Care

Publications/Guidance
Maternity services website: the Healthcare Commission has launched a website that enables pregnant women and their families to see details of the quality of care provided by their local maternity services. The new site allows people to access information on each trust, and see how they scored on three key questions:-

		Are practices in place to help ensure a high quality and effective maternity service?
		Is there adequate staffing and facilities and are these used effectively?
		Are women informed, counselled and supported to ensure they have a positive maternity experience?

The website also gives trusts' maternity services a score out of five in 25 different areas, including how well each local trust provided recommended antenatal screening, on appropriate use of caesarean sections and on the quality of support they offered parents in caring for the baby after discharge.

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

Children

Publications/Guidance
Safeguarding children in whom illness is fabricated or induced: A review of the implementation of the 2002 guidance within the NHS. This reviews how the report Safeguarding Children in Whom Illness is Fabricated or Induced has been implemented within NHS settings since it was published in 2002. It makes a number of proposals for improvement.

Review of the Use of Restraint in Juvenile Secure Settings. This is a written ministerial statement to Parliament by Justice Minister David Hanson on 20 March 2008. He gives an update on an ongoing independent review into the use of restraint in secure children's homes, training centres and young offender institutions.

Speech, language and communication services for children. The Bercow Review, which the Government commissioned in September 2007, aims to improve services for children and young people from birth to 19 who have speech, language and communications difficulties, which could range from a delay in speaking to a severe stammer, or could be related to other disabilities such as autism or cerebral palsy. The interim report has been presented to the Secretaries of State for Health and for Children, Schools and Families.

Transition planning from children's to adult health services. Transition: moving on well is a good practice guide for health professionals and their partners on transition planning for young people with complex health needs or a disability.

Updated Child Health Promotion Programme [CHPP]. Child Health Promotion Programme (CHPP): Pregnancy and the first five years of life builds on the children’s National Service Framework and is intended to provide preventative services tailored to the individual needs of children and families, as well as acting as a best practice guide for children’s services. It is a tool for supporting commissioners to meet obligations on breast-feeding, obesity prevention, infant mortality and the 12-week antenatal assessment, and also to help to improve general health and well-being among children and families in the community.

News
Trends in children and young people's care - Emergency admission statistics 1996-2006. This statistical report provides information on trends in emergency admissions for children and young people aged 0 -19 years over the period 1996/97 to 2006/07.


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

Clinical Management

Publications/Guidance
Labouring to better effect: services for women in early labour. The National Institute for Health Research Service Delivery and Organisation Programme (SDO) has published this research summary presenting an overview of the range of services maternity care providers have introduced to provide advice to women in early labour, focusing on what midwives and women think of them. The full study documents are also available.

Ionising Radiation (Medical Exposure) Regulations 2000: a report on regulation activity from 1 November 2006 to 31 December 2007. The Healthcare Commission (HC) has published its first report on x-ray and radiological incidents. It shows that one in three involve the wrong patient and that reporting is patchy. The HC analysed 329 incidents reported to it during the 14 month period from November 2006 to December 2007 under the Ionising Radiation (Medical Exposure) Regulations (2000). The incidents were reported by 107 organisations – 96 NHS acute trusts, nine independent sector providers and two primary care trusts. 77 NHS acute hospital trusts have reported no incidents to the HC. Specifically, the incidents reported comprise: diagnostic x-rays including CT scans (240 incidents) radiotherapy treatment (66 incidents) nuclear medicine (23 incidents), where radioactive substances were injected into a patient for imaging purposes. The HC stresses that the majority of incidents reported to it were of a low dose and carried little risk to patients.

Consultations
Competencies for recognising and responding to acutely ill patients in hospital. Copies of a consultation setting out a framework of competencies for recognising and responding to acutely ill patients in hospital, designed to inform and assist National Health Trusts in the implementation of NICE clinical guidelines CG50, are now available. Consultation closes on 17 June 2008.

Bevan Brittan Updates
Claims online - March 2008: “I don't want Daddy to know” – Challenging a Court Order for disclosure. What do you do when a young child you are treating does not want their parents to have access to confidential information in their medical records, and the court has made an order for disclosure?

Claims online - March 2008: Aorto-Caval Compression Risk Management Alert and request for views about standard midwifery practice.

Claims online - March 2008: Case update. Our comments on a number of recent cases.


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

Commercial Healthcare

Publications/Guidance
Focus on Quality and Outcomes Framework 2008.The BMA’s General Practitioners Committee has published a guidance note for GPs explaining the changes being made to the Quality and Outcomes Framework (QOF) of the nGMS contract . The QOF changes take effect from Tuesday 1 April 2008 until 31 March 2009.

The DH has published its third quarterly report on NHS finance and service performance The Quarter - quarter 3 2007-08. The report shows that the NHS is still on course for a £1.8bn surplus for this financial year, with only 17 trusts reporting a deficit. This surplus is about 2% of the overall NHS budget and shows sensible financial management. The report includes performance updates on 18 weeks, tackling infections, improving health and well-being, and reducing health inequalities.

DH: Choice at referral - guidance and supporting information for 2008-09: ‘Free Choice’ will be fully introduced from April 2008 for all patients who require an elective referral. They can choose to be treated by any provider that meets NHS eligibility criteria, and can book their first appointment on-line. This best practice guidance supplements existing guidance on choice at referral policy and implementation by setting out a framework to govern the full roll out of Free Choice in 2008/09. There is also supporting guidance for referrers and providers, and on the impact of Free Choice on Choose & Book. There are also letters explaining the free choice policy and highlighting the public awareness campaign that will run in local newspapers and radio stations to inform the public about their rights to choose.

Free choice at the point of referral. This briefing summarises the most recent official data relating to choice of hospital at the point of GP referral. It argues that if the government's objective for choice to drive improved quality is to be met, at least some patients need to be choosing a hospital on the basis of quality. But existing data suggest that many more patients are picking the hospital that is easiest to get to rather than basing their choice on quality-related factors, such as low infection rates.

Code of practice for the promotion of NHS-funded services. This code of practice sets out rules around promotional material issued by providers of NHS services to ensure that: the information patients receive is not misleading, inaccurate, unfair or offensive, that the brand and reputation of the NHS is protected, and that expenditure on promotional activity is not excessive.

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

Commissioning

Publications/Guidance
Disease management information. This version of the DMIT (disease management information toolkit) updates the first version, which was published in May 2007, with the latest available HES data. DMIT is aimed at commissioners of health and social care services and provides evidence on emergency bed days and interventions. Action: The toolkit can help health and social care organisations strengthen their management of key long-term conditions.

Evaluation of one-stop shop models of sexual health provision. In 2001, the Government published the National sexual health and HIV strategy and one of the recommendations was the provision of more comprehensive and integrated sexual health services. One of the commitments in the strategy was to undertake an evaluation of different models of one-stop shops. This report provides findings and information for PCT commissioners and service providers considering an integrated approach as well as those already providing integrated services.

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

Employment/Human Resources

Legislation
The weekly rates of statutory maternity, paternity and adoption pay will increase from 6 April 2008 to £117.18. The standard rate of statutory sick pay will increase to £75.40. The earnings threshold for these payments will increase to £90.

The government announced last month that, from October 2008, the national minimum wage rate for adults will increase from £5.52 to £5.73 and, for 18-21 year olds, the rate will increase from £4.60 to £4.77. The rate for 16-17 year olds will rise from £3.40 to £3.53.

The Information and Consultation of Employees Regulations 2004, which require organisations to undertake collective consultation with employees on specific issues, are extended so that, from 6 April 2008, they will cover undertakings with 50 or more employees.

The Conduct of Employment Agencies and Employment Businesses (Amendment) Regulations 2007 come into force on 1 April 2008. The Regulations aim to increase protection for agency workers by strengthening the rules regulating employment agencies in relation to the fees they may charge, and the information that they must provide to workers.

Amendments to the Sex Discrimination Act 1975.  From 6 April 2008, the Sex Discrimination Act 1975 will be amended by the Sex Discrimination Act 1975 (Amendment) Regulations 2008 which set out that:-

		in relation to complaints of discrimination on the grounds of pregnancy or maternity leave, there is no requirement for an element of comparison with a woman who is not pregnant or on maternity leave;
		the requirement to show that sexual harassment was on the "grounds" of the victim's gender has been removed; and
		there is a new requirement for employers to take reasonably practicable steps to protect their employees from harassment by third parties, not employed by them, such as patients or agency workers, where the employer is aware of the harassment and the victim has been harassed more than twice.  The two instances of harassment do not need to be by the same person.

For women whose expected week of childbirth is on or after 5 October 2008, there will be a new right to claim discrimination in relation to the non payment of any bonus payable during the two week period of compulsory maternity leave, and women will have the right to the same terms and conditions during "additional maternity leave" (the second 26 week period of leave) as are applicable during "ordinary maternity leave"; (the first 26 week period of leave).

The Corporate Manslaughter and Corporate Homicide Act 2007 (“the Act”) comes into force on 6 April 2008 and creates a new offence of corporate manslaughter. The offence does not apply to individuals, but will apply to organisations where management has breached a duty of care and this has resulted in a death.
In deciding whether or not there has been a breach, courts will take into account:-

		whether the organisation was in breach of health and safety legislation;
		how serious the management failure was; and
		how much of a risk there was of death occurring.

The Act lists factors which a jury may take into account in making their decision regarding an alleged offence, such as attitudes, policies, systems or accepted practices in the organisation that were likely to have encouraged a management failure.

Penalties imposed by the Act are:

		an unlimited fine;
		a Remedial Order (requiring an organisation to remedy the failures that caused the death);
		a Publicity Order (requiring an organisation to publicise the conviction).

A defence is available if an organisation has put in place reasonable safeguards and death occurs in any event. It is, therefore, now more important than ever to ensure that health and safety procedures are in place, and that they are followed up and enforced. The Act makes it clear that there will be no defence where a paper policy is in place but is ignored. NHS Employers has produced a briefing containing a summary of the new legislation and advice for employers.

Publications/Guidance
Tough new employment checks for all NHS staff are to be introduced on 1 April. The checks have been revamped following last summer's failed terror attacks in London and Glasgow after it emerged key suspects had come to the UK to work in the NHS. NHS Employers, which represents trusts on workforce issues, has published updated standards to support trusts. These include face-to-face ID checks and holding photo ID for all staff, as well as 'right to work checks' to meet new Home Office immigration rules which came into effect in February.

In summary, the new guidance sets out that:-

		pre-employment checking must be integral to policies and procedures;
		one department is given responsibility for carrying out checks;
		a dedicated manager should lead that process;
		checks should be proportionate to the role being filled and should only be undertaken once a provisional offer has been sent out;
		all pre-employment checks should be thorough and lawful, in line with discrimination legislation; and
		where checks are delegated to an external agency, employers should satisfy themselves that checks are being undertaken by that agency in accordance with the standards required.

Remember that, as from 29 February 2008, new requirements have been in place in relation to employing migrant workers. Please see last month's edition of Bevan Brittan's Health and Social Care Update for details.

The National Audit Office has issued a report on NHS pay modernisation - new contracts for general practice services in England that critically examines the negotiation and implementation of the new GMS contract and how well it is working in practice, including the extent to which the new contracting regimes have achieved the benefits intended by the DH. It finds that the new GP contract has contributed to improved recruitment and retention of GPs, with numbers increasing from 26,833 to 30,931 since 2003; however, the contract has cost the DH £1.76bn more than it originally budgeted for. The NAO concludes that PCTs have not made use of all the levers in the new contract. Money for new local services has not led to improvements such as increased opening hours and some of the most deprived areas remain under-doctored. Some 40% of GPs believed that aspects of the contract had not helped tackle health inequalities. It recommends that the DH develop a strategy for yearly negotiations on the Quality Outcomes Framework (QOF) and the QOF should be based more on health outcomes. PCTs should provide more services based on local need and review the number and skills of staff employed to commission and performance manage GP services with the aim of improving local commissioning.

The Secretary of State for Health has published his response to Aspiring to excellence: Final report of the independent inquiry into Modernising Medical Careers which considers how best to progress Sir John Tooke's recommendations regarding national and local planning for recruiting and training doctors in the future.

Cases
In South London & Maudsley NHS Trust v Dathi the Employment Appeal Tribunal ("EAT") considered the admissibility of evidence which came to light the in the course of correspondence between the parties' during proceedings. In considering this case, the EAT had to consider the interplay between two important public policies: the ability for people to give evidence in proceedings without fear of being prosecuted or sued for what they say; and the right of individuals to bring claims of unlawful harassment and victimisation. In this case, Mrs Dathi, who was a Tanzanian woman who worked as receptionist for the South London and Maudsley NHS Trust, brought tribunal proceedings against the Trust. Mrs Dathi claimed that the Trust's failure to disclose certain documents, as part of those proceedings, amounted to an act of unlawful discrimination against her. Mrs Dathi also claimed that the Trust victimised her by refusing to disclose certain documentation (in a disclosure letter) and by a number of arguments made in a letter regarding costs which the Trust's advisers had sent to the Employment Tribunal. The Employment Appeal Tribunal held that it had no jurisdiction to hear Mrs Dathi's claims of discrimination and victimisation as it found that the correspondence on which she sought to rely was protected by absolute immunity. The EAT said that the relevant letters came into existence for the purpose of the proceedings and thus both attracted absolute immunity. Mrs Dathi's claims were, therefore, struck out.

In the Employment Appeal Tribunal case of Atkins v Wiltshire Primary Care Trust , the EAT rejected a claimant's appeal against a decision of the Employment Tribunal that she was not constructively dismissed. The claimant was a nurse who worked for the Trust at night and, following a disciplinary investigation, the Trust required that Ms Atkins worked during the day (so that she could undertake some further training, which could not be provided at night). Mrs Atkins resigned and claimed that she had been constructively unfairly dismissed because of the way in which she had been treated. The Employment Tribunal did not agree with Ms Atkins, and she appealed to the EAT, on the basis that the Employment Tribunal had failed to consider her contract of employment in sufficient detail. The EAT said that Mrs Atkins' appeal would fail, as her original complaint to the Employment Tribunal did not focus on the Trust's requirement that Mrs Atkins work during the day; it was concerned largely with Mrs Atkins allegations of general bad treatment by the Trust. The EAT said that Mrs Atkins could not now change the emphasis of her claim and, in any event, even if she could do so, the EAT did not feel that the requirement to work during the day was the real reason why the claimant resigned.
The High Court has ruled that the capping of GP's pensions for three years, between 2004-2006, was unlawful. GPs were expecting to receive a rise of 50% over three years, but this was retrospectively capped to 48% over five years. The High Court has said that this was an attempt to re-negotiate an arrangement that had already been put in place and was, therefore, unenforceable. However, the Department of Health has been given permission to appeal, so this may well not be the end of this issue.

The European Court of Justice ("ECJ") has set out an important ruling on the rights of female employees undergoing IVF treatment. In Mayr v Bäckerei und Konditorei Gerhard Flöckner the ECJ was asked to consider at what stage women undergoing such treatment are “pregnant” for the purposes of the EC Pregnant Workers Directive.
In this case, Ms Mayr had been dismissed while undergoing IVF treatment, but before her fertilised ova had been transferred to her uterus. Ms Mayr argued that she was pregnant at this stage in her treatment and, therefore, entitled to protection under the Pregnant Workers Directive ("the Directive"). However, the ECJ disagreed with her and said that, for the purposes of the Directive, women cannot be considered to be pregnant at this stage in their treatment. Part of the ECJ's reasoning was that the effect of granting protection at this stage in conception could result in injustice, because fertilised ova are sometimes stored for extended periods of time, as a precautionary measure. The ECJ said this would provide women with protection under the Directive for much longer than would be fair.
However, women undergoing IVF treatment are not left entirely unprotected as a result of the ECJ’s decision. The ECJ went on to hold that, as only women can undergo IVF treatment, any discrimination against them on those grounds would amount to unlawful direct discrimination.

News
The government has announced that it is going to create a new fund which will enable public sector employees, including doctors and nurses, to still receive pension contributions whilst working as volunteers abroad. This is in response to a review by Lord Crisp into how UK expertise in health could best be used to assist efforts to improve health in developing countries. The aim is that this fund will help to encourage health care workers to volunteer abroad. Under this scheme, beneficiaries would receive pension benefits for the period of their absence, at the level of salary they received when they left to start their period of volunteering.

A survey published in the journal Occupational Medicine, has found that one in three nurses have suffered a violent attack at work, whether by patients or their relatives. The study was based on a pool of 39,894 nurses across 10 countries in Europe, and found that the effects of violence led to problems with recruitment and nurses leaving the profession, increased sick leave and "burnout". This follows on from a UK report by the Health Commission in February this year which said that four in ten nurses working in mental health had been attacked at work.

The DH has announced an extra £7m funding to boost development opportunities for Specialty and Associate Specialist doctors as part of the package of initiatives linked to the approval of their new contracts, taking the support available to improve their professional development up to £12m from 2008/09. Once doctors' new contractual arrangements are agreed, the introduction of a new grade of Specialty Doctor will be shortly followed by good practice guidance on employing and supporting specialty doctors, to ensure that employers get the best out of their specialty doctor workforce through a more structured approach to their professional development. The government has announced that it will provide a "golden hello", worth a total of £3,000, for midwives who return to their profession. This sum is part of a package which will include free training, support with childcare, travel costs and a maximum cash lump sum of £1,500. This development is in response to a report from the Healthcare Commission, earlier this year, which said that staffing levels were falling below the Royal College of Midwives' target of 36 midwives per 1,000 deliveries. A campaign, with the aim of encouraging midwives to return to work, will be launched this summer.

Health professionals recognise the benefits of work. A ground-breaking deal has been signed by more than 30 healthcare professional bodies under which the bodies pledged to do all they could to help people enter, stay in or return to work where appropriate, as evidence suggests staying in or returning to work is usually good for health and recovery.

The conciliation and arbitration service, ACAS, has called on employers to focus on employees' health at work and has published a guide to help them do so. This follows on from a report by the National Director for Health and Work, Dame Carol Black, which set out that ill health is costing the British economy £100 billion. Dame Black's report highlighted that businesses should be seeking to become involved in preventing sickness absence at an earlier stage. Some of the key areas covered in the ACAS guide are:

		how to recognise health problems with your employees;
		what makes a healthy workplace;
		a health, work and well being checklist;
		further sources of information.

This links in with the proposals in Dame Black's report that doctors should be providing employees with "well notes" and focussing on what employees can do at work, rather than what they cannot do.

Bevan Brittan Updates
Discrimination and harassment round-up. The scope of employees’ protection from discrimination and harassment has been considered, and narrowly interpreted, in three recent key decisions. Sarah Lamont considers how the employment law land lies following this trio of cases.

Unilateral variations to contract. If a contractual change is imposed on an employee and they agree to it but “under protest”, is it fair to dismiss them if they then insist on working to their original contract? Nicola Stibbs reports.

News round-up. April may be the cruellest month, but it is also, traditionally, one of two months of the year during which the government introduces legislative changes (the other being October). This month’s news round-up, reported by Alastair Currie, focuses on the changes which will be taking effect in the coming weeks.

Mock employment tribunal. Details on our half and full day workshops.

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

Estates and Facilities

Publications/Guidance
Assessing design quality in LIFT primary care buildings. Published by the Commission for Architecture and the Built Environment (CABE), this survey report outlines the findings of CABE research into the design quality of new health buildings provided under the LIFT (local improvement finance trust) programme. The research is based on a survey of 20 primary care buildings built under the first three waves of the LIFT programme between 2002 and 2006. Using industry-accepted measurements, the research reveals a variable picture of design quality in the new buildings. The summary is also available.

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

Foundation Trusts

News
Monitor has announced that Camden and Islington NHS Foundation Trust has been authorised as from 2 March 2008. This brings the total number of FTs to 89. Camden and Islington is the first social and mental health trust to attain FT status.

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

Governance

Publications/Guidance
Reporting financial management information to the Board: this guide has been developed by the National Audit Office (NAO) to assist public sector bodies in assessing the effectiveness of their reporting of financial management information to Boards. It considers the scope, quality and presentation of financial information provided to them to run the organisation. It is designed to help organisations and their Boards consider whether their current processes for reporting financial information are fit for purpose and represent best practice.

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

Health and Safety

Legislation
The Corporate Manslaughter and Corporate Homicide Act 2007 (“the Act”) comes into force on 6 April 2008 and creates a new offence of corporate manslaughter. The offence does not apply to individuals, but will apply to organisations where management has breached a duty of care and this has resulted in a death.
In deciding whether or not there has been a breach, courts will take into account:-

		whether the organisation was in breach of health and safety legislation;
		how serious the management failure was; and
		how much of a risk there was of death occurring.

The Act lists factors which a jury may take into account in making their decision regarding an alleged offence, such as attitudes, policies, systems or accepted practices in the organisation that were likely to have encouraged a management failure.

Penalties imposed by the Act are:

		an unlimited fine;
		a Remedial Order (requiring an organisation to remedy the failures that caused the death);
		a Publicity Order (requiring an organisation to publicise the conviction).

A defence is available if an organisation has put in place reasonable safeguards and death occurs in any event. It is, therefore, now more important than ever to ensure that health and safety procedures are in place, and that they are followed up and enforced. The Act makes it clear that there will be no defence where a paper policy is in place but is ignored. NHS Employers has produced a briefing containing a summary of the new legislation and advice for employers.

Publications/Guidance
Safe births - everybody's business: independent inquiry into the safety of maternity services in England. According to an independent inquiry commissioned by the Kings Fund, the overwhelming majority of births in England are safe, despite growing pressures on maternity services. However, it warns that the lack of a systematic approach to ensuring safety across maternity services is creating unnecessary risks, and calls for a range of practical improvements. The inquiry focuses specifically on the safety of maternity services rather than their quality or efficiency, and concentrates on the safety of mothers and babies during birth. It identifies the key factors in improving safety as: stronger governance at board level better team and multidisciplinary working more training in safety, including training on the labour ward good management of staffing levels and skill mix.

Independent investigation of serious patient safety incidents in mental health services: good practice guidance. The National Patient Safety Agency (NPSA) has launched guidance aimed at improving and standardising the approach to independent investigations into serious patient safety incidents in mental health services. It describes the three main stages of the independent investigation process, examining the initial service management review, internal NHS mental health trust investigations and strategic health authority independent investigations.

News
HSC/HSE merger. The Health and Safety Commission and the Health and Safety Executive were originally established as part of the 1974 Health & Safety at Work Act as two separate Non Departmental Public Bodies. From 1 April 2008 HSE became the single national regulatory body responsible for promoting the cause of better health and safety at work.

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

Inquests

Publications/Guidance
The Government's Response to Coroners' Recommendations Following the Inquests of Gareth Myatt and Adam Rickwood. Following the inquests into the deaths of Gareth Myatt and Adam Rickwood, the government promised a full response to the coroners; recommendations. This plan is a working document which demonstrates the volume of work underway to enhance safeguarding and child protection in the under-18 estate.

Government Response to Coroners' Recommendations Following the Deaths of Gareth Myatt and Adam Rickwood: Written ministerial statement by Jack Straw. This is a written ministerial statement to Parliament by Secretary of State for Justice Jack Straw on 27 March 2008. He talks about the Government's response to coroners' recommendations following inquests into the deaths of two teenagers at secure training centres.

Coroners Bill - Changes made from consultation. Changes to the draft Coroners' Bill have been announced concerning an obligation on organisations to respond to coroners' recommendations to prevent future deaths, appeals, and inspection arrangements. Other changes relate to the notification by a registered medical practitioner of a death, juries for work place death inquests, and the duty to investigate deaths occurring abroad.

Coroners Bill: Changes made resulting from consultation - Written ministerial statement by Bridget Prentice. This is a written ministerial statement to Parliament by Justice Minister Bridget Prentice on 27 March 2008. She talks about changes to Government plans to reform the coroner system.

MoJ- Discussion Paper - Sensitive reporting in Coroners Reports. The government announced in October 2007 that Clause 30 of the draft Coroners Bill, which proposed introducing a power for coroners to impose reporting restrictions in inquests where there was no public interest, was to be removed from the Bill. This decision was the result of an extensive consultation culminating in a workshop discussion involving a range of interested stakeholders with differing views. Improving the way that the coroner system meets the needs of the bereaved while also serving the public interest is a key objective of our coroner reform proposals. As an alternative to legislating on reporting restrictions, this discussion paper considers whether the Press Complaints Commission's code of conduct might be refined to ensure there is appropriate emphasis on the need for sensitive reporting of coroners' cases. The discussion paper also considers what more could be done to increase public awareness about the code and the possible presence of the press at inquests.

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

Mental Health

Publications/Guidance
Independent investigation of serious patient safety incidents in mental health services: good practice guidance. The National Patient Safety Agency (NPSA) has launched guidance aimed at improving and standardising the approach to independent investigations into serious patient safety incidents in mental health services. It describes the three main stages of the independent investigation process, examining the initial service management review, internal NHS mental health trust investigations and strategic health authority independent investigations.

Improving access to psychological therapies: Implementation plan - National guidelines for regional delivery. Copies of the DH guidelines on improving access to psychological therapies and an implementation plan for regional delivery are available.

Policy paper on refocusing mental health services on patient's recovery. Making Recovery a Reality from the Sainsbury's Centre for Mental Health [SCMH] suggests that helping people to recover their lives should be the top priority for mental health services. This means giving service users the chance to determine what future they want for themselves and offering practical support to help them to achieve it. The policy paper marks the beginning of the Sainsbury Centre recovery project, which will look in more detail at how recovery can be made a practical reality in mental health services and in the criminal justice system.

Responsible Medical Officers: Report on completed leave. This is the form that should be used by responsible medical officers to report on medical leave from hospital that has been granted to restricted patients.

Guidance for Responsible Medical Officers: Leave of absence for patients subject to restrictions. This document gives information to responsible medical officers on gaining permission to grant leave from hospital to detained restricted patients.

Updated policy guidance: Care Programme Approach [CPA] Following the national consultation, this guidance, Refocusing the care programme approach: Policy and positive practice guidance, aims to aid trusts and commissioners in reviewing local practice to refocus CPA within mental health services.

DH: Giving effective notice to terminate an existing contract for provision of Mental Health Services: the DH has written to the all PCT Chief Executives regarding its development of standard NHS contracts for Mental Health, Ambulance and Community Services, which will be mandatory from April 2009. The DH's letter reminds PCTs of the need to give notice by 1 April 2008 to Mental Health, Ambulance and Community Services providers to terminate their existing contracts and introduce the new standard contract from April 2009. This Guidance Note, with the letter, sets out the requirement for PCTs to give notice to service providers to terminate existing contracts, to enable the introduction of new standard contracts from 2009. So that the notice to terminate does not jeopardise the approval process for authorisation of aspirant Mental Health FTs, PCTs should agree interim contracts with aspirant FTs which run from the date of authorisation for an 18-month term -this will provide the necessary certainty of income to satisfy the authorisation process. The letter also announces that DH will introduce new forms of contracts for polyclinics/healthcare centres in the summer of 2008 for immediate use, based on the APMS framework.

Cases
R (Rayner) v Secretary of State for Justice [2008] EWCA Civ 176 (CA): The relevant test with regards to the speed of a referral to a mental health review tribunal of a patient detained in hospital under the Mental Health Act 1983 by the Secretary of State for the Home Department pursuant to s.75(1) was whether there had been a failure to proceed with reasonable despatch having regard to all the material circumstances.

News
New Horizons for Mental Health Commissioning: An opportunity to help shape the agenda. This letter invites attendees to a seminar on 7 May 2008 on world-class commissioning for mental health, integrated mental health commissioning and mental health priorities.

Nottinghamshire psychiatric patients have launched a High Court test case battle for the right to go on smoking while detained in hospital.

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

Patient

Publications/Guidance
NICE Guidance: Community engagement. This guidance supports people working in the NHS and other health sectors who have a direct or indirect role in community engagement.

Public and patient involvement in the NHS. The BMA has published a discussion paper that stresses the need for clear structures allowing the full involvement of the public and patients in NHS decision-making processes. It is critical of plans to replace existing Patient and Public Involvement (PPI) forums with Local Involvement Networks (LINks). LINks are due to be introduced in the NHS in England in April 2008. They will be fewer in number (one per local government authority) than PPI forums, and will have no over-arching national body to co-ordinate their work. The funding for LINks will come through local authorities and will not be ring-fenced.

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

Primary Care Trust

Publications/Guidance
Audit Commission: Improving medium-term financial planning - a practical guide for Primary Care Trusts is aimed at PCT finance directors, PCT Boards and all those involved in the planning process, to help them assess the quality of their arrangements and integrate financial planning with the wider strategic planning and commissioning processes. The briefing provides a commentary on current PCT performance in medium-term financial planning, with detailed guidance for PCTs to use as necessary. It identifies ten steps that PCTs can use to assess and improve their medium-term financial planning arrangements and highlights notable practice case studies.

DH: Giving effective notice to terminate an existing contract for provision of Mental Health Services: the DH has written to the all PCT Chief Executives regarding its development of standard NHS contracts for Mental Health, Ambulance and Community Services, which will be mandatory from April 2009. The DH's letter reminds PCTs of the need to give notice by 1 April 2008 to Mental Health, Ambulance and Community Services providers to terminate their existing contracts and introduce the new standard contract from April 2009. This Guidance Note, with the letter, sets out the requirement for PCTs to give notice to service providers to terminate existing contracts, to enable the introduction of new standard contracts from 2009. So that the notice to terminate does not jeopardise the approval process for authorisation of aspirant Mental Health FTs, PCTs should agree interim contracts with aspirant FTs which run from the date of authorisation for an 18-month term -this will provide the necessary certainty of income to satisfy the authorisation process. The letter also announces that DH will introduce new forms of contracts for polyclinics/healthcare centres in the summer of 2008 for immediate use, based on the APMS framework.

Improving medium-term financial planning: a practical guide for primary care trusts: this Audit Commission briefing on medium-term financial planning for PCTs is based on a review of PCT local delivery plans and Medium-term financial plans [MTFPs], and gives a commentary on current PCT performance and detailed guidance for PCTs to use as necessary. The briefing is aimed at PCT finance directors, PCT Boards and all those involved in the planning process; both finance and non-finance staff. It aims to encourage PCTs to prioritise medium-term financial planning.

Bevan Brittan updates
New Operating Framework 2008-09 : We have produced a flyer for PCTs and a flyer for SHAs highlighting changes to their roles brought about by the New Operating Framework. If you would like a copy of either please email Claire Bentley

PMS/GMS Contract Regulations. We have produced a flyer for all PCTs updating them on the January 2008 amendments to the NHS (Primary Medical Services Miscellaneous Amendments) Regulations 2007 and the implications for PCTs. If you would like a copy please email Claire Bentley

Equitable Access flyer. We have produced a flyer for PCTs indicating the areas of support Bevan Brittan could give for the five key issues facing PCTs in meeting the targets for delivery of the two new streams of primary care procurements required by the Equitable Access Programme. If you would like a copy please email Claire Bentley.

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

Prison Health

Publications/Guidance
The transfer of funding and commissioning responsibility from HM Prison Service to NHS Primary Care Trusts for these activities will take place in April 2008. Full information on the precise allocations for these services will be issued shortly by the Department of Health.
Escort and bedwatch costs: transfer of funding from HM Prison Service to Primary Care Trusts.
Annex to Escort and bedwatch costs

Review of the Use of Restraint in Juvenile Secure Settings. This is a written ministerial statement to Parliament by Justice Minister David Hanson on 20 March 2008. He gives an update on an ongoing independent review into the use of restraint in secure children's homes, training centres and young offender institutions.

The Government's Response to Coroners' Recommendations Following the Inquests of Gareth Myatt and Adam Rickwood. Following the inquests into the deaths of Gareth Myatt and Adam Rickwood, the government promised a full response to the coroners; recommendations. This plan is a working document which demonstrates the volume of work underway to enhance safeguarding and child protection in the under-18 estate.

Government Response to Coroners' Recommendations Following the Deaths of Gareth Myatt and Adam Rickwood: Written ministerial statement by Jack Straw. This is a written ministerial statement to Parliament by Secretary of State for Justice Jack Straw on 27 March 2008. He talks about the Government's response to coroners' recommendations following inquests into the deaths of two teenagers at secure training centres.

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

Regulation

Consultations
Consultation on the Medical Profession (Miscellaneous Amendments) Order 2008. This Department of Health consultation seeks views on a draft order to implement two of the reforms set out in the white paper Trust assurance and safety: the regulation of health professionals in the 21st century. Responses to the consultation are due by 5 June 2008.

DH: The future regulation of health and adult social care in England - a consultation on the framework for the registration of health and adult social care providers: the Health and Social Care Bill, currently progressing through Parliament, will establish from April 2009 a new regulator for health and adult social care services, the Care Quality Commission (CQC), formed from the Healthcare Commission, CSCI and the Mental Health Act Commission. This consultation seeks views on which health and adult social care services should require registration with the CQC and what the requirements for registration should be. It will be illegal for unregistered health and adult social care organisations to provide services that come within the scope of registration. The scope and requirements for registration will be set in regulations later this year, following a further consultation. The consultation also seeks views on when providers of regulated services should be required to have a registered manager, and how primary care services should be included in the new registration system. It sets out plans for transition to the new registration system: it will come into force from April 2010 with the exception of regulations on healthcare associated infections, which will come into force during 2009/10. The consultation closes on 17 June 2008.

PDS agreements - termination provisions: note on the judgement of Mr Justice Collins in the Crouch case. The Department will take a view on how best to deal with this judgement and at that stage further information regarding the Department's views will be available.

Cases
R (Crouch) v South Birmingham PCT; Secretary of State for Health and British Dental Association (Interested Parties) (Unreported, 26 February 2008) (Admin Ct): C, an orthodontist, applied for judicial review of the FHSAA's decision to uphold the terms of a personal dental services (PDS) agreement between C and the PCT. The agreement was subject to the terms of the NHS (Personal Dental Services Agreements) Regulations 2005 (SI 2005/3373) and the General Dental Services and Personal Dental Services Transitions Provisions Order 2005 (SI 2005/3435), which included a provision that the minimum duration of a PDS agreement was to be five years. C's agreement provided that the PCT could terminate it at any time without cause by written notice. C claimed that the termination provisions in the agreement were not lawful; he also contended that the PCT had failed to consult the public adequately in order to assess local orthodontal needs before seeking to introduce the PDS agreement.
The court held, allowing C's application, that it was not open to the PCT to include such a termination clause in a PDS agreement. Schedule 3 para.66 to the 2005 Regulations provided that a PDS agreement had to be terminated in accordance with the Regulations. Unless an orthodontist breached the agreement or one of the proscribed grounds for termination arose, a PCT could not terminate a PDS agreement except on the date provided for in that agreement. There should be no need for a provision to terminate without cause provided that an orthodontist gave the services that he had contracted to provide and those services were required; if the level of services required rose or fell it was open to the parties to vary the agreement. The PCT was not required by s.11 of the Health and Social Care Act 2001 to consult the public in order to assess local orthodontal needs before the units of orthodontic activity to be provided by a contracting orthodontist could be agreed in an agreement.

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

Third Sector

Publications/Guidance
Volunteering in the Public Services: Health and social care. This report is the first in a series examining the role of volunteers and volunteering in public services. It identifies a largely untapped source of volunteers in service users. It argues that they could make an enormous contribution as volunteers in health and social care because no one understands what it is like to have a condition like a person who has it themselves. The review's main recommendations are:-

		in-house volunteering hubs should be established within government agencies to help mainstream volunteering in health and social care services
		when commissioning services, Government agencies should consider the social benefits and true costs of volunteering
		employee volunteering schemes should become commonplace throughout health and social care services
		NHS websites should signpost their users to peer group support websites, and to more general volunteering opportunities
		a programme board should be set up, with a remit to increase volunteering in health and social care and ensure that volunteers are properly managed
		both the Government and charities need to make more of the huge, largely untapped, resource of service users as volunteers

News
The Cabinet Office has announced the launch of the Charity Tribunal which will act as an independent appeal body allowing charities to challenge legal decisions of the independent regulator, the Charity Commission. Experienced lawyer, Alison McKenna has been appointed as President of the Charity Tribunal. Cases can be taken to the Tribunal from 18 March 2008.

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

General

Publications/Guidance
Healthcare Travel Costs Scheme: instructions and guidance for the NHS: this document provides information and guidance to NHS organisations on the Healthcare Travel Costs Scheme (HTCS), which replaces the current Hospital Travel Costs Scheme. The main differences between the HTCS and its predecessor are: subject to a limited exception, patients referred by a doctor or dentist for non-primary care services under the National Health Service Act 2006 are now eligible to have their travel expenses to receive such services paid for under the scheme, where they meet the eligibility criteria; and road and toll charges may now be reimbursed through the scheme. The document is in two parts covering: the legal requirements in relation to the administration of the HTCS scheme; and good practice guidance on how the scheme may be delivered, including details on eligibility criteria and best practice resources.

National Programme for IT in the NHS: benefits statement 2006/07. According to the first annual benefits statement published by Connecting for Health, the new IT systems in the NHS are on course to deliver better care and an estimated £1.14 billion in savings by 2014. It shows that since its introduction, the National Programme for IT has delivered a total of £208 million in savings. Of those savings to 31 March 2007:

		£192 million has been saved through the delivery of the National Network for the NHS - a secure, high quality network that underpins many applications (with an additional £95 million per year of forecast recurrent savings using evidence from 2006/7)
		£14 million had been saved from the use of digital imaging and scans (plus an additional £35 million per year of forecast recurrent savings now the system is fully implemented)
		£617,000 savings on software licensing and hardware maintenance costs has been achieved (plus a forecast £1.6 million of annual savings using evidence from 2006/7)

This provides a forecast of £120 million a year in annual savings based on information for 2006/7. The overall cost of the National Programme for IT in the NHS is estimated to be £12.4 billion by 2012, of which £2.4 billion had been spent by 31 March 2007, including £390.8 million payments to suppliers.

The General Medical Council has published new guidelines, Personal Beliefs and Medical Practice, which say that doctors must display posters or give out information leaflets on any ethnical objections they hold on abortion or other contentious medical issues. The recommendations have been drawn up amid growing concerns about the possibility of a doctor's personal beliefs conflicting with a treatment they are duty bound to provide. Doctors must set aside their own beliefs where a patients wishes it, or refer the patient to another doctor.

The DH has issued a Guide to what we do and how we do it. Originally produced for all staff at DH and contractors, it has now been made available to those outside DH who wish to know more about how it operates. It should be read on the basis that it is written for staff internally. It covers such subjects as: how it works with external partners; how it's organised; and how it manages its business. There is also a Glossary of terms used in DH.

Review of NHS health library services National Service Framework for quality improvement for NHS funded library services. The NHS Institute for Innovation and Improvement has published the NHS library services Review and NSF. The review, written by Professor Peter Hill, has highlighted the centrality of library, knowledge and information services within the NHS and describes four key purposes for library and knowledge service: clinical decision making by patients, their carers as appropriate, and health professionals commissioning decision and health policy making research lifelong learning by health professionals. The NSF defines the outcomes required for library/knowledge services in England. It provides the national quality assurance framework for service improvement. The intention is that library/knowledge services are aligned to the business needs of the NHS and are demonstrably delivering to need and expectation. It enables NHS organisations and service managers to develop service improvement plans. It also enables commissioners to describe what needs to be commissioned and expected performance outcomes.

Community engagement to improve health. Published by NICE, this guidance makes recommendations about how communities can effectively be involved in the planning, design and delivery of services that can improve people’s health and well-being and address the wider social determinants of health.

NICE Guidance: Smoking cessation services. This document provides guidance on smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities.

Newss
English prescription charges rise by 25p. From April 1, 2008 the cost of a prescription in England will rise GBP 0.25 to GBP 7.10. Prescription prepayment certificates will also increase to GBP 27.85 for 3 months and GBP 102.50 for 12 months. Dental charges are also increased.

The Electronic Prescription Service: an introduction to Release 2 for healthcare professionals. Connecting for Health has published this booklet giving a high-level overview of how the Electronic Prescription Service will affect current business processes used in prescribing and dispensing environments, how it will be introduced, and the benefits it will bring. It is aimed at all members of staff who will have responsibility for implementing or using the service once Release 2 is introduced.

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