Health and Social Care Update April 2010

Legal intelligence for professionals in health and social care

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.

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

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

 

Care

Publications/Guidance
Ordinary residence: guidance on the identification of the ordinary residence of people in need of community care services, England. This guidance provides information and advice to local authorities and certain other bodies on the identification of the ordinary residence of people in need of community care services. The guidance anticipates the coming into force of s.148 of the Health and Social Care Act 2008 on 19 April 2010. It revokes and replaces the existing ordinary residence guidance contained in LAC(93)7 from that date. The guidance should be read in conjunction with the following Directions: Ordinary Residence Disputes (National Assistance Act 1948) Directions 2010; Ordinary Residence Disputes (Community Care (Delayed Discharges etc.) Act 2003 Directions 2010; and the Ordinary Residence Disputes (Mental Capacity Act 2005) Directions 2010.

Personal care at home consultation: The government response. This is the Government's response to a consultation on proposals for regulations and guidance made under the Personal Care At Home Bill.

Securing good care for people: options for reform. This report proposes new, fairer funding arrangements for adult social care, a review of the current settlement for older people and a long-term staged approach to reform based on political consensus.

Funding care: how can each generation pay its fair share? This briefing argues that a new system of social care needs to share the cost equitably and proposes that this could be done through a two-track levy where each generation pays its own costs.

Consultations
Consultation on interim registration fees for providers of adult social care and independent health care. This consultation seeks views on a proposed fees scheme for independent healthcare and adult social care providers who will be registered under the Health and Social Care Act 2008 from 1 October 2010. The consultation closes on 16 June 2010.

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

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Children

Publications/Guidance
The report from the taskforce on the health aspects of violence against women and children. An independent taskforce was set up to identify the role and response of the NHS in relation to violence against women and children and to make recommendations on what more could be done to meet their needs. The taskforce also comprised four sub-groups which have produced individual reports and their key findings and recommendations have formed this overarching report. It makes recommendations around improving the early identification of victims; enhancing the quality of and access to services; raising awareness of violence against women and children; training and development; and partnership working.

National Framework for Children and Young People's Continuing Care. This framework sets out an equitable, transparent and timely process for assessing, deciding and agreeing bespoke packages of continuing care for those children and young people under the age of 18 who have continuing care needs that cannot be met by existing universal and specialist services alone.

NHS services and children's centres - how to share information appropriately with children's centre staff. Sets out the framework for information sharing between all practitioners based at a children’s centre, so that information can be shared appropriately. It focuses particularly on sharing information relevant to delivering effective health services via a children’s centre. The leaflet sets out the legal context, and explains different approaches to sharing information on a case by case basis, and pre-planned bulk sharing of information. It flags the important distinction between the need for centres systemically to have access to basic personal information, and the need to share more detailed information on a case by case basis.

Outcomes of inter agency training to safeguard children: Final report to the Department for Children, Schools and Families and the Department of Health. The overall aim of this study was to develop an evidence base for interdisciplinary training to safeguard children by assessing the scope and content of programmes commissioned by local safeguarding children boards, and the participation in courses of professionals and others in contact with and/or working with children.

Currency options for the Healthy Child Programme: Transforming Community Services. This publication is a tool for commissioners of community services that contribute to the first five years of the universal Healthy Child Programme (HCP). Commissioners can use this to develop a more transparent approach to paying for these services.

Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children. This document sets out how organisations and individuals should work together to safeguard and promote the welfare of children. It is addressed to practitioners and front line managers who have particular responsibilities for safeguarding and promoting the welfare of children, and to senior and operational managers.

The Chief Adviser on the Safety of Children: First annual report to Parliament - 2010. This is the first annual report on safeguarding progress, which includes the views of the Chief Adviser on the Safety of Children about the implementation of the recommendations in Lord Laming’s report, The Protection of Children in England: A progress report. It also advises the Government on the effective implementation of safeguarding policy.

Establishment of a system-wide target for reducing unnecessary delay in care and supervision proceedings. The Ministry of Justice response to Lord Laming's recommendation on the establishment of a system-wide target for reducing delays in care and supervision proceedings includes a new inter-agency approach that will come into force on April 1, 2010, and that incorporates a partnership of local authorities, Cafcass, the Legal Services Commission and HM Courts Service working together and removing barriers that stand in the way of safeguarding children.

Cases
M.A.K. v United Kingdom 45901/05 [2010] ECHR 363 (ECtHR). The court held that, while there were relevant and sufficient reasons for the authorities to suspect that a child had been abused at the time when she was admitted to a hospital, a delay in consulting a dermatologist, who could have diagnosed the child's skin condition some days earlier, interfered with the right of the child and her father to respect for their family life and was not proportionate to the legitimate aim of protecting the child from harm. Also, there was no justification, in the circumstances, for a decision to take a blood test and intimate photographs of a child, against the express wishes of both her parents, while she had been alone in the hospital. Accordingly, there had been breaches of Art.8 ECHR.

Consultations
Public consultation on continuing need for a controlled activity category in the Vetting and Barring Scheme. The Vetting and Barring Scheme (VBS) includes a category of controlled activity in relation to children or vulnerable adults, comprising posts in the further education, healthcare and local authority sectors. This consultation seeks on whether the Government should propose in the medium term to reduce this category in the VBS or remove it entirely, by moving some posts into regulated activity, and removing others from regulation by the VBS. The consultation closes on 17 June 2010.

Legislation
Mental Health Act 2007 (Commencement No.11) Order 2010 (SI 2010/143 (C. 17)) brings into force on 1 April 2010 amendments to the Mental Health Act 1983 that will oblige mental health trusts and PCTs to ensure an age-appropriate environment for young people in need of in-patient care. Section 31(3) of the Mental Health Act 2007 inserts a new s.131A into the Mental Health Act 1983. It will ensure that patients aged under 18 are treated in an environment in hospital which is suitable having regard to their age (subject to their needs), with the purpose of preventing the inappropriate admission of children and young people to adult psychiatric wards by April 2010.

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

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Clinical Management

Publications/Guidance
NHS emergency planning guidance: Planning for the development and deployment of Medical Emergency Response Incident Teams in the provision of advanced medical care at the scene of an incident. This is best practice guidance to NHS organisations for developing and deploying medical emergency response incident teams.

NHS emergency planning guidance: The ambulance service guidance on dealing with radiological incidents and emergencies. This document describes the role of NHS ambulance trusts in planning, preparing and responding to radiation incidents and emergencies involving irradiated and contaminated people.

Ready to go? Planning the discharge and the transfer of patients from hospital and intermediate care. This is a good practice guide for health and social care professionals.

Bevan Brittan Training
Obstetric workshop - Midwifery issues. Wednesday 28 April 2010. 9.30am – 12.30pm. Registration from 9.15am. Jennifer Fraser, midwifery expert and the London MPLI team will run a workshop focusing on the role of the midwife in serious untoward incidents, complaints and clinical negligence claims. We will consider how obstetric adverse incidents can be avoided, the risk management implications of such incidents as well as looking at the medico legal process of a complaint and clinical negligence claim. There will be a case study and the session is intended to be interactive with focus on group discussion and feedback. There is no charge for this session.For more information click here.

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

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Clinical Research

Publications/Guidance
Guidance on the attribution of NHS non-commercial research costs, support costs and treatment costs. This document clarifies the distinction between the three categories of costs associated with non-commercial research studies.

Health protection legislation (England) guidance. Department of Health guidance, published in conjunction with the Health Protection Agency and the Chartered Institute of Environmental Health, explains the notification requirements on registered medical practitioners and laboratories testing human samples, as well as the health protection powers available to local authorities and justices of the peace, under the Public Health (Control of Disease) Act 1984, as amended by the Health and Social Care Act 2008, and the regulations made under it.

News
The Government has announced plans to sell NHS research and innovation to other countries across the world. Alongside the plan for the new organisation, NHS Global, the Government announced that the Medical Research Council has been cleared to invest a further GBP 250 million in a laboratory complex in London, and plans to appoint a minister for life sciences.

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Commissioning

Publications/Guidance
Successful commissioning toolkit. This toolkit aims to help local commissioners in the public sector get better value for money from third sector organisations. It also aims to help third sector organisations become more informed about the commissioning process, and about what they should expect from financial relationships with the public sector.

Valuing people now: transfer of funding and commissioning of social care for adults with learning disabilities from the NHS to local Government: final returns 2010/11 by 31 March 2010. From April 2009, funding and commissioning of social care for adults with learning disabilities transferred from the NHS to local authorities. This letter to PCT and local authority lead commissioners gives guidance on implementation and requests final returns for 2010-11 by 31 March 2010.

Principles and rules of cooperation and competition. This document sets out revised PRCC in commissioning and provision of NHS services. The PRCC were first issued under the 2007/08 Operating Framework and are intended to support cooperation and competition in the interests of patients and taxpayers in relation to: commissioning and procurement; cooperation and collusion; conduct of individual organisations; and mergers and vertical integration. These new PRCC will supersede the original PRCC of December 2007 from October 2010 onwards.

Commercial skills for the NHS. Sets out a strategy for supporting staff to develop their commercial skills and for supporting local commissioners and providers by facilitating access to specialist commercial expertise and infrastructure at regional and national level. It supersedes "Necessity not Nicety – a new commercial operating model for the NHS" (May 2009).

Practice Based Commissioning Group and Independent Leads Survey: Wave 2. This is the second wave of research for the new practice based commissioning (PBC) survey, conducted between February and March 2010. The previous PBC GP practice survey (August 2007 – September 2009) asked GP practices for their views of PBC. For this new survey, lead individuals within PBC groups and independent practices have been invited to take part as they are ideally placed to provide informed feedback as to their organisation’s experience of PBC locally. The aims of the survey are to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PBC.

Bevan Brittan Updates
Sharper teeth for PMS commissioners. From April 1 2010 the Department of Health will be rolling out amendments to the current PMS Agreement Regulations enabling PCTs to terminate PMS Contracts on six months notice. In this article we look at the reasons for the change and the implications for PCTs.

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

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Complaints

Bevan Brittan Portal
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. You may like to take a look at the forum and see what colleagues have posted about different topics. In addition you may want to write a post/query of your own.
If you would like more information about the portal please contact Claire Bentley or Julie Chappell.

Bevan Brittan Training
Obstetric workshop - Midwifery issues. Wednesday 28 April 2010. 9.30am – 12.30pm. Registration from 9.15am. Jennifer Fraser, midwifery expert and the London MPLI team will run a workshop focusing on the role of the midwife in serious untoward incidents, complaints and clinical negligence claims. We will consider how obstetric adverse incidents can be avoided, the risk management implications of such incidents as well as looking at the medico legal process of a complaint and clinical negligence claim. There will be a case study and the session is intended to be interactive with focus on group discussion and feedback. There is no charge for this session.For more information click here.

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Data Protection

Publications/Guidance
NHS services and children's centres - how to share information appropriately with children's centre staff. Sets out the framework for information sharing between all practitioners based at a children’s centre, so that information can be shared appropriately. It focuses particularly on sharing information relevant to delivering effective health services via a children’s centre. The leaflet sets out the legal context, and explains different approaches to sharing information on a case by case basis, and pre-planned bulk sharing of information. It flags the important distinction between the need for centres systemically to have access to basic personal information, and the need to share more detailed information on a case by case basis.

Caldicott Guardian Manual 2010. The manual takes account of developments in information management in the NHS and in councils with social services responsibilities since the publication of the Caldicott report. It sets out the role of the Caldicott Guardian within an organisational Caldicott/confidentiality function as a part of broader information governance.

Consultations
Consultation on proposed regulations on “duty of co-operation”: relating to sharing information about the conduct or performance of health care workers to protect patient safety. The Department of Health is consulting on draft regulations which will impose duties on designated bodies, including employers and contractors of health care workers, in all sectors, and regulatory bodies, relating to sharing information about the conduct or performance of health care workers to protect patient safety. The regulations require appropriate safeguards in place when relevant information is shared.

News
The British Medical Association (BMA) has criticised how patients' confidential medical records have been placed on a controversial NHS database without their knowledge or consent. There are concerns the new database is not safe from online hacking and that patients have been added before they have been given the opportunity to protest. The speed of the project has also been criticised by the BMA and the organisation has called for the scheme to be suspended.

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

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Employment/HR

Publications/Guidance
The impact of the NHS market: an overview of the literature. This report collates all the academic evidence on the effectiveness of market-based reform in the NHS to date. The authors find that the NHS risks a 'lose-lose' situation and that benefits are in evidence, but not widespread.

Assuring the quality of senior NHS managers - research report. Following publication of the Next Stage Review report, the Department of Health asked Ian Dalton, Chief Executive of North East Strategic Health Authority, to chair an Advisory Group on Assuring the Quality of Senior NHS Managers. The final report of the Advisory Group and the supporting research report are now available.

Putting our heads together: what makes senior joint posts work? This report from the NHS Confederation PCT Network contains feedback from joint post directors - including chief executives of both the council and PCT - about the benefits and pitfalls of combining health and other local public service functions. The report argues that although joined-up working is a good way of saving costs and improving health outcomes the DH is not always a ‘credible advocate’. It also reveals that the ‘silo mentality’ of middle management often gets in the way of joint working and that there is a danger that staff became confused over competing chains of command. The Confederation calls for stronger national support for joint working but says that changes to services needed to be driven locally.

Survey of NHS staff 2009. This is the seventh annual survey of NHS staff. It provides trusts with information about the views and experiences of employees that can help to improve the working lives of staff and the quality of care for patients. Almost 290,000 NHS staff were asked for their views on working in the NHS in October 2009 and 55% responded.

A framework for staff engagement: An introduction to staff engagement in the NHS and guidance on starting staff engagement policy. This is an introduction to achieving staff engagement in the NHS.

News
Achievement of target to create 5,000 health apprenticeships. Announces that the health sector has exceeded its aim to recruit 5,000 public sector apprentices.

Bevan Brittan Updates
Unproven allegations & reputational risk: if there’s smoke, do you need to find the fire? If an employer learns of a serious allegation against an employee which, if it came to light, could put the employer in an untenable position, what action is the employer entitled to take?  Can disciplinary proceedings start on the basis of the available information and, if they can, what would be the ‘fair reason’ for any resulting dismissal? In other words, if you can see the smoke, do you need to establish that there definitely is a fire?  Sarah Michael examines a recent decision which sets out how an employer should proceed in these circumstances.

Pensions: uncertain times. Flexible retirement was introduced to provide a practical option for employees who wished to draw down some, or all, of their pension and continue working.  But, the waters were muddied when the Age Discrimination Regulations came into force and created some uncertainty about how death and pension benefits should be handled for such employees.  Pension trustees and administrators are also currently faced with uncertainty over how to proceed in the light of the controversy over the default retirement age.   Christine Johnston takes a look at the issues.

Harassment: an update and a look to the future. The Courts and Tribunals have been busy in recent weeks, finessing the law in relation to harassment, and employers will be pleased to hear that they have been taking a robust approach.  Sarah Lamont sets out the latest developments, and looks at how the Equality Bill is likely to change the law relating to harassment.

News round-up. Alastair Currie reports on the latest developments in employment law news.

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Finance

Publications/Guidance
Monitoring use of money to implement End of Life Care Strategy. Templates to monitor how the additional money provided to help implement the End of Life Care Strategy in 2009/10 is being invested have been issued to SHA and PCT Directors of Finance.

Fewer hospitals, more competition. This report looks at public spending and discusses ways in which the NHS budget could be cut. It discusses reconfiguration of hospital services and looks at ways in which standards of care and productivity can be improved.

VAT - provision of health professionals, nursing auxiliaries, care assistants and support workers by employment businesses - clarification of policy. HM Revenue and Customs Brief 12/10 clarifying the VAT position on supplies of staff by employment businesses in the health and welfare sector.

Quality accounts 2: reviewing NHS Foundation Trusts' experiences and plans. The Foundation Trust Network has launched this publication on the practical elements of producing quality accounts, including engagement and assurance.

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

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Foundation Trusts

Publications/Guidance

Monitor has published the Compliance Framework 2010/11. This latest revision of the Compliance Framework includes:

• changes to reflect the introduction, from 1 April 2010, of the Care Quality Commission’s enhanced registration requirements;
• a redesign of the structure for rating governance risk so as to reflect more closely an escalation of risk towards a potential significant breach of the Authorisation;
• an extension and redesign of service performance measures for mental health foundation trusts;
• clarification of clinical quality governance expectations;
• the inclusion of mandatory services risk within our governance risk rating;
• a refinement of our approach with regard to the assessment of indicators of potential financial weakness; and
• the duty in the Health Act 2009 for NHS foundation trusts, as with all NHS organisations, to have regard to the NHS Constitution.

Robert Francis Inquiry report into Mid-Staffordshire NHS Foundation Trust. Report from an inquiry that was conducted following concerns about standards of care at Mid Staffordshire NHS Foundation Trust, and an investigation and report published by the Healthcare Commission in March 2009. Robert Francis has heard evidence from patients, their relatives and staff to inform his report and the 18 recommendations he makes.
The DH and the Trust Board have accepted the recommendations of the Inquiry in full. See also the Joint statement from Monitor and CQC on the current position at Mid Staffordshire NHS Foundation Trust.
To support all NHS organisations to learn from and respond to the recommendations of the report, three reports have been published that help embed effective governance and detect and prevent such serious failures occurring again:
 Review of early warning systems in the NHS: describes the systems and process, and values and behaviours which make up a system for the early detection and prevention of serious failures. It represents the shared view of DH, Monitor and the CQC and makes clear that safeguarding patients is the responsibility of every organisation and every member of staff - from doctors and nurses in hospitals to commissioners in PCTs and those who manage and regulate the system in SHAs the CQC and Monitor;
 Report of the Advisory Group on assuring the quality of senior NHS managers: final report of the Advisory Group, chaired by Ian Dalton, that was set up to develop proposals to further raise the standards of senior NHS managers. It recognises that, while the overwhelming majority of NHS managers meet high professional standards everyday, a very small number sometimes demonstrate performance or conduct that lets down the patients they serve as well as their staff and organisations. The Group's recommendations include replacing the Code of Conduct for NHS managers with a new statement of professional ethics and consultation on a system of professional accreditation for senior NHS managers. The report is supported by research undertaken by PwC that was commissioned to provide an independent evidence base to inform the Group's work; and
 The Healthy NHS Board: sets out the guiding principles that will allow NHS board members to understand the collective role of the board, governance within the wider NHS, approaches that are most likely to improve board effectiveness, and the contribution expected of individual board members.

Sir David Nicholson has written a letter to all NHS Board Chairs and Chief Executives, asking them to read the report in full and review their own standards of care to ensure that such problems are avoided in future. Robert Francis QC’s Inquiry report recommends a further independent inquiry of the commissioning, supervisory and regulatory bodies. The Secretary of State has proposed that Robert Francis QC chairs this Inquiry also and he has agreed to do so. Draft terms of reference have been published, seeking comments from interested parties. Robert Francis will lead a scoping exercise before terms of reference are finalised and the Inquiry commences formally.

Consultations
Consultation on the de-authorisation of NHS foundation trusts. Under ss.52B-52E of the NHS Act 2006 (inserted by s.15 of the Health Act 2009) Monitor can consider de-authorising an NHS foundation trust which is seriously failing to comply with its terms of authorisation or any requirement(s) imposed on it under any enactment; or the Secretary of State for Health may write to Monitor requesting that Monitor consider the de-authorisation of an NHS foundation trust. This paper seeks views on Monitor's proposed approach and guidance on the criteria for de-authorisation. The proposed approach is based on the principles that:
 Monitor will serve notice on the Secretary of State that a de-authorisation notice would be justified only where Monitor is satisfied that it has exhausted its regulatory powers to facilitate the NHS FT returning to full compliance with its authorisation within a reasonable timeframe;
 given the scope of Monitor’s powers, Monitor considers de-authorisation an action of last resort in situations where it is satisfied that the NHS FT in question is unlikely to be rendered sustainable under any use of Monitor’s powers; and
 use by Monitor of its statutory powers of intervention to avert failure is discretionary. The extent to which Monitor decides to use these powers, and over what period, will necessarily vary from case to case according to the particular circumstances of the NHS FT and its specific failings against the terms of its authorisation.
The consultation closes on 26 May 2010.

Bevan Brittan Updates
Revised Code of Governance for NHS Foundation Trusts. Monitor has issued a new Code of Governance ("Code") for NHS Foundation Trusts which comes into force on 1 April 2010. The new Code makes some significant changes to the 2006 Code of Governance previously in force. It's important that Foundation Trusts are aware of the revisions to the Code and how this may impact upon their current internal governance arrangements and documentation. Although not mandatory guidance, the Code is considered best practice and good reasons will be required for any departure from it.

Monitor issues new guidance on the private patient income cap. Following a recent ruling of the High Court, Monitor has updated the NHS Foundation Trust Financial Reporting Manual and published revised guidance (“the Guidance”) on the private patient income cap (“PPI Cap”). This article highlights the key features of the guidance and advises on the actions that Foundation Trusts will need to consider to ensure they conform to the PPI cap. 

Health Alert: Consultation on the de-authorisation of NHS foundation trusts. This article examines Monitor’s proposed guidance regarding the de-authorisation powers introduced in the (not yet imposed) Health Act 2009. It covers the criteria and consultation Monitor must consider when assessing the compliance of NHS Foundation Trusts.

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

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Governance

Publications/Guidance

Monitor has published the Compliance Framework 2010/11. This latest revision of the Compliance Framework includes:

• changes to reflect the introduction, from 1 April 2010, of the Care Quality Commission’s enhanced registration requirements;
• a redesign of the structure for rating governance risk so as to reflect more closely an escalation of risk towards a potential significant breach of the Authorisation;
• an extension and redesign of service performance measures for mental health foundation trusts;
• clarification of clinical quality governance expectations;
• the inclusion of mandatory services risk within our governance risk rating;
• a refinement of our approach with regard to the assessment of indicators of potential financial weakness; and
• the duty in the Health Act 2009 for NHS foundation trusts, as with all NHS organisations, to have regard to the NHS Constitution.

Code of governance for NHS foundation trusts. This code of governance was first published in 2006. Following reviews in 2008 and 2009 of its application, and also taking account of more recent developments in governance practices specific to NHS foundation trusts, it has been updated. The updated version will apply from 1 April 2010.

Bevan Brittan Updates
Revised Code of Governance for NHS Foundation Trusts. Monitor has issued a new Code of Governance ("Code") for NHS Foundation Trusts which comes into force on 1 April 2010. The new Code makes some significant changes to the 2006 Code of Governance previously in force. It's important that Foundation Trusts are aware of the revisions to the Code and how this may impact upon their current internal governance arrangements and documentation. Although not mandatory guidance, the Code is considered best practice and good reasons will be required for any departure from it.  

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Health and Safety

Publications/Guidance
Exporting of medicines for profit. Dr Keith Ridge has written this letter to NHS Hospital Chief Pharmacists outlining his concerns about exporting medicines for profit and risking the safety of patients.

Consultations
Consultation on proposed regulations on “duty of co-operation”: relating to sharing information about the conduct or performance of health care workers to protect patient safety. The Department of Health is consulting on draft regulations which will impose duties on designated bodies, including employers and contractors of health care workers, in all sectors, and regulatory bodies, relating to sharing information about the conduct or performance of health care workers to protect patient safety. The regulations require appropriate safeguards in place when relevant information is shared.

Bevan Brittan Training
Obstetric workshop - Midwifery issues. Wednesday 28 April 2010. 9.30am – 12.30pm. Registration from 9.15am. Jennifer Fraser, midwifery expert and the London MPLI team will run a workshop focusing on the role of the midwife in serious untoward incidents, complaints and clinical negligence claims. We will consider how obstetric adverse incidents can be avoided, the risk management implications of such incidents as well as looking at the medico legal process of a complaint and clinical negligence claim. There will be a case study and the session is intended to be interactive with focus on group discussion and feedback. There is no charge for this session. For more information click here.

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

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Healthcare Associated Infection

Consultations
Consultation on the Health and Social Care Act 2008 Code of Practice for healthcare, including primary care, and adult social care on the prevention and control of infections and related guidance. This consultation seeks views on a code of practice and supporting guidance that will help providers of healthcare, including primary care, and adult social care to plan and implement how they prevent and control healthcare-associated infections. It sets out criteria that the Care Quality Commission will use to assess compliance with the registration requirement. The consultation closes on 24 June 2010.

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

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Inquests

Publications/Guidance
Summary of reports and responses under Rule 43 of the Coroners Rules. A Ministry of Justice report, which aims to improve public health and safety by identifying action that the coroner considers should be taken to prevent future deaths, sets out reports and responses that were received under rule 43 of the Coroners Rules 1984, as amended by the Coroners (Amendment) Rules 2008 between 1 April and 30 September 2009. The report reveals that Rule 43 reports were issued by 53 per cent of coroner districts between these dates, identifies trends, and highlights wider implications.

Independent Advisory Panel on Deaths in Custody. This is the website of the independent advisory panel on deaths in custody. The panel will play an important role in helping to shape government policy in this area through the provision of independent advice and expertise to the Ministerial Board on Deaths in Custody.

Cases
R (Pounder) v HM Coroner for North & South Districts of Durham & Darlington; Youth Justice Board, Serco Home Affairs Ltd and Lancashire CC (Interested parties) [2010] EWHC 328 (Admin) (Admin Ct). The court held that a coroner who had conducted an inquest into the death in custody of a teenage boy had to recuse himself from presiding over a fresh inquest into the death as he had previously expressed decided views on matters which were important in the later inquest.

Consultations
Reform of coroner system: consultation. Seeks views on the detail of reform of the coroner system in England and Wales, to inform the drafting of secondary legislation under Part 1 of the Coroners and Justice Act 2009. It covers nine policy areas, including: the specific types of deaths that should be reported to coroners; post-mortem examinations; and the new appeals and complaints systems. The consultation closes on 1 July 2010.

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

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Mental Health

Publications/Guidance
Confident communities, brighter future: a framework for developing wellbeing. This DH report sets out the first framework for mental well-being and aims to provide an evidence base from which local authorities and the NHS can act to reduce inequalities and improve mental health in their areas.

Valuing people now: a new three-year strategy for people with learning disabilities. Valuing people now sets out the Government's strategy for people with learning disabilities for the next three years following consultation. It also responds to the main recommendations in Healthcare for All, the independent inquiry into access to healthcare for people with learning disabilities.

One year on - the first report from the National Advisory Council for children's mental health and psychological wellbeing. This report looks at examples of progress of the CAMHS review, but also at the many challenges that need to be tackled if the Review recommendations are to be achieved. It outlines how the National Advisory Council will continue to work with young people, Government and the field to stimulate more open debate and to find solutions in the current economic climate.

Paths to personalisation in mental health: a whole system, whole life framework. This guide has been produced to help all those involved understand how things will need to be done differently to make personalisation a reality for people with mental health needs. The guide provides information about what personalisation means for mental health services and supports, offers examples of what needs to be in place to make things work, and provides pointers to good practice and sources of advice and information. 

Improving dementia services in England - an interim report: nineteenth report of session 2009-10. This report examines understanding and responding to the scale and urgency of dementia; driving and monitoring change in services for people with dementia; and delivering the National Dementia Strategy at local level.

New Horizons: Towards a shared vision for mental health - Report on responses to the consultation. This document summarises the responses to a consultation on the government's plans to target the root causes of mental illness and support the local development of higher quality, more personalised services.

Relational security. The DH has developed a suite of materials to assist people who work in secure mental health services to understand the concept of relational security. In February 2010 following ten regional training events, these materials were introduced to all medium secure services in England. An evaluation of the impact of these materials at service level will be complete in April 2010 informing any further rollout of this and related material across the wider secure system.

A better future: a consultation on a future strategy for adults with autistic spectrum conditions: the government response. During the summer of 2009 the Department of Health consulted on a strategy for adults with autism in England. This is the Government's response to that consultation.

Working it out: employment for people with a mental health condition. This briefing explains the link between employment and positive mental health as an important issue for the NHS, both in terms of supporting service users to recover from mental health conditions and for improving staff productivity. It outlines the key themes from recently launched government policies in this field and sets out actions for the NHS, as both an employer and service provider.

Realising the benefits: IAPT at full roll-out. This report details the next steps in the move towards the full roll out of Improving Access to Psychological Therapy (IAPT) services. The guidance provides support for established and developing services, focusing on quality standards and analysing the progress that has been made in rolling out services to date.

Fulfilling and rewarding lives: the strategy for adults with autism in England. The Government has published its first strategy aimed at delivering 'fundamental change' in service provision for the approximately 400,000 adults with autistic spectrum conditions (ASCs). A delivery plan for the first year should be published by the end of this month. Key points from the strategy document include: the DH will establish a national autism programme board; autism awareness training should be incorporated into equality and diversity courses across the public sector; NICE will shortly publish autism guidance; the DH will publish guidance for mental health and learning disabilities services covering areas such as premises and staff communication and the DH will lead on agreeing a protocol around information.

Consultations
Violent Offender Order (information about release or transfer) Regulations - a targeted consultation. A Home Office (HO) consultation on the Violent Offender Order (VOO) (information about release or transfer) Regulations, which will make it a legal requirement for responsible bodies, including mental health services (where an individual is detained under the Mental Health Act 1983 Pt 3), to notify the police service or the receiving institution if an offender subject to a VOO is to be released or transferred from their care. The HO seeks views specifically of mental health service providers on: the extent to which they may be affected by the proposals and to establish what support they would need from the Home Office to enable them to comply with the new duty to notify; and the development of a short guide and/or standard template to enable hospitals to more easily comply with the proposed duty to notify. Comments by May 12, 2010.

Legislation
Mental Health Act 2007 (Commencement No.11) Order 2010 (SI 2010/143 (C. 17)) brings into force on 1 April 2010 amendments to the Mental Health Act 1983 that will oblige mental health trusts and PCTs to ensure an age-appropriate environment for young people in need of in-patient care. Section 31(3) of the Mental Health Act 2007 inserts a new s.131A into the Mental Health Act 1983. It will ensure that patients aged under 18 are treated in an environment in hospital which is suitable having regard to their age (subject to their needs), with the purpose of preventing the inappropriate admission of children and young people to adult psychiatric wards by April 2010.

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

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Obesity

Publications/Guidance
Healthy Weight, Healthy Lives: a research and surveillance plan for England - update on progress. This document includes an overview of key strategic developments and partnerships on developing the evidence base on obesity since the publication of Healthy Weight, Healthy Lives: a research and surveillance plan for England. It recognises that developing the evidence base is an ongoing progress and a long-term venture. However, even within this first year, considerable progress has been made in terms of building upon existing infrastructure and investments.

If you would like more information about any of the items in this section please contact Julie Chappell.

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Primary Care Trust

Publications/Guidance
Inclusion health: Improving primary care for socially excluded people. This is a practical guide to support PCTs in commissioning improved primary care services for socially excluded people.

Getting the most out of PROMS: putting health outcomes at the heart of NHS decision-making. Patient-reported outcome measures (PROMs) use a series of structured questions that ask patients about their health from their point of view, so as to enable the patient perspective to inform decision-making at all levels of the NHS. This report examines how PCTs can strengthen their commissioning by using PROMs to assess value for money. It also shows how clinical teams can benchmark and improve their performance.

NHS Pharmaceutical Services: transfer of the global sum to PCT allocations. This letter draws attention to important considerations in managing funding for NHS services provided by community pharmacies and appliance contractors, following devolvement of the centrally held funding to PCTs from 1 April 2010.

Primary care and Emergency Departments: report from the Primary Care Foundation. In May 2009 the DH commissioned the Primary Care Foundation to study the impact of using primary care within or alongside A&E. The report highlights that use of primary care clinicians in A&E departments can benefit patients where services are integrated and clinicians work together. The findings of this report are being developed into a guide for commissioners on use of primary care clinicians with A&E departments and this guide will be available soon.

NHS Pharmaceutical Services: Transfer of the global sum to primary care trust allocations. This letter draws attention to important considerations in managing funding for NHS services provided by community pharmacies and appliance contractors, following devolvement of the centrally held funding to primary care trusts from 1 April 2010.

Primary Care Trust procurement guide for health services. Sets out expectations of PCT Boards on the use of procurement to improve services for patients. The guidance is consistent with law, including the application of the UK Public Contracts Regulations to commissioning of health services and reflects overarching principles of transparency, proportionality, non-discrimination and equality of treatment. The guide is referenced in the NHS Operating Framework for 2010/11. It should be read in that context and in conjunction with the Principles and Rules for Cooperation and Competition and the national standard contracts guidance.

Consultations
Teenage pregnancy strategy: beyond 2010. This document sets out how the Department for Children, Schools and Families want to build on the existing Teenage Pregnancy Strategy to strengthen its delivery in all local areas and make further progress towards halving the under 18 conception rate and improving outcomes for teenage parents and their children. PCT and local authority chief executives are invited to respond by 20 May 2010.

Your choice of GP practice: a consultation on how to enable to register with the GP practice of their choice. Seeks views on proposals that give patients a much greater choice of GP practice. It sets out the different options for organising healthcare for patients, and the potential implications of their choices if the current system of GP practice boundaries is removed. It has been developed following a period of initial engagement with NHS colleagues, GPs, practice managers, and professional and patient groups. The consultation closes on 28 May 2010.

National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations 2010 (SI 2010/914). These regulations, which come into force on 24 May 2010, make amendments to the framework Regulations which govern the provision of NHS community pharmaceutical services. They give effect to the provisions in the National Health Service Act 2006 which require PCTs to develop and publish pharmaceutical needs assessments. The amendments also make some unrelated technical changes to the framework Regulations, including correcting an error which allowed a PCT, in certain circumstances, to grant dispensing rights to a doctor when that surgery is within 1.6km of an existing pharmacy.

Legislation
Health Act 2009 (Commencement No. 2) Order 2010 (SI 2010/779 (C.52)). This Order brings s.25 of the Health Act 2009 into force on 24 May 2010, requiring each PCT in England, in accordance with regulations made by the Secretary of State, to develop and publish statements relating to the need for pharmaceutical services in its area.

Bevan Brittan Updates
Sharper teeth for PMS commissioners. From April 1 2010 the Department of Health will be rolling out amendments to the current PMS Agreement Regulations enabling PCTs to terminate PMS Contracts on six months notice. In this article we look at the reasons for the change and the implications for PCTs.

New Performers Lists Directions: PCT List Management Procedures due for Review. The Secretary of State has issued Directions to PCTs which require PCTs to review and implement a range of procedures in relation to the management of Medical, Dental and Ophthalmic Performers Lists.  The Directions require PCTs to undertake a series of reviews by 1 July 2010, to implement the relevant procedures at the earliest opportunity, but no later than 31 March 2011, and to continually undertake reviews moving forward. To assist PCTs, we have produced a short guide to the Directions explaining what PCTs need to do now and over the next 12 months.

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

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Prison Health

Publications/Guidance
IDeA: Offender and ex-offender health. When councils, criminal justice agencies, primary care trusts and the third sector work together, they can achieve more. By tackling the health inequalities of some of the most disadvantaged residents, councils can not only reduce offending but improve well-being for communities. This gives more information.

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

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Regulation

Publications/Guidance
Monitor has published the Compliance Framework 2010/11. This latest revision of the Compliance Framework includes:

• changes to reflect the introduction, from 1 April 2010, of the Care Quality Commission’s enhanced registration requirements;
• a redesign of the structure for rating governance risk so as to reflect more closely an escalation of risk towards a potential significant breach of the Authorisation;
• an extension and redesign of service performance measures for mental health foundation trusts;
• clarification of clinical quality governance expectations;
• the inclusion of mandatory services risk within our governance risk rating;
• a refinement of our approach with regard to the assessment of indicators of potential financial weakness; and
• the duty in the Health Act 2009 for NHS foundation trusts, as with all NHS organisations, to have regard to the NHS Constitution.

Regulating for better care. This is the Care Quality Commission's first case study in the Regulating for Better Care series that looks at improvement in care across health and social care settings following action by the CQC. This edition focuses on how ambulance trusts have made improvements in the area of infection prevention and control after being inspected.

Progress in implementing the White Paper 'Trust, assurance and safety': March 2010. This document summarises the progress the DH has made in implementing the White Paper 'Trust, assurance and safety: The regulation of health professionals in the 21st century'.

Guide to Monitor for Local Involvement Networks (LINks). This leaflet describes the three main strands of Monitor's role, how Monitor regulates NHS foundation trusts and outlines their formal powers. The leaflet also describes how LINks can work with NHS foundation trusts, and in particular governors.

Protecting the public from unregistered practitioners: tackling misuse of protected title. In this project, the Council for Healthcare Regulatory Excellence (CHRE) have considered the risk to the public presented by those who pass themselves off as registered professionals. They began with a narrow question about the difficulties in title misuse prosecution and developed into a focus on the risk to patient and public safety arising from to title misuse. The final report has now been published.

Invisible patients: Report of the Working Group on the health of health professionals. This report specifically focuses on the health issues facing regulated health professionals and identifies some priorities for addressing them. It looks at how ill health in health professionals may affect their professional practice, the difficulties they face in seeking help and the role of the health profession regulatory bodies.

Consultations
Revalidation consultation: the way ahead. The General Medical Council has launched a consultation on revalidation, with proposals on how it will work, when it will be rolled out, and what doctors and employers need to do. The closing date for comments is 4 June 2010.

News
First wave of NHS trusts registered under new system for monitoring standards. The CQC has announced plans to give 66 NHS trusts a licence to provide services under a new, tougher system for regulating standards in the NHS. For two of trusts, Mid Staffordshire NHS Foundation Trust and Milton Keynes Hospital NHS Foundation Trust, registration will be conditional on further action being taken to address concerns about the safety and quality of care. The regulator will register the remaining 64 trusts without conditions but it stresses that no trust can be complacent and all must ensure that standards are maintained at all times. The press release contains a full list of the trusts .

Bevan Brittan Updates
Monitor issues new guidance on the private patient income cap. Following a recent ruling of the High Court, Monitor has updated the NHS Foundation Trust Financial Reporting Manual and published revised guidance (“the Guidance”) on the private patient income cap (“PPI Cap”). This article highlights the key features of the guidance and advises on the actions that Foundation Trusts will need to consider to ensure they conform to the PPI cap. 

Health Alert: Consultation on the de-authorisation of NHS foundation trusts. This article examines Monitor’s proposed guidance regarding the de-authorisation powers introduced in the (not yet imposed) Health Act 2009. It covers the criteria and consultation Monitor must consider when assessing the compliance of NHS Foundation Trusts.

Health Alert: GMC Consultation "Revalidation: the way ahead." In this article Vincent Buscemi looks at the GMC’s proposed new process of professional regulation for practitioners.

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

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General

Publications/Guidance
Healthcare for single homeless people. This paper presents the results of analysis aimed at better understanding the health needs and relative healthcare costs of people who are homeless or living in certain types of insecure or short-term accommodation.

Sharing the learning: user-led organisations action and learning sites 2008-2010. This guide describes the background to establishing the user-led organisations action and learning sites, and provides a snapshot of the good practice resources resulting from this project.

Volunteering: involving people and communities in delivering and developing health and social care services. This strategic vision sets out to enhance the profile of volunteering, highlight its potential in terms of health, well-being and addressing health inequalities, and promote good practice across the health and social care system. The vision identifies key actions needed to address perceived obstacles to volunteering and create an environment in which volunteering is promoted and supported wherever it has the potential to help reduce inequality, enhance service quality and improve outcomes for individuals and communities. It is intended to engage all those working in the health and social care field as a starting point for discussion and action on the five key strategic themes of: leadership; partnership; commissioning; volunteer management; and support for individual volunteers.

Enhanced recovery. This letter explains the concept of enhanced recovery as an innovative approach to elective surgery that has the potential to support delivery of the QIPP programme. It has benefits for both patients and the NHS - improving quality of care by helping patients to recover sooner after major surgery, and reducing length of stay with obvious benefits to the NHS.

Front line care: report by the Prime Minister’s Commission on the Future of Nursing and Midwifery in England 2010. This report sets out a vision for the future of nurses and midwives. It states that nurses and midwives must renew their pledge to society to deliver high quality, compassionate care, and must be better supported to do so by their employers. Among its 20 recommendations, it highlights the need to prepare nurses to meet the growing need for highly skilled care for people with long-term conditions and the complex needs of ageing. It sees nurses as centre stage to deliver this care, both in hospitals and in people’s homes, but they must be properly equipped and supported to do so. It also stresses the importance of skilled midwifery to meet the challenges of a rising birth rate and persistent health inequalities.

Outpatient department survey 2009. This national survey of the views of adult outpatients asked people about their most recent visit to an Outpatient department. The survey included questions on waiting for the appointment, hospital facilities, seeing a doctor, any tests and treatment undertaken during the appointment, as well as any medications prescribed. The results from the survey are used by NHS trusts to help understand the experiences of their patients and improve their performance. The Care Quality Commission will also use the results from the survey in a range of ways, including using the results in regulatory activities such as registration, monitoring ongoing compliance, and reviews.

Productive ward evaluation. The Productive Ward Programme, designed by the NHS Institute for Innovation and Improvement in collaboration with the NHS, sets out an innovative and practical way for clinicians and other frontline staff to take the lead in improving ward-based services. This study aims to tell the story of the Productive Ward to date and determine its impact on the NHS. The evaluation will seek to answer why and how the Productive Ward has been so influential and to identify factors that may enhance the benefits of this programme and, more widely, future innovative approaches to service and quality improvement.

Exporting medicines for profit. David Nicholson has written this letter to highlight that exporting medicines for profit jeopardises both patient care, and the terms of NHS contracts for medicines. Trusts holding a wholesale dealer's licence are also bound by Regulations relating to the supply of medicinal products.

Changes to the NHS Constitution: Government response to the consultation on new patient rights. Sets out the Government's response to a consultation on proposed new patient rights to treatment. Following the consultation, a revised NHS Constitution has been published that includes a new right to start non-urgent treatment within 18 weeks, and to see a specialist where cancer is suspected within two weeks of referral, or for the NHS to take all reasonable steps to offer a range of alternative providers where this is not possible. This new right comes into effect on 1 April 2010.
See also:
 Implementation of the right to access services within maximum waiting times -
 Guidance for strategic health authorities, primary care trusts and providers;the handbook to the NHS Constitution for England; and
 Primary Care Trusts and Strategic Health Authorities (Waiting Times) Directions 2010.

Practice statement: Composition of tribunals in relation to matters that fall to be decided by the Health, Education and Social Care Chamber on or after 18 January 2010. This Practice Statement issued by the Tribunals Judiciary sets out the composition of the tribunal for Primary Health Lists cases, mental health cases, special educational needs or disability discrimination in schools cases, and other cases.

Age equality in health and social care: a report on the consultation. This report results from the report by Sir Ian Carruthers and Jan Ormondroyd (October 2009) that recommended action that the DH, the NHS and social care more generally should take to prepare for the introduction of the new public sector equality duty and of the ban on age discrimination. DH plans now to take forward the actions set out in the table, in preparation for implementation of the measures on age in the Equality Bill.  

On the state of public health: Annual report of the Chief Medical Officer 2009. This annual report draws attention to major health challenges requiring immediate action and details progress made in key areas identified in previous annual reports. It addresses the benefits of physical activity, preparation for cold weather to reduce health risks, treatment for rare diseases, grandparenting and health, and the link between climate change and health.

Advancing health: Examples of the work of the Chief Medical Officer for England, 1998-2010. This report summarises Sir Liam Donaldson's work during his time as Chief Medical Officer. It gives an overview of the Chief Medical Officer's role and describes some of the advances that have been made during Sir Liam's term in office.

General election - guidance. This letter to NHS chief executives provides initial information on handling the general election period once it starts. It includes links to previous guidance and advice on where to direct further queries.

The personalisation agenda: implications for the third sector. This paper sets out the major features of the personalisation agenda and, drawing on existing evidence, sets out the key implications of this for the third sector and for future research.

Rising to the challenge: health priorities for Government and the NHS. This report sets out what the NHS Confederation see as the major priorities facing the NHS, what NHS leaders can do now to help develop the system and enhance patient care, and what a new government will need to do post-election to facilitate this and create the necessary conditions for progress.

The NHS quality, innovation, productivity and prevention challenge: an introduction for clinicians. This booklet has been published to support clinical teams and NHS organisations to meet the quality and productivity challenge and provides ways in which NHS clinicians can get involved in shaping the response locally.

Fixing NHS IT: a plan of action for a new government. This report maps out an action plan for NHS IT to assist policy makers determine the way forward. It claims that the government could save £1bn by realigning the NHS IT programme and boosting its performance.

Consultations
Review of access to the NHS by foreign nationals. The Department of Health invites views on planned changes to the National Health Service (Charges to Overseas Visitors) Regulations 1989 (SI 1989/306), aimed at preventing health tourism. Proposed changes include: requiring visitors to the UK to have health insurance; extending the period of time that UK residents can stay outside the country on a regular basis before losing their automatic entitlement to NHS treatment; and introducing the principle that failed asylum seekers who are not co-operating with the UK Border Agency should not be entitled to free healthcare. Comments by 30 June 2010.

Regulation of Investigatory Powers Act 2000 - revised interception of communications code of practice. The Home Office is seeking views on proposed changes to the statutory codes of practice for covert surveillance and covert human intelligence sources that give guidance on the interception of communications under Part 1 of the 2000 Act. The consultation closes on 7 June 2010.

News
Revealed: new designs transform patients' privacy and dignity in NHS hospitals. Announces the launch of new design prototypes to improve patient privacy and dignity. The prototypes are the culmination of Design for Patient Dignity, a programme from the Department of Health and Design Council, which has brought together seven teams of leading UK designers and manufacturers with frontline healthcare staff to help solve privacy and dignity issues for patients. They include revolutionary ‘bed pods’ and screening systems, modular toilets and washrooms, and a redesigned patient gown.

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