Care

Publications/Guidance
Common core principles to support self-care - a guide to support implementation: sets out seven common core principles designed to help health and social care staff support people to live independently, stay healthy and make the most of their lives by managing their conditions. The principles capture best practice in order to support service reform and promote choice, control, independence and participation of people who use services.

The use of anti-psychotics for people with dementia in care homes. In Always a last resort, the All-Party Parliamentary Group on Dementia examines the use of anti-psychotics 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, including "more pro-active support for care home staff from GPs, community psychiatric nurses and psychiatrists".

Integrating NHS Care: lessons from the frontline. This briefing paper reports on a series of seminars held at the Nuffield Trust in February and March 2008 to explore experience in the NHS in integrating care. The paper identifies the lessons to emerge from the examples presented at the seminars, and the implications for the NHS in the context of the Darzi review. The aim of this briefing is to suggest the practical steps that need to be taken to achieve closer integration of care.

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.

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.

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.

Consultations
The case for change - why England needs a new care and support system. A Department of Health consultation paper sets out the case for an open debate about the long term future of England's care and support system. The aim is to engage with the public and key stakeholders about how the existing system can meet the challenges of the future. Comments by November 2008.

News
£50m to double time nurses spend on patient care: announces £50m investment in the Productive Ward programme, designed by the NHS Institute for Innovation and Improvement, which empowers nurses to look at how their ward is organised and make changes that allow them to spend more time with patients. The programme has been piloted in four trusts and there are 10 learning partners, one in each SHA. A further two trusts are rolling the programme out across all of their wards. The £50m investment will allow Ward Sisters to take advantage of the Productive Ward tools so that every ward has the opportunity to think about how they can reduce unnecessary paperwork and increase the amount of time they spend on direct patient care.

The NHS has been ordered by the Equality and Human Rights Commission to end the care bias against men, reports the Times. The paper reports that the Commission has written to strategic health authorities warning them to ensure that doctors and hospitals give equal priority to men and women. The article goes on to cite health inequalities, including the fact that men are twice as likely to die from the 10 most common cancers that affect both men and women.

Care home patients to get abuse protection. Increased protection against abuse and eviction will be provided for elderly and vulnerable people living in private care homes following an agreement by House of Lords peers to amend the Health and Social Care Bill. The amendment will enable residents of private care homes to bring claims under the Human Rights Act 1998.

Bevan Brittan Training
Dramatic changes are taking place in the way that health and social care are provided, regulated and commissioned. In September Bevan Brittan is holding its annual Regulated Care Sector Seminar 2008. This seminar which is free of charge will provide you with valuable information to enable your business to prepare for the changes that are afoot. The seminar will take place in our London, Bristol and Birmingham Offices. If you would like to attend one of the sessions please email Neil Grant.

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

Children

Publications/Guidance
When to share information: best practice guidance for everyone working in the youth justice system. This guidance has been developed as a cross-governmental initiative on behalf of Department of Health, Department for Children, Schools and Families, the Youth Justice Board and the Prison Service. The guidance is set out in a pathway approach, with best practice case studies used to identify when, what, where and how information needs to be shared to ensure improved outcomes for children and young people, as outlined in Every Child Matters: Change for Children.

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

Clinical Management

Publications/Guidance
A new industry code of practice published on May 8, 2008 will encourage pharmaceutical companies to do more to identify the side effects of medicines. New promotional information produced from November 2008 must explicitly and prominently state that adverse events should be reported and provide details of a website to contact with concerns. The UK operates a yellow card system (YCS) by which doctors, nurses, pharmacists and patients are encouraged to inform of any problems but there are concerns that only a tenth of side effects are reported and that the information is often of limited value. The Medicines and Healthcare Products Regulatory Agency has recently stepped up its campaign on the use of the YCS.

Cases
Peters (by her Litigation Friend Miles) v (1) East Midlands SHA (2) Halstead; Nottingham City Council (Part 20 Defendant) [2008] EWHC 778 (QB). Where a patient had been left gravely handicapped as a result of the negligence of a health authority, but the local authority also had a statutory obligation under the National Assistance Act 1948 s.21 to provide for the costs of her care in a private care home, both the health authority and the local authority were liable to the patient for the future costs of her care. See the commentary by 1 Chancery Lane.

Arnup v M W White Ltd [2008] EWCA Civ 447 (CA). Under the Fatal Accidents Act 1976 s.4, all benefits received by the dependant as a result of the relevant death were to be left out of account in the assessment of damages.

Langdon (by her Mother & Litigation Friend Osborne) v Williams [2008] EWHC 741 (QB). A general practitioner was liable in negligence to the claimant in a personal injury action for his failure to properly examine her during a consultation and his consequent failure to properly diagnose her as suffering from meningitis.

Bevan Brittan Updates
Claims online - May 2008: New Maternity Deaths at Northwick Park. Hospital Northwick Park Hospital, part of North West London Hospitals NHS Trust has started an inquiry after three maternity patients died within a three month period. Nicola Pegg investigates.

Claims online - May 2008: Case Updates. A round up of recent cases by Jonathan Fuggle.

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

Clinical Trials

News
Seven new partnerships between NHS organisations and leading universities will receive a total of £64 million to conduct research and improve care in major conditions including heart disease, stroke, diabetes and obesity. The new NIHR (National Institute for Health Research) Collaborations for Health Research and Care were selected by an independent international selection panel and will start work on 1 October 2008.

Medical research centre proposed: announces the University of Bristol's and United Bristol Healthcare NHS Trust's plans for a new £6.6m Clinical Research and Imaging Centre (CRIC) at St Michael's Hospital in Bristol that will house a highly advanced MRI scanner, sleep laboratory and clinical investigation suite. The scanner will be used to examine brain activity in patients with mood disorders, such as depression, and drug and alcohol addictions, while the sleep laboratories will house studies into the links between sleep disorders and obesity in children.

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

Commissioning

News
Innovation for Life Challenge Fund. Ivan Lewis, the Care Services Minister, has launched the Innovation for Life Challenge Fund - a discrete funding stream from within the DH Social Enterprise Investment Fund (SEIF). In parallel with the opening of the SEIF’s second round, up to £100,000 per SHA will be available in 2008/9 to support innovative and collaborative commissioners who are ready to take forward social enterprise solutions to meet local health and well-being challenges.

DBERR: Small businesses to get free access to public sector contracts: announces that from 1 May until 31 July 2008, the Supply2.gov.uk website will allow new registrants to gain free access to public sector contracts valued under £100,000 for the UK and Northern Ireland. Once the free trial is over the registrant will revert to the free local area access as specified at registration, unless they select to maintain access at the national level or upgrade to an alternative level. Supply2.gov.uk is owned by DBERR and is managed by procurement solutions service provider BiP Solutions Ltd, allowing UK public sector organisations to publicise their lower-value contracts free of charge. DBERR is encouraging health bodies, local authorities and government departments to play their part too by making sure that more small business opportunities are advertised on Supply2.

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

Data Protection

Publications/Guidance
Summary Care Record early adopter programme: an independent evaluation by University College London. A University College London (UCL) research team, led by London GP Professor Trisha Greenhalgh, has published its independent evaluation of the first year of the Summary Care Record (SCR) programme. The team found that although the SCR offers real benefits for treating patients in emergency and unscheduled care settings, the 'complicated' technical system needs to be refined before being rolled out. Nevertheless, both NHS staff and patients were largely positive or amenable to the programme, with most people valuing the benefits of instant access to medical records over the small risk of data loss or breach. There is also an executive summary available.

When to share information: best practice guidance for everyone working in the youth justice system. This guidance has been developed as a cross-governmental initiative on behalf of Department of Health, Department for Children, Schools and Families, the Youth Justice Board and the Prison Service. The guidance is set out in a pathway approach, with best practice case studies used to identify when, what, where and how information needs to be shared to ensure improved outcomes for children and young people, as outlined in Every Child Matters: Change for Children.

Information governance assurance programme. This letter from NHS Chief Executive David Nicholson draws attention to actions needed on information governance policies and processes.

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

Embryology

Publications/Guidance
Review of the Human Genetics Commission. This is a letter from Minister for Public Health Dawn Primarolo to acting chair of the Human Genetics Commission Sir John Sulston on 9 May 2008. She accepts the main findings of the Commission's review and sets out revised terms of reference for the Commission.

News
Women win the right to children without fathers: key ruling for single women and lesbians: MPs vote for new laws on IVF treatment (Times, 20 May 2008). Members of Parliament have agreed to remove the requirement placed on fertility clinics to consider a child's need for a father. The Human Fertilisation and Embryology Bill will replace the requirement for a father with "supportive parenting" giving lesbians and single women the right to fertility treatment without requiring a father or similar male role model, ending a perceived discrimination against single women and lesbians.

Bevan Brittan Updates
Claims online - May 2008: Changes in the law on abortion. As the Human Fertilisation and Embryology Bill makes its passage through Parliament, Jackie Linehan looks at some key issues.

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

Employment/Human Resources

Publications/Guidance
House of Commons Health Committee: Modernising medical careers: this report critically examines the Government's setting up of the Modernising Medical Careers (MMC) programme of work in 2003 that was intended to address difficulties in the postgraduate medical training system with a new centralised recruitment system, the Medical Training Application Service (MTAS), and its subsequent handling of the 2007 recruitment crisis that resulted from inadequate preparation during the implementation of the reforms. The Committee finds that there were serious problems with the management of the MMC reforms, and particularly the introduction of MTAS, by DH and its partners. A divided and inappropriate governance structure, flawed project and risk management and poor communication with junior doctors were the most serious failings. Their inquiry also uncovered wider problems with policy development and leadership for MMC. The report makes a number of recommendations for change and improvement in response to the shortcomings which undermined MMC.

A new guidance document, Employing and Supporting Speciality Doctors, has been published by NHS Employers and the MMC team, following the launch of the new contract for speciality doctors. The guidance provides a number of recommendations for employers, and aims to align the employment and professional development of speciality doctors – formerly Staff and Associate Specialists – with the national contract model. It can be accessed through the NHS Employers website.

Consultations
Removing or suspending chairs and non-executives of primary care trusts and NHS trusts from office: feedback on the consultation to introduce powers of suspension. Outcome of the consultation on introducing powers of suspension and a single approach to the removal of chairs and non-executives of primary care trusts and NHS trusts from office.

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.

News
ACAS has launched a consultation on its new Code of Practice on disciplinary and grievance procedures. The new Code of Practice is designed to reflect the recommendations made by the Gibbons Review, which formed the basis of the Employment Bill 2007. The Code of Practice will be supported by more detailed guidance notes on handling workplace disciplinary and grievance issues, to be published next year. Responses to the consultation are being sought by ACAS by 25 July 2008. Contact details are available in the consultation document.

Bevan Brittan Updates
Band and deliver! NHS Equal pay claims explained.. Following implementation of Agenda for Change (AFC) in 2004 many thousands of claims have been issued in employment tribunals by female employees claiming equal pay compared to fellow male employees. John Moore reports.

Facing off Facebook: online social networking and employment issues. Are your employees online but off message? With 8 million Facebook users registered in the UK, and the fastest growing demographic being the over 25’s, employers can no longer afford to ignore online social networking sites as the preserve of bored students and teenagers. Sara Touzel looks at the workplace issues raised by such sites and considers what, if anything, employers should be doing.

TUPE loophole? Service provision changes and TUPE 2006. The Transfer of Undertakings Regulations 2006 were intended to clarify some of the ambiguities surrounding transfers of employment, particularly in relation to transfers between contractors. However, this area of law does not submit easily to simplification. Like Hercules decapitating the mythological Hydra, as fast as the government cuts off one area of uncertainty in relation to employee transfers, another springs up. Sarah Lamont looks at one of the first decisions on TUPE and service provision changes and what might be a potential loophole.

News round-up. The latest news and developments in employment law, reported this month by Chloe Edwards including tighter new rules for skilled foreign workers, consultation on new Code of Practice, DBERR publishes new guidance on pregnancy and work, Employment tax reminders and When is a grievance not a grievance? When it’s an appeal.

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

Estates and Facilities

Bevan Brittan Services
Why are asbestos claims a problem for the NHS?

	exposure to asbestos in the NHS was rife in the 50's, 60's and 70's, and still continued in the 80's and 90's. Maintenance workers were most commonly exposed, but we have also seen claims from porters and even nursing staff.. The number of asbestos-related claims against employers is still rising, and isn't expected to peak before 2012
	a claim for mesothelioma (asbestos-related cancer) will be worth anywhere between £150k and £400k, and is not covered by the NHSLA's Liabilities to Third Parties scheme - the NHS organisation will have to pay for claims out of its own budget;
	in mesothelioma cases, if a claimant can show that an employer exposed them to asbestos, the employer will be required to pay for the whole claim, even though a host of other employers might have exposed the same person to asbestos as well - it is up to the employer to pursue a contribution from other organisations;.

Why are we best placed to help?

	we have a strong track record of tracking down other employers who have also exposed the employee to asbestos, and persuading them (or their insurers) to share the cost of settlement;
	we draw up "databases" of witness and documentary evidence for each client, meaning that we can cross-refer evidence on different cases and reduce the time taken to investigate claims;
	we have a strong track record of defeating claims where there is no strong evidence of asbestos exposure by our clients, or where there is a limitation defence - again saving the clients six-figure sums;
	it can be easy to run up significant costs in investigating incidents that might have occurred up to 50 years ago. We run all asbestos cases on strict budgets that are agreed with the client in advance, giving them certainty as to their legal spend on each case;
	we are giving proactive advice to clients on forthcoming developments – for example an impending test case that could force recent or current insurers to pay out on some historic asbestos claims, and a possible government “deal” with the insurance industry over fixed-rate payments on pleural plaque cases. In both instances we are advising clients on how best to protect their interests (and their finances) in anticipation of these changes.

Click here to view Bevan Brittan Asbestos flyer.

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

Foundation Trusts

Publications/Guidance
Compliance Framework. Monitor has updated its Framework, which is a risk-based approach to regulating NHS foundation trusts. This version of the Framework (which replaces the version published in April 2007) will apply to NHS foundation trusts for their 2008/9 annual plan submissions and subsequent in-year monitoring. It includes:

		healthcare targets and national core standards by which Monitor will directly assess service performance as indicators of effective governance
		updated self-certification boards will be required to sign
		refined reporting requirements for membership
		requirements underpinning self-certification on clinical quality.

Identifying risk, taking action: Monitor's approach to service performance in NHS Foundation Trusts. This publication, by Monitor, describes how it assesses governance in NHS FTs.

News
Monitor has announced that four more NHS Foundation Trusts have been authorised as from 1 May 2008:

		Colchester Hospital University NHS Foundation Trust (formerly Essex Rivers NHS Trust);
		Surrey and Borders Partnership NHS Foundation Trust;
		Somerset Partnership NHS Foundation Trust; and
		Norfolk and Norwich University Hospitals NHS Foundation Trust

Monitor has announced that four more NHS Foundation Trusts have been authorised as from 1 June 2008:

		Cambridgeshire and Peterborough NHS Foundation Trust;
		North East London NHS Foundation Trust;
		University Hospitals Bristol NHS Foundation Trust.

The announcement means there are now 99 NHS foundation trusts in total, of which 26 are mental health NHS foundation trusts.

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

Health and Safety

Publications/Guidance
NHS Number programme: this "Dear Colleague" letter from NHS Medical Director Professor Sir Bruce Keogh highlights work to help healthcare organisations achieve complete adoption of the NHS Number as the national identifier for patients, organisations, which will significantly improve safety by ensuring that patients are correctly identified.

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

Foresight Training Resource Pack. The National Patient Safety Agency (NPSA) has developed this resource to support nurses and midwives, working in all care settings to improve awareness of the factors that combine to increase the likelihood of patient safety incidents. It has been specifically designed to be flexible, so that it can be used in team meetings, handovers, mandatory training sessions and stand alone sessions, facilitated by members of staff.

Bevan Brittan Services

Why are asbestos claims a problem for the NHS?

	exposure to asbestos in the NHS was rife in the 50's, 60's and 70's, and still continued in the 80's and 90's. Maintenance workers were most commonly exposed, but we have also seen claims from porters and even nursing staff.. The number of asbestos-related claims against employers is still rising, and isn't expected to peak before 2012
	a claim for mesothelioma (asbestos-related cancer) will be worth anywhere between £150k and £400k, and is not covered by the NHSLA's Liabilities to Third Parties scheme - the NHS organisation will have to pay for claims out of its own budget;
	in mesothelioma cases, if a claimant can show that an employer exposed them to asbestos, the employer will be required to pay for the whole claim, even though a host of other employers might have exposed the same person to asbestos as well - it is up to the employer to pursue a contribution from other organisations;.

Why are we best placed to help?

	we have a strong track record of tracking down other employers who have also exposed the employee to asbestos, and persuading them (or their insurers) to share the cost of settlement;
	we draw up "databases" of witness and documentary evidence for each client, meaning that we can cross-refer evidence on different cases and reduce the time taken to investigate claims;
	we have a strong track record of defeating claims where there is no strong evidence of asbestos exposure by our clients, or where there is a limitation defence - again saving the clients six-figure sums;
	it can be easy to run up significant costs in investigating incidents that might have occurred up to 50 years ago. We run all asbestos cases on strict budgets that are agreed with the client in advance, giving them certainty as to their legal spend on each case;
	we are giving proactive advice to clients on forthcoming developments – for example an impending test case that could force recent or current insurers to pay out on some historic asbestos claims, and a possible government “deal” with the insurance industry over fixed-rate payments on pleural plaque cases. In both instances we are advising clients on how best to protect their interests (and their finances) in anticipation of these changes.

For more information in relation to Bevan Brittan asbestos services please contact Paul Taverner.

Bevan Brittan Training
Dramatic changes are taking place in the way that health and social care are provided, regulated and commissioned. In September Bevan Brittan is holding its annual Regulated Care Sector Seminar 2008. This seminar which is free of charge will provide you with valuable information to enable your business to prepare for the changes that are afoot. The seminar will take place in our London, Bristol and Birmingham Offices. If you would like to attend one of the sessions please email Neil Grant.

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

Hospital Infection

Publications/Guidance
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.

Deep cleaning NHS Hospitals: Request for case studies. This is a letter from Chris Beasley, Chief Nursing Officer, seeking feedback from strategic health authorities on examples of good practice resulting from the deep cleaning NHS hospitals programme.

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

Human Organs and Tissue

Bevan Brittan Updates
New Rules For Cord Blood Collection. This update looks at questions such as:-

	Does your maternity unit collect cord blood at birth?
	Do you have an appropriate Human Tissue Authority Licence?

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

Inquests

Legislation
Draft Legislative Programme 2008/09: the Government has published its plans for legislative and key non-legislative action in next year's Parliamentary session. The final programme will be published in the Queen's Speech later this year. A proposed bill of particular interest is the Coroners and Death Certification Bill: aims to deliver an improved system of death investigation for families so that they can be assured that the cause of death of their relative has been properly established and that, where possible, lessons can be learned to prevent future deaths. This will include: the creation of a new national coroner service, and a new group of medical examiners to scrutinise independently the causes of death given by doctors on death certificates; a new system of secondary certification of deaths that are not referred to the coroner; new powers of investigation for coroners; and new rights of appeal against coroners' decisions.

Publications/Guidance
Pandemic Influenza: Guidance on the management of death certification and cremation certification. This document proposes changes to the procedures for death and cremation certification that could be used in a severe influenza pandemic in order to enable doctors to spend as much time as possible on the care of the living and to ensure that processes for death and cremation certification can be managed as effectively as possible during a pandemic.

Summary of responses to the consultation on improving the process of death certification. This document provides an overview of respondents' comments on the proposals to address weaknesses identified by the Shipman Inquiry in the process of death certification in England and Wales.

Common Themes from Analysis of 120 Prisons and Probation Ombudsman Reports. This letter, written by Richard Bradshaw, Director of Offender Health, deals with best practice issues on learning from Prisons and Probation Ombudsman reports on death in custody.

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

Mental Health

Legislation
Mental Health Act 2007: Commencement orders, regulations and other secondary legislation. This page gives information on the Mental Health Act 2007, including details of commencement orders, regulations and other secondary legislation.

Revised Mental Health Act 1983 Code of Practice and new secondary legislation. The government has published a revised Mental Health Act 1983 Code of Practice and new secondary legislation. Subject to Parliament they will come into force, along with the main changes to the 1983 Act, on 3 November 2008.

Publications/Guidance
The use of police stations as places of safety under section 136 of the Mental Health Act 1983. Home Office Circular 7/2008 details legislative changes addressing the unsuitability of detaining those with mental health problems in police stations. It includes guidance on when it is possible for a police officer to transfer a person from one place of safety to another before an assessment has been carried out. (See comment by Sainsbury Centre for Mental Health)

Paying the price: the cost of mental health care in England. This report from the King's Fund, the results of a year-long study into the costs of meeting the mental health needs of the nation over the next two decades, reveals that mental illness in England cost £50 billion in 2007. Almost half, £22.5 billion represents money spent on direct NHS and social care services to support people with mental disorders. The rest, £26.1 billion, represents the estimated cost to the economy of earnings lost because of the thousands of people unable to work due to their mental illness. Although it finds that the prevalence of most mental disorders, including schizophrenia, is likely to remain stable over the next 20 years, it predicts a huge increase in dementia - up by almost two-thirds (61 per cent) from 582,827 to 937,636 due to an ageing population. As a result of this, and above inflation rises in health care costs, the bill for mental health services is expected to grow from £22.5 billion to £47 billion. The report contains chapters on eight different specific disorders: depression, anxiety disorders, schizophrenic disorders, bipolar and related conditions, eating disorders, personality disorder, disorders affecting children and adolescents, and dementia.

Mental Health Act 2007: Report on the consultation exercises on the draft revised code of practice and secondary legislation. This report covers the results of a consultation on the Mental Health Act 2007 and secondary legislation.

Mental Health Act 2007 (Commencement No. 5 and Transitional Provisions) Order 2008 - guidance on transfers between places of safety: guidance for NHS bodies and social services authorities on the effect of the amendment to the Mental Health Act 1983 s.135 and s136, 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.

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.

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.

Smokefree mental health units from 1 July 2008. This letter highlights legislation that requires all mental health facilities to be smokefree from 1 July 2008. If you would like a copy of the Bevan Brittan update in relation to this case please email Claire Bentley.

Cases
X v NHS Trust [2008] EWHC 986 (Admin Ct). Where a hospital order had been made pursuant to the Mental Health Act 1983 s.37 and the 28-day period for compliance with the order had expired, the order nevertheless remained valid until set aside. Therefore, although the detention of the offender after the expiration of that period was technically unlawful, the obligation to comply with the order, albeit late, subsisted and his detention was lawfully justified.

R (G) v Nottinghamshire Healthcare Trust [2008] EWHC 1096 (Admin) (Admin Ct): the court has ruled that patients at Rampton Hospital, a high-security psychiatric hospital, will not be allowed to smoke in their rooms as they could not be permitted to risk the health of others or themselves. The patients applied to quash Reg.10(3) of the Smoke-free (Exemption & Vehicles) Regulations 2007 (SI 2007/765) on the grounds that it breached their right to respect for family life under Art.8 ECHR as it prevented them from smoking in "the privacy of their own home". The court held that preventing a person smoking does not generally involve such adverse effect upon the person's 'physical or moral integrity' as would amount to an interference with the right to respect for private or home life within the meaning of Art.8. It did not accept the notion of an absolute right to smoke wherever one is living. There was powerful evidence that, in the interests of public health, strict limitations upon smoking, and a complete ban in appropriate circumstances, were justified. Given the harm which smoking may cause, the measures taken by the Secretary of Health and the Trust were proportionate. If you would like a copy of the Bevan Brittan update in relation to this case please email Claire Bentley.

News
Department of Health announces Adult Autism Strategy. The Government's first strategy on adults with autism and Asperger's syndrome will be published late in 2008, following investment of £500,000 into research on the number of adults with the condition and their specific transition needs.

The latest national statistics on Attitudes to Mental Illness produced by the Department of Health were released on 8 May 2008 according to the arrangements approved by the UK Statistics Authority.

Bevan Brittan Training
The changes to the Mental Health Act 1983 will be in place by October 2008.The Mental Health Law Team at Bevan Brittan offers a 3 hour course covering issues raised by the Act as well as bespoke packages tailored to specific needs. Click here for details of the Bevan Brittan Mental Health Act Training.

Dramatic changes are taking place in the way that health and social care are provided, regulated and commissioned. In September Bevan Brittan is holding its annual Regulated Care Sector Seminar 2008. This seminar which is free of charge will provide you with valuable information to enable your business to prepare for the changes that are afoot. The seminar will take place in our London, Bristol and Birmingham Offices. If you would like to attend one of the sessions please email Neil Grant.

Bevan Brittan Booklets
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.

Patient

Publications/Guidance
National survey of adult inpatients 2007. The Healthcare Commission has published its fifth survey of inpatients to be carried out since 2002. In the biggest survey of patients staying overnight in English NHS hospitals, 42 per cent of respondents gave their care the top possible rating, up from 38 per cent in 2002, and an increase from 41 per cent in the last survey. The survey also shows that satisfaction with overall care remains high with the proportion of patients saying their care is “good”, “very good” or “excellent” at 92 per cent. But the Healthcare Commission added that there were variations in the responses of patients at different NHS trusts, 77 per cent of patients rated their care as “excellent” in the best performing trust, but only 24 per cent in the lowest-performing. The survey, coordinated for the Healthcare Commission by the Picker Institute, considered responses from just under 76,000 recent adult inpatients at 165 hospital trusts in England.

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. If you would like a copy of the Bevan Brittan Update on this case please email Claire Bentley.

Project London: report and recommendations 2007. The humanitarian aid organisation, Médecins du Monde UK (MdM UK; also known as Doctors of the World UK) has released this report of two years of operating a free medical clinic based in London. The clinic provides healthcare on a temporary basis, while helping migrants access mainstream health services to which they are entitled. The team consists of trained, qualified GPs, nurses and support workers who volunteer their time to make this happen.

Consent: patients and doctors making decisions together. The General Medical Council (GMC) has published guidance on the importance of the doctor-patient partnership. It sets out the key principles of good decision making, which apply to all care, from simple treatments for minor conditions to major surgery. The guidance will come into effect from 2 June 2008. It replaces Seeking patients’ consent: the ethical considerations.

Report on self reported experience of patients from black and minority ethnic groups. A report and analysis published jointly by the Department of Health and the Healthcare Commission which examines variations in the self-reported views of National Health Service patients from different ethnic groups across a range of healthcare settings.

No patient left behind: How can we ensure world-class primary care for black and ethnic minority people? The 2007 GP Patient Survey highlighted significant variations between GP practices in levels of patient satisfaction, together with lower satisfaction rates for people from some BME groups. In response, the Secretary of State announced in July 2007 that he was asking Professor David Colin-Thomé, National Clinical Director for Primary Care, and Professor Mayur Lakhani (former Chair of the RCGP) to lead two reviews into access and responsiveness of primary care services. In this report, Professor Lakhani looks specifically at the reasons for lower satisfaction among patients from some BME communities.

An Accreditation Scheme for Health and Social Care Information: Next steps and testing phase. This letter sets out the next steps for the information accreditation scheme, which will improve patients' experiences by making it easier for them to judge the quality of information and make decisions about their health, health care and social care.

Cases
R (A) v West Middlesex University Hospital NHS Trust [2008] EWHC 855 (Admin) (Admin Ct, 11 April 2008): the court held that 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 UK for NHS services, was unlawful. If you would like a copy of the Bevan Brittan Update on this case please email Claire Bentley.

R (Eisai Ltd) v National Institute for Health & Clinical Excellence; Shire Pharmaceuticals Ltd and Association of the British Pharmaceutical Industry (Interveners) [2008] EWCA Civ 438 (CA, 1 May 2008): the court held that NICE had 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. The Court of Appeal (CA) has ruled that the National Institute for Clinical Excellence (NICE) must disclose how it measures the benefits of novel treatments. The case was brought by the manufacturers of an Aricept, an Alzheimer's drug, which NICE ruled should not be prescribed to patients with mild symptoms, as the cost-benefit model it uses to assess new treatment failed to show that it provided good value. NICE was adjudged to have acted unfairly in making its appraisal of the drug but then refused the manufacturers full access to its cost-benefit model, a move which the CA has now ruled unlawful. The manufacturers, Eisai and Pfizer, will receive the full details of the model and make new representations to NICE which will then make a fresh appraisal of the drug. The ruling could also affect other appraisals NICE has made using economic models.

Bevan Brittan Updates
Failed asylum seekers and entitlement to free NHS treatment.

Changes in the law on Abortion

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

Primary Care Trust

Publications/Guidance
Framework for managing choice, cooperation and competition. This Framework supports SHAs and PCTs in understanding the roles, responsibilities, values and behaviours required for the effective management of choice and competition within the NHS. It should be read in conjunction with the Principles and Rules for Cooperation and Competition, published as Annex D of the 2008/9 Operating Framework, and the PCT Procurement Guide (see below). The DH will be issuing a further series of tools and guidance for system managers throughout the year.

PCT Procurement Guide for Health Services. The PCT Procurement Guide for Health Services provides guidance for primary care trusts (PTCs) on the procurement of health services through formal tendering and market-testing exercises. It sets out the policy and regulatory context for procurement, and issues to consider when developing a procurement strategy. The Guide should be read in conjunction with the Principles and Rules for Cooperation and Competition, published as Annex D of the 2008/9 Operating Framework, and the Framework for Managing Choice, Cooperation and Competition (see above)

NHS Next Stage Review: Leading Local Change. A Department of Heath report, published ahead of nine local SHA visions to be outlined in a final report in June 2008, sets out five pledges on how the NHS will manage changes to services. According to the report PCTs now have a duty to ensure: changes are of benefit to patients; changes are clinically driven; all change is locally-led; patients, carers, the public and other key partners are involved in changes; and existing services are not withdrawn until new and better services are available.

Pandemic Flu Planning: Agreement on general practice remuneration - Guidance note for primary care trusts. This guidance details the ministerially endorsed agreement reached between NHS Employers and the BMA's general practitioners committee on the maintenance of income where general practices are involved in responding to a pandemic influenza.

Consultation on Business Case Approval Guidance for Primary Care Trusts with existing LIFTs. Draft guidance for PCTs on completing a business case for new projects with existing NHS Local Improvement Finance Trust companies (LIFTs).

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

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.

When to share information: best practice guidance for everyone working in the youth justice system. This guidance has been developed as a cross-governmental initiative on behalf of Department of Health, Department for Children, Schools and Families, the Youth Justice Board and the Prison Service. The guidance is set out in a pathway approach, with best practice case studies used to identify when, what, where and how information needs to be shared to ensure improved outcomes for children and young people, as outlined in Every Child Matters: Change for Children.

Shortchanged - Spending on Prison Mental Health Care. A report published by the Sainsbury Centre for Mental Health shows that prison inreach teams get £300 in funding for every prisoner in England. This is only about one-third of what they need to offer the same level of service as community mental health services. Short-changed finds that there is wide variation in funding for prison mental health care which cannot be explained by higher costs or different needs between regions. Some 4,700 prisoners now get support from inreach teams. But this is much less than the estimated one in twelve prisoners who has severe mental health problems.

Common Themes from Analysis of 120 Prisons and Probation Ombudsman Reports. This letter, written by Richard Bradshaw, Director of Offender Health, deals with best practice issues on learning from Prisons and Probation Ombudsman reports on death in custody.

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

Regulation

Cases
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.

General Medical Council v Das (Unreported) (Admin Ct, 7 May 2008). Where complaints made about nursing homes run by a medical practitioner were the subject of an ongoing criminal investigation, an order imposing conditions on his practice was extended by 12 months.

Chyc v General Medical Council [2008] EWHC 1025 (Admin) (Admin Ct). Where a doctor had been found guilty of serious professional misconduct and his name erased from the medical register, an appeal under the Medical Act 1983 s.40 against the findings of fact of a fitness to practise panel was dismissed, as the panel had been plainly entitled to come to such conclusions on the evidence and had taken full opportunity to consider that evidence carefully and conscientiously.

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.

News
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.

Bevan Brittan Training
Dramatic changes are taking place in the way that health and social care are provided, regulated and commissioned. In September Bevan Brittan is holding its annual Regulated Care Sector Seminar 2008. This seminar which is free of charge will provide you with valuable information to enable your business to prepare for the changes that are afoot. The seminar will take place in our London, Bristol and Birmingham Offices. If you would like to attend one of the sessions please email Neil Grant.

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

General

Publications/Guidance
Draft Legislative Programme 2008/09: the Government has published its plans for legislative and key non-legislative action in next year's Parliamentary session. The final programme will be published in the Queen's Speech later this year. Proposed Bills of particular interest to health bodies are:

		National Health Service Reform Bill: will take forward those proposals arising from Lord Darzi’s NHS Next Stage Review of the NHS in England that would require legislation to enable their implementation. This would include: provisions on publishing an NHS Constitution; enabling and encouraging PCTs to be more responsive to their local communities; and giving greater scope for patients to shape the care they receive;
		Coroners and Death Certification Bill: aims to deliver an improved system of death investigation for families so that they can be assured that the cause of death of their relative has been properly established and that, where possible, lessons can be learned to prevent future deaths. This will include: the creation of a new national coroner service, and a new group of medical examiners to scrutinise independently the causes of death given by doctors on death certificates; a new system of secondary certification of deaths that are not referred to the coroner; new powers of investigation for coroners; and new rights of appeal against coroners' decisions; and
		Equality Bill: aims to make Britain a fairer place where people have the opportunity to succeed whatever their race, gender, disability, age, sexual orientation, religion or belief. This will be achieved through: a single Equality Duty on public bodies; making public bodies more transparent; extending existing positive action measures; and consolidating existing legislation into one Act.

Comments on the draft legislative programme as a whole, and also on specific policy issues and individual Bills, are required by 6 August 2008.

Our NHS Our Future: NHS next stage review - Leading local change. This report forms part of Lord Darzi's NHS Next Stage Review. It presents local visions for the NHS and the principles that will guide their implementation. In it he issued five pledges to the public and staff on how the NHS will handle changes to services. They are:

		change will always be to the benefit of patients
		change will be clinically driven
		all change will be locally-led
		the local NHS will involve patients, carers, the public and other key partners
		existing services will not be withdrawn until new and better services are available to patients.

Published alongside this document is Changing for the better: guidance when undertaking major changes to NHS services which refers to eight key steps to deciding on substantive service changes to make the five pledges a reality.

Evaluation of Early Medical Abortion (EMA) pilot sites: final report. This evaluation report was commissioned by the DH to assess the safety, effectiveness and acceptability of EMAs in non-traditional settings, and to help establish a protocol to cover the elements and processes required for the delivery of a safe EMA service in non-traditional settings.

Working with Black and Minority Ethnic Communities: A guide for Stop Smoking Service managers. Stop Smoking Services play a key role in the overall tobacco control approach, along with measures such as tackling contraband tobacco and working with young people. This document aims to support Stop Smoking Managers who are trying to make their services accessible to people from Black and Minority Ethnic (BME) communities.

News
Internet developments that brought us sites such as Facebook, YouTube and Wikipedia are now set to revolutionise healthcare, according to a new research report from online news service and publisher, E-Health Insider. Titled 'Web 2.0 in the Health Sector: Industry Review with a UK perspective' the report concludes that new applications based on social health networks and content generated by health service users themselves - such as reviews of doctors and hospitals - will rapidly evolve to challenge existing healthcare systems and create new ways of delivering our healthcare.

Bevan Brittan Services
Bevan Brittan has a comprehensive library service and a specialist team of Practice Support Lawyers who concentrate on effective knowledge management and professional support. We also provide training and advice at Trust offices reviewing the management of their knowledge generally and advising how to put systems in place to effectively manage their knowledge. Click here to view our flyer on the Bevan Brittan Knowledge Management Services in Health. If you would like more information please contact Claire Bentley.

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