Health and Social Care Update - December 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	Health and Safety
Children	Inquests
Commissioning	Mental Health
Data Protection	Primary Care
Employment/HR	Prison Health
Finance	Regulation
Foundation Trusts	General
Governance

 

Care

Publications/Guidance
Diabetes in care homes: awareness, screening, training. To mark World Diabetes Day 2010, Diabetes UK has launched a report examining diabetes care in care homes. According to the report, one care home resident with diabetes is admitted to hospital every 25 minutes due to failings in screening and training. The report found six out of ten care homes in England, which have residents with diabetes, fail to provide any training to their staff about the condition. The report also revealed less than a quarter (23 per cent) of care homes screen residents for diabetes on admission, and less than a third (28 per cent) screen for the condition on an annual basis.

Carers and personalisation: improving outcomes. A guide on emerging evidence, including examples to illustrate how the principles of personalisation have been applied, emphasising the value of finding ways forward that make sense and work best locally.

Recognised, valued and supported: next steps for the Carers Strategy. The strategy identifies the actions that the Government will take over the next four years to support its priorities to ensure the best possible outcomes for carers and those they support, including:
 supporting those with caring responsibilities to identify themselves as carers at an early stage,
 recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages
 enabling those with caring responsibilities to fulfil their educational and employment potential
 personalised support both for carers and those they support, enabling them to have a family and community life
 supporting carers to remain mentally and physically well

Banking for people who lack capacity to make decisions. This plain-English guide published by the British Banking Association is intended to ensure people lacking mental capacity get the banking services they need. See also Ombudsman news issue 90 which contains a useful article on this topic.

Cases
R (Booker) v NHS Oldham; Direct Line Plc (Interested party) [2010] EWHC 2593 (Admin) (Admin Ct). The court held that it was unlawful and irrational for a PCT to withdraw nursing care from an eligible patient on the basis that she had the means to fund a privately provided care package by reason of damages received from an insurance company.

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

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Children

Publications/Guidance
Ministry of Justice: Response to comments and recommendations from the Lambert Report. This is an update of progress made in response to David Lambert's review of operational procedures for the identification, placement and safeguarding of vulnerable young people in custody. It provides details of the progress made since the document was first published in 2006.

A fair start: A personalised pathway for disabled children and their families. This paper is the first in a joint policy document series produced by the Centre for Welfare Reform and the Health Services Management Centre. The paper proposes that local and national leaders work with families and communities to create a Personalised Pathway for the care, support and education of disabled children and their families, that will enable children with the most significant disadvantages to get a fair start in life.

The chance of a lifetime? Bliss baby report 2010. This report reveals that services caring for sick and premature babies are being stretched to the limit and not meeting minimum standards. It outlines the shortage of nursing staff in specialist hospital care units in England and makes recommendations for necessary improvements to ensure that the best neonatal care will be delivered.

Home Office: Violence against women and girls. This strategy brings together work to tackle violence against women in the UK with details of the international approach to tackle this global problem. It covers specialist services over the next four years including improving the response to rape, creating more training and early intervention programmes and giving new powers and better support for victims.

Improving services for women and child victims of violence: the Department of Health action plan. This action plan sets out how the Department of Health in partnership with others will take action by Spring 2011 to address many of the issues that came out of the Taskforce work. It aims to lay the foundations for embedding high quality evidence based practice within the NHS in response to violence and abuse and is set around four key themes: awareness-raising; workforce, education and training; improving quality of services; and evidence and information.

Seen and heard: supporting vulnerable children in the youth justice system. Children with learning disabilities and other impairments are more likely to go to prison than other young people because the youth justice system is failing to recognise their needs, according to this survey of youth offending team staff. The report identified a lack of routine screening and assessment to identify children’s support needs. Information received from children’s services, such as special educational needs teams and child and adolescent mental health services, was limited. Although staff spoke highly of specialist services and support, many reported gaps in provision. 

Vaccinations at 12 and 13 months of age. This document provides a simplification of the routine childhood immunisation schedule.
 
News
4,200 new health visitors to boost young children's and families' health and wellbeing. The Government has launched a national recruitment drive to create 4,200 new health visitors and build a rejuvenated profession, with the aim of increasing the number of health visitors by almost 50 per cent. This commitment was confirmed in the Spending Review. The level of funding will be announced in due course.

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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Commissioning

Publications/Guidance
The essential guide to GP commissioning. This document is intended as an introduction for professionals and managers in primary care who want to gain an understanding of the new world of ‘Liberating the NHS’ and as a practical guide for those who wish to be involved in the development of the opportunities presented by the changes.

If you require further information about any of the items raised in this section please contact David Owens. 

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Data Protection

Publications/Guidance
A question of balance - Independent assurance of information governance returns. To ensure a common approach to information governance audits across the NHS, the Department of Health commissioned this internal audit assurance framework for the Information Governance Toolkit self-assessments. It will will help NHS organisations to focus on what they need to do to respect patient rights, sustain public trust, improve healthcare outcomes and maximise the benefits that can be gained from high quality information and modern information technologies.

Confidentiality: NHS Code of Practice. Supplementary guidance: public interest disclosures. This document expands upon the principles set out with the Department of Health's key guidance Confidentiality: NHS Code of Practice. It is aimed at aiding staff in making difficult decisions about when disclosures of confidential information may be justified in the public interest.

Bevan Brittan Updates
Substantial fine handed to Local Authority for breach of the Data Protection Act. In handing down the first monetary penalty under the Data Protection Act 1998 (DPA) , the Information Commissioner's Office (ICO) has this week given a very clear signal to all public authorities in relation to the priority that must be given to data security.

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Employment/HR

Publications/Guidance
Transforming Community Services: pay for senior staff in provider organisations. Letter from Sir David Nicholson to NHS chairs in England about guidelines for pay awards for senior staff in provider organisations.

Health, work and well-being in the NHS. This briefing aims to help senior managers in the NHS make staff health and well-being part of their organisation’s culture and embed it into their organisational policies. It outlines the important role of staff health and well-being in delivering quality, innovation, productivity and prevention (QIPP) and in meeting responsibilities to staff under the NHS Constitution. It also examines the business case for improving staff health and well-being and sets out what trusts need to do to help meet the challenge of achieving £555 million in savings on sickness absence.

Staff engagement in the NHS: some local experience. This briefing sets out some tips on how to effectively engage your staff and help meet the current challenges facing the NHS. It provides case studies from organisations that have successfully engaged with their staff through a variety of methods and describes the benefits that they have achieved as a result.

Supporting appraisals: a simpler KSF. Following an independent review, the Knowledge and Skills Framework (KSF) has been simplified to provide an easy-to-use tool that trusts can tailor, to support staff development as part of appraisals. This briefing outlines the simplified KSF, its role in appraisals and how trusts are adapting the KSF and increasing appraisal rates.

Appraisals and Knowledge and Skills Framework (KSF) made simple – a practical guide. This guide, produced by the NHS Staff Council, covers the independent review of KSF, how the KSF has been simplified and how KSF can be used to support staff development as part of appraisals. The guide has a range of practical tools and tips from trusts which are also available on NHS Employers website, for trusts to download and tailor to meet local needs.

The support workforce: developing your patient-facing staff for the future. This briefing explains why employers need to assess the shape of their workforce and invest in the development of their support workers to ensure both flexibility and sustainability in workforce supply. It considers some of the current issues facing employers and highlights options available to help NHS organisations meet these challenges.

National trends. This quarterly report aims to provide a baseline showing how peaks and troughs in seasonal demand for flexible workers relate to particular geographical regions or specific Trust categories.

Raising and escalating concerns: guidance for nurses and midwives. This guidance establishes principles for best practice in the raising and escalating of concerns and aims to complement local whistleblowing policies and safeguarding procedures.

National Apprenticeship Advisory Committee - Making apprenticeships an important and sustainable part of the health sector workforce - Final report and Department of Health response to recommendations. This page links to a report and set of recommendations to ministers for improvements that would develop a sustainable vision for the role of apprenticeships in the health sector in the medium to longer term.

Flexible workforce: strategic planning to reduce costs and improve quality. With the NHS expected to reduce management and agency costs by 45 per cent and make £500 million in savings by 2013/14, this briefing will help to inform strategic planning for a temporary workforce that will both reduce costs and make the most of available resources.

QIPP national workstream: back office efficiency and management optimisation. This report estimates that the NHS could release £600m a year for front line services by improving the back office functions of health organisations.   

Bevan Brittan Updates
Age discrimination matures. As age discrimination legislation beds in, case law on how it applies continues to filter through. This month, the Employment Appeal Tribunal has looked at whether cost alone is a sufficient reason to justify an ‘ageist’ dismissal; and whether a retirement procedure must be undertaken genuinely or is just a ‘tick box’ exercise.  Joanna Smart reports.

Employment news round-up November 2010. As Christmas approaches, Alastair Currie takes a look at what gifts are under the Employment law tree for Employers this month: two plum puddings in the form of two proposals to reduce the employment law burden on employers; a tribunal decision on the Acas Code and SOSR dismissals; the validity (or otherwise) of Compromise Agreements under the Equality Act; and finally…how not to earn extra cash for Christmas. 

Scope of TUPE extended? Sarah Lamont reports on a decision which causes for pause for thought for any organisation which has in place arrangements for employees to be ‘hosted’ by a third party on a long term basis – for example, long term secondees or agency workers.  It is possible that such ‘non contractual employees’ are now covered by the Directive from which TUPE is derived and, although set in a group company context, this case may have a wider application.  

If you require further information about any of the items raised in this section please contact Claire Bentley.

 

Finance

Publications/Guidance
Sustainable finances: reporting on sustainability for NHS finance managers. The paper is aimed at anyone with financial control in the NHS and is designed to help NHS finance experts understand the health, cost, governance and reputational benefits associated with reporting on sustainability issues.

2010/11 funding for re-ablement linked to hospital discharge. This letter from David Flory, NHS Deputy Chief Executive, to SHA Chief Executives details the £70m 2010/11 funding allocations for re-ablement to improve hospital discharge.

The Personal Care at Home Act 2010 and charging for re-ablement (LAC (DH) (2010) 6). This circular advises local authorities of the legal position on charging for re-ablement and the development of re-ablement services with the £70m allocation via the NHS in 2010/11 in support of post-hospital discharge. It also confirms that the Personal Care at Home Act will not be implemented. The circular cancels LAC(2010)1  with effect from 1 October 2011, and LASSL(2010)1 with immediate effect.

Audit Commission: Financial management of personal budgets - challenges and opportunities for councils. This report, which is aimed at finance staff and staff in adult social services, examines personal budgets in adult social care and considers the financial management and governance implications for councils. It reviews the approaches to transition from providing services to providing personal budgets, the choices for allocating money, and how councils can plan for the financial implications. It also considers changes in social care commissioning and the governance arrangements needed for personal budgets.

Amendment to paragraph 119 of the Guidance on Direct Payments 2009. The 2009 guidance aims to assist local councils in making, managing and administering direct payments. This update notes changes made in the Community Care, Services for Carers and Children’s Services (Direct Payments) (England) (Amendment) Regulations 2010 that extend direct payments to previously excluded groups.

Guidance on direct payments for community care, services for carers and children's services: England 2009. (Updated 29 October 2010.) The aim of this guidance is to assist local councils in making direct payments. Together with the Annexes, it also provides guidance on how local councils might manage and administer direct payments. It replaces ‘Direct payments guidance: community care, services for carers and children’s services (Direct Payments) guidance’ issued in 2003. The guidance has been updated to reflect recent legislative changes that extend direct payments to previously excluded groups. An impact assessment and equality impact assessment have been carried out.

Fairer contributions guidance 2010 - calculating an individual's contribution to their personal budget. Guidance for councils in England to use when determining what contribution, if any, a person receiving a personal budget should make towards it. It amends the 2009 guidance to reflect legislative changes in relation to charging for temporary residential accommodation.

Collaboration beyond borders: European funding opportunities for the NHS. This briefing provides an overview of the health topics funded by the EU, discusses the benefits of engaging with an EU programme and gives advice on how NHS organisations can access these opportunities.

Cases
R (Savva) v Kensington & Chelsea RLBC [2010] EWCA Civ 1209 (CA). The Court of Appeal has held that, in calculating a personal budget under s.2 of the Chronically Sick and Disabled Persons Act 1970 and reg.14 of the Community Care, Services for Carers and Children's Services (Direct Payments) (England) Regulations 2009, a local authority had been entitled to use an indicative figure based on the recipient's assessed eligible needs and those of others in the area. The figure had only been used as a starting point: the local authority had not lost sight of its absolute duty to meet the recipient's needs or provide a budget with which to meet them.

If you require further information about any of the items raised in this section please contact Claire Bentley.

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Foundation Trusts

Publications/Guidance
Making sustainability add up: a strategic priority for foundation trusts. This report looks at how foundation trusts can account for sustainability and the work they have been doing in this area. Accounting for sustainability – that is, measuring, reporting, and managing the social and environmental impacts of doing business – is now a strategic priority for foundation trusts. It is essential not only to meet changing regulatory priorities, and the demands of local communities, but also to understand and realise financial, reputational, and public health gains.

Care Quality Commission: Medway NHS Foundation Trust - Review of compliance. This is the review of compliance at Medway NHS Foundation Trust.

If you require further information about any of the items raised in this section please contact David Owens.

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Governance

Publications/Guidance
The NHS atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality. In the recent White Paper, Equity and Excellence: Liberating the NHS, there is a commitment to providing better value from the resources available to healthcare. This requires the NHS to address variations in activity and spend. Such variations indicate the need to focus on appropriateness of care, and to investigate the possibilities that there is overuse of some interventions and that some lower value activities are undertaken. In the atlas, Right Care presents a series of 34 maps of variation selected from topics which National Clinical Directors and others have identified as being of importance to their clinical specialty.

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Health and Safety

Publications/Guidance
Learning lessons from serious case reviews: year 2. This report from Ofsted evaluates serious case reviews. It found that although local areas are learning lessons from reviewing cases, more needs to be done to ensure the review process improves the way children across the country are protected from harm.

Foundation for excellence: an evaluation of the foundation programme. This report is the result of an evaluation of the foundation programme for medical students. The report found that the foundation programme has many strengths and provides a critical interface between medical school and medical practice. However, the report also highlights concerns around patient safety, particularly in regard to junior doctors being ask to practice beyond their level of competence.

Anti-cancer medicines. The National Patient Safety Agency (NPSA) regularly undertakes themed reviews of patient safety incident reports to better understand risks in a specified area of practice and identify actions and strategies to minimise preventable harms to patients. Patient safety incident reports involving anti-cancer medicines reported between 1 November 2003 and 30 June 2008 were selected for review.

Raising and escalating concerns: guidance for nurses and midwives. This guidance establishes principles for best practice in the raising and escalating of concerns and aims to complement local whistleblowing policies and safeguarding procedures.

Snapshot: safer clinical systems. This snapshot looks at how the Health Foundation’s Safer Clinical Systems programme is testing and demonstrating improvements to healthcare systems to make care safer. It shares the learning from the first phase of the programme, including a short summary of the work of the Safer Clinical Systems teams. It also highlights the key priority areas organisations need to focus on to improve the safety of their clinical systems.

Advanced Level Nursing: A position statement. This position statement on advanced level nursing is intended to be used as a benchmark to enhance patient safety and the delivery of high quality care by supporting local governance, assisting in good employment practices and encouraging consistency in use of titles. It has been developed for nursing but it may have relevance to midwifery, health visiting and allied health professions.

Improving care for people with long-term Conditions: 'At a glance' information sheets for healthcare professionals. These information sheets cover a range of topics including care planning, care co-ordination, managing need and assessment of risk, motivating people to self care, goal setting and action planning and end of life care. They are part of a series of information sheets for doctors, nurses, those delivering personal health budgets, allied health professionals, health trainers and anyone supporting individuals with long-term conditions.

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Inquests

Cases
R (on the application of McLeish) v HM Coroner for the Northern District of Greater London (2010) QBD (Admin) (Calvert Smith J) 17/11/2010 Failing to provide a parent of the deceased with information which meant that they lost the chance of requesting additional investigations deprived the parent of one of the principal purposes of an inquest which was an opportunity to determine the cause of death.

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

Bevan Brittan Online Resources
NEW! Bevan Brittan Mental Health Portal. Bevan Brittan has a wealth of mental health knowledge it would like to share with clients. We have therefore developed an online resource which has been designed to bring various sources of mental health information and guidance into one place. The aim is simple - to keep professionals in mental health up-to-date with what is happening in an ever changing landscape. If you would like more information please contact Claire Bentley.  

Publications/Guidance
Mental Health Act Annual Report 2009/10 published by CQC. The main focus of the report is the areas that that CQC found needed to improve. The areas where CQC believe improvements are needed are:
Admission - While the number of people treated in mental health wards has been steadily declined, the proportion receiving such care as detained rather than voluntary patients is growing.
Involvement - The use of care plans allows people to participate more in decisions over their treatment but the report found a great deal of variance in the way in which patients are involved in the process.
Community treatment - The introduction of community treatment orders in 2008 brought in a new method of supervision for patients whose rights are restricted under the MHA. The report looks at the use of these orders.
Consent to treatment - CQC assessment of consent has shown a large rise over the past five years in the proportion of patients deemed incapable of consent and also those given medication under urgent treatment powers.
Control and restraint - CQC Commissioners have raised several concerns over the use of control and restraint on mental health wards during 2009/10 and we believe some of these examples were avoidable.

Independent Investigation into the Care and Treatment of Tennyson Obih. Tennyson Obih was found guilty of the murder of PC Jon Henry in June 2007 and sentenced to 25 years’ imprisonment in March 2009 whilst under the care of the former Bedfordshire and Luton Mental Health and Social Care Partnership NHS Trust . NHS East of England commissioned an independent investigation, as required under the terms of the Department of Health’s guidance HSG (94)27. The report is separate from any criminal investigation by the police, and the purpose is to ensure that the NHS takes the maximum learning possible from the case, and uses that learning to continually improve mental health services. The associated action plan which has been published by the Trust is available here.

The Third Year of the Independent Mental Capacity Advocacy (IMCA) Service 2009-10. The Mental Capacity Act created the Independent Mental Capacity Advocates (IMCAs) service and this is the third annual report of their activities. Over 9,000 people benefited from the support of IMCAs last year. This represents a 39% increase in referrals.

Confidentiality: NHS Code of Practice. Supplementary guidance: public interest disclosures. This document expands upon the principles set out with the Department of Health's key guidance Confidentiality: NHS Code of Practice. It is aimed at aiding staff in making difficult decisions about when disclosures of confidential information may be justified in the public interest.

Making Drama out of a Crisis: Authentic Portrayals of Mental Illness in TV Drama. A new study published by Shift finds that, despite clear improvements over recent years, prime time TV drama struggles to present an accurate picture of mental illness.

National Oversight Group annual report 2009-10. The National Oversight Group for High Secure Services brings together significant partners to provide oversight for the high secure services on behalf of the Secretary of State for Health.  

Nothing ventured, nothing gained: Risk guidance for people with dementia. This publication provides best practice guidance for assessing, managing and enabling risk for people living with dementia. It is aimed at commissioners and providers in health and care across all sectors.

Memorandum to the Justice Select Committee: post-legislative assessment of the Mental Capacity Act 2005. This memorandum provides a preliminary assessment of the Mental Capacity Act 2005 and has been prepared by the Ministry of Justice for submission to the Justice Select Committee. It reflects policy that spans both the Ministry of Justice and the Department of Health and the Welsh Assembly Government and so has input from all three. It will be published as part of the process set out in the document: Post Legislative Scrutiny – The Government’s Approach.

Commissioning talking therapies for 2011/12. This note supports PCTs in commissioning services to meet the needs of local people who are experiencing the common mental health problems of depression and anxiety disorders. Specifically, it supports commissioners in developing local business cases for 2011/12 that generate efficiency and cash savings of £600 to £1,500 for each patient who recovers as a result of their talking therapy treatment.

Protection of Vulnerable Adults (POVA) scheme: record retention and disposal policy. The Secretary of State for Health has a duty to make proper provision for the care of the records he holds. This document sits alongside the Department of Health's general data protection policy general policy, sets out the document retention and disposal policy applied to the POVA scheme and provides for the systematic review, retention and destruction of personal information contained in POVA case files held by the Secretary of State after they have been closed.

Mental Capacity Act 2005: guidance for providers. This guidance published by the CQC explains how the Mental Capacity Act 2005 affects the way that registered care, treatment and support services make decisions on behalf of people who cannot make some decisions for themselves.

Deprivation of liberty safeguards: guidance for providers. This guidance looks at the Mental Capacity Act deprivation of liberty safeguards, how to apply for authorisation to deprive a person of their liberty and what CQC look for when monitoring practice in care homes and hospitals.

Consultations
Common mental health disorders: guideline consultation. This clinical practice guideline on Common mental health disorders: Identification and pathways to care is being developed for use in the NHS in England, Wales and Northern Ireland. Registered stakeholders for this guideline are invited to comment on the provisional recommendations via the NICE website. Individuals and organisations not registered as stakeholders are not able to comment but can register as a stakeholder or contact the registered stakeholder organisation that most closely represents their interests and pass comments to them. Note that the provisional recommendations presented here do not constitute NICE's formal guidance on this topic. The recommendations are provisional and may change after consultation.

Measuring national well-being - Office for National Statistics. ONS is developing new measures of national well-being. The aim is that these new measures will cover the quality of life of people in the UK, environmental and sustainability issues, as well as the economic performance of the country. See also NMHDU page on measuring well being.

Cases
In the Matter of G (TJ) [2010] EWHC 3005 (Fam). The court said in para 55 "The best interests test involves identifying a number of relevant factors. The actual wishes of P can be a relevant factor: section 4(6)(a) says so. The beliefs and values which would be likely to influence P's decision, if he had capacity to make the relevant decision, are a relevant factor: section 4(6)(b) says so. The other factors which P would be likely to consider, if he had the capacity to consider them, are a relevant factor: section 4(6)(c) says so. Accordingly, the balance sheet of factors which P would draw up, if he had capacity to make the decision, is a relevant factor for the court's decision. Further, in most cases the court will be able to determine what decision it is likely that P would have made, if he had capacity. In such a case, in my judgment, P's balance sheet of factors and P's likely decision can be taken into account by the court. This involves an element of substituted judgment being taken into account, together with anything else which is relevant. However, it is absolutely clear that the ultimate test for the court is the test of best interests and not the test of substituted judgment. Nonetheless, the substituted judgment can be relevant and is not excluded from consideration."

Secretary of State for Work and Pensions v SS(DLA) [2010} UKUT 384. The tribunal held that:- 
 The tribunal's decision was by a majority but the decision notice said it was unanimous. This was an error of law which could have been corrected if the subsequent statement of reasons had acknowledged the mistake.
 There is no legal obligation to state whether a decision is unanimous or by a majority. However the absence  of that legal obligation does not prevent a tribunal from giving that information and if they do so the statement should be accurate.
 If the decision is by a majority and a statement of reasons is prepared a brief statement of the reasons of the dissenting minority member should be given.
 The decision of the tribunal was set aside and the case was sent back to a new tribunal for rehearing.

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

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Primary Care

Publications/Guidance
The GP practice index. This report shows that potentially more than £100 million could be saved by GP Practices if they were to more effectively deal with four conditions that are treatable in the community. It reviews four conditions with high volumes of non-elective admissions to hospital.

The essential guide to GP commissioning. This document is intended as an introduction for professionals and managers in primary care who want to gain an understanding of the new world of ‘Liberating the NHS’ and as a practical guide for those who wish to be involved in the development of the opportunities presented by the changes.

NHS orthodontic contract - Advice for Primary Care Trusts. The guidance outlines options for PCTs when considering how to continue provision of NHS orthodontic services after the majority of contracts end in March 2011.

The quality of care in general practice: capturing opinions from the front line. The Inquiry into the Quality of General Practice in England, commissioned by The King’s Fund, has been collecting and examining evidence on the quality of care and services provided by GPs and other health professionals working in general practice. This paper offers a snapshot of health professionals’ views and raises key issues for further debate.

The national audit of theatre equipment 2010. The first ever audit of UK laparoscopic operating theatres has revealed that only one in ten hospitals (11 per cent) are operating with the highest standard of equipment and resource considered adequate to carry out safe, advanced laparoscopic (keyhole) surgery. The audit found a wide variation in the availability and quality of equipment available in theatres across the country, including almost 28 per cent of hospitals operating with obsolete and, in some cases, potentially unsafe standard equipment.

NHS Choices primary care consultation final report. This report gives an overview of the NHS Choices service, the achievements for the year, and plans for the coming year. Imperial College London surveyed 4,000 people and found one-third of those who logged on to www.nhs.uk reduced their GP call-outs and appointments as they found the information they needed before contacting their doctor. Given that an average GP visit costs £32, this is the equivalent of saving the NHS £44 million a year.

GP Consortia Pathfinder Programme: letter from Dame Barbara Hakin. This letter from the National Managing Director of Commissioning Development to SHA Chief Executives sets out the detail and next steps of the GP Consortia Pathfinder Programme. Groups of GP practices keen to participate in the pathfinder programme should be invited to put themselves forward to their SHA, who will be responsible for considering these expressions of interest. The timetable for considering expressions of interest should be no longer than four weeks: SHAs should be in a position to identify the first group of pathfinders by the beginning of December 2010 and be ready to receive applications by the end of October. Other prospective pathfinders will be able to join the programme thereafter on a rolling basis. The expectation is that there will be a continuous stream of pathfinders identified throughout 2011/12.

NICE referral advice recommendations database. This online database offers GPs advice on referring patients from primary to secondary care. The database covers referral advice for patients with the range of conditions NICE has published guidance on, such as suspected cancer, lower back pain and psoriasis. It highlights recommendation from NICE guidance which clearly identifies where patients might benefit from secondary care or specialist services and, by implication, those where patients would not benefit from these services.

Toolkit to support the development of Primary Care Federations. This toolkit has been designed to support the development of Primary Care Federations. It focuses on providing advice and support to those practitioners and managers in primary care who are thinking about, or have embarked upon, developing a Federation for the purposes of providing services in a collaborative manner. 

Tackling inequalities in life expectancy in areas with the worst health and deprivation. This is the third report of the House of Commons Public Accounts Committee and it evaluates the Department of Health's performance in reducing health inequalities. The report takes in evidence from the Department of Health on why it has failed to meet its health inequalities target, the role of GPs, and the lessons of this for the new NHS.

Cases
R (Booker) v NHS Oldham; Direct Line Plc (Interested party) [2010] EWHC 2593 (Admin) (Admin Ct). The court held that it was unlawful and irrational for a PCT to withdraw nursing care from an eligible patient on the basis that she had the means to fund a privately provided care package by reason of damages received from an insurance company.

Legislation
National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administration Arrangements) (England) Amendment (No.2) Regulations 2010 (SI 2010/2649). These regulations, which came into force on 1 December 2010, amend SI 2002/2375 regarding the responsible commissioner where one PCT enters into an arrangement to place an adult with long-term care needs in residential care in the area of another PCT. It provides that the placing PCT shall meet the cost of planned NHS services, whether or not those services include nursing except in cases where the only planned service is NHS-funded nursing care. 

News
Evaluation of the scale, causes and costs of waste medicines. New research published by the York Health Economics Consortium and The School of Pharmacy, University of London, finds that in England in 2009 NHS primary and community care prescription medicines waste (valued in terms of the purchase prices of medicines discarded, rather than taken by the patients for whom they were prescribed) cost £300 million.

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
Integrated Drug Treatment System for Prisons (IDTS) allocations for 2010/11. This letter confirms IDTS funding allocations for 2010/11 for all adult prisons. This funding is to progress the development of enhanced clinical services for prison drug treatment.

Seen and heard: supporting vulnerable children in the youth justice system. Children with learning disabilities and other impairments are more likely to go to prison than other young people because the youth justice system is failing to recognise their needs, according to this survey of youth offending team staff. The report identified a lack of routine screening and assessment to identify children’s support needs. Information received from children’s services, such as special educational needs teams and child and adolescent mental health services, was limited. Although staff spoke highly of specialist services and support, many reported gaps in provision.

Prison Healthcare - Escort and bedwatch costs guidance on prolonged hospital stays. This letter gives additional guidance on the issue of prisoners requiring a prolonged hospital stay.

Cases
R v Qazi and Hussain [2010] EWCA Crim 2579 (CA). The Court of Appeal set out the approach that a sentencing  court should take in order to ensure compliance with Art.3 ECHR when sentencing an individual with a serious medical condition.

News
A new agreement on justice cooperation between the UK and the Russian Federation has been signed. The Memorandum of Understanding at the Ministry of Justice agrees that the two Ministries would exchange best practice and expertise on a range of justice matters such as prison reform, the enforcement of contracts and data protection in support of President Medvedev’s rule of law agenda.

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

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Regulation

Publications/guidance
Should healthcare support  workers be regulated? As the scope of support worker practice widens, there is an increasing concern about their lack of regulation and the risks that they may present to public safety. In response to growing calls for the introduction of healthcare support worker regulation, the Nursing and Midwifery Council commissioned the National Nursing Research Unit to undertake a scoping review of the subject. This Policy + presents their main findings and conclusions.

Overview of adult social care. This briefing from CQC provides an overview and commentary on trends in the regulated adult social care market over recent years. It is based on CQC's responsibilities under the Care Standards Act 2000, which came to an end on 1 October 2010. It has been compiled using data on council commissioning patterns, national minimum standards and registration data. It finds that adult social care services have improved significantly since 2008 but further growth in the market is required to meet future needs. The data shows that this year, 83% of care homes, home care services, nursing agencies and shared lives schemes were rated good or excellent compared to 69% in 2008.
CQC has published two technical reports alongside this overview report:
 The adult social care market and the quality of services; and
 The quality of care services purchased by councils – 2010. 

'Right-touch' regulation. The Council for Healthcare Regulatory Excellence (CHRE) has outlined its approach to regulation. They have have identified the following eight elements that sit at the heart of right-touch regulation:
 Identify the problem before the solution
 Quantify the risks
 Get as close to the problem as possible
 Focus on the outcome
 Use regulation only when necessary
 Keep it simple
 Check for unintended consequences
 Review and respond to change

Consultations
Consultation on registration fees scheme. The CQC has launched a consultation on the fees it proposes to charge providers of health and adult social care. These fees cover CQC's work in registering providers and monitoring their compliance with essential levels of safety and quality. The consultation sets out proposals to simplify fees and put in place a single long-term scheme that will cover all providers registered now and those who will be registered from April 2011. It proposes a framework for how fees will be charged based on principles such as fairness, simplicity and proportionality. The consultation closes on 17 January 2011. 

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

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General

Publications/Guidance
NHS standard terms and conditions of contract for the purchase of goods and supply of services. The DH has published updated terms and conditions for use by NHS bodies procuring goods and services from commercial organisations. These are not for the procurement of clinical services from other NHS bodies or independent sector providers.

Healthy Lives, Healthy People: Our strategy for public health in England - Letter to NHS chief executives. This is a letter from the Secretary of State for Health to NHS chief executives following the publication of the White Paper 'Healthy Lives, Healthy People: our strategy for public health in England on 30 November 2010.

Pandemic H1N1 flu. These publications report on pandemic H1N1 (swine flu) vaccine uptake among frontline healthcare workers and patient groups in primary care in England in 2009-10.

A vision for adult social care: capable communities and active citizens. This document sets out how the Government wishes to see services delivered for people with a new direction for adult social care, putting personalised services and outcomes centre stage.

Ethnic monitoring: is health equality possible without it? This briefing examines the potential impact of ethnic monitoring on health services. Ethnic monitoring practices can help health services to demonstrate a clear and localised understanding of where inequalities exist and therefore take informed measures to address them.

Liberating the NHS: National Quality Board’s advice on implementing the White Paper. This letter sets out advice from the National Quality Board on implementing the proposals set out in the government's White Paper, Equity and Excellence: Liberating the NHS and its associated consultation documents.

Department of Health business plan 2011-2015. This business plan sets out the vision and priorities for the Department of Health as well as the key commitments involved in delivering the reform programme. It sets out the key indicators in understanding the costs and outcomes of health and social care services and also provides additional data that Boards and the public will find useful.

Consultations
Consultation on Cancer Drugs Fund. Seeks views on plans to establish a £200m Cancer Drugs Fund from April 2011, which will provide a means of improving patient access to cancer drugs prior to the anticipated reform of arrangements for branded drug pricing on expiry of the current Pharmaceutical Price Regulation Scheme (PPRS) at the end of 2013. The consultation sets out the context and case for change, the objectives for the Fund, the implications these have for the structure of the Fund and invites views on how to ensure that the Fund delivers its objectives as best as possible. The consultation closes on 19 January 2011.

Impact of the health White Paper: what do doctors think? The survey questioned 500 GPs and 500 hospital doctors shortly after the consultation on the health White Paper closed. It underlines the challenge facing the government in convincing doctors that the proposed reforms will improve the quality of care. It also reflects concerns that reforms may distract the NHS from the urgent task of improving productivity, with more than 40 per cent of respondants believing that GP commissioning will make it more difficult to tackle health inequalities.

Proposals for the reform of legal aid in England and Wales. Seeks views on proposals for reform of legal aid in England and Wales. The proposals represent a radical, wide-ranging and ambitious programme of reform which aims to ensure that legal aid is targeted to those who need it most, for those cases in which legal advice or representation is justified. This consultation is aimed at providers of publicly funded legal services and others with an interest in the justice system.

Proposals for reform of civil litigation funding and costs in England and Wales. This consultation seeks views on implementing a package of Lord Justice Jackson's proposals for reforming conditional fee agreements and other aspects of civil litigation funding and costs. The consultation closes on 14 February 2011.

Diabetes in adults quality standard. Coinciding with World Diabetes Day, the NICE draft quality standard on diabetes is currently out for consultation until 16 December 2010. The draft quality standard addresses the care of adults with diabetes and consists of 15 statements, each with associated quality measures outlining what best practice would look like.

Choosing a high-quality hospital: the role of nudges, scorecard design and information. This report explores how information can help patients to make informed choices. It is based on a research study, which began with a series of focus group discussions, the results of which informed the design of an online experiment. People were presented with information using a number of different ‘scorecards’ comparing the performance of hospital, and different ‘nudges’ were used to influence their choices.

Bevan Brittan Online Resources
NEW! Bevan Brittan Mental Health Portal. Bevan Brittan has a wealth of mental health knowledge it would like to share with clients. We have therefore developed an online resource which has been designed to bring various sources of mental health information and guidance into one place. The aim is simple - to keep professionals in mental health up-to-date with what is happening in an ever changing landscape. If you would like more information please contact Claire Bentley.  

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