01/08/2011
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
Publications/Guidance
Dignity in practice - An exploration of the care of
older adults in Acute NHS Trusts. The aim of this study by the
British Geriatrics Society is to look at evidence-based guidance
for policies and practice to promote dignified care.
Route to success: the key contribution of nursing
to end of life care. This guide highlights the key nursing
contributions within the six steps of the end of life care pathway.
It focuses predominantly on how nurses can and do contribute to
planned (and unplanned) end of life care for adults in England.
Fairer care funding. The Commission on Funding
of Care and Support, chaired by Andrew Dilnot, has published its
final report on changes to the funding of adult social care in
England. It recommends that costs should be capped and the
means-tested threshold increased. Instead of individuals paying all
their care costs until they have assets of less than £23,250, as
under the current system, the proposals would mean that those with
high care costs would only pay up to a set amount and after that
their care costs would be paid for by the State. The Commission
estimates that its proposals, based on a cap of £35,000, would cost
the State around £1.7bn.
Among the recommendations in the report are:
individuals’ lifetime contributions
towards their social care costs – which are currently potentially
unlimited – should be capped. After the cap is reached, individuals
would be eligible for full state support. This cap should be
between £25,000 and £50,000. The Commission considers that £35,000
is the most appropriate and fair figure;
the means-tested threshold, above
which people are liable for their full care costs, should be
increased from £23,250 to £100,000;
national eligibility criteria and
portable assessments should be introduced to ensure greater
consistency;
all those who enter adulthood with a
care and support need should be eligible for free state support
immediately rather than being subjected to a means test;
a new universal deferred payment
scheme for anyone who would be unable to afford care charges
without selling their home. Local authorities should be allowed to
charge interest to recover their costs, to make the scheme cost
neutral, and to remove the disincentive they currently face in
promoting the scheme;
new social care legislation should
place duties on local authorities to provide information, advice
and assistance services in their area, and to stimulate and shape
the market for services;
the Government should review the scope
for improving the integration of adult social care with other
services in the wider care and support system.
The Government has stated that it welcomes the report. It will consider each recommendation carefully to test whether it meets the wider objectives for reform, including increased personalisation, choice and quality, closer integration of health and social care and greater prevention and early intervention. The Government will need to consider the acknowledged significant costs of implementing the reforms against other calls on constrained resources. The Government wants to create a social care system that offers people and their carers choice and personalised, high quality care. It will be engaging with the care sector over the autumn to develop and refine its priorities and plans for action, bearing in mind the financial context.
Funding the right care and support for everyone. This report recommends the introduction of the first per-patient funding system for palliative care in the NHS. The proposals include the development of a palliative care tariff based on need, a funding system which incentivises good outcomes for patients, irrespective of time and setting, and providing incentives for commissioning integrated care packages which stimulate community services.
A quest for quality in care homes. The report by the British Geriatrics Society reviews current NHS support for care homes. It describes what should and could be done and calls for national action by Government and local action by NHS commissioners, planners and clinical services to improve the quality of NHS support to care homes. It highlights the need to build joint professional leadership from the health, social, and care home sectors, statutory regulators and patient advocacy groups to find solutions.
Home care in London. This paper explores the issue of home-based social care in London. It provides policymakers and commissioners with a clearer idea of what makes for good quality home-based care, the challenges that exist for delivering it, and how the increasing demand can be met. Our research identified three key tests to ensure home-care is of good quality.
Making care safer. This report by the Health Foundation collects together the testimony given by family and carers of people living in a care home, specifically around issues of medication safety. Three day-long focus groups were held in 2010, in Manchester, Birmingham and London. The issues and potential solutions raised by the groups are presented in this report under four main headings: communication and information sharing; prescribing and administration of medication; staff development and support; and advocacy and rights.
Keeping patients safe when they transfer between care providers.
This guidance aims to increase the priority given to medicines
information transfer and promote best practice in line with
existing national initiatives. It has been developed in
collaboration with pharmacy, medical, nursing and allied health
professional bodies, plus patients, national agencies and health
and social care professionals.
Keeping patients safe when they transfer between
care providers - Professional guidance
Keeping patients safe when they transfer between
care providers - Organisational guidance
Help get the right medicines when you move care
providers.
Bevan Brittan Updates
Housing Allocation: Registered Providers’ responsibility to assist
local housing authority. Local authorities have a statutory
responsibility to secure suitable accommodation for the occupation
of eligible homeless (housing) applicants with priority.
However, many local authorities in England and Wales have
transferred their housing stock to social landlords hence the need
for assistance from Registered Providers in the discharge of their
functions in this area. Even in cases where a local authority
still retains/owns its housing stock, demand for social housing
often far outweighs supply such that local authorities have to rely
on housing associations to provide accommodation to housing
applicants in the discharge of their duty.
If you wish to discuss any of the items raised in this section please contact Carlton Sadler.
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Children
Publications/Guidance
The RCN's UK position on health visiting in the
early years. The Royal College of Nursing has published
evidence of the important role that health visitors play in the
lives of children and families. The briefing provides evidence for
health visiting as a means of improving public health in a
challenging time for the NHS. The principles position statement
sets out core values to guide the development of health visiting
across the UK.
Evidence base for Family Nurse Partnership
(FNP). The evidence base for FNP is robust with three high
quality US trials showing a wide range of positive impacts for
children and mothers over the short, medium and longer term. This
summary leaflet provides more information on this evidence
base.
Commissioning Guide for Children, Young People and Maternal Health. Also see executive summary. NHS North West has developed a guide which identifies what the most important child health issues are in the region, and what can be done to improve outcomes. The Guide has been produced through a collaboration of GPs, nurses, therapists, local government and the voluntary sector, and informed by the views of children and carers.
A child-centred system - The Government’s response to the Munro review of child protection. Sets out the Government's response to Professor Eileen Munro’s recommendations to reform the child protection system that were published in May 2011. The response outlines the Government’s intention to build a system focused on the needs, views and experiences of vulnerable children. Ministers agree with Professor Munro that the current system is overly focused on complying with procedures and targets as a measure of success. The new approach is based on developing professional expertise and providing a range of help and services to children and families that meet all their needs. The Government states that it will reduce central regulation and prescription and place greater trust and responsibility in skilled professionals and local leaders to bring about long-term reform.
Where is my advocate? A scoping report on advocacy services for children and young people in England. The Office of the Children's Commissioner has published a report entitled ‘Where is my advocate?', to establish an accurate picture of the advocacy provision available in England. The report suggests that there is a postcode lottery system for children attempting to access advocacy and that no national strategy exists to ensure the entitlements children have are consistently met across England.
Transferring children to and from theatre: RCN position statement and guidance for good practice. This publication aims to support health care staff to develop locally agreed guidelines for the assessment and management of children and young people being transferred between hospital departments, ensuring they are safely transferred to and from theatre.
If you wish to discuss any of the items raised in this section please contact Penelope Radcliffe or Deborah Jeremiah.
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Clinical Management
Publications/Guidance
Acute care toolkit for handover. This toolkit
aims to provide a framework for standardisation of clinical
handover practice, audit and monitoring of the process, and
defining accountability and responsibilities in the
process.
If you wish to discuss any of the items raised in this section please contact Jackie Linehan
Commissioning
Publications/Guidance
The joint strategic needs assessment: a vital tool
to guide commissioning. This briefing gives a step-by-step
guide to what a joint strategic needs assessment (JSNA) is and
lists five principles behind a good JSNA.
Commissioning Guide for Children, Young People and
Maternal Health. Also see executive summary. NHS North West has developed
a guide which identifies what the most important child health
issues are in the region, and what can be done to improve outcomes.
The Guide has been produced through a collaboration of GPs, nurses,
therapists, local government and the voluntary sector, and informed
by the views of children and carers.
Managing conflicts of interest in clinical
commissioning groups. This paper summarises the key points from
conversations between NHS Confederation and commissioners,
providers, regulators and professional bodies. It also sets out
some draft principles that clinical commissioning groups might
adopt when developing local policies for managing conflicts of
interest, and some outstanding policy questions that may require
further consideration and debate.
Developing the NHS Commissioning Board. This
document sets out initial proposals from the NHS Commissioning
Board development team about how the Board will operate and how it
will be organised. It aims to give staff and stakeholders further
clarity about the suggested design of the Board, and to serve as
the basis of further engagement on how the Board should
develop.
Commissioning cancer services. This best practice document is a transitional update to the Cancer Commissioning Guidance to support the commissioning of cancer services across the NHS. It sets out key issues and questions that commissioners and cancer network teams will wish to take into consideration when assessing local health needs and reviewing services, developing their contract service specifications and monitoring performance. It should be read alongside the Cancer Commissioning Toolkit.
Act & early to avoid A&E - commissioning end of
life care: initial actions for new commissioners. The purpose
of this briefing is to help identify the immediate priority actions
to commission effective end of life care.
Clinical commissioning: securing better outcomes
for the NHS and its patients. This discussion paper explains
how clinical commissioning holds the key to tackle the three major
challenges facing the NHS in England over the next five years:
improve the health of the population; reduce health inequalities;
and create a service that delivers better services to patients
whilst achieving ambitious efficiency savings.
Feasibility of transferring budget and commissioning responsibility for forensic sexual offences examination work from the police to the NHS: evidence base to support the impact assessment. This publication supports an impact assessment that emerged from the feasibility study carried out by HSMC between September 2010 and February 2011. The impact assessment proposes that funding and commissioning responsibility for forensic examinations for sexual offences work should transfer from the police to the NHS, with improved quality standards.
If you require further information about any of the items
raised in this section please contact
David Owens.
Employment/HR
Publications/Guidance
Workforce risks and opportunities: nursing and
midwifery. This report reviews the key workforce risks and
opportunities within the nursing and midwifery workforce in 2011
and beyond. The purpose of this project is to provide an assessment
of current workforce issues and potential opportunities for
improvement.
A guide to consultant job planning. This guide, written with the British Medical Association, emphasises the need for consultants and managers to work closely together to meet their shared responsibility of providing the best possible patient care within the resources available to them. It highlights the benefits of effective preparation for both managers and consultants and covers objective setting, information gathering, supporting resources which may be required and some of the contractual provisions relevant to component parts of the job plan.
Human resources (HR) transition framework. This framework provides the overarching guiding standards for the Department of Health, NHS and Arm's Length Bodies relating to the movement of employees to the new or changed bodies proposed in the Health and Social Care Bill 2011. It has been developed with employers and Trade Unions, to deliver transparent and fair HR processes for the organisations to which staff and functions may transfer at local and national level.
Who will care? Protecting employment for older
nurses. This guidance
provides information for RCN representatives and officers to help
them influence health and social care employers to apply good
practice in the effective management of the older nursing
workforce.
See also Who will care? Nurses in the later stages of their
career. This research
provides information about the employment patterns, preferences and
retirement decisions of nurses approaching retirement age.
Human resources (HR) transition framework. The HR Transition Framework provides the overarching guiding standards for the Department, NHS and Arm's Length Bodies (ALBs) relating to the movement of employees to the new or changed bodies proposed in the Health and Social Care Bill 2011.
The NHS equal pay toolkit. The toolkit aims to guide employers through their legal responsibilities in relation to equal pay audits. The toolkit builds on the Equality and Human Rights Commission’s work but recognises that the NHS has a national pay structure and job evaluation scheme in place under the Agenda for Change agreement.
Consultations
Supporting our future NHS Workforce: Consultation
report. Following a public consultation on proposed changes to
the NHS Bursary Scheme, changes have been agreed. This is a report
of the outcome of that consultation including a description of the
consultation process, key findings and a summary of the responses.
An Impact Assessment and Equalities Impact Assessment are being
published alongside the consultation report.
News
Law Society Scotland: Social media access in the
workplace can expose employers to online
defamation.
If you wish to discuss any of the items raised in this section
please contact
David Widdowson, Julian
Hoskins or
Sarah Michael.
Estates
Publications/Guidance
Good design – it all adds up. This report
provides evidence for how well designed buildings can deliver
tangible social and economic benefits to those who use them and
invest in them. It brings together research from the UK and abroad
to illustrate the benefits that good design in housing, education,
health, the workplace and public spaces can bring, and what happens
if that investment is not made.
Accelerating the release of public sector land for development. This Dear Colleague letter from David Flory, Deputy NHS Chief Executive, sets out points and actions that the NHS can take locally to support the Government’s initiative to release enough public land to build up to 100,000 new homes by 2015.
Legislation
The
draft
Water Industry (Schemes for Adoption of Private Sewers) Regulations
2011 will require statutory sewerage undertakers to take
ownership of all private sewers and lateral drains that are
connected to the public sewerage system on 1 July 2011. The
regulations provide for an overnight transfer of ownership on 1
October 2011. The transfer will apply to residential and commercial
properties.
If you require further information about any of the items raised in this section please contact Rob Harrison or Mark Calverley.
Finance
Publications/Guidance
Fairer care funding. The Commission on Funding
of Care and Support, chaired by Andrew Dilnot, has published its
final report on changes to the funding of adult social care in
England. It recommends that costs should be capped and the
means-tested threshold increased. Instead of individuals paying all
their care costs until they have assets of less than £23,250, as
under the current system, the proposals would mean that those with
high care costs would only pay up to a set amount and after that
their care costs would be paid for by the State. The Commission
estimates that its proposals, based on a cap of £35,000, would cost
the State around £1.7bn.
Among the recommendations in the report are:
individuals’ lifetime contributions
towards their social care costs – which are currently potentially
unlimited – should be capped. After the cap is reached, individuals
would be eligible for full state support. This cap should be
between £25,000 and £50,000. The Commission considers that £35,000
is the most appropriate and fair figure;
the means-tested threshold, above
which people are liable for their full care costs, should be
increased from £23,250 to £100,000;
national eligibility criteria and
portable assessments should be introduced to ensure greater
consistency;
all those who enter adulthood with a
care and support need should be eligible for free state support
immediately rather than being subjected to a means test;
a new universal deferred payment
scheme for anyone who would be unable to afford care charges
without selling their home. Local authorities should be allowed to
charge interest to recover their costs, to make the scheme cost
neutral, and to remove the disincentive they currently face in
promoting the scheme;
new social care legislation should
place duties on local authorities to provide information, advice
and assistance services in their area, and to stimulate and shape
the market for services;
the Government should review the scope
for improving the integration of adult social care with other
services in the wider care and support system.
The Government has stated that it welcomes the
report. It will consider each recommendation carefully to test
whether it meets the wider objectives for reform, including
increased personalisation, choice and quality, closer integration
of health and social care and greater prevention and early
intervention. The Government will need to consider the acknowledged
significant costs of implementing the reforms against other calls
on constrained resources. The Government wants to create a social
care system that offers people and their carers choice and
personalised, high quality care. It will be engaging with the care
sector over the autumn to develop and refine its priorities and
plans for action, bearing in mind the financial context.
Whole of government accounts (WGA). This
publication is a consolidated set of financial statements for the
UK public sector. The aim of WGA is to enable Parliament and the
public better to understand and scrutinise how taxpayers’ money is
spent.
Money matters: review of cost-effective initiatives.
This is a set of case studies, produced for IRISS by the Institute
of Public Care, on initiatives, which through detailed costings,
have been shown to be cost effective.
Landscape review: Formula funding of local public
services. The National Audit Office has published a review of
three formula-based grants from central government to fund local
public services. under which £152 billion, one-fifth of all
government spending, was allocated in 2011-12. One of the grants
reviewed is the Primary Care Trust allocations administered by the
Department of Health which are designed to fund services across the
majority of healthcare.
Funding the right care and support for
everyone. This report recommends the introduction of the first
per-patient funding system for palliative care in the NHS. The
proposals include the development of a palliative care tariff based
on need, a funding system which incentivises good outcomes for
patients, irrespective of time and setting, and providing
incentives for commissioning integrated care packages which
stimulate community services.
The Quarter, quarter 4 2010/11. David Flory’s report for the fourth quarter January to March 2010/11 provides a summary of the NHS financial position and performance against the national priorities set out in the Revision to the Operating Framework for the NHS in England 2010/11. This Quarter shows that the NHS has performed well, and includes a chapter on performance over the winter period which shows that the severe weather in December did challenge the NHS but these challenges were met. Out of 21 measures, it shows the NHS has improved or maintained quality of services in 20 areas, while highlighting only one area (non-admission of under-18 year olds to adult psychiatric wards) where the NHS needs to focus its efforts.
The cost of implementing personal health budgets. This third interim independent evaluation report on the personal health budgets pilot programme looks at set-up costs involved for the 20 in-depth evaluated pilot sites to implement personal health budgets. Costs examined include project management, system development, workforce development and support planning and brokerage.
NHS expenditure. This documents NHS expenditure
since 1948, gives a summary of the structure of the NHS and how it
is financed and a description of how PCTs are allocated
funding.
National Data Collection – Primary and community
Care property. Letter from Bob Alexander, Director of NHS
Finance, Department of Health, about initiation of data collection
exercise in order to provide an England wide picture of the
location and status of infrastructure and equipment used to deliver
primary and community care.
Sharper axes, lower taxes: big steps to a smaller state. This report published by IDEA (a pro market think-tank) provides a comprehensive spending review, proposing an additional £215bn of public spending cuts, on top of the coalition's current plans. It makes recommendations for two future economic models for funding the NHS.
Legislation
NHS Foundation Trusts and Primary Care Trusts (Transfer of
Trust Property) Order 2011 (SI 2011/1552). This Order, which
comes into force on 20 July 2011, transfers property held on trust
(charitable property) from the NHS Foundations Trusts and PCTs to
other NHS bodies, following the transfer of services from the PCT
to the NHS body under the Transforming Community Services
programme. Order transfers the funds from the body currently
holding the funds to the body that will then be the corporate
trustees for them. Copies of the schedules of trust property
transferred under this Order can be obtained from the Department of
Health.
News
Government announces extension of International Accounting
Standard 27 to all NHS organisations. HM Treasury has announced
that Monitor has agreed to extend the consolidation accounting
standard to all NHS organisations from 1 April 2013. This
application has been deferred since the adoption of International
Financial Reporting Standards across central government on 1 April
2009. This decision will ensure that the highest standards apply to
the reporting of public expenditure. The deferral will allow time
to achieve consistent and correct application across the NHS. This
decision does not affect NHS-linked charities - the regulation of
charities remains a separate matter and the responsibility of the
Charity Commission.
Bevan Brittan Updates
Public Sector equality duty Public bodies now need to consider
the public sector equality duty in their decision making. In
an era of funding cuts the question is when should that duty be
carried out and how? Bevan Brittan is the largest provider of
legal services to the public sector and we understand the
application of this duty to budget setting and
implementation.
If you require further information about any of the items raised in this section please contact David Owens.
Foundation Trusts
Publications/Guidance
Survey of NHS foundation trust governors
2010/11. The objective of the survey was to understand how
governors feel about their ability to perform their role, and to
identify potential areas for improvement.
Current practice in NHS foundation trust member
recruitment and engagement. This report outlines the progress
that foundation trusts have made in membership recruitment and
engagement.
Case study: University Hospital of South Manchester
NHS Foundation Trust. This case study has been prepared with
the University Hospital of South Manchester, through interviews
with members of its boards of directors and governors, to share the
learning from their experience of the trust being in significant
breach of its terms of authorisation.
Do hospitals respond to greater autonomy? Evidence
from the English NHS. This paper examines the impact of the
foundation trust (FT) policy on hospital performance by looking at
measures such as financial management, quality of care and staff
satisfaction. The paper finds that generally FTs perform better
than non-FTs. However, these differences appear to be long-standing
rather than the effect of the FT policy per se and there is some
evidence of a convergence in hospital performance between FTs and
non-FTs.
NHS Foundation Trusts: consolidated accounts
2010/11. This publication presents the consolidated accounts
for the 136 NHS foundation trusts authorised at 31 March 2011.
If you require further information about any of the items raised in this section please contact Vincent Buscemi.
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Freedom of Information
Publications/Guidance
Release of documents relating to contaminated blood
products: litigation over infection of haemophiliacs with HIV.
The DH has published documents relating to litigation over
infection of haemophiliacs with HIV through contaminated blood
products. In addition, the Department made a commitment to release
the attached information in response to an earlier FOI request for
Ken Clarke's papers related to decisions on haemophiliacs /
response to the haemophilia HIV litigation during the late
1980s.
If you wish to discuss any of the items raised in this section please contact James Cassidy .
Governance
Publications/Guidance
Better care for people with long-term conditions:
the quality and good governance of telehealth service. This
report highlights the challenges that currently exist in the
healthcare sector and includes a set of detailed recommendations
for healthcare commissioners, providers and policy makers to ensure
those deploying telehealth services address critical governance,
quality and safety issues.
If you require further information about any of the items raised in this section please contact Vincent Buscemi.
Health and Safety
Publications/Guidance
Making care safer. This report by the Health
Foundation collects together the testimony given by family and
carers of people living in a care home, specifically around issues
of medication safety. Three day-long focus groups were held in
2010, in Manchester, Birmingham and London. The issues and
potential solutions raised by the groups are presented in this
report under four main headings: communication and information
sharing; prescribing and administration of medication; staff
development and support; and advocacy and rights.
Keeping patients safe when they transfer between care providers.
This guidance aims to increase the priority given to medicines
information transfer and promote best practice in line with
existing national initiatives. It has been developed in
collaboration with pharmacy, medical, nursing and allied health
professional bodies, plus patients, national agencies and health
and social care professionals:-
Keeping patients safe when they transfer between
care providers - Professional guidance.
Keeping patients safe when they transfer between
care providers - Organisational guidance.
Keeping patients safe when they transfer between
care providers - Organisational guidance.
Infection Control
Consultations
Infection control: guideline consultation. A
clinical practice guideline on Infection Control is being developed
for use in the NHS in England, Wales and Northern Ireland.
Registered stakeholders for this guideline are invited to comment
on the provisional recommendations by 07/09/2011.
Mental Health
Publications/Guidance
Ten standards for adult in-patient mental
healthcare. This report from the Royal College of Psychiatrists
describes the ten standards for working-age adult in-patient wards
that working psychiatrists believe to be central to wards and
high-quality care being delivered effectively.
Five ways to wellbeing. This document contains
a set of evidence-based public mental health messages aimed at
improving the mental health and wellbeing of the whole population.
They were developed by nef (the new economics foundation) as part
of the Foresight Project on Mental Capital and Wellbeing. It
presents the results of a scoping exercise looking at how the five
ways to wellbeing have been used across the UK since their launch
as part of the Foresight report in October 2008.
Review into the needs of families bereaved by
homicide. This publication by Victims' Commissioner Louise
Casey includes the largest ever survey of bereaved families. It
calls for a law that will set out rights that the criminal justice
system should afford families, as well as the practical help and
support they should receive.
National Dementia Strategy: Equalities action
plan. This Equalities action plan sets out a series of planned
actions in relation to the implementation of the National Dementia
Strategy and the Dementia Commissioning Pack. It supplements the
Equality Impact Assessment published alongside the National
Dementia Strategy in 2009 and has been compiled in line with the
requirements of the Equality Act 2010.
Launch of Dementia Commissioning Pack. The
Dementia Commissioning Pack provides practical resources for health
and social care commissioners to work together to improve the
quality of both specialist dementia services and general health and
care services for people with dementia and their carers.
Supporting high-risk victims of domestic violence -
A review of Multi-Agency Risk Assessment Conferences (MARACs).
This report by the Home Office presents the key findings of the
review of Multi-Agency Risk Assessment Conferences (MARACs). It
includes the case for putting MARACs on a statutory basis.
No health without mental health: guides. These
two briefings, aimed at community groups and general practices, explain in practical terms
the ways in which general practitioners, community groups and
voluntary organisations can improve life chances for people with
mental health conditions. Guide for community organisations.
Court of Protection guidance on tenancy agreements, June
2011. The Association of Public Authority Deputies (APAD), and
a number of other court users, have asked the court for guidance on
how to make applications in relation to signing or terminating
tenancy agreements on behalf of adults who lack the mental capacity
to understand or sign the agreement themselves. The situation
arises mainly where adults with learning disabilities are moved
from hospital or care home settings into supported living
arrangements in the community, that allow greater autonomy and
independent decision making. Many of the adults will have the
capacity to make certain decisions, such as dealing with social
security benefit payments, but will lack the capacity deal with the
tenancy arrangement. The policy of assessing clients to support a
move to supported living could affect several hundred adults per
year across England and Wales. This guidance has been drawn up with
the approval of the Senior Judge of the Court of Protection, and
sets out: the circumstances when it is necessary to make an
application; the court’s requirements for such applications; and
puts in place streamlined procedures for receiving applications in
bulk, thereby simplifying some parts of the court procedure.
Guidance on the High Security Psychiatric Services
(Arrangements for Safety and Security at Ashworth, Broadmoor and
Rampton Hospitals) Directions 2011. The revised Directions come
into force on 1 August 2011. New issues covered by the revised
Directions include:
A duty upon the
Trusts to co-operate with each other in developing security
arrangements.
Searching of
patients involving the removal of clothing
Specified
employment opportunities
Provision of
training
This document contains:
general information
(paras.3-5) about the High Security Psychiatric Services
(Arrangements for Safety and Security at Ashworth, Broadmoor and
Rampton Hospitals) Directions 2011
specific guidance
about the implementation of certain of the requirements contained
in the Directions (paragraph 6).
general guidance on
the manner in which policies (including procedures and protocols)
should be produced, and promulgated to staff, within the high
security hospitals (paras.7-12).
Forced marriage and mental health. This paper
by the Race Equality Foundation considers both the extent of Forced
Marriage in the UK, and the impact that Forced Marriage, and other
associated problems, such as domestic abuse, can have upon the
mental health of its victims.
Cases
PH v (1) A Local Authority (2) Z Ltd (3) R [2011] EWHC 1704 (Fam).
Declarations were made pursuant to s.15 of the Mental Capacity Act
2005 that a sufferer of Huntingdon's Disease lacked capacity to
make a decision as to his residence and care.
PS v Sunderland City Council (2011) EWHC 1918 (Admin) The claimant's detention as a patient in a mental health hospital was unlawful because the s3 MHA 1983 application made by the local authority, through an approved mental health professional, was unlawful in itself because the claimant's nearest relative only withdrew her objection to the application because she had been given incorrect and misleading advice. Court also said that this case should not be interpreted as prescribing what amounts to consultation.
Consultations
Safety and Security Directions – response to
consultation. Response to consultation on new safety and
security directions and guidance for the high secure hospitals
Consultation on preventing suicide in England: a
cross-government outcomes strategy to save lives. This document
sets out a proposal for a new suicide prevention strategy for
England with the aims of reducing the suicide rate and improving
support for those bereaved or affected by suicide. The draft
strategy brings together knowledge about groups at higher risk of
suicide, effective interventions and resources available. The
closing date for consultation responses is 11 October 2011.
Consultation responses will inform the final strategy, early in
2012.
News
Hospital phobia woman ordered to have surgery. A
cancer patient who has a phobia of hospitals should be forced to
undergo a life-saving operation if necessary, a High Court judge
has ruled.
If you wish to discuss any of the items raised in the above section please contact Simon Lindsay.
Obesity
Cases
R (Condliff) v North Staffordshire PCT [2011] EWCA
Civ 910 (CA). The court dismissed C's appeal against the PCT's
refusal of his Individual Funding Request (IFR) for laparoscopic
gastric by-pass surgery to be funded by the NHS. C suffered from
diabetes and had other health disorders; he was morbidly obese,
with various associated co-morbidities and his health was
deteriorating. His BMI was 43 but the PCT did not fund such surgery
for those with a BMI under 50 except on exceptional grounds. C
applied for funding but the PCT decided that the evidence did not
demonstrate exceptionality. He claimed that the PCT's adoption of
an IFR policy by which IFRs were to be considered and determined
solely by reference to clinical factors breached his rights under
Art.8 ECHR. The court held, dismissing his appeal, that the PCT was
entitled to set an IFR policy which reflected what it reasonably
considered to be a fair balance between the interests of
individuals and the community and a fair balance between different
patients with similar health conditions. The PCT's IFR policy did
not show a lack of respect for C's private and family life, so as
to bring Art.8 into play. Even if art.8 were applicable, there were
legitimate equality reasons for the PCT to adopt the policy that it
did and its decision was well within the area of discretion or
margin of appreciation properly open to it. See also BBC
news report
Bevan Brittan Updates
Too fat to fly and other supersized stories. At a time when
British women take up the mantle of being the fattest in Europe and
NHS Trusts are criticised for a failure to tackle their own staff’s
obesity, here are 3 cases arising from the impact of the obesity
epidemic not only on the NHS but also further afield.
If you would like more information about the portal please contact Julie Chappell.
Primary Care
Publications / Guidance
The legacy of primary care trusts. The
Government has proposed to abolish PCTs in April 2013. This paper
sets out an assessment of the performance of PCTs since their
establishment. It examines how effective they have been, as
assessed against what they have been asked to deliver. It also
examines how their role has changed, as both provider and
commissioner, since they were initially established.
If you wish to discuss any of the items raised in the above section please contact David Owens.
Regulation
Publications/Guidance
The Commons Health Committee has published reports
on their annual accountability hearings with the General Medical
Council (GMC) and Nursing and Midwifery Council:-
Annual accountability hearing with the NMC
Annual accountability hearing with the GMC
Your choice: how to get better public services. This report argues that whilst the Government is correct to look to choice and competition, it should take an evolutionary approach to change and emphasises the vital role which regulation should play in shaping the development of the market. It also presents a set of requirements for successful public sector reform.
Monitor's annual report and accounts 2010/11. This publication provides a review of the year and includes performance against the priorities set in the 2010/11 business plan.
Consultation
Consultations for regulation of social workers in England. The
Health Professions Council has launched two consultations to invite
stakeholders for their views on first, its standards of proficiency for social workers in
England and second, the threshold level of qualification for entry to
the social workers part of the Register. The consultation will
run until 18 November 2011.
Consultation on proposed changes to regulations for
Care Quality Commission registration. The Care Quality
Commission (CQC) took responsibility for the regulation of health
and adult social care providers in April 2009. The regulatory
framework that CQC operates is underpinned by two main sets of
regulations: The Health and Social Care Act 2008 (Regulated
Activities) Regulations 2010, and The Care Quality Commission
(Registration) Regulations 2009. Consultation closes on 7 October
2011. The issues being consulted on fall under three broad headings
which are Changes to the extent of regulation; Technical
amendments, and Minor clarifications.
News
Government announces extension of International Accounting
Standard 27 to all NHS organisations. HM Treasury has announced
that Monitor has agreed to extend the consolidation accounting
standard to all NHS organisations from 1 April 2013. This
application has been deferred since the adoption of International
Financial Reporting Standards across central government on 1 April
2009. This decision will ensure that the highest standards apply to
the reporting of public expenditure. The deferral will allow time
to achieve consistent and correct application across the NHS. This
decision does not affect NHS-linked charities - the regulation of
charities remains a separate matter and the responsibility of the
Charity Commission.
If you wish to discuss any of the items raised in this section please contact Carlton Sadler
General
Publications/Guidance
Open Public Services White Paper. Seeks
comments on the Government's plans for radical changes to the way
in which public services are delivered. The proposals are based on
five key principles: Choice; Decentralisation; Diversity; Fair
access; and Accountability :-
People are to have a right to choice
enshrined in law.
Services will be opened up to new
providers, with diversity the default setting, and the State will
need to justify why it runs a monopoly service.
In selected areas, commissioners will
have to seek and fully consider a minimum of three providers when
they contract for services, and transparently link payment to
results.
Communities and neighbourhoods will be able to commission services
at "hyper-local scale".
The Government will consult with local
authorities about how to further open up locally commissioned
services in areas such as customer contact, property and facilities
management, family support, back office services, support for
looked after children and housing management.
The Government will look at applying
the Foundation Trust model to other public services, and will
explore extending different models of increased independence and a
more diverse provider base to children’s centres – including
considering employee mutuals and how to achieve a greater role for
voluntary and private sector providers.
There will now be a “listening period” over the summer, enabling a
wide-ranging consultation with individuals, communities, public
sector staff, providers and others with an interest in how public
services are delivered. This will be followed in November by
details of how Departments will take forward ideas to implement
open public services over the rest of this Parliament, including
proposals for legislation.
Bevan Brittan has published an overview of the White Paper's
proposals and their implications for public bodies: Public services open for business.
The national framework for NHS continuing
healthcare and NHS-funded nursing care - July 2009 (revised).
The revised framework has been produced as a result of a commitment
to review the national framework within 12 months of its
publication. It clarifies and supports consistency in the
determination of eligibility for NHS continuing healthcare and NHS
funded nursing care. NHS bodies and local authorities are
encouraged to work together to prepare for implementation in
October 2009
Operational guidance to the NHS: extending patient
choice of provider. Guidance for the NHS on extending patient
choice of provider with accompanying impact assessment and
equalities analysis. It takes into account the relevant issues
raised in response to the consultation 'Liberating the NHS: Greater
choice and control', and the NHS Listening Exercise. From April
2012, the Government will begin rolling out selected community and
mental health services for competition between external providers.
This document provides guidance to providers and commissioners on
implementation of the Government commitment to extend patient
choice of provider. Crucially for providers, the next steps in
implementing the Any Qualified Provider (AQP) strategy are:
By October 2011 providers should
participate in local engagement processes being led by
commissioners, which will inform decisions about where offering
choice of provider will improve services.
Between April and September 2012,
providers will need to consider if they wish to respond to
invitations to deliver services through the AQP model.
Qualified providers will need to
register for payment purposes and will be held to account for
monitoring quality via the NHS Standard Contract. Details of how
potential providers will be qualified will be published in Autumn
2011.
The type of services opened to external competition will increase
in 2013 dependent on the success of competition in the above
areas.
More information is on the DH Modernisation Hub.
The Government has also published its response to the consultation on extending
patient choice of provider (any qualified provider).
Number of patients staying in mixed sex accommodation continues to fall. New statistics show that since December 2010, when monthly collection of mixed sex accommodation was first introduced, the number of reported breaches has fallen by 84 per cent. In June 2011, hospitals reported that 1,933 patients were placed in mixed-sex accommodation without any justification. This compares to 2,011 for May 2011 – a decrease of 4 per cent.
Reablement: policy, research and practice
briefing. Reablement is a key policy priority for health and
social care in increasing independence, reducing costs and
promoting partnership work. This briefing examines the evidence
around reablement in terms of the implications for practice and has
identified the main areas that local authorities need to
consider.
NHS Chief Executive Innovation review - call for
evidence and ideas. The NHS Chief Executive has asked Sir Ian
Carruthers to lead a review on his behalf on how the spread of
innovations can be accelerated across the NHS and produce a report
in November 2011 that will inform the strategic approach to
innovation in the modernised NHS.
The performance of the health sector in meeting the
Public Sector Equality Duties. Moving towards effective equality
outcomes. This research report examines performance on the
former race, disability and gender equality duties by Strategic
Health Authorities and Primary Care Trusts in England. These duties
were replaced by the new public sector equality duty in April
2011.
Palliative care for older people: better
practices. This publication provides examples of better
palliative care for older people to help governments,
policy-makers, practitioners and voluntary and statutory
organisations meet the needs of this vulnerable population.
Right to run. This publication provides
guidance to public sector workers who are interested in setting up
a social enterprise or mutual. It outlines every stage of the
process, provides a checklist of actions and examples of successful
case studies.
E Health competency framework: defining the role of
the expert clinician. This framework has been developed to
define the knowledge, skills and behaviours that are required by
practising clinicians who have a role in eHealth at a local,
regional or national level. The framework covers a broad range of
domains from generic competences required by all, such as the safe
and secure management of health information, to areas of in depth
informatics knowledge which may only be required by a limited
number of individuals.
Achieving equality in organ donation and
transplantation in the UK: challenges and solutions. The
combination of low numbers of black and minority ethnic organ
donors and the higher prevalence of conditions such as diabetes and
hepatitis mean that these communities are disproportionately
represented on transplant lists. This results in minority ethnic
patients waiting on average twice as long for some transplants as
their white counterparts. This paper promotes a 'two-pronged'
approach, tackling barriers to black and minority ethnic groups
organ donation in the short term and employing longer term
preventative medical interventions which may reduce the need for
organs in these communities in the future.
Shared value: rebuilding pharma's contract with
society. This report explores the growing challenge of
reconciling unmet patient need with pharmaceutical R&D, in the
context of changes in what society is willing to pay for and
concerns among investors about the return on investment. It
concludes that the industry needs to reframe its social contract to
ensure that market signals about unmet patient need and incentives
for R&D are better aligned, and offers recommendations to
society, industry and investors to help make this happen.
The Discharge Summary Implementation Toolkit has
been produced with the aim to help trusts implement the
nationally-agreed Discharge Summary. It is intended that this will
improve the information provided to patients and create a better
way of patients and GPs working together in an informed manner, and
in turn could result in a reduction of readmissions.
Can we measure "failure to rescue"? "Failure to
rescue" refers to a death after a treatable complication. The rate
of failure to rescue in surgical patients derived from routine
administrative data is recognized as an important indicator of
patient safety by the United States Agency for Healthcare Research.
In this report a consideration is given to whether these methods
can be used in England.
Post-legislative assessment of the Health Act
2006. Government departments are obliged to undertake a
preliminary assessment of the Acts they are responsible for since
2005 and within three to five years after an Act has received Royal
Assent. This is a preliminary assessment of the Health Act 2006.
The main purposes of the Act are: to ensure protection from the
health dangers of secondhand tobacco smoke; to provide a statutory
footing to reduce levels of health care associated infection; to
provide for safer management of controlled drugs, and improvements
to pharmacy and ophthalmic services, as well as changes to the
administration of the NHS.
Taking stock of regenerative medicine in the United
Kingdom. This DBIS report establishes that the UK retains a
leading position in Europe and globally in the science and
commercial translation of regenerative medicine. The quality of
work in research and academia is world class, supported by a strict
but permissive legislative and regulatory framework that is helping
innovation to flourish. The UK is at the forefront of this rapidly
evolving technology and is in a good position to take advantage of
its promise. However, despite the huge potential to deliver new
treatments and commercial successes, regenerative medicine also
faces some key challenges. In the context of these challenges and
significant investment by Government, this report takes stock of
developments across the development pathway.
Living well at home. The All Party
Parliamentary Group on Housing and Care has produced a report from
its Inquiry into 'Living Well at Home' .
Management of blood-exposure in police
officers. This is a letter from National Clinical Director for
Urgent and Emergency Care Professor Matthew Cooke to NHS trusts. It
clarifies existing policy on the need for officers to receive
assessment, and any necessary initial post exposure prophylaxis
treatment, following exposure to the blood of others.
An outcomes strategy for people with chronic
obstructive pulmonary disease (COPD) and asthma in England. At
present, COPD is the second most common cause of emergency
admission to hospital and is one of the most costly diseases in
terms of acute hospital care. Asthma also poses clear resource
pressures on the NHS. This strategy sets out six shared objectives
to improve outcomes for COPD and asthma through high-quality
prevention, detection and treatment and care services.
See also the Government response to the consultation on the
outcomes strategy.
System reset: transforming public services through
IT. The Government faces a huge challenge in tackling the UK's
budget deficit. This report shows that IT is already making many
public service transactions easier for citizens and reducing costs
within government, and more could be done. It identifies solutions
to ten challenges that Government must overcome to ensure IT has a
transformative role in public service delivery.
High quality women’s health care: a proposal for
change. This report proposes significant changes to the way NHS
women’s health services are structured. The report concludes that
the combined force of the NHS reforms, workforce and financial
pressures against a backdrop of rising demand, increasing
complexity and changes in demographics means that the delivery of
women’s health care in the current configuration cannot be
sustained.
In this together: building knowledge about
co-production. This report tells the stories of people who are
improving public services by working with the people who use them
and delivering public services in a radically different way. It
describes a range of practical projects and includes personal
testimonies from individuals directly involved. These examples
demonstrate reciprocal relationships between professionals, people
using services, their families and neighbours – an approach known
as ‘co-production’.
Using social media: practical and ethical guidance
for doctors and medical students. This guidance provides a
brief overview of the challenges and potential pitfalls that health
professionals may encounter when using social media. It gives
practical and ethical guidance on a range of subjects including,
protecting patient confidentiality, defamation, the public-private
boundary and the potential impact of social media use on medical
education and employment.
Piloting Payment by Results for drugs recovery - draft outcome definitions. Following the announcement of the eight pilot sites in April 2011, work has been taking place to develop and implement pilots exploring how to incentivise drug and alcohol recovery systems to improve delivery of outcomes.
Cases
Nield and Acromas Insurance Co Ltd v Loveday ( 13 July 2011) (Div
Ct). A claimant who had brought a personal injury action following
a RTA was sent to prison for nine months for contempt as he
had verified his statement of claim and witness statement despite
knowing that they contained much false information which tended to
exaggerate the value of his claim. His wife, who had verified false
statements to support his claim, admitted her contempt and was
given a suspended six-month sentence.
Legislation
Bribery Act 2010 (Consequential Amendments) Order 2011 (SI
2011/1441). This Order, which came into force on 1 July 2011,
makes consequential amendments to secondary legislation to take
account of the abolition of the common law offences of bribery and
embracery, and the repeal of the Public Bodies Corrupt Practices
Act 1889, and the Prevention of Corruption Acts 1906 and 1916 by
the Bribery Act 2010. The changes include amending reg.23 of the
Public Contracts Regulations 2006 to make section 1 and section 6
offences mandatory grounds for exclusion.
See also Bribery Act 2010 – Guidance about procedures which
relevant commercial organisations can put into place to prevent
persons associated with them from bribing (section 9 of the Bribery
Act 2010). The Bribery Act 2010, which came into force on 1
July 2011, creates a new offence under s.7 which can be committed
by commercial organisations which fail to prevent persons
associated with them from bribing another person on their behalf.
An organisation that can prove it has adequate procedures in place
to prevent persons associated with it from bribing will have a
defence to the s.7 offence. This statutory guidance helps
commercial organisations of all sizes and sectors understand what
sorts of procedures they can put in place to prevent bribery. There
is also a non-statutory Quick Start Guide which sets out the key
points.
NB: Although the guidance refers to "commercial organisations", the
DH considers that it will catch NHS Bodies such as PCTs, NHS
Trusts, FTs, SHAs and special health authorities and any
incorporated body that engages in commercial activities whether or
not it pursues primarily charitable or education aims or purely
public functions.
News
Quality and safety standards report: Castlebeck
Care (Teesdale) Ltd. The Care Quality Commission has published
details of the enforcement action it has taken against Castlebeck
Care (Teesdale) Ltd which failed to protect the safety and welfare
of patients at Winterbourne View. The effect of this action is that
the assessment and treatment centre near Bristol has been
closed.
NHS hospital wins right to challenge closure of children's heart surgery unit.
Bevan Brittan Updates
Claims case round-up. In this month's cases round-up, Ed
Duckworth looks at some further developments on Part 36
offers, how easy it is to change experts and whether a potential
Claimant can sell their claim on.
Expert Immunity - decision overdue? In this article, Raj Kang, reviews the recent landmark case of Jones v Kaney where expert witnesses have lost their 400 year old immunity from being sued in civil courts. The full ramifications of this decision are yet to emerge but it is clear that the implications are far-reaching.
Is this claim exaggerated? – six steps to check. Defendants often feel that claims they are presented with are excessive and, occasionally, potentially fraudulent. Recent case law indicates that Judges are not always sympathetic towards allegations by Defendants of fraud or exaggeration (see below). Such allegations need to be pleaded in a Defence supported by a statement of truth so this is not a step which will be taken lightly. It is therefore crucial that attempts are made to resolve any quantum disputes before trial and to ensure that ample evidence is obtained. This article describes the steps that can be utilised to dispute heads of loss that do not add up.
Fraud scam - Suppliers' changing bank details. Bevan Brittan LLP is aware of a new kind of fraud that is becoming prevalent in the marketplace. The fraud is relatively easy to operate and thus easy to avoid from the point of view of the victim.
Public services open for business. The Government has finally launched its White Paper on reforming public services, that it has trailed as critical to reform in health, education, social care, welfare and housing and would affect all citizens. In this article, we provide an overview of the proposals and consider their implications for public bodies.
Bevan Brittan Training
Bevan Brittan is commited to providing you with first class
training on topical issues relevant to your
organisation. Here is a list of ‘dates for your diary’. You will be
invited to attend events relevant to you and your organisation in
due course.
If you wish to discuss any of the items raised in this section please contact Claire Bentley.
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