Health and Social Care Update June 2010

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.

09/06/2010

Claire Bentley

Claire Bentley

Associate

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 click here.

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

 

Care

Publications/Guidance
Residential care home workforce development: the rhetoric and reality of meeting older residents’ future care needs. This study examines the best way of meeting the future needs of older care home residents. Exploring evidence from an in-depth study of three residential homes, it confirms that training care staff in basic clinical skills can enhance health and social care provision for older people in residential homes. It found that this approach could boost older people's quality of life by making them more comfortable, increasing their well-being, and reducing the chance of them being unsettled by a move to a nursing home. The report also concludes that residential homes will not be able to provide this choice unless there is financial support for new role carers and their training.

Training
Neil Grant will be speaking at this Butterworths conference on Wednesday 7 July on "Operating in a new environment." If you would like to attend please click here.

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

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Children

Publications/Guidance
Children's heart surgery - the need for change. This document reviews how children’s heart surgery services are currently provided in England and suggests new ways to deliver these services so that all children have equal access to the highest standards of care.

One year on: Healthy lives, brighter futures - The strategy for children and young people's health. This letter from Secretary of State for Health Andy Burnham and Secretary of State for Children, Schools and Families Ed Balls provides an update on the child health strategy.

Not just a phase: a guide to the participation of children and young people in health services. This report provides information to ensure the safe, meaningful and ethical participation of children and young people within the delivery of quality child health services and practically demonstrates how a culture of participation can be created. 

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

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Clinical Management

Publications/Guidance
Putting quality first in the boardroom: improving the business of caring. This report is based on observations of nurse executives and their boards at six NHS trusts. The report starts by examining what is meant by the term ‘clinical quality’ and why it has the potential to be marginalised in the boardroom. It goes on to consider the dynamics of the boardroom and the role of the nurse executive. The main observations of the report relate to board members’ behaviour and attitudes to the question of discussing and improving clinical quality.

Mixing of medicines prior to administration in clinical practice: medical and non-medical prescribing. Following recommendations from the Commission on Human Medicines, regulations were amended in December 2009 to enable doctors and other prescribers to mix medicines themselves and to direct others to mix medicines. This guidance outlines the agreed parameters, principles and key points on mixing of medicines.

Cases
Matthew Buxton v Abertawe bro Morgannwg University Local Health Board (Successor in title to Swansea NHS Trust & Abertawe Bro Morgannwg University NHS Trust [2010] EWHC 1187 (QB). A doctor who had prescribed a patient medication which was known to be effective for one of his eye conditions but would exacerbate another condition if it still persisted had not acted negligently as her decision had not been one that no reasonably competent ophthalmologist could have made.

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
Good practice in research and consent in research. This guidance sets out the good practice principles that doctors are expected to understand and follow if they are involved in research.

Give and take? Human bodies in medicine and research: consultation paper. This Nuffield Council on Bioethics consultation paper seeks views on the extent to which people should be encouraged or incentivised to donate organs, eggs and sperm; the control a person providing such material should have over its future use; and whether useful comparisons can be made with people taking part in "healthy volunteer" trials. Comments by 13 July 2010.

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Commissioning

Publications/Guidance
Cross-border healthcare and patient mobility: revised advice on handling requests from patients for treatment in countries of the European Economic Area - guidance for the NHS. These Regulations, Secretary of State's Directions and guidance aim to help local health commissioners handle requests from the public to go to other European Economic Area under arrangements based on the freedom to provide services in Article 56 of the Treaty of the European Union.

Involving users in commissioning local services. This study by Age Concern London brought commissioners and service users together to discuss how service users can be involved in shaping local services. The project reflected on what's happening at the moment and how user involvement in commissioning could work in practice.

Commissioning for sustainable development: a how-to guide for commissioners. This report outlines how NHS commissioners can make decisions which have an immediate and long-lasting consequences in the communities they serve. It should be used in conjunction with Healthy Futures 9: commissioning for sustainable development which considers what sustainable commissioning is and its role as an integral part of NHS core business.

Patient choice: how patients choose and how providers respond. The policy of offering patients a choice in where they receive hospital treatment was intended to create competition between providers, encouraging efficiency and responsiveness to patients’ preferences and ultimately to drive up the quality of care. This report examines how choice of provider is operating in practice and its impact on hospital providers.

The influenza immunisation programme 2010/11. This letter contains information for all commissioners and providers of social care services about the annual seasonal flu immunisation programme 2010/11.

Commissioning health care in prisons 2008/2009. This report from the CQC assesses how PCTs and local councils commission health and social care for offenders. The report is an overview of findings from questionnaire surveys, which the CQC carried out with the lead PCT for each prison that HMIP inspected in that year. It includes recommendations for PCTs, and highlights arrangements for continuity of care when prisoners are released or transferred as an area that was getting worse rather than better in its sample of PCTs. 

Bevan Brittan Updates
Bevan Brittan LLP produce a focused Procurement Update along with a number of publications and alerts written by partners and lawyers that discuss legal issues relating to all aspects of the procurement regime and on emerging procurement themes at EU level. We also hold regular procurement seminars. If you would like to receive these publications and information on procurement events, please contact Claire Booth.

Commissioning to increase public health capacity. "If we are to succeed in improving the health service, we must also improve the public health of the nation. We must promote good health, stronger locally-owned public health strategies and effective screening and prevention of disease." Andrew Lansley, 13 May 2010.

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

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Data Protection

News
Health records found in Asda car park. NHS Forth Valley may have committed a serious contravention of the UK Data Protection Act following the discovery of medical records (sensitive personal data) in a car park. A computer memory stick containing the sensitive information was found by a 12 year-old outside an Asda store. The stick is understood to have contained the criminal histories of some violent patients, in addition to details about staff at the Tryst Park unit at Bellsdyke Hospital. A spokeswoman for NHS Forth Valley said "We have clear policies in place on the safe use of portable data devices. We can confirm a member of staff has been suspended in connection with this incident." A spokesperson from the Information Commissioner's Office, which can now issue fines for serious contraventions of the DPA, said "we will be looking into how the data breach occurred and will consider what remedial action needs to be taken to prevent any further breaches."

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
Very senior managers' pay. This letter from NHS Chief Executive David Nicholson advises that for those covered by the national Pay Framework, there will be a 0% uplift to basic pay for 2010/11, a performance pot (for 2009/10) of 5% of pay bill, and a 5% limit on individual performance awards; and awards for 2010/11 will be limited to the top 25% of performers. Also, there will be no increase to remuneration for chairs and non-executive directors for 2010/11.

Bevan Brittan Updates
It’s no sacrifice: salary sacrifice and pension schemes. All employers, particularly those in the public sector, will be contemplating ways in which they may reduce costs as the nation’s finances are squeezed over the coming months and years, and salary sacrifice arrangements can shave thousands off an employer’s tax bill, while being a tax efficient way of staff receiving benefits.  Christine Johnston sets out the pros and cons of such schemes, and highlights the pensions issues of which employers should be aware. 

May 2010 Employment news round-up. Chloe Edwards looks at this month’s developments in employment law news: holiday pay and sick leave (Stringer is applied!), new Acas and HSE guidance, the tax status of retail vouchers and an update on two important discrimination cases.  Plus, what will the new Conservative-Liberal Democrat coalition mean for employment law...?

Rants and pants: M&S whistleblower claim. When Marks & Spencer employee, Tony Goode, complained that the company’s proposed changes to its redundancy scheme were ‘disgusting’, and then leaked details of the proposals to The Times, was he simply a disgruntled employee airing his views – or a legally protected ‘whistleblower’?  Sarah Michael explains why the Employment Appeal Tribunal decided that Mr Goode was the former rather than the latter.

Three Lions, a pipe of Pringles, a can of bitter and an “upset tummy boss...” The condition known as ‘World Cup Fever’ is easy to diagnose: symptoms are likely to appear around the second week in June, resulting in a swift and intense aversion to work-related exertion. The good news is that this condition is seasonal and short-term: it will resolve itself, with little intervention, by mid-July. Tim Woodward looks at what you can do to minimise any disruption over the summer caused by the World Cup, and how you may even turn it into a positive advantage.  

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Finance

Publications/Guidance
NHS accounts guides for non-executives and governors. The Audit Commission and the Healthcare Financial Management Association have revised their guides which help non-executives and governors to get a more detailed grasp of their organisation's annual accounts. The guides explain the role of the non-executive director or governor and the external auditor. They also include an invaluable list of questions to help understand and gain assurance on the detail of the financial statements. The guides were originally developed in 2007 and have now been updated for 2010 to reflect changes following the introduction of the International Financial Reporting Standards.
 NHS trust accounts: A guide for non-executive directors;
 Primary care trust accounts: A guide for non-executive directors;
 Foundation trust accounts: A guide for non-executive directors; and
 Foundation trust accounts: A guide for governors.

Detailed guidance for the dry-run of external assurance on the quality reports. Detailed guidance for NHS foundation trusts and their auditors to enable them to carry out the dry run of the external assurance proposals on the 2009/10 Quality Reports (or state of readiness review), as specified in para.7.74 of the Annual Reporting Manual 2009/10, issued on 16 April 2010.

McKinsey report on the fiscal future of the NHS. In February 2009 McKinsey was instructed by the DH to provide advice on how commissioners might achieve world-class NHS productivity to inform the second year of the world-class commissioning assurance system and future commissioner development. The advice from McKinsey, in the form of these slides, was provided in March 2009.

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
New foundations: the future of NHS Trust providers. This briefing compiles the results of a snapshot survey carried out by the Royal College of Nursing which aimed to evaluate the performance, engagement and quality of care in NHS Foundation Trusts in England.

NHS foundation trust annual reporting manual 2009-10
. This document provides guidance to foundation trusts on producing their annual reports and accounts. It was previously called the NHS Foundation Trust Financial Reporting Manual 2009/10 and has been renamed to reflect the enhancements Monitor have made to the manual following consultation on additional reporting requirements.

Real involvement for SHAs: working with people to improve health and health services. This guidance covers regulations issued under section 242A of the NHS Act 2006 which came into force on 1 April 2010, placing a new duty on SHAs to involve users. The regulations set out the detail of what SHAs must do to involve users in regional strategic plans, and this statutory guidance provides advice on implementation.

Detailed guidance for the dry-run of external assurance on the quality reports. Detailed guidance for NHS foundation trusts and their auditors to enable them to carry out the dry run of the external assurance proposals on the 2009/10 Quality Reports (or state of readiness review), as specified in para.7.74 of the Annual Reporting Manual 2009/10, issued on 16 April 2010.

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

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Governance

Publications/Guidance
Measuring sustainable development in the NHS. This document provides guidance on measuring sustainable development within the NHS and it includes practical governance and a reporting structure to promote sustainability.

A review of collaborative procurement across the public sector. This review by the National Audit Office and Audit Commission finds that although collaborative procurement has the potential to improve value for money, the public sector procurement landscape is fragmented, with no overall governance. It recommends that, given the size of public sector procurement spend and the potential to significantly improve value for money, public bodies should work together much more effectively than they currently do and there should be a clear framework to coordinate public sector procurement activity.

NHS sustainable board leadership programme. This resource pack is designed to help leaders and those responsible for developing board leadership programmes integrate sustainability in their leadership programmes. This programme will help boards understand that making decisions with sustainability in mind will reduce costs, while improving patient healthcare and system efficiency. It also promotes a better use of natural resources. The pack consists of a summary report, a full report, a facilitator’s guide and slideshow.

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Health and Safety

Publications/Guidance
Shift-work, rest and sleep: minimising the risks. This discussion paper examines the effect of shift-working on the health and performance of junior doctors and the effect that this has on patient safety. The paper calls for detrimental effects of fatigue on the doctor and their patients to be recognised and managed to reduce associated risks and for good working practice to encompass risk management strategies.

How safe are clinical systems? This study covered seven NHS organisations and identifies the variation in the reliability of five key healthcare systems and processes: availability of information when making clinical decisions; prescribing; handover; availability of equipment in operating theatres; and availability of equipment for inserting intravenous lines.

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Healthcare Associated Infection

Publications/Guidance
Mandatory surveillance weekly reports. Beginning this week, the Department of Health will be publishing weekly hospital data on MRSA bloodstream infections and C.Difficile between March and May 2010. Previously, data was only published monthly and by NHS trust. From early July, infection figures for every NHS hospital in England will be updated on data.gov.uk weekly, giving statistics for each of the previous 12 weeks. This document provides guidance on the collection of data for this new initiative.

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

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Inquests

Publications/Guidance
Help is at hand: a resource for people bereaved by suicide and other sudden, traumatic death. This guide is targeted at those who are affected by suicide or other sudden, traumatic death. It aims firstly to help people who are unexpectedly bereaved in this way. It also provides information for professionals who come into contact with bereaved people, to assist them in providing help and suggest how they themselves may find support if they need it.

Cases
Jones v HM Coroner for the Southern District of Greater London; Virdi (Interested Party) [2010] EWHC 931 (Admin) (Admin Ct). The court held that it was appropriate for an open verdict to be quashed and a new inquest ordered where there had been insufficient inquiry made into the means by which a deceased came to die from fentanyl toxicity. There was also a wider public interest in a full inquiry given that there had been a considerable number of deaths in the United States and the United kingdom linked to unintended overdoses of fentanyl.  

Bevan Brittan Training
Inquest Update - Wednesday 16 June 10am -12pm. Bevan Brittan London office. Bevan Brittan’s Inquest Update this year focuses on the impact of recent key cases upon healthcare related deaths, such as Savage v South Essex Partnerships NHS Trust [2010] and Rabone v Pennine Care NHS Trust [2009] . We will also look at the Coroners and Justice Act which received Royal Assent in November 2009. We have been working closely with healthcare organisations across the UK and would like to invite you to this interactive session to discuss the changes that have already been made as a result of key decisions/legislation and to explore how those yet to come into force will affect your organisation.

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
Effectiveness of Child and Adolescent Mental Health Services as at December 2009. This statistical release measures key aspects of service provision that should be in place locally to effectively meet the needs of children and young people with mental health problems

Implementing recovery: A methodology for organisational change. The Sainsbury Centre has published a document aimed at supporting mental health organisations to ensure that recovery is at the heart of their services. There is a three stage process identified for each of the ten challenges, namely Engagement, Development and Transformation. The challenges include: Changing the nature of day-to-day interactions and the quality of experience; ensuring organisational commitment, increasing personalisation and choice, redefining service user involvement and transforming the workforce.

Adult safeguarding scrutiny guide. This guide is written for local authority officers and members involved in the overview and scrutiny process. It is also for independent chairs of Safeguarding Adults Boards who may be requested to participate in the work of overview and scrutiny committees (OSCs). It considers how local arrangements work to safeguard adults in the local authority area and how OSCs can contribute to better safeguarding in this complex and sensitive area of public service. It is designed to assist officers and members (and independent chairs) in shaping and developing the best way to exercise their responsibilities locally. The guide includes a set of key references and advice on further reading and websites that will be helpful when scrutinising safeguarding arrangements.

Look at the Care Quality Commission page entitled "What to expect if your rights are restricted under the Mental Health Act." In this section you will find information about what a patient can expect if their rights are restricted and what they should do if they are not satisfied with the care they have received and want to make a complaint.

The Mental Capacity Act 2005 Deprivation of Liberty Safeguards – the early picture. On 24 March 2010 the Information Centre for Health and Social Care published quarterly activity data for MCA DOLS for the first time. The Department has provided a short briefing to accompany that publication, that draws together the headlines about the first nine months of MCA DOLS activity and reminds practitioners of the guidance in the Code of Practice in relation to five specific practice issues that have been raised regularly with the Department during the first year of the implementation of the Safeguards.

Guidance for doctors: Treatment and care towards the end of life: Good practice in decision making. Guidance for doctors: Treatment and care towards the end of life: Good practice in decision making. Comes into effect on 1 July 2010. This guidance replaces the booklet Withholding and withdrawing life-prolonging treatments (2002). It expands on the guidance in Consent, patients and doctors making decisions together, which sets out the principles on which good clinical decisions should be based, and provides a framework for good practice when providing treatment and care for patients who are reaching the end of their lives.

Bevan Brittan Training
Mental Health. 03 November 2010 : Location: Kings Orchard, 1 Queens Street, Bristol BS2 0HQMental Health. 20 October 2010 : Location: Interchange Place, Edmunds Street, Birmingham B2 2TAMental Health. 12 October 2010 : Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF If you wish to discuss any of the items raised in the above section please contact Simon Lindsay.

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Primary Care Trust

Publications/Guidance
Developing tariffs for integrated sexual health services. This briefing document outlines the development of the London Sexual Health Programme tariff which is an agreed set of currencies for integrated sexual health services to be paid by PCTs to providers of sexual health services.

NHS continuing healthcare refunds guidance. This DH guidance sets out the approaches to be taken by PCTs and local authorities when a decision is awaited on eligibility for NHS continuing healthcare or there is a dispute following a decision. It explains responsibilities for providing services during these periods and for refunding the costs of services provided.

General Practitioners Committee Sessional GPs representation working group report. The BMA’s General Practitioners Committee have announced a series of wide-ranging changes to the way sessional GPs are represented within the BMA. This report is based on conclusions drawn from a large-scale consultation process and makes recommendations in order to better represent the interests of salaried and locum GPs

Bevan Brittan Updates
A little bit more on PDS Plus. The “PDS Plus” is the latest addition to the standard NHS primary dental services contracts, and is the model contract to be used by PCTs in their Dental Access Procurements. Our alert sets out a number of issues that PCTs should consider in relation to this, from our experience of advising on the PDS Plus.

“Proszę otworzyć buzię” (“Open wide”). The legislation that applies to NHS funding of treatment abroad has brought in changes affecting treatments from 23 August 2010; this article outlines what the changes mean for health care commissioners, including new duties on PCTs to supply information about treatment funding to patients.

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
Commissioning health care in prisons 2008/2009. This report from the CQC assesses how PCTs and local councils commission health and social care for offenders. The report is an overview of findings from questionnaire surveys, which the CQC carried out with the lead PCT for each prison that HMIP inspected in that year. It includes recommendations for PCTs, and highlights arrangements for continuity of care when prisoners are released or transferred as an area that was getting worse rather than better in its sample of PCTs.

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 business plan 2010-2011. This business plan for 2010-11 builds on Monitor’s corporate plan for 2009-2012. It refines Monitor’s overall goals and sets out a detailed agenda for the coming year.

Putting quality first in the boardroom: improving the business of caring. This report is based on observations of nurse executives and their boards at six NHS trusts. The report starts by examining what is meant by the term ‘clinical quality’ and why it has the potential to be marginalised in the boardroom. It goes on to consider the dynamics of the boardroom and the role of the nurse executive. The main observations of the report relate to board members’ behaviour and attitudes to the question of discussing and improving clinical quality.

Inpatient services: Survey of adult inpatients 2009. More than 69,000 adult patients from 162 acute and specialist NHS trusts in England responded to the CQC's 2009 inpatient survey between September 2009 and January 2010, a response rate of 52%. The results from the survey are used by NHS trusts to understand the experiences of their patients and help improve their performance. The CQC will also use the results from the survey in a range of ways, including use of the results from each trust in its assessment of NHS performance as well as in regulatory activities such as registration, monitoring ongoing compliance, and reviews. The 2009 survey points to big improvements in cleanliness and a decline in mixed sex accommodation but persistent problems remain in other areas including a lack of information around medicines.

The British Medical Association (BMA) has rejected General Medical Council (GMC) reforms designed to prevent malpractice by doctors. Although it supported in principle the concept of revalidation, whereby doctors would be required to prove their fitness to practice on a five-yearly basis, the BMA dismissed the GMC's plans as overly-bureaucratic.

Cases
Southall v General Medical Council [2010] EWCA Civ 407 (CA). The court held that the GMC's Fitness to Practise Panel had provided inadequate reasons for their finding that a consultant paediatrician was guilty of serious professional misconduct where it was alleged that he had accused a mother of drugging and murdering one of her children.

Southall v General Medical Council [2010] EWCA Civ 484 (CA). The court held that, in the circumstances, where the GMC's Fitness to Practise Panel had provided inadequate reasons for its finding that a consultant paediatrician was guilty of serious professional misconduct, it was inappropriate to remit the case to the panel for amplification. However, the case was remitted for the GMC to determine whether it was appropriate to pursue the charges before a fresh panel.

Bevan Brittan Training
Regulation. 29 September 2010 : Location: Kings Orchard, 1 Queens Street, Bristol BS2 0HQ

Regulation. 16 September 2010 : Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London EC4M 7RF

Regulation. 14 September 2010 : Location: Interchange Place, Edmunds Street, Birmingham B2 2TA 

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 London affordability study. Healthcare for London is a strategy for health care in the capital for the next 10 years which aims to localise care where possible and specialise where necessary. In April 2009, NHS London commissioned a detailed study into the affordability of its plans. Healthcare for London are now releasing three documents. First, the study that was circulated within the NHS. Second, the main slide pack containing the original analysis. Thirdly, the most recent version of the study which contains additional context and provides NHS London's current perspective on the original findings.

GMC End of life care guidance. New guidance for doctors Treatment and care towards the end of life: good practice in decision making, published 20 May 2010, comes into effect on 1 July 2010. This guidance replaces the booklet "Withholding and withdrawing life-prolonging treatments" (2002).

The smoke filled room. This report examines the influence of the tobacco industry on health policy in the UK. Issues surrounding packaging, marketing and sales of tobacco and cigarettes are discussed in this paper.

Expert Advisory Group on AIDS annual report 2009. This report from the Expert Advisory Group on AIDS (EAGA) outlines their activity for 2009. The EAGA is an advisory non-departmental public body which is non-statutory and provides advice on matters relating to HIV/AIDS which may be referred to by the Chief Medical Officers of the Department of Health.

Prescription charges review: implementing exemption from prescription charges for people with long term conditions. This report is the result of an independent review led by the President of the Royal College of Physicians on how a prescription charge exemption for those with long term conditions should be implemented and phased in. The review takes in the views of patient representative groups, charities and other interested parties.

Healthcare Travel Costs Scheme: instructions and guidance for the NHS. Updated Department of Health guidance advises on the Healthcare Travel Costs Scheme following the entry into force of the National Health Service (Travel Expenses and Remission of Charges) Amendment Regulations 2010 (SI 2010/620) in April 2010.

Department of Health on service reconfiguration. This letter from the Chief Executive of the NHS, Sir David Nicholson, sets out the need for service reconfiguration following the announcement of the Secretary of State’s policy commitments. It highlights four key areas in which reconfiguration processes need to improve as plans for significant service change are developed and consulted on.  

Alcohol-use disorders: preventing harmful drinking. This newly released guidance from NICE is aimed at commissioners, managers and practitioners. It identifies how government policies on alcohol pricing, its availability and how it is marketed could be used to prevent harmful drinking. The guidance goes on to make recommendations regarding policy changes in order to effectively prevent harmful drinking nationwide. This document has been published alongside two other pieces of guidance addressing harmful drinking: Alcohol-use disorders in adults and young people: clinical management and Alcohol dependence and harmful use: diagnosis and management in young people and adults.

News
Large variations in medical cover in hospitals at night. Research carried out by the Royal College of Physicians has identified large variations in the provision of medical cover at night, with some doctors being responsible for up to 400 patients. The study, to be published later in the year in Clinical Medicine, examined the makeup of clinical teams in hospitals in England and Wales and the number of patients for which each team was responsible. It found that, at night, doctors were responsible for an average of 61 patients, but the range was from 1 to 400.

An independent review of prescription charges, published by the Department of Health, contains recommendations on how a prescription charge exemption for people with long term conditions should be implemented, including how it would be phased in. Any decisions on future changes to the system of prescription charges and exemptions will be to be taken in the context of the autumn 2010 Spending Review.

Bevan Brittan Updates
Liverpool Care Pathway.  In this article Hannah Taylor explores the Liverpool Care Pathway ("The LCP") refining the core principles surrounding end of life care. 

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