Health and Social Care Update - July 2009

01/07/2009

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

Care

Publications/Guidance
Emergency services review. This document gives information on the Emergency Services Review, which has been commissioned by the SHAs to: undertake analysis to understand why standards were challenged last winter and how this can be avoided in the future; develop practical tools to enable local health communities to assess and strengthen the sustainability of emergency care provision; and put in place direct, practical support for organisations and communities that want it to improve their performance.

Transforming health and social care: the Social Enterprise Investment Fund. This document contains information and guidance about the Department of Health's Social Enterprise Investment Fund and how the fund supports social enterprises in health and social care.

Pandemic influenza: guidance for commissioners and providers of social care. The aim of this guidance is to provide local authorities and other social care organisations with the tools and resources needed to plan for pandemic flu. It has been produced primarily for commissioners and providers of social care services, but may also be relevant to those supplying and supporting the social care sector. The guidance covers all causes of pandemic flu, but will be of immediate help to social care organisations during the current swine flu outbreak.

Balanced decision-making for people who use care services. Health and Safety Executive. This circular provides advice to health and safety regulators (for clarity and convenience referred to as inspectors) who are involved in the regulation of social care activities. The circular explains the priorities that Local Authority Social Service Departments (LASSDs) and social care providers have with regard to supporting adults and older people who need care and support to live with dignity and independence within the community, whilst ensuring risks are identified and managed. The general principles of risk management will also apply to the health care sector.

Quality Framework: Guidance for community services. This guidance sets out how the seven elements of the quality framework apply to community services. It includes a set of proposed indicators of quality that will be developed and assured for publication.

Transforming community services: ambition, action, achievement. Six best practice guides have been launched to support NHS practitioners and clinical leaders to transform services locally and help empower local staff to lead on modernising community services. These best practice guides have a vital role to play in the delivery of the intentions for High Quality Care for All: the Next Stage Review:

Transforming services for health, wellbeing and reducing inequalities;
Transforming services for children, young people and families;
Transforming services for acute care closer to home;
Transforming services for people with long term conditions;
Transforming rehabilitation services; and
Transforming end of life care.

Common core competences and principles for health and social care workers working with adults at the end of life. The National End of Life Care Programme has worked with Skills for Health and Skills for Care to outline the core skills and knowledge that aims to help staff across health and social care to respond with confidence when caring for people at the end of their lives. The guidance outlines the principles that underpin quality end of life care and groups skills into four sections: communications; assessment and care planning; symptom management and maintaining comfort; and advance care planning.

Consultations
Care Quality Commission: Consultation on new registration standards. All regulated health and adult social care providers will be required by law to register with the Care Quality Commission from April 2010. This consultation seeks views on whether the CQC's guidance appropriately reflects the new registration standards and what should rightly be expected of a safe, quality care service. The consultation closes on 24 August 2009.

Bevan Brittan Updates
Regulated Care Update - Bevan Brittan's Regulated Care Update provides a summary of Tribunal and High Court cases relating to the regulated care sector. It will be of particular interest to those of you dealing with regulatory compliance and risk management in the care sector, whether as providers, commissioners or regulators.

Bevan Brittan Training
Bevan Brittan is hosting two sessions in our London and Birmingham offices on the 15 October and 20 October respectively. These are free seminars covering the important journey to full Care Quality Commission registration under the Health and Social Care Act 2008 for the NHS from April 2010 and for the independent sector by October 2010. We will be looking at the new regulatory framework, focussing on the powers of the regulator and the issue of judging compliance against regulations and compliance criteria. An additional important issue for providers will be the apparent need to submit applications for registration to enter the new regulatory system which is likely to include a requirement for declarations of compliance with the regulations and relevant standards to made in those applications. It will provide attendees with an up-to-date legal perspective on the changes and inform decisions about operational changes that might need to be made in light of the new system. More information and a booking form will be available in future editions of this Health and Social Care Update.

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

Children

Publications/Guidance
Review of patient safety for children and young people. This review highlights some of the patient safety issues for children, young people and their families, outlines current National Patient Safety Agency (NPSA) partnership work streams, and identifies key actions for stakeholders.

Safeguarding children and young people from sexual exploitation. This guidance is aimed at local safeguarding children board partners, practitioners and other professionals working with children and young people. It is intended to help them safeguard and promote the welfare of children and young people who are at risk of being, or who are being, sexually exploited. It is supplementary to, and should be used in conjunction with, the Government’s statutory guidance Working Together to Safeguard Children.

Perinatal mortality 2007. The latest report from the Confidential Enquiry into Maternal and Child Health (CEMACH) shows an improvement in the stillbirth and neonatal death rates in the UK. Maternal age was noted to be a significant risk factor for stillbirths, perinatal and neonatal death and the figures also show an increasing trend of later motherhood.

Promoting the health of looked after children: A study to inform revision of the 2002 guidance. The overall purpose of this research was to provide evidence to assist DCSF and the Department of Health in revising the guidance on improving the health of looked after children.

Systematic Reviews of Interventions Following Physical Abuse: Helping practitioners and expert witnesses improve the outcomes of child abuse. This study brought together the published and grey literature on interventions for children who have experienced physical abuse in order to present a complete picture of all the available evidence and to draw out the implications of this for policy, practice and future research.

Bevan Brittan Updates
Baby P and The Care Quality Commission Report. The case of Baby Peter, a 17 month old boy, who died on 3 August 2007 after suffering a fracture/dislocation of the thoracolumbar spine, has shocked and appalled society. As a result of Baby Peter’s death, there have been a number of investigations and reports by bodies and individuals who have a connection with child safeguarding. This article summarises the main issues highlighted from the report by the Care Quality Commission into the health care of Baby Peter and sets out suggestions for managing safeguarding in the future.

Tracey Lucas has prepared a summary of the report of Lord Laming, the Government response and the report from the Care Quality Commission into the death of Baby Peter. If you would like a copy, please contact Tracey Lucas

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

Clinical Management

Publications/Guidance
Same-sex accommodation: your privacy, our responsibility. This briefing provides a background to the Department of Health’s 'Same-sex accommodation: your privacy, our responsibility initiative', launched in January 2009, to provide clearer guidance and support for hospitals. The subject is at the heart of patient perceptions about the quality of care they receive in hospital and the briefing sets out the practical issues that boards must address to ensure their patients’ privacy and modesty is protected at all times.

Focus on: sick patients with suspected cancer. This document released by the NHS Institute for Innovation and Improvement aims to provide hospital teams with guidance on how to improve the management of emergency patients with suspected cancer. It is part of the High Volume Care series which highlights good practice within key services in the NHS in order to improve quality and service delivery.

Swine flu clinical package. This clinical package is a set of tools for use in a pandemic situation by frontline healthcare professionals. The tools have been designed to be used during the phase of a pandemic when there is increased demand for clinical care.

Pandemic influenza: recommendations on the use of antiviral medicines for pregnant women, women who are breastfeeding and children under the age of one year. These recommendations are a supplement to the Department of Health guidance: Pandemic influenza: guidance on preparing maternity services. It reinforces and clarifies the advice in the main guidance, and provides advice for the use of antiviral medicines in women who are breastfeeding. It also gives details of the safety and efficacy of these medicines.

Low back pain: Early management of persistent non-specific low back pain. The National Institute for Health and Clinical Excellence has published guidance recommending that GPs offer patients acupuncture for back pain, as well as other treatments including osteopathy and chiropracty. It is the first time NICE has endorsed the use of alternative therapies on the NHS.

Cases
Manning (Executor of the Estate of Manning, deceased) v King's College Hospital NHS Trust [2008] EWHC 3008 (QB) (QBD). Following its earlier finding of medical negligence by a hospital trust, the court determined the damages payable to a deceased patient's husband and children for bereavement and dependency under the Fatal Accidents Act 1976 and damages for her estate under the Law Reform (Miscellaneous Provisions) Act 1934, including damages for pain, suffering and loss of amenity suffered by her prior to her death.

Oliver (Executor of the estate of Oliver, deceased) v Whipps Cross University Hospital NHS Trust and Waltham Forest PCT [2009] EWHC 1104 (QB) (QBD) . The court held that a firm of solicitors was entitled to assess a claim for clinical negligence that was accepted under a conditional fee agreement as having a 50 per cent chance of success, which allowed it to charge a 100 per cent success fee. The claim was of a kind that had uncertain prospects, and based on what the solicitors knew when the fee agreement was made, the claim could easily have been assessed as having chances of success lower than 50 per cent.

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

Clinical Research

Publications/Guidance
National Research Ethics Service Plan outlines the key activities that they will carry out in the current financial year. Activities are focused on meeting the objectives and aims described in the National Patient Safety Agency business plan. The NRES plan summarises activities, primarily for the REC community, and promotes awareness of the NRES agenda.

The National Research Ethics Service year in review 2008-9 has been published. It sets out what NRES does and has some guidance for REC's.

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

Commissioning

Publications/Guidance
Pandemic influenza: guidance for commissioners and providers of social care. The aim of this guidance is to provide local authorities and other social care organisations with the tools and resources needed to plan for pandemic flu. It has been produced primarily for commissioners and providers of social care services, but may also be relevant to those supplying and supporting the social care sector. The guidance covers all causes of pandemic flu, but will be of immediate help to social care organisations during the current swine flu outbreak.

A guide to practice based commissioners in developing good cancer care services. This document supports the Cancer Reform Strategy commitment to developing world class commissioning of cancer services across the NHS. There will be a transition from central direction towards more locally driven improvement in cancer services and development of effective tools to support practice based commissioners in providing world class commissioning. This guidance is one of these tools and sits alongside the cancer commissioning guidance and toolkit providing a range of benchmarked information and data.

The framework for procuring external support for commissioners (FESC): A practical guide. This document describes the framework for procuring external support for commissioners, which is a procurement tool to help PCTs address gaps in commissioning capability or capacity by providing easy access to high-quality commissioning solutions from pre-qualified and experienced private sector partners.

Patient and public engagement - the early impact of world class commissioning. According to this report, PCTs have noticed significant changes in the last two years to the way they organise patient and public engagement in commissioning, amounting to the beginnings of a cultural shift.

The intelligent board 2009: commissioning to reduce inequalities. This report challenges PCT boards to ask difficult questions about their understanding of health inequalities and offers solutions about how boards might answer them. It aims to revisit the principles and approach first set out in 'The intelligent board' and to apply them to the challenge of commissioning to tackle inequalities. The report is also supported by a website.

Commissioning in a cold climate. This document looks at how commissioners can respond to the big challenges in the coming years. It says policy makers will need to ensure commissioners have the right tools to deliver the scale of change required. Payment by Results and the current standard NHS and GP contracts will need to be reviewed to ensure they are designed to drive efficiency and productivity. It highlights a number of ways in which commissioners can improve quality in the NHS by driving efficiency and productivity through best practice, reducing the prices of services and volumes of activity, and looking at cheaper, high quality options available.

Personalisation briefing for commissioners. The Social Care Institute for Excellence (SCIE), in partnership with ADASS and the Putting People First team, has published this briefing on the implications of personalisation for commissioners. It includes examples of how councils have revised their commissioning strategies to support personalisation. This is the first in a series of briefings on personalisation for different groups of professionals including housing providers, domiciliary care providers and personal assistants.

Regulated fertility services: a commissioning aid - June 2009. An expert group on commissioning NHS infertility provision was established by the Department of Health at the beginning of 2008, with the aim of identifying the barriers to the implementation of the NICE fertility guideline and helping PCTs move towards the implementation of the guideline. This guidance was produced by the expert group.

Practice-based commissioning in action: a guide for GPs. The guidance provides access to advice, practical examples and details of where to find further support. Although primarily designed for those just starting out with PBC, it also contains information and useful tips of interest to those that have already made progress but are looking to expand their activity further.

News
Bevan Brittan advised in relation to the West Midlands Cooperation and Competition Panel relating to Echotech Limited and Worcestershire PCT. A copy of the decision can be obtained from David Owens. .

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

Data Protection

News
The Information Commissioner Richard Thomas has ordered an overhaul of data security in the NHS after 140 security breaches were reported between January and April 2009. Mr Thomas has written to the Department of Health's top civil servant, Hugh Taylor, demanding immediate improvements in the handling of personal data within the NHS.

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

Employment/HR

Publications/Guidance
New FAQs regarding European Working Time Directive. In anticipation of the impending 1 August deadline for implementing the 48-hour working week for junior doctors, NHS Employers has published a number of frequently asked questions (FAQs) about the working time regulations.

Updated FAQs regarding Specialty and Associate Specialist doctors. On a similar note the FAQs for Specialty and Associate Specialist (SAS) doctors have also been updated.

Medical revalidation explained. From autumn 2009, all doctors who wish to practise medicine in the UK will require a Licence to Practise. NHS Employers have produced a briefing which explains the key elements of the process of revalidation, including the introduction of the Licence to Practise and relicensing and recertification.

New Stress Management Guidance Published. New guidance has been launched as part of a four-year project to identify the management behaviours that will help organisations reduce stress at work. The guidance is jointly funded by the Chartered Institute of Personnel and Development (CIPD), the Health and Safety Executive (HSE) and Investors in People (IIP).

The role of the nurse. This discussion paper aims to give employers a summary of the emerging issues and to provoke thought and discussion about proposals to modernise the nursing workforce.

Measuring what matters. Mental health and employment services should report regularly how well they help people to get and keep paid work. This report presents a set of key indicators that can be used routinely so that service users and their families can see how well services are performing.

NHS Pay Modernisation in England: Agenda for Change. This is a report from the Public Accounts Committee. They took evidence from the NHS and the Department of Health on the benefits resulting from Agenda for Change, and on the implementation of the Knowledge and Skills Framework across the NHS.

Cases
The House of Lords has finally delivered its decision in the long running case of Stringer and Others v Her Majesty’s Revenue and Customs (previously known as Ainsworth v HMRC) on the much vexed topic of a workers entitlement to holiday pay during sick leave. The decision of the European Court of Justice in January this year (see our Alert!) was that a worker who is on indefinite sick leave for the whole of an annual leave year is entitled to a period of four weeks’ paid annual leave, despite the fact they are not actually at work; the right to paid annual leave is carried over at the end of a leave year if the worker was on sick leave for the whole of that year; and that a worker does not lose this entitlement if they were absent on sick leave for part of the year and were still on sick leave when their employment terminates. In light of this the parties in the Stringer case agreed that there was only one issue left in dispute between the parties for the House of Lords to decide. The outstanding issue was whether a claim based on an alleged failure to make payments due under Regulations 13, 14 and 16 of the Working Time Regulations 1998 could be brought by way of a claim for unauthorised deduction from wages under Part II of the Employment Rights Act 1996. The House of Lords unanimously decided that it could as ‘holiday pay’ falls within the definition of wages set out under section 27 of the Employment Rights Act. The decision has implications in relation to the time limits available to potential claimants, as the provisions are more generous under the Employment Rights Act (where a claim for unlawful deductions can be bought within three months of the last in a series of deductions),than the Regulations (a claim under which must be bought within three months beginning with the date on which it is alleged that the exercise of the right under the Regulations should have been permitted, or, if this was not reasonably practicable, within such a further period as the Tribunal considers practicable). In reaching their decision their Lordships confirmed that in light of the ECJ’s decision all parties involved in the case agreed that the decision of the Court of Appeal should be set aside and the orders of the Employment Appeal Tribunal in Ainsworth be restored. This means that a worker can accrue and take statutory holiday during sick leave, which will not be welcome news for employers.

In the recent case of McAvoy and others v South Tyneside Borough Council and others the EAT decided an issue which has intrigued employment practitioners for many years. It held that a man may bring a "piggyback" equal pay claim using as his comparator a woman who has brought a successful equal pay claim. Therefore, if a woman, F1, brings a successful claim using a male comparator M1, a male colleague M2 working alongside F1 can use F1 as his comparator and claim the same arrears of pay as she has been awarded. The EAT saw no reason to limit arrears to the date when the comparator brought her claim as the original Employment Tribunal had decided. It was held that if the woman had received the correct pay at the time that it fell due, the man would have been entitled to its equivalent. This decision will be a tonic for male NHS workers who have brought "piggyback" claims which will depend on the success of claims by women. Such claims have been stayed pending the outcome of the women's claims. The Respondents have, however, been given leave to appeal the decision to the Court of Appeal.

Consultations
EU agency workers' directive consultation. The Department for Business Innovation and skills (DBIS) has launched a consultation paper to discuss the implementation of the EU Agency Workers Directive (the Directive) into UK law. The Directive aims to protect temporary agency workers through the application of the principle of 'equal treatment' compared to permanent staff, covering issues such as pay, benefits and access to training. Consultation closes on 31 July 2009.

Reforming the medical statement. The DWP is seeking views on the design of a new medical "fit note" to replace the current "sick note" and help more people stay in work rather than drift into long term sickness. The fit note will help people get advice about staying in work, and if they can't work what their employers can do to help them return to work sooner. The new system, which will be computer-generated in GP surgeries, is expected to be rolled out in Spring 2010. The introduction of the fit note forms part of the Government's response (Cm.7492) to Dame Carol Black's report into the health of Britain's working age population. Comments are required by 19 August 2009.

Consultation about the future of nursing and midwifery. The Prime Minister launched the Commission on the Future of Nursing and Midwifery in March 2009 to ensure that frontline nurses and midwives have the support, skills, and competencies they need to design and deliver quality services. The Commission are due to report by March 2010 and are running this consultation in order to get views from interested parties. Comments must be submitted by 10 August 2009.

Equality Bill: Making it work - Ending age discrimination in services and public functions - a consultation. The Government Equalities Office seeks views on age discrimination proposals, including proposals concerning health and social care, and financial services providers. Comments by September 30, 2009.

News
Junior doctors to comply with requirements of the European Working Time Directive (EWTD). Announces that most junior doctor rotas will be compliant with the requirements of the EWTD by 1 August 2009. A small number of services, about three per cent so far, have been given more time to meet the Directive through derogation. These include services delivering 24-hour immediate patient care, supra specialist services and units in rural and isolated areas.

NHS – amongst the top employers for working families. The NHS was recently named among England's top employers for working families by the work-life balance charity Working Families. Such was the strength of submissions from NHS organisations that the expert panel of judges chose to acknowledge the NHS collectively as an employer that offers excellent benefits to working families.

New shortage occupation list. A new shortage occupation list for recruiting from overseas can be found on the UKBA website. The list applies to advertisements placed on or after 15 June 2009, and a number of non-consultant, non-training medical posts have been added. On a similar note, for the 2009 recruitment process only, employers will be able to recruit postgraduate doctors and dentists who have qualified from a UK university into accredited training posts without applying the resident labour market test, as part of transitional arrangements announced by the UK Border Agency recently.

The DH Chief Scientific Officer has issued a statement on UK-wide Modernising Scientific Careers that sets out progress following the closure of the consultation on The Future of the Healthcare Science Workforce - Modernising Scientific Careers: The Next Steps, which set out more comprehensive proposals to transform the future training and career pathways of the healthcare science workforce.

Bevan Brittan Updates
New life for LIFO. The introduction of The Employment Equality (Age) Regulations 2006 was a welcome relief for many of the UK’s employees, both old and young, providing them with protection against discrimination on the grounds of their age. Now, as the economy faces its toughest test since the Second World War and with unemployment for the over fifties higher than for any other age group, this protection is more important than ever, particularly if redundancies are being contemplated. Tim Woodward takes a look at the impact of the Regulations on the conduct of a redundancy exercise.

Unfair dismissal – A Trap for Employers with Final Salary Pension Schemes? Not many final salary pension schemes remain open for members, and a recent decision of the Employment Appeal Tribunal will do little to encourage employers to continue bearing the risk of providing employees with final salary pensions. Christine Johnson explains more.

Cheltenham Borough Council v Laird - Lessons learned. The recent decision of Cheltenham Borough Council v Laird must be one of the messiest local government bun fights to pass through the High Court. Sarah Lamont explains more.

Nothing compares to you … The use of comparators, both real and hypothetical, is not a new concept in employment litigation. That said, it is not the most straightforward concept either, and has been the downfall for many employees in closely contested cases. Two recent cases have drawn attention to this difficult area and Helen Clarke takes a closer look and what counts as an appropriate comparator both in an equal pay and part time worker context.

Retention of Employment Model - changes after 1 July 2009. The use of the Retention of Employment (ROE) Model will be greatly restricted from 1 July 2009. This could have significant implications for all NHS Trusts and particularly for Foundation Trusts. From 1 July 2009 access to the NHS Pension Scheme (NHSPS) will only be available for employees seconded under a ROE arrangement made after 13 January 2009 where specifically approved by the Secretary of State.

News Round-up. Alec Bennett reports on the latest developments in employment law including the introduction of fit notes, the impending change to the national minimum wage rates, the costs implications of lying in tribunal and an update on the Equality Bill’s passage through parliament.

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

Finance

Publications/Guidance
Dealing with the downturn: the greatest ever leadership challenge for the NHS? This paper explores the financial situation facing the NHS and suggests how NHS leaders should respond to the severe contraction in finances they are likely to face.

Health in a cold climate: Developing an intelligent response to the financial challenges facing the NHS. This report draws on discussions at a series of four seminars, the aim of which was to explore the financial context in which the NHS is working and opportunities for using resources more efficiently. Each seminar was led by experts in NHS management and finance and participants included leaders from the public and private health care sectors. The ideas set out in this paper are based on the presentations at the seminars and the points made in the discussions they generated.

NHS IFRS briefing paper 6: Accounting for PFI and LIFT schemes under IFRS. This Audit Commission briefing paper on IFRS considers the accounting arrangements for PFI and LIFT schemes in the NHS. Further information for auditors will be published in line with the DH’s future guidance on these matters when available.

The use of management consultants by the NHS and the Department of Health: fifth report of session 2008-09. Each year, the House of Commons Health Committee undertakes an annual Public Expenditure Questionnaire (PEQ) inquiry in which the DH's expenditure is examined. Following the latest PEQ in December 2008, an evidence session was held with senior DH officials to question them about the information contained in the PEQ. This report follows the evidence session and focuses on the use of management consultants by the NHS and the DH.

Department of Health business plan 2009-11. This plan outlines what the Department will do in the two years 2009-11 to lead and support the Government’s objectives for health and social care, and to support Ministers in their accountability to the public and Parliament.

The Quarter: quarter 4, 2008/09. David Flory's fourth quarterly report of 2008/09 on NHS finance and service performance shows that the NHS has had a successful year. Notable achievements include delivering the shortest waiting times for patients since records began; continuing to improve access to primary care; driving down further the number of healthcare associated infections; and making robust plans and preparations to deal with any pandemic flu outbreak. It also shows that the NHS has demonstrated strong financial sustainability during times of economic uncertainty.

Private gain and public loss; the Private Finance Initiative (PFI) and the Norfolk and Norwich University Hospital (NNUH); a Case Study. The report analyses PFI in the hospital sector in the UK, with particular reference to the Norfolk and Norwich University Hospital, one of the earliest and biggest PFI hospitals.

Learning disabilities directed enhanced services (DES) - worked examples. This paper provides four examples using different possible scenarios of how payments for the learning disabilities directed enhanced service should be calculated.

Healthcare Student Support Systems: A review of the literature. This study investigates evidence of the impact of healthcare and similar student financial support systems on a range of factors including value for money and equality. It also contains a descriptive summary of the funding systems for healthcare students in other countries.

Bevan Brittan Training
Fraud: Knowing the problem and how to solve it. 08 July 2009 : 17:00 - 18:30 The effect of fraud in the NHS and healthcare generally is particularly pernicious. Reducing fraud losses is a key part of ensuring operational efficiency - the resultant savings can make a major contribution to maintaining and enhancing standards of patient care in a challenging financial climate. Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF.

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

Foundation Trusts

Publications/Guidance
NHS foundation trusts: review of twelve months to 31 March 2009. Results published by Monitor indicate that foundation trusts are continuing, in most cases, to meet national standards and targets in key areas such as combating healthcare associated infections. The report reviews data on key service performance issues and includes the end of year financial position for the 115 NHS foundation trusts authorised at 31 March 2009.

NHS IFRS briefing paper 6: Accounting for PFI and LIFT schemes under IFRS. This Audit Commission briefing paper on IFRS considers the accounting arrangements for PFI and LIFT schemes in the NHS. Further information for auditors will be published in line with the DH’s future guidance on these matters when available.

Bevan Brittan Updates
FT Terms of Authorisation (CCP). From 1 May 2009 Monitor will be amending the Standard Terms of Authorisation to include a new condition relating to compliance with the Principles and Rules of Co-operation and Competition.

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

Freedom of Information

Publications/Guidance
Freedom of information in the NHS. This briefing aims to help NHS organisations fulfil the spirit of the freedom of information legislation in the most timely and efficient way. It includes a checklist to provide guidance to trusts on what the best procedures are and where they are entitled to turn down requests.

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

Governance

Publications/Guidance
Department of Health: Departmental Board Annual Report 2008-09. This document is the 2008-09 annual report of the Department of Health's Departmental Board. The Departmental Board was constituted in its current form in October 2007, following the Capability Review of the Department of Health, which recommended that steps be taken to strengthen its corporate governance structures.

Bevan Brittan Training
Fraud: Knowing the problem and how to solve it. 08 July 2009 : 17:00 - 18:30 The effect of fraud in the NHS and healthcare generally is particularly pernicious. Reducing fraud losses is a key part of ensuring operational efficiency - the resultant savings can make a major contribution to maintaining and enhancing standards of patient care in a challenging financial climate. Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF.

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

Health and Safety

Publications/Guidance
Questions are the answer - seven questions every board member should ask about patient safety. Board members can identify gaps in their safety culture, and work to improve it, by answering seven key questions set out in the joint NPSA, NHS Confederation and Appointments Commission factsheet.

Review of patient safety for children and young people. This review highlights some of the patient safety issues for children, young people and their families, outlines current National Patient Safety Agency (NPSA) partnership work streams, and identifies key actions for stakeholders.

Make your health information technology work for you. The Institute for Health Improvement are running this new webinar series of five sessions intended to help you use your health information technologies to improve quality, safety and efficiency.

Health and Safety Executive pledge. The Health and Safety Executive has issued a challenge to employers to sign up to a pledge which commits them to taking a lead on health and safety in the workplace which includes reducing the number of work-related deaths, debunking the myths around health and safety and reducing accidents.

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

Healthcare Associated Infection

Publications/Guidance
Reducing healthcare associated infections in hospitals in England. This report examines the extent and impact of healthcare associated infections; the effectiveness, sustainability and cost of the Department of Health's approach; and the effectiveness of action taken in hospitals to prevent and control infections. It also looks at the barriers to improvement and recommends the steps that the NHS should take to sustain and make further progress.

Tackling healthcare associated infections through effective policy action. The aim of this report is to examine the evidence base for the range of infection control policies, and identify areas for action in tackling the problem. It builds on the 2006 BMA Board of Science publication 'Healthcare associated infections - a guide for healthcare professionals' which sets out the responsibilities healthcare professionals have in managing and reducing the incidence of HCAIs. The report is intended for policy makers with strategic or operational responsibility for public health in the UK, and will be of interest to healthcare professionals and patients.

Appeals Procedure for Apportioning of MRSA Bacteraemias. This letter sets out modifications by the Department of Health and the Health Protection Agency to the procedure for reviewing non-trajectory submissions.

Consultations
A new objective for MRSA: National Quality Board stakeholder engagement - consultation. This consultation seeks views on a new MRSA objective to continue to drive improvements in the NHS. It will run from 11 June 2009 to 24 July 2009.

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

Inquests

Cases
R (Allen) v HM Coroner for Inner North London; Camden & Islington Mental Health & Social Care NHS Foundation Trust (Interested Party) [2009] EWCA Civ 623 (CA). An investigation under the European Convention on Human Rights 1950 art.2 was triggered where the death of a mental health patient who had been detained by the state raised issues as to whether the medical authorities had failed in their obligation to take general measures to save her from dying and whether the death was caused by a breach of the operational obligations to take steps to save the patient from death. In the circumstances, the investigation into the death undertaken by a coroner could not be criticised.

Bevan Brittan Updates
Inquests – Should the verdict stretch as wide as the Inquiry? This article will review the implications of three linked applications for judicial review all concerning inquests into deaths in custody. At each inquest it was alleged that acts/ omissions on the part of the Prison Service had caused or contributed to the death. The investigative obligation under Article 2 (the Right to Life) was engaged in all.

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

Mental Health

Publications/Guidance
Care Quality Commission: Phase one and two national priority indicators for mental health trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of mental health trusts.

Care Quality Commission: Phase one and two national priority indicators for learning disability trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of learning disability trusts.

Commissioning mental health care in the criminal justice system: 10 top tips for PCT boards. According to this report, the NHS should be offering people with mental health problems more support when they are in the criminal justice system. The document sets out ten questions PCT board members can ask to find out how well their PCT is serving prisoners and offenders in their area. The questions include funding of prison mental health care, support for the most vulnerable offenders and resettlement for ex-prisoners as well designated 'places of safety' for people in need of urgent care away from police custody.

Supporting people with autism through adulthood. This report examines the range of services for adults with autism and their carers in England, including health and social care, education, benefits and employment support. The report explores the possible impacts of providing specialised health, social care and employment support for adults with high-functioning autism. It concludes that wider implementation of such services would require an estimated additional expenditure of £40m per year by PCTs and local authorities to provide specialised health and social care teams across the whole of England.

Attitudes to mental illness 2009. This report presents the results of the latest survey on public attitudes to mental illness.

Approved mental health professionals, approved clinicians and best interests assessors: Guidance on changes to qualifying requirements for psychologists from 1 July 2009. Suitably qualified and experienced psychologists are among the professionals eligible for the role of approved mental health professional and approved clinician under the Mental Health Act 1983 and of best interests assessor under the Mental Capacity Act 2005 deprivation of liberty safeguards (MCA DOLS). From 1 July 2009, the qualifying requirements for psychologists in these roles will change to reflect the introduction of statutory regulation of psychologists. This note explains those changes as they apply in England.

Prepared to care: challenging the dementia skills gap. The All-Party Parliamentary Group on Dementia have examined the readiness of the social care workforce to deliver personalised care to people with dementia. They found a large variation in the dementia skills of the social care workforce. This report sets out the scale of the challenge in training the caring professions in dementia, and how it may be met.

Joint Commissioning Framework for Dementia. This framework provides best practice guidance for commissioning dementia services. It includes a joint strategic needs assessment template, a summary of evidence for dementia services, commissioning levers against each of the strategy's objectives and a summary of South East Coastal strategic health authority dementia metrics.

Practical guide to preparing for Mental Health Payment by Results. This practical guide contains 10 actions to help local health economies prepare for mental health payment by results.

Mental Health Payment by Results: Update letter. This letter provides an update on the latest developments in payment by results for mental health and clarifies the governance arrangements for the project.

Clustering booklet for use in Mental Health Payment by Results evaluation work: July to December 2009. This booklet has been designed for use in a specific piece of evaluation work that will help in the preparation for MH PbR.

Consultations
IAPT data set consultation. The Improving Access to Psychological Therapies (IAPT) programme is currently working with the Information Standards Board (ISB) to develop a national information standard for improving access to psychological therapies. The programme is required to verify and document the utility of the IAPT minimum data set. Central to this is the principle that data collection should be proportionate to the treatment being offered, and integrated with clinical priorities. They are therefore seeking views on the current data set and data set omissions. Comments must be submitted by 30 June 2009.

News
Attempts to ban smoking on psychiatric wards are simply driving the habit underground, a survey suggests.

Bevan Brittan Updates
Can Community Treatment Orders be used effectively whilst there continues to be a shortage of Second Opinion Approved Doctors? At the Law Society Mental Health Act Conference on 30 April 2009, concerns were expressed at the number of Community Treatment Orders (CTOs) being made and the fact that this far exceeds the initial estimates by the Department of Health.

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

Primary Care Trust

Publications/Guidance
Care Quality Commission: Phase one and two existing commitment and national priority indicators for primary care trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of primary care trusts.

Practice-based commissioning in action: a guide for GPs. PBC offers front-line clinicians the opportunity to play a major role in the development and delivery of strategies and activities that improve local health and well-being. This guide advises GPs on how to get started, and how to make their ideas for change a reality.

Supporting patients to make informed choices in primary care: what works? This policy paper on the provision of patient information notes that current methods have limited reach and effectiveness. The report found that while most patient information is provided in the form of written leaflets or via the internet, around one in five British people do not have basic literacy and struggle to read, and one third of households do not have a home internet connection. The report also notes that older people, ethnic minority communities and those on lower incomes are among the groups who are most likely to have literacy problems and least likely to use the internet.

GP Patient Survey: Guidance for primary care trusts on quality and outcomes framework patient experience indicators. This document gives guidance on how to treat some data from the GP patient survey.

Joint documents promote pharmacy to the NHS. These documents, 10 High Impact Changes in PCT Commissioning Practice and 5 High Impact Changes for SHAs are part of a strategy to promote the role of pharmacists to commissioners, managers, general practitioners and others in primary care. They also seek to influence the commissioning of pharmacy services by PCTs under World Class Commissioning and the integration of pharmacy into Practice Based Commissioning (PBC).

Primary care service framework: Gypsies and travellers. The focus of this service framework is Romany Gypsy, Roma and Irish traveller communities; however, the principles it contains may be applied to develop services (or consult local people on developing services) for other traveller groups. The purpose of this framework is to equip PCT commissioners with the necessary background knowledge, service and implementation details to work with providers and practitioners to deliver accessible primary care services, over and above mainstream services, for gypsy and traveller communities and to improve gypsy and traveller health and quality of life by providing effective, appropriate, ongoing support.

Primary care service framework: Alcohol. This service framework is for adult patients who are drinking to hazardous and harmful or dependent levels. The document has been updated to include recent policy changes and is supported by a range of enhanced tools to support implementation. A complementary suite of resources and supportive notes is also available.

Tackling health inequalities: targeting routine and manual smokers in support of the Public Service Agreement (PSA) smoking prevalence and health inequality targets. This guidance supports the achievement of the PSA smoking prevalence and health inequality 2010 targets. It aims to provide PCTs and local authorities with a firm rationale as to why targeting routine and manual smokers will in turn help reduce smoking prevalence. Evaluation will occur during National Support Team field visits in addition to feedback from Regional Tobacco Policy Managers who will disseminate the guidance.

GP Patient Survey: Guidance for primary care trusts on quality and outcomes framework patient experience indicators. This guidance supports verification of quality and outcomes framework indicators related to the GP patient survey.

NHS Health Check service specification published. The Pharmaceutical Services Negotiating Committee have published a national service specification template for the NHS Health Check service, developed collaboratively with the Department of Health. The template service specification provides a starting point for the development of local service specifications by LPCs and PCTs.

Primary care trust survey: provision of IVF in England 2008. The Department of Health sent a survey out to PCTs earlier this year about the provision of IVF treatment by PCTs. Each PCT provided the information, however in some cases this information is for less than a full year. The results are shown in this report.

News
New primary care approach boosts referrals to NHS stop smoking services by 49%. The DH is rolling out a new systems-based approach to improve stop smoking interventions in primary care. This new approach has increased referrals to local NHS Stop Smoking services by up to 49% in pilot areas.

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

Prison Health

Publications/Guidance
Commissioning mental health care in the criminal justice system: 10 top tips for PCT boards. According to this report, the NHS should be offering people with mental health problems more support when they are in the criminal justice system. The document sets out ten questions PCT board members can ask to find out how well their PCT is serving prisoners and offenders in their area. The questions include funding of prison mental health care, support for the most vulnerable offenders and resettlement for ex-prisoners as well designated 'places of safety' for people in need of urgent care away from police custody.

Prison health IT programme: national roll-out. This letter from Offender Health and the National Offender Management Service announces that the roll-out of the first national clinical IT system for prisons across England will now commence across the country in June 2009.

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

Regulation

Publications/Guidance
Voices into action: How the Care Quality Commission is going to involve people. This publication contains a Charter for involving people in the CQC's work as the regulatory body for health and adult social care in England. It also intends to make sure that the providers and commissioners of health and adult social care services ask for people's views and that they respond to what they say.

What's it all for? Removing unnecessary bureaucracy in regulation. This report calls on the Department of Health and regulators to simplify providers' process of reporting and calls for a reduction in unnecessary form-filling by improving how regulators collect and share information.

Care Quality Commission Reviews in 2009-10. This report outlines how the Care Quality Commission will be assessing and rating health and adult social care organisations in 2009-10.

Care Quality Commission: NHS trust declarations. These declarations from trusts declare whether they are meeting core safety and quality standards. They are the first stage of the commission's annual NHS performance assessment.

Care Quality Commission: Phase one and two existing commitment and national priority indicators for acute and specialist trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of acute and specialist trusts.

Care Quality Commission: Phase one and two national priority indicators for ambulance trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of ambulance trusts.

Care Quality Commission: Phase one and two national priority indicators for mental health trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of mental health trusts.

Care Quality Commission: Phase one and two existing commitment and national priority indicators for primary care trusts. This document details the approved phase one and two performance indicators that the commission will use as part of the 2009-10 periodic review of primary care trusts.

Better, safer doctors: implementing medical revalidation. From autumn 2009 all doctors who wish to practise medicine in the UK will require a Licence to Practise. This is the first step in introducing a system for regularly checking and assuring every doctor's continued fitness to practise, known as revalidation. This briefing explains the key elements of the process, sets out the various roles and responsibilities, and discusses the areas that remain to be resolved as revalidation gets underway.

Nursing competence: what are we assessing and how should it be measured? Developing and assessing competence are high on the current nursing agenda. The Nursing and Midwifery Council (NMC) is developing new pre-registration competencies to meet changing healthcare priorities; work proceeds apace on developing competencies for post-registration specialties; and policies for nursing careers advocate progression through demonstration of competency linked to the Agenda for Change banding. This Policy+ highlights challenges for nursing practice, education and management.

Cases
Southall v General Medical Council [2009] EWHC 1155 (Admin) (Admin Ct). The court held that the GMC Fitness to Practise Panel had been entitled to find a consultant paediatrician guilty of serious professional misconduct following his interview of a patient's mother at which he accused her of murdering her first son who had been found to have committed suicide.

Jalloh v Nursing & Midwifery Council (Unreported, 10 June 2009) (Admin Ct). The court held that the Council's Conduct and Competence Committee had correctly decided that a nurse's fitness to practise was impaired where there were a number of serious failures to perform essential duties. In particular, the nurse had failed to carry out basic life support measures in respect of a suicidal patient who had hanged himself, and she had failed to respond adequately to the crash team's questions and to assist them.

News
The Department of Health has announced that it will set up a new independent regulator for pharmacy professionals and pharmacy premises in Great Britain in spring 2010. The new General Pharmaceutical Council will replace the Royal Pharmaceutical Society of Great Britain as the regulator for pharmacists and pharmacy technicians. The Council will develop new standards to provide a clearer framework within which to work to ensure that public health, safety and wellbeing continue to be at the centre of pharmacy services.10 key facts about the General Pharmaceutical Council explains the changes. See also the DH's response to the consultation Health Care and Associated Professions (Pharmacy): The Pharmacy Order 2009 that discussed the proposed new regulator.

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

General

Publications/Guidance
NHS inpatient and outpatient hospital waiting times and waiting lists. This page links to statistics on inpatient and outpatient hospital waiting times in NHS organisations in England.

Whole Systems Demonstrators: an overview of telecare and telehealth. This leaflet provides an overview of the Whole System Demonstrator (WSD) programme, a two year research project funded by the Department of Health to find out how technology can help people manage their own health while maintaining their independence. The WSD programme is believed to be the largest randomised control trial of telecare and telehealth in the world to date. The WSD Action Network (WSDAN) has been established to disseminate the lessons learned on the three sites and will become a source for the collected worldwide evidence on the effectiveness of Telehealth and Telecare.

Single Equality Scheme 2009 - 2012. The Single Equality Scheme (SES) describes both the commitment and how the Department of Health intends to meet the duties placed on it by equality and human rights legislation. The SES is relevant to the functions and operations across the Department of Health and its Arm's Length Bodies in so far that they refer to the policy environment.

Women and medicine: the future. This report was commissioned following heightened interest in the increasing number of women entering the medical profession at undergraduate level. The aim of the report and its recommendations is to guide the profession and policy makers towards the development of a high quality workforce.

The NHS Constitution: All you need to know about how the NHS Constitution affects you as a provider or commissioner of NHS care. This leaflet is aimed at NHS staff. It gives background information about the NHS Constitution, and explains those parts that are most relevant to NHS staff.

Health Bill: second reading, House of Commons. The King's Fund has produced this briefing ahead of the second reading of the Health Bill in the House of Commons. The briefing examines the measures outlined in the Bill to: introduce a Constitution for the NHS; pilot direct payments for patients; require providers of NHS-funded care to produce annual quality accounts; and make further provisions on tobacco control.

Review of NHS dental services in England. Professor Jimmy Steele has published his independent Review of NHS Dental Services. The review has been running since December 2008 when the previous Health Secretary, Alan Johnson, appointed the review team to help the Government to ensure that every person who wants to access an NHS dentist can do so and that NHS dentists deliver high quality care and offer preventative work.

NHS Connecting for Health: reviews of the National Programme for IT. The Office of Government Commerce and the Department of Health have decided to make public a number of reviews of the National Programme for IT. These relate to issues which were examined through the Gateway Process at key decision points in order to provide assurance that they should progress to the next stage.

The Flu pandemic game: a business continuity training resource. The Flu Pandemic Game was originally developed by Camden PCT using NHS resources in partnership with Camden Council. It was designed as a training resource for their staff and to help managers of local businesses and voluntary organisations develop their business continuity plans. The Department of Health has adapted the game and there are two versions available, one specifically for use in GP practices and the other for use by healthcare and other related organisations.

Consultations
Summary of responses to the 2004 public consultation: "Proposals to exclude overseas visitors from eligibility to free NHS primary medical services". This is a summary of responses to the consultation on proposals for introducing a system of charges for those overseas visitors who would not be eligible to receive free NHS treatment.

The Marmot Review - strategic review of health inequalities. An interim report on the evidence and emerging themes of the independent strategic review of health inequalities post 2010, led by Professor Sir Michael Marmot, has been published for consultation. Comments must be submitted by 5 August 2009.

News
UK ratifies human rights treaty for disabled people. The UK has ratified an international treaty that enshrines the human rights of disabled people, Jonathan Shaw, Minister for Disabled People has announced. The United Nations Convention on the Rights of Persons with Disabilities is a powerful and explicit statement, which states that disabled people must be able to enjoy, on an equal basis, the same human rights as others.

Bevan Brittan Updates
Ten years on from "Zero Tolerance". It is almost 10 years since the government first launched the zero tolerance campaign. Nevertheless at the Royal College of Nurses congress in May delegates heard that frontline healthcare professionals continue to be at great risk of violence or verbal abuse from members of the public.

Stranger than fact. A review of The Associate by John Grisham and the Preliminary Report on the Review of Civil Litigation Costs by Lord Justice Rupert Jackson.

Hospital Car Parking charges – a bitter pill to swallow? Charging for parking at hospitals has become a controversial and politically sensitive issue. There has been a huge impact on the numbers of people wishing to park at hospital as a result of issues such as increased car ownership, the concentration of specialist medical services in fewer areas, the construction of new hospitals on the outskirts of towns with poor public transport access and the treatment of more people as outpatients. Claire Bentley looks at the issues.

Cases Update. A round-up of recent cases by Georgia Ford and Matthew Trinder including an illustration of the need to treat limitation evidence with caution.

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

Health and Social Care Update - July 2009

01/07/2009

Care

Children

Clinical Management

Clinical Research

Commissioning

Data Protection

Employment/HR

Finance

Foundation Trusts

Freedom of Information

Governance

Health and Safety

Healthcare Associated Infection

Inquests

Mental Health

Primary Care Trust

Prison Health

Regulation

General

Claire Bentley

Associate

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01/07/2009

Claire Bentley

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