Health and Social Care Update - March 2010

This Update prepared by Claire Bentleycontains 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.

03/03/2010

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 email Claire Bentley.

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

 

Care

Publications/Guidance
The Productive Ward: releasing time to care - learning and impact review, final report. ‘Productive Ward: releasing time to care’ is a ward-based quality improvement programme that aims to increase the proportion of time nurses spend in direct patient care, improve experience for staff and patients and to make structural changes to the use of ward spaces. This review of the programme’s impact and learning considers the evidence for whether the promise of the programme is being fulfilled.

LGA briefing: Personal Care at Home Bill - Lords Second Reading. The Personal Care at Home Bill that is currently going through Parliament would enable regulations to be made requiring personal care to be provided free to persons with the highest needs in their own homes. This briefing critically examines the Bill's key messages and its implications for local authorities. The Bill has completed the Commons stages and received its 2nd Reading in the Lords on 1 February 2010. Its progress can be tracked on the Parliament Bills web page.

State of care. This report from the CQC takes an in-depth look at the state of care nationwide. It gives a complete picture of health care and adult social care in England – including how well the two sectors work together.

Does the experience of staff working in the NHS link to the patient experience of care? An analysis of links between the 2007 acute trust inpatient and NHS staff surveys. This report by Jeremy Dawson, Institute for Health Services Effectiveness at Aston Business School, links the results of the 2007 acute inpatient and staff surveys using a series of statistical analyses intended to highlight the most important relationships between the two surveys.

Consultations
Adult social care - consultation phase. This Law Commission consultation seeks views on proposals to reform the law on adult social care, with a unified statute to replace the current legal framework. The proposals include: establishing a core set of overarching principles to guide social care decisions; introducing a single and explicit duty to assess individuals’ needs; a duty on local authorities to provide community services for all those eligible; the introduction of a single duty to assess the needs of any carer; and a statutory duty on local authorities to investigate when they suspect that vulnerable adults are being abused or neglected. The proposals do not cover funding. The consultation closes on 1 July 2010.

News
CQC review of healthcare in care homes begins. The Care Quality Commission (CQC) has launched its special review of healthcare for people living in care homes and will be seeking information from PCTs and local authorities in the next few weeks.

CQC prosecutes care home for breaches in regulations
.

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

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Children

Publications/Guidance
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.

An evaluation of the provision of mental health services for looked after young people over the age of 16 accommodated in residential settings. Access to child and adolescent mental health services is inconsistent for young people in care, with provisions varying from good to none at all, according to this report. It looks at mental health provision in 27 children’s homes in eight local authorities across England and highlights the barriers for young people in accessing mental health provision as well as good practice.

Giving children a healthy start - A review of health improvements in children from birth to five years. This report from the Audit Commission assesses the local implementation of national policy from 1999 to 2009 on the health of children from birth to five years of age in England. It examines local service planning and delivery, including priority setting, and how local bodies can improve service delivery and access for vulnerable groups such as black and minority ethnic (BME) communities, lone and teenage parents. The report discusses the impact of government funding on health outcomes for the under-fives; how effectively local bodies manage their resources; and the extent to which they are providing good value for money. It provides recommendations for national and local bodies, as well as examples of notable practice.

Children's community equipment: proposals for funding and DH workshop. This letter from Jacqueline Naylor, DH Ill & Disabled Child Team, invites each SHA to submit proposals for funding for innovative activities within and across PCTs to help achieve transformation of children's community equipment and related services. The closing date for SHA proposals is 1 March 2010. The DH is holding a workshop for SHAs, PCTs and their partner local authorities on 19 February that will look at different models and options.
The letter follows on from a recent consultant's report which noted that in many areas the commissioning and provision of children’s equipment was poor. It analysed the various factors underlying this, and concluded that mainstreaming transformation of children's community equipment services would require change in four major areas: governance, pathways, sourcing strategies and management of equipment once bought (equipment stores).

Vetting and barring myth buster. This information, set out in a letter from Ed Balls, Secretary of State for Children, Schools and Families, clarifies when a person does not have to register with the Independent Safeguarding Authority (ISA) regarding personal and family arrangements, and also sets out other exemptions from the new Vetting and Barring Scheme.

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
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.  

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

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Commissioning

Publications/Guidance
Confirmation of Payment by Results (PbR) arrangements for 2010-11. The DH has published information and guidance in support of Payment by Results in 2010-11. The road-testing of the 2010-11 tariff and draft guidance concluded on 22 January 2010. The 2010-11 PbR guidance has been clarified in a number of areas, in response to feedback received at road-test; however, no changes have been made to mandatory tariff prices or trim points. The information includes a document setting out details of changes that have been made to some other elements of the tariff information spreadsheet.

Code of conduct for Payment by Results: from 1 April 2010. This Code of Conduct is aimed at all commissioners and providers, including those from the independent sector - and other bodies with regulatory and/or performance management responsibilities - operating within the PbR system, but without prejudice to any future Government decision on extending the scope of PbR. Its purpose is to establish the principles that should govern organisational behaviour under PbR and set expectations as to how the system should operate. In this way, the Code of Conduct should minimise as well as guide the resolution of disputes under PbR.

Private Patient Income Cap - revised and updated rules. Revised rules and guidance from Monitor on how the PPI Cap should be operated by NHS Foundation Trusts with effect from 1 April 2010. This follows the High Court judgment in R (Unison) v Monitor [2009] EWHC 3221 (Admin) (December 2009) which determined that the previous interpretation by Monitor of the income that should be included as private patient income for the purposes of the PPI Cap was not valid.

Delivering same-sex accommodation: Self declaration. This letter introduces the declaration process for all providers of NHS-funded care. Monitor will be introducing similar reporting requirements for NHS foundation trusts. The accompanying information has been developed to help provider organisations to determine their position.

Commissioning for quality: delivering national priorities. This briefing highlights some actions commissioners can take to ensure they secure best value for patients and taxpayers when commissioning for two NHS priorities in 2010/11: delivering same-sex accommodation as part of the thrust towards high-quality care; and improving cleanliness and further reducing healthcare associated infections.

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

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Complaints

Publications/Guidance
Clarification of Complaints Regulations 2009. This document clarifies the position on new regulations for handling NHS and adult social care complaints that came into effect on 1 April 2009.  

News
Figures from the NHS Information Centre show the level of complaints against GPs has risen by 12 per cent in the last year. Almost 40,000 complaints were made in total with the most common category of complaint being around clinical care. Many papers link the figures to the recent decision by a coroner around poor out of hours care provided by German doctor Daniel Ubani.  

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 any of the items in this section please contact Claire Bentley or Julie Chappell.

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Data Protection

Publications/Guidance
Guidance for access to health records requests. This document provides guidance on access to health records for both living and deceased individuals.

Bevan Brittan Updates
NHS Data Security in the Spotlight  - This article highlights the new published guidance and increased penalties incurred for breaches of the Data protection Act (“DPA”). 

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
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.

Pay circular (AfC) 2/2010. Informs employers of the changes to national pay scales that take effect from 1 April 2010 for staff covered by the Agenda for Change agreement. This follows the decision of the NHS Pay Review Body not to seek a remit to review the pay uplift for 2010/11, as set out in the multi-year agreement.

NHS Job Evaluation Handbook (third edition). Produced by the NHS Staff Council Job Evaluation Group, this is the comprehensive guide on job evaluation (JE) for organisations, including mainstreaming JE, resolving issues on blocked matching and evaluating jobs, weighting and scoring, band ranges and how to use job profiles.

Statement of fitness for work – A guide for General Practitioners and other doctors. Guidance for GPs on the new Fit Note which replaces the sick note from 6 April 2010. Doctors will be able to advise if a patient "may be fit for work" and offer advice on the effects of their health condition. Doctors will have the option to advise that their patient would be able to work, subject to the employer’s agreement, if temporary changes such as reduced working hours or amended duties could be accommodated.

Legislation
General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010 (SI 2010/234). This Order, which mainly comes into force on a day (or days) to be appointed, implements recommendations made by the report of the Tooke inquiry into Modernising Medical Careers that there should be far-reaching reforms to the structure of medical education and training in the UK. It abolishes the Postgraduate Medical Education and Training Board and provides for its functions to be performed by the General Medical Council. It also contains provision to allow a GP to be automatically re-included on the GP Register where he has been temporarily re-registered as a doctor in an emergency pursuant to s.18A Medical Act 1983.

Reforming the Medical Statement: Government response to the consultation on draft regulations - The Social Security (Medical Evidence) and the Statutory Sick Pay (Medical Evidence) (Amendment) Regulations 2010. This is the Government's response to a consultation on draft regulations that will support the revised medical statement. The aim is for the revised medical statement to allow a doctor to consider not only whether their patient is unfit for work, but also whether their patient may be able to do work based on the doctor’s assessment of the patient’s health condition; it also simplifies the suite of medical statements.

News
First doctors to undergo strengthened assessments. Over 3,000 doctors will test a new system of strengthened appraisal intended to provide assurance on whether they are up-to-date with medical advances and fit to practise. The pilot scheme, which will cover doctors working in a wide range of NHS healthcare settings across England, will begin in January 2010 and run through to 31 March 2011.

Bevan Brittan Updates
The Equality Bill: What does it mean?  - The Equality Bill was published by the Government on 27 April 2009.  It is hoped that once it becomes law, the Bill will “… make Britain stronger, fairer and more equal.” John Moore explains more...

Statutory Holiday Entitlement Saga Continues - Last year saw the promulgation of a number of decisions, from the European Court of Justice down, on the much vexed issue of the right to take statutory holiday. The beginning of 2010 has seen the saga continue with yet another decision on this topic, this time dealing with the issue of the notice requirements a worker has to observe in order to exercise their right to take statutory holiday. Alec Bennett explains more...

News Round-up - Mike Smith reports on the latest developments in employment law news.

Employer Debt - Hope or Confusion - In this article, Christine Johnson explains the vagaries of interpretation behind ‘employment cessation events’ and ‘employer debts’ that the recent Cemex case has thrown into a further state of confusion. Read more…

Court of Appeal Reverses EAT Decision - In March 2009 we reported on a case where the Employment Appeal Tribunal allowed the transferral of benefits for employees who had moved from a public to a private sector environment. The Court of Appeal has now reversed the EAT’s decision, in this article Sarah Lamont explains more…

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Finance

Publications/Guidance
Quality accounts: launch of the framework for 2010. This letter from NHS Chief Executive David Nicholson announces the publication of the NHS (Quality Accounts) Regulations 2010 (SI 2010/279) on the framework for Quality Accounts, following last autumn's consultation, and the development of a toolkit of useful guidance and case studies to help NHS providers prepare their Quality Accounts. The toolkit features best practice guidance and useful tools based on the findings from the Quality Reporting process in 2009 and discussions with stakeholders. It is an interactive document, designed to be used online.

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.

News
Hospitals can keep charity donations as Treasury defers rule change. According to the Times, HM Treasury has announced that a change to accounting rules, which would have compelled hospitals to place all charitable donations in the general NHS budget, has been postponed. The change, part of new accounting rules due to take effect in April 2010, has been deferred for a year and will be subject to a review of its likely impact on NHS charities.

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
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.

Joint statement from Monitor and the Care Quality Commission (CQC) on the current position at Mid Staffordshire NHS Foundation Trust. The CQC believes Mid Staffordshire NHS Foundation Trust is safe to provide services. But it has also made it clear that the Trust must address remaining concerns quickly.

Letters to Foundation Trusts
Letter to FTs: Same Sex Accommodation – declaration exercise
- Annex 1: Checklist of Actions Required before and after 31 March 2010
- Annex 2: Provider DSSA Self Declaration Checklist
- Annex 3: Declaration of compliance

News
Monitor has announced that three more NHS Foundation Trusts have been authorised as from 1 March 2010: 5 Boroughs Partnership NHS Foundation Trust, Cornwall Partnership NHS Foundation Trust and South Warwickshire NHS Foundation Trust. This means that there are now 129 NHS foundation trusts in total, of which 40 are mental health NHS foundation trusts. 

Consolidation of charitable accounts. As announced by HM Treasury on Friday 5 February, there will be a one year deferral from the Treasury’s Financial Reporting Manual requirement to consolidate charitable funds administered via a corporate trustee arrangement. Monitor will not require NHS foundation trusts to consolidate charities for the purpose of their 2009-10 and 2010-11 accounts. Monitor is currently consulting on amendments to the Compliance Framework for 2010-11. Section 3.4 includes information on the consolidation of foundation trust accounts and the calculation of the Financial Risk Ratings.  As a result of the deferral above, Monitor will not take into account charitable funds in NHS foundation trusts’ Financial Risk Ratings in 2010-11.

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

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Governance

Publications/Guidance
Healthy NHS Board: Principles for good governance. This guide from the NHS National Leadership Council explains what good governance means for health organisations and their boards. It sets out the three key roles for boards – to formulate strategy, ensure accountability, and shape a positive culture for their organisation. Success is built upon a sound understanding of the local and national context, effective use of intelligence and proactive engagement with patients, the public, staff and local partners.

Management practices in the NHS. This briefing describes a survey of clinicians and hospital managers to explore how well NHS hospitals are managed.

Clinical governance and adult safeguarding: an integrated process. The report on the consultation on the No Secrets review highlighted that adult safeguarding systems were underdeveloped within the NHS. Respondents argued that there is a need to clarify the relationship between adult safeguarding, adverse incident reporting, patient safety, and complaints. This guidance and flow chart have been developed to encourage organisations to establish local robust arrangements to ensure that adult safeguarding becomes fully integrated into NHS systems.

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Health and Safety

Publications/Guidance
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.

Joint statement on hospital standardised mortality rates. Professor Sir Bruce Keogh has established a working group to look at the complicated issue of hospital standardised mortality ratios and develop a single methodology for the NHS. The group will include key groups involved in developing and using HSMRs as well as leading academics and other interested parties including Dr Foster, the Academy of Medical Royal Colleges, the CQC and Monitor. The group will report back to the National Quality Board on progress. In addition, the NHS Confederation will be developing a practical guide to using and interpreting HSMRs.

Corporate manslaughter and health and safety offences causing death. This Sentencing Guidelines Council guidance on corporate manslaughter and health and safety offences which cause death sets out principles to guide courts in dealing with companies and organisations that cause death through a gross breach of care or where breach of health and safety requirements are a significant cause of death. The guidance covers: factors likely to affect seriousness; compensation; publicity orders; remedial orders; and costs. The guidance also recommends that fines for companies and organisations found guilty of corporate manslaughter should seldom be below £500,000.
The MoJ has also issued a press release that highlights how courts can now make publicity orders against companies convicted of corporate manslaughter, that would compel them to inform shareholders, customers and (in the case of local authorities, hospital trusts and police forces) local people of the conviction, giving details of the case, the fine imposed and any remedial work they have been ordered to do. The publicity order could require the company to put a statement on its website or make an announcement in a newspaper.

Adding insult to injury: NHS failure to implement patient safety alerts. This research by AVMA investigates NHS bodies' failure to implement patient safety alerts issued by the National Patient Safety Agency. The report is based on a Freedom of Information request made to the Department of Health, which manages the Central Alert System.

Learning from the best: what the NHS needs to do to implement high quality care for all. This paper, written in conjunction with the NHS Institute for Innovation and Improvement, sets out how the NHS can learn from high performing health organisations in the delivery of quality. The paper draws on discussions at a two-day seminar which brought together NHS leaders and researchers to explore the evidence from a range of international and UK studies. Key messages include: the need for an integrated approach, with quality as the business strategy; alignment across organisations - the emphasis being whole system thinking and working; and stable and sustainable leadership, which is dispersed throughout organisations and which emphasises strong clinical leadership.

Reports on patient safety, NHS culture and quality. Think tank Policy Exchange has obtained under the Freedom of Information Act a series of reports by international patient safety experts which show that the government was warned in the strongest terms about the system of hospital regulation and its potential flaws.

Bevan Brittan Updates
Driving “being open” … is a legal duty of candour required? - Joanna Lloyd looks at recent arguments on openness and the proposals for a legal Duty of Candour. 

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

Publications/Guidance
Response to the consultation on the Health and Social Care Act 2008 Code of Practice for health and adult social care on the prevention and control of infection and related guidance, and prevention and control of Infection in care Homes. This is a summary of responses to a consultation on a code of practice and supporting guidance that will help providers of health care and adult social care to plan and implement how they prevent and control healthcare-associated infections.

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

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Inquests

News
David Gray inquest. The Cambridgeshire North and East Coroner has ruled that systemic failings in the way the National Health Service provides out-of-hours care led to the death of a pensioner at the hands of "incompetent" German locum Daniel Ubani.

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
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.

An evaluation of the provision of mental health services for looked after young people over the age of 16 accommodated in residential settings. Access to child and adolescent mental health services is inconsistent for young people in care, with provisions varying from good to none at all, according to this report. It looks at mental health provision in 27 children’s homes in eight local authorities across England and highlights the barriers for young people in accessing mental health provision as well as good practice.

At a glance: personalisation briefing. This briefing examines the implications of the personalisation agenda for people with autistic spectrum conditions.

Keeping children and young people in mind. This leaflet summarises the government’s full response to the review of child and adolescent mental health services and sets out the features of good services that all local areas should be working towards delivering.

Changes to the childhood pneumococcal conjugate vaccine. A letter to immunisation leads and coordinators to inform them of a replacement vaccine that will be introduced into the childhood routine immunisation programme in the spring.

Bevan Brittan Updates
Care Quality Commission - Registration And Mental Health Act Policies - From 1st April 2010 all providers of assessment or medical treatment for persons detained under the Act will need to be registered with the The Care Quality Commission ("the Commission") who is the new regulator for health and adult social care services.  

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

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Obesity

Publications/Guidance
Change4Life one year on. This document reports on the first twelve months of the Change4Life campaign. Change4Life, which launched to the public in January 2009, is the social marketing part of the Healthy Weight, Healthy Lives cross-governmental strategy for England. In its first year, Change4Life focused on those families with children aged 5-11, who were at greatest risk of becoming overweight or obese. One year on reports back on how Change4Life has performed against the targets set out in the Change4Life marketing strategy, together with what had been learned about using marketing to influence behaviour one year on.

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

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Patient Engagement

Publications/Guidance
Engaging and responding to your community - a brief guide to Local Involvement Networks. Local Involvement Networks (LINks) exist in every local authority area of England to give people more influence over how their local health and social care services are planned and delivered. This guide for health and social care managers explains more about LINks. It outlines how, through proactive engagement they can better understand the needs of their community. It highlights how working with the LINk should be a key part of commissioning, running and reviewing health and social care services. 

Help shape your local health and social care: Your guide to Local Involvement Networks (LINks). This sets out the right of members of the public to be involved in discussions and decisions about health and social care services. It also gives more information about LINks.

Engaging and responding to communities: a brief guide to Local Involvement Networks. LINks exist in every local authority area of England to give people more influence over how their local health and social care services are planned and delivered. This guide is for health and social care managers and explains more about LINks. It outlines how, through proactive engagement they can better understand the needs of their community and how working with their LINk can be a key part of commissioning, running and reviewing health and social care services.

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

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Primary Care Trust

Publications/Guidance
Piloting Quality Accounts for primary care and community services providers. NHS North East and NHS East Midlands are working with a range of providers across general practice, dentistry, community Healthcare services provision, out of hours and urgent care provision and community pharmacy to pilot Quality Accounts in 2010. This pilot aims to explore how Quality Accounts for these providers could best develop. An evaluation of these reports will help inform the direction of any requirements relating to the production of Quality Accounts by primary care and community services providers. The framework for the testing has been developed in discussion with those involved. The document is aimed at those undertaking the pilots, but may also be of interest to others.

Transforming Community Services: The assurance and approvals process for primary care trust-provided community services. This guidance supports PCTs as they develop proposals for the future shape of their community services. It also supports SHAs in their role to assure PCT proposals for community provider organisational forms. The guidance makes it clear that only in exceptional circumstances will the  PCT be allowed to retain a provider arm.

General practice out-of-hours services: project to consider and assess current arrangements. In June 2009, the Care Quality Commission began an investigation into the provision of out of hours primary care services in five PCTs by Take Care Now (TCN). The inquiry was prompted by the tragic death of a patient in February 2008 after he was treated by a locum doctor from Germany. In October 2009, the CQC issued an interim statement on this investigation, which prompted the DH to commission a short piece of work to review the local commissioning and provision of out of hours services. This report sets out the findings of that review. The review concludes that patients were being put at risk by out of hours services that were poorly monitored, chosen for ease rather than quality and delivered without guidance from local doctors. It makes a number of important recommendations on: the commissioning and performance management of out of hours services; the selection, induction, training and use of out of hours clinicians; and the management and operation of medical Performers Lists, including tighter vetting, a requirement for local GP input in the formation of out of hours services, and doctors' fluency in English. NHS Trusts will also be required to follow a model contract when commissioning such services.
The NHS Chief Executive, David Nicholson, has written to all PCT and SHA chief executives about the action they should now take in light of the report.

Delivering quality in primary care: performers lists - language knowledge. Sets out interim guidance to PCTs in England to assist in making decisions about whether or not a doctor has sufficient knowledge of English to be included on the local performers list.
Bevan Brittan has issued a Health Alert to PCTs on the implications of this guidance: Language testing of doctors for inclusion on Performers List.

Statement of fitness for work – A guide for General Practitioners and other doctors. Guidance for GPs on the new Fit Note which replaces the sick note from 6 April 2010. Doctors will be able to advise if a patient "may be fit for work" and offer advice on the effects of their health condition. Doctors will have the option to advise that their patient would be able to work, subject to the employer’s agreement, if temporary changes such as reduced working hours or amended duties could be accommodated.

Transforming Community Services: The assurance and approvals process for primary care trust-provided community services. This guidance supports PCTs as they develop proposals for the future shape of their community services. It also supports SHAs in their role to assure PCT proposals for community provider organisational forms.

Chemotherapy services in the community: A guide for PCTs. A guide to PCTs on the potential to develop chemotherapy services in the community. It will help each PCT, together with their Cancer Network, to consider whether there are further opportunities to devolve chemotherapy from cancer centres and cancer units to community settings while maintaining safety and quality and delivering an efficient service.

News
Figures from the NHS Information Centre show the level of complaints against GPs has risen by 12 per cent in the last year. Almost 40,000 complaints were made in total with the most common category of complaint being around clinical care. Many papers link the figures to the recent decision by a coroner around poor out of hours care provided by German doctor Daniel Ubani.

Devon Doctors is leading the way says Minister. Tessa Jowell, Minister for the Cabinet Office, has met with out of hours service Devon Doctors to discuss how the doctors run and manage their enterprise, and how their mutual model benefits quality and continuity between in and out of hours GP care. Devon Doctors is a social enterprise owned by all of the 176 GP practices of Devon. Its status means that the GP practices cannot make profit from their ownership but do have a direct influence over the services provided to their patients in the out of hours period. The Minister will examine how this mutual model – with greater staff, community and service-user involvement – can be expanded more widely across public services.

Bevan Brittan Updates
Community Services: Transferring for Real?  - In this article we look at the issues surrounding the Department of Health's decision to implement a national standards system prioritising local patient needs above legislature.

Health Alert: Language testing of doctors for inclusion on Performers List - The Department of Health has issued interim guidance to PCTs in England on the language testing of overseas doctors. The guidance is intended to assist PCTs in deciding whether a doctor has sufficient knowledge of English to perform primary medical services in the PCT’s area, and therefore to be included on the PCT’s Performers List.

Transforming Community Services - The Department of Health have re-imposed a hard deadline of 31 March 2010 regarding the national standards for provider reform which PCTs are required to agree with SHAs in respect of their proposals for the future of their provider arms. 

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
Guidelines for the clinical management of people refusing food in immigration removal centres and prisons. This document provides information for health professionals in prisons and immigration removal centres on the physical effects of food refusal, the most effective practical and clinical management of individuals refusing to eat and drink, legal aspects and the relevance of the Mental Capacity Act 2005. It also addresses the considerable dangers and risks associated with re-feeding individuals who have been starving but who then decide to eat again.

Cases
Carter v Ministry of Justice [2010] EWHC 60 (QB) (QBD). The court held that the failure, by a prison's medical officer, to take a prisoner's medical history at a consultation amounted to a breach of duty and was negligent in light of the prisoner's previous complaints about a breast lump and prior consultations with other medical officers. Had a history been taken, the prisoner would have been made the subject of a non-urgent referral to a breast clinic obviating the need for a future consultation with a GP.

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

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Regulation

Publications/Guidance
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.

Legislation
Draft Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These draft regulations, which are due to come into force on 1 April 2010, set out the health and social care activities that are to be "regulated activities" for the purposes of the Health and Social Care Act 2008. These regulated activities will be subject to regulation by the Care Quality Commission, a new body set up by the Act, which, amongst its other functions, is responsible for regulating providers of regulated activities. The regulations also contain the registration requirements relating to safety and quality that providers of regulated activities must meet. Failure to do so will be an offence. Other registration requirements (which are subject to a lower maximum fine in the event of prosecution) are set out in the Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112). For certain offences, a fixed penalty is payable as an alternative to prosecution. The instrument prescribes these offences and specifies the monetary amount of the penalty in each case. See the explanatory memorandum.

Bevan Brittan Updates
Care Quality Commission - Registration And Mental Health Act Policies  - From 1st April 2010 all providers of assessment or medical treatment for persons detained under the Act will need to be registered with the The Care Quality Commission ("the Commission") who is the new regulator for health and adult social care services. 

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

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General

Publications/Guidance
Update - NHS carbon reduction strategy. This updates the 2009 NHS Carbon Reduction Strategy (CRS) that gives information on the opportunities and ways in which NHS organisations can save money by reducing their carbon emissions and become more sustainable. It should be used in conjunction with the CRS.

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.

National Quality Board Annual Report 2009/10. The first annual report of the National Quality Board details the body's work in 2009 on improving quality in the NHS and sets out its priorities for 2010 including: aligning the system to achieve large-scale quality improvement; developing proposals for a quality information strategy; and establishing what good governance for quality within NHS provider organisations looks like.

Marmot Review report - Fair society, healthy lives. Final report of the Strategic Review of Health Inequalities in England post 2010, chaired by Sir Michael Marmot, that aimed to propose an evidence based strategy for reducing health inequalities from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities. It draws further attention to the evidence that most people in England aren't living as long as the best off in society and spend longer in ill-health. It argues that, traditionally, government policies have focused resources only on some segments of society. To improve health for all and to reduce unfair and unjust inequalities in health, action is needed across the social gradient.

The cost of cancer. The bill for cancer in England is £18.33bn annually, according to new figures that take into account healthcare costs, costs to patients and families and losses in productivity. This report finds that these costs are set to increase to £24.72bn over the next ten years.

A guide to values in the NHS. The Values Development Resource – developed by the NHS, for the NHS – that can help other organisations to start to develop and embed their own local values – is now available.

A guide to values in the NHS. The NHS Constitution states that the NHS is founded on a common set of principles and values that bind together the communities and people it serves – patients and public – and the staff who work for it. The Values Development Resource, developed by the NHS, for the NHS, that can help other organisations to start to develop and embed their own local values, is now available. It contains approaches that organisations can use to start a values conversation amongst staff, patients and communities, and a values movement within organisations across the country. More information is available on the NHS Living Our Local Values website.

Six years on: delivering the Diabetes National Service Framework. The Diabetes National Service Framework (NSF) set out the first ever set of national standards for the treatment and care of people with diabetes. This report reviews the development and delivery of diabetes services and identifies the progress made over the past six years towards meeting the Diabetes NSF. The report also identifies areas where improvement is still needed to help direct diabetes services over the coming years. A key focus will be helping staff from the diabetes multidisciplinary team to work more closely with people with diabetes to help them manage their condition better. This will be supported by the commitment made to all patients with a long-term health condition to offer them a personal care plan by summer 2010. The survey for the first time provides an accurate figure of 22,947 people under the age of 18 living with diabetes in England, the vast majority of cases being Type 1 diabetes. This data is now being used to inform the NHS on how to provide the best services for young people with diabetes.

PbR data assurance framework: findings from the accident and emergency pilots. The Audit Commission has reviewed accident and emergency (A&E) data for Payment by Results (PbR) purposes in eight acute trusts to see if they should extend the PbR data assurance framework to cover A&E activity. This briefing sets out the findings from the pilot review.

Providing transport in partnership. Gives advice to local authorities and NHS agencies on the benefits of integrating the organisation and procurement of transport provided for patients and clients across various sectors, including community transport.

Community transport - LTP best practice. Highlights the benefits of community transport and explain how local authorities can engage with the sector, focusing on partnership working. The DfT is strongly encouraging local authorities to approach and work more closely with community transport providers.

Standards for the management of sexually transmitted infections. These standards provide a framework for monitoring performance which covers the core principles of STI care, staff training, clinical assessment and management, diagnostics, information governance, links to other services, clinical governance and the engagement of patients and the public.

Helping trusts embed the NHS Constitution locally. The Department of Health (DH) has produced a number of materials to help NHS organisations embed the NHS Constitution and NHS Values at a local level. From 19 January 2010, all NHS organisations are under a legal obligation to have regard to the NHS Constitution in all their decisions and actions. Access the materials and case studies from NHS Employers' staff engagement web pages.

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.

Consultation on a strategy for services for Chronic Obstructive Pulmonary Disease (COPD) in England. Seeks views on a draft strategy to tackle the growing problem of Chronic Obstructive Pulmonary Disease. The DH has already identified personalised care plans as important for helping all people with long-term conditions including those with COPD and asthma to understand and manage their condition. The strategy sets out a number of clear recommendations to improve outcomes for patients and help to reduce the cost of COPD to the NHS. The consultation closes on 6 April 2010.

Legislation
Personal Injuries (NHS Charges) (Amounts) Amendment Regulations 2010 (SI 2010/189). These regulations, which come into force on 1 April 2010, increase the charges recovered from persons who pay compensation in cases where an injured person receives NHS hospital treatment or ambulance services. The increase in charges relates to an uplift Hospital and Community Health Services (HCHS) annual inflation. See the explanatory memorandum.

News
Top British designers and architects to improve privacy and dignity in NHS hospitals. The Government has launched the new Design for Patient Dignity project which teams up the DH with the Design Council to bring together some of the best minds in the design industry with those working on the frontline in the NHS, as part of a programme of works by the DH to improve patient privacy, dignity and care experience. Six teams of leading UK product, interiors, fashion and systems designers, architects and manufacturers have been appointed to work on a range of briefs that will help to improve the hospital environment and patient experience, such as new ward layouts, more dignified toileting and washing facilities, and new ways of improving the physical and emotional security of patients being transferred within hospitals.

Bevan Brittan Updates
The Human Rights Act and its Prevalence in the World of Medicine - This article sets out the impact of the Human Rights Acts 1998 on worldwide health services. It looks at the evidential consequences since the act was first established.  

Health Focus – The Health Act 2009  - Tracey Lucas looks at the resultant factors from the implementation of the Health Act 2009.

Patient Responsibility and Contributory Negligence - Catherine Radford explores the relationship between patient responsibility and contributory negligence. 

Government Announcement – Pleural Plaques - The Government will not be reinstating compensation for Pleural Plaques. They have stated, however, that claimants with ongoing cases will receive one-off payments. Adrian Neale discusses the implications of the decision.

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