Health and Social Care Update July 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.

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Care	Health and Safety
Children	Healthcare Associated Infection
Clinical Management	Mental Health
Commissioning	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.

Mobile working readiness assessment framework. This framework has been designed by the NHS for the NHS to assist community services to help them understand their current state of readiness for adopting mobile working technology and associated work processes. It also assesses the level of risk that the proposed scope for adopting mobile solutions would introduce based on the current state of readiness and the local context.  

Dartington review on the future of adult social care. This publication is an independent review on the future of adult social care which aims to offer an authoritative and evidence-based assessment of the development of adult social care between now and 2020. Where possible, the authors have sought to draw on existing evidence and also consider likely future scenarios. The intention of this review was twofold: to evaluate the current situation and to identify prospects and opportunities for change. Alongside the review, supplementary evidence reviews are available as well: What can England learn from the experiences of other countries?; The future adult social care workforce; and Personalisation, sustainability and adult social care.

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.

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
Birmingham Children's Hospital NHS Foundation Trust. This report reviews the services provided at Birmingham Children’s Hospital NHS Foundation Trust.

Change to statutory guidance. - On 10 June, Tim Loughton MP, Parliamentary Under Secretary of State for Children and Families announced a change to the statutory guidance set out in Chapter 8 relating to Serious Case Reviews of Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children. Local Safeguarding Boards should publish overview reports of all new SCRs initiated on or after 10 June 2010, together with the executive summary; neither document should contain identifying details. A letter to local authorities and their Board partners on Local Safeguarding Children Boards has been issued and provides guidance under section 16(2) of the Children Act 2004. This letter should be read in conjunction with Chapter 8. Working Together is addressed to practitioners and front line managers who have particular responsibilities for safeguarding and promoting the welfare of children and to senior and operational managers. Part 2 of the document is issued as non-statutory practice guidance.

Care Quality Commission: Involvement and action taken by health bodies in relation to the case of Baby Peter Connelly - Progress against the recommendations of our intervention report. This report shows that the four NHS trusts that provided care to Baby Peter have improved the way they safeguard children.

You need to know. This report presents the key findings of the National Autistic Society's research into why so many children with autism have mental health problems and how CAMHS services can work better for children with autism.

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
Pledge to children with life-threatening conditions. The Government has confirmed its commitment to help children with life-limiting or life-threatening conditions, with up to £30m being made available for this year to help children's hospices, networks and other providers develop local children's palliative care projects. In addition, Professor Sir Alan Craft has been asked to chair a panel to consider proposals, which will be funded in-year only. In 2007, Sir Alan led an independent review that identified variation in the availability of children's palliative care services and issues around their sustainability. The current funding will help to address these key issues.

Bevan Brittan Updates
Safeguarding children. In this article Deborah Jeremiah explains the statutory obligations and responsibilities of Primary Care Trusts, NHS Trusts and NHS Foundation Trusts in relation to safeguarding children.

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

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Clinical Management

Publications/Guidance
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.

Pressure ulcer productivity calculator. The pressure ulcer productivity calculator has been developed to help NHS organisations and commissioners understand the productivity and cost elements associated in treating patients with pressure ulcers. The tool has been developed using the results of research into the cost of pressure ulcers in the UK and will also assist in the long term reduction of pressure ulcer incidences.  

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.

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

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Commissioning

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.

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.

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.

Giving GPs budgets for commissioning: what needs to be done? In this briefing paper, six national organisations conclude that handing real budgets to GP commissioning groups has the potential to help improve patient care but it will need time and careful design to make it successful.

Bevan Brittan Updates
“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.

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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Employment/HR

Publications/Guidance
Time for training: a review of the impact of the European Working Time Directive on the quality of training. Professor Sir John Temple has launched his independent review of the impact of the European Working Time Directive on the quality of training for doctors, dentists, pharmacists and healthcare scientists.

Gibb v Maidstone & Tunbridge Wells NHS Trust [2010] EWCA Civ 678 (CA). The court held that the terms of a compromise agreement executed between an NHS Trust and its former chief executive purporting to determine the level of compensation in lieu of notice upon termination of her employment was not irrationally generous. There was no reason why an employer such as the Trust, faced in difficult and controversial circumstances with the need to terminate a long-standing employee's contract, should be obliged, when settling terms of severance, to disregard past service and an employee's future likely difficulties when calculating the amount of compensation.

Bevan Brittan Updates
Summer of discontent. David Widdowson explains the options available to employers when summer tensions may result in tensions in employee relations.

News round-up June 2010. Alastair Currie provides a round-up of the latest developments in employment law news, including an update on the implementation of the Equality Act and the employment aspects of the 2010 Budget.

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Finance

Publications/Guidance
Dr Foster readmissions research. This report examines 7, 14 and 28 day readmissions rates in conjunction with current tariffs to explore the impact of possible changes to funding levels in the NHS.

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
Birmingham Children's Hospital NHS Foundation Trust. This report reviews the services provided at Birmingham Children’s Hospital NHS Foundation Trust.

Consultation on the de-authorisation of NHS foundation trusts. This document sets out Monitor’s proposed approach and guidance on the criteria for de-authorisation of NHS foundation trusts. The outcomes of the consultation noted that Monitor can consider de-authorising an NHS foundation trust or the Secretary of State for Health may recommend an NHS foundation trust for de-authorisation to Monitor.

Independent Inquiry of the commissioning, supervisory and regulatory bodies in relation to Mid-Staffordshire NHS Foundation Trust. The Health Secretary Andrew Lansley, has announced that there will be a full public inquiry into the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid-Staffordshire NHS Foundation Trust. The Inquiry, to be chaired by Robert Francis QC, will have the full statutory force of the Public Inquiries Act 2005 including the power to compel witnesses to attend and speak under oath. It will look to explain how events at the Trust went undetected and unchallenged for so long by the wider regulatory and supervisory bodies responsible for monitoring the performance of the Trust. The terms of reference, timetable, key documents, etc can be accessed on the Inquiry website.

NHS foundation trust 2010-11 annual planning. The Annual Plan Review (APR) in 2010-11 has been redesigned and enhanced to reflect some of the main and evolving challenges over the next three years.

2009-10 annual accounts guidance for NHS foundation trusts. This page contains guidance for NHS foundation trusts to aid in the completion of their 2009-10 Foundation Trust Consolidation templates. These templates will be used by Monitor to produce the 2009-10 Consolidated Foundation Trust Accounts.

NHS foundation trusts: Review of twelve months to 31 March 2010. This report on the performance of NHS foundation trusts and Monitor’s regulatory activity is based on quarterly submissions to Monitor by the 129 NHS foundation trusts authorised at 31 March 2010.

Monitor responds to publication of governance review into Tameside Hospital NHS Foundation Trust. In February 2010, Tameside Hospital NHS Foundation Trust and Monitor jointly commissioned an independent review of governance to look in detail at how effectively the Trust Board runs the hospital, and what areas could be improved. This review is now complete and the Trust has published the findings.

Monitor's FT Bulletin June 2010.

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

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Health and Safety

Publications/Guidance
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.

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.

The role of boards in improving patient safety. This publication from Monitor offers guidance to NHS FT Boards on helping to bring about improvements to patient safety measures. Although developed by Monitor for NHS FTs, its principles apply equally to other NHS settings. It draws on evidence and best practices from UK pilot sites, and also taps the experience of healthcare providers in other developed countries who use similar principles and approaches.

News
Health Secretary sets out ambition for a culture of patient safety in the NHS. Andrew Lansley has stated that hospitals should be responsible for reducing the number of emergency readmissions following treatment, and support treatment at home, as part of a single payment. The Government proposes to introduce payments which encapsulate a more integrated care pathway by giving hospitals responsibility for a patient’s care for 30 days after they are discharged. Making hospitals responsible for a patient’s ongoing care after discharge will create more joined-up working between hospitals and community services, which will improve quality and performance and shift the focus to the outcome for the patient, rather than the volume of activity paid to the hospital.

Trust sentenced over bed rail death of disabled man. Basildon and Thurrock University Hospitals NHS Foundation Trust has been fined £50,000 by Basildon Crown Court and ordered to pay £40,000 in costs for breaches of s.3(1) of the Health & Safety at Work etc Act 1974, following the tragic death in its care of a severely disabled young man. Kyle Flack, who had the body of a 12-year-old boy, was blind, deaf, quadriplegic and had cerebral palsy, died at Basildon University Hospital early on 12 October 2006 after his head became trapped between the bottom rail surrounding his bed and the edge of the bed itself. He died from asphyxiation. Investigations by HSE found the Trust had no systems in place on each ward for assessing the risk to patients from bed rails. The Trust's practice for obtaining, recording and disseminating information about Kyle's needs was found to be poor,  and staff did not formally share knowledge of individual patients.

Bevan Brittan Updates
The first three months – the new sentencing guideline relating to fatal health and safety offences and corporate manslaughter. This article focuses on the application of the Definitive Guideline in cases concerning health and safety offences causing death (not on Corporate Manslaughter Act offences) and, in particular, those concerning public bodies.

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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.

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Mental Health

Publications/Guidance
Improving services for adults with autism. The issue of service provision for people with autism has gained a considerable amount of cross-party attention over the past few years. The previous Government published its strategy for adults with autism in England, Fulfilling and rewarding lives, on 3 March 2010, and its first year delivery plan on 2 April 2010. The 2009 Autism Act placed a statutory requirement on the Government to publish guidance by December 2010, which is expected to be consulted on this summer. This briefing summarises the key points of Fulfilling and rewarding lives and the first year delivery plan that accompanies it, focusing particularly on what it means for the NHS.

You need to know. This report presents the key findings of the National Autistic Society's research into why so many children with autism have mental health problems and how CAMHS services can work better for children with autism.

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.

LAC (DH)(2010)3: The Mental Capacity Act. The Mental Capacity Act 2005 requires a review of much existing policy and practice in relation to enabling people who lack capacity to be assisted to make decisions and access services. This circular covers 2010-11 resources for the implementation of the Act.

Maximising resources in adult mental health. This Audit Commission report looks at the scope for improving the efficiency of the acute care pathway in adult mental health, while maximising quality.

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.

News
Regulator calls on Devon Partnership NHS Trust to ensure mental health services for older people are up to standard. The CQC has published the findings of a detailed investigation follows serious concerns that were raised about the quality of care provided by Devon Partnership NHS Trust. The report shows that the Trust has already made significant improvements to its services for older people; but it says that a history of inadequate supervision of staff had allowed poor practice to continue unchallenged until 2008. The report highlights a failure to properly manage medicines, leading to medication being administered inappropriately in one unit, the Harbourne Unit in Totnes, until November 2008. The full report and a summary are on the CQC website.

Doctors to flag up mentally ill patients who own guns. After talks between the Association of Chief Police Officers and the British Medical Association, GPs will now tell the police if they fear patients who own guns have become so mentally ill that they could be a serious danger to the public. A BMA statement said: "While there is a clear public interest in a confidential health service, where there are serious threats to individuals, confidentiality can be breached. Where doctors know that a patient has a firearm and, in their view, as a result, presents a risk of harm to themselves or others, both legally and ethically, this information can be disclosed without consent."  

Psychological therapies offered across the NHS. The Health Secretary has confirmed the Government’s commitment to increase access to psychological therapy services by pledging £70m over the next year. This will ensure services can continue to run this year and that new services can be established.

Bevan Brittan Updates
Rabone - Clarity and Article 2 – an oxymoron? Nadia Persaud examines the decision of the Court of Appeal in the case of Rabone v the Pennine Care Trust. The Court has provided some helpful guidance in relation to the application of Article 2 to patients who are not detained under the Mental Health Act.  As well as helpful guidance on claims for breach of Article 2, the case will have a significant impact upon healthcare inquests.  

New responsibilities for NHS Trusts in relation to children admitted onto Psychiatric wards. In this article Laura Forsyth examines Section 131A of the Mental Health Act 1983 which came into force on 1 April 2010. 

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
Implementation of the right to access services in the maximum waiting times. Guidance to strategic health authorities, primary care trusts and providers. Guidance on implementing the new patient rights to access services within maximum waiting times (18 weeks for non-urgent consultant-led elective care, and two weeks for urgent cancer referrals, from GP referral). The guidance describes the duties placed on PCTs and SHAs in the Primary Care Trusts and Strategic Health Authorities (Waiting Times) Directions 2010 (in force 1 April 2010) and sets out some of the mechanisms these bodies might want to adopt to fulfil their legal obligations. The guidance also covers actions providers of NHS services could take in order to fulfil their contractual obligations.

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.

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.

The GP patient survey: briefing for strategic health authorities, primary care trusts and GP practices on the GPPS 2009-10. Briefing on the background and payments associated with the GP Patient Survey 2009/10.

GP budget holding: lessons from across the pond and from the NHS. This report draws on lessons from the United States and previous NHS experience to identify the risks and the safeguards that have to be put in place to implement such a policy effectively. It shows that giving GPs control over budgets can lead to improvements in patient care and better use of health care resources.

Implementation of the Right to Access Services in the Maximum Waiting Times: Guidance to strategic health authorities, primary care trusts and providers. This document provides guidance on implementing the new patient rights to access services within maximum waiting times (18 weeks for non-urgent consultant-led elective care, and two weeks for urgent cancer referrals, from GP referral).

Giving GPs budgets for commissioning: what needs to be done? In this briefing paper, six national organisations conclude that handing real budgets to GP commissioning groups has the potential to help improve patient care but it will need time and careful design to make it successful.  

More power to the patient. The DH has announced that eight PCTs are to road test direct payments for personal health budgets, allowing them to give the money for someone's care directly to them, allowing individuals to decide how, where and from whom they receive their healthcare, in partnership with the local NHS. The pilots will run until 2012.

Bevan Brittan Updates
“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
Care Quality Commission: Involvement and action taken by health bodies in relation to the case of Baby Peter Connelly - Progress against the recommendations of our intervention report. This report shows that the four NHS trusts that provided care to Baby Peter have improved the way they

Cases
R (Remedy UK Ltd) v General Medical Council [2010] EWHC 1245 (Admin) (Admin Ct). R, a company limited by guarantee, was founded to represent doctors who had lost confidence in a new scheme for recruitment of junior doctors, and a new computerised system of making appointments for junior doctors' training posts, MTAS. R applied for judicial review of the GMC's decision not to subject the Chief Medical Officer for England (CMO) and a professor who chaired the recruitment and selection steering group, to the GMC's disciplinary process. R sought to hold them accountable for what it perceived to be their responsibility in allowing the MTAS scheme to be adopted and implemented in circumstances which have caused damage to doctors, patients and the standing of the profession.
The court held that functions exercised by the CMO and the professor were too remote from the profession of medicine to bring them within s.35C(2) of the Medical Act 1983 and so they could not be held accountable through the GMC's fitness to practise procedures for seriously flawed policies devised for the recruitment and training of junior doctors. The concept of fitness to practise was not limited to clinical practice alone and there was no reason why a doctor who was seriously deficient in research, or who engaged in teaching students in an incompetent manner, could not properly be subject to the fitness to practise procedures for those failings. However, the administrative functions being exercised by the CMO and the professor could not be described as exercising functions which were part of their medical calling or sufficiently closely linked to the practice of medicine. The making and implementation of government health policy was not a medical function, even where the policies in issue directly related to doctors and closely affected the medical profession.

Bradshaw v General Medical Council [2010] EWHC 1296 (Admin) (Admin Ct). The court held that allegations against a doctor of making false accusations, fabricating and altering original documents and lying to a disciplinary investigator that arose out of his alleged personal relationship with a colleague and did not affect his clinical competency and performance would still be likely undermine public confidence in a doctor's core duties and responsibilities of honesty and integrity, and the GMC had been entitled to make an interim order to suspend his registration.

Consultations
Care Quality Commission: Consultation on revised enforcement. Deadline date: 31 August 2010. This consultation seeks views on the Commission's enforcement policy. There are changes to Warning Notice arrangements, and it has added ‘Compliance Actions’ and ‘Improvement Actions’ to its possible regulatory responses. The basic approach and the principles it will follow when responding to failure to comply with the essential standards remains unchanged from its existing policy. The finalised enforcement policy should be published on 1 October 2010.

News
Regulator calls on Devon Partnership NHS Trust to ensure mental health services for older people are up to standard. The CQC has published the findings of a detailed investigation follows serious concerns that were raised about the quality of care provided by Devon Partnership NHS Trust. The report shows that the Trust has already made significant improvements to its services for older people; but it says that a history of inadequate supervision of staff had allowed poor practice to continue unchallenged until 2008. The report highlights a failure to properly manage medicines, leading to medication being administered inappropriately in one unit, the Harbourne Unit in Totnes, until November 2008. The full report and a summary are on the CQC website.

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

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General

Publications/Guidance
Inpatient Survey 2009. This briefing note summarises the key findings from a survey of more than 69,000 adult patients over 162 acute and specialist NHS trusts in England. The results from this survey are used by NHS trusts to understand the experiences of their patients and to help improve their performance. The Care Quality Commission 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.

Making the most of frontline staff in the NHS. This document identifies areas where NHS trusts and foundation trusts could make efficiency savings by making the most of their frontline staff. The authors suggest that there is the potential to make significant savings by making better use of doctors and nurses. The variation in nurse numbers, use of bank and agency nurses and grade mix suggests there is the capacity to improve productivity and reduce costs.

Seeing ambulance services in a different light. NHS ambulance services are seeing more people, faster, and offering better quality care than ever before. This factsheet from the King's Fund illustrates six important roles ambulance services play and how they are helping to ensure patients receive better care.

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.

Future physician: changing doctors in changing times. This report of a working party argues that doctors are in an ideal position to drive changes in healthcare for the benefit of patients. The report urges doctors to take up leadership positions in medicine and public life to accelerate improvement in health outcomes. The authors argue that doctors, in partnership with patients and others, can be the catalyst for change and improvement.

The influenza immunisation programme 2010/11. This letter contains information about the annual seasonal influenza immunisation programme for winter 2010/11, including influenza immunisation for frontline health and social care staff, and the poultry worker immunisation programme.

Implementation of Medicines for Human Use (Miscellaneous Amendments) Order 2010: midwives exemption list. This letter sets out the situation regarding midwifery exemptions as a result of changes to the Statutory Instruments which came into force on 1 June 2010. It includes advice from the Medicine and Healthcare Products Regulatory Agency on the position of student midwives. 

Allergy services: still not meeting the unmet need. In 2007, the House of Lords Science and Technology Committee published its report into allergy, in which it set out various recommendations for the improvements of allergy service provision across the UK. Now, three years on, this report reviews the changes that have been made to service provision since then. The overall conclusion is that the actions taken to implement the original recommendations in full have been largely unsatisfactory, but many examples of best practice have been identified. 

Report of the Swine Flu Critical Care Clinical Group and key learning points for future surge planning. The Critical Care report builds on the work undertaken during the 2009/10 swine flu pandemic to increase critical care capacity. The report incorporates key learning points for future surge planning. The most important is the recommended work for critical care networks, which must be robust and well prepared as the essential foundation for any response for surge in demand.

Learning the lessons from the H1N1 vaccination campaign for health care workers. This report provides the NHS and social care sector with information on lessons learnt from the H1N1 health and social care worker vaccination programme. 

News
Abolition of the four-hour waiting standard in Accident and Emergency. This letter from Health Secretary Andrew Lansley to the President of the College of Emergency Medicine considers the abolition of the four-hour waiting standard. He states that the four hour standard is to be abolished from April 2011; in its place will be a "dashboard" of quality indicators that will give a broader picture of the success of each A&E department.

Bevan Brittan Updates
Forced Marriage – The Role of the Healthcare Professional. In this article Annette Parker explores the legalities and complexities of forced marriage and explains how it differs from arranged marriage. 

Trust Handling of Requests for Information in Criminal Proceedings. Jane Bennett and Tracey Lucas explain the increasing demand on Trusts to disclose records for the purpose of prosecuting or defending criminal cases. 

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

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