Health and Social Care Update - December 2009

This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

01/12/2009

Legal intelligence for professionals in health and social care

This Update prepared by Claire Bentley contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

  Care   Foundation Trusts
  Children   Health and Safety
  Clinical Management   Healthcare Associated Infection
  Clinical Research   Inquests
  Commissioning   Mental Health
  Complaints   Primary Care Trust
  Data Protection   Prison Health
  Employment/HR   Regulation
  Finance   General
     
  

 

Care

Publications/Guidance
Dignity in care: input assessment - DH interventions. This review aims to answer whether the dignity in care campaign is making a difference to the way services are being provided and commissioned across health, social care, local authorities and the independent sector and the way people experience care.

Walk a mile in my shoes: scrutiny of dignity and respect for individuals in health and social care services: a guide. This guide will assist Overview and Scrutiny Committees to raise awareness and understanding of dignity and respect for individuals who are receiving health and social care services.

The real cost of quality care and support. This report was published as a response to the green paper on the future funding of care and claims that more resources are needed to fund better quality care. The report found that care services with high star ratings spend up to 20% more on staff and their training, development and management, as well as putting service users at the centre of everything they do. Not-for-profit providers consistently get better quality ratings.

Personalisation briefing: implications for residential care homes. This briefing examines the implications of the personalisation agenda for managers of residential care homes.

Care Quality Commission: A guide to the new system of registration. This publication gives an overview of the new system of registration for health and adult social care in England. It describes the main features of the new system and highlights the key dates involved.

Care Quality Commission: The scope of registration. This publication is for people and organisations that provide, or are intending to provide, healthcare or adult social care in England. It is to help them understand whether they need to register with the Care Quality Commission under the Health and Social Care Act 2008. It is not a definitive description of the law, but it aims to help those providing services and answer as many of their questions as possible.

Care Quality Commission: NHS trusts - How to apply for registration: overview. This is a short guide informing NHS trusts how to apply for registration, which will become necessary from 4 January 2010.

Consultations
Personal Care at Home: A consultation on proposals for regulations and guidance. This consultation seeks views on proposals for regulations and guidance made under the Personal Care At Home Bill. The consultation will last from 25 November 2009 until 23 February 2010, but the Department would very much welcome earlier responses, if possible, by 26 January.

Charging for residential care: the property disregard and partners under 60. This letter to local authority chief executives seeks views on a proposal to amend the National Assistance (Assessment of Resources) Regulations 1992 (SI 1992/2977) to reflect the longstanding policy and practice of disregarding property where a partner aged under 60 continues to reside in the family home. The consultation closed on 26 November 2009.

Legislation
Draft Health and Social Care Act 2008 (Regulated Activities) Regulations 2009. These draft regulations detail the new framework against which the Care Quality Commission will regulate providers of health and adult social care. The requirements set out the essential levels of safety and quality of care that providers must deliver for people who use their services, but gives them flexibility on how they do it. Subject to approval by Parliament, the new system will be introduced for NHS healthcare providers in April 2010 and for private and voluntary health care and adult social care providers from October 2010, making it illegal for organisations to provide services that fall under the new framework without registering.

Queen's Speech - Personal Care at Home Bill. The Government intends to introduce a Bill that guarantees free personal care for the 280,000 people with the "highest needs", such as those with serious dementia or Parkinson's disease. It will protect the savings of the 166,000 people who currently get free care, saving them from having to pay future charges. It also promises to help 130,000 people needing to enter care homes for the first time to "regain their independence", and offers adaptations to the neediest people's homes to increase their independence. The Bill will apply to England only.

Health and Social Care (Independent Living) Bill. This Private Members' Bill has been introduced into Parliament by Lord Ashley of Stoke and received its 1st Reading in the Lords on 23 November 2009. Clause 1 states that "The purpose of this Act is to ensure that disabled persons enjoy the same choice, freedom, dignity, control and substantive opportunities as persons who are not disabled at home, at work, and as members of the community, and consequently to ensure that families and carers of disabled persons enjoy greater health, wellbeing, equality and opportunities to participate in social and economic life". It sets out 13 general principles that apply for the purposes of the Act. The Bill imposes various duties on local authorities and NHS bodies, including a duty to promote independent living for disabled persons; it also confers certain rights upon disabled persons for independent living.

Personal Care at Home Bill. This Bill has been introduced into Parliament and had its 1st Reading in the Commons on 25 November 2009. It amends s.15 of the Community Care (Delayed Discharges etc) Act 2003 so as to remove the restriction on the period for which personal care may be provided free of charge to persons living at home. There are also Explanatory Notes and an Impact Assessment that gives a cost benefit analysis of the Bill's provisions. The Bill's progress through Parliament can be tracked on the Parliamentary Bills web page.

Bevan Brittan Updates
CQC Registration - step onto the level playing field. All NHS provider organisations will need to submit applications for full registration with the Care Quality Commission ("CQC") between 4 and 29 January 2010 as the regulator takes the next steps towards a single regulatory system across both the public and independent health sectors. 

Bevan Brittan Training
Neil Grant and Carlton Sadler are presenting at a Butterworth conference on Thursday 21 January  2010 entitled "Regulation of Health and Social Care Providers : A Brave New World." For more information click here. 

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

Back to top

Children

Publications/Guidance
Improving safety, reducing harm: children, young people and domestic violence: a practical toolkit for front-line practitioners. This toolkit provides specific information about children, domestic violence and related issues; an overview of Every Child Matters and the tiers of intervention; principles of commissioning services; risk assessment and safety planning information; guidance for schools; clear explanations of key standards and policies; sample forms and key fact sheets.

Meeting the health needs of children and young people: a guide for commissioners. Calls on NHS trusts to adapt to changing patterns of childhood disease in the community by investing in new community teams to better meet the needs of children and young people who are ill.

Commercial and procurement skills for commissioners of children's services. This page links to a set of guidance documents designed to help commissioners understand and apply commercial and procurement skills in their work. The documents cover the key principles of procurement, an overview of both strategic procurement and the contracting process, an overview of resource mapping and a basic jigsaw tool designed to help commissioners understand the key principles of change management.

Toolkit for high quality neonatal services. This guidance helps the NHS improve the care provided for premature and sick babies during their first days, with practical advice on how to improve the areas that really matter to parents. The Toolkit includes a set of eight principles for quality neonatal services and a framework to assist commissioners. It implements the Neonatal Taskforce's recommendations that neonatal care should become more family-centred to ensure the psychological as well as physical needs of babies and families are considered.

Children's services inspection by Ofsted with CQC. Ofsted have published their first inspection reports into safeguarding and services for looked after children, which include contributions by the Care Quality Commission (CQC) in the assessment of health partners. This three-year programme of inspection of services for children and young people within a local authority area commenced in June and will include all 152 English authorities. Details about the inspection framework are available on the Ofsted website. Reports are currently available for Devon, Staffordshire, Cambridge, Cornwall and North Yorkshire and York and can be found on the inspections section of the Ofsted website. More details of CQC’s involvement with inspection of health partners can also be found.

News
National Children’s Services Mapping Children’s Services Mapping. CSM is a voluntary on-line data collection exercise that has been in place since 2002. It is carried out annually and from 2008 collects information from PCTs, NHS trusts and LAs on the children’s services that they commission and provide. It describes the nature of children’ services provision, their investment, workforce and functions locally, regionally and nationally. It aims to support good practice commissioning to deliver improved outcomes for children, young people and their families. This year’s National CSM data collection commenced on Sunday 1st November and the website is now open for registration. PCTs and NHS Provider Trusts will take part as in previous years by nominating a senior member of staff to be the mapping lead. The mapping lead takes responsibility for co-ordinating the exercise and must register their individual organisation.

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

Back to top

Clinical Management

Publications/Guidance
Legal issues relevant to non-heartbeating organ donation. Sets out the DH's view of the legal position in relation to the action that can be lawfully taken prior to death to support non-heartbeating donation. The guide is produced in response to Recommendation 3 of the Organ Donation Taskforce Report which states that 'urgent attention is required to resolve outstanding legal, ethical and professional issues in order to ensure that all clinicians are supported and are able to work within a clear and unambiguous framework of good practice'. The intention is that those working in this area will be able to use it to draw up more detailed guidance to support clinical practice. This guidance is only applicable in England and Wales.

Managing patients' medicines after discharge. This CQC report looks at how well patients' medication is managed after leaving hospital. During its visits, the CQC saw some evidence of good practice, but also found the following concerns: GP practices and hospitals do not always share timely, complete patient information on medication changes when people move between services; reviewing and updating of GP records is sometimes left to administrative staff; GPs do not routinely review new medication with a patient after they leave hospital; and monitoring and learning from serious incidents is patchy. From April 2010, all trusts will be required by law to register with CQC and must meet a new set of standards. Effective management of medicines will be a requirement of registration, and CQC will take action where trusts fall short of meeting this. The regulator therefore urges all trusts and GP practices to use the findings of its study to identify problem areas in preparation for registration.

Delivering same-sex accommodation (DSSA): principles. Lists the 17 principles that have been developed to ensure each organisation delivers the highest standards of privacy and dignity within all areas of a hospital, other trusts and providers. The principles support existing DSSA policy and guidance and aim to further clarify DSSA clinical definitions amongst leaders and staff within the NHS. It is intended for the principles to be used in conjunction with other guidance to drive forward improvement and ensure sustainability within each organisation.

Cases
Farraj v (1) King's Healthcare NHS Trust (2) Cytogenetic DNA Services Ltd [2009] EWCA Civ 1203 (CA). The Court of Appeal has held that a hospital did not owe a non-delegable duty of care in respect of the genetic testing of a tissue sample which was sent to be cultured by a reputable independent cytogenetics laboratory.

News
Accident and Emergency attendances: total time spent in A&E from arrival to admission, discharge or transfer; and waiting for emergency admission through A&E, quarter ending 30 September 2009. Statistics for Q2 2009/10. The Health Minister has issued a responses to A&E hospital episodes data claiming that the data shows that the overwhelming majority of A&E patients were seen within three hours, well within the four-hour standard.

Bevan Brittan Updates
Litigants in person. Managing the un-manageable: practical tips on dealing with Litigants in Person by Laura Hartwell and Julie Charlton.

Consent: Where are we now? Nicola Pegg reviews the recent case law post-Chester and suggests that the bar has been raised on Consent.

Cases update

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

Back to top

Clinical Research

Publications/Guidance
Making clinical research less of a trial: EU consultation on the functioning of the Clinical Trials Directive. The European Commission has launched a public consultation seeking views on how to improve the functioning of the Clinical Trials Directive. This consultation outlines the key issues raised and seeks views from NHS organisations.

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

Back to top

Commissioning

Publications/Guidance
Directions about reports on consultation with regard to commissioning decisions and relevant decisions 2009. These decisions trigger the duty on PCTs and SHAs to produce reports each year on consultation in relation to commissioning decisions, with effect from April 2010.

Real accountability: guidance on the NHS duty to report on consultation. Guidance on s.24A and s.17A of the NHS Act 2006 that, as from April 2010, will require all PCTs and SHAs that commission services to explain how they have acted upon feedback from patients and the public. This report aims to help the NHS get ready for the legislation. The guidance explains the legal obligations and provides practical help and advice in terms of preparing and publishing reports.

Commercial and procurement skills for commissioners of children's services. This page links to a set of guidance documents designed to help commissioners understand and apply commercial and procurement skills in their work. The documents cover the key principles of procurement, an overview of both strategic procurement and the contracting process, an overview of resource mapping and a basic jigsaw tool designed to help commissioners understand the key principles of change management.

Outline Service Specification: personalised care planning for people with long term conditions. This Outline Service Specification has been developed to assist NHS commissioners to put in place appropriate arrangements to ensure people with long-term conditions have informed choice of, and access to, services that best enable them to manage their condition.

World-class Commissioning for the health and well-being of people with learning disabilities. This is a practical guide to support commissioners to meet the needs of people with learning disabilities and ensure they are fulfilling their duty to promote equality.

Beyond practice-based commissioning: the local clinical partnership. This joint paper by the Nuffield Trust and the NHS Alliance examines how practice-based commissioning can be developed. While there may be many ways this could happen, this paper considers one broad model – that of multi-specialty groups of clinicians – for example GPs as well as hospital-based specialists – taking responsibility for the provision and commissioning of local healthcare.

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

Back to top

Complaints

At Bevan Brittan we have set up an e-portal to assist complaints managers in the NHS. The portal is of use to all NHS complaints managers who are often handling very sensitive and complex work. It provides tailored access to a range of up-to-date knowledge and information enabling you to have a central, structured and focused source of information on complaints.

It also has a discussion forum for use by complaints managers to share tips and knowledge with each other. Currents topics are:-
  Recording complaints and the PSHO
  Managing a complaint and legal proceedings
  Complaints procedure and the 2009 regulations
  Complaints training
  Aggregated data on complaints

If you would like more information about the portal and the discussion forum please contact Claire Bentley.

Back to top

 

Data Protection

Publications/Guidance
Nothing but the truth? a discussion paper. Sets out important issues as the basis for discussion on how to ensure data about local public services is fit for purpose. It asks if citizens, along with frontline staff, managers, politicians, central government and local public service regulators, can have confidence in the data they rely on and, if not, what needs to be done about it.

News
New accreditation scheme for health information providers. The Information Standard has been launched as a kite-mark scheme to enable consumers of health and social care information (members of the public) to be assured that they are accessing reliable trustworthy information sources. Rather than assessing information materials separately, the scheme will operate by assessing the processes that providers of information go through to produce materials. Participation in the assessment is voluntary for all types of information producers and some of the examples of the types of criteria needing to be met to receive the quality mark include: a commitment to producing high quality information that is updated as needed and clear awareness and documentation of the particular needs of the target audience and how these will be met.

Summary Care Records launched in London. The DH has launched the Summary Care Record scheme in London. A Summary Care Record is a secure electronic summary of core information, such as medications, allergies, adverse reactions and key health information, derived initially from the patient’s GP record and added to as necessary by other healthcare staff treating the patient. It enables key medical information about the patient to be accessible wherever the patient is treated. The first records to be created in London are due to be uploaded in Southwark at the Princess Street Group Practice on 19 November. Everyone living in the capital will be written to, outlining the initiative, and offering them the choice to opt out of having a Summary Care Record created.

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

Back to top

Employment/HR

Publications/Guidance
Improving staff engagement: a practical toolkit. This briefing provides pointers on how to get staff engagement rights and offers tips that have high impact at low cost. In addition it also looks at the roles managers have to play in ensuring staff are clear on what is expected of them as identifying where employees know what is expected dramatically improves performance and engagement levels.

Clinical Leadership Development Programme. This letter to SHAs discusses the development of the Clinical Leadership Fellowship programme.

NHS workforce and planning: limitations and possibilities. This report recommends that the emphasis of workforce planning should not be solely on ‘new’ recruits but on how the system can develop new skills for those who are already employed in the service. It concludes that the focus should be on developing a flexible approach to workforce planning that doesn’t seek long-term precision but can enable the current workforce to evolve and adapt to the health care environment.

Leading the NHS workforce through to recovery. This briefing looks at the way that employers who have worked through past and present challenges adjusted their workforce and HR strategies to meet them, and urges immediate action from workforce leaders to meet the challenges ahead. 

Pension choice? Career and retirement options for the NHS. This briefing is for boards and human resource directors in NHS organisations in England. It covers the strategic issues and potential risks for boards in relation to the NHS Pension Choice exercise. It outlines how good employment practice during the Choice exercise will help organisations to support staff, retain skills and prepare for the future.

Reaping the rewards: retraining refugee healthcare professionals for the NHS. This briefing explores the benefits for the NHS in supporting and employing refugee healthcare professionals. It provides information about refugees’ right to work in the UK, a framework for engagement for the NHS, as well as showcasing the work of trusts in this area.

Guidance for employers on promoting mental wellbeing through productive and healthy working conditions. The guidance is for those who have a direct or indirect role in, and responsibility for, promoting mental wellbeing at work. This includes all employers and their representatives, irrespective of the size of the business or organisation and whether they are in the public, private, or voluntary sectors.

Medical Training Initiative (MTI) guide. This guidance is designed to allow overseas doctors to undertake up to two years of training and experience in the UK. It explains the benefits of the MTI and signposts additional information.

Developing specialties in medicine: Protocol for handling applications for new Certificate of Completion of Training specialties, new sub-specialties and for decommissioning specialties which are no longer needed. This document gives information on training certificates for new and older medical specialties. It lists the protocol for handling applications for new CCT specialties, and for decommissioning specialties which are no longer needed. 

NHS health and well-being review. The DH has published the final documents of an independent review of the health and well-being of NHS staff that was commissioned in November 2008 to take forward Dame Carol Black’s review of the health of Britain’s working age population "Working for a healthier tomorrow". The review, chaired by Dr Steve Boorman, gathered and analysed evidence relating to health and well-being across the service, to provide the DH with a better understanding of health and well-being in the NHS, and its links to productivity, efficiency, and patient experience. If the report's recommendations are implemented, NHS organisations could see a reduction in staff sickness absence, an improvement in the quality of patient care and potentially save the NHS around £555m each year. This web page links to the final report, the interim report, Dr Boorman's letter to Secretary of State and the DH's response, which sets out a proposed action plan for implementing the recommendations from Dr Boorman’s report across the NHS.  

Legislation
Criminal Justice and Immigration Act 2008 (Commencement No 13 and Transitory Provision) Order 2009. SI 2009/3074: Power to remove persons causing disturbance on English NHS premises from 30 November 2009.

Bevan Brittan Updates
Belief in Climate Change can Constitute a Philosophical Belief. The Employment Appeal Tribunal recently held in Grainger Plc & Others v Mr T Nicholson that a belief in climate change can constitute a philosophical belief for the purposes of the Employment Equality (Religion or Belief) Regulations 2003.  Mr Nicholson has therefore been given the green light to take his employer, Grainger Plc, to an Employment Tribunal for unfair dismissal on the grounds of his belief in climate change.  Nicola Stibbs reviews the impact of this decision.

Double Win for Bevan Brittan in Redundancy Pay Judgments. Two recent unanimous decisions in the Employment Tribunal have seen Bevan Brittan successfully defending claims for redundancy payments made against two different South West NHS Trusts.  In both cases, the Tribunals dismissed claims for redundancy payment, concluding that both individuals had unreasonably refused offers of suitable alternative employment. Mike Smith explains.

Employment Eye - News Round-up. Marie-Claire Boyle reports on the latest employment news.

Paying Small Pensions as Lump Sums - New Rules and Pitfalls. Beneficial changes are to be made from 1 December 2009 to the rules applying to the commutation of trivial pensions under the Registered Pension Schemes (Authorised Payments) Regulations 2009 (SI 209/1171).  From that date, occupational pension schemes and public service pension schemes are authorised to make “de minimis” lump sum payments of up to £2,000 to new and existing pensioners aged between 60 and 75 instead of paying small pensions from the scheme.

The EAT and Court of Appeal give useful guidance in two important cases. From chamois leather to sham contracts... The Court of Appeal, in the recent case of Autoclenz Ltd v Belcher and Others has revisited the much discussed issue of the importance of express contractual provisions in determining an individual's status as an employee, worker or self-employed contractor.  Jane Wallenstein explains more. Coleman v Attridge - EAT widens the scope of "associative" to any third party. Although the DDA prohibits discrimination in employment against a disabled person and harassment which relates to a disabled person’s disability, it does not expressly protect non-disabled individuals from discrimination or harassment based on their association with a disabled person.  Chloe Edwards sets out the latest position in this long running litigation. 

Back to top

Finance

Publications/Guidance
Means to an end: Joint financing across health and social care. This Audit Commission report finds that instead of concentrating on the mechanics of joint financing and partnership working, councils and the NHS should look at how their joint funding can improve people's lives.

The Audit Commission has published two reports on the quality of the work of its appointed auditors for its stakeholders. The first is the Audit quality review process. The second is the Audit practice annual quality report that summarises the results of the quality review of the work of the Audit Commission's own staff as auditors to local government and NHS bodies, including the views of the Audit Inspection Unit that carried out an independent review.

Auditors' Local Evaluation overview 2009/10. The Auditors' Local Evaluation assesses how well NHS trusts manage and use their financial resources and highlights areas for improvement.

Means to an end: Joint financing across health and social care. The central message of this report is that when using joint finance arrangements trusts need to have a clearer focus on Value for Money (VfM) and how it will improve patient's experience. Around 3.4 per cent of health and social care spending is currently pooled in some way. However this is rarely linked to any quantifiable outcome measures. From a limited evidence base, the report finds there is little sign that increased pooling has decreased lengths of stay, mental health admissions or falls among older people. The Audit Commission is now working with the Care Quality Commission to develop a tool with which trusts can apply a consistent set out performance measures for their joint finance arrangements.

The human factor: how transforming healthcare to involve the public can save money and save lives. This report examines the challenges faced by the National Health Service. It shows how radical new ways of innovating can reduce spending at the same time as increasing health and wellbeing.

More for less: Are productivity and efficiency improving in the NHS? This Audit Commission briefing paper looks at how NHS money has been spent, whether PCTs have been successful in keeping more patients out of hospital and whether hospitals have become more efficient. It highlights that the NHS is treating more patients at lower cost and trusts are starting to meet the challenges of the future.

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

Back to top

Foundation Trusts

Publications/Guidance
Toolkits on service line reporting. Service lines are the units from which the Foundation Trust’s services are delivered, each with their own focus on particular medical conditions or procedures and their own specialist clinicians. Service line management (SLM) uses the data from service line reporting (SLR), to develop an organisation structure and management framework within which clinicians and managers can plan service activities, set objectives and targets, monitor their service’s financial and operational activity, and manage performance. Monitor has published five toolkits on SLM and SLR that draw on evidence and best practice from UK pilot sites and the experience of healthcare providers worldwide who use similar principles and approaches within their healthcare systems:
1. Working towards service-line management: a how-to guide: sets out the processes and structures necessary to implement SLM within a trust setting using checklists, practical tools and examples of good practice;
2. Working towards service-line management: organisational change and performance management: looks at having the right organisation structure and the use of service-line data as a tool to manage performance, in order to maximise the benefits of the service line approach. This guide can be used by trusts who have already put in place SLR to gather financial and operational data; and
3. Guide to developing reliable financial data for service-line reporting: describes a process of seven steps towards the implementation of SLR. It also describes how trusts can overcome some of the obstacles that may arise when introducing SLR, and includes an example work plan for implementation;
4. Working towards service-line management: a toolkit for presenting operational service-line data: describes a range of SLR tools and shows how they can be used to present data about the performance of service lines; and
5. Working towards service-line management: using service-line data in the annual planning process: explains how trusts can work towards using SLR data in the annual planning process, with examples and principles gained from working with pilot trusts.

Consultations
Call for evidence - review of restrictions on private patient income: the NHS foundation trust private patient income cap. The Department of Health has launched a call for written evidence to inform a review of the 'private patient income cap' for NHS Foundation Trusts. Submissions must be made by 31 December 2009.

Consultation on additional annual reporting requirements 2009/10. Monitor is seeking views on proposals for additional annual reporting requirements for NHS foundation trusts for 2009/10. The proposals cover five main categories of reporting: Quality; Sustainability; Valuing people - Equality and diversity and Staff feedback; NHS Constitution; and Regulatory findings. The consultation document includes the examples of the proposed format of reporting in each of the above five categories, and indications as to how reporting requirements in each of these, and the related assurance, may be likely to develop. The consultation closes on 25 January 2010.

Back to top 

Health and Safety

Publications/Guidance
Improving safety, reducing harm: children, young people and domestic violence: a practical toolkit for front-line practitioners. This toolkit provides specific information about children, domestic violence and related issues; an overview of Every Child Matters and the tiers of intervention; principles of commissioning services; risk assessment and safety planning information; guidance for schools; clear explanations of key standards and policies; sample forms and key fact sheets.

Health Committee - first special report on patient safety. This report sets out the Care Quality Commission, Monitor, and Professor Sir Ian Kennedy's responses to the Health Committee's Sixth Report of Session 2008-09 on patient safety.

National confidential enquiry into patient outcome and death. A recent study by NCEPOD examines the care given to all patients older than 28 days who died within four days of admission to hospital between October 2006 and March 2007, in all hospitals in England, Wales and Northern Ireland. A total of 2,195 cases were included in the study, and the purpose was to identify where care could have been better and to recommend learning points. An expert panel judged that in 34 per cent of cases there was 'room for improvement,' and in nearly 5 per cent of cases care was 'less than satisfactory.' Some of their other key findings include: insufficient consultant involvement in assessments and diagnosis, interventional radiology equipment not being available 24 hours and low rates of interventions to prevent venous thrombo-embolism. 

If you wish to discuss any of the items raised in this section please contact Adam Kendall

Back to top

Healthcare Associated Infection

Publications/Guidance
Reducing healthcare associated infection in hospitals in England: 52nd report of session 2008-09. This is the third report from the Public Accounts Committee on healthcare associated infection. The report found that hospital cleanliness has improved and the priority given to reducing C difficile and MRSA has started to have an impact on overall infection prevention and control. However, it does also find evidence to suggest that progress has not been matched on other healthcare associated infections.

The Max4Health hand hygiene campaign. This report sets out the results of an evaluation of the Max4Health hand hygiene campaign undertaken at Southampton University Hospitals NHS Trust over a nine week period between February and April 2009.

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

Back to top

Inquests

Cases
Dowler v HM Coroner for North London (Unreported, 6 November 2009) (QBD). The court has held that it was appropriate, pursuant to s.13 of the Coroners Act 1988, for a coroner's inquest to be quashed and for a new inquest to be held before a different coroner where a number of breaches of the Coroners Rules had occurred, and where criticisms of a general practitioner made by the coroner meant that it was inappropriate for the same coroner to hear the new inquest.

Legislation
Coroners and Justice Act 2009. This Act has received Royal Assent. It includes the first major reforms for over 100 years of the coroner system by creating a new framework for England and Wales, establishing more consistent inspection and quality standards, and incorporating new rights of appeal for bereaved families who are unhappy with a coroner’s decision. The new Coroners’ Service, with national leadership provided by a new Chief Coroner, will reduce delays and improve the quality of investigations and inquests through improved powers and guidance for coroners. The Act comes into force on various dates, including 12 November 2009, 1 January 2010, 12 January 2010, and appointed days.

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

Back to top

Mental Health

Publications/Guidance
Report from the Ministerial Summit on dementia research. One of the commitments made in the National Dementia Strategy was to hold a ministerial summit on dementia research. This took place on 21 July 2009. The independent report of the event is now available. The DH has also announced, following the Summit, that it is establishing a new ministerial group that will drive forward research into the causes, cure and care of dementia. The new group, chaired by Care Services Minister Phil Hope, will also focus on increasing the volume, quality and impact of dementia research.

Applying the NHS performance framework to mental health trusts. This document informs mental health trusts, PCTs and SHAs of the criteria against which mental health performance will be assessed. It should be read alongside Implementing the NHS Performance Framework.

Preventing suicide: a toolkit for mental health services. The toolkit, originally published in 2003, has been amended to reflect recent policy changes and has had input from key stakeholders, service users, carers and experts.

Swine flu H1N1: updated guidance for mental health services in England. This is updated guidance for mental health services and partners on planning and responding to the swine flu H1N1 pandemic.

A civilised society: mental health provision for refugees and asylum-seekers in England and Wales. Mind has found evidence that the UK's complex asylum seeker process, detention centres and aspects of UK life are actively worsening the mental health of refugees and asylum seekers. This report claims that a lack of support and resources for refugees and asylum seekers is both exacerbating pre-existing mental health conditions and triggering them in the first place. In a related report, Mind worked with Refugee Community Organisations (RCOs) to examine the role they play in refugee and asylum seeker mental health and found that PCTs and Local Authorities need to do more to improve their engagement with RCOs and develop more culturally appropriate services.

Improving health, supporting justice: the national delivery plan of the Health and Criminal Justice Programme Board. This report contains the Government's national delivery plan for health and criminal justice as developed by the Health and Criminal Justice Programme Board. This builds on Lord Bradley's 2009 review of mental health and learning disability in the criminal justice system. It contributes to key government initiatives around protecting the public, reducing health inequalities, reducing reoffending and health improvement and protection.

Counting the cost: caring for people with dementia. This report finds that people with dementia, who occupy a quarter of all hospital beds, are staying in hospital far longer than people without the condition who go in for treatment. The report is based on research involving 2,400 people on hospital wards and calls for all hospitals to reduce the average length of stay for a person with dementia by at least a week.

Promoting mental wellbeing at work. This NICE guidance is intended to offer employers of all sectors evidence-based advice about what they can do to promote mental wellbeing through 'productive and healthy working conditions.' Such conditions encompass both the emotional and physical aspects of work, including just reward, satisfaction and prospects for development, level of control over work, job stability, as well as noise, dust, and other hazards. According to the guidance employers should: ensure a whole-organisation approach to improving the mental wellbeing of their employees, put systems in place for assessing and monitoring their mental wellbeing and offer and support flexible working where practical.

Report on the prescribing of anti-psychotic drugs to people with dementia. Presents the findings of an independent clinical review of the use of anti-psychotic drugs in care for people with dementia. It concludes that the drugs are being wrongly prescribed to around 145,000 patients a year. The Minister for Care Services Phil Hope has pledged to appoint a Clinical Director for Dementia who will carry out an audit of doctors' prescribing of anti-psychotic drugs.

For those who served: Meeting the healthcare needs of veterans in England. This leaflet (with accompanying poster) has been produced by the Department of Health in partnership with the Royal British Legion. It is aimed at military veterans and provides information on accessing priority treatment (subject to clinical need). It also signposts where additional help can be provided in relation to mental health issues.

Mental health and the economic downturn. In September 2009 a one-day meeting on mental health and the economic downturn was held which explored the impact the downturn was having on mental health, as well as where some of the solutions may lie for those working at a local and national level in service provision and policy. This briefing builds on the outcomes of that meeting, outlining the challenges facing the sector and setting out how policy makers, organisational leaders and health and social care professionals should respond.

World-class Commissioning for the health and well-being of people with learning disabilities. This is a practical guide to support commissioners to meet the needs of people with learning disabilities and ensure they are fulfilling their duty to promote equality.

Legislation
Autism Act 2009. The Autism Bill has received Royal Assent. The Act is the first ever disability-specific law in England. It requires the Secretary of State to draw up an autism strategy, along with guidance on the implementation of that strategy which NHS bodies and local authorities must follow. The Act comes into force on 12 January 2010.

News
Responding to media coverage regarding who has the authority to manage a person's affairs if they lose their mental capacity, the Government has agreed for Sir Mark Potter, President of the Court of Protection, to set up a committee to review the current Court of Protection rules to ensure that they provide an efficient and effective service.

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

Back to top

Primary Care Trust

Publications/Guidance
More for less: Are productivity and efficiency improving in the NHS? This Audit Commission briefing paper looks at how NHS money has been spent, whether PCTs have been successful in keeping more patients out of hospital and whether hospitals have become more efficient. It highlights that the NHS is treating more patients at lower cost and trusts are starting to meet the challenges of the future.

Real accountability: guidance on the NHS duty to report on consultation. Guidance on s.24A and s.17A of the NHS Act 2006 that, as from April 2010, will require all PCTs and SHAs that commission services to explain how they have acted upon feedback from patients and the public. This report aims to help the NHS get ready for the legislation. The guidance explains the legal obligations and provides practical help and advice in terms of preparing and publishing reports.

Legislation
Directions about reports on consultation with regard to commissioning decisions and relevant decisions 2009. These Directions are issued under s.17A, s.24A and s.8 of the NHS Act 2006, and trigger the duty on PCTs and SHAs to produce reports each year on consultation in relation to commissioning decisions, with effect from April 2010. The first reports will cover the period April 2009 to March 2010 and will be produced before the end of September 2010.

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

Back to top

Prison Health

Publications/Guidance
Action plan on offender health is launched. A cross-government action plan to improve the health of offenders in prison aims to: ensure there are liaison and diversion services which assess individuals' health needs in all courts over the next five years; train staff across the criminal justice system to identify where health issues may need to be addressed and share information across the different elements of the system that come into contact with that individual; ensure that offenders have access to the same levels of healthcare as everyone else; and improve continuity of care by developing care pathways that enhance health and social care provision and contribute to the delivery of justice.

Bevan Brittan Training
Medical law: annual prison health update.10 December 2009 : 14:00 - 18:00. Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. 3 years has now passed since all Primary Care Trusts took over responsibility for commissioning prison health services in their local prisons.

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

Back to top

 

Regulation

Publications/Guidance
Getting ready for registration. Legislation introducing a new registration system for all regulated health and adult social care services in England has now been laid before Parliament. To help care providers get ready for registration, the Care Quality Commission has published three short guides: a guide to the new system of registration; the scope of registration; and NHS trusts: how to apply for registration overview.

Care Quality Commission: A guide to the new system of registration. This publication gives an overview of the new system of registration for health and adult social care in England. It describes the main features of the new system and highlights the key dates involved.

Care Quality Commission: The scope of registration. This publication is for people and organisations that provide, or are intending to provide, healthcare or adult social care in England. It is to help them understand whether they need to register with the Care Quality Commission under the Health and Social Care Act 2008. It is not a definitive description of the law, but it aims to help those providing services and answer as many of their questions as possible.

Care Quality Commission: NHS trusts - How to apply for registration: overview. This is a short guide informing NHS trusts how to apply for registration, which will become necessary from 4 January 2010.

Response to the report and recommendations of the Review of the Conduct Function of the General Social Care Council. This document sets out the Government's response to the report and recommendations of the Council for Healthcare Regulatory Excellence's review of the General Social Care Council's conduct function. The review was commissioned following the discovery of a backlog of conduct cases at the GSCC.

General Social Care Council (GSCC) response to CHRE report into its conduct function.

Response to the consultation on draft regulations for the framework for the registration of health and adult social care providers. In spring 2009, the Department of Health consulted on a set of draft regulations, which set out the detail of a new registration system to be operated by the new Commission. This document provides the response to the consultation.

Consultations
Regulatory fees – have your say: Fees for National Health Service providers that are registered under the Health and Social Care Act 2008 from April 2010. From April 2010, NHS providers must pay fees for their registration with the Care Quality Commission under the Health and Social Care Act 2008. This consultation seeks views on proposals for an interim scheme of fees for NHS providers while the registration system is being phased in during 2010-11. The CQC will consult in late 2010 on a single long term fee proposal for all health and social care, effective from April 2011 onwards. The consultation closes on 26 January 2010.

News
Monitor's November Newsletter.

Bevan Brittan Updates
CQC Registration - step onto the level playing field. All NHS provider organisations will need to submit applications for full registration with the Care Quality Commission ("CQC") between 4 and 29 January 2010 as the regulator takes the next steps towards a single regulatory system across both the public and independent health sectors.

Bevan Brittan Training - January 2010
Neil Grant and Carlton Sadler are presenting at a Butterworth conference on Thursday 21 January  2010 entitled "Regulation of Health and Social Care Providers : A Brave New World." For more information click here.

Bevan Brittan Training - February 2010
Preparing for the New Regulatory System: Registration, Inspection, Compliance and Enforcement. From April 2010 onwards, the Care Quality Commission will extend the scope of its regulatory remit over providers of health and adult social care services in both the public and independent sectors.  All providers who undertake “regulated activities” will be required to be properly registered under the Health and Social Care Act 2008.  The key changes will be:-
 NHS Providers:  registration which, to date, has been based solely on compliance with the Code of Practice on Healthcare Associated Infections (HCAIs), will be extended and measured against a new set of requirements and standards governing all aspects of the running of the organisation.  These requirements will replace the Standards for Better Health.
 Social Care and Independent Healthcare Providers: from October 2010 services will require registration under the 2008 Act, rather than the Care Standards Act 2000.
This will mean:-
 A wider scope of services requiring registration. 
Applications having to be made for registration to enter the new system.
 A new set of registration requirements and guidance to comply with.
 Wider and more robust enforcement tools for the regulator.

Following on from our successful September 2009 seminars on regulation, Bevan Brittan is running two additional free training sessions on the New Regulatory System at our London office from 10am -12.30pm on 17 February 2010 and at our Birmingham office from 10am - 12.30pm on 24 February 2010.

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

Back to top

 

General

Publications/Guidance
Future health: sustainable places for health and well-being. Drawing on examples and research, this report shows how good planning can have a positive impact on public health, how health trusts can cut carbon and costs by co-locating services, and how designers can influence people's well-being. The report will be of interest to health trusts, planners, policymakers and premises providers.

Safe management and use of controlled drugs. This letter highlights the recommendations in the recently published annual report of the Care Quality Commission on the safer management of controlled drugs and the responsibilities of trust chief executives to support their accountable officers in their day-to-day role in delivering these recommendations.

Wellcome Trust: The health benefits of tackling climate change. Executive summary of a study prepared for The Lancet that models the effects of different policies to reduce greenhouse gas emissions in high and low-income countries. Case studies focus on power generation, transport, household energy, food and agriculture. The report calls on health ministers and professionals across the world to recognise the danger that climate change poses to health, in the run up to the UN conference in Copenhagen in December.

Medical technology: can we afford to miss out? In this report, the Medical Technology Group warn that any cuts to NHS technology budgets would cost more in the long-run and risk damaging the quality of life of thousands of patients with diabetes, heart disease and other long-term conditions.

Integrated care and support plan (ICSP): high level process. This document describes the collaborative approach used to develop a high-level, generic model for integrated care and support planning and specifically, how Common Assessment Framework messaging would be used to support the sharing of care and support planning information between health and social care systems.

Real accountability: guidance on the NHS duty to report on consultation. Guidance on s.24A and s.17A of the NHS Act 2006 that, as from April 2010, will require all PCTs and SHAs that commission services to explain how they have acted upon feedback from patients and the public. This report aims to help the NHS get ready for the legislation. The guidance explains the legal obligations and provides practical help and advice in terms of preparing and publishing reports.

Choice at the point of referral. For the past three years patients referred by their GP for a specialist outpatient consultation have had a choice over where to be treated. As part of a larger research project, a survey was sent to patients in four case study areas of England to ask them about their experience of referral and choosing a hospital for treatment. This report summarises survey findings and shows that implementation of the policy is not yet complete, and that most patients do not experience referral as the policy envisaged.

Achieving age equality in health and social care. This review, undertaken by Sir Ian Carruthers and Jan Ormondroyd, takes into consideration the experiences of patients, service users and carers and supports the implementation of age provisions within the proposed Equality Bill.

Emergency planning: development of an integrated plan for the management of blood shortages. This paper updates the integrated plan for blood shortages released in 2004 and the NHSBT external document ESD/PCS/HL/001/012 released in January 2005. The original plan was prepared by the Chief Medical Officer's National Blood Transfusion Committees (NBTC) subgroup on contingency planning, and lists actions to be taken by both NHSBT then the National Blood Service, and hospitals in the event of a potential or actual red cell shortage.

Cases
R (Bristol-Myers Squibb Pharmaceuticals Ltd) v National Institute for Health and Clinical Excellence [2009] EWHC 2722 (Admin) (Admin Ct). The court held that there had not been a breach of Directive 89/105 where NICE had refused to recommend using a drug in the NHS, in accordance with criteria notified to the European Commission, as the drug was not cost-effective when there was a high demand for it and resources were scarce.

Consultations
NHS Constitution: an consultation on new patient rights. Seeks views on proposed new patient rights to treatment within a maximum of 18 weeks from a GP referral and to be seen by a cancer specialist within two weeks from a GP referral, or where this is not possible, for the NHS to take reasonable steps to offer a range of alternative providers. The proposed rights also include NHS health checks for those aged 40 to 74 to assess their risk of heart disease, stroke, diabetes and kidney disease. The consultation closes on 5 February 2010.

Age equality in health and social care. This consultation seeks views on preparing the NHS and social care in England for the age requirements in the Equality Bill that affect the provision of services and exercise of public functions. The Scottish Executive and the Welsh Assembly Government are considering separately what action to take to prepare the NHS and social care in Scotland and Wales for implementation of the Equality Bill. There will also be further consultation on a draft Order in 2010. The consultation closes on 15 February 2010.

Legislation
Patient Transport Bill. This Private Members' Bill has been introduced into Parliament by Baroness Greengross and received its 1st Reading in the Lords on 23 November 2009. It places a duty on PCTs, hospital trusts and local transport authorities to co-operate with each other in order to co-ordinate the provision of patient transport services provided by PCTs and hospital trusts with the provision of other passenger transport services within the areas over which the trusts have responsibility.

Health Act 2009. The Health Act received Royal Assent on 12 November 2009. It includes measures to:
  strengthen tobacco control;
  place a duty on all NHS bodies, private sector and third sector providers of NHS services to have regard to the NHS Constitution; and 
  pilot direct payments to give patients greater choice and control over their health care;
  enable the de-authorisation of Foundation Trusts in certain, exceptional, circumstances;
  increase powers of suspension;
  establish a regime for unsustainable NHS providers to protect patients and staff from failing services; and 
  reform pharmacy services.
The Act comes into force on a day, or days, to be appointed.

News
Nursing set to become all graduate entry by 2013. The Health Minister has announced that the minimum level for pre-registration courses for nurses will be raised from diploma to degree level from 2013, putting in place the Nursing and Midwifery Council (NMC) recommendation to make all courses for new nurses degree level. The courses will meet new standards developed by the NMC, the professional regulator for nursing.

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

Back to top

Related Insights

Court of Protection Seminar SAVE THE DATE (Leeds)

by Simon Lindsay

CIH Fire Safety Event : Sensible Solutions - Bristol

by Steven Eccles

Seminar: Key Topics for Social Care Providers (Birmingham)

by Monica Macheng

Seminar: Key Topics for Social Care Providers (London)

by Stuart Marchant

Bevan Brittan successfully defends provider from prosecution

by Samantha Minchin

The Social Housing Green Paper

by Sarah Greenhalgh

The merry-go-round of Social Housing Regulation

Bevan Brittan advises clinicians in landmark end-of-life judgment

by Stuart Marchant

Mental Capacity Law and Policy

Patient Safety: Another step forward (Joint Committee reports on...

by Simon Lindsay

Keep up to date With Bevan Brittan

What interests you?

About you?

You can view our privacy policy here