Health and Social Care Update - July 2012

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	Information and Data Sharing
Commissioning	Inquests
Employment/HR	Mental Health
Estates and Facilities	Primary Care
Finance	Regulation
Foundation Trusts	General

 

Care

Publications/Guidance
The right care the right place: delivering care closer to home. This report argues that delivering care closer to the home could provide better, healthier outcomes for patients and help ease NHS budgetary pressures by saving £3.4bn a year. It sets out recommendations to remove barriers in order to make the delivery of care close to the home more widespread.

The route to success in end of life care – achieving quality for lesbian, gay, bisexual and transgender people. This report finds that lesbian, gay, bisexual and transgender people are at risk of not receiving high quality end of life care services, with many facing problems in terms of being treated with dignity and respect and seeks to address this. It follows the nationally recognised six-step end of life care pathway and provides case studies, issues for health and social care staff to consider and key recommendations.

Quality care for older people with urgent and emergency care needs ('The Silver Book'). The focus of this guide is on care for older people over the first 24 hours of an urgent care episode, with the specific remit to help decrease variations in practice; influence the development of appropriate services across the urgent care system; identify and disseminate best practice; and influence policy development.

News
Middle classes who pay for their own care have fewer rights. A legal loophole means that those who have to fund their own care do not have the same protections under the Human Rights Act as those whose care is provided by the state, it discloses.

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

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Children

News
Children's Hospice and Hospice-at-Home Grant 2012/13. The Coalition's Programme for Government committed to the continuance of £10m revenue funding annually to children hospices from 2011 and establishment of a per patient funding system. Including financial year 2012/13, children’s hospices have received a total of £67m through the annual DH Children’s Hospice and Hospice at Home Grant. This table sets out individual allocations for the last three financial years.  

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

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Commissioning

Publications/Guidance
Deciding how to pay: remuneration for clinical commissioners. From April 2013, clinical commissioning groups (CCGs) as independent statutory bodies will be locally accountable for agreeing the rates and methods of remuneration that will enable them to operate effectively. CCGs will need to decide on remuneration arrangements not just for staff but also for members of the governing body, and a range of other ‘non-employed’ individuals involved in CCG activities. This briefing is designed to support CCGs as they navigate the complexities of remuneration for clinical commissioners. It identifies the key issues to be aware of and suggests ten recommendations to help ensure openness, fairness and sustainability.

Functions of clinical commissioning groups. This publication updates "The Functions of GP Commissioning Consortia: A working document" that was first published in March 2011. This version reflects the final content of the Health and Social Care Act 2012 and aims to support the discussion that emerging CCGs will be having as they continue to develop. The document sets out the proposed range of CCG functions, covering the key statutory duties of CCGs – the “must dos”, and the key statutory powers – the things that CCGs have the freedom to do, if they wish, to help meet these duties.

Securing excellence in commissioning primary care. This document outlines the single operating model for the commissioning of primary care services within the NHS. It describes the system by which the NHS Commissioning Board will use the £12.6bn that is spent on commissioning primary care to secure the best possible outcomes for patients.

Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-commissioned services. The NHS Commissioning Board has published a draft Code of Conduct setting out additional safeguards that CCGs will be advised to use when commissioning services for which GP practices could be providers. The Code is designed to support CCGs in further developing their governance arrangements. It is also intended to allow wider engagement on the proposals, which the NHS CB can take into account when it publishes statutory guidance on managing conflicts of interest later in the year.

Recovery resources. This online resource has been designed to support commissioners and services in meeting the drug strategy outcomes. It features evidence and guidance; case studies of local initiatives; and links to other useful material. 

Consultations
Our NHS care objectives: A draft mandate to the NHS Commissioning Board. Under the Health and Social Care Act 2012, the Government must set objectives for the Board in a mandate, which must be updated every year, following consultation. In order to provide stability for the NHS, the mandate can only be changed mid-year in limited circumstances. The DH is now seeking views on a draft mandate to the NHS Commissioning Board that sets out the Health Secretary's expectations for the health service and marks the move to a more patient-centred, independent, transparent and outcomes focused NHS. The annexes include: the NHS Outcomes Framework; Key measures for assessing progress; The legal duties of the NHS Commissioning Board; and the Choice Framework. The consultation closes on 26 September 2012. The final mandate will be published in the autumn, ready to come into force from April 2013. 

Legislation
National Health Service (Clinical Commissioning Groups) Regulations 2012 (SI 2012/1631). These regulations, which come into force immediately after the commencement of s.25 of the Health and Social Care Act 2012 (date as yet unknown), provide for the membership, name, establishment and governance of a Clinical Commissioning Group (“CCG”), and also for the variation of a CCG’s constitution, and for the merger and dissolution of CCGs. They also set out the factors that the NHS Commissioning Board must consider in connection with an application to establish a CCG, or when an established CCG seeks to vary its constitution, to be dissolved or to merge with another CCG, and the procedure that should apply to such applications.

Bevan Brittan Updates
Clinical Commissioning Groups’ authorisation: Detailed requirements. The Department of Health has now made the first set of regulations governing the activities of Clinical Commissioning Groups which focus very much on the authorisation process. The National Health Service (Clinical Commissioning Groups) Regulations 2012 cover a number of different points.

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
World class education and training, for world class healthcare: Introducing Health Education England. This publication sets out the role of the new Health Education England organisation for NHS chief executives, directors of HR, all staff in HEE sender organisations and trade unions. It outlines the vision and purpose, values and culture and the proposed advisory structure.

NHS staff tracking. This provides an overview of NHS staff morale and engagement, plus awareness of attitudes towards a range of Department of Health and NHS initiatives. The questionnaire includes a core module covering staff morale and advocacy.

Review of the NHS equal pay toolkit. The NHS Staff Council’s Equality and Diversity Group developed an equal pay toolkit in 2011, which was designed to help HR and E&D practitioners to initiate equal pay audits. NHS Employers are running a survey to establish the extent to which NHS organisations are conducting equal pay audits, and whether the toolkit is being used effectively to support this. 

Continuing professional development: guidance for all doctors. This guidance was published to help doctors across the UK keep their knowledge and skills up to date throughout their working life. It is aimed at helping doctors as they reflect on their practice, prepare for their annual appraisal, and ultimately for their revalidation. It was developed in co-operation with doctors, medical Royal Colleges, employers, patients and the public, following widespread public consultation earlier this year and emphasises that doctors must take account of the needs of their patients and their healthcare teams when considering the learning they may need to undertake.

Guidance and information on supporting revalidation. This guidance has been devised to simplify the appraisal process and the supporting information doctors need in order to revalidate. Following extensive work and consultation coordinated by the AoMRC, the specialty guidance frameworks have been produced based on AoMRC’s core framework (agreed by all member colleges and faculties) to ensure commonality in appraisal for revalidation regardless of a doctor’s specialty.

Model staff engagement policy. NHS Employers has developed a model staff engagement policy based on good examples and learning from those organisations who already have a policy in place. It needs to be adapted and customised locally where indicated.

Occupational health services SLA template. This template can be adapted locally for occupational health units to use with their providers. It is fully endorsed by NHS Employers and is currently undergoing Quality Assurance for inclusion on the SEQOHS Knowledge Management System.

News
Junior doctors will spend a minimum of four working days shadowing the job that they will be taking up from this summer.

New armour to stop age discrimination in the NHS. A prohibition on age discrimination in public and private service provision will come into effect in October 2012. There will be specific exceptions from the relevant provisions of the Equality Act 2010, including insurance companies still being able to use age to assess risk.

NHS Pension Scheme. A House of Commons Library Standard Note discusses recent reviews of the NHS Pension Scheme.

Bevan Brittan Updates
How liable can public sector employers be? Jodie Sinclair looks at the recent decision in the High Court case of (R) Bakhsh v Northumberland Tyne and Wear NHS Foundation Trust, where consideration was given as to whether the European Convention on Human Rights (ECHR) extends liability for public sector employers beyond the ordinary statutory unfair dismissal scheme.

News Round Up - Employment Law. Anne Palmer takes you through some recent developments in the world of employment law, including:
 The case of Christou & Anor v London Borough of Haringey, which looks at the fairness of an employee’s dismissal following a second disciplinary process
 The High Court case of CEF Holdings Ltd and another v Mundey and others regarding the enforceability of restrictive covenants
 An update on the Enterprise and Regulatory Reform Bill following its second reading in the House of Commons this month
 The proposed New Local Government Pension Scheme.

Some Other Substantial Reason (SOSR) Dismissals. Lara Feghali tackles the complex area of SOSR dismissals, providing some further guidance on this issue by reference to case law, including the recent case of the Governing Body of Tubbenden Primary School v Sylvester.

If you require further information about any of the items raised in this section please contact Julian Hoskins or James Gutteridge.  

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Estates and Facilities

 

Publications/Guidance
Update to accelerating the release of surplus public sector land. David Flory, Deputy NHS Chief Executive, has written to all NHS organisations with an update on their contribution to accelerating the release of surplus public sector land initiative and further information on the assistance available to them.

If you require further information about any of the items raised in this section please contact  Rob Harrison or Mark Calverley.  

Back to top   Finance 

Publications/Guidance
Personal health budgets evaluation: Experiences and outcomes for budget holders at nine months. This fifth interim independent evaluation report assesses the effectiveness of the personal health budget pilot programme. It is based on interviews with 52 budget holders and 13 carers in the pilot which suggest that there is widespread potential for personal health budgets to lead to improvements in health and well-being; however, these benefits risked being reduced by delays and other problems in implementing personal health budgets. The report highlights the importance of information, advice and support, and identifies some challenges.

Healthy lives, healthy people: Update on public health funding. Sets out current thinking on local authority public health finance and in particular: the next steps on moving from the estimates of baseline spending published in February 2012 to actual allocations for 2013-14 which are expected to be published by the end of 2012; provides further information on the high level design of the health premium which will be targeted towards areas with the worst health outcomes and most need; conditions on the ring fenced public health grant which state how the grant may be used, including proposals for local authority financial reporting requirements on public health spend. It also gives the Advisory Committee on Resource Allocation’s (ACRA) interim recommendations on the public health formula. The DH welcomes feedback on the approach used and the proposed formula which will inform ACRA’s continuing work to finalise their recommendations for 2013-14 public health allocations.

Private healthcare market investigation. The Competition Commission has published an issues statement as part of its investigation into privately funded healthcare. The issues statement identifies the key questions to be examined. The statement is based on the Competition Commission’s initial consideration of an appropriate frame-work for the investigation and takes into account the OFT's decision document and evidence so far gathered.

I'll tell you what I want, what I really really want. This briefing looks at how patients are increasingly exercising their right to choose where and how they receive their care, and how healthcare organisations can offer them what they want.

Securing the future financial sustainability of the NHS. The NHS delivered a £2.1bn surplus in 2011-12 but there is some financial distress in NHS trusts with some very large deficits. It concludes that it is hard to see how continuing to give financial support to organisations in difficulty will be a sustainable way of reconciling growing demand for healthcare with the size of efficiency gains required within the NHS and that without major change for some providers, the financial pressure on them will only get more severe.

NHS and social care funding: the outlook to 2021/22. This report, funded by the Nuffield Trust, examines what can be expected once the current unprecedented period of broadly flat NHS funding in real terms ends in 2014-15.

Healthcare across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland. The report finds variations in health outcomes across the four nations, and will help health departments examine how better value for money could be achieved.

Bevan Brittan Updates
NHS Trusts – the consequences of failure. The announcement that the Secretary of State has commenced the process which is likely to lead to the appointment of a Trust Special Administrator at South London Healthcare NHS Trust makes it clear that the DH’s approach towards NHS Trust deficits is coming to an end.

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
Director-governor interaction in NHS foundation trusts: a best practice guide for boards of directors. This best practice guidance is the result of a project to identify the key factors for establishing strong director-governor interaction within foundation trusts. It is aimed at existing foundation trusts and aspirant foundation trusts.

NHS foundation trusts: review of twelve months to 31st March 2012. At the beginning of 2011/12, Monitor identified a number of key challenges that could present significant risks for the foundation trust sector. This review report finds that, in the main, the sector continues to cope with these challenges. 

Introduction to Monitor's future role. Monitor's role will change as they take on a number of new responsibilities under The Health and Social Care Act 2012. This briefing outlines their new functions.  

Evaluation of the reimbursement system for NHS-funded care. Evaluation of the reimbursement system for NHS-funded care is an in-depth, independent and extensive evaluation of the reimbursement system in the NHS in England. It is the most comprehensive analysis of pricing in the NHS that has been done. On 5 July 2012 Monitor published a summary of stakeholder responses to the report.

Choice and Competition Framework. The NHS Commissioning Board Authority and Monitor are working together to create a joint Choice and Competition Framework for commissioners, informed by commissioners. It will aim to help them decide how and when to use competition to best effect to help improve outcomes for patients. 

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
Keeping patients safe when they transfer between care providers – getting the medicines right. This report calls for improvements to the transfer of information about medicines when patients move between care settings. It outlines the results of a six-month project involving over 30 healthcare organisations which volunteered to implement RPS guidance on transfer of medicines information.

Mandatory health care associated infection (HCAI) surveillance: redevelopment of the HCAI data capture system (MESS). This letter highlights the development of a new web based HCAI surveillance computer system. It will replace the existing system used to collect the mandatory HCAI surveillance data for reporting MRSA, MSSA, and E. coli bacteraemias, and C. difficile infection. It is expected to go live in April 2013. 

Market report, Issue 1: June 2012 . This is the first of CQC's quarterly market reports which outline the results of their day-to-day inspection work. It provides information on the number of inspections carried out; where they are carried out; what the inspections found; and how well government standards were being met across these services. In addition to this, a particular type of care will be focused on in each report. This first report focuses on maternity services.

Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. This clinical guideline offers evidence-based advice on the diagnosis and management of venous thromboembolic diseases, investigations for cancer in patients with venous thromboembolism and the role of thrombophilia testing.

Cardiac arrest procedures: Time to intervene? This NCEPOD report highlights the process of care for patients aged 16 and over, who received cardiopulmonary resuscitation in an in-hospital setting. The report takes a critical look at areas where the care of patients might have been improved, and factors which may have affected the decision to initiate a resuscitation attempt. Remediable factors have also been identified in the clinical and the organisational care of these patients.

Guidance for use of CNST cover published. Guidance for use of the clinical negligence scheme for trusts (CNST) cover for management of the clinical negligence risks of qualified independent sector providers (IS Providers) of treatment delivered to NHS Patients under the NHS Standard Contract for 2012-2013 was sent to strategic health authorities and primary care trust chief executives in June. A letter provides instructions on how the clinical negligence risks associated with NHS commissioned elective activity undertaken by IS Providers can be covered by the CNST with respect to the NHS standard contracts for services (“NHS standard contracts”) let to IS providers that meet the relevant qualification criteria under “any qualified provider” for 2012-2013. These cover arrangements are to apply on “progression” independent sector treatment centres procurements that are planned or are underway, where clinical negligence risks are to be covered by the CNST. This is an interim solution, and has been put in place because IS Providers are not yet able to become members of the CNST in their own right. This solution was informed by discussions with IS Providers, the NHS Litigation Authority and other stakeholders. 

PIP breast implants: web forum on patient experiences - second report of session 2012–13. Women who received substandard breast implants have had their say about their experiences in a web forum run by the House of Commons Health Committee. This report contains a summary of the comments received on the forum which ran in May 2012.

Principles of quality in national clinical audit. This guidance follows three rounds of consultation. The original draft of the text was released in October 2011, and was produced in response to the debate regarding reaching agreement on the markers of quality in national clinical audit. Feedback has been obtained from a wide range of stakeholders at all levels, including frontline clinical audit staff. 

Legislation
Quality and Safety of Organs Intended for Transplantation Regulations 2012 (SI 2012/1501). These regulations, which come into force fully on 27 August 2012, implement EU Directive 2010/53 that imposes quality and safety requirements in relation to the procurement and transplantation of organs intended for transplantation. They set out the legal framework for organ procurement and transplantation in the UK, based on the requirements of the Directive, covering the donation, testing, characterisation, procurement, preservation, transport, transplantation and disposal of an organ intended for transplantation. The Regulations also establish a national competent authority to ensure compliance with European Union quality and safety standards, require the establishment of a traceability system for human organs, and a reporting system for serious adverse events and reactions and to facilitate the safe use and exchange of human organs.

News
The new European Union legislation on pharmacovigilance has come into force. With the European Medicines Agency and the EU member states implementing the legislation, it aims to promote and protect public health by strengthening the existing Europe-wide system for monitoring the safety and benefit-risk balance of medicines.

Bevan Brittan Updates
PIP breast implants - Joanna Lloyd examines the road ahead. Joanna Lloyd reviews the final report into PIP breast implants of the NHS Medical Directors expert group.

Good practice in complaints investigation. Dealing with complaints effectively throughout the NHS is fundamental to maintaining the confidence of patients in relation to its performance, efficiency, quality and safety of care. This article by Claire Bentley and Nadia Persaud provides a checklist to consider when managing complaints.

Is the NHS learning from its mistakes? We also report on the NHSLA's review of claims for 2010/2011.

Informed consent and patient information leaflets. The law relating to consent is of central importance to patients, clinicians and those who act for them because it protects the ethical principle of autonomy, the right of individuals to have the final say about what is or is not done to their bodies. The courts take a dim view of treatment that is provided without a patient’s consent, and the clinician who ignores a patient’s wishes risks, in the very worst circumstances – where consent is not just uninformed but entirely vitiated as unreal – a finding of battery.

Metal-on-metal hip replacements - who owns your implant? Current issues over hip implants and the issue of ownership of a prosthesis are reviewed by Jodie Hemming.

Claims case round-up. Review of interesting cases that have caught our attention.

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

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  Information and Data Sharing

Publications/Guidance
Clear and present data: how access to our medical records can help life-saving science. This report argues that data from medical records should be made available to medical researchers in order to facilitate potentially vital and innovative breakthroughs. It shows how the information contained in medical records has helped to better understand the factors that lead to heart and circulatory disease and sets out what needs to happen to make sure we can all benefit from this information.

Freedom of Information (FOI) requests . The Department of Health have published details of FOI releases to requests.

Open Data White Paper: Unleashing the Potential.This document sets out in the Open Data command paper how the government is putting data and transparency at the heart of government and public services. It is intended to make it easier to access public data; easier for data publishers to release data in standardised, open formats; and engraining a ‘presumption to publish’ unless specific reasons (such as privacy or national security) can be clearly articulated.

Using electronic health records (EHR) to improve quality and efficiency: the experiences of leading hospitals. This briefing examines nine hospitals that recently implemented a comprehensive EHR system and finds that clinical and administrative leaders built EHR adoption into their strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated services. It found that successful implementation depended on: strong leadership, full involvement of clinical staff in design and implementation, mandatory staff training, and strict adherence to timeline and budget.

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

Back to top  Inquests 

Publications/Guidance
First national VOICES survey of bereaved people – key findings report. The Office for National Statistics (ONS) has published the results of the first national survey of bereaved people. The VOICES (views of informal carers for the evaluation of services) survey was conducted during 2011 and 2012. The Department of Health, with support from the ONS, has produced a report, the ‘First national VOICES survey of bereaved people: key findings report’, to make the findings from the survey more accessible.

If you require further information about any of the items raised in this section please contact  Joanna Lloyd or Nadia Persaud. 

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Mental Health

 

Bevan Brittan Mental Health Extranet.
Free resource for Bevan Brittan NHS clients. Bevan Brittan has a wealth of mental health knowledge it would like to share with NHS clients. We have therefore developed an online searchable extranet designed to bring various sources of mental health information and guidance into one place.

The extranet also contains a forum for use by members to share knowledge and information. Forum issues currently being discussed are:-
 Capacity to enter into marriage
 S117 and Scotland
 Vicarious liability and s13
 Consent to treatment provisions

If you would like information about how to access the Bevan Brittan Mental Health Extranet please email Claire Bentley by clicking here.

Training 
If you would like to know about our lunch time training sessions just let Claire Bentley know. You can attend in London, Bristol or Birmingham.

Publications/guidance
The Mental Health Act 2007: a review of its implementation. This report examines key issues in the operation of the Mental Health Act five years on. It finds that while there have been some improvements in the treatment of people detained under the Act there remain major concerns about the use of compulsory powers and the availability of advocacy and support for the most vulnerable people. It argues that CCGs and local authorities must ensure that they uphold the rights of people detained under the Mental Health Act as they take up their new responsibilities.

Mental health quality profiles. These quality profiles show how individual trusts compare across a range of quality indicators encompassing the domains of the Outcomes Framework.

How mental health loses out in the NHS. A report published on Monday 18 June by the London School of Economics reveals the horrific scale of mental illness in Britain – and how little the NHS does about it. Mental illness is now nearly a half of all ill health suffered by people under 65 – and it is more disabling than most chronic physical disease. Yet only a quarter of those involved are in any form of treatment.

The right to be heard: Review of Independent Mental Health Advocate (IMHA) services in England. A new study from the University of Central Lancashire (UCLan) reveals that understanding of the role of advocacy is critical to ensuring people get the support they need from mental health services. The study, funded by the Department of Health, looked at the quality of IMHA services, used by people who have been detained under the Mental Health Act.

Supporting recovery in mental health. The Implementing Recovery through Organisational Change project is a new approach to helping people with mental health problems that aims to change how the NHS and its partners operates so that they can focus more on helping those people with their recovery. The Department of Health commissioned the NHS Confederation’s Mental Health Network and the Centre for Mental Health to pilot this major national project involving 29 mental health provider sites from April 2010. This briefing details the interim findings of the project.

Department of Health review: Winterbourne View Hospital - interim report. this report sets out initial findings from the review of events at Winterbourne View private hospital and a wider investigation into how the health and care system supports vulnerable people with learning disabilities and autism. It is based on evidence from the CQC's focused inspection of 150 hospitals and care homes for people with learning disabilities and other evidence submitted to the review. It includes 14 national actions to improve the care and support of very vulnerable people with learning disabilities or autism, including:
 a Concordat will be made in the autumn by key partner organisations, including the ADSS, the LGA, the Royal Colleges and the NHS Commissioning Board, that contains a national public commitment to deliver the right care for people with learning disabilities or autism and challenging behaviour;
 the DH will work with the NHS Commissioning Board Authority to agree by January 2013 how best to embed Quality of Health Principles in the system, using NHS contracting and guidance; and
 encouraging the CQC to carry out unannounced inspections at any time and to look at how their registration requirements could be changed to improve the quality of services. 
The final report will be published when criminal proceedings have concluded and the DH will publish a follow up report one year later to make sure that progress has been made. 
See also the CQC’s report Learning Disability Services Inspection Programme: national overview that gives details of its inspections. It concludes that while no abuse on the scale of Winterbourne View was found, half of the hospitals inspected failed to meet CQC standards of care. Independent services were twice as likely (33% compliant) to fail to meet these standards as NHS providers (68% compliant).

COCOA: Care for Offenders Continuity of Access. This report is the result of a three-year project which investigated access to mental health services and continuity of care for offenders in prison or carrying out community service. It makes recommendations for the improvement of on-going care for offenders rather than diverting users towards mental health services.

DH review – Winterbourne View interim report. This letter from David Nicholson, NHS Chief Executive, and David Behan, Director General Social Care, Local Government and Care Partnerships, highlights action to be taken forward by NHS bodies and local authorities as set out in the recent interim report of the review into the events at Winterbourne View hospital that was published on 25 June 2012. They say that PCTs and local authorities need to work together to assure themselves that they are continuing to take all action needed to improve outcomes for people with learning disabilities in preparation for the outcomes of the final report into the events at Winterbourne View, which will be published in the autumn.

Practice standards for young people with substance misuse problems. These standards propose that services invest in the psychosocial development and well-being of young people with substance misuse problems to give them the best chance of a normal life. They have been developed in partnership with substance misuse organisations, paediatricians, psychologists and nurses.

Autism pathway. This guideline on the referral, diagnosis and management of autism in adults provides a full clinical pathway of care for those with the condition. It makes a case for early diagnosis of autism in adults as it can help them access the services they need, including assistance with getting jobs and keeping hold of them. The guideline forms part of the Department of Health's autism strategy.

Public Guardian Board annual report. The final annual report of the Public Guardian Board highlights the areas that should be at the top of the progressive agenda for the Office of the Public Guardian.

Unlocking Diagnosis: All-Party Parliamentary Group report 2012. Fewer than half of people with dementia ever receive a formal diagnosis. 

Cases
X Primary Care Trust v XB [2012] EWHC 1390 (Fam), (2012) MHLO 54. This case concerned an application by X PCT for declarations as to the validity of an advance decision made by XB that he wished, amongst other things, to have his ventilation removed in certain defined circumstances. The three practice points are set out in paras.33 - 35:
 (para 33) Firstly, in the event that there is an issue raised about an advance decision, it is important it is investigated by the relevant health authorities or relevant bodies as a matter of urgency. This will clarify issues at an early stage. It will enable relevant primary evidence to be gathered (for example, by taking statements) and, if required, an application made to this court. The judges who sit in the Court of Protection are experienced in dealing with urgent applications, as this case has demonstrated;
 (para 34) Secondly, there is no set form for advance decisions, because the contents will inevitably vary, depending on the person's wishes and situation. The Mental Capacity Code includes guidance on what should be included in an advanced decision at paragraphs 9.10 to 9.23. At paragraph 9.19 the Code lists matters that it is helpful to include in an advance decision; and
 (para 35) Thirdly, there are number of proforma advance decisions available on the internet. One of the difficulties in this case was the inclusion in the proforma of a 'valid until' date. Those organisations that have such terms in their proformas may want to look again at the necessity for that being in the pro forma form. It is clearly in the interests of the person who has made the advance decision, his or her family, and those who have responsibility for providing or withholding treatment that there is clarity in relation to what the terms of the advance decision are.

Coombs v Dorset NHS Primary Care Trust [2012] EWHC 521 (QB) (QBD). The court held that a patient detained under a provision of the Mental Health Act 1983 was not as a matter of public policy, or otherwise, prevented from paying for his own treatment or care. Hearing of appeal in the Court of Appeal commences on 23 or 24 October 2012.

A Local Authority v (1) E (by her Litigation Friend the Official Solicitor) (2) A Health Authority (3) E'S Parents [2012] EWHC 1639 (COP). The Court of Protection held that E, who suffered from extremely severe anorexia nervosa, lacked capacity to make decisions about life sustaining treatment and that it was in her best interests to be fed, if necessary by force.

Consultation
Consultation paper on the need for powers of entry and intervention in adult safeguarding. Adult Safeguarding staff in England may need new powers to enter homes and intervene where they suspect a vulnerable adult is at risk of abuse and where a third party is preventing entry. Views from legal advisors and others suggest existing powers may be insufficient in such circumstances. However, there are legitimate concerns about the extent and remit of any new powers and these are matters not covered by the current legislative commitments given by the Government. As a consequence, a consultation paper has now been launched to stimulate debate and establish whether such powers are needed. The principle of consulting on these matters is supported by the British Association of Social Workers, Mencap, Unison, the United Kingdom Homecare Association, the British Institute of Learning Disabilities, the National Pensioners Convention, Action for Advocacy, Scope, Ringrose Law LLP, and Solicitors for the Elderly. To have your say, email legislation@elderabuse.org.uk before Wednesday 11 July 2012.

News
Mental health problems no longer a bar to becoming an MP, serving on a jury or being company directors.

Mental health unit is ready for youngsters.

Employers Urged to Offer Flexible Working to Support Mental Health Needs. Speaking at the launch at the Work Foundation, Health Minister Lord Howe has set out how leading companies have signed up to a new Responsibility Deal pledge to help manage and support employees with mental health needs in the best possible way. The first signatories have committed to "embed the principles of the Mental Health Workplace Adjustments Guide within HR procedures to ensure that people with mental health conditions are managed at work in the best way possible with reasonable flexibilities and workplace adjustments." Thousands of individuals with mental health needs could be offered more flexible working hours. 

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

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Primary Care

Publications/Guidance
Functions of clinical commissioning groups. This publication updates "The Functions of GP Commissioning Consortia: A working document" that was first published in March 2011. This version reflects the final content of the Health and Social Care Act 2012 and aims to support the discussion that emerging CCGs will be having as they continue to develop. The document sets out the proposed range of CCG functions, covering the key statutory duties of CCGs – the “must dos”, and the key statutory powers – the things that CCGs have the freedom to do, if they wish, to help meet these duties.

Medical generalism: why expertise in whole person medicine matters. This report is RCGP's response to the report produced by the Independent Commission on Generalism. It describes how medical generalists provide care that is both focused on individual wellbeing and delivers wider benefits. It calls for GPs to be given more support to protect and enhance their vital role, including longer training; more time with patients; better access to diagnostics and better communication with specialists.

Securing excellence in commissioning primary care. This document outlines the single operating model for the commissioning of primary care services within the NHS. It describes the system by which the NHS Commissioning Board will use the £12.6bn that is spent on commissioning primary care to secure the best possible outcomes for patients.

Quality and outcomes framework (QOF) frequently asked questions. NHS Employers and the General Practitioners Committee of the British Medical Association have now published the updated set of joint QOF frequently asked questions for use by primary care organisations and general practice.

Guidance to support the transfer of public health functions from PCTs to local authorities. This guidance, produced jointly by DH and the LGA, supports the transition of public health functions prior to the formal transfer on 1 April 2013. It advises on achieving effective transition working arrangements with minimal risk, as well as reminding the parties of the good HR practice that applies to such arrangements. It includes: key principles; a checklist of key stages; a checklist of what such a transition working agreement might include; and a sample agreement.
The LGA has developed an online resource From transition to transformation in public health to assist the transfer of public health to local authorities. The web page includes links to guidance on managing the transition, case studies and national policy documents.

2012 Local Health Profiles. Give a snapshot of health in each English local authority area. They can be used to help local government and health services understand their community’s needs, so that they can work to improve people’s health and reduce health inequalities.

Legislation
NHS Bodies (Transfer of Trust Property) Order 2012 (SI 2012/1512). This Order, which comes into force on 26 July 2012, transfers property held on trust (in these cases charitable property) between NHS bodies, in particular from the bodies listed as relevant old Trusts in column 1 of the Schedule to the bodies listed as relevant new Trusts in column 2 of the Schedule.

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

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Regulation

  

Publications/Guidance
Fair playing field review. The Secretary of State has asked Monitor to carry out an independent review of matters that may be affecting the ability of providers of NHS services to participate fully in providing NHS services. Monitor are now seeking initial submissions to help them consider whether the list of possible areas for study needs to be extended, what the key issues in each of the areas identified are and the scale of patient detriment those issues throw up.

Regulating ethics and conduct at the Council for Professions Supplementary to Medicine (CSPM) - 1960 to 2002. The HPC replaced the CSPM in 2002 and during this time there has been significant change in all areas of professional regulation. This research report looks at how the CPSM boards and their conduct committees developed their standards of conduct and ethics and how they dealt with some of the basic issues of the day. It does not reflect current HPC policy but is intended to provide a useful tool in informing the debate on professional conduct and ethics.

Lessons learned reports. These independent reports, produced by KPMG, summarise the lessons learned from the authorisation of Morecambe Bay NHS FT and Monitor's role in the events leading to Peterborough and Stamford NHS FT's substantial structural deficit. Both reports make recommendations which the board of Monitor has accepted and which are in the process of being implemented.

Strategic review of the Nursing and Midwifery Council (NMC) - final report. This review looks at progress made since the interim report as well as the operational management and regulatory functions of the NMC.

Performance review 2011/12. The performance review is an annual check on how effective the regulators have been in protecting the public and promoting confidence in health professionals and themselves. It assesses the regulators’ performance in their four regulatory functions: guidance and standards, education and training, registration and fitness to practise using the CHRE's Standards of Good Regulation. This report contains both an overview of general findings about the performance of the regulators, and our individual detailed reports on the performance of each of the regulators against the Standards of Good Regulation.

Introduction to Monitor's future role. Monitor's role will change as they take on a number of new responsibilities under The Health and Social Care Act 2012. This briefing outlines their new functions.

Legislation
Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2012 (SI 2012/1513). These regulations, which mainly come into force on 18 June 2012, make a series of amendments to SI 2010/781 so as change the scope of regulated activities for the purposes of registration of health or social care providers. In particular, they amend the requirements which apply where a service provider is a partnership so that each partner will be required to be of good character and physically and mentally able to carry on the regulated activity, but that the partnership collectively should have the necessary qualifications, skills and experience to carry on the regulated activity.

Consultations
Fertility and human tissue regulators . This consultation seeks views on proposals to change responsibility for regulating fertility treatment and human tissue. The consultation closes on 28 September 2012.

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

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General

Publications/Guidance
Emergency planning for specific types of major incidents. The DH has issued two sets of guidelines to NHS ambulance services that highlight action for emergency treatment in the event of a deliberate release of organophosphorous (OP) nerve agents and the deliberate or accidental release of hydrogen cyanide.

Technical amendment to the category A8 ambulance response time. This letter requests plans from ambulance trusts that demonstrate improvement in category A Red 1 performance. There is an expectation that each ambulance trust will achieve the 80 per cent response time standard within eight minutes by April 2013.

Maintaining NHS emergency preparedness, resilience and response staff capability during transition. This letter sets out expectations for maintaining NHS resilience going forward. The letter provides direction to SHA and PCT cluster chief executives as well as NHS CBA Regional Directors of how resilience to respond to incidents must be maintained during transition.

Reducing patient handover delays from ambulances to hospitals. This letter from David Flory, Deputy NHS Chief Executive, was sent to PCT cluster chief executives and focuses on the concerns of patient handovers from ambulances to hospitals. This is not a widespread problem, however the long handover times in a number of places is sufficient to warrant focused attention.

The impact of telehealth on use of hospital care and mortality. This report evaluates the impact of telehealth on hospital use and mortality from the Department of Health’s Whole System Demonstrator pilots – believed to be the largest ever trial of telehealth. The project considered the impact of telehealth on patients’ hospital use and mortality. This research summary highlights the main findings, whilst offering reasons for caution against being over-optimistic about what telehealth can deliver. It also provides some suggestions as to how future studies might best be designed.

Community health champions: creating new relationships with patients and communities. This factsheet introduces the community health champion approach to engaging communities. Altogether Better has been working to share learning about the community health champion model and increase the voice of patients and communities in shaping health and social care services.

Public perceptions of the NHS and social care. This regular survey provides a check on public sentiment and experience relating to the NHS and social care. It has been running at regular intervals since spring 2000 and is conducted by Ipsos Mori. The results of the study form an overall picture, as perceived by the public, of the NHS and social care. Core questions are asked in each wave of the survey, but there is flexibility that allows the survey reflects the most current issues facing the NHS.

Public involvement in research: impact on ethical aspects of research. This report provides examples of the impact of public involvement in the ethical design and conduct of research. It draws on findings from three reviews and more recent literature to illustrate how public involvement throughout a study can help to make research more ethical.

Health and Social Care Act explained. This is a series of factsheets on the Health and Social Care Act 2012 first published in October 2011, updated 15 June 2012. They include case studies of policies in action, and FAQs on topics and their key themes.

National Health Service and Public Health Service in England: Secretary of State’s Annual Report 2011/2012. From 1 April 2013, the Secretary of State for Health will be under a new duty to produce the annual report relating to the performance of the health service in England, which will be laid before Parliament. The Health Secretary’s annual report will be the principal method by which Parliament will hold the Health Secretary to account for the performance of the health service in England. This annual report has been published a year earlier than is required by law in order to enable Parliament and the public to see the direction the NHS is heading.

Report on the effect of the NHS Constitution. This report seeks to clarify the effect of the NHS Constitution on those who use NHS services and who work in the NHS. It considers whether, and to what extent, the Constitution has made a difference to patients, staff, carers and the public, and examines the degree to which it is succeeding in its aims.

Get in on the act - Health and Social Care Act 2012. This guide produce by the LGA gives a summary of the 2012 Act and sets out the implications for local government. It draws together aspects of the legislation that relate to the major changes for local government; and gives further details, where they are known, of how the legislation will be developed through regulation, guidance and policy. It also considers important aspects of the ongoing health reforms which do not appear on the face of the legislation but which are relevant to it and to the work of local government.

Informing and influencing the new local health landscape - A guide for local Compacts. This guidance for voluntary and community bodies provides a detailed overview of the new health landscape, with information about the key elements of local health reform, and explains how the new and emerging health landscape will affect local Compact partnerships. It outlines how local Compacts can influence the development of local health partnerships and structures, and discusses who local Compact partnerships should be communicating with and how. It also contains a one page guide with key tips on how the voluntary and community sector can use local Compacts to inform and influence the new health landscape.

Healthcare for the homeless: homelessness is bad for your health. This report identifies that there is a range of solutions to the healthcare challenges faced by the homeless. It presents a number of models of care that have measurable evidence of success but which need to be adopted more widely and examples of effective models that are operated in other countries. 

Legislation
National Health Service (Charges to Overseas Visitors) Amendment Regulations 2012 (SI 2102/1586) These regulations, which come into force on 1 October 2012, amend the National Health Service (Charges to Overseas Visitors) Regulations 2011 (SI 2011/1556):
 so that the Human Immunodeficiency Virus (HIV) is no longer stated as an exception in the provision of treatment without charge for sexually transmitted infections to all overseas visitors;
 to remove the exemption for Olympic and Paralympic Games family members; and
 to clarify the provision where someone would be exempt under reg.8 and to clarify the position of a member of the family of an overseas visitor under reg.24, in response to previous criticism for the Joint Committee on Statutory Instruments. 

News
Ambulance response times: all trusts meet eight minute national standard for first time. Health and Social Care Information Centre (HSCIC) figures show that every single ambulance trust in England for the first time has met the national standard for responding to emergency calls in eight minutes.

Bevan Brittan Updates
Academic Health Science Networks: Expressions of interest sought. Following the publication of Innovation Health and Wealth in December 2011 the Department of Health agreed to work with the NHS, universities and industry to designate Academic Health Science Networks (AHSN). The first networks are to go live in 2012/13.

The 2012 Olympics - A race for healthcare or business as usual? The 2012 London Olympics are due to start on 27 July.  The UK and its economy are very different environments compared to 2005 when London won the bid to host the Games; and there has been much press speculation about the burden that the Olympics will place upon an already heavily stretched NHS. In this article Georgia Ford focuses on the position of secondary care providers.

To resuscitate or not to resuscitate – That is the question? In June 2012 a critical report was published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) highlighting the inadequacies in cardiopulmonary resuscitation (CPR) practice in hospitals. The study was carried out on 585 patients who suffered from a cardiac arrest during their admission to hospital, focusing on how they were treated before, during and after the cardiac arrest event. This article examines the criticisms and recommendations raised about the CPR decision making process.

“Love: a temporary insanity, curable by marriage” (Ambrose Bierce). Under Article 12 of the European Convention of Human Rights, men and women of marriageable age have the right to marry. However, this right is expressed as being subject to "the national laws governing the exercise of this right". Essentially, the starting point is that everyone has a right to marry in accordance with the limitations of the legal frameworks.

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

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