Health and Social Care Update November 2010

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	Health and Safety
Children	Inquests
Clinical Management	Mental Health
Clinical Research	Obesity
Commissioning	Primary Care
Employment/HR	Prison Health
Finance	Regulation
Foundation Trusts	General

Care

Publications/Guidance
Reaching out to carers innovation fund 2010/2011: Information pack for voluntary organisations. The DH is keen to improve early identification of carers so that they can be supported in considering their various options and make informed choices about their lives. It is inviting bids for grants of up to £25,000 from voluntary sector organisations in England who, in addition to their primary work with individuals with particular conditions, illnesses or with particular age groups, are keen to support carers. The funding is being made available under s.64 of the Health Services and Public Health Act 1968 for projects in 2010/2011. The closing date for applications is 17 November 2010.

End of life care planning with people who have a personal health budget. This discussion paper focuses on the current context of practices and policies that impact on end of life, including those that need to be explored with people who have a personal health budget.

Deaths in older adults in England. This report looks at deaths in people aged 75 and over to examine differences in place and cause of death by age band, from old to extreme old age. The report highlights the importance of understanding the differing needs of older adults at the end of life.

Implementing the End of Life Care Strategy: lessons for good practice. This report published by the Kings Fund looks at three Marie Curie Delivering Choice programmes, which work to identify the barriers to good care and highlights examples of good practice from across the country. It argues that significant progress can be made by rolling out existing good practice and adapting it to local contexts, and that the public spending squeeze need not stand in the way of further improvements to end-of-life care.

News
Nearly 1,000 care homes are without a registered manager, says regulator. The CQC has reported that nearly 1,000 residential care homes do not have an appropriately experienced and qualified registered manager in place, despite this being a requirement of the new Health and Social Care Act 2008 from 1 October 2010. CQC will use its enforcement powers where necessary; these include issuing a warning notice, carrying out a prosecution, and suspending or closing a service.

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

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Children

Publications/Guidance
Publication of Serious Case review overview reports and Munro Review of child protection. The Government has published the two Serious Case Review (SCR) overview reports into the tragic death of Peter Connelly in Haringey, in order to restore public confidence and improve transparency in the child protection system. This letter to Directors of Children's Services and Chairs of LSCBs notifies them of a change to the statutory guidance in Chapter 8 of "Working together to safeguard children" relating to the publication of SCRs, and also informs them of an independent review, chaired by Professor Eileen Munro, into improving child protection. The two SCR overview reports and other supporting documents are available on the DfE website.

Learning lessons from serious case reviews: year 2. This report from OFSTED evaluating serious case reviews has found that although local areas are learning lessons from reviewing cases, more needs to be done to ensure the review process improves the way children across the country are protected from harm.

Department of Health: What to expect after vaccinations. This leaflet explains the common side-effects of vaccinations that might occur in babies and young children up to five years of age. It is intended for nurses and other immunisation practitioners to download and print out for parents and guardians when their children are being immunised.

Grasping the nettle: early intervention for children, families and communities. This paper summarises local practice validated as excellent or deemed promising in response to the joint call for effective practice from ADCS and C4EO. It highlights the early messages from an analysis of these initial case studies.

Promoting the quality of life of looked-after children and young people. This joint guidance from NICE and the Social Care Institute for Excellence is for all those who have a role in promoting the quality of life (that is, the physical health, and social, educational and emotional wellbeing) of looked-after children and young people. The focus of the guidance is on how organisations, professionals and carers can work together to help looked-after children and young people reach their full potential and enjoy the same opportunities in life as their peers. The recommendations cover local strategy and commissioning, multi-agency working, care planning and placements, and timely access to appropriate health and mental health services.

New quality standard on specialist neonatal care. NICE has launched a new quality standard on specialist neonatal care services. These services are defined as high-dependency, surgical or intensive care.

Ministry of Justice: Response to comments and recommendations from the Lambert Report. This is an update of progress made in response to David Lambert's review of operational procedures for the identification, placement and safeguarding of vulnerable young people in custody. It provides details of the progress made since the document was first published in 2006.

Postnatal care: still a Cinderella story? This report summarises findings of survey of 1260 first-time mothers' experiences of NHS postnatal care and makes ten recommendations for improvement of services.

Scrutiny of vetting and barring scheme gets underway. The Home Office has announced that the Government is to undertake a thorough review of the Vetting and Barring Scheme that will re-examine whether the scheme is the most appropriate mechanism to protect children and vulnerable people and, if so, how many roles should be covered by it. The final recommendations for the scheme will be announced early in the New Year.

News
4,200 new health visitors to boost young children's and families' health and wellbeing. The Government has launched a national recruitment drive to create 4,200 new health visitors and build a rejuvenated profession, with the aim of increasing the number of health visitors by almost 50 per cent. This commitment was confirmed in the Spending Review. The level of funding will be announced in due course.

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

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Clinical Management

Publications/Guidance
Primary care and emergency departments. This report on Primary Care and Emergency departments will be followed by a commissioning guide for PCTs and PBC groups.

Reviews into Summary Care Record. These reviews, commissioned by the Health Minister Simon Burns, have concluded that a Summary Care Record containing core patient information will prove valuable for patients needing emergency care.

Bevan Brittan Updates
Claims case round-up. Nicola Pegg reviews recent clinical negligence case updates.

A day in the life of an Obstetrician. Having handled claims arising out of obstetric alleged negligence for almost 10 years, I felt that I had a pretty good idea of what went on in a maternity unit.  When we were therefore approached by one of our local Trusts and asked as to whether or not spending some time shadowing their consultants would be of interest, I was polite but slightly sceptical.

Bevan Brittan Training
Complaints and claims forum. 01 December 2010 . Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF. Further details to follow.
register your interest in this event.

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Clinical Research

Publications/Guidance
Regional Trauma Networks: Clinical Advisory Group document. This report contains advice on the planning and designing of networks by the NHS Clinical Advisory Groups for major trauma to their colleagues in the NHS. The report is hosted on the East Midlands Strategic Health Authority website, along side other relevant supporting information.

Enhancing the benefits from biomedical and health research spillovers between public, private and charitable sectors in the UK. The Office of Health Economics and RAND Europe jointly organised a high level Forum in May 2010 to discuss how to maximise the benefit of spillovers from biomedical and health research. The key points from the Forum have been published in this report.

Being a good research partner: the virtues and rewards. This publication looks at the role and value of research, and in particular health services research, to English NHS organisations. It confronts some of the perceived barriers to getting engaged in research and explores the link with high performance and improved patient outcomes.

News
Government launches new programme to make UK global partner of choice for R&D collaboration. Announces the launch of the Therapeutic Capability Clusters programme, a world-first initiative to boost partnership between academics, clinicians and the life sciences industry to deliver the medicines of the future faster to UK patients and to secure the UK’s position as the global partner of choice for R&D collaboration. The programme will develop three-way partnerships between the life sciences industry, clinicians and academics to develop the best approaches to run experimental medicine studies and find novel ways to treating or diagnosing a whole range of diseases. The first phase establishes two clusters in inflammatory respiratory disease (such as asthma and Chronic Obstructive Pulmonary Disease) and in joint and related inflammatory diseases (such as arthritis). The Science Minister David Willetts has also announced plans by the Medical Research Council to invest more than £10m in consortia in two disease areas, complementing the Therapeutic Capability Clusters programme.

If you require further information about any of the items raised in this section please contact Claire Bentley.

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Commissioning

Publications/Guidance
Strategic Commissioning Development Unit (SCDU): commissioning packs. Commissioning packs are tools to help commissioners improve the quality of services for patients, through clearly defined outcomes that help drive efficiency by reducing unwarranted variation in services. Each pack contains a set of tailored guidance, templates, tools and information to assist commissioners in commissioning healthcare services from existing providers, or for use in new procurements.

Putting GP-led commissioning into practice. This discussion paper has been produced using information gathered from interviews in four different areas with GPs and PCT staff who have worked together on GP commissioning. In each area, a GP commissioning organisation has been successfully established and is now redesigning aspects of care and making decisions that affect how NHS funds are spent. It explores how GPs, managers and other colleagues have been able to overcome barriers to progress and seeks to establish what learning has arisen that will be of use to GPs and managers in other localities as they increase their activity around GP commissioning.

GP commissioning: does size matter? The report shows that there is little, if any, evidence that smaller organisations are better at commissioning than larger ones. It also argues that the transition will be costly, almost certainly resulting in a dip in performance in the short to medium term.

Impact of the health White Paper: what do doctors think? The survey questioned 500 GPs and 500 hospital doctors shortly after the consultation on the health White Paper closed. It underlines the challenge facing the government in convincing doctors that the proposed reforms will improve the quality of care. It also reflects concerns that reforms may distract the NHS from the urgent task of improving productivity, with more than 40 per cent of respondants believing that GP commissioning will make it more difficult to tackle health inequalities.

If you require further information about any of the items raised in this section please contact David Owens.

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Employment/HR

Publications/Guidance
The Equality Act 2010: employment implications for the NHS - October 2010. This briefing aims to give the latest position and understanding about the Equality Act from a human resources perspective. It also aims to help NHS organisations to ensure that they are fulfilling the requirements of the Act by giving useful checklists and top tips.

How to create an attractive and supportive working environment for health professionals. Policy brief looking at the challenges health policy-makers face in matching increasing demand for health care with a sufficient supply of health professionals in times of existing and projected health-workforce shortages.

Focus on Health and Safety. TUC biennial survey of safety reps 2010. In this survey of more 1,800 safety reps, nearly two-thirds (62%) said that stress is one of the top five problems faced by the workforces they represent, while more than a quarter (27%) picked out stress as the hazard at work that most concerns them. Stress is more often found in the public than in the private sector, the survey shows, with 68% of public sector union reps saying it is a problem, compared with 54% in the private sector.

News
Call to abolish NHS 'lifetime bonuses' for consultants. The BBC has found that large pay bonuses cannot be taken away from doctors, even if their performance deteriorates, because of a loophole in the system. It states that a pay protection clause means that doctors have continued to get the payouts even though the 'bonuses' have been formally withdrawn from them. The independent Doctors' and Dentists' Review Body is carrying out a review of the NHS bonus scheme and is due to report next summer.

Bevan Brittan Updates
Oh no - not another Equality Act article! Much ink has been spilt over the progress of the Equality Act 2010 – there has been seemingly endless speculation on the progress of the Act and what its final form might mean for HR.  To take stock of where we have got to with the Act, David Widdowson focuses on which provisions now apply, what is still on hold, and what action you should be taking now.  A full Bevan Brittan briefing note on the contents of the Act is also available by emailing here. 

Employment news round-up October 2010. The nights are drawing in, there’s a distinct cold snap in the air and the school run traffic jams have started again; but there are good things about October too: stamping on crunchy leaves, games of conkers and the Bevan Brittan October employment law news updater, provided this month by John Moore.

Age discrimination and retirement ages. The default retirement age is being put out to pasture next October and, once it goes, employers will have to objectively justify compulsory retirement ages.  A recent decision of the European Court of Justice has provided some help with the question of how courts and tribunals might approach the thorny issue of what ‘justification’ may mean.  Sarah Lamont reports.

Bevan Brittan Training
Employment Equalities: what’s in, what’s out, what’s shaken all about - Bristol. 30 November 2010 : Registration: 09.30, Seminar 10.00 - 11.30am.
register your interest in this event.

Employment equalities: what’s in, what’s out, what’s shaken all about - Birmingham. 02 December 2010 : Registration: 9.30, Seminar 10.00 - 11.30am.
register your interest in this event.

Employment equalities: what’s in, what’s out, what’s shaken all about - London. 08 December 2010 : Registration: 9.30am, Seminar 10 - 11.30am.
register your interest in this event.

Employment Law: Efficiencies & Joint working - the HR and TUPE Essentials -Sheffield. 04 November 2010 : Registration: 1.30, Seminar 14.00 - 16.30. Location: The Source at Meadowhall, 300 Meadowhall Way, Sheffield, S9 1EA.
register your interest in this event.

If you require further information about any of the items raised in this section please contact Claire Bentley.

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Finance

Publications/Guidance
Auditors' local evaluation and use of resources 2009/10. This Audit Commission annual report assesses how well NHS trusts and PCTs manage their resources and deliver value for money. It also includes a summary of the scores for Auditors' local evaluation (ALE) for NHS trusts and use of resources for PCTs. The scores show the overall strength of financial management and are clearly linked to financial performance and accounts. It shows that an overall surplus of £1.5bn was recorded by NHS trusts, PCTs and SHAs. Problems persist at a small percentage of NHS bodies: out of 260 bodies assessed, six trusts and four PCTs failed to achieve financial balance in 2009/10. No organisation had its accounts qualified on grounds of truth and fairness and there was no difference overall between draft and final accounts. The use of resources assessment for PCTs, which is more demanding than the evaluation for NHS trusts, shows that six PCTs recorded the lowest overall score available in 2009/10, while only one PCT got the top score. Overall, however, PCTs have significantly improved their approach to managing their finances. Three quarters of PCTs were managing their finances well in 2009/10.

Public dividend capital 2010-11. The DH has issued guidance on the availability of public dividend capital (PDC) for capital investment at foundation trusts in 2010/11. PDC is available to finance capital allocated from the DH's 2010/11 Capital Budgets, and to finance asset transfers between FT and other NHS bodies via "circular flow of funds" arrangements. PDC is available to FTs to finance allocations from 2010/11 DH central budgets. Central capital allocations in 2010/11 are cash backed, i.e. FTs will be able to draw PDC equal to the amount allocated. The guidance includes details of the capital allocated in 2010/11. As in previous years, FTs will be able to transfer assets between themselves and other NHS organisations, via a circular flow of funds. The guidance sets out the conditions applying to circular flows, and includes a return that should be sent to the DH by 1 November 2010 if FTs want to action a circular flow in 2010/11.

Update on work to prepare the tariff for Payment by Results for 2011-12. This letter from David Flory, Deputy NHS Chief Executive, provides information on the PbR tariff for 2011-12. The tariff has been designed around the proposals set out in the Revision to the 2010-11 Operating Framework and the Health White Paper 'Equity and Excellence: Liberating the NHS'.

A shower not a hurricane. This paper analyses the recent Spending Review, arguing that the cuts are more modest than anticipated and that the alternatives could be more severe.

NHS resources and reform: response to the White Paper Equity and Excellence: Liberating the NHS, and the 2010 Spending Review. The White Paper Equity and Excellence: Liberating the NHS will be implemented in a period of significant financial challenge for the NHS. This briefing paper presents a comprehensive analysis of the White Paper and Spending Review, drawing on national and international evidence.

If you require further information about any of the items raised in this section please contact Claire Bentley.

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Foundation Trusts

Consultations
Consultation on proposed financial reporting amendments to the NHS Foundation Trust Annual Reporting Manual for 2010-11. Monitor has launched an 8-week consultation on the proposed financial reporting amendments to the NHS Foundation Trust Annual Reporting Manual for 2010-11. The closing date for this consultation is 5pm on Friday 10 December 2010.

If you require further information about any of the items raised in this section please contact David Owens.

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Health and Safety

Publications/Guidance
Review of coding for success implementation. Coding for success was published in 2007 and described how barcoding and similar technologies can be used to improve patient safety, reduce costs and improve efficiency. This review aims to outline progress made since 2007, and was recommended by the Health Select Committee in its 2009 report on Patient Safety.

Occupational health and safety standards. This document outlines the legal requirements, best practice examples and signposting advice on meeting standards for the key areas of occupational health and safety.

Physical control in care. This document has been created by NOMS to train staff in safe methods of restraining young people in secure training centres. The 2010 manual is split into two distinct training guides. The first is the PCC manual, which includes guidance on holds, spontaneous incidents and handcuffs. Separately, the personal protection manual contains guidance on breakaway techniques and managing weapon attacks. The decision to divide the manual was taken to emphasise the difference between techniques used to safely restrain an individual and those used to separate staff from a potentially volatile and dangerous situation. Both manuals have been designed to be used as part of an intensive training course and under no circumstances should any holds or techniques be used without professional supervision.

Working with radiation in the NHS – advice for managers and staff. This document is intended to offer advice to managers at all levels, and their staff, on how to work more safely with exposure to radiation in their everyday jobs. It will also be particularly useful to chief executives, who may be unaware of their range of responsibilities in relation to radiation services.

Consultations
The NHS Constitution and whistleblowing - a paper for consultation. Seeks views on proposals amending the NHS Constitution to:

• insert an expectation that NHS staff will raise concerns about safety, malpractice or wrong doing at work which may affect patients, the public, other staff or the organisation itself as early as possible; 
• insert a NHS pledge to support all staff in raising concerns about safety, malpractice or wrong doing at work, responding to and where necessary investigating the concerns raised; and
• highlight in the NHS Constitution the existing staff legal right to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment.
• The consultation closes on 20 January 2011.
  
  Expanding the list of 'never events'. 'Never events' are serious, largely preventable patient safety incidents that should not occur if the relevant preventative measures have been put in place. This guidance aims to engage external partners and seek comments and suggestions on the draft list of events and on the framework for recovering costs when they occur. Comments and suggestions are invited by 19 November 2010.

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Inquests

Publications/Guidance
Reform of the Coroner System Next Stage: Preparing for implementation: Response to consultation. A Ministry of Justice report sets out the Government's response to the consultation "Reform of the Coroner System Next Stage: Preparing for Implementation", including a summary of responses received to each question. In general, there was support for the aims and objectives of the proposed reforms, although there were a range of views about individual strands of policy. The report also includes a brief summary of how the Government intends to progress each area consulted on, in the light of consultation responses and a written ministerial statement made to Parliament.

Ministry of Justice: Response to coroners' recommendations from Gareth Myatt and Adam Rickwood inquests. This is an updated version of the action plan outlining the government's response to coroners' recommendations in the inquests into the deaths of two teenagers in secure training centres. It provides details of the progress made since the document was first published in March 2008.

Coroners and Justice Act 2009 - Implementation of homicide provisions. This is a circular on the provisions in the Coroners and Justice Act 2009. it relates to the partial defences of diminished responsibility and loss of control (replacing provocation), and infanticide, which came into force in England and Wales on 4 October 2010.

Bevan Brittan Updates
Is it an inquest or a claim? When preparing a statement for the Coroner, Mr A raised a concern that, although the cause of death of Mrs X was clostridium difficile, a review of her notes demonstrated that there may have been a missed opportunity to diagnose cancer.  This was many months previously, but it was arguable that the delay in diagnosis had led to more extensive surgery with increased chances of infection (which had materialised), leading to antibiotics and ultimately c.diff.

Bevan Brittan Training
Inquest update - Birmingham. 22 November 2010 : Registration: 13.00, Seminar 13.30 - 17.00.
register your interest in this event

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

Bevan Brittan Online Resources
NEW! Bevan Brittan Mental Health Portal. Bevan Brittan has a wealth of mental health knowledge it would like to share with clients. We have therefore developed an online resource which has been designed to bring various sources of mental health information and guidance into one place. The aim is simple - to keep professionals in mental health up-to-date with what is happening in an ever changing landscape. If you would like more information please contact Claire Bentley.  

Publications/Guidance
Achieving justice for victims and witnesses with mental distress: A mental health toolkit for prosecutors and advocates. Mind's mental health toolkit and related quick quide complement the CPS public policy statement Supporting victims and witnesses with mental health issues and associated relevant prosecution guidance. They offer thorough information and advice about mental distress and its implications, including practical tools to mitigate these and grant victims and witnesses equal access to justice.

We need to talk: getting the right therapy at the right time. This report, published by Mind, found that the Improving Access to Psychological Therapies scheme has had a dramatic impact on waiting times for people with depression and anxiety. However across England 1 in 5 people are still waiting over a year to access psychological therapies such as cognitive behavioural therapy or counselling.

Development of services for people with learning disabilities or mental illness in England. This report highlights developments since 2003 in services for people with mental illness and learning disabilities.

‘Six Lives’ progress report. This report looks at the progress made to improve healthcare for people with learning disabilities in line with the recommendation of the Parliamentary and Health Service Ombudsman and Local Government Ombudsman in their March 2009 investigation ‘Six Lives’.

MARSIPAN: Management of really sick patients with anorexia nervosa. These guidelines were produced with the aim of reducing the number of avoidable deaths of patients with severe anorexia nervosa on general medical units. The guidelines are aimed at all medical, nursing and dietetic staff working in hospitals to which a patient with severe anorexia nervosa could be admitted.

Economic and social costs of mental health problems in 2009/10. This policy paper calculates what the economic and social costs of mental illness are. The figure includes the costs of health and social care for people with mental health problems, lost output in the economy, for example from sickness absence and unemployment, and the human costs of reduced quality of life.

No health without public mental health: the case for action. This is a position statement from the Royal College of Psychiatrists.

Mental Health Foundation website: best interests tool. The Best Interests Determination General Research and Evaluation Tool (BRIDGET) allows professionals to evaluate a best interests process that they have been involved in. Completing the online tool allows professionals to download a report that indicates how closely the process followed the Mental Capacity Act and its Code of Practice. BRIDGET is a companion tool the Assessment of Mental Capacity Audit Tool (AMCAT), a simple online tool to help staff and others evaluate, reflect and learn about an assessment of mental capacity they have done. Audit an assessment using AMCAT.

Monitoring the use of the Mental Health Act in 2009/10. The Care Quality Commission’s first report on the exercise of its functions in keeping under review the operation of the Mental Health Act 1983..

Consultations
Draft guidance by the Tribunal as to the role of Independent Mental Health Advocates at tribunal hearings. Comments invited by the Tribunals Service on:-
 Problems for IMHAs
 Role of the IMHA
 Attendance at the hearing
 Seating arrangements
 Relationship with the legal representative
 Procedural issues
 Giving evidence
 Asking questions and addressing the panel
 Access to the Tribunals decision.
This document is in draft form for consultation. Any comments are welcomed by Judge Neville Chamberlain by 15 November 2010.

Reform of Coroner System consultation response. A total of 182 responses to the consultation paper were received and published on 14 October. The respondents were from a wide range of sectors which included coroners, coroners officers, voluntary organisations, pathologists, registrars, local authorities, investigating authorities, bereaved people, police authorities, government departments, legal and medical profession, media, faith groups, individuals and other interested parties. The report summarises the responses received to each question. In general, there was support for the aims and objectives of the proposed reforms, although there were a range of views about individual strands of policy. The report also includes a brief summary of how the government intends to progress each area consulted on, in the light of consultation responses and the Written Ministerial Statement (WMS) made to Parliament. 

Bevan Brittan Updates
The right to life, the need for clarity. Julie Charlton examines the obligations that Article 2 of the European Convention on Human Rights (ECHR) places on NHS Trusts this having been considered by the courts in two recent cases, Savage v South Essex Partnership NHS Foundation Trust and Rabone v Pennine Care NHS Trust.

Is it an inquest or a claim? Joanna Lloyd explores the difference between an inquest and a claim. 

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

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Obesity

News
Surgery for obese could 'save millions of pounds'. Following NICE guidance on bariatric surgery could save the economy hundreds of millions of pounds and the NHS around £56m every year, leading surgeons have said.

A woman has succeeded in a landmark attempt to force the NHS to fund her gastric bypass operation. Berkshire East PCT originally refused to offer Hazel Kent the operation as her body mass index was too low, but has now agreed to fund the operation after she threatened legal action.  

Hospitals criticised over facilities for obese patients. A Somerset woman who was too overweight to fit in a hospital scanner has criticised the NHS for not providing better care for obese patients.

If you would like more information about any of the items in this section please contact Julie Chappell.

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Primary Care

Publications/Guidance
Auditors' local evaluation and use of resources 2009/10. This Audit Commission annual report assesses how well NHS trusts and PCTs manage their resources and deliver value for money. It also includes a summary of the scores for Auditors' local evaluation (ALE) for NHS trusts and use of resources for PCTs. The scores show the overall strength of financial management and are clearly linked to financial performance and accounts. It shows that an overall surplus of £1.5bn was recorded by NHS trusts, PCTs and SHAs. Problems persist at a small percentage of NHS bodies: out of 260 bodies assessed, six trusts and four PCTs failed to achieve financial balance in 2009/10. No organisation had its accounts qualified on grounds of truth and fairness and there was no difference overall between draft and final accounts. The use of resources assessment for PCTs, which is more demanding than the evaluation for NHS trusts, shows that six PCTs recorded the lowest overall score available in 2009/10, while only one PCT got the top score. Overall, however, PCTs have significantly improved their approach to managing their finances. Three quarters of PCTs were managing their finances well in 2009/10.

Strategies to achieve cost-effective prescribing: guidance for primary care trusts and clinical commissioning groups. This guidance has been produced to assist PCTs and clinical commissioning groups in implementing the Quality, Innovation, Productivity and Prevention (QIPP) agenda. The guidance contains some specific advice (paragraph 7) on the principles to be adopted in framing and administering a prescribing incentive scheme where a PCT decides to use this mechanism to encourage cost-effective prescribing by their GP practices.

Primary care and emergency departments. This report on Primary Care and Emergency departments will be followed by a commissioning guide for PCTs and PBC groups.

Quality improvement in general practice. This discussion paper reviews approaches to quality improvement and their current usage in general practice. It makes recommendations for action at multiple levels of the health system to nurture and support improvements in quality in general practice.

The proposals to implement ‘Generic Substitution’ in primary care, further to the Pharmaceutical Price Regulation Scheme (PPRS) 2009. This document contains the Department of Health’s response to the consultation on the proposals to implement 'generic substitution' in primary care. It is published alongside an analysis of responses report authored by Greenstreet Berman Ltd for COI and the Department of Health.

Putting GP-led commissioning into practice. This discussion paper has been produced using information gathered from interviews in four different areas with GPs and PCT staff who have worked together on GP commissioning. In each area, a GP commissioning organisation has been successfully established and is now redesigning aspects of care and making decisions that affect how NHS funds are spent. It explores how GPs, managers and other colleagues have been able to overcome barriers to progress and seeks to establish what learning has arisen that will be of use to GPs and managers in other localities as they increase their activity around GP commissioning.

GP commissioning: does size matter? The report shows that there is little, if any, evidence that smaller organisations are better at commissioning than larger ones. It also argues that the transition will be costly, almost certainly resulting in a dip in performance in the short to medium term.

NICE referral advice recommendations database. This online database offers GPs advice on referring patients from primary to secondary care. The database covers referral advice for patients with the range of conditions NICE has published guidance on, such as suspected cancer, lower back pain and psoriasis. It highlights recommendation from NICE guidance which clearly identifies where patients might benefit from secondary care or specialist services and, by implication, those where patients would not benefit from these services.

Toolkit to support the development of Primary Care Federations. This toolkit has been designed to support the development of Primary Care Federations. It focuses on providing advice and support to those practitioners and managers in primary care who are thinking about, or have embarked upon, developing a Federation for the purposes of providing services in a collaborative manner.

Consultations
Your choice of GP practice - a summary of the consultation on enabling people to register with the GP practice of their choice. Sets out a summary of responses from the March 2010 consultation that sought people’s views on a range of proposals to remove the current system of practice boundaries to enable people to register with any GP practice, regardless of where they lived. It looked at a range of issues that might arise when people choose to register away from home and considered some of the ways in which the NHS could address these. The responses show that the majority of the public support the aim of enabling them to have the choice to register with any practice willing to provide them the care and services expected. The consultation identified a number of related policy and logistical issues to resolve with the profession and with the NHS prior to implementation that will now be worked through. The DH will publish a more detailed policy framework and its formal response early next year, setting out the changes necessary to secure the care and services wanted by the majority of respondents.

News
GPs can take control in new pathfinder consortia. Announces a new pathfinder programme that will identify and support groups of GP practices who are keen to make faster progress in taking on the new roles set out in the NHS White Paper. It will enable GPs to test different design concepts of GP Consortia and identify any issues and areas of learning early on so that these can be shared across the GP community. To kick-start the programme the Department has made £1 million available from central funding to support regional learning programmes across England. GP practices keen to participate in the pathfinder programme will need to put themselves forward to their PCT and SHA from the end of October.

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

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Prison Health

Publications/Guidance
Physical control in care. This document has been created by NOMS to train staff in safe methods of restraining young people in secure training centres. The 2010 manual is split into two distinct training guides. The first is the PCC manual, which includes guidance on holds, spontaneous incidents and handcuffs. Separately, the personal protection manual contains guidance on breakaway techniques and managing weapon attacks. The decision to divide the manual was taken to emphasise the difference between techniques used to safely restrain an individual and those used to separate staff from a potentially volatile and dangerous situation. Both manuals have been designed to be used as part of an intensive training course and under no circumstances should any holds or techniques be used without professional supervision.

Ministry of Justice: Response to comments and recommendations from the Lambert Report. This is an update of progress made in response to David Lambert's review of operational procedures for the identification, placement and safeguarding of vulnerable young people in custody. It provides details of the progress made since the document was first published in 2006.

Bevan Brittan Training
Annual Prison Health Update. 09 December 2010 : Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF. register your interest in this event.

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

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Regulation

Publications/Guidance
Key themes from stage two of Monitor’s Annual Plan Review 2010. This paper outlines common themes identified by Monitor which emerged from the second stage of its review of foundation trusts’ annual plans covering the years 2010-11, 2011-12 and 2012-13, which was carried out by independent advisers.

Should healthcare support workers be regulated? As the scope of support worker practice widens, there is an increasing concern about their lack of regulation and the risks that they may present to public safety. In response to growing calls for the introduction of healthcare support worker regulation, the Nursing and Midwifery Council commissioned the National Nursing Research Unit to undertake a scoping review of the subject. This Policy + presents their main findings and conclusions.

Consultations
Care Quality Commission launches consultation on fees. The Care Quality Commission (CQC) has launched a consultation on the fees it proposes to charge providers of health and adult social care. These fees cover CQC’s work in registering providers and monitoring their compliance with essential levels of safety and quality. The consultation sets out proposals to simplify fees and put in place a single long-term scheme that will cover all providers registered now and those who will be registered from April 2011. It proposes a framework for how fees will be charged based on principles such as fairness, simplicity and proportionality.

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General

Publications/Guidance
Revenue generation initiative - reporting information about treatment of overseas visitors. This letter from Valerie Ferguson, Head of Overseas Healthcare, reminds NHS chief executives about the ability to reclaim the costs of treating visitors from the European Economic Area and Switzerland and asks for support in recording and reporting treatments of these visitors, in order to improve the financial position of the NHS and align processes with other European Economic Area member states.

A model for service provision for pregnant women with complex social factors. The care that women should be offered during pregnancy is outlined in NICE clinical guideline 62 ('Antenatal care'). However, pregnant women with complex social factors may need additional support to use antenatal care services. This guideline describes how access to care can be improved, how contact with antenatal carers can be maintained, the additional support and consultations that are required and the additional information that should be offered to pregnant women with complex social factors.

Central government's use of consultants and interims. This report, which focuses on 17 central government departments, finds that in 2009-10, these departments spent over £1 billion on consultants and interim managers (temporary replacements for permanent staff). The amount of money being spent by government on external consultants has fallen slightly since 2006-07. However, government is not getting value for money from its use of consultants because it often lacks the information, skills and strategies to manage them effectively.

Pandemic H1N1 flu. These publications report on pandemic H1N1 (swine flu) vaccine uptake among frontline healthcare workers and patient groups in primary care in England in 2009-10.

The 21st century doctor: understanding the doctors of tomorrow. This joint publication reports on the quality and insight of the next generation of young doctors.

Real time patient feedback. This best practice guide to using real-time patient feedback is informed by a pilot study carried out across a diverse range of 22 practices in England in 2009-10. The study collected useful learning from practice managers and GPs on how to get the most out of real-time patient feedback.

Consultations
Consultation on Cancer Drugs Fund. Seeks views on plans to establish a £200m Cancer Drugs Fund from April 2011, which will provide a means of improving patient access to cancer drugs prior to the anticipated reform of arrangements for branded drug pricing on expiry of the current Pharmaceutical Price Regulation Scheme (PPRS) at the end of 2013. The consultation sets out the context and case for change, the objectives for the Fund, the implications these have for the structure of the Fund and invites views on how to ensure that the Fund delivers its objectives as best as possible. The consultation closes on 19 January 2011.

Liberating the NHS: Greater choice and control. A consultation on proposals. Seeks views on detailed proposals, first outlined in the Health White Paper, that envisage a presumption of greater choice and control over care and treatment, choice of treatment and healthcare provider becoming the reality in the vast majority of NHS-funded services by no later than 2013/14. This consultation explains the proposals in more details and seeks the views of patients, the wider public, healthcare professionals and the NHS on: proposals for offering more choice for patients and service users; how shared decision making can become the norm; how it can happen: information, 'any willing provider' and other tools; and making safe and sustainable choices. The consultation closes on 14 January 2011.

Liberating the NHS: An information revolution. A consultation on proposals. Seeks views on detailed proposals regarding the Government’s agenda to create a revolution for patients - "putting patients first" - giving people more information and control and greater choice about their care. The information revolution is about transforming the way information is accessed, collected, analysed and used so that people are at the heart of health and adult social care services. The paper seeks views on issues that will form the basis of its proposed Information Strategy. The consultation closes on 14 January 2011.

Bevan Brittan Training
Frameworks – A procurement law workshop. London. 10 November 2010 : Registration:12.45pm, seminar: 1.30pm - 4.30pm
This half day session will use a practical case study approach to look at issues arising in setting up and operating framework agreements. Framework agreements are a long established method of purchasing in the UK but it is an area for potential pitfalls, not least since the implementation of the requirements in the new remedies Directive. The increase in shared purchasing arrangements and the need to find savings in all aspects of public expenditure means that the use of frameworks is set to increase. Those setting up and using framework agreements need to be fully aware of the legal issues.
register your interest in this event

Bevan Brittan Online Resources
NEW! Bevan Brittan Mental Health Portal. Bevan Brittan has a wealth of mental health knowledge it would like to share with clients. We have therefore developed an online resource which has been designed to bring various sources of mental health information and guidance into one place. The aim is simple - to keep professionals in mental health up-to-date with what is happening in an ever changing landscape. If you would like more information please contact Claire Bentley.    

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