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

 

Care

Publications/Guidance
Oversight of user choice and provider competition in care markets. This report from the National Audit Office examines the oversight of user choice and provider competition, where care users receive state funding as a personal budget (including direct payments) or using their own funds (self-funders). It also evaluates the arrangements in place for building market oversight capability. It does not look at publicly-funded care where the local authority purchases care, nor does it examine the value for money of individual institutions’ performance, such as individual local authorities or the Care Quality Commission or local authority commissioning where users do not receive a personal budget or a direct payment.

State of care 2010/11. The CQC has published its third annual report to Parliament on the state of health and adult social care in England. The report covers the period April 2010 until March 2011 and encompasses evidence from the CQC’s first year of regulation under the Health and Social Care Act 2008.

Short-notice care home closures: A guide for local authority commissioners. Closing a home at short notice can be a distressing and complex task for residents, families, care home staff and commissioners. SCIE has brought together examples of how others have managed closures and produced an online guide with top tips, tools, examples and useful links. The guide, which was produced in conjunction with the Association of Directors of Adult Services (ADASS), is aimed primarily at commissioners, but will be useful to all those involved. And although the focus is on managing unplanned, short-notice closures, it may also be relevant to planned closures.

Who cares? The implications of a new partnership to fund long-term care. This report from the Chartered Insurance Institute (CII) provides insight into the likely implications of the Dilnot Commission's findings on both the public’s experience of the care system and the role of the private sector in providing advice and funding solutions. The report identifies the key issues and sets out their implications. It then presents contributions from key players in the debate looking at the main relationships between the care funding model, the market for care products and services and the drivers of consumer awareness and engagement. It also discusses the current political climate for reform

Social care and clinical commissioning for people with long-term conditions. This briefing has been produced by the Social Care Institute for Excellence in conjunction with The King's Fund. It summarises how working with adult social care can help clinical commissioning groups manage their new responsibilities.

Commissioning integrated care in a liberated NHS. This report explores how commissioners can play a key role in developing more joined-up and efficient services.

News
Transfer of Southern Cross Healthcare to new operators. Announces that the restructuring committee has decided to transfer all the care home operator’s homes to new operators. Southern Cross will continue in operation until the transfer process is complete, anticipated to be by the end of October 2011. The company will then be closed.   

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

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Children

Publications/Guidance
Services for the identification and treatment of hazardous drinking, harmful drinking and alcohol dependence in children, young people and adults. This guide for commissioners provides support for the local implementation of NICE guidance through commissioning and is a resource to help commissioners, clinicians and managers to commission evidence based and quality services across England. It also aims to support joint commissioning and partnership working between NHS and partner organisations.

Commissioning young people’s substance misuse services in secure estate 2011/12. The DH announced the transfer of responsibility for funding secure estate substance units from the MoJ to DH on 31 March 2011. This letter from Richard Bradshaw (Director for DH Offender Health), Ray Hill (Director of Secure Accommodation at Youth Justice Board) and Rosanna O'Connor (Director of Delivery, NTA) provides an outline and overview of next steps for local delivery and implementation. 

Government prioritises children’s oral health in new dental contract trials. Announces that 68 dental practices will trial new changes to the current dental contract, looking at ways of increasing patient access and promoting preventative dental treatments like fluoride varnish, which helps to prevent tooth decay in children. 

Standards for assessing, measuring and monitoring vital signs in infants, children and young people. The assessment, measurement and monitoring of vital signs are important skills for all practitioners working with infants, children and young people. Important information gained by assessing and measuring vital signs can be indicators of health and ill health. The standards in this revised guidance provide criteria for practitioners in achieving high quality nursing care. 

Consultations
Department for Education: Revised statutory guidance on the roles and responsibilities of the director of children's services and the lead member for children's services - A consultation. This consultation seeks views by 6 January 2012 on revised statutory guidance for local authorities on the roles and responsibilities of the Director of Children's Services and Lead Member for Children's Services. Following consultation, the guidance will be revised and will replace the version issued in 2009.  

News
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 Research

Publications/Guidance
Protocol for the release of confidential abortions data for bona fide research purposes. Guide for academic researchers requiring access to abortion data for scientific research purposes.

Consultations
If you wish to discuss any of the items raised in this section please contact Deborah Jeremiah.  

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Commissioning

Publications/Guidance
'Ready Reckoner' clinical commissioning groups running costs tool. An interactive running costs tool and guide for Clinical Commissioning Groups (CCGs) that enables them to consider the financial implications of different commissioning support arrangements and staffing structures, and to work through the potential impact that their population coverage has on resources. The model builds on work undertaken across the NHS with SHAs, PCT clusters and pathfinders and incorporates the best elements from this work. 

Commissioning London’s HIV services. This report prepared by Civitas focuses on the commissioning of HIV services in London, documenting the findings of semi-structured interviews conducted with key stakeholders in late 2010. It found a fairly broad consensus on how the commissioning of HIV services should be organised in London; and on the future model of HIV care.

Guidance for commissioning integrated urgent and emergency care: a whole system approach. This guidance prepared by the Royal College of General Practitioners aims to provide clear, practical advice and information for commissioners of urgent and emergency care services, to help them take a strategic approach, which is patient-centred and focused on improving clinical outcomes. 

Services for the identification and treatment of hazardous drinking, harmful drinking and alcohol dependence in children, young people and adults. This guide for commissioners provides support for the local implementation of NICE guidance through commissioning and is a resource to help commissioners, clinicians and managers to commission evidence based and quality services across England. It also aims to support joint commissioning and partnership working between NHS and partner organisations.

Commissioning young people’s substance misuse services in secure estate 2011/12. The DH announced the transfer of responsibility for funding secure estate substance units from the MoJ to DH on 31 March 2011. This letter from Richard Bradshaw (Director for DH Offender Health), Ray Hill (Director of Secure Accommodation at Youth Justice Board) and Rosanna O'Connor (Director of Delivery, NTA) provides an outline and overview of next steps for local delivery and implementation. 

Developing clinical commissioning groups: towards authorisation. This document is aimed at those interested in becoming a clinical commissioning group (CCG) in the new system and sets out the early thinking on the authorisation process – the process by which CCGs will be assessed as ready to take on responsibility for health care budgets for their local communities. The authorisation process is based on a phased approach:
   A configuration phase so that aspiring CCGs can undertake a risk assessment and understand their geography and responsibilities.
   A development path phase so that CCGs can gain experience on commissioning and establish a track record with local authorities.
   The final stage is the authorisation process where CCGs will apply to the NHS Commissioning Board to be established and authorised.
This will be determined through a robust process of authorisation, run by the proposed NHS Commissioning Board, with input from Health and Wellbeing Boards and local clinicians. This will not be a one-off test but groups will be held to account on an annual basis by the NHS Commissioning Board. 

Improving coding, costing and commissioning - Annual report on the PbR data assurance programme 2010/11. The Audit Commission's annual report looking at the Payment by Results (PbR) data assurance programme finds that the data used to inform the current PbR tariff in the last financial year was generally good, but the NHS needs to improve the quality of its data if the Government is to expand its PbR system. An important finding from the research is that there are simple solutions available to trusts wanting to improve their data. Greater use of basic checks by trusts would lead to improved data quality - these include checking submissions against other data sources, and benchmarking unit costs against those of other providers. Better senior leadership within organisations and greater clinical involvement are also needed. The report finds that trusts that followed recommendations from their auditors saw the quality of their data improve substantially. The report includes a checklist covering ten key areas that senior hospital managers can use to improve reference cost data quality.

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

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Employment/HR

Publications/Guidance
Working for personalised care: A framework for supporting personal assistants working in adult social care. This document sets out an approach to enable support for an evolving workforce of personal assistants in the adult social care sector and their employers over the coming years. It has been produced jointly with people who use services, their personal assistants and sector partner organisations.

How to meet your responsibilities under the new Agency Workers Regulations. The new Agency Workers Regulations 2010 come into force on 1 October 2011, placing certain responsibilities on employers, agency workers and agencies. The regulations give agency workers equal terms and conditions to permanent staff after they have been employed for 12 weeks and it is possible that implementation of the regulations may produce problems for NHS trusts, particularly with regards to monitoring arrangements. This guide, produced by NHS Employers and the Recruitment and Employment Confederation, outlines how the regulations will impact upon NHS organisations and agency workers, as well as offering information on where responsibilities under the regulations may lie.
NHS Employers has also identified five high impact actions based on evidence from NHS trusts that have been successful in managing their temporary workforce. These show the key actions all organisations should complete to ensure the most effective use of their temporary and flexible workforce.

NHS staff management and health service quality. Presents findings from a research project into the experience of NHS staff at work. It suggests recommendations to improve staff management in order to raise care standards.

NHS Pay Review Body: Review for 2012. Written and statistical evidence from the Health Departments for England and Wales relating to those staff earning £21,000 or less and information on those earning more than £21,000. It also provides brief information on the recruitment and retention of junior pharmacists which the NHS Pay Review Body noted in its last report that it wished to keep under review. 

Managing industrial disputes: guidance for employers in the NHS. The NHS Employers organisation has produced some guidance on managing industrial disputes in the NHS.

The NHS Employers organisation's submission to the NHS pay review body: 2012/13. NHS Employers has submitted evidence to the NHS Pay Review Body, to inform its consideration of the £250 uplift for Agenda for Change staff earning £21,000 or less.

Bevan Brittan Updates
Employment news round-up. Sarah Lamont reports on the latest employment news: the arrival of the Agency Workers Regulations; Employment Tribunal Statistics for 2010/2011; the abolition of the Default Retirement Age; DWP guidance on Maternity Leave and Pension contributions and a recent case highlighting that for Article 6 of the ECHR to be engaged an employee's dismissal must categorically end their professional career.

Tweeting, blogging and the world of social networking. As online social networking becomes the fastest addiction since the office worker discovered caffeine, Yasmin Allen looks at the latest in a spate of cases dealing with work related comments posted on Facebook and the recent ACAS guidance on social networking.

Two jobs, one sickness absence, one dismissal. Can an employee who has two different jobs continue working for one employer whilst being signed off sick from another?  Mike Smith looks at the recent case of Perry v Imperial College Healthcare NHS Trust which has helped clarify this issue further. 

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

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Finance

Publications/Guidance
NHS funding and expenditure. The House of Commons Library has published a Standard Note that provides a summary of the structure, funding process and expenditure of the NHS in England, and describes how PCTs are allocated funding. It includes tables showing net government and NHS expenditure.

Warning signs for organisations in transition. This briefing prepared by Healthcare Financial Management Association contains a checklist of ‘red-light’ issues that audit committees need to be on the lookout for during transition.

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

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Foundation Trusts

Publications/Guidance
Compliance framework 2011-12. Outlines Monitor’s risk-based approach to regulating NHS foundation trusts. It sets out Monitor's approach to monitoring compliance by NHS FTs with their Terms of Authorisation and for intervening in the event of failure to comply. It applies from 1 April 2011 and forms the basis on which annual plan submissions and subsequent in-year reports should be made in 2011. It incorporates a number of changes to the regulatory approach since the framework was originally published in March 2011, including: changes to how Monitor uses the A&E clinical quality indicators following recent DH guidance; the results of recent consultations on quality governance assurance in transactions and governance risk in community services; and a number of clarifications from the Compliance Framework Frequently Asked Questions. Deleted text has been struck through, while new text is highlighted in red.

Bevan Brittan Events
Governance for Foundation Trusts. 08 December 2011.

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

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Governance

Publications/Guidance
Board assurance prompt: Health and Wellbeing Boards. Briefing from the Good Governance Institute targeted at those developing Health and Wellbeing Boards (HWBBs), or who need to understand and work with HWBBs in the future. It is intended to support informed debate as the precise form and role of HWBBs emerge, and to encourage local health and social care economies to lay the foundations for better partnership working.

Bevan Brittan Events
Governance for Foundation Trusts. 08 December 2011.

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

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Health and Safety

Publications/Guidance
Reconfiguring hospital services: briefing. This paper from the King’s Fund calls for radical changes to improve the process for reorganising hospital services and to prevent politicians from blocking essential changes that improve the quality and safety of NHS care. The paper highlights the urgent need to reorganise hospital services in some parts of the country to improve the quality and safety of care. It concludes that the current decision-making process for hospital reconfigurations is complex and bureaucratic, posing significant risks to the delivery of safe services. The paper makes a number of recommendations for changes to the Health and Social Care Bill and puts forward two more radical options for ‘depoliticising’ the reconfiguration process.

Health and Safety Executive: Getting to grips with hoisting people. This publication explains the problems associated with hoisting people and sets out guidance to deal with them. It covers fixed, mobile and overhead hoists. The advice is intended for health and social care providers or other organisations who move and handle people and will help them to comply with their legal duties.

Multiple pregnancy: The management of twin and triplet pregnancies in the antenatal period. New clinical guideline from NICE on antenatal care for twin and triplet pregnancies says women with a multiple pregnancy should receive specialist care from an experienced multidisciplinary team to avoid higher than necessary rates of assisted birth and caesarean section, and ensure they receive appropriate neonatal risk assessment before birth. These women also need more monitoring and more frequent antenatal visits due to the higher risks which can be associated with twin and triplet pregnancies. An increase in the number of women receiving specialist care for multiple pregnancies should also result in a lower number of preterm births and neonatal complications, resulting in potential cost savings for the NHS. Current NHS antenatal care for women with a multiple pregnancy varies considerably, impacting on how a woman is cared for during her pregnancy and its outcome. This is the first time NICE has published recommendations for health professionals on how antenatal services for women pregnant with twins or triplets can be improved.  

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Inquests

Publications/Guidance
Summary of reports and responses under Rule 43 of the Coroners Rules. This publication gives details of coroners’ reports and responses received from organisations asked to consider action to prevent future deaths between 1 October 2010 and 31 March 2011.

Improving the process of death certification. This letter from Professor John Newton to Directors of Public Health provides an update on the national reforms to death certification under the Health and Social Care Bill. The Bill includes an important amendment to the Coroners and Justice Act 2009 transferring responsibility for the appointment of medical examiners and related activities from PCTs to local authorities.
The DH has also published guidance Death certification reforms: New duty on local authorities that provides an overview of the death certification reforms and an update on work to prepare for implementation of these reforms from April 2013. 

Bevan Brittan Events
Annual Inquest Update. 31 October 2011 : Registration from 9.30am, 10am - 12.30pm. Bevan Brittan’s Inquest Update this year focuses on the impact of recent key cases upon healthcare related deaths, such as Savage v South Essex Partnerships NHS Trust [2010] and Rabone v Pennine Care NHS Trust [2010]. We will also provide an update in relation to the implementation of the Coroners and Justice Act 2009.  We have been working closely with healthcare organisations across the UK and would like to invite you to this interactive session to discuss the changes that have already been made as a result of key decisions/legislation and to explore how those yet to come into force will affect your organisation.

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

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Mental Health

Publications/Guidance
NHS support for social care: provision of support for memory services. This Dear Colleague letter from David Behan, Director General for Social Care and David Flory, Deputy NHS Chief Executive, relates to the announcement about provision of £10m of additional funding support to social care via PCTs for Memory Services. The letter clarifies the expectations placed on PCTs and local authorities in spending these resources.

Working with under 18 year olds: guidance for commissioners, IAPT service providers and those working in IAPT services. Provides guidance to those working in Improving Access to Psychological Therapies (IAPT) services, as well as commissioners and providers of services, regarding working with under 18 year olds. The need for this guidance has arisen following reports from the British Association for Behavioural and Cognitive Psychotherapies (BABCP) that its members were being approached by IAPT services to provide training for services working with children as young as 13 at the request of commissioners.

Think child, think parent, think family: interim evaluation report. This report by the Social Care Institute for Excellence evaluates the first year of implementation and aims to capture learning about how to implement the 'Think child, think parent, think family' guide and evaluate early indications of the impact of implementing the guidance in a local area. The guidance was developed to help services improve their response to parents with mental health problems and their families.

Parental Mental Health and families. Working with families in which an adult carer has a mental health problem can be complex. The SCIE has produced an eLearning resource which sets out all the key relationships, linkages and systems that need to be understood in Parental Mental Health and Families work.

The Family Courts: Media access & reporting. This report looks at the thorny issue of reporting cases and considers the tension between concerns about "secret justice" on the one hand and the expectation of privacy and confidentiality for the family on the other hand.

Mental health care and the criminal justice system. This briefing paper examines the provision of mental health care for adults in the criminal justice system. It looks at what has been achieved to date and identifies priorities for further work.

The size and burden of mental disorders and other disorders of the brain in Europe 2010. This study examines the extent of mental health disorders across Europe and attempts to estimate the potential burden and size in order to inform policy-making in the EU.

The world Alzheimer report 2011: the benefits of early diagnosis and intervention. This report shows that there are interventions that are effective in the early stages of dementia, some of which may be more effective when started earlier, and that there is a strong economic argument in favour of earlier diagnosis and timely intervention.

NICE have published guidance on Autism spectrum disorders in children and young people: recognition, referral and diagnosis.

The governance of adult safeguarding: findings from research into Safeguarding Adults Boards. The research for this report explored the governance arrangements for safeguarding adults. Drawing on a systematic review of the literature, workshops attended by safeguarding specialists, a survey of Safeguarding Adults Boards’ documentation, key informant interviews and data from regional and national safeguarding work programmes, the findings focus on five key features of Safeguarding Adults Boards.

Self-neglect and adult safeguarding: findings from research. This research comprised a scoping study of the concept of self-neglect as defined in the literature and interpreted in adult safeguarding practice. The report draws on a systematic review of the literature, workshops with senior managers and practitioners in specialist safeguarding roles, a focus group with adult social care practitioners and interviews with key informants.

User involvement in adult safeguarding. This report is about involving people who use services in adult safeguarding. It looks at policies and practice, as well as examples of how user involvement is being supported, barriers to greater user involvement, and lessons learned from evaluating adult safeguarding processes.

Mental capacity - OFT guidance for creditors. Office of Fair Trading (OFT) guidance for businesses when they are considering granting credit to people who might not have the mental capacity to make informed borrowing decisions, includes advice on: mental capacity and its relevance to a lending/borrowing decision; indicators that borrowers have, or may have, mental capacity limitations; practices and procedures; and regulatory compliance and enforcement.

Mental health care and the criminal justice system. This briefing paper examines the provision of mental health care for adults in the criminal justice system. It looks at what has been achieved to date and identifies priorities for further work.

Cases
WCC v GS [2011] EWHC 2244 (COP). The Court of Protection found that an 83 year old woman with dementia lacked capacity to conduct litigation, to make decisions in respect of her care requirements, to decide where she wanted to live and to decide issues relating to contact with her family. In order to determine her best interests the court considered s.4 MCA 2005, the Code of Practice and relevant best interests cases. The court also set out the types of conditions that need to be borne in mind when considering contact conditions.

W (By her litigation friend B) v (1) M (By her litigation friend the Official Solicitor) (2) S (3) A NHS Primary Care Trust [2011] EWHC 2443 (Fam) (CoP). The Court of Protection held that it was not in the best interests of a patient in a minimally conscious state for artificial nutrition and hydration to be withdrawn. The court had carry out a balancing exercise by identifying the factors on each side which were relevant to the patient's best interests.

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

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Obesity

Publications/Guidance
Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children . NICE have published updated clinical guidance on obesity.

Evaluation data collection tool. This tool has been developed to assist practitioners to collect standardised summary data from any weight management, diet or physical activity intervention.  

If you would like more information about this section please contact Julie Chappell. 

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Primary Care

Publications/Guidance
NHS support for social care: provision of support for memory services. This Dear Colleague letter from David Behan, Director General for Social Care and David Flory, Deputy NHS Chief Executive, relates to the announcement about provision of £10m of additional funding support to social care via PCTs for Memory Services. The letter clarifies the expectations placed on PCTs and local authorities in spending these resources.

Measuring patient experience in the primary care sector. This briefing provides an overview of patient experience as a measure of quality in healthcare and research in this field.

The effect of financial incentives on the quality of health care provided by primary care physicians. This systematic review aimed to assess the impact of financial incentives on performance and quality in primary care. It found that there was insufficient evidence to recommend the use of financial incentives and suggests caution and care in implementing financial incentive schemes.

Does better disease management in primary care reduce hospital costs? This research paper discusses how general practice disease management may affect hospital costs and describes the estimation methods used to detect these effects.

Care planning: improving the lives of people with long term conditions. This report focuses on people with long term physical health problems and provides guidance to help GPs and their teams better support such patients in gaining more control over their health and improving the quality of their lives.

Bevan Brittan Updates
DH Guidance - Future Ownership & Management of Estate in the Ownership of PCTs in England. The Department of Health issued guidance (published on 4 August 2011) on the ownership of the PCT estate, largely to address the consequences of the TCS transfers but not specifically limited to that. The purpose of this article is to bring to your attention some important operational issues that you should be considering as part of implementing that guidance.

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

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Prison Health

Publications/Guidance
The route to success in End of Life Care – Achieving quality in prisons and for prisoners. Practical guide for both prison staff and health and social care professionals guide on delivering high quality end of life care to prisoners. The guide follows the six steps of the end of life care pathway, beginning with initiating discussions as end of life approaches and concluding with care after death. It emphasises the need for all those involved in a person's care to work across service boundaries to identify those nearing the end of life and respond accordingly. It says that regular assessments and reviews, advance care planning and communication between professionals and services are vital to improving end of life care in prisons. It is particularly important that prison staff and NHS staff working within prisons form good communication channels with local community services.

Mental health care and the criminal justice system. This briefing paper examines the provision of mental health care for adults in the criminal justice system. It looks at what has been achieved to date and identifies priorities for further work.

News
Prison staff face court over suicide. The Herald reports that the widow of a man who hanged himself in jail after being taken off suicide watch has launched a landmark compensation case.

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

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Regulation

Publications/Guidance
Compliance framework 2011-12. Outlines Monitor’s risk-based approach to regulating NHS foundation trusts. It sets out Monitor's approach to monitoring compliance by NHS FTs with their Terms of Authorisation and for intervening in the event of failure to comply. It applies from 1 April 2011 and forms the basis on which annual plan submissions and subsequent in-year reports should be made in 2011. It incorporates a number of changes to the regulatory approach since the framework was originally published in March 2011, including: changes to how Monitor uses the A&E clinical quality indicators following recent DH guidance; the results of recent consultations on quality governance assurance in transactions and governance risk in community services; and a number of clarifications from the Compliance Framework Frequently Asked Questions. Deleted text has been struck through, while new text is highlighted in red.

State of care 2010/11. The CQC has published its third annual report to Parliament on the state of health and adult social care in England. The report covers the period April 2010 until March 2011 and encompasses evidence from the CQC’s first year of regulation under the Health and Social Care Act 2008.

House of Commons Health Committee annual accountability hearing with Monitor. This report assesses Monitor's performance and the context for its duties as part of the Committee's series of sessions with regulators in health and social care. It concludes that Monitor's operations over the past year have taken place in an extremely challenging context — not only in terms of its own changing role under the Health and Social Care Bill and the arm's length bodies review, but also in terms of the wider pressures and change in the healthcare landscape. Although the proposed revisions to the Health and Social Care Bill have helped to define Monitor's future role more clearly, and some uncertainty will be removed as the Bill progresses through Parliament, Monitor will continue to operate in an extremely challenging context in the years to come. The Committee intends to repeat this exercise on an annual basis and will invite Monitor to appear before it again in 2012, to update the Committee on progress.

House of Commons Health Committee annual accountability hearing with the Care Quality Commission. This report arises from the Committee's decision to review the work of the CQC on an annual basis, given the breadth of the CQC's agenda and the vital place it occupies in ensuring standards of care. It concludes that the bias in the work of the CQC away from its core function of inspection and towards the essentially administrative task of registration represents a significant distortion of priorities. Although the evidence presented by the CQC acknowledges this distortion of priorities and argues that corrective action has now been taken, the Committee believes it is important to understand how this misallocation of resources arose, not least in order to reduce the risk of the same thing happening again. The Committee expects to see clear evidence by next year of the CQC leadership openly acknowledging challenges and setting priorities that reflect its core duty to ensure the safety and quality of care. It notes the CQC's request for an additional 10% of resources to fund its inspection regime - it already has concerns about the way the CQC has handled and prioritised its existing resources and does not believe that additional resources will address these concerns unless they are deployed as part of a clear strategy.

Consultations
Judgement framework and enforcement policy consultation. The Care Quality Commission is simplifying and strengthening its regulatory model to reflect its focus on its core business of monitoring and inspecting and to build on what it has learned in the last 18 months. The proposed changes will result in most services being inspected more often and the inspections becoming more targeted. As a result of these changes, it is seeking views on changes to its key guidance. The consultation closes on 9 December 2011.

Regulatory fees – have your say. Fees for all providers that are registered under the Health and Social Care Act 2008 from April 2012. The CQC has launched a consultation on the fees it proposes to charge providers of health and adult social care services from 1 April 2012. This includes out-of-hours (OOH) services that will be registering with CQC for the first time in 2012. These fees will cover itsw work to register providers and monitor their compliance with essential standards of quality and safety. The consultation covers its proposals for adjusting and extending the current fees scheme. It will launch a further consultation next year as part of a long-term review of the fees scheme which it will implement phases from April 2013. The consultation closes on 28 December 2011.

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

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General

Publications/Guidance
Transforming NHS ambulance services. This report from the Commons Public Accounts Committee examines the value for money that ambulance services provide. It finds that under the NHS reforms, there is still a great deal of vagueness around who will be responsible for what in the new system. It is not clear who will be responsible for commissioning ambulance services, who will be responsible for improving efficiency across ambulance services, or who will intervene if a service runs into financial trouble or seriously underperforms. In the future, ambulance services will become foundation trusts and be directly accountable to Parliament, but it is not realistic for each ambulance service to be individually accountable for value for money. There needs to be greater clarity on the roles and responsibilities of the DH, commissioners and ambulance trusts, with appropriate structures for accountability to Parliament on value for money. In addition, a more integrated emergency care system is required to ensure that ambulances are not kept waiting outside accident and emergency, can hand over patients faster and get back out to help others. The DH has plans to align the objectives of those involved in the provision of urgent and emergency care providers. There are also varying levels of collaboration between ambulance, fire and police services which should be strengthened and Government should investigate the scope for further cooperation to identify savings in areas such as procurement and back-office services.

No vaccine, no cure: HIV and AIDS in the United Kingdom. This report claims that the current priority given to preventing HIV and AIDS in the UK is inadequate and a new priority must be given to prevention policies if the epidemic is to be stemmed. It says that the numbers accessing care have trebled since 2000 and that HIV and AIDS remains one of the most serious public health issues confronting the Government at the start of the 21st century.

Always on call, always concerned: A survey of the experiences of older carers. This report by the Princess Royal Trust for Carers highlights the concerns of older carers while demonstrating how essential it is to support local centres that look after older carers’ needs. It makes recommendations to local authorities and local health providers on the need to support older carers.

Consent and confidentiality in clinical genetic practice: guidance on genetic testing and sharing genetic information. This report aims to guide healthcare professionals through the legislation that applies to the use of genetic data and samples. The guidance includes worked examples based on real cases illustrating how complex situations can be dealt with in practice. A key focus of the report is to illustrate how the family can be important in what otherwise might seem to be individual decisions.

N=1: Why people matter in medicines. This report from a subgroup of the Royal College of Physicians Medicines Forum outlines the need to bridge the gap between patients and the medical industry for a more beneficial, effective system of prescribing. It refers to the need for healthcare professionals to use ‘patient terms’ and real life language and highlights that there is often uncertainty about what is available to the public in terms of life-changing therapeutic products and what modern medicine can offer. It recommends that GPs should be able to refer patients with medication problems to a pharmacist adviser who can also be used as a source of advice for both patients and GPs on medication related issues. Other practical recommendations in the report focus on more effective engagement, service improvement and improving research for the benefit of the public.

Does income inequality cause health and social problems? The main aim of this study was to review the evidence concerning the impact of income inequality on health and social problems. It also considered a range of policy implications. The study’s main conclusion is that both individual income (in terms of poverty/material circumstances) and income inequality (relative income) make a difference to health and social problems. It suggests a range of policy mechanisms that could be used to do this.

Consultations
Proposals to introduce independent prescribing by podiatrists and physiotherapists. These two consultations seek views on proposals for podiatrists and physiotherapists to become independent prescribers of medicines. It also proposes that podiatrist independent prescribers  and physiotherapist independent prescribers are allowed to mix licensed medicines prior to administration and direct others to mix, and to be able to prescribe independently from a limited list of controlled drugs. This would be achieved primarily by changes to the Medicines Act 1968 and the Misuse of Drugs Regulations 2001. Both consultations close on 8 December 2011.

News
Prime Minister and Health Secretary announce new commitments on 24/7 NHS care. Announces that patients will be able to access the NHS at any time 365 days a year through the new free to call NHS 111 service – the number to call for all non-emergency NHS care and advice. The service will replace NHS Direct, which the Government announced it was scrapping last year. It will give health advice and information about services such as out-of-hours GPs, walk-in centres, emergency dentists and pharmacies. The Government says it will reduce confusion and effectively abolish the concept of "out-of-hours" in the NHS. The NHS 111 service, currently available in County Durham and Darlington, Nottingham City, Lincolnshire and Luton, will be rolled out in the Isle of Wight and Chesterfield and surrounding areas before Christmas, and nationally from April 2012.

Bevan Brittan Updates
Claims case round-up. A review of the recent case law on Part 36 offers.

Data security: if data is lost and possible sanctions that can be imposed. Few would take issue with a statement that the NHS and its associated parts need to be trusted to maintain the confidentiality and security of personal information.  The principles of information security require that all reasonable care is taken to prevent inappropriate access, modification or manipulation of data.  In the NHS, the most sensitive data is, of course, patient record information.

Dos and don'ts of investigating hospital acquired infection cases. Sian Morgan reviews the best way to approach investigating cases alleging hospital acquired infection.

Witness management. “The law is reason, free from passion” (Aristotle) - or perhaps not if you are a clinician accused of negligence. Obtaining good factual evidence is essential for the successful defence of a claim.  The key to obtaining that evidence is effective and empathetic communication with the doctors, nurses or midwives who were involved in the care of the patient and from whom we seek factual evidence. 

Bevan Brittan Events
Claims and complaints forum. 06 December 2011  

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

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