Care

Publications/Guidance
CSCI has launched an online survey as part of its major review of the current system of eligibility for social care, Fair Access to Care Services. It is seeking views and experiences from the public, people who use care services and all interested parties including council representatives, providers, voluntary and community organisations on issues and problems associated with the current eligibility system. The survey will be on the CSCI website until 9 May.

Improving choice at end of life. An independent King’s Fund evaluation has revealed that significantly more people have been helped to choose to die in their own homes at no greater cost to the NHS as part of a pilot project led by Marie Curie Cancer Care. Since 2004, UK charity Marie Curie’s Delivering Choice Programme has worked with doctors and nurses in hospitals, hospices and community services to give people in Lincolnshire with terminal illnesses the choice of dying at home, rather than in hospital. The King's Fund's analysis of the impact and costs of the programme concludes that it represents a cost effective model of care that can make choosing to die at home a real option for dying patients.

Teams without walls: the value of medical innovation and leadership. The success of providing care closer to home lies in developing ‘teams without walls’, according to a working party of three medical Royal Colleges. Teams without walls brings together healthcare professionals from primary and secondary care to work across traditional health boundaries to deliver care that puts the patient first. The working party, made up of representatives from the Royal College of Physicians, the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health, suggests that jointly commissioned integrated health services should be provided by primary and secondary care working together.

Nutritional care in hospitals. The National Patient Safety Agency (NPSA) has launched the first three in a series of ten fact sheets to support the 10 key characteristics of good nutritional care in hospitals produced by the Council of Europe Alliance (UK). The fact sheets have been developed by the NPSA in conjunction with the Royal College of Nursing, the Hospital Caterers Association, the National Association of Care Caterers and key stakeholders from the private sector. The first three releases explore the following:-

		Food service and nutritional care is delivered to the patient safely
		Implementation of Protected Mealtimes to provide an environment conducive to patients enjoying and being able to eat their food
		Supporting a multi-disciplinary approach to nutritional care and valuing the contribution of all staff groups working in partnership with patients and users

News
The Home Office has announced that the new vetting and barring scheme under the Safeguarding Vulnerable Groups Act 2006, operated by the Independent Safeguarding Authority (ISA), will go live in October 2009. The ISA scheme will mean a single vetting authority maintains a constantly updated list of people who are not allowed to work with children or vulnerable adults, incorporating all existing barring lists. If a person is not barred from employment with vulnerable people they will be ISA registered, although it will remain the employer's decision whether to hire them. The authority will work alongside the Criminal Records Bureau, which will continue to issue criminal records disclosures to help employers make recruitment decisions.

DH: £2 million joint project with Comic Relief to investigate prevalence of elder abuse on NHS wards and in care homes - part of package to strengthen support: announces three new measures to strengthen the protection of vulnerable old people in institutional care settings:

		possible amendment of the Health and Social Care Bill currently going through Parliament to make care homes providing publicly-arranged accommodation directly subject to duties under the Human Rights Act, thus reversing the effect of the House of Lords' decision in June 2007 in Johnson v Havering LBC [2007] UKHL 27 that the provision of publicly-arranged accommodation in a private care home is not considered a function of a public nature;
		people funding their own care to have the right to refer complaints to an independent adjudicator - details will be confirmed later this year; and
		£2m funding for a new joint research initiative between Comic Relief and the DH investigating the dignity and safety of older people being cared for in institutional settings.

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

Children

News
The Home Office has announced that the new vetting and barring scheme under the Safeguarding Vulnerable Groups Act 2006, operated by the Independent Safeguarding Authority (ISA), will go live in October 2009. The ISA scheme will mean a single vetting authority maintains a constantly updated list of people who are not allowed to work with children or vulnerable adults, incorporating all existing barring lists. If a person is not barred from employment with vulnerable people they will be ISA registered, although it will remain the employer's decision whether to hire them. The authority will work alongside the Criminal Records Bureau, which will continue to issue criminal records disclosures to help employers make recruitment decisions.

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

Clinical Management

Cases
Hibbert Pownall & Newton (a Firm) v Whitehead (Administrator of the Estate of Paula McLeish, deceased) and McLeish (CA ) (Unreported, 4 April 2008): a firm of solicitors that was professionally negligent in litigating a mother's "wrongful birth" clinical negligence claim by failing to conclude it before she died was not liable to pay damages to the mother's estate for the care costs of the relevant child after the mother's death, as those losses were not recoverable.

Jones v Royal Devon & Exeter NHS Foundation Trust [2008] EWHC 558 (QBD): a mother was entitled to recover general damages of £20,000 in respect of her prolonged pathological grief reaction to the death of her daughter, which was occasioned through the negligence of the defendant NHS trust.

Varma v General Medical Council [2008] EWHC 753 (Admin) (Admin Ct, 16 April 2008): Dr V appealed against the GMC's decision that his name be erased from the Medical Register and that his registration be immediately suspended, in respect of various allegations of misconduct. The court held that there had been no abuse of process by the GMC's Fitness to Practise Panel when it had refused to stay the proceedings after concluding on the medical evidence that Dr V was fit to participate and that he was merely voluntarily electing not to do so. The court should be slow to interfere with an exercise of judgment or discretion by a specialist panel, which turned to a large extent on its assessment of written and oral medical evidence.

General Medical Council v Sathananthan [2008] EWHC 872 (Admin) (Admin Ct, 23 April 2008): the GMC applied to extend an interim suspension order imposed on Dr S, a consultant psychiatrist, who had been charged with serious professional misconduct for issuing private prescriptions of controlled drugs in an irresponsible manner. The GMC said that there were concerns about Dr S's care of patients and that it needed a 12 month extension to complete its investigations. The court held, granting the application, that an interim suspension order was proportionate and necessary for the protection of the public. In view of Dr S's prescribing history, this was one of the relatively rare cases where an interim suspension order was appropriate. Given the time that the GMC had already had, a 6 month extension was appropriate.

Bevan Brittan Updates
Claims Online - Ensuring optimal learning from adverse incidents: the importance of a robust SUI investigation. Duncan Astill investigates the importance of a robust SUI investigation

Claims Online - Considering and Granting Extensions in Time. Avinder Sidhu sets out common scenarios in which extensions are requested and factors to take into account when deciding whether to grant an extension.

Claims online - Case updates. Julie Charlton looks at a number of recent cases.

Claims Online - Seminar Programme: May 2008. Details of our case and CPR annual update on Tuesday 13 May.

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

Clinical Trials

Legislation
Medicines for Human Use (Clinical Trials) and Blood Safety and Quality (Amendment) Regulations 2008 (SI 2008/941): these regulations, which came into force on 1 May 2008, amend SI 2004/1031 (the Clinical Trials Regulations) in order to: enable children to take part in emergency care trials when there would be no time to seek initial consent before administering the medicine; allow the Gene Therapy Advisory Committee to notify UKECA that its advice is not required on routine gene therapy trials and for applications to be transferred to another recognised ethics committee for an opinion; and modify the procedures for operation of ethics committees to widen the available expertise, reduce administrative burden and rationalise the documents an applicant must submit for an opinion.

News
DH: New Biomedical Research Units announced: announces 12 new National Institute for Health Research Biomedical Research Units, each of which is a partnership between an NHS Trust and a university. The Units, which will complement the existing 12 NIHR Biomedical Research Centres in London, Oxford, Cambridge, Liverpool, Manchester and Newcastle, will work in major areas of ill-health and clinical need which have traditionally received relatively limited amounts of research funding: heart disease; deafness and hearing problems; gastrointestinal and liver disease; musculoskeletal disease (including arthritis); nutrition (including obesity) and respiratory disease (including asthma).

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

Commercial Healthcare

News
DH: Moving forward with health reform - more Independent Sector Treatment Centre schemes: announces that three more Independent Sector Treatment Centre (ISTC) Schemes have been given the go ahead, two in Greater Manchester and one in Hampshire & IoW. The schemes are expected to provide over 1.5m contracted procedures and outpatient consultations, including general surgery, orthopaedics, ophthalmology, and diagnostics. This will bring the total number of schemes in Phase 2 to 10, seven of which have already started to deliver services to patients. Final proposals for the Avon, Gloucestershire and Wiltshire Electives scheme are now being considered and the Government expects to announce a decision on this shortly. The three remaining ISTC schemes that will be taken forward by the NHS are: London North Electives, Essex Electives and Hertfordshire Electives.

Bevan Brittan Updates
Public Consultation and Personal Dental Service Agreements.

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

Commissioning

Publications/Guidance
Changes to the portfolio of nationally commissioned services from April 2008 and the National Commissioning Group intentions for 2008/09. This Dear Colleague letter gives information about changes to the portfolio of the National Commissioning Group from 2008/09 and about other changes to national commissioning arrangements from April 2008.

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

Complaints

Publications/Guidance
Spotlight on complaints: the Healthcare Commission is urging NHS trusts to learn from patients’ complaints and improve complaints handling, with key proposals including apologising more often when they do make mistakes. This report looks at how complaints are handled and the common themes to enable trusts to learn lessons from them.

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

Data Protection

Publications/Guidance
A Department of Health response to the consultation paper. A code of practice for the use of powers to counter NHS fraud and security incidents. This is the response to a consultation which sought comments on a draft Code of Practice setting out the requirements that NHS CFSMS counter fraud or security management specialists should follow when obtaining, handling, using and disclosing information obtained through the use of powers contained in the NHS Act 2006 and NHS (Wales) Act 2006.

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

Embryology

Publications/Guidance
Genetics white paper review 2008. The 2003 'Genetics' White Paper detailed how the Government plans to bring the advances of genetics to the patient bedside and set out a plan of investment of over £50m spread across some 30 commitments. This document details progress since 2003.

News
Government announces appointment of new national clinical director for transplant: Chris Rudge has been appointed as National Clinical Director for Transplant to drive forward Government plans to increase the number of people who can benefit from an organ transplant.

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

Employment/Human Resources

Publications/Guidance
National survey of NHS staff 2007. This is the fifth annual national survey of NHS staff from the Healthcare Commission (HC), conducted between October and December 2007. The survey is believed to be the largest annual staff survey in the world. Almost 156,000 employees from all 391 NHS trusts in England (54% of staff) responded to a questionnaire asking about their views and experiences of working for the NHS. The purpose of the survey is to look at the attitudes and experiences of NHS staff both nationally, because of the importance of the NHS, and by individual trust, so that employers can review any issues with their own staff and take action. To enable this, the HC has already provided each NHS trust with its own detailed report.

A new document, Navigating Equality and Diversity in the NHS has been published by NHS employers. The document sets out key aspects of NHS equality and diversity requirements, action points for Trusts and signposts readers to the organisation that created the guidance.

A NHS pay circular for doctors and dentists has been issued. This circular provides information on the changes in the national pay and conditions of service of hospital medical and dental staff and doctors and dentists in public health, the community health service, salaried primary dental care and salaried general practitioners. The changes apply from 1 April 2008 and should be backdated, where applicable.

Review Body on Doctors' and Dentists' Remuneration: thirty-seventh report 2008. This review covers 185,000 doctors and dentists in the United Kingdom. The Review Body does not see any major cause for concern in recruitment and retention. The economic background suggests a period of difficulty and restraint. The Consumer Prices Index will exceed the 2% inflation target, and the Retail Prices Index stood at 4.1% in January. The Review Body outlines the conflicting submissions made to it by the professional bodies and the health departments and the NHS. Following careful appraisal of the assumptions behind the spending plans, the main recommendation is that all salaried members of the Body's remit group should receive the same basic increase of 2.2%.

Guidance on working conditions for consultants and survey results on space for hospital doctors. The British Medical Association (BMA) has published results of a survey on office space. According to the BMA, patient care and confidentiality are being affected because hospital doctors do not have the resources they need. The BMA has also issued best practice guidance to define the standards and facilities by which consultants of all natures can expect to work.

New nurses' toolkits for education and training. New toolkits have been launched by Education for Health containing evidence based, disease specific business proposals for nurses to establish their current levels of knowledge, understanding and experience, and to plan development of their competencies within the framework of the health needs of their practice population.

Cases
R (Bapio Action Ltd) v Secretary of State for the Home Department [2008] UKHL 27 (HL, 30 April 2008): the House of Lords has held that the SoS's guidance to NHS employing bodies on the recruitment of international medical graduates (IMGs) was unlawful. The effect of the April 2006 guidance was that, when NHS employers were looking for junior doctors to fill postgraduate training positions, applicants who were not UK or EEA nationals and whose leave to remain in the UK would not extend beyond the duration of the position on offer, should not be offered the position unless there were no suitable candidates who were UK or EEA nationals. The Lords held that the grant of Highly Skilled Migrant Programme (HSMP) status to IMGs within the UK who enjoyed such status at the date of the guidance had given those persons a legitimate expectation that they would be able to seek and obtain employment in the fields of their skill, and the guidance would have fundamentally undermined their legitimate expectations. By issuing the guidance, the SoS as one emanation of the Crown was exercising her prerogative to give informal guidance inconsistently with the legitimate expectations generated by the Immigration Rules and the practice adopted by another emanation of the Crown, the Home Secretary. The inconsistency and its effects were so profound as to render such guidance invalid.

The case of Bidwell v Havering Primary Care Trust concerned the unfair dismissal of a nurse who took a second job working night shifts, whilst she was also working during the day for the Respondent, Havering Primary Care Trust. The Claimant, Miss Bidwell, had been working 37.5 hours per week, during the day, at a rehabilitation unit of a hospital in Hornchurch, Essex. In April 2005, the Trust discovered that Miss Bidwell had also been working night shifts at a care home, which had resulted in her working a total of around 100 hours per week. The Trust felt that this secondary employment, in the care home, amounted to Miss Bidwell working excessive hours, potentially putting the safety of patients at risk. The Trust dismissed Miss Bidwell, without notice and, following an unsuccessful appeal, she brought a complaint of unfair dismissal. An Employment Tribunal found that Miss Bidwell’s dismissal had been unfair, but reduced the compensation awarded to her by 30% in order to reflect her contributory fault. The Tribunal found that the Trust had acted with a “closed mind” when it considered Miss Bidwell’s circumstances. For example, no consideration had been given to Miss Bidwell’s explanation that she could get some sleep during the night shift and that there had been no specific complaints or concerns about Miss Bidwell’s performance during her “day” job at the Trust. Furthermore, during the appeal hearing Miss Bidwell had explained that she would now be prepared to give up her second job, but her dismissal was, nevertheless, upheld. The Employment Appeal Tribunal held that the various factors enumerated and relied upon by the employment tribunal had justified its conclusion that the dismissal had been unfair on the basis that dismissal had not been within the reasonable range of responses open to the employer. Whilst the Employment Appeal Tribunal felt that the reduction of 30% was on the low side, they did not feel that it was wrong in law. Accordingly, the employer's appeal against the Employment Tribunal’s ruling was dismissed.

In Selvarajan v the GMC , a London GP (together with a local chemist) had defrauded the NHS of approximately £150,000 in fraudulent prescriptions, with the proceeds being split between the GP and the chemist. On finding against the GP for this fraudulent claim, the GMC’s Fitness to Practice Panel (“the Panel”) decided that Dr Selvarajan should be struck off the Medical Register. Dr Selvarajan appealed to the High Court against the severity of the penalty imposed by the Panel, on the grounds that the Panel misdirected itself on the relevance of the passage of time between the conduct admitted. There had been a delay of approximately four years. In making its decision, the High Court noted that the history of the case had to be taken into account: that the Appellant was a highly regarded professional (as evidenced by numerous testimonials) whose devotion to the welfare of his patients was not in question. Until the events that gave rise to the proceedings against Dr Selvarajan, he had an unblemished record and the dishonest conduct started as a result of financial difficulties that Dr Selvarajan was then facing. Before the Panel decided on the sanction to impose, Dr Selvarajan argued that it would be a breach of his human rights to erase his registration, given the delay in concluding the proceedings. The Panel determined that the delay was irrelevant factor and erased Dr Selvarajan’s name from the medical register. Dr Selvarajan appealed. The High Court decided that Dr Selvarajan’s submission in respect of delay was correct and the delay of four years should have been taken into account by the Panel. However, the High Court decided that Dr Selvarajan’s misconduct was so serious, and sustained over such a long period of time, that the penalty of erasure from the Medical Register was appropriate. If a lesser penalty had been imposed, then the public’s confidence in the medical profession may have been undermined.

The Employment Appeal Tribunal in Ahari v Birmingham Heartlands and Solihull Hospitals NHS Trust  considered whether Dr Ahari’s claim for direct race discrimination was lodged out of time and, accordingly, time barred. Dr Ahari had sought to rely upon evidence given to the General Medical Council's Fitness to Practise Panel (“the Panel”) to demonstrate a continuing act of discrimination for the purposes of his race discrimination claim. If Dr Ahari could show a continuing act of discrimination, then the time limit for lodging his claim would, effectively, be extended, as time would only start to run from the end of the “continuing act” of discrimination, i.e. the end of the evidence given to the Panel. However, it was held that the Panel was a quasi-judicial body and that, therefore, the evidence in question had attracted the protection of absolute witness immunity. This meant that Dr Ahari could not rely on this evidence as part of his discrimination claim and the claim had, therefore, been presented out of time. Dr Ahari’s appeal was dismissed.

News
Proposed three-year pay award: Health Secretary Alan Johnson has announced that the DH had agreed with NHS Employers, UNISON and the Royal College of Nursing (RCN) a proposed three-year pay package for all NHS Agenda for Change (AfC) staff (including nurses, midwives and allied health professionals) which will now be subject to consultation by members of all the trade unions covered by Agenda for Change. The proposed package incorporates the NHS Pay Review Body recommendation for 2008/09.

New NHS projects to improve occupational health for local businesses: announces that businesses in six areas across the country are to benefit from NHS advice and support to improve the physical, mental and social well-being of their staff. The six new demonstration projects (Merseyside, East London, West Yorkshire, the North East, Devon and Worcestershire) will share £11m of capital funding to provide better quality occupational health services (OH) for local businesses. The announcement follows Dame Carol Black's report Working for a healthier tomorrow, which showed that work can be good for health, reversing the harmful effects of long-term unemployment and prolonged sickness absence. These innovative schemes create a countrywide network of 11 demonstration projects, which pave the way for other trusts to develop their own occupational health services to be more effective for the benefit of the wider business community. The funding will be managed by NHS Plus, a network of NHS OH departments across England, supplying quality services to non-NHS employers.

Unison have negotiated a six-figure settlement payment for a former trainee nurse, Tanya Dodd, who developed an allergy to latex while she was working for Scarborough General Hospital. The ward on which Ms Dodds worked only provided latex gloves, and she was told that using non-latex gloves, without authorisation, would amount to a disciplinary offence. At no point were the risks of latex products explained to Ms Dodds and neither was she given the option of using a different type of glove. As a consequence of the exposure to latex, Ms Dodds has an allergy which means that she has to live in a latex-free environment and must also avoid foods which contain proteins which are similar to latex, such as grapes and melons. The alternative open to the Trust would have been to have provided Ms Dodds with power-free gloves, or low protein gloves which can reduce latex allergy and latex induced asthma. NHS Plus (an occupation health network) does not recommend a complete ban on latex gloves in the workplace, but does suggest that alternatives should be considered. Their guidance can be downloaded here.

An enquiry into alleged bullying and harassment at the National Midwifery Council (NMC) has been launched by the government. The health minister, Ben Bradshaw, has asked the Council for Healthcare Regulatory Excellence to look into allegations that funds have been misspent, that staff time was misused and that NMC trustees were prevented from undertaking their work. The NMC has vigorously denied the allegations and has said that it is confident that it will show that there is no bullying or harassment at the NMC.

As "key workers", nurses who participate in affordable housing schemes will be given cash to help them with the costs of moving house, such as solicitors' costs and new furniture. The grants will be to the value of up to £1,500 and will be offered to buyers who take up a shared equity loan under the government's Open Market Home Buyers Scheme . More than £3,000,000 has initially been earmarked for the first wave of grants, which would fund grants for 2,000 key workers.

The Government has announced that it will not appeal the outcome of the Judicial Review into the calculation of GP’s pensions. In March 2008, the High Court ruled that the Government had acted unlawfully when it retrospectively introduced a limit on the amount that GPs could receive on retirement, under their NHS pensions for the years 2004-2006. Permission was given to appeal, but the Government has confirmed that it will not do so.

Transfers of employment between local government and the NHS, under the Transfer of Undertakings Regulations 2006 (usually referred to as “TUPE”) are increasingly commonplace. This can raise some tricky issues in relation to pensions, and it is important to remember that the Local Government Pension Scheme (LGPS) and the NHS pension schemes are not considered comparable for the purposes of the HM Treasury Guidance 'A Fair Deal for Staff Pensions' where employees are the subject of a TUPE transfer. A letter summarising the position is available on the on the NHS Pensions Authority website. It is likely that this position will remain unchanged when the current revisions to the NHS pension scheme and the LGPS are completed. Therefore , if staff are transferring between the NHS and Local Authorities , this issue may be addressed by providing membership of the LGPS together with the Local Authority providing any additional undertakings requested by the Government Actuary's Department (GAD) as necessary to provide additional benefits to ensure comparability. Equally, if the staff are transferring from the Local Authority to the NHS, this issue may be addressed by providing membership of the NHS pension scheme together with the relevant NHS body providing any additional undertakings requested by GAD as necessary to provide additional benefits to ensure comparability.

Bevan Brittan Employment Updates
Putting a stop to swinging the lead. Most workplaces have one: the employee who either exaggerates illnesses or dishonestly takes time off work with suspect ailments. These are commonly known as ‘malingerers’ and dealing with them can be tricky. However, as Lisa Norman reports, there are various tactics available for tackling this type of problem employee.

Minimal requirements for step one grievance letters. The Employment Appeal Tribunal has looked at the statutory dispute resolution procedures and has, again, set the bar very low in respect of the requirements for a valid a step one grievance letter, as Raj Basi explains.

News round-up. The employment arena has been as busy as ever, and Mugni Islam-Choudhury reports on the latest news and developments of which you need to be aware this month.

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

Foundation Trusts

Publications/Guidance
Monitor: NHS foundation trusts - review of nine months to 31 December 2007: this third quarter report on NHS FTs' performance for 2007-08 describes a sector delivering good overall performance with no NHS foundation trust currently at risk from intervention for financial reasons. Some NHS FTs are failing to meet the target to reduce rates of MRSA, and the report reveals that Monitor has to date required seven NHS FTs to attend meetings to explain their plans to improve performance in this area. The total number of MRSA cases in the NHS FT sector has continued to fall; however, a significant number of trusts (24 out of 83) are already in breach of their full-year target with a further 11 reporting that they are at risk of breaching the target. The report also highlights performance in meeting the target for accident and emergency admissions, with 24 NHS FTs failing at some stage during the quarter, to achieve the target of treating 98% of A&E admissions within four hours of arrival.

News
Monitor announced on 31 March 2008 that three more foundation trusts will be authorised from 1 April 2008:

		Mid-Cheshire NHS Foundation Trust;
		Medway NHS Foundation Trust; and
		Oxfordshire & Buckinghamshire Mental Health NHS Foundation Trust.

The announcement means there are now 92 NHS FTs, of which 22 are mental health NHS FTs.

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

Health and Safety

News
A Healthcare Commission report into its investigation of Staffordshire Ambulance Service NHS Trust shows that managers took risks with the safety of patients, staff and volunteers. The investigation, covering the period April 2004 to June 2007, highlights problems at the former trust including the poor management of controlled drugs, "community first responders" (emergency ambulance volunteers) and an out-of-hours GP service. The Commission points out that the trust was a good performer in terms of response times for emergency calls. It was considered to be innovative in its introduction of new equipment and services and had good relationships with patients and the public but these achievements were undermined by a culture and approach that did not prioritise safety and that put patients at risk. West Midlands Ambulance Service NHS Trust took over Staffordshire Ambulance Service NHS Trust in October 2007 and has already made progress on addressing these issues.

Health and Safety Commission and Health and Safety Executive merge to form a single regulatory body: the DWP has announced the merger of the HSC and HSE as from 1 April 2008 to form a single national regulatory body responsible for promoting the cause of better health and safety at work. The merged body will be called the Health and Safety Executive and will provide greater clarity and transparency whilst maintaining its public accountability.

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

Hospital Infection

Publications/Guidance
Deep cleaning NHS hospitals: request for case studies. Dear Colleague letter from Chris Beasley, Chief Nursing Officer, seeking feedback from SHAs on examples of good practice resulting from the deep cleaning NHS hospitals programme.

MRSA and C. difficile quarterly report figures. The Health Protection Agency (HPA) has published its latest quarterly report on MRSA (meticillin-resistant Staphylococcus aureus) bloodstream infections and C. difficile (Clostridium difficile) infection figures. There were 1,087 cases of MRSA reported in England for October to December quarter of 2007. This represents a 0.6% increase on the previous quarter. There were 9,872 cases of C. difficile reported in patients aged 65 years and over between October and December 2007. This represents an 8% reduction in reported cases in this age group from the previous quarter. However the HPA cannot be confident that the apparent reduction in the C. difficile figures is an accurate reflection of the current situation, as the figures for some trusts may not be complete.

News
Deep clean success on the horizon for NHS: on 29 March 2008 Health Secretary Alan Johnson announced the latest data on the first national programme of hospital deep cleaning. Detailing the next steps in maintaining hospital cleanliness, he announced that specially-trained teams from the Healthcare Commission would go into hospitals to check that they are meeting and maintaining stringent standards of cleanliness.

NHS staff survey shows significant improvement in hospital infection control.

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

Human Organs and Tissue

Publications/Guidance
Implementation of the Organ Donation Taskforce recommendations. NHS Medical Director Sir Bruce Keogh has written this Dear colleague letter to all NHS Chief Executives outlining the Department of Health's initial plans for implementing the Organ Donation Taskforce's 14 recommendations.

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

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. It has drawn up an action plan responding to each of the 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.
See also the Written ministerial statement to Parliament by Secretary of State for Justice Jack Straw on 27 March 2008, in which 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.

See also the Written ministerial statement to Parliament by Justice Minister Bridget Prentice on 27 March 2008 in which 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 or Nadia Persaud.

Mental Health

Legislation
Mental Health Act 2007 (Commencement No. 5 and Transitional Provisions) Order 2008 - guidance on transfers between places of safety. Guidance has been published for NHS bodies and social services authorities on the effect of the amendment to the Mental Health Act 1983 ss 135 and 136, made by the Mental Health Act 2007 s.44, enabling persons thought to have a mental disorder to be transferred from one place of safety to other places of safety within a maximum period of detention of 72 hours.

Publications/Guidance
JCHR report - Scrutiny of mental health legislation: follow up: 16th Report of Session 2007-2008.

Deprivation of Liberty Safeguards Implementation Tool. This implementation tool is for local Mental Capacity Act implementation networks to use when estimating the number of assessments and staff that are likely to be required in 2009-10.

Project initiation document: Mental Health Payment by Results Development Project. This document aims to define the Mental Health Payment by Results Development Project, to form the basis for its ongoing management, and the assessment of its overall success. It provides a statement of how and when the project's objectives are to be achieved.

Improving Access to Psychological Therapies (IAPT) commissioning toolkit. This commissioning toolkit is designed to help PCTs improve or establish stepped care psychological therapies following NICE guidelines. The toolkit is structured around the commissioning cycle and is specifically linked to the World Class Commissioning competencies. It brings together a wide range of existing tools and guides and includes positive practice examples throughout.

The Mental Capacity Act 2005: New resources. This letter sets out the new resources available to the health sector for the year 2008-09 for work to support the Mental Capacity Act 2005.

The use of antipsychotics for people with dementia in care homes. In Always a last resort, the All-Party Parliamentary Group on Dementia examines the use of antipsychotics for people with dementia in care homes. The Group heard that over-prescribing is a significant problem in many care homes. These drugs are prescribed as a response to the behavioural and psychological symptoms of dementia, experienced as a result not only of the condition, but also as a result of a wider and more complex set of problems external to the individual’s condition. These problems include a lack of support from external services. The report recommends a five point action plan of which one is 'more pro-active support for care home staff from GPs, community psychiatric nurses and psychiatrists'.

From strength to strength. Published by the Mental Health Act Commission (MHAC), this report shows that committed engagement of service users throughout the organisation can make a real difference to what an organisation does and achieves. It describes how the MHAC has involved service users, the methods used, and how service users have influenced and developed these methods. It also discusses the benefits of user involvement, the barriers to effective involvement, some of the challenges faced, and ways of overcoming these. It provides examples of some of the work that service users have been involved in with the Commission.

Consultations
Child and Adolescent Mental Health Services review: call for evidence. The Secretary of State for Children, Schools and Families and the Secretary of State for Health have asked Jo Davidson (Chair) and Bob Jezzard (Vice-Chair) to lead an independent Review of CAMHS (Child and Adolescent Mental Health Services). The Review will investigate how universal, targeted and specialist services can be improved to meet the needs of children and young people who are experiencing, or are at risk of, mental health problems. This consultation calls for evidence from all individuals, organisations and groups. Closing date is 7th July 2008.

Bevan Brittan Updates
Simon Lindsay has produced a Supervised Community Treatment flowchart card which sets out the key points in relation to Supervised Community Treatment. If you would like a copy please contact Lisa Selby.

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

Patient

Legislation
Local Involvement Networks (Duty of Services-Providers to Allow Entry) Regulations 2008 (SI 2008/915): these regulations, which came into force on 1 April 2008, impose a duty on services providers to allow authorised representatives of LINks to enter and view certain premises in certain circumstances and observe the carrying-on of certain activities on those premises. They also set out additional persons who are to be services-providers for the purposes of s.225 and who will therefore have to comply with the duty to allow authorised representatives to enter and view the premises that they own or control and to view activities carried-on on those premises.

Publications/Guidance
NHS Choices: Delivering for the NHS. This document describes the NHS Choices public information service. As an integral part of the health and social care system, it will drive improvements in healthcare and utilise technologies to re-shape the way people engage with their own health, each other and the NHS.

DH: Local Involvement Networks and the NHS complaints process: Part 14 of the Local Government and Public Involvement in Health Act 2007 abolishes Patients' Forums from 1 April 2008 and establishes LINks in their place to find out what citizens want from local services, monitor and review the care they provide and to tell those who run and commission services what the community thinks. This letter to all health body chief executives outlines the implications of the introduction of LINks, with details of NHS and providers' duties relating to LINks. It also announces forthcoming changes to the NHS complaints process.
For a summary of LINks' role and powers, see the DH press release.

The DH has also produced a briefing for independent providers that explains about LINks and their implications for independent providers of health and social services.

DH: Directions on matters to be addressed in Local Involvement Network annual reports 2008: Secretary of State's guidance, issued under s.227 of the Local Government and Public Involvement in Health Act 2007, to LINks setting out their duties when providing annual reports to the Secretary of State.

DH: Directions about the arrangements to be made by relevant bodies in respect of Local Involvement Networks 2008: gives guidance to commissioners of health and social care services on the requirements they need to include in their future contracts with independent providers. These amendments relate to allowing LINks representatives to enter and view services, as well as providing LINks with information relating to services they might run which are publicly funded.

Report of the National Patient Choice Survey, England: November 2007: this report gives the final results of around 78,000 responses to the 10th National Patient Choice Survey commissioned to assess the implementation of choice at PCT level.

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.

NHS Choices: delivering for the NHS: describes how the NHS Choices public information service, as an integral part of the health and social care system, will drive improvements in healthcare and utilise technologies to re-shape the way people engage with their own health, each other and the NHS. Providers should note the opportunity to promote services to local communities and the chance to feedback on the future of NHS Choices.

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

Primary Care Trust

Legislation
DH: National Health Service Pharmaceutical Services (Fees for Applications) Directions 2008: gives directions to PCTs on their ability to charge for pharmaceutical services. The Directions come into force on 21 April 2008. There is also supplementary guidance on Implementing the Health Act 2006: NHS (Pharmaceutical Services) (Amendment) Regulations 2008.

Publications/Guidance
Report of the National Patient Choice Survey, England: November 2007: this report gives the final results of around 78,000 responses to the 10th National Patient Choice Survey commissioned to assess the implementation of choice at PCT level.

Should primary care trusts be made more accountable? A King's Fund discussion paper. According to this King's Fund discussion paper, there is a need for greater clarity about what politicians mean when they talk about increasing local accountability in the NHS. It could be interpreted as meaning local people should be consulted ahead of changes in services, or that PCTs should provide more information on how decisions are made, or it could mean the right to demand certain services and even the power to remove health bosses who do not meet their expectations. The paper discusses a range of options for reforming the relationships between PCTs and their public.

DH: Revised guidance - primary care dental contracts: Advice on managing end of year issues: this note provides advice for SHAs to share with PCTs on year end performance issues, including: arrangements for carrying forward any under-delivered services within the 4% tolerance allowed for within dental contracts; and working with dental providers to ensure, as far as possible, that an even pattern of service is delivered throughout the contract year, and any early completion of contracted activity is managed. It updates January 2007 guidance.

Prison Health

Publications/Guidance
Integrated Drug Treatment System for Prisons (IDTS). A third wave of DH funding for IDTS from 2008/9 onwards has been approved for the development of enhanced clinical services for drug treatment in a further 38 prisons.

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

Regulation

Publications/Guidance
Health and Safety Commission and Health and Safety Executive merge to form a single regulatory body: the DWP has announced the merger of the HSC and HSE as from 1 April 2008 to form a single national regulatory body responsible for promoting the cause of better health and safety at work. The merged body will be called the Health and Safety Executive and will provide greater clarity and transparency whilst maintaining its public accountability.

Cases
Gopakumar v General Medical Council [2008] EWCA Civ 309 (CA): the court held that the character directions given by a legal assessor before a Fitness to Practise Panel in respect of a GP charged with serious professional misconduct were not analogous to the directions which a judge in a criminal trial would give to a jury, and did not cast doubt upon the panel's decision to find the charge proved.

R (on the application of Eisai Ltd) (Claimant) v National Institute for Health & Clinical Excellence (Defendant) & (1) Shire Pharmaceuticals Ltd (2) Association of the British Pharmaceutical Industry (Interveners) [2008] EWCA Civ 438. The National Institute for Health and Clinical Excellence acted unfairly during a consultation process by making available to consultees only a read-only version of an economic model used to assess the cost-effectiveness of drugs and refusing to make available a fully executable version of the model.

GMC v Kanagaratnam Sathananthan. [2008] EWHC 872 (Admin). The General Medical Council's Interim Orders Panel had been justified, on the basis of public safety, in imposing an interim suspension order on a General Practitioner who had allegedly prescribed large quantities of controlled drugs to a number of patients in an irresponsible manner. In the circumstances, it was appropriate to extend that order for a period of six months so that the General Medical Council could complete its investigation.

News
Healthcare Commission steps up pressure on weak trusts: Healthcare Commission inspectors have followed up all 33 organisations rated "weak" last year for their quality of services. The Commission has held follow up meetings with 32 trusts. With the remaining trust (Royal Cornwall Hospitals NHS Trust) it sent a team of inspectors to carry out a more detailed intervention - this trust had scored "not met" on 70% of the standards and had performed poorly for the second consecutive year. The Commission is reassured by the way trusts were responding; however it states that it is important that improvements were made and maintained for patients. The Commissions has also published a summary of feedback from the meetings with Trusts.

DH: Candidate for future post of Care Quality Commission Chair announced: the Care Quality Commission (CQC) will be created in October 2008 to take over from CSCI, the Healthcare Commission and the Mental Health Act Commission from 1 April 2009. The DH has announced that Baroness Young of Old Scone, currently the Chief Executive of the Environment Agency, is the Government's candidate for the future post of CQC Chair. The Health Select Committee will hold a public pre-appointment scrutiny hearing and report on the candidate's suitability for the post; the Secretary of State will then consider the conclusions of the Committee's report before deciding whether or not to proceed with the appointment.

Healthcare Commission launches inspection programme. The Healthcare Commission (HC) has launched the biggest inspection programme ever carried out in NHS acute trusts to check whether they are meeting standards on infection control. It will inspect all 172 acute trusts annually, with 25 trusts to be visited in the first two months - these trusts have been informed. The HC will target their visits on particular areas of risk, without disclosing the exact date of the spot check. The visits will take place over one to two days, although it may be extended if necessary. In particular, trusts should check they are meeting the 11 mandatory duties outlined in the government’s hygiene code, which came into force as part of the Health Act 2006.

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

Third Sector

Legislation
Office of the Third Sector: Charities Act 2006 - more changes implemented: announces provisions of the Charities Act 2006 that came into force on 1 April 2006. These includes the new statutory definition of ‘charity’ and various accounting and reporting changes to bring the legal framework for charities up to date, as well as changes to charity law, including a requirement for professional fundraisers to state how much they are paid when asking for public donations.

News
DH: £24 million boost for health and social care: announces the award of Section 64 grants to voluntary and community organisations (awarded under s.64 of the Health Services and Public Health Act 1968) that will fund a total of 150 new grants and 220 continuing grants, more than £17m of which is for projects that support high quality health and social care in England. The full list of approved grants is on the DH website.

The Office of the Third Sector has announced that the £215m Futurebuilders Fund is open to all areas of public service delivery as from 1 April 2008. The Futurebuilders Fund was set up in 2004 to assist front-line voluntary and community organisations to build their capacity to increase the scale and scope of their public service delivery in five areas of service delivery. Futurebuilders will now be able to invest in organisations operating in any public service sector.

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

General

Publications/Guidance
The health impact of climate change: promoting sustainable communities. The South East Regional Public Health Group has produced this guidance document for the Department of Health. It contains advice for public health professionals on what can be done to mitigate and adapt to climate change and promote sustainable communities. This has been a collaborative effort with the UK Public Health Association (UKPHA), Faculty of Public Health and the Chartered Institute of Environmental Health (CIEH), as well as the content verified across government. The guidance document asks health professionals to consider the health impacts of climate change and provide information on how societies can adapt to the most severe impacts - such as heatwaves and flooding, with adequate planning.

Sustainable Development Commission: Healthy futures - the NHS and climate change: this publication is the seventh in a series that looks at the NHS's contribution to sustainable development. It looks at why and how NHS organisations can take serious action against climate change, drawing from examples of NHS trusts that have demonstrated significant results through the NHS carbon management programme.

Nutrition screening survey in the UK in 2007. A nutrition screening survey of adults on admission to hospitals, care homes and mental health trusts has found high levels of malnutrition. The report from the British Association for Parenteral and Enteral Nutrition (BAPEN) lists the following key points:

		malnutrition in adults on admission to hospitals and care homes affects almost 1 in 3 subjects, who were mostly in the high risk category. Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories, and all ages. It is also common in mental health units;
		nutritional screening policies and practice vary between and within health care settings, whilst malnutrition continues to be under-recognised and under-treated;
		much of the malnutrition present on admission to institutions originates in the community. Consistent and integrated strategies to detect, prevent and treat malnutrition should exist within and between all care settings.

Failed Asylum Seekers and Ordinary Residence: Letter to NHS trust chief executives. This letter to NHS trust chief executives explains a recent ruling in the High Court that makes it possible for failed asylum seekers to be considered 'ordinarily resident' in the UK, and, consequently, entitled to free NHS hospital treatment.

In the run up to their annual conference, the NHS Confederation are publishing a series of debate papers on future challenges to the NHS. The first paper is on funding of Social Care. You can download a pdf version to print, or view it over the internet and make comment via their debate forum.

Cases
R (A) v West Middlesex University Hospital NHS Trust [2008] EWHC 855 (Admin) (Admin Ct, 11 April 2008): guidance given by the Minister of State for Health to NHS trusts about the implementation of the National Health Service (Charges to Overseas Visitors) Regulations 1989, advising NHS trusts to charge failed asylum seekers who would otherwise be treated as ordinarily resident in the United Kingdom for NHS services, was unlawful.

Bevan Brittan Updates
If you would like a copy of the Bevan Brittan update on the above case please email Jane Bennett.


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