Care

Legislation
Health and Social Care Bill: this Bill will receive its second reading on 26 November. It received its 1st Reading in the House of Commons. It:

		establishes a new body, the Care Quality Commission (CQC) that replaces the Healthcare Commission, CSCI and the Mental Health Act Commission;
		establishes a statutory framework for the regulation of each of the healthcare professions and for the social care workforce;
		updates the Public Health Act 1984 to strengthen the response to infectious disease and provide a response to contamination, creating broader and more flexible provisions to provide a more effective and proportionate response to infectious disease; and

inserts a duty on PCTs to make arrangements to secure continuous improvement in the quality of healthcare provided by or for them, replacing the current duty to improve quality in s.45 of the Health and Social Care (Community Health and Standards) Act 2003, so as to align it more closely with the duty imposed on English local authorities by s.3 LGA 1999.

Children

Publications/Guidance
Children's health, our future: a review of progress against the National Service Framework for Children, Young People and Maternity Services 2004. This report provides an overview of the work of the NSF. It outlines key policy milestones, progress to date, and the major challenges and opportunities still ahead. It shows how policy makers and healthcare providers are responding to the challenges and shaping the child health agenda by making significant changes to the way health services are planned and delivered.

The DH has published its response to the June 2007 review of the role of health visitors "Facing the Future" that was undertaken as part of Modernising Nursing Careers. The response includes recommendations on the workforce and sets out the Government’s plans for taking forward the relevant recommendations. It focuses on Recommendation 9 that there should be national guidance that strengthens and updates the NSF standard on the Child Health Promotion Programme, and goes beyond the minimum core to include a model of progressive universalism bringing together screening, early detection, health promotion, health protection and parenting support into one programme for all families.

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

Clinical Management

Publications/Guidance
Standards of Medical Care for Older People - Expectations and Recommendations. This document describes the British Geriatrics Society's recommendations for standards of care for specialist services for older people and those with whom they work.

Urgent care pathways for older people with complex needs. This report suggests detailed advice on how to improve urgent care for older people. It sets out a practical ambulance service and A&E urgent care pathway for older people with complex needs caused by falls, confused states or hip fracture. It identifies best clinical practice in these three areas and constructs a clear and auditable clinical care pathway.

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

Commissioning

Publications/Guidance
Audit Commission has published a report Putting commissioning into practice that looks at how the financial management arrangements supporting practice based commissioning are working, the incentives for GP practices to engage with it and the obstacles to its introduction. The report finds that the main ingredients of success are:

Few areas had all these factors in place. The report contains a series of recommendations for the government, PCTs, practices and SHAs, and examples of notable practice to help improve their approach to practice based commissioning.

Welcoming social enterprise into health and social care - a resource pack for social enterprise providers and commissioners: this pack is designed to support the development of social enterprise in England. It offers both those wanting to start and those already operating a social enterprise a useful gateway to important information needed to set up or expand service in the health and social care arena. The pack is also useful to commissioners who want to contract with social enterprises.

Commissioning guide to community eye care services. This guide offers a practical, analytical, ‘how to’ approach to some of the key issues in commissioning high quality community eye care services locally.

Good practice guidance published on the commissioning of specialist adult learning disability health services for adults. The DH has published good practice guidance on commissioning services for adults with learning disabilities. The guidance will assist in responding to shortcomings identified services in recent Healthcare Commission reports.

Commissioning tools for shifting care closer to home. The NHS Institute for Innovation and Improvement has launched a series of tools designed to support trusts in shifting care closer to home. The tools will enable trusts to prioritise opportunities, deliver overall programmes and deliver individual projects.

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

Complaints

News
Latest NHS complaints figures published

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

Data Protection

Publications/Guidance
The Government response to the Health Committee report on the Electronic Patient Record. The House of Commons Health Select Committee published its report into the Electronic Patient Record on 13 September 2007. This Command Paper sets out the Government’s response to the conclusions and recommendations in that report.

Consultations
MoJ: Freedom of Information Act 2000 - designation of additional public authorities. This seeks views as to whether the Government should use its powers under s.5 FOIA 2000 to extend the coverage of the Act to include a range of organisations that perform public functions, and if so, which organisations it should consider. It discusses: five possible approaches to extending coverage; possible criteria to use in deciding whether an organisation exercises functions of a public nature and whether it provides services under contract with a public authority; and how to implement the s.7 requirement to specify which functions or services are covered. It also asks for nominations of organisations to be considered for coverage. Comments are required by 1 February 2008.

MoJ: Draft Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2007 - responses to consultation. This summarises responses to the consultation on draft regulations that proposed to allow public authorities to calculate better the actual costs that would be incurred in complying with requests for information, particularly the problem of requests that are disproportionately burdensome on public authority resources. The Government has decided in light of the responses to make no changes to the existing fees regulations but it does intend to deliver a package of measures to make better use of the existing provisions to improve the way FOI works and to meet the concerns particularly of local authorities.

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

Embryology

Legislation
Human Fertilisation & Embryology Bill is published. The main elements of the Bill are:

Implementation of European Directive 2005/36/EC for health and social care professions in the UK. Consultation results and the Government's response: Directive 2005/36 aims to make it easier for qualified professionals to practise their professions in European countries other than their own, with a minimum of red tape but with due safeguards for public health and safety and consumer protection. It provides for the mutual recognition of diplomas, certificates and other evidence of formal qualifications in order to assist the free movement of professionals throughout the EU. It must be transposed it into domestic law by 20 October 2007. This paper sets out the changes proposed to implement European Directive 2005/36/EC into domestic law.- this has now been done by the European Qualifications (Health and Social Care Professions) Regulations 2007 (SI 2007/3101) that come into force on 3 December 2007 and 1 April 2008.

Publications/Guidance
Guide to implementing service-line management. This guide is the latest in Monitor’s series of publications showing how managing by service lines can be implemented in a health setting. It shows how the use of robust service-line reporting structures and information enables service-line management, where each service line is managed as a business unit by frontline staff, and explores how to implement this.

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

Estates and Facilities

News
Energy performance certificates (EPCs) are being introduced in phases for different types of properties. The timetable for their introduction is set out in the Energy Performance of Buildings (Certificates and Inspections) (England and Wales) Regulations 2007(as amended).

A revised timetable has been published on the DCLG website and the main changes are:

		From 6 April 2008, EPCs will be required for the construction, sale or rent of commercial properties over 10,000 square metres, not 500 square metres.
		From 1 July 2008, EPCs will be required for the construction, sale or rent of commercial properties over 2,500 square metres.

Foundation Trusts

Publications/Guidance

The Guide to Implementing Service-Line Management is the latest in Monitor’s series of publications showing how managing by service lines can be implemented in a health setting. Service-lines are the key units within which the NHS Foundation Trust’s services are delivered to patients, with discrete resources used to meet a related set of patient needs. This guide shows how the use of robust service-line reporting structures and information enables service-line management, where each service line is managed as a business unit by frontline staff, and explores how to implement this.

 

Consultations 

Monitor has issued a consultation on proposed amendments to the NHS Foundation Trust Financial Reporting Manual 2007-08. The major changes cover: accounting for donations; FRSs 26 and 29 in relation to financial instruments; FRS 17 retirement benefits; Merger accounting treatment and disclosures; and the example accounting policy note. There are also a number of minor changes. Responses are required by 7 December 2007.

 

News
On 1 November 2007 Monitor announced that two more foundation trusts have been authorised:

This brings the total number of NHS foundation trusts to 79, of which 17 are mental health NHS foundation trusts.

 A decision on Medway NHS Trust and Northamptonshire Healthcare NHS Trust was deferred to a later date, pending resolution of issues regarding their authorisation. In line with Monitor's deferral policy these issues should be capable of resolution within 12 months.

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

Health and Safety

Legislation
A new offence of corporate manslaughter will come into force on April 6, 2008. The Corporate Manslaughter and Corporate Homicide Act 2007 changes the basis on which companies are liable for prosecution for manslaughter. Gross failures in the management of health and safety, causing death, will be liable to prosecution as corporate manslaughter. Copies of a guide to the Corporate Manslaughter and Corporate Homicide Act 2007 are available.

Training

At Bevan Brittan we can help by providing a tailored training session to your Board and senior managers on Corporate Manslaughter, assist with undertaking a high level review of governance arrangements and putting in place solid processes to deal with the unexpected. If you would like more information please contact Duncan Astill.

Publications/Guidance
Better blood transfusion - safe and appropriate use of blood. (HSC 2007/001.) This Department of Health circular replaces HSC 2002/009 and sets out a new programme of action for the NHS to build on the success of previous Better Blood Transfusion initiatives to further improve the safety and effectiveness of transfusion.

The PEAT (Patient Environment Action Team) data for 2007 has now been published. Standards of cleanliness and food were inspected, with both areas showing sustained progress this year. Trusts scored “acceptable” or above in 99.5 per cent of cases for hospital food and in 98 per cent of cases for the patient environment (encompassing cleanliness). The PEATs consist of NHS staff, including nurses, matrons, doctors, catering and domestic service managers, executive and non-executive directors, dieticians and estates directors. They also include patients, patient representatives and members of the public. In line with the approach taken by the Healthcare Commission, PEAT is an entirely self-assessed system. A number of sites are independently validated by independent teams.

Recognising and responding appropriately to early signs of deterioration in hospitalised patients. This report sets out why deterioration incidents happen and helps NHS staff working in acute hospitals to improve patient safety in this area. It includes a checklist of questions, a toolkit, links to a variety of resources and good practice examples. The NPSA is recommending that every acute trust sets up a multidisciplinary ‘deterioration recognition group’ to lead and coordinate efforts to improve the safety of patients who are vulnerable to deterioration. These groups should lead on reviewing local systems and processes and coordinating efforts to ensure optimum patient safety.

Tool to help prevent patients being re-admitted to hospital and reduce emergency bed days. - An advanced tool, known as PARR++, that enables PCTs to identify patients most at risk of emergency re-admission to hospital is now freely available to the NHS. PCTs can better target care for these patients, reducing ill health such that expensive hospital care is needed less. The tool is a new version of a free computer programme, called Patients at Risk of Re-hospitalisation (PARR), originally developed for the Department of Health in 2006 by a partnership between the King’s Fund, Health Dialog UK – a subsidiary of Health Dialog Services Corporation – and New York University.

Health Protection Agency. Hospital Acquired Infection quarterly reports, latest stats & studies available online.

News
The Health Secretary has announced details of regional funding for the Deep Clean programme as part of the Government’s programme to tackle healthcare associated infections and ensure patient safety. All Trusts will have to submit detailed deep clean plans, including costs, to their PCTs and SHAs, who will monitor performance against this plan, as per normal performance management arrangements. All NHS hospitals in England should carry out a deep clean by the end of March 2008. Foundation Trusts will also be invited to agree plans and funding for additional deep cleaning with local commissioners, together with local arrangements for checking the agreed work has been carried out. SHAs will, in turn, be expected to report progress across their regions to the DH.

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

Inquests

Cases

R (on the application of PAUL & RITZ HOTEL LTD) v ASSISTANT DEPUTY CORONER OF INNER WEST LONDON (2007). [2007] EWHC 2721 (Admin). A witness statement of a witness who was overseas and unwilling to attend an inquest and whom the coroner could not compel to attend, could not be adduced under the Coroners Rules 1984 r.37 unless another witness was called to deal with the evidence.

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

Mental health

Training dates
This year has seen unprecedented change in mental health law affecting service provision, rights of service users and responsibilities of providers across all sectors. Mental health is an area increasingly under the spotlight from politicians, regulators and service user groups.

To help you understand how these changes will affect your service Bevan Brittan has organised a series of seminars, each will be followed by networking and refreshments.

The seminars, many of which are free, are aimed at Legal Services Managers, clinical and managerial staff involved in service provision in acute and community NHS Trusts, PCTs, Care Home services, statutory regulators, private sector providers and GP consortia. They are taking place at our offices during September 07 – February 08. If you would like a copy of the flyer setting out these sessions please email Claire Bentley.

Bevan Brittan Mental Health Team
If you would like to view the Bevan Brittan mental health team click here.

Bevan Brittan Booklets/Updates
We have produced a credit card size booklet that sets out the Mental Capacity Act 2005 key points. If you would like a copy please email Claire Bentley with your name and postal address.

Publications/Guidance
Deprivation of Liberty Safeguards and Mental Capacity Act 2005 local implementation networks. The Safeguards are due to be implemented in April 2009. Local Mental Capacity Act implementation networks are invited to incorporate the implementation of the Deprivation of Liberty Safeguards into their work.

Services for People with Learning Disability and Challenging Behaviour or Mental Health Needs. This is an updated version of the guidance originally produced in 1993. It sets out the actions that should be taken in order to effectively meet the needs of people with challenging behaviour. It is not mandatory and no extra resources will be provided for its implementation. Councils and health bodies should take it into account in setting their own priorities and policies. It will also be useful to people using services, their families and representatives, staff and those responsible for commissioning of local services as a statement of best practice. It is an updated version of the guidance originally produced by Professor Mansell and his project team in 1993.

Maintaining the report momentum towards excellent services for children and young people's mental health. This report aims to:-

If you wish to discuss any of the items raised in this section please contact Simon Lindsay who leads the specialist Mental Health team at Bevan Brittan.

Patient

Legislation

The Local Government and Public Involvement in Health Act 2007 received Royal Assent on 30 October 2007. Part 14 contains provisions bringing in a fresh approach to giving people a say in their local health services. As of April, existing Patient and Public Involvement Forums and their co-ordinating body, the Commission for Patient and Public Involvement in Health (CPPIH) will be replaced with 150 Local Involvement Networks (LINks). The Government is making £84m available to support the national programme for the establishment of LINks, most of which will go to local authorities. The funding that each area receives will depend on factors such as population and deprivation. The legislation also updates and strengthens the duty on NHS bodies to involve and consult local communities about changes to services, and also introduces a new requirement for PCTs and local authorities to produce a Joint Strategic Needs Assessment (JSNA) which will describe the future health and wellbeing needs of their local populations and will help local authorities and PCTs decide how best to meet those needs/provide those services through their next local area agreements.

 

Publications/Guidance
The DH has published guidance for NHS organisations on Hospital Travel Costs Schemes, which clarifies the roles and responsibility of NHS organisations in administrating and publicising HTCS to patients and the public. The key components are:
 

News
On 15 November 2007 the Health Secretary issued a Ministerial Statement on a package of measures to deliver more choice and faster treatment to patients. Key points in the announcement:
 

		3 ISTC schemes have been approved to move to financial close: PET-CT North, PET-CT South and the renal dialysis services scheme in Cheshire and Merseyside, Yorkshire, Lincolnshire, and Nottinghamshire;
		the procurement of 7 further ISTC schemes is to proceed;
		6 ISTC schemes should not proceed as they were unlikely to provide acceptable value for money as the local NHS has successfully improved capacity to meet patients' needs;
		the contract with Care UK for the provision of diagnostic services in the West Midlands is to be terminated because of an unacceptably low rate of use and a very low prospect of the utilisation increasing which represents poor value for money to the taxpayer;
		there will be a new forum for independent sector providers, the Independent Sector Procurement Forum, to advise the DH on local procurement practice on policies and practices related to local procurement of clinical services in order to ensure a level playing field;
		the Clinical Negligence Scheme for Trusts will be extended to non-NHS providers of NHS services;
		plans to promote patient choice and make patients more aware that they can be seen by private sector providers free of charge if they choose, with a Code of Promotion to help guide local providers to inform patients about the local choices available to them;
		new guidance to the NHS about how it should work with the private and voluntary sector, setting out clear competition principles and simple rules for commissioners and providers to apply consistently for all those that provide services on behalf of the NHS, including social enterprise and third sector organisations as well as the independent sector;
		a continuing role for the independent sector in helping to improve primary care services and providing additional GP surgeries.

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Primary Care Trusts

News
The DH has announced the 38 PCTs who have been identified as having the poorest GP provision and will be the first to benefit from plans to deliver 100 new GP practices over the next three years. The new practices will increase capacity in places that need it most and offer a range of innovative services, such as extended opening hours and extended practice boundaries, as well as increasing patient choice. The first practices are expected to open to patients in a year's time and will be funded from the £250m access fund announced last month. The access fund will also provide at least 150 GP-led health centres across the country.

Prisons

Publications/Guidance
Prisoners suffer from lack of basic care for mental health problems. Getting the Basics Right published by the Sainsbury Centre for Mental Health recommends policy changes to help the NHS build up a primary care mental health service in every English prison. It recommends that every prison in England should have its own dedicated general practice with its own budget. The paper also calls for a new professional body to set standards for prison primary care and for practices outside prison to have clearer incentives to improve the care they offer to former prisoners and those at highest risk of being imprisoned.
 
The Offender Health team has developed a set of voluntary indicators to measure the quality of prison health services and to help achieve the objective of NHS-equivalent standards. The data is intended to support and inform existing local performance management processes.

News

The DH originally planned to transfer commissioning responsibility and funding for prison healthcare escorts and bedwatches from HM Prison Service to PCTs from April 2007. It has now sent a letter to PCT Chief Executives announcing that the timetable for transfer is to be deferred to April 2008.

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

Regulation

Publications/Guidance
The DH has also published a Guidance note on the implementation of Directive 2005/36/EC in the United Kingdom for health and social care professions that provides general guidance to regulatory bodies on the obligations placed upon them by the Directive.

Cases 
Moody v General Osteopathic Council [2007] EWHC 2465 (Admin) (Admin Ct): the court held that the Professional Conduct Committee of the General Osteopathic Council had been entitled to find an osteopath guilty of professional incompetence on the basis of his failure to take an adequate medical history from a patient and his failure to treat the patient appropriately. The osteopath's removal from the register was justified.

 

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