers the highest standards of privacy and dignity within all areas of a hospital, other trusts and providers. The principles support existing DSSA policy and guidance and aim to further clarify DSSA clinical definitions amongst leaders and staff within the NHS. It is intended for the principles to be used in conjunction with other guidance to drive forward improvement and ensure sustainability within each organisation.

Bevan Brittan Updates
A round up of cases from Nicola Pegg covering issues such as costs, provisional damages and limitation.

Good news on interim payments. Matt Trinder reports.

Injured and need care? – How to get it… Julie Chappell reviews the eligibility for state assistance available to injured patients. 

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

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Clinical Research

Publications/Guidance
New database to inform prioritisation of European cancer research. A 'Database of Cancer Uncertainties' has gone live on the NICE website. The database will collate details of the major gaps in evidence which are identified during guidance development. These evidence gaps can then be promoted as research priorities to prospective research funders.

Decontamination of surgical instruments: Progress review 2008. This report has been updated to include much of the research presented at the twice yearly DECON meetings and published papers. The 2008 report will provide information for the DH with the aim of progressing these results from the research field into practical application within an NHS setting.

Consultations
The Human Fertilisation and Embryology Act 1990: disclosure of identifying information for research: regulations for consultation. The DH invites views on draft regulations establishing a process for authorising the disclosure of information retained by the Human Fertilisation and Embryology Authority, for research purposes, where it is impractical to obtain consent from the person to whom the information relates. The regulations incorporate amendments made as a result of a previous consultation exercise in January 2009. If approved the regulations will enter into force on April 6, 2010. Comments by 2 December 2009.

News
New study to examine benefits of Personal Health Budgets. The DH has announced 20 sites across England that have been selected to participate in a study to identify the benefits of Personal Budgets (PHBs) for health and the patient groups who will benefit most from them. The study will be conducted through a partnership between three existing research teams at three institutions including the University of Kent. The full evaluation will last three years, with newsletters, research summaries and interim reports made available online. The press release includes a list of the 20 sites and a case study demonstrating how PHBs are transforming the lives of patients with long term conditions.

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

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Commissioning

Publications/Guidance
Commissioning local breastfeeding support services. This commissioning guidance aims to assist commissioners and PCTs in providing coherent services that will promote breastfeeding and reduce inequalities.

Emergency services review. This report from the Office of Strategic Health Authorities presents the findings of a review of emergency services' recent performance and supports the identification and adoption of best practice. The Emergency Care Intensive Support Team, established by the review, is now supporting the implementation of this guidance, hosting events and supporting organisations to deliver the outcomes outlined in the documents. The ESR Team has issued a series of supporting best practice documentation, guides and toolkits alongside the report.

Tackling demand together: a toolkit for improving urgent and emergency care pathways by understanding increases in 999 demand. This toolkit has been produced by a group of ambulance providers and primary care trust commissioners together with the Department of Health to offer practical analysis, worksheets and tools to help all commissioners and providers improve urgent and emergency care services through better understanding of the factors affecting significant rises in 999 demand.

The NHS as preferred provider. The Secretary of State's recent speech at the King's Fund focused on putting quality at the core of the NHS and assured that "the NHS is our preferred provider". This "Dear colleague" letter advises NHS Chief Executives on how the DH proposes to move this policy forward through the development of future guidance. There is also a letter from the SoS to the TUC General Secretary that lists the core principles which commissioners will be expected to follow, and suggests the process to be followed in a number of draft scenarios.

World class commissioning - an introduction. This guide provides a brief introduction to world class commissioning, which is about delivering better health and wellbeing for the population, improving health outcomes and reducing health inequalities. In partnership with local government, practice-based commissioners and others, PCTs, supported by SHAs, will lead the NHS in turning the world class commissioning vision into a reality, adding life to years and years to life.

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

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Complaints

At Bevan Brittan we have set up an e-portal to assist complaints managers in the NHS. The portal is of use to all NHS complaints managers who are often handling very sensitive and complex work. It provides tailored access to a range of up-to-date knowledge and information enabling you to have a central, structured and focused source of information on complaints. It also has a discussion forum for use by clients to share tips and knowledge with each other. If you would like more information about the portal and the discussion forum please contact  Claire Bentley.

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Employment/HR

Publications/Guidance
Review Body on Doctors’ and Dentists’ Remuneration for 2010. This document sets out all UK health departments' written evidence in support of a pay review for doctors and dentists in 2010.

New Guidance has been published dealing with the thorny issues of making severance payments to senior managers, who are generally covered by the Very Senior Managers Pay Framework. The guidance explains the process to be followed and includes draft templates for proposals to the remuneration committee, writing to the strategic health authority, and applying for HM Treasury approval.

Changes to consultants’ terms and conditions of service and corrigendum to M&D 1/2009. This is a pay circular informing the service of changes to the consultants' terms and conditions of service and a corrigendum to Annex A Section 7 of Pay Circular (M&D)1/2009 to correct an earlier rounding error in the Associate Specialist 2008 locum rates. The changes are effective from 1 September 2009.

The Government's response to the Health Select Committee's report on the use of management consultants in the NHS and the Department of Health. In June 2009 the Commons Health Committee published a report on the use of management consultants in the NHS and DH that examined the amount spent by the NHS on management consultants and whether they were obtaining value for money from those contracts. This document sets out the Government's response to the Committee's recommendations on the collection of detailed information on NHS expenditure and use of management consultancy, and the need for the improved management and assessment of value from those consultancy services.

Achieving age equality in health and social care. In April 2009, the then Secretary of State for Health commissioned a review of age discrimination and age equality in the health and social care sector. The review analysed evidence about the nature, extent and variability of age discrimination in health and social care services. It also considered what reforms are already in train to tackle age discrimination and support greater age equality. It looked at evidence from a wide variety of sources, including academic research, stakeholder submissions, personal testimony and the conclusions of a number of workshops and engagement events. A report of this review has been published.

NHS Employers submission to the NHS Pay Review Body 2010/11. This document presents NHS Employers' evidence to the NHS Pay Review Body for the 2010/11 pay round. It outlines key messages to the review body made on behalf of NHS organisations in England. It provides background information on the multi-year settlement for Agenda for Change staff; a section about the review clause; recruitment and retention and affordability.

Survey on 48 hour week Working Time Directive readiness. This report details a survey to review the readiness of NHS trusts for the introduction of the European Working Time Directive 48 hour working week in August 2009. The document was commissioned by DH in November 2008 and represented data collected in January 2009.

Medical Training Initiative (MTI) guide. This guidance is designed to allow overseas doctors to undertake up to two years of training and experience in the UK. It explains the benefits of the MTI and signposts additional information.

Senior Salaries Review Body: Review for 2010 - Written evidence from the Department of Health. This written evidence supports efforts to set salaries at the right levels to recruit, retain, and motivate sufficient numbers of high quality leaders and managers to deliver Government policy for the benefit of patients, and to do so in a manner that is affordable in both the short and longer terms.

Women doctors: making a difference. This report from the National Working Group on Women in Medicine highlights current barriers that prevent female practitioners in the medical profession from reaching senior positions and leadership roles and sets out recommendations on how best to address these. The report is a direct response to the concern raised in the Chief Medical Officer's 2006 Annual Report that despite there being an increase in the number of females entering the profession over the last 20 years, few have reached senior leadership positions compared to their male counterparts. The Working Group was chaired by Baroness Ruth Deech.

Patients are being harmed by working time limits, finds RCS study. The RCS has published the findings from its survey of 900 surgeons about the impact of the European Working Time Directive (EWTD), which aims to restrict weekly working hours to no more than 48 hours. The sample is comprised of 'more than' 360 consultants and 'more than' 500 trainees. Key findings include: 62 per cent confirmed that the service/specialty within which they work was currently compliant with EWTD; 70 per cent estimated they were working in excess of the 48 hour limit; 44 per cent felt that compliance had only been attained 'at the expense of patient safety' and 64 per cent believed quality of care had suffered as a result of EWTD.

NHS Employers has produced revised FAQs for employers on the Working Time Directive. The revised FAQs include new information on where an opt-out might be appropriate, how locum doctors' hours should be counted, and indemnity arrangements.

New FAQs for employers re Pandemic Flu have also been produced dealing with tricky issues such as the use of students and retired staff during the flu pandemic. The FAQs are the result of discussion with NHS organisations, the Department of Health and key stakeholders.

NHS Employers has published a new online guide on the current UK equality and diversity legislation for employers. The online guide looks across the eight diversity strands, outlining what the legislation is and what employers need to do. It also sets out shared learning from trusts and sources of further information, including the full legal texts.

Bevan Brittan Updates
Age Discrimination: Further cases on objective justification. Two recently published age discrimination cases have provided some, if not total, clarity on the issue of justification in age discrimination claims. Sarah Lamont explains more.

“Bank” workers NOT employees… .The vexed question of whether a “bank” worker is actually an employee has troubled HR professionals and employment lawyers alike for many years. A decision of the Employment Appeal Tribunal, earlier this year, appears to have provided a definitive answer, but is this the end of the story? Mike Smith explains more.

Pension Quality Mark – Good for employers and employees. On 21 September 2009 the National Association of Pension Funds (NAPF) introduced the Pension Quality Mark (PQM) - a certificate, similar to the kite mark, which confirms that the company’s defined contribution (“DC” or “money purchase”) pension scheme has met the key qualifying criteria on contribution rates, governance and communications. Christine Johnston explains more. 

News Round-up. Lara Feghali reports on the latest developments in employment law including details of the increased “Vento” guideline payments for injury to feelings awards, news that the Civil Service is to end forced retirement at 65, confirmation that there is to be no change to statutory sick pay (SSP) in respect of a pandemic flu outbreak, information on a new code of practice on tips and service charges, confirmation that tax relief on child care vouchers is to be abolished and details of the Tribunal statistics for 2008/09.

Events
Public sector employment law workshop. 

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

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Finance

Publications/Guidance
Auditors’ local evaluation and use of resources 2008/09: summary results for NHS trusts and primary care trusts. Each year the Audit Commission assesses how well NHS trusts and PCTs manage their resources and deliver value for money. For 2008/09, these assessments have been based on the Auditors' Local Evaluation for NHS trusts and use of resources for PCTs. This national report outlines the scores and how they should be viewed in the context of the overall financial performance of the NHS in 2008/09.

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

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Foundation Trusts

Publications/Guidance
Guide to Monitor for NHS foundation trust governors. Sets out what Monitor does, how it regulates FTs and how governors can interact with Monitor.

Monitor has published 5 toolkits on service line reporting.

Your statutory duties: a reference guide for NHS foundation trust governors. Examines ways in which NHS FT governors can deliver their statutory duties. It sets out these duties, and provides suggested advisory process steps to deliver them, which reflect best practice. The guide was produced following a 12-week consultation process.

Consultations
Consultation on additional annual reporting requirements 2009/10. This consultation document sets out proposals for additional annual reporting requirements for NHS foundation trusts for 2009/10. The proposals in the consultation cover five main categories of reporting:

1. Quality;
2. Sustainability;
3. Valuing people
- Equality and diversity
- Staff feedback;
4. NHS Constitution; and
5. Regulatory findings.

The consultation document includes the examples of the proposed format of reporting in each of the above five categories, and indications as to how reporting requirements in each of these, and the related assurance, may be likely to develop. Monitor is consulting on these proposals in order to:

1.finalise guidance for the 2009/10 quality accounts (as anticipated in the NHS Foundation Trust Financial Reporting Manual for 2009/10, section 7.72);
2. include reporting requirements against the NHS Constitution; and
3. further develop the reporting requirements in line with best practice (i.e. incorporating elements of Corporate Social Responsibility reporting).  
These proposals, if agreed, will be for inclusion in the 2009/10 annual reports and accounts of NHS foundation trusts. This consultation closes at 5pm Monday 25 January 2010.


Response to consultation on the de-authorisation of NHS foundation trusts. Sets out the DH's response to the July 2009 consultation on proposed changes that would enable Monitor and the Government to de-authorise failing NHS FTs and remove foundation status. It summarises the responses received, and outlines the Government's intention to take action as part of the Health Bill currently before Parliament.

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

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Governance

Publications/Guidance
18 weeks - next steps. This letter to SHA Chief Executives outlines outlines the steps necessary to the success of the 18 weeks pledge.

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

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Health and Safety

Publications/Guidance
Managing patients’ medicines after discharge from hospital. The Care Quality Commission has published findings from its study of how well patients’ medication is managed after leaving hospital. It visited 12 PCTs, as commissioners of GP and hospital care, and surveyed 280 of their GP practices. The report suggests that the NHS may be at risk of failing to prevent harm to patients from medicines unless it improves sharing of vital information when people move between services.

The Government response to the Health Select Committee Report 'Patient Safety'. Sets out the Government's response to the House of Commons Health Select Committee's Report on Patient Safety, published on 3 July 2009.

News
Completion of reform to the healthcare regulatory bodies. The DH has announced the completion of reforms that mark a significant milestone in the Government’s programme to make safety and quality paramount in the care of patients by modernising the regulation of healthcare professionals, as set out in the White Paper "Trust, Assurance and Safety". The key features of the reforms are: each regulator has moved to a fully appointed council, with parity between lay and professional members, to ensure that professional interests do not dominate; new council members for the regulators will be independently appointed by the Appointments Commission against specific criteria relating to their skills and expertise; and smaller, more board-like councils will enhance the ability of the regulators to act strategically.

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

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Healthcare Associated Infection

Publications/Guidance
The Max4Health hand hygiene campaign. This report sets out the results of an evaluation of the Max4Health hand hygiene campaign undertaken at Southampton University Hospitals NHS Trust over a nine week period between February and April 2009.

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

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Inquests

Publications/Guidance
Coroners and Justice Bill: a parliamentary briefing paper prepared for Report Stage in the House of Lords on October 21, 2009. This paper sets out the views of the Bar Council and the Criminal Bar Association on key aspects of the Coroners and Justice Bill 2009 ahead of the Report Stage in the House of Lords, which started on 21 October 2009. 

Bevan Brittan Updates
The Coroners and Justice Bill. The draft Coroners Bill was initially published in June 2006 for the purpose of delivering a better service for bereaved people and those who interact with the coroner’s service, to introduce national leadership for the service and to ensure that inquests and investigations undertaken by coroners are more effective. Tracey Lucas reviews the position.

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

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Mental Health

Publications/Guidance
CQC 2009 survey of mental health acute inpatient services. The Care Quality Commission 2009 survey of people who had recently had an inpatient stay for acute mental health problems was the first of its kind and collected responses from over 7,500 people. The survey asked people all about their experiences of acute inpatient mental health services along the pathway from admission to leaving hospital, including the care and treatment they received, day-to-day activities, and relationships with staff.

Supporting Learning Disability Partnership Boards to implement the National Carers Strategy. This booklet offers guidance to learning disability partnership boards to help them ensure that carers of people with learning disabilities and carers with learning disabilities are supported in their own right and involved in local service developments that affect their lives and the lives of the people they care for.

The Mental Capacity Act: Fact sheet for social scientists. This is a fact sheet to assist social scientists in meeting the requirements of the Mental Capacity Act when carrying out social science research that includes people who lack capacity.

A summary of changes to direct payments. This leaflet sets out changes to the direct payment scheme that will take effect from 9 November 2009. The changes will extend the scheme to people who lack the capacity to consent and people with mental health problems who are subject to mental health and certain criminal justice legislation.

Supporting people with autism through adulthood. Published by the House of Commons Public Accounts Committee, this report looks at developing a strategy and services for adults with autism, autism awareness and access to services, and improving the effectiveness of services for adults with autism.

Absent without leave: definitions of escape and abscond. Definitions of escape, attempted escape, abscond and failure to return in secure mental health services.

News
Improved forms and clearer guidance to help you protect your future. The Office of the Public Guardian (OPG) has introduced shorter and simpler forms to organise a lasting power of attorney (LPA). The forms, which must be registered with the OPG for a fee of GBP 120 per form, cover property and financial affairs, and are improved versions of October 2007 forms; LPAs can still be made on previous forms until 31 March 2011.

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

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Pandemic Influenza

Publications/Guidance
Stock Management System training manuals. The Stock Management System (SMS) provides users with an effective tool to manage the distribution of antivirals to PCTs and collection points in the event of a pandemic. It will provide stock level information, reports and the ability to record issuance from GP prescribed antiviral information. These training manuals are to provide guidance to users of the SMS for antivirals.

Swine flu clinical package. This is a set of tools for use by frontline healthcare professionals, in severe and exceptional circumstances, during a pandemic flu situation.

Guidance on sickness certification in response to the swine flu pandemic. This document clarifies that the existing arrangements for provision of medical certificates or self-certification have not changed in light of the swine flu pandemic. The situation is being kept under close review to enable action to be taken quickly, should it be necessary.

The H1N1 swine flu vaccination programme 2009-2010. This letter provides information to assist immunisation leads, pandemic influenza leads and flu co-ordinators in further planning for the swine flu (influenza A (H1N1v) 2009) vaccination programme.

Rotation of doctors in training during pandemic influenza. As part of ongoing organisational preparedness, Ian Dalton, National Director of NHS Flu Resilience and Pat Hamilton, Director of Medical Education (England) have written this letter outlining arrangements for the rotations of doctors in training in the event of serious pandemic flu. It is accompanied by a paper by Prof David Sowden, the Pandemic Flu educational advisor to the Department of Health, and a statement of support from the Postgraduate Medical and Education Training Board (PMETB).

Pandemic influenza: Additional measures to meet workforce supply. This document summarises the agreed arrangements on issues such as re-registration, professional indemnity and pre-employment checks that will enable local employers to quickly recruit appropriately qualified health professionals if they should be needed to deal with pandemic influenza.

Pandemic Influenza: Recommendations on the use of antiviral medicines for pregnant women, women who are breastfeeding and children under the age of one year. Gives information on the dose of oseltamivir for children aged six months and over and up to one year of age and treatment of pregnant women.

A (H1N1) Swine influenza: Additional planning guidance and winter management and reporting for 2009-10. This is a letter to NHS chief executives explaining the latest guidance to support pandemic planners based on the latest science and understanding of the swine flu virus, and to ensure that all organisations continue to plan for managing swine flu alongside the added pressures of winter.

A (H1N1) Swine influenza: Additional planning guidance.
This is a letter to Directors of Adult and Children's Services explaining the latest guidance to support pandemic planners based on the latest science and understanding of the swine flu virus, and to ensure that all organisations continue to plan for managing swine flu alongside the added pressures of winter.

Swine flu: guidance for planners. This updated guidance has been published to support pandemic planners based on the latest science and understanding of the swine flu virus.

A (H1N1) Swine Influenza: Vaccination programme update. A letter from Ian Dalton, National Director of NHS Flu Resilience, to NHS Chief Executives, providing further information on the swine flu vaccination programme.

The H1N1 swine flu vaccination programme 2009-2010. Letter providing information to assist immunisation leads, pandemic influenza leads and flu co-ordinators in further planning for the swine flu (influenza A (H1N1v) 2009) vaccination programme.

Swine Flu Vaccination Programme: Information to support the vaccination of pregnant women. This is a letter to GPs and practice nurses introducing a questions and answers document and other information materials.

Clinical professionals brief on swine flu vaccination. This paper aims to provide clinicians with further information about the swine flu vaccination programme. It combines information about the vaccines and the proposed programme for their administration from the Department of Health with evidence from a variety of peer-reviewed sources.

Vaccination (H1N1 Swine) for Health Protection Agency Staff. This is a letter from National Director of NHS Flu Resilience Ian Dalton requesting assistance in the vaccination of Health Protection Agency staff.

H1N1 swine flu vaccination programme: information materials and vaccine schedule information. This dear colleague letter outlines the information materials for the H1N1 swine flu vaccination programme that are now published on the Department of Health website.

Legislation
The Primary Medical Services (Directed Enhanced Services - pandemic influenza (H1N1) vaccination scheme) and Statement of Financial Entitlements (Amendment) (No.6) Directions 2009. These Directions require PCTs to offer to enter into a Directed Enhanced Service with their existing primary medical care contractors who hold a list of registered patients, by 13 November 2009, to deliver the H1N1 vaccine to patients in the priority groups identified in the CMO letter of 13 August 2009.

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

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Primary Care Trust

Publications/Guidance
General practice in England: an overview. This briefing from the King's Fund sets out how general practice is organised, contracted and financed, analyses the impact of recent government policy, and looks at future trends.

Improving quality in primary care. Practical guide to support PCTs, as commissioners of primary care, in working with local clinicians and other stakeholders, including patients, to promote continuous quality and productivity improvement in primary care services.

Out-of-hours primary care services: Primary care trusts' contract and performance management arrangements. This letter to PCTs in relation to the Care Quality Commission's independent inquiry into provision of out-of-hours GP services reiterates that PCTs have a legal obligation to make sure OOH services are delivered safely and to a high standard.

Reviewing patients who have waited longer than 18 weeks. As set out in David Flory's Quarter 4 2008-09 report, PCTs need to understand and act upon the reasons for any unnecessary waits over 18 weeks. This guidance suggests methods for reviewing and reporting waits longer than 18 weeks in order to understand the causes of unnecessary waits, and to drive further improvements in patient experience.

Legislation
Primary Care Trust Medical Services Directions 2009.These Directions are given to PCTs in England and came into force on 17 September 2009. They revoke and replace the Primary Care Trust Medical Services Directions 2008.

Alternative Provider Medical Services Directions 2009. These Directions have been given to PCTs in England and came into force on 17 September 2009.

News
Patients to rate GP practices online. The DH has launched a new online comparison service that will give people all the information they need to decide which of England's 8,300 practices is right for them, to enable them to register with a GP practice of their choice. The tool will make it easier to find key information in one place, such as opening times and additional facilities offered by the GP practice. Patients will also be able to read other people’s comments about the quality of the GP service.

Secretary of State for Health Andy Burnham has announced that NHS patients are to be legally entitled to receive private treatment if they are not seen within the 18 week waiting time target. Cancer patients will also receive funding for private treatment if they have not seen an NHS specialist within two weeks of GP referral. The two legal rights are designed to entrench the reduction in waiting times over recent years and prevent waiting lists growing. The waiting times are due to be placed on the statute book for the first time and will be passed through parliament before the next general election. Mr Burnham said the move would embed patients' rights and will be a "key battleground for the next election."

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

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Regulation

Publications/Guidance
Guidance: Sharing information gained during regulatory activity. Provides guidance on how the Care Quality Commission shares information about service providers with commissioners of care, such as councils, PCTs and other organisations.

Performance ratings 2008/09. The CQC has published the performance ratings for all 392 NHS trusts in England. The assessment, also known as the ‘annual health check’, shows big improvements for patients in areas such as accident and emergency waiting times, treatment referral times, and chlamydia screening rates, and big reductions in MRSA and C. difficile cases. But CQC raises concerns about the 20 trusts rated "weak” this year on quality and a further 27 that have not been higher than “fair” for quality and financial management in the last four years.

Guide to Monitor for NHS foundation trust governors. Sets out what Monitor does, how it regulates FTs and how governors can interact with Monitor.

Your statutory duties: a reference guide for NHS foundation trust governors. Examines ways in which NHS FT governors can deliver their statutory duties. It sets out these duties, and provides suggested advisory process steps to deliver them, which reflect best practice. The guide was produced following a 12-week consultation process.

Cases
Gerstenkorn v General Medical Council (Unreported, 12 October 2009) (Admin Ct). The court held that the GMC's Fitness to Practise Panel was entitled to find that a consultant renal transplant surgeon's fitness to practise was impaired by reason of his misconduct and deficiency in his professional performance, and the erasure of his name from the medical register was the appropriate sanction.

Ndisang v Nursing and Midwifery Council [2009] EWHC 2487 (Admin) (Admin Ct). The court held that, where the Nursing and Midwifery Council's Conduct and Competence Committee had incorrectly found a charge of misconduct against a nurse in a care home who had given the key of a drug cupboard to a care worker, there was no proper basis to interfere with its decision that the nurse's fitness to practise was impaired and to make a caution order against him, as the charge made no material difference to the Committee's considerations in reaching its decision.

Muscat v Health Professions Council [2009] EWCA Civ 1090 (CA). The court held that the existence of a right to review was a factor to be taken into account by the court when exercising its discretion as to whether to admit fresh evidence on appeal. In this case, that diminished the importance of the public interest in not striking off a qualified health professional.

S v Health Professions Council (Unreported, 23 October 2009) (Admin Ct). The court held that a period of 16 months between the initial hearing of a complaint about the conduct of a healthcare professional by the Health Professions Council’s Conduct and Competence Committee, and the final hearing at which he was struck off, did not give rise to a breach of his right to a fair trial under art.6(1) ECHR. The process had been conducted expeditiously and fairly.

Consultations
Response to the consultation on draft regulations for the framework for the registration of health and adult social care providers. In spring 2009, the Department of Health consulted on a set of draft regulations, which set out the detail of a new registration system to be operated by the new Commission. This document provides the response to the consultation.

Consultation on Care Quality Commission Strategy for 2010-15. This consultation seeks views on the Commission's five-year strategic plan.

Legislation
Draft Health and Social Care Act 2008 (Regulated Activities) Regulations 2009. These draft regulations detail the new framework against which the Care Quality Commission will regulate providers of health and adult social care. The requirements set out the essential levels of safety and quality of care that providers must deliver for people who use their services, but gives them flexibility on how they do it. Subject to approval by Parliament, the new system will be introduced for NHS healthcare providers in April 2010 and for private and voluntary health care and adult social care providers from October 2010, making it illegal for organisations to provide services that fall under the new framework without registering.

News
Completion of reform to the healthcare regulatory bodies. The DH has announced the completion of reforms that mark a significant milestone in the Government’s programme to make safety and quality paramount in the care of patients by modernising the regulation of healthcare professionals, as set out in the White Paper "Trust, Assurance and Safety". The key features of the reforms are: each regulator has moved to a fully appointed council, with parity between lay and professional members, to ensure that professional interests do not dominate; new council members for the regulators will be independently appointed by the Appointments Commission against specific criteria relating to their skills and expertise; and smaller, more board-like councils will enhance the ability of the regulators to act strategically.

The Care Quality Commission (CQC) is encouraging NHS employees to provide feedback on their experiences at work by participating in the seventh annual NHS Staff Survey.

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

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General

Publications/Guidance
Independent sector treatment centres. Independent sector treatment centres (ISTCs) provide services to NHS patients but are owned and run by organisations outside the NHS. This briefing paper explains why ISTCs were introduced, and how they are funded, staffed and regulated. It assesses their impact so far, including the quality of their services and whether they provide good value for money. Finally, it examines what their future may be now that the contracts ISTC providers hold with the Department of Health are beginning to expire.

Reclaiming costs of visitor treatment from European Economic Area (EEA) member states. From 12 October 2009 the DH has changed the arrangements which NHS trusts should follow in recording and reporting treatments (including planned treatments) of visitors from the EEA and Switzerland. This letter gives more information.

Access to healthcare abroad. Informs tells citizens about how they can get healthcare in other countries in the European Economic Area.

Guidance on changes to recording and reporting data about necessary and planned treatment of overseas visitors from the European Economic Area (EEA). This letter advises on changes to be made to the collection and reporting of data about overseas visitors from 12 October 2009, with detailed guidance about the processes, and information about future workshops. See also Leaflets on the European Health Insurance Card, healthcare entitlement for European Economic Area and non-European Economic Area visitors and hospital treatment for non-resident UK citizens - part of a suite of information for overseas visitor managers in support of the new arrangements by which NHS trusts should record and report treatments (including planned treatments) of visitors from the EEA and Switzerland.

The CRC energy efficiency scheme and the NHS. The Carbon Reduction Commitment energy efficiency scheme, which will begin in April 2010 with an introductory three-year phase, is a mandatory energy efficiency scheme that will affect both the public and the private sector. This Briefing outlines the main details of the scheme which will affect NHS trusts.

International health: Department of Health (DH) objectives and ways of working. This is a guide primarily for DH staff, to help DH work more effectively internationally. It sets out objectives for their international work and describes the roles and responsibilities of different parts of DH. The role that the DH has in taking forward the government's global health strategy is also discussed. The publication describes some of the key partners and international organisations that they work with.

Working together to save lives: the Organ Donation Taskforce Implementation Programme's annual report, 2008/09. This first annual report of the ODTIP details the progress made in the first year of the Programme, which was set up by the Government to increase organ donation by more than 50% by 2013 with the aim of enabling the NHS to carry out more than 1,400 extra transplants every year. The Programme aims to do this by implementing the 14 recommendations of made by the Organ Donation Taskforce in January 2008. The report shows progress that has been made since the implementation team began its work in June 2008, particularly the changes in structures and arrangements in the NHS with the move to a centrally managed, and enlarged, network of Donor Transplant Coordinators and the appointment of Clinical Leads for Organ Donation within hospital trusts.

Managing patients' medicines after discharge. This CQC report looks at how well patients' medication is managed after leaving hospital. During its visits, the CQC saw some evidence of good practice, but also found the following concerns: GP practices and hospitals do not always share timely, complete patient information on medication changes when people move between services; reviewing and updating of GP records is sometimes left to administrative staff; GPs do not routinely review new medication with a patient after they leave hospital; and monitoring and learning from serious incidents is patchy. From April 2010, all trusts will be required by law to register with CQC and must meet a new set of standards. Effective management of medicines will be a requirement of registration, and CQC will take action where trusts fall short of meeting this. The regulator therefore urges all trusts and GP practices to use the findings of its study to identify problem areas in preparation for registration.

Consultations
Prioritisation for quality improvement: National Quality Board stakeholder engagement. The Department of Health seeks views on the proposed process by which the National Quality Board will advise the Government on clinical priorities and on topics for National Institute for Health and Clinical Excellence quality standards. Comments are required by 10 November 2009.

The Human Fertilisation and Embryology Act 1990: disclosure of identifying information for research: regulations for consultation. The regulations establish a procedure for authorising the disclosure of identifying information held by the Human Fertilisation and Embryology Authority, for research purposes, where it is not practicable to obtain consent to the disclosure from the persons to whom the information relates. This is the second consultation exercise and covers the amendments made to the draft regulations as a result of the responses received to the first consultation exercise that took place at the start of 2009. Responses should be submitted by 2 December 2009.

Direct payment for health care: a consultation on proposals for regulations and guidance. Seeks views on proposals for piloting direct payments for health care, as part of the wider pilot programme to explore personal health budgets announced in High Quality Care For All. Personal health budgets are intended to help create a more personalised NHS by giving people more control over their care. PCTs are already able to offer personal budgets that do not involve giving money directly to individuals. The Health Bill, which has now completed its main Parliamentary stages and should receive Royal Assent shortly, extends these options by providing power to allow direct payments, where the individual would be given the money to buy their own health care as agreed in a care-plan. This consultation will inform the regulations and guidance to make direct payments happen. The consultation closes on 8 January 2010.

Protecting the NHS in relation to patient mobility and cross-border healthcare: Draft regulations and guidance. ECJ case law on patient mobility under Article 49 of the EU Treaty means that patients are able to seek any healthcare (including private care) in another European Economic Area (EEA) Member State, and, as long as they are entitled to the treatment in question under their home healthcare system, they are eligible to have their costs reimbursed. For patients travelling from the UK, this reimbursement can be up to the level of the cost for the same treatment provided in the UK under the NHS. Any additional costs must be met by the individual. Patients from EEA countries can likewise pay to receive NHS treatment and claim reimbursement from their home health system. The DH is seeking views on the content, clarity and appropriateness of the draft regulations and draft guidance on prior authorisation and reimbursement of costs in respect of applications from patients to access cross-border healthcare under the provisions of Art.49 EU. The stakeholder consultation runs until 20 November 2009 and the new regulations and guidance should come into force in January 2010.
The DH is holding an NHS stakeholder engagement event on 19 November 2009 on the proposed interim regulations and guidance.

Legislation
Human Fertilisation and Embryology Act 2008 (HFEA). This Act came into force on 1 October 2009. It: ensures all human embryos outside of the body are subject to regulation; ensures regulation of human admixed embryos; bans sex selection for non-medical reasons; recognises same sex couples as legal parents of children conceived through use of donated sperm, eggs or embryos; replaces the reference to "the need for a father" with "the need for supportive parenting"; revises rules on the use of HFEA collected data; and extends storage time of embryos to up to 55 years.

National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Wales) (Amendment) Regulations 2009 (SI 2009/2607 (W.21)). These regulations, which come into force in Wales on 20 October 2009, amend SI 2007/121 (W.11), which abolished charges in respect of drugs and appliances supplied to patients registered with GPs in Wales, or registered with GPs in England and who hold a valid entitlement card. These regulations broaden the list of medical conditions which entitle a patient to apply for a certificate which exempts that patient from the requirement to pay a charge, to include cancer, the effects of cancer and the effects of cancer treatment.

News
Secretary of State for Health Andy Burnham has announced that NHS patients are to be legally entitled to receive private treatment if they are not seen within the 18 week waiting time target. Cancer patients will also receive funding for private treatment if they have not seen an NHS specialist within two weeks of GP referral. The two legal rights are designed to entrench the reduction in waiting times over recent years and prevent waiting lists growing. The waiting times are due to be placed on the statute book for the first time and will be passed through parliament before the next general election. Mr Burnham said the move would embed patients' rights and will be a "key battleground for the next election."

Bevan Brittan Updates
Assisted Suicide: A Step Towards a More Compassionate Law? A review of R (on the application of Purdy) v DPP (2009) UKHL 45 & DPP Guidelines.

Events
Medical law: annual prison health update

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

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