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   Foundation Trusts
  Children   Information and Data Sharing
  Clinical Risk   Mental Health
  Commissioning   Primary Care
  Complaints   Public Health
  Employment/HR   Regulation
  Finance   General 



Stories from the present, lessons for the future. The Patients Association has published its fourth annual ‘Patient Stories’ report – a series of case studies highlighting experiences of care. ‘Stories from the present, lessons for the future’ catalogues 13 accounts from patients or relatives who have experienced poor care in hospitals and care homes around the country.

Adult Social Care Outcomes Framework 2013/14. This Outcomes Framework (ASCOF) supports local authorities to rise to the challenge of delivering the main White Paper priorities by providing a clear focus for local priority setting and improvement, and by strengthening the accountability of councils to local people. It: describes the principles for the way in which the ASCOF should be used, and its role in supporting local improvement; provides a national commentary on adult social care outcomes in 2011/12 (the first year of the operation of the framework); sets out the ASCOF for 2013-14; and provides a forward look for the development of the ASCOF in future years.
It should be read alongside Improving health and care: the role of the outcomes frameworks, which sets out in more detail how the frameworks work together to support delivery of the Department’s vision for health and social care.

End of life care facilitator competency framework. This competency framework has been developed to support high quality practice by encouraging and assisting end of life care facilitators to continually review their learning and practice. It provides a basis to support and improve the quality of practice by encouraging and assisting learning, and enhancing knowledge and skills.

A good death: the role of the local authority in end of life care. In recent years the health sector has taken the lead role in end of life care provision and the engagement of local authorities has been more mixed. However, many local authority services, such as social care and housing, are crucial components when delivering high quality end of life care. This report by the Local Government Information Unit (LGIU) looks at the role of local authorities in this agenda and how councils can develop their part in this important service provision.

Compassion in practice: nursing, midwifery and care staff - our vision and strategy. This three-year vision and strategy for nursing, midwifery and care staff aims to build the culture of compassionate care in all areas of practice. Actions include: recruiting, appraising and training staff according to values as well as technical skill; regularly reviewing organisational culture and evidence for staffing levels; doing more to assess patients’ experience; and helping staff make every contact count for improving health and wellbeing.

What about end of life care? Mapping England’s health and wellbeing boards’ vision for dying people. This report finds that although a number of Health and Wellbeing Boards have set out in their strategies how they will improve end of life care, for example by better identification of people who are dying and co-ordinating care and bereavement support, many have failed to do so. An accompanying toolkit aims to help various bodies and organisations to consider their vision for people approaching the end of life. 

State of Care report 2011/2012. The Care Quality Commission (CQC) has published a report which examines all care sectors and explores why some care services are not meeting CQC standards. The report found increasing pressures on care services, due to increased demand, were having a negative impact on the standard of care.

Market oversight in adult social care. This consultation seeks views on policy proposals to strengthen oversight of the social care market and new measures to protect people who rely on care services in the event of provider failure. The proposals look at what further measures are needed to strengthen and clarify the responsibility of local authorities in relation to care users in the event of the failure of a care provider, and whether a targeted model of central oversight would be appropriate and if so, what the elements of this model would be. The closing date for comments is 1 March 2013.

If you wish to discuss any of the items raised in this section please contact Carlton Sadler

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Funding allocations announced for new children’s hospice 2012/13 grant. Announces details of the funding allocations for the additional £721,000 made available for new children’s hospices set up within the last 3 years.

Damning child protection report sparks fears of new 'get tough' approach.

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

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Clinical Risk     

CNST and commercial alternatives - independent briefing paper published 30 October 2012. An independent analysis has been published by Marsh UK on the NHS Litigation Authority and the commercial insurance market. Marsh has combined its knowledge of the NHS LA and the commercial insurance market to highlight the key differences and areas of analysis for any foundation trust considering commercial alternatives. The paper which has been produced by the consulting division of Marsh, looks at coverage issues and financial costs, including the transitional costs of leaving CNST. It sets out the key factors which should be considered by foundation trusts to ensure that the right level of protection is in place for the long-term at an efficient cost. Marsh is a commercial insurance broker and risk advisor and was appointed by the Department of Health in 2011 to conduct an 'industry review' of the NHS LA. The review was published by the Department of Health in 2012 and found the risk pooling scheme to be a valid concept which is widely accepted and endorsed. Its stewardship and administration under the NHS LA was found to have been effective.

The management of adult diabetes services in the NHS. The Commons Committee of Public Accounts has published a report on the management of adult diabetes services in the NHS, which highlights a number of issues in the provision of services for diabetics including a high rate of people developing complications from lack of basic support and care.

The 2012 Dr Foster Hospital Guide, containing performance metrics on every hospital trust in England, is now available. In addition to publishing traditional mortality indicators, this year’s Hospital Guide highlights information on the vital link between quality and efficiency. This year's guide demonstrates evidence of wide variations in hospital mortality rates, and calls for safer medicine and hospital care that consistently delivers good outcomes. Findings also show that many acute hospitals are often working at between 95 and 100% capacity, leaving patients at risk; infections becoming more difficult to control; orderly management of admission and discharge becoming strained; and the likelihood of mistakes occurring increasing. The guide suggests that many of the people currently in hospital beds could be treated in a more appropriate setting. It particularly highlights the number of frail elderly people finding themselves admitted to hospital because of lack of access to more relevant treatment.

Cancer patients in crisis: responding to urgent needs. This report found that emergency admissions for patients with cancer remain problematic despite the development of acute oncology. It identifies the difficulties faced by the health professionals who need to treat them promptly and effectively but may not be familiar with cancer management. It also provides a range of tools and suggestions for better treatment, across the settings where this occurs from the community and general practice to hospital acute care.

Acute care toolkit 5: teaching on the acute medical unit. This toolkit helps clinicians and trainees ensure there is a focus on quality education as well as delivering essential care. It focuses on maximising opportunities for teaching and learning, and includes technical tips and examples for weaving teaching and learning into the daily work of an acute unit.

Policy+: what are the benefits and challenges of ‘bedside’ nursing handovers? This issue of Policy+ examines different approaches to implementation, evidence of the benefits, and challenges associated with bedside handover in acute hospital settings. 

Making connections with the challenges of unscheduled care. This publication is the result of work with a number of acute hospital sites to understand the complexity of urgent and emergency care attendances, and admissions. It shares the issues, the outcomes and identifies some tried and tested solutions that can ease the burden of unscheduled care. 

Implementing a ‘duty of candour’: a new contractual requirement on providers - analysis of consultation responses. This analysis examines responses to the consultation on proposals to toughen transparency in NHS organisations and increase patient confidence announced by Health Minister Dr Dan Poulter following a public consultation. The Government’s proposal was for a contractual requirement, implemented through the NHS Standard Contract, covering NHS acute, ambulance, community and mental health care providers. The contract would require these organisations to be open with patients when things go wrong with their healthcare and give them information about any investigations that have taken place, or any lessons learned. The Government has now announced that it will create regulations that require the NHS Commissioning Board to include a contractual duty of openness in all commissioning contracts from April 2013.

Management of hip fracture in adults. This guidance aims to support the integrated commissioning of high-quality, evidence-based services for people who have fractured their hip. It provides advice on the commissioning of services for people with fragility fracture of the hip or fracture of the hip due to osteoporosis or osteopenia, including services for the ongoing secondary prevention of further hip fracture/fragility fractures.

Free to choose? Reform and demand response in the English National Health Service This paper uses a new model to estimate whether the increased patient choice brought into effect by the NHS reforms will increase demand on hospital services, looking particularly at clinical quality and waiting times for surgical procedures. It found that demand faced by hospitals increased post-reform, giving hospitals potentially large incentives to improve their quality of care. It also found that hospitals responded strongly to the enhanced incentives due to increased demand. Findings suggest that greater choice can enhance quality, leading to significant reductions in mortality and an increase in patient welfare.

Seven day consultant present care This report brings together 20 colleges and faculties who have committed to the recommendation that patients in hospital should be reviewed by a consultant at least once every 24 hours, including weekends and bank holidays, unless there are good reasons for them to not to have a daily review. It outlines a series of areas for improvement and highlights that it is unacceptable to not provide consultant-led care at weekends if evidence suggests that this is best for patients. It also calls for the NHS to ensure that appropriate resources and adequate numbers of consultants are provided to enable consultant-led care to be achieved, seven days a week.

Drug use disorders quality standard. This quality standard, covering adult drug misuse, highlights an integrated approach between the NHS, social services, local authorities and the voluntary sector as a fundamental part of quality care in order to deliver the best chance of recovery. 

Surgeons under scrutiny. Radio 4 at 8pm on 6 December. Matthew Hill looks at why surgeon Rob Jones, the obstetrician who delivered the Prime Minister's child Florence in 2010, was able to remain in practice for twenty years at the Royal Cornwall Hospitals NHS Trust, despite being subject to eight inquiries into his clinical competence. The Report speaks to NHS Medical Director Sir Bruce Keogh, asking him what lessons can be learnt from this case.

Surgeon Ian Paterson faces inquiry over 1000 'unnecessary' breast operations.

Hunt orders review into OFSTED style ratings for NHS and social care. The review will look at the way in which a new ratings system could help end the ‘crisis in standards of care’ that exists in parts of the health and social care system. It will look in particular at how information about services can be communicated to the public and how this information can be used to drive up standards across the system.

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

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The Mandate: A mandate from the Government to the NHS Commissioning Board April 2013 - March 2015. The Government has published its Mandate to the NHS Commissioning Board that sets out the objectives for the NHS and highlights the areas of health and care where the Government expects to see improvements. It focuses on five areas:
 helping people live longer;
 managing ongoing physical and mental health conditions;
 helping people recover from episodes of ill health or following injury ;
 making sure people experience better care; and
 providing safe care.
It is accompanied by Financial Directions to the NHS Commissioning Board that set out certain additional and expenditure controls to which the NHS Commissioning Board must adhere and the particular uses of resources which must, or must not, be taken into account in relation to each limit.

NHS Outcomes Framework 2013 to 2014 – focus on measuring health outcomes. The DH has published the latest version of the NHS Outcomes Framework that sets out the outcomes and corresponding indicators that will be used to hold the NHS Commissioning Board to account for improvements in health outcomes. This latest version of the framework builds on the previous two versions of the framework and contains measures to help the health and care system to focus on measuring outcomes. It describes how the NHS Outcomes Framework will work in the wider system, and highlights the indicator changes since the December 2011 edition. There is also a Technical Appendix containing detailed information about each of the indicators in the framework.

Standards for board members and members of Clinical Commissioning Group governing bodies in the NHS in England. The Professional Standards Authority has published new standards for members of NHS boards and CCG governing bodies in England. These standards are aimed at supporting them to understand the extent of their personal responsibility in making sure care, dignity and respect are central to service delivery in their organisations. The Standards cover three domains: personal behaviour; technical competence; and business practices. They put compassion and respect at the heart of NHS leadership.

Integrated ambulance commissioning in the new NHS. This briefing explains how ambulance commissioning currently works. it is aimed at clinical commissioners who may be new to this area. It is designed to support the efforts being made by the National Ambulance Commissioners Group (NACG), which is hosted by the NHS Confederation, to ensure that ambulance commissioning responsibilities are effectively transferred from PCTs to CCGs. New commissioners need to have a good understanding of the role and significance of ambulance commissioning if a safe and effective ambulance service is to be maintained as part of a high-quality urgent and emergency care system.

NHS continuing healthcare. This briefing outlines for commissioners and providers the challenges and opportunities they will need to consider as the responsibilities change for assessing eligibility for and commissioning CHC. 

Exploring the early workings of emerging clinical commissioning groups. This report presents the findings from a study of developing CCGs in England which explored the early experiences of emerging CCGs as they set themselves up as pathfinders and moved towards authorisation, investigating the factors that had affected their development and drawing out lessons for the future.

Securing equity and excellence in commissioning specialised services. The NHS CB has published a new Operating Model for specialised services that sets out how a single, national system will ensure patients are offered consistent, high quality services across the country. The number of patients requiring specialised services is small with services located in specialist centres in major towns and cities across England. Concentrating services to provide the same national standards of quality will ensure that specialist staff can be more easily recruited and the necessary levels of training maintained. The new Operating Model and associated Commissioning Intentions mark a clear move away from regional commissioning to a single national approach to both commissioning and contracting.

Malnutrition matters: meeting quality standards in nutritional care - a toolkit for commissioners and providers in England This toolkit contains guidance for commissioners and providers on defining the relevant, measurable outcomes related to nutritional care within services in order to gain value for money, a summary of national nutritional care standards, recommendations and tools for assessment, development, education and training.

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

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NHS complaints procedures in England - Commons Library Standard Note. A House of Commons Library Standard Note provides information on the NHS complaints procedures in England.

If you wish to discuss the item raised in this section please contact Julie Chappell.

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Cost benefit and equality analysis for medical revalidation. Medical revalidation commenced in December 2012 to strengthen the regulation of licensed doctors in the UK. Revalidation is a five yearly process which gives doctors a clear framework to reflect on and improve their quality of care, as well as providing assurance to patients and the public that doctors are keeping up to date and remain fit to practise.

Engaging your staff: the NHS staff engagement resource. This toolkit contains a wide range of information including: an introduction to staff engagement; practical working examples; evidence on the benefits of an engaged workforce; and access to a series of tools and resources. It is aimed at all staff groups, from clinicians, HR managers and communications teams to senior managers.

Frontline first: protecting services, improving care. This report reviews the state of the NHS workforce as the coalition government’s term reaches its halfway point. It finds that nursing is suffering from cuts while other professions are increasing in numbers. It argues that these figures reveal a looming crisis in nursing, as the demand for nursing care increases. It cites the formation of Health Education England as an opportunity to take a long-term approach to workforce planning and secure the future supply of nursing staff.

Implementing health and well-being. This new section of the NHS Employers website is intended to assist local health and well-being leads implement health and well-being strategies and plans by providing information, advice, guidance and links to best practice in a number of key implementation areas. These include: achieving board engagement; building the business case for investing in health and well-being; developing and implementing a health and well-being strategy; and developing management competence in dealing with employee health and well-being.

Workforce planning tools. These tools were commissioned by the Department of Health and are designed to help employers effectively plan their healthcare science workforce. Tools have been developed for three areas of the healthcare science workforce; pathology, physiological sciences and physical science and engineering. They are designed to be used by staff responsible for collecting and analysing healthcare science workforce data to support employers with the healthcare science modernisation agenda. They will also provide employers with a method for analysing the activity of the current healthcare science workforce and the services provided. 

Supporting apprentices in the workplace. This leaflet provides advice and information for RCN representatives supporting apprentices in the workplace, and identifies areas for concern, such as pay below the legal minimum, poor quality training and ‘pre-employment apprenticeships’ with no pay. It also defines an apprenticeship framework and looks at the employment of apprenticeships in health care among young workers and established older workers.

NHS whistleblowing procedures in England - Commons Library Standard Note. A House of Commons Library Standard Note sets out the current rights and procedures for NHS staff to raise concerns about safety, malpractice or wrong doing at work (popularly known as "whistleblowing").

Staff survey analysis toolkit. This tool aims to aid with analysis of staff survey results and also comparison with similar NHS organisations.

Consultation on amendments to the NHS pension scheme regulations.  A Department of Health consultation seeks views on draft National Health Service Pension Scheme, Additional Voluntary Contributions and Injury Benefits (Amendment) Regulations. The Regulations will amend previous Regulations and, inter alia, accommodate the new structure and function of NHS administration that the Health and Social Care Act 2012 creates from 1 April 2013, and apply increases to member contribution rates. Comments by 12 February 2013.

Bevan Brittan Updates
Employment Eye - Political opinion as reason to dismiss. In relation to an employee who was dismissed because he was elected a local councilor for the BNP, the European Court of Human Rights has decided that the UK Government has broken the European Convention on Human Rights, because there of the lack of protection under UK law for employees dismissed on the grounds of their political beliefs or affiliation. This case is important for both private and public sector employers; but has a more immediate impact on public sector employers, because of the potential for public sector employees to bring claims under the Human Rights Act. Anne Palmer reports.

Employment Eye: A mineshaft and a legal minefield: the TUPE 'one-off event' exemption. The Employment Appeal Tribunal has, this month, provided the first precedent setting analysis of the exemption from TUPE for ‘single specific events or tasks of short term duration’. In this case, reported by Alec Bennett, the EAT looked at whether a one-year contract between a coach operator and a school, to transport school children, came within the exemption.

Employment Eye: News round-up. Jodie Sinclair and Laurie Child provide this month’s employment news round-up, including: details of the Government’s new ‘flexible parental leave’ proposals; the latest on the future of the ‘Fair Deal’ pension policy; proposed changes to Agenda for Change contracts; streamlining of dismissal procedures for senior Local Authority executives; and a summary of the new requirements for independent contractors to the NHS. 

If you require further information about any of the items raised in this section please contact Julian Hoskins or James Gutteridge.  

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Personal Health Budgets discussion paper. This discussion paper outlines the BMA's position on personal health budgets and also reports on the findings of a survey of BMA members. The survey asked for members' thoughts on the principles behind personal health budgets, the likely impact on patients, and the NHS and doctors' readiness for the introduction of personal health budgets.

A simple guide to Payment by Results (PbR). This guide provides an introduction for newcomers to PbR, from NHS health professionals, managers and administrators, to people engaged in academic study and interested members of the public both in the UK and abroad. It replaces the version released in August 2011.

Improving birthing environments: Department of Health capital fund programme 2012. This funding programme invites bids from NHS providers for £25 million of capital in 2012-13 so that the birthing environment in maternity units can be improved. Successful projects will have demonstrated involvement and support from service users and the ability to deliver the project in the current financial year. The deadline for applications is midday on the 31st December 2012.

Evaluation of the personal health budget pilot programme. A report, commissioned by the Department of Health, evaluates the personal health budget programme, which aims to improve patient outcomes by placing patients at the centre of decisions about their care. The report finds that, under the programme: people's quality of life improved; if half of the people eligible for NHS Continuing Healthcare chose to take the offer of a budget, this could mean a potential saving of around GBP 90 million; the amount of times people had to attend hospital decreased overall.

A decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22. This report highlights the funding challenges facing the NHS and social care system in England over the next decade. It focuses on the portion of the total NHS budget in England that is currently spent by PCTs on commissioning services for the population of England, which makes up around 80% of the total budget for the NHS in England. It also examines funding pressures on social care services, and examines options for achieving the current QIPP challenge of £20 billion in productivity savings by 2014/15. 

'How to: reduce expenditure on medical locums' guide. Despite a general trend across the NHS toward a reduction in the number and use of temporary and agency staff, the number of medical locums being used by NHS trusts is increasing, as is the overall cost. Recent estimates suggest that 50% of expenditure on agency staff in the NHS is spent on medical locums and that these costs are continuing to rise.

Achieving savings from high cost drugs. This report sets out how commissioners and providers of NHS services can work together to achieve savings in the use of high cost drugs. 

£25 million to improve maternity wards and more help for mums and babies. Announces a new £25m fund to improve birthing environments. Maternity services will be able to apply for new funds to improve their maternity environments, such as en suite facilities, rooms where partners can stay overnight or a wider range of facilities available like birthing pools, this enabling women to able to give birth with more dignity and in more comfort. As a further boost to new parents, the NHS Information Service for Parents is being expanded to cover older babies up to six months old and by April 2013 will be further expanded to cover children up to 18 months of age.

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

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Foundation Trusts 

Bevan Brittan Articles
The Mid-Staffordshire NHS Foundation Trust Public Inquiry – staff recruitment, standards, and engagement. Robert Francis QC’s report into the Mid Staffordshire NHS Foundation Trust Public Inquiry ('the Inquiry') is due to be issued to the Secretary of State in January 2013.  The features of good governance which will emerge from the Inquiry are likely to provide valuable learning beyond the NHS and across the entire health and social care sector.

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

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Information and Data Sharing

Delegating record keeping and countersigning records: guidance for nursing staff This guidance draws on the Nursing and Midwifery Council (NMC) code to clarify issues of delegating record keeping and countersigning records for nursing staff and employers.

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

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Mental Health


Bevan Brittan Mental Health Extranet.
This is a free resource for Bevan Brittan NHS clients. Bevan Brittan has a wealth of mental health knowledge it would like to share with NHS clients. We have therefore developed an online searchable extranet designed to bring various sources of mental health information and guidance into one place.

The extranet also contains a forum for use by members to share knowledge and information. Forum issues currently being discussed are:-
  Ban on age discrimination - Claire Bentley and Simon Lindsay have included in this series of posts a knowledge note on the Equality Act, age discrimination and the impact on the NHS.
  Funding aftercare  - Simon Lindsay has included a knowledge note in this post on the case of R (Sunderland City Council) –v- South Tyneside Council [2012] EWCA 1232.  The Court of Appeal looked at which of the 2 authorities was responsible for funding aftercare under s.117 of the Mental Health Act 1983 and the meaning of the word “residence" and how that defines which body pays. Simon reviews what the Court of Appeal decided and the criteria to apply.
 s136 and under 18s - Guidance and standards
 Consent forms for admission to hospital

If you would like information about how to access the Bevan Brittan Mental Health Extranet please email Claire Bentley by clicking here.

Training - If you would like to know about our lunch time training sessions just ask Claire Bentley.  You can attend in our London, Bristol or Birmingham office.

Equally accessible? making mental health services more accessible for learning disabled or autistic people. People with learning disabilities or autism deserve equal access to mental health services and good treatment, but they currently receive variable treatment across England reports the NHS Confederation.

Isle of Wight Council criticised for withdrawing support for child with mental health difficulties. Local Government Ombudsman, Dr Jane Martin, has found the Isle of Wight Council wrongly withdrew social services support from a child in need, leading to cancellation of a residential school placement.

The abandoned illness. This report is the result of a year-long inquiry into the delivery of care for patients affected by schizophrenia and psychosis. Recommendations include: a radical overhaul of poor acute care units, including better use of alternatives to manage the transition between hospital and community services; greater partnership and shared decision making with service users; extending general practitioner training in mental illness to improve support for those with psychosis managed through primary care; extending the 'Early Intervention for Psychosis' services rather than cutting or diluting them; action to address inequalities and meet the needs of disadvantaged groups; and greater use of personal budgets, particularly for those with long-term care needs.

With money in mind: the benefits of liaison psychiatry. Liaison psychiatry services are increasingly seen as an essential component of effective care in acute hospitals. Their clinical effectiveness has been well documented, but little has been known up until now about their potential economic impact. This briefing outlines the benefits that the Birmingham RAID liaison psychiatry service has brought in terms of cost savings and improved health and well-being for patients. It will be of particular interest to all those who commission and provide acute hospital and mental health services.

Mental Health (Discrimination) (No. 2) Bill: Committee Stage Report - Commons Library Standard Note. A House of Commons Library Standard Note sets out information for the Report Stage of the Mental Health (Discrimination) (No.2) Bill on 30 November 2012. The Bill is intended to reduce the stigma and negative perceptions associated with mental illness.

Miss G - Independent Multi-agency Review Report.. An Independent Multi-agency Review Report in respect of Miss G (Hannah Bonser), written by Professor Pat Cantrill, has been published. The report says that no single agency owned Miss G's care and frequent movements between agencies resulted in some fragmentation of the care she received. The report concludes that there were missed opportunities to work with Miss G more effectively and it makes 21 recommendations for organisations directly involved or interested in her care. See BBC News report.

Children held in police cells under Mental Health Act. Children as young as 11 were held in police cells in England and Wales in 2011 because officers thought they were mentally ill, the BBC has learned.

Patients with psychosis should be offered therapy. Clinical Commissioning Groups should commission services for people with schizophrenia and psychosis in line with NICE guidelines, including the use of cognitive behavioural therapy (CBT) for psychosis, say experts. Currently, just one in ten people who could benefit from the therapy have access to it, despite being approved by NICE. At the same time, almost half of all practitioners, people using mental health services and their families say that CBT is the most important intervention alongside the use of medication. The findings come from an independent inquiry into the standard of care for people with schizophrenia in England published by The Schizophrenia Commission - which was set up by the charity Rethink Mental Illness.

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

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Primary Care

TARGET antibiotics toolkit. This toolkit aims to help clinicians and commissioners use antibiotics responsibly and meet CQC requirements. It has been developed by the RCGP and The Antimicrobial Stewardship in Primary Care (ASPIC) collaboration of professional societies including GPs, pharmacists, microbiologists, clinicians, guidance developers and other stakeholders. It includes: the HPA antibiotic guidance template which can be modified locally; patient information leaflets; self assessment check list for GPs and commissioners; audit tools with indicators of responsible antimicrobial use; and links to online clinical modules and other useful resources.

Find your 1%: helping GPs to support people to live and die well. This resource pack has been developed to be a practical tool to help GPs identify those patients who may be in their last year of life and talk to them about their preferences. It contains information on: identifying people at the end of life; having end of life care conversations; putting plans in place; managing and co-ordinating care; and space for GPs to include local information such as the telephone numbers of hospices, palliative care teams and pharmacies which stock palliative care drugs.

Good practice guidance for PCT decision making processes on drugs and treatments: equality analysis. The NHS Constitution includes a right for patients to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. This equality analysis accompanies the establishment of this NHS Constitution Right in the standing rules regulations.

Securing excellence in GP IT services: operating model This document explains how the management of IT systems for GP practices will be organised from April 2013. It enables CCGs to make decisions to suit particular local requirements, ensuring information and technology supports clinical commissioning to improve health outcomes for patients. Procurement of GP clinical systems through the GP Systems of Choice scheme and local service providers, or any national systems, will continue to be supported nationally.

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

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Public Health

Public health functions to be exercised by the NHS Commissioning Board. The NHS CB and the DH have published their detailed agreement showing how the NHS CB will drive improvements in the health of England’s population through its commissioning of certain public health services. The agreement sets out the outcomes to be achieved in exercising these public health functions and provides ring fenced funding for the NHS CB to commission public health services.

Public Health Outcomes Framework - technical refresh. This technical refresh of the framework is the fulfilment of the promise to continue improving the range and quality of information in the framework. The update looks specifically at the part of the framework entitled Improving outcomes and supporting transparency. It should be read alongside Improving health and care: the role of the outcomes frameworks, which sets out in more detail how the frameworks work together to support delivery of the Department’s vision for health and social care. It has also published an interactive Public Health Outcomes Framework Data Tool with the first set of baselines, which will allow local authorities to assess their own outcomes against the various indicators.

Implementing NICE public health guidance for the workplace: overcoming barriers and sharing success. An audit into trust implementation of NICE public health guidance for the workplace found that 44% had an overarching strategy for staff health and wellbeing. This report calls for board level lead in every NHS trust to take proactive responsibility for staff health improvement and wellbeing.

Public Health England (PHE) people transition policy module 2 This module sets out the agreed framework for the terms and conditions for those transferring into PHE and for new staff appointed to PHE after the 1st April 2013.

New professional body for health visitors. A new Institute of Health Visiting (IHV) has been established as a UK centre of excellence to support the development of consistently high-quality health visiting practice. The aim of the IHV is to raise standards in health visiting practice, and help improve public health outcomes for all children, families and communities. The IHV is not a regulatory body or a trade union – the Nursing and Midwifery Council will maintain its role as the regulator for health visitors.

IAPT three-year report: the first million patients The IAPT programme is a large-scale initiative that aims to increase significantly the availability of NICE-recommended psychological treatments for depression and anxiety disorders within NHS commissioned services in England. This report details the origins of the programme and highlights progress and successes after the first three full financial years of roll-out. It also outlines future requirements, particularly in meeting the financial commitments to 2015 in the Spending Review 2010 and political commitments outlined in the Coalition Agreement and other documents, together with plans to meet them.  

If you wish to discuss any of the items raised in the above section please contact Olwen Dutton 

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2012 accountability hearing with the General Medical Council. The Health Committee has published the report of its 2012 Accountability Hearing with the General Medical Council, in which it criticises the revalidation requirement which asks doctors to seek feedback from their patients every five years as not being challenging enough.

Care homes sector – enforcement of regulation. BIS is consulting with the adult care homes sector on how the enforcement of regulation can be improved. The Focus on Enforcement consultation is part of an initiative to drive up standards and enable providers to achieve the highest standards of care, while removing confusing bureaucratic requirements that divert carers from meeting the needs of residents. It focuses on the way regulation is delivered and compliance is achieved. The closing date for comments is 18 December 2012.

The Care Quality Commission (CQC) has issued two warnings requiring Basildon and Thurrock University Hospitals NHS Foundation Trust to make immediate improvements. Serious concerns were raised following unannounced inspections on 3 November in response to a number of serious incidents involving the care of children. The CQC has ordered an independent investigation be held into the paediatric services provided.

Hunt orders review into OFSTED style ratings for NHS and social care. The review will look at the way in which a new ratings system could help end the ‘crisis in standards of care’ that exists in parts of the health and social care system. It will look in particular at how information about services can be communicated to the public and how this information can be used to drive up standards across the system.

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

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Strategic clinical networks: single operating framework. This framework aims to strengthen continuity of care across a wide spectrum of health conditions. The new model set to be in place by April 2013 brings together management support and clinical leadership for mental health, dementia, neurological conditions, maternity and children, cancer and cardiovascular services. This will contribute to the overarching purpose of the clinical networks, which is for clinicians to gather and share insight into treating complex conditions, and offer treatment across a number of settings.

Choosing the place of care: the effect of patient choice on treatment location in England, 2003-2011. This report by the Institute for Fiscal Studies, commissioned by the Nuffield Trust, examines the effect of patient choice and the independent sector on treatment location in England. it considers the extent to which patients or their referring doctors have been choosing a different location of care since 2006. It is the first output from a three-year joint programme of work between the IFS and the Nuffield Trust on "understanding competition and choice in the NHS", which will establish long-term expertise in the use of competition and market mechanisms in health care both in England and internationally.

Update on launch of NHS Property Services Ltd. The Chief Executive of NHS Property Services Ltd, Simon Holden, has written to NHS bodies with an update on progress in planning for the launch of NHS Property Services Ltd in April 2013. Following the close down of SHAs and PCTs, this new company will be set up to maintain, manage and develop around 3,600 NHS facilities, from GP practices to administrative buildings. The letter also provides advice on what services are in and out of scope for NHS Property Services Ltd and actions that must be taken to ensure all current functions are picked up by the new system.

NHS 111 – Public Sector Equality Duty (PSED) Analysis of Impact on Equality (AIE). This report considers the impact of the transition from NHS Direct’s 0845 telephone service to NHS 111. It also considers mitigation methods to address any disproportionate impact and opportunities to maximise evidence based 'positive action'. The Equality Act 2010 allows service providers to take action that may involve treating one group more favourably where this is a proportionate way to help members of that group overcome a disadvantage, participate more fully, or meet needs they have that are different from the population as a whole. It was identified that individuals were more likely to have used NHS 111 if they had a disability or limiting long term illness, indicating that NHS 111 is reaching some groups of the population with the greatest needs. Respondents were less likely to have used NHS 111 if they were older or male. This is broadly in line with NHS Direct's 0845 4647 telephone service and appears to be inherent in telephone based health care.

Emergency planning in health care: scoping study of the international literature, local information resources and key stakeholders. This report seeks to identify the evidence requirements of the emergency planning community and expand the evidence base around emergency planning in UK healthcare. This includes major incidents, disease outbreaks and natural disasters. It aims to create a more consistent terminology in this area; to compare national models of emergency care; and to determine which interventions are most effective in dealing with emergencies.

Future trends overview. This overview summarises some of the most significant trends and drivers that will potentially affect health and social care services over the next 20 years. It also discusses the implications of these in order to provide an evidence base for future debate and thinking. It is aimed at policy-makers and health and social care leaders engaging in long-term, strategic thinking about how services need to change.

The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life. This report sets out the results of a study, commissioned by Marie Curie Cancer Care, examining the impact of the Marie Curie home-based nursing service on patient outcomes and hospital usage. It examines whether the home-based nursing service helps more people to die at home, reducing both hospital use and costs at the end of life. 

Care UK buys Harmoni, the firm that beat it to NHS phonelines. The Guardian reports that Harmoni, the biggest provider of the new NHS 111 telephone helpline, has been bought by Care UK. The helpline is set to replace NHS Direct from April 2013.

Health Red Tape Challenge launched. The DH is inviting the public to give their ideas on how to remove excessive burdens and reduce bureaucracy across the health and social care sector, to give health professionals more time to care for patients. The initiative is part of the Red Tape Challenge, the Government’s drive to reduce unnecessary regulation. The Healthy Living and Social Care theme will be live on the Red Tape Challenge website until 11 December 2012. 

Improving health and care: the role of the Outcomes Frameworks. Sets out how the three Outcomes Frameworks - Adult Social Care, the NHS and Public Health - work together to achieve the desired outcomes for the health and care system. It explains the principles behind the outcomes frameworks, including: how they support quality improvement for individuals; how the three frameworks are aligned; the role of shared and complementary indicators; and how they will work together in practice to help the system address the challenges facing the health and care system.

Health policy under the Coalition Government: A mid-term assessment. This review by The King's Fund considers how the NHS is performing under the Coalition Government, following on from their major review of NHS performance from 1997 to 2010. It examines the policies introduced by the Coalition Government, assesses how far these will address current and emerging performance issues, and identifies further action needed. The report focuses on eight key aspects of health care: access; patient safety; promoting health; managing long-term conditions; clinical effectiveness; patient experience; equity; and efficiency. It addresses these against a backdrop of three significant areas of change: major reforms to the NHS; the drive to achieve £20bn of productivity savings by 2015 (the Nicholson challenge); and reduced spending on social services.

Chief Medical Officer: Annual report Vol.1: This first of two volumes of the Chief Medical Officer Professor Dame Sally Davies’s annual report provides a comprehensive picture of England’s health. It brings together a number of data sources in one place for the first time and is designed to be used by local authorities and local health professionals as they work together to improve the health of local populations. 

NHS Outcomes Framework 2013/14 mind map. This mind map brings together on one page all the indicators for each of the five domains in the NHS Outcomes Framework 2013/14. It highlights the new additions for 2013/14 as well as the overarching indicators and is intended to provide an overview of the framework as a whole.

Death certification reform: A case study on the potential impact on mortality statistics. In light of proposed changes to the death certification process due to be implemented in April 2014, an Office for National Statistics case study on medical examiner scrutiny of death certificates found that in 78 per cent of cases the underlying cause of death remained unchanged. The changes will require the certified cause(s) of all deaths that are not investigated by a coroner to be independently scrutinised and confirmed by a locally appointed medical examiner.

Best practice tariffs and their impact. This briefing from the Audit Commission sets out an assessment of how best practice tariffs impact at a local level and how implementation can be improved. It focuses on their influence on day case surgery, fragility hip fractures and acute stroke. It offers recommendations to both national tariff setters and the local bodies they aim to incentivise.

MHRA seeks views on the regulation of medical devices. The Medicines and Healthcare products Regulatory Agency (MHRA) has begun a consultation of proposals from the European Commission on improving the regulation of medical devices. The MHRA highlights particular proposals from the Commission and makes its own suggestions for improvements. Feedback is requested from the public, healthcare professionals and all interested parties. The consultation closes on 21 January 2013.

Summary of consultation responses on the United Kingdom plan for rare diseases. The Department of Health has published a summary of the responses it received to its consultation on a 'UK plan for rare diseases'. All of the responses received to the consultation will be fed into the production of the final UK plan. The final UK plan is expected to be published by the end of 2013. Responses include those from clinicians, GPs, NHS commissioners, researchers, patient support groups, specialist organisations, the pharmaceutical industry, patients and carers.

The implementation of European Reference Networks (ERN) on the application of patients' rights in cross-border healthcare. The European Commission is consulting on the implementation of European Reference Networks (ERN) on the application of patients' rights in cross-border healthcare. The consultation closes on 24 January 2013. 

Hospital "was wrong not to resuscitate dying woman". A full hearing challenging the law on "Do Not Resuscitate" orders will take place in February 2013 after the High Court was told on 5 November 2012 that Janet Tracey died after the orders were twice inserted into her medical notes without her or her family's knowledge. Cambridge University Hospitals NHS Foundation Trust maintains the family were aware of the order. The hearing will also consider the family's claim that the Secretary of State for Health acted unlawfully in failing to set any clear policy or national guidance.

Bevan Brittan Updates
Allerdale revisited – Beware of relying on your own default. The Court of Appeal has recently handed down a significant judgment in the case of Charles Terence Estates Ltd (CTE) v Cornwall Council [2012] EWCA Civ 1439, which shows a further tightening of the scope for public authorities to seek to rely on their own failings in trying to avoid liabilities that they might otherwise be taken to have agreed. 

Hitting the target, missing the point, and losing the plot – A snapshot of the themes arising from the Mid Staffordshire Public Inquiry. There is much anticipation and expectation for Robert Francis QC’s report into the Mid Staffordshire Inquiry. The latest announcement of delay in the issuing of the report (which is now due in early January) means that it will not live up to its previous billing by the Health Service Journal as “the most important NHS event of 2012”, but it could well make it the headline act of 2013.

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

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