Health and Social Care Update - September 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	Governance
Children	Health and Safety
Clinical Management	Mental Health
Commissioning	Primary Care
Complaints	Prison Health
Employment/HR	Regulation
Foundation Trusts	General

 

Care

Publications/Guidance
‘The billion dollar question’: embedding prevention in older people’s services - 10 ‘high impact’ changes. This policy paper reviews emerging evidence around prevention in older people’s services. It identifies and reviews ten high impact changes, addressing the acknowledged need to embed prevention into older people’s services.

Still hungry to be heard. Nearly a third (29.4%) of nurses are not confident that it would be noticed if a relative of theirs was malnourished when entering hospital, according to this report which was released as part of Age UK’s Still Hungry to be Heard campaign. The results spark fears that older people are still being left to go hungry in hospital.

Removing the policy barriers to integrated care in England. International experience demonstrates that integrating healthcare services can deliver more efficient, patient-focused care. The White Paper, Equity and Excellence: Liberating the NHS, provides an opportunity to develop integrated care systems. In the UK, a number of health and social care organisations are at the forefront of this initiative, but there are several policy barriers to be overcome if these systems are to be adopted more widely. This briefing uses five cases studies of health economies in the English NHS and examines how local clinicians and managers are working together to develop more coordinated services.

End of Life Care Strategy: Second annual report. The End of Life Care Strategy aims to improve care for people approaching the end of life whatever their diagnosis and wherever they are, including enabling more people to be cared for and die at home if they wish. It covers all adults in England with advanced, progressive illness and care given in all settings. In particular it aims to change people’s attitudes towards discussion of death and dying so that they are more comfortable with expressing their wishes and preferences for care at the end of life. The strategy also aims to support the development of services in the community so that people can choose to die at home if that is their preference. This second annual report sets out the continuing progress in implementing the strategy, highlights the need for further work and identifies the action intended for this coming year. It concludes that good progress has been made in improving end of life care but more needs to be done to make sure everyone gets the highest quality of care, in the setting of their choice.

Community engagement report for the Health Foundation. This report looks at how communities are defined and addresses barriers that some communities face when accessing health services. There is a key focus on maternity, where the report finds there are specific obstacles around engagement.

Engaging communities for health improvement: a scoping study for the Health Foundation. A community engagement project involves talking to people in different communities about what they want and need from their healthcare services. This report looks at community engagement projects and provides some ideas about what can make them work well.

Pillars of the community: the RCN's UK position on the development of the registered nursing workforce in the community. This policy statement highlights 27 core conditions that the Royal College of Nursing believes should be satisfied for community services to survive and develop as more care is delivered closer to home, while helping health services throughout the UK to become more efficient.

End of Life Care Strategy: second annual report. In July 2008 the Department of Health published the End of Life Care Strategy - promoting high quality care for all adults at the end of life. This second annual report sets out the continuing progress in implementing the strategy, highlights the need for further work and identifies the action intended for this coming year.

Removing the policy barriers to integrated care in England. This briefing paper by the Nuffield Trust uses five case studies of health economies in the English NHS as a basis for examining how local clinicians and managers are working together to develop closer service integration and less fragmented care for patients. The authors conclude that the reforms outlined in the NHS White Paper, such as handing groups of GPs commissioning responsibilities, accompanied by real budgets, have the potential to deliver more seamless care for patients. However, the experiences of the areas studied – Torbay, Nottingham, Redbridge, Trafford and Cumbria – indicate that policy in areas such as GP commissioning and local leadership, competition, incentives and regulation needs to be developed to better support moves towards integration. They also stress the need to involve both clinicians and members of the public in service redesign. The paper focuses on what is facilitating or impeding change and sets out proposals for policy-makers that are designed to enable more rapid progress towards developing better coordinated services. It is intended as a contribution to discussions about the direction health reform should take under the new Coalition Government following the publication of the NHS White Paper.

Consultations
Refreshing the National Carers Strategy - call for evidence. This letter from the Minister for Care Services calls for views on the key priorities, supported by evidence of good practice, on what will have the greatest impact on improving carers’ lives in the next four years. Comments should be submitted by 20 September 2010. 

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

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Children

Publications/Guidance
Review of paediatric cardiac services at the Oxford Radcliffe Hospitals NHS Trust. This report reviewed the paediatric cardiac surgical service at the Oxford Radcliffe hospital. It makes a number of recommendations for improvement including more effective operational planning; new clinical governance arrangements; an overhaul of the system for dealing with serious untoward incidents; more effective clinical and managerial leadership; and the wider adoption of techniques to identify adverse trends in surgical outcome earlier. 

National Service Framework for Children, Young People and Maternity Services: Type one diabetes in childhood and adolescence. This guidance describes a care pathway for a child with type one diabetes. The 'patient journey' also provides a starting point for the development of new local strategies for managing complex childhood conditions.

Demos examines care system for looked-after children. The think tank Demos has investigated how the care system could deliver the best outcomes for looked after children. Its report argues that decisive entry to care, quality of placement and stability are key determinants of children's later outcomes. Among the recommendations are the following: linking pre-care and in-care experiences to later life outcomes; a statutory duty on local authorities to offer family group conferencing; mental health assessments to be mandatory for children entering care; and strengthened commissioning of child and adolescent mental health services.

Consultations
Call for evidence on the role of doctors in child protection. The GMC is asking all those involved in child protection, or who have knowledge and experience about the issues, to submit evidence about doctors' roles and responsibilities in child protection. This includes doctors from all areas of practice, health professionals, social workers, police, lawyers, children and young people and their families and carers. The evidence will inform new GMC guidance for all doctors involved in child protection work. The new guidance will help doctors to meet the standards of professional conduct and performance that is expected of them when they work in this complex and challenging area. It expects to issue this new guidance at the end of 2011. The call for evidence is the first step in the process of developing the new guidance. The consultation closes on 24 September 2010. It is open to anyone with an interest who wishes to respond.

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

Bevan Brittan Updates
Claims round-up. Rebecca White reviews the latest case roundup.

Is tort law appropriately applied to clinical negligence claims? Susan Bradford examines tort law in the applications of criminal negligance claims.

Res Ipsa Loquitur – “Forewarned is forearmed” or “A Word to the Wise” Catherine Radford explores the ramifications of applying Res Ipsal Loquitur (or the matter speaks for itself) when assessing injury claims.

Bevan Brittan Training
Complaints & Claims Forum. 01 December 2010 : Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF

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

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Commissioning

Publications/Guidance
Commissioning for personalisation: from the fringes to the mainstream. This report examines how personalisation is reshaping public services. It first takes stock of how far the personalisation agenda has advanced, highlighting its penetration into a wide range of services and identifying common themes across these sectors. Second, the report reflects on the issues thrown up by the implementation of personalised public services, with a focus on commissioning as a key site of transformation.

Best practice guidance for managing appointment slot issues within Choose and Book. This document is aimed at commissioners and all providers (Acute Trusts, PCTs, the independent sector) with directly bookable services on Choose and Book. It informs them about the process they have to follow when patients, referrers or the National Appointments Lines are unable to book an appointments on Choose and Book because there are no appointment slots available with their chosen provider.

Principles and Rules for Cooperation and Competition. This document sets out revised Principles and Rules for Cooperation and Competition (PRCC) in commissioning and provision of NHS services. The PRCC were first issued under the 2007/08 Operating Framework and are intended to support cooperation and competition in the interests of patients and taxpayers. The PRCC have been reviewed to ensure they are consistent with the Health White Paper: Equity and Excellence: Liberating the NHS which set out the Government’s strategy for the NHS including the commitment that, wherever relevant, patients should have a choice of any willing provider that meets NHS standards, within NHS prices. It should be read in that context and also in conjunction with the Procurement Guide for Commissioners of NHS-Funded Services (see below) and the National Standard Contracts guidance. The original PRCC of December 2007 will continue to remain in force until October 2010. The new PRCC, except Principle 7, will supersede them and come into force from October 2010 onwards.

Procurement guide for commissioners of NHS-funded services. This Guide supersedes the PCT Procurement Guide published in March 2010 and the elements of Commercial Skills of the NHS concerned with the procurement of clinical services. The Guide has been reviewed to ensure it is consistent with the Health White Paper: Equity and Excellence: Liberating the NHS which set out the Government's strategy for the NHS including the commitment that, wherever relevant, patients should have a choice of any willing provider that meets NHS standards, within NHS prices. The guidance sets out expectations of commissioners on the use of procurement to improve services for patients and is consistent with law, including the application of the UK Public Contracts Regulations to commissioning of health services and reflects overarching principles of transparency, proportionality, non-discrimination and equality of treatment. It should be read in that context and in conjunction with the Principles and Rules for Cooperation and Competition (see above) and the National Standard Contracts guidance.

Exercising Healthy Outcomes: Sport and exercise medicine - A guide for commissioners to developing musculoskeletal and exercise medicine services. This is a guide to inform the NHS about the medical specialty of sport and exercise medicine. It outlines how to create a cost-efficient service to provide medical support to patients and staff who wish to engage in health-enhancing physical activity, exercise or sport.

Implementing trauma systems: key issues for the NHS. This report highlights the key questions that regional commissioners and trauma care providers (ambulance services, hospitals, and rehabilitation units) will need to address to develop regionally appropriate changes to save more lives and reduce long-term disability. The report also analyses the key issues and summarises the debates surrounding trauma system development, and also emphasises that a single model will not be appropriate for all localities.

Department of Health response to the public's comments on The Coalition: Our Programme for Government on the NHS. Contains the DH response to the public's comments on the NHS, based on the top three issues raised by the public: the need to reduce bureaucracy, the argument that not all targets are inappropriate and questions regarding how GP commissioning will work.

The principles of GP commissioning: a General Practitioners Committee statement in the context of "Liberating the NHS". This statement from the British Medical Association (BMA) outlines their views on what the fundamental principles underlying the development of GP commissioning should compromise. The BMA argue that these principles should be used to define policy, inform debate and negotiations and ensure that good medical practice is enshrined within the proposed White Paper changes to the NHS.

Consultations
Consultation on changes to the Principles and Rules for Cooperation and Competition. The Principles and Rules for Cooperation and Competition (PRCC) set out the rules that commissioners and providers of NHS services are expected to follow to ensure cooperation and competition. The Department of Health conducted a review of the PRCC in July 2010 following the White Paper and the PRCC now includes a new commitment that patients should have a choice of any willing provider wherever relevant and this is now reflected in Principle 5 (see above). Monitor are now carrying out a consultation on the adoption of the new version of the PRCC for NHS foundation trusts. The consultation will close on 27 August 2010.

House of Commons Select Health Committee inquiry into commissioning. The Health Committee has issued an invitation to submit written evidence for its inquiry into commissioning. The Coalition Government regards more empowered and effective commissioning as the key to successful delivery of its objectives for the NHS. The new Health Committee has therefore decided to hold an inquiry into how the new government intends to resolve the issues which have undermined the effectiveness of commissioning in the NHS. This document provides guidance on giving written evidence. The deadline is 6 October 2010.

Bevan Brittan Training
Welcome to commissioning! Over the next two and a half years GPs will be forming themselves into consortia to take on the current PCT commissioning role. Whilst the detail of the arrangements is yet to emerge, the broad direction of travel and the implications of this are beginning to become apparent. PCTs need to address the task of supporting the development of their GP consortia to take on this role and the consortia themselves, and the individual GPs, need to understand the scope of the obligations which they will undertake.

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

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Complaints

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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Employment/HR

Publications/Guidance
Flexible nursing - report for NHS Professionals. This report calls for a strategic approach to the flexible workforce that addresses both the demands of healthcare professionals and the pressure to restrain expenditure.

Sector employability toolkit. New resources to help healthcare employers tackle hard-to-fill entry-level vacancies, while helping local unemployed people back into sustainable employment, have been launched by Skills for Health with Jobcentre Plus. The toolkit offers best practice resources to run a five-week pre-employment programme, during which candidates’ employability skills are developed through on- and off-the-job training. This will be of interest to NHS and local authority chief executives, especially in areas of high unemployment where low employability skills may present a particular recruitment challenge for entry-level vacancies.

Consultation
General Medical Council (GMC) Equality Scheme 2011 - 2014 consultation. The General Medical Council invites views on the themes and objectives to further its draft 2011-2014 Equality Scheme for gender, race and disability. Key areas identified include: the provision of accessible information and services; helping doctors to provide high quality care; being a fair regulator; and helping to create positive change. The draft scheme will go to the Council for approval in early 2011. Comments by October 15, 2010.

Equality Act 2010: The public sector equality duty - promoting equality through transparency. The public sector equality duty has a key role in ensuring that fairness is at the heart of public bodies’ work and that public services meet the needs of different groups. The 2010 Act also gives ministers the power to impose specific duties, which are legal requirements designed to help public bodies meet their obligations under the public sector equality duty. This paper seeks views on draft regulations for the specific duties and the list of public bodies that will be subject to the general and specific duties. The consultation closes on 10 November 2010.

Working and training in the National Health Service – a guide for international medical graduates thinking about working or training in the UK. This web-based guidance is aimed primarily at overseas-qualified medical practitioners from outside of the European economic area. NHS organisations can use the guide as part of their recruitment and induction material. The guide aims to make doctors and dentists from outside the UK aware of the opportunities available and to help them understand the immigration processes and requirements. It includes details of sources of further information and where to check for up-to-date details of immigration and other requirements.

A framework for managing staff costs in a period of spending reduction. This paper sets out a framework for effective management of staff costs in a challenging environment of cost reduction in public services. It builds on the high level principles set out in the National Audit Office’s short guide to structured cost reduction.  

News
Impact of doctor working time cap on patient safety survey. This survey, conducted by the Royal College of Surgeons, has found that European law brought in to improve patient safety and the working lives of doctors, has failed according to polled surgeons on the first anniversary of its implementation.

Bevan Brittan Updates
Default retirement age has one foot in the grave. Anne Palmer summarises this month's announcement from Business Innovation and Skills (BIS) regarding the proposed abolishment of the default retirement age by October 2011.

The Health White Paper: What about the workers? The far reaching changes proposed by the Health White Paper will have major implications for workforce management. Although the publication is short on detail, the changes that are being proposed clearly contemplate savings in manpower – but precisely how these are to be achieved remains to be seen. This article looks at five areas that will be of particular interest to HR teams.

Human rights and disciplinary hearings. Julian Hoskins examines the options for employers regarding legal representation at internal dismissal cases.

News round-up August 2010. John Moore reports on an employment tribunal decision on holiday pay during long term sick leave (a Stringer loophole?); the possible scrapping of the ‘two tier code’; the latest on the Equality Act 2010 and provides an update on regulations that are now under review.

All change: workforce implications of the Health White Paper. Julian Hoskins reports on how the NHS White Paper, published this month, impacts on workforce matters and highlights the legal requirements that are likely to be engaged as the proposals are implemented.

Bevan Brittan Training
Equity and Excellence: Liberating the NHS. 09 September 2010 : Registration: 9am Seminar: 9.30am - 11.30am. Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF. In rapid response to the publication of the White Paper this event is planned to take an early look at its content and the possible implications for HR and the workforce. The session will be jointly led by David Amos, who as well as having been the HR Director of UCLH has recent experience of working in the Cabinet Office, and by David Widdowson, a senior partner in Bevan Brittan and its employment team. We will look at the major changes proposed by the Government, in what has been described as one of the biggest shake ups of the NHS since its inception and will highlight those areas which are likely to have an impact on the practice and provision of future NHS HR services. Whilst the details of the new agenda will have to wait until consultation is complete, we are offering an opportunity to take part in an interactive discussion to share views, ask questions and identify and explore the issues that NHS HR Teams will need to deal with in the future as part of this major reorganisation of services.
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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Foundation Trusts

Bevan Brittan Updates
Foundation Trust Application. On 12 July 2010 the Government issued its White Paper "Equity and excellence: Liberating the NHS" which states that all NHS trusts will become or become part of a Foundation Trust within the next 3 years.

Transforming Community Services Agenda – what FTs need to know. The Revisions to the NHS Operating Framework 2010/11 published by the Department of Health on 21 June 2010 confirm the new Government's intention to progress the Transforming Community Services Agenda and cement the timeframe which has to be met.

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

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Governance

Publications/Guidance
Evaluation of the Leadership Qualities Framework 360 review process. The NHS Leadership Qualities Framework (LQF) was launched in 2002 specifically for senior leaders within the NHS. The LQF is supported by a 360 review tool, designed to support individuals identify where their strengths and development needs align with the NHS Leadership Qualities. This report is an evaluation of the impact the LQF 360 tool has on the individual, the organisation and the wider NHS.

NHS sustainable development management plans (SDMP): guidance for writing a board level SDMP. Having a board approved SDMP is one of the cornerstones of the NHS Carbon Reduction Strategy and underpins the overlap between social, economic and environmental factors that is core to the NHS. This guidance aims to help organisations write a board level SDMP or update current plans.

Leadership needs of medical directors and clinical directors. The King’s Fund conducted a survey of clinical and medical directors to find out what skills they believed they need to face future challenges. This report summarises the findings.

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

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Health and Safety

Publications/Guidance
The safer management of controlled drugs - CQC Annual report 2009. This report makes recommendations on how chief executives, accountable officers, the Royal Colleges and the Department of Health could aid the safer management of controlled drugs. It concludes that health and social care organisations are continuing to develop systems and services to manage controlled drugs more effectively, as well as sharing information on concerns and best practice at a local and national level.

Procedures for placing a risk of violence marker on electronic and paper records. This guidance covers the use of markers on patients’ care records, which alert NHS staff to the risk of physical violence or aggression, either from the patient or someone associated with them, when they treat certain individuals. Procedures for placing a risk of violence marker on electronic and paper records introduces safeguards to make sure that personal records are only marked where there has been a reported incident or evidence of violent or aggressive behaviour.

Implementation of patient safety alerts. This report looks at the implementation of patient safety alerts issued by the National Patient Safety Agency. It states that there are still large numbers of trusts who have not complied with the alerts and also points to unsatisfactory monitoring and regulation of non-compliance with patient safety alerts.

Managing serious incidents in National Screening Programmes. This guidance is endorsed by the National Patient Safety Agency and its purpose is to make explicit the requirements for national screening programme related serious incidents and to provide clarity and understanding for all staff providing NHS funded care.

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

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Mental Health

Publications/Guidance
The triangle of care - carers included: a guide to best practice in acute mental health care. This guide emphasises the need for better local strategic involvement of carers and families in the care planning and treatment of people with mental ill-health. It recommends better partnership working between service users and their carers, and organisations.

Improving Access to Psychological Therapies (IAPT): data handbook (v1.0). This handbook aims to provide guidance for all data collection issues within the IAPT programme such as: utilising outcomes data for patient-centred care, improving clinical practice and service quality; help with routine outcome measurement using standard clinical metrics; and using clinical records which will form the basis of the future National Data Set.

Fair treatment now. A new report from the charity Rethink highlights that mental health costs about £33.75bn each year but that less than 25 per cent of that amount is spent on health services. The document includes surveys undertaken with service users, carers and GPs. Key findings include: only 31 per cent of GPs felt they had the appropriate level of knowledge to commission mental health services; and only 16 per cent of service users were in receipt of all NICE-recommended treatment for their conditions. Rethink's recommendations to deliver more equitable treatment include: wider access to psychological therapies for those with severe mental health problems; a mental health payment by results tariff; a national programme to ensure sufficient GP commissioning skills; and access to Choose and Book for mental health patients.

NMHDU mental health fact files. Seven short documents outlining key facts and figures:
(1) Mental health and employment,
(2) Mental health and housing,
(3) The costs of mental ill health,
(4) Public mental health and well-being,
(5) Equalities in mental health,
(6) Stigma and discrimination in mental health, and
(7) Ensuring greater access to talking therapies

Admission and discharge from secure accommodation. Some children and young people in secure care are being placed as far away as 200 miles from their families, damaging their chances of receiving coordinated support, according to a report published by Ofsted, the Office for Standards in Education, Children’s Services and Skills. While young people generally receive good emotional support within secure establishments, the report  highlights how the limited number and range of secure establishments undermines efforts to support them when they are admitted and discharged from a secure placement. Many young people are placed a long distance from home, depriving them of valuable family support and making it more difficult for agencies to plan and assist them as they prepare to return to life in the community.

Department of Health response to the public's comments on The Coalition: Our Programme for Government on social care and disability. Contains the DH response to the public's comments on social care and disability, based on the top three issues raised by the public: improving the care of older people and people with disabilities, improving palliative care services and investing in mental health services.

Improving Access to Psychological Therapies (IAPT) year one sites data review. Improving Access to Psychological Therapies is a programme designed to make psychological therapies for common mental health problems widely available. Following pilot work in Doncaster and Newham, the first wave of rollout sites started operation in 2008. This report is a study of their work in the year from October 2008 to September 2009. Allowing for varying start times, this was roughly their first full year of operation.

Cross-border Transfers of Patients Under the Mental Health Act. This document outlines the considerations for the transfer of a patient from England to Scotland, Northern Ireland, the Channel Islands or the Isle of Man.

Section 67 of the Mental Health Act. One document on this page outlines the Secretary of State for Health's discretionary power to refer cases involving certain patients to the First-tier Tribunal. Another sets out when patients and their relatives may apply.

Cases
RT v LT & Anor [2010] EWHC 1910 (Fam) (27 July 2010). LT lacked capacity in relation to residence and contact with her family. The court said that " wherever possible, the plain words of the Act should be directly applied to the facts of the case in hand, and that complicating factors should, if possible, be avoided...That said, there will be cases in which it may be necessary to look at pre- or even post Act authority on the question of capacity. One example relates to the field of sexual relations."

BB v AM 2010 EWHC 1916. Court concluded that "she is being deprived of her liberty. She is away from her family, in an institution under sedation in circumstances in which her contact with the outside world is strictly controlled, her capacity to have free access to her family is limited, now by court order, and her movements under the strict control and supervision of hospital staff. Taking these factors altogether, the cumulative effect in my judgment is that BB is currently being deprived of her liberty and I so declare.”

AH v West London MH NHS Trust.(2010) UKUT 264 (AAC). It is justified for tribunal hearings to be held in private. Court looked at the factors to be considered when considering whether to direct that a hearing should be in public.

Consultations
Implementing 'Fulfilling and rewarding lives': consultation for statutory guidance for local authorities and NHS organisations to support implementation of the autism strategy. Seeks views on draft guidance to health and social care services that focuses on the seven areas required by the Autism Act 2009, in each case identifying what health and social services bodies are already expected to do, and then setting out any additional requirements introduced by the strategy. The consultation closes on 22 October 2010. 

Bevan Brittan Updates
Clarification of scope of section 117 services. This article clarifies the meaning of section 117 and the scope of the aftercare services which authorities must provide. 

The Mental Capacity Act 2005. Laura Forsyth examines the first report on data relating to the Mental Capacity Act 2005.  

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

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Primary Care

Publications/Guidance
PCT World Class Commissioning (WCC) assurance results 2009/10. This report analyses aggregate PCT scores on governance and the WCC competencies. Please note that as five PCTs have yet to publish their results, the report is not yet comprehensive but it will be updated when these results are available. The results of the analysis show improvement since the first year of the WCC assurance process and this reflects well on the progress that PCTs have made over the past 18 months. 

Medicines management options for local implementation. This report outlines how GPs can use NHS resources more efficiently to reduce primary care prescribing. It encourages GPs to review, and where necessary, revise prescribing to ensure that it is in line with NICE recommendations.

Delivering dental access more effectively: a PCT resource pack for working with providers. This resource pack has been developed to help PCTs further engage with providers and dentists on delivering dental access more effectively. The pack includes key advice on dental regulations; a guide to developing a local performance policy; advice on the effective use of information and e-reporting; information on contract variations; and case studies.

Implications of contracting directly with GP federations. This briefing paper provides advice and information for PCTs regarding opportunities for commissioning from GP federations.

The role of GPs in maternity care - what does the future hold? This research paper assesses the current state of general practice involvement in maternity care, what GPs can do to stimulate and maintain care quality and how care quality can be measured.

Government Response to Health Committee report on the use of overseas doctors in out-of-hours care. The coalition Government has published its response to the Health Select Committee's report on employing overseas doctors to provide out-of-hours services. Among the key points in the document were: the Government confirms it is examining a range of potential safeguards to ensure that all foreign doctors "have proven their competence and language skills"; it is also evaluating ways in which the current system of language checks can be made more robust outside of the current EU directive on professional mobility; an assertion that "there is no doubt that out-of-hours care needs urgent reform"; an endorsement of the Committee's call for "rigorous standards in respect of recruitment, induction and training"; and PCTs are urged to be stringent in undertaking statutory duties.

The national specifications for cleanliness in the NHS: guidance on setting and measuring performance outcomes in primary care medical and dental premises. As part of the Health and Social Care Act 2008, Care Quality Commission (CQC) registration will require healthcare providers to comply with essential standards of quality and safety. This includes the need to protect those who may be at risk of exposure to infections. These national cleanliness specifications provide a framework for primary dental care providers and primary medical care providers to demonstrate to the CQC how they ensure their premises are clean and safe and meet the required standards.

Risk of febrile convulsions in children aged under five years and seasonal influenza vaccines marketed by Pfizer Vaccines. This letter alerts GPs and PCT immunisation co-ordinators to a possible increased risk of febrile convulsions in children under five years of age associated with the use of influenza vaccine marketed by Pfizer Vaccines for the 2010/11 influenza season. 

The principles of GP commissioning: a General Practitioners Committee statement in the context of "Liberating the NHS". This statement from the British Medical Association (BMA) outlines their views on what the fundamental principles underlying the development of GP commissioning should compromise. The BMA argue that these principles should be used to define policy, inform debate and negotiations and ensure that good medical practice is enshrined within the proposed White Paper changes to the NHS. 

Bevan Brittan Updates
Surely not a mini-PCT? The NHS White Paper "Liberating the NHS" has confirmed the Government's proposal for commissioning to be devolved to GP commissioning consortia, and the follow-up consultation paper "Commissioning for Patients" has fleshed out some of the detail of the proposals and identified areas for consultation. In this note we look at the proposals and some of the implications for the development of GP commissioning consortia.   

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
Prison and Probation Ombudsman Report 2009-2010. The Prisons and Probation Ombudsman (PPO) has launched its new Annual Report. During 2009/2010 the PPO received 4,641 complaints and opened 193 investigations into deaths.

Bevan Brittan Events
Annual Prison Health Update 09 December 2010. Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF. Further details to follow.
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
Moving forward with healthcare support workforce regulation - a scoping review: evidence, questions, risks and options. This research paper presents the findings of a commissioned project on the regulation of healthcare support workers. The objectives of this research project were to assess the evidence of risk presented by an unregulated healthcare support workforce; identify key questions to be addressed in developing models of regulation and make recommendations for further work in moving regulation forwards. 

Moving forward with healthcare support workforce regulation - a scoping review: evidence, questions, risks and options. This research paper presents the findings of a commissioned project on the regulation of healthcare support workers. The objectives of this research project were to assess the evidence of risk presented by an unregulated healthcare support workforce; identify key questions to be addressed in developing models of regulation and make recommendations for further work in moving regulation forwards. 

Focused on better care. CQC - Annual Report 2009/2010. This report sets out information about:
1. Creating a new system of registration.
2. Making sure everyone has a voice.
3. Driving improvements in care.
4. Our priorities.
5. Putting our principles into practice.
6. Looking forward. 

Consultations
Fitness to practise adjudication for health professionals: assessing different mechanisms for delivery. A paper for consultation. The Health and Social Care Act 2008 provides the legal framework for the Office of the Health Professions Adjudicator (OHPA), which would be separate from the health regulators and adjudicate separately on Fitness to Practise matters for GMC registrants initially and subsequently for GOC registrants. The Government has reviewed the progress towards implementation of OHPA and is seeking views on whether delivery of adjudication can be delivered more proportionately through other means. The consultation closes on 11 October 2010.

Consultation on equality and human rights. The CQC and EHRC are seeking views on draft guidance on equality and human rights for inspectors and assessors to use when they monitor providers according to the CQC's standards and registration requirements. The consultation closes on 12 November 2010.

News
Registration support for providers of dental services. Announces that the CQC is extending its national contact centre's opening hours and publishing new guidance on registration to help support primary dental providers preparing to apply for registration. All providers have to be registered from 1 April 2011. The Newcastle-based centre will now open from 8.30am to 8pm Monday to Thursday, from 8.30am to 5.30pm on Friday and from 8am to 4pm on Saturdays. CQC has also issued new guidance for the providers of primary dental services that provides more information on the application process, which has been refined following a series of pilot projects. CQC is expecting applications from more than 8,500 providers.

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

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General

Publications/Guidance
Market research for online communities in the NHS. This research was prompted by recognition that networking and the sharing of knowledge is not often done effectively in the NHS. There were four broad learning outcomes from the work, providing information on: what affects people’s use of online resources and why some networks work; how do people go about sharing ideas at the moment; what technologies are people using at present and for what purposes; and do people want a new network?

Department of Health response to the public's comments on The Coalition: Our Programme for Government on public health. Contains the DH response to the public’s comments on public health, based on the top three issues raised by the public: the need for better health prevention, the need for better sexual health services and whether the NHS should charge patients who are treated for lifestyle illnesses.

Variations in place of death in England: inequalities or appropriate consequences of age, gender and cause of death? This report reveals big variations in the percentage of deaths that occur in hospital – both between the English regions and at a local authority level. It also shows that people on low incomes are more likely to die in hospital, with 62% of deaths amongst people in the most deprived quintile of the population occurring in hospital. Amongst the most affluent fifth of the population the figure is 55%. The report cautions however that these inequalities might reflect a greater incidence of diseases requiring hospital care at the terminal stage amongst people in lower socio-economic groups.

Games 2012: Responsibilities for delivery of Health Bid Commitments. Letter from Helen Shirley-Quirk, 2012 Director and Director for Pandemic Influenza Preparedness, to all SHA Chief executives highlighting the publication of a Memorandum of Understanding (MOU) between the DH and the London Organising Committee of the Olympic Games and Paralympic Games Limited (LOCOG). The MOU sets out the key principles that will govern the provision of health resources and services for the 2012 Olympic and Paralympic Games. Under the terms of the health Olympic Bid commitments and this MOU, LOCOG is solely responsible for providing medical services, including first aid, at all LOCOG Events and LOCOG Venues during Games-time. The NHS is responsible for the provision of ambulance services and secondary care through Designated Hospital Providers and for plans to maintain normal NHS services during Games-time.

Continuing care for veterans. This note is to remind those involved in the care of veterans of the commitments given around priority healthcare and prostheses provision for veterans.

Dyslexia, dyspraxia and dyscalculia: a guide for managers and practitioners. This guidance gives practical information on dyslexia, dyspraxia and dyscalculia and their potential impact on an individual. It also sets out to raise awareness of the legal and professional responsibilities in respect of these conditions. Also available is a summary guide for managers as well as a toolkit for nursing staff.

Paying for the NHS. This report poses questions about the balance of power between the state and the individual in determining the future health of British citizens. It is widely accepted that the NHS will be forced to fundamentally change the way it provides healthcare in the next decade, slowly shifting more of the burden from the state towards the individual. This report aims to better understand how the balance will shift by analysing both the role of the state and changing behaviours among the public.

The Coalition Government's NHS reforms: an assessment of the White Paper. This briefing concludes that the reforms are substantial and will result in fundamental changes to the organisation and delivery of care to patients in the NHS in England. While the briefing supports the overall direction of travel, it warns that the reforms will require significant management expertise to implement smoothly.

NHS Pension Scheme retirement flexibilities: resource pack. This resource pack aims to provide NHS organisations with the information they need to better understand the strategic context of the NHS Pension Scheme. It addresses the need to attract and retain the right mix of skills and experience in the healthcare workforce, and outlines how the retirement flexibilities available in the NHS Pension Scheme can be used to add value to the staff reward package and the employment offer. 

Moving beyond sponsorship: Interactive toolkit for joint working between the NHS and the pharmaceutical industry. To enable NHS organisations and the pharmaceutical industry to work together in the interests of patients, the Ministerial Industry Strategy Group recommended that the Department should develop an interactive toolkit to support joint working so as to improve patient outcomes. The purpose of this toolkit is to encourage NHS organisations and staff to consider joint working as a realistic option for the delivery of high-quality healthcare and a way to drive efficiency in the delivery of services in both primary and secondary care, and to provide the necessary information and have easy access to the tools which will help to enter into joint working. The initial version of the toolkit was published in March 2008. Following feedback from users, the toolkit has been updated to include some new templates as well as more examples of good practice for reference. This toolkit should be used in conjunction with the document "Best practice guidance for joint working between the NHS and the pharmaceutical industry".
The templates are all available on the DH website.

Improving data quality in the NHS: Annual report on the PbR assurance programme 2010. This Audit Commission report summarises the results of the Payment by Results (PbR) data assurance programme since it began in 2007. For the last three years, the Audit Commission has looked at over £200m worth of payments for inpatient treatments. The report finds that the accuracy of clinical coding has improved since 2007. The coding error rate has dropped from 16%to 11% in three years, which shows that NHS organisations have made real progress in tackling the quality of their data. But there remains wide variation between the best and worst performing trusts, even if the gap is narrowing. Errors are continuing to affect payments. The Commission estimates that of the £21bn spent on the four specialties it's audited for three years, £1bn (5%) was paid wrongly. To continue to improve data quality, the report makes a series of recommendations for PCTs and NHS trusts to consider.

Adaptation to climate change in NHS organisations: what you need to know. This guidance summarises the current knowledge on adapting to climate change in NHS organisations. It describes what climate change adaptation is, why it is a priority for the NHS and how organisations can include adaptation in their Sustainable Development Management Plans.

'Equity and Excellence: Liberating the NHS' - opportunities and challenges. In this commentary paper, the Bow Group Health Policy Committee outline their response to Equity and Excellence: Liberating the NHS – the Health White Paper, which sets out the Government's long-term vision for the future of the NHS in England. The analysis focuses on five key areas, which feature prominently in the White Paper. These include GP commissioning, quality and outcomes, public health, efficiency savings and QUANGOs, and value and innovation.

Consultations
Public service ombudsmen. The Law Commission is conducting a review of the law relating to the public services ombudsmen. This consultation paper contains detailed provisional proposals for reform. The consultation period will run until 3 December 2010.

News
111 - The new number for the future of non-emergency health services. Announces the launch of the NHS 111 service, which guides patients to a locally available service or provides appropriate advice and information 24 hours a day, 365 days a year. The number can be used when someone needs help fast but it is not life threatening, or when they do not know who to call. The new 111 service has been launched initially in County Durham and Darlington; calls are handled by North East Ambulance Service NHS Trust, who also handle 999 calls. It will also be launched in three other pilot areas in 2010: Nottingham City, Lincolnshire, and Luton. A full assessment of the service in these areas will guide the national roll out of the NHS 111 service.  

Bevan Brittan Updates
What’s in the Specimen Jar? Post Mortem Sector Changes. Jackie Linehan examines the Human Tissue Authority's (HTA) new Post Mortem report on compliance. 

ProCure 21+ finally launched. The Department of Health announced the launch for the new ProCure21+ framework on 3 August 2010.  It replaces the existing ProCure21 framework, which comes to an end in September, commencing 1 October 2010. 

The Health White Paper “Equity and excellence – liberating the NHS”: the legal challenges. The publication of the Health White Paper “Equity and excellence – liberating the NHS” on 12 July 2010 has clearly set the direction of travel for the Coalition Government’s health reforms. This article provides an initial assessment of its proposals. It will be followed by a series of alerts, identifying the key legal issues as they crystallise.

Bevan Brittan Events

Healthcare Seminar. 30 September 2010 : Registration:9.30am, seminar: 10am - 12.30pm. Location: Interchange Place, Edmunds Street, Birmingham B2 2TA. This workshop is designed to bring you up to date on a range of healthcare issues that you will come across on a daily basis. Our updates and practical advice on managing complex issues has proved to be invaluable. This will enable you to deal with issues in-house without the need to incur legal costs. Guidance and cases constantly update the law that informs your role and this workshop will ensure you are as up to date and informed as you can be.  

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

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