01/12/2009
Legal intelligence for professionals in health and social care
This Update prepared by Claire Bentley 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
Publications/Guidance
Dignity in care: input assessment - DH
interventions. This review aims to answer whether the dignity
in care campaign is making a difference to the way services are
being provided and commissioned across health, social care, local
authorities and the independent sector and the way people
experience care.
Walk a mile in my shoes: scrutiny of dignity and
respect for individuals in health and social care services: a
guide. This guide will assist Overview and Scrutiny Committees
to raise awareness and understanding of dignity and respect for
individuals who are receiving health and social care services.
The real cost of quality care and support. This
report was published as a response to the green paper on the future
funding of care and claims that more resources are needed to fund
better quality care. The report found that care services with high
star ratings spend up to 20% more on staff and their training,
development and management, as well as putting service users at the
centre of everything they do. Not-for-profit providers consistently
get better quality ratings.
Personalisation briefing: implications for
residential care homes. This briefing examines the implications
of the personalisation agenda for managers of residential care
homes.
Care Quality Commission: A guide to the new system
of registration. This publication gives an overview of the new
system of registration for health and adult social care in England.
It describes the main features of the new system and highlights the
key dates involved.
Care Quality Commission: The scope of
registration. This publication is for people and organisations
that provide, or are intending to provide, healthcare or adult
social care in England. It is to help them understand whether they
need to register with the Care Quality Commission under the Health
and Social Care Act 2008. It is not a definitive description of the
law, but it aims to help those providing services and answer as
many of their questions as possible.
Care Quality Commission: NHS trusts - How to apply
for registration: overview. This is a short guide informing NHS
trusts how to apply for registration, which will become necessary
from 4 January 2010.
Consultations
Personal Care at Home: A consultation on proposals
for regulations and guidance. This consultation seeks views on
proposals for regulations and guidance made under the Personal Care
At Home Bill. The consultation will last from 25 November 2009
until 23 February 2010, but the Department would very much welcome
earlier responses, if possible, by 26 January.
Charging for residential care: the property disregard and partners under 60. This letter to local authority chief executives seeks views on a proposal to amend the National Assistance (Assessment of Resources) Regulations 1992 (SI 1992/2977) to reflect the longstanding policy and practice of disregarding property where a partner aged under 60 continues to reside in the family home. The consultation closed on 26 November 2009.
Legislation
Draft Health and Social Care Act 2008 (Regulated
Activities) Regulations 2009. These draft regulations detail
the new framework against which the Care Quality Commission will
regulate providers of health and adult social care. The
requirements set out the essential levels of safety and quality of
care that providers must deliver for people who use their services,
but gives them flexibility on how they do it. Subject to
approval by Parliament, the new system will be introduced for NHS
healthcare providers in April 2010 and for private and voluntary
health care and adult social care providers from October 2010,
making it illegal for organisations to provide services that fall
under the new framework without registering.
Queen's Speech -
Personal Care at Home Bill. The Government intends to introduce
a Bill that guarantees free personal care for the 280,000 people
with the "highest needs", such as those with serious dementia or
Parkinson's disease. It will protect the savings of the 166,000
people who currently get free care, saving them from having to pay
future charges. It also promises to help 130,000 people needing to
enter care homes for the first time to "regain their independence",
and offers adaptations to the neediest people's homes to increase
their independence. The Bill will apply to England only.
Health and Social Care (Independent Living)
Bill. This Private Members' Bill has been introduced into
Parliament by Lord Ashley of Stoke and received its 1st Reading in
the Lords on 23 November 2009. Clause 1 states that "The purpose of
this Act is to ensure that disabled persons enjoy the same choice,
freedom, dignity, control and substantive opportunities as persons
who are not disabled at home, at work, and as members of the
community, and consequently to ensure that families and carers of
disabled persons enjoy greater health, wellbeing, equality and
opportunities to participate in social and economic life". It sets
out 13 general principles that apply for the purposes of the Act.
The Bill imposes various duties on local authorities and NHS
bodies, including a duty to promote independent living for disabled
persons; it also confers certain rights upon disabled persons for
independent living.
Personal Care at Home Bill. This Bill has been introduced into Parliament and had its 1st Reading in the Commons on 25 November 2009. It amends s.15 of the Community Care (Delayed Discharges etc) Act 2003 so as to remove the restriction on the period for which personal care may be provided free of charge to persons living at home. There are also Explanatory Notes and an Impact Assessment that gives a cost benefit analysis of the Bill's provisions. The Bill's progress through Parliament can be tracked on the Parliamentary Bills web page.
Bevan Brittan Updates
CQC Registration - step onto the level playing field. All NHS
provider organisations will need to submit applications for full
registration with the Care Quality Commission ("CQC") between 4 and
29 January 2010 as the regulator takes the next steps towards a
single regulatory system across both the public and
independent health sectors.
Bevan Brittan Training
Neil Grant and Carlton Sadler are presenting at a Butterworth
conference on Thursday 21 January 2010 entitled "Regulation of Health and Social Care Providers : A Brave
New World." For more information click here.
If you wish to discuss any of the items raised in this section please contact Neil Grant.
Children
Publications/Guidance
Improving safety, reducing harm: children, young
people and domestic violence: a practical toolkit for front-line
practitioners. This toolkit provides specific information about
children, domestic violence and related issues; an overview of
Every Child Matters and the tiers of intervention; principles of
commissioning services; risk assessment and safety planning
information; guidance for schools; clear explanations of key
standards and policies; sample forms and key fact sheets.
Meeting the health needs of children and young people: a guide for commissioners. Calls on NHS trusts to adapt to changing patterns of childhood disease in the community by investing in new community teams to better meet the needs of children and young people who are ill.
Commercial and procurement skills for commissioners of
children's services. This page links to a set of guidance
documents designed to help commissioners understand and apply
commercial and procurement skills in their work. The documents
cover the key principles of procurement, an overview of both
strategic procurement and the contracting process, an overview of
resource mapping and a basic jigsaw tool designed to help
commissioners understand the key principles of change
management.
Toolkit for high quality neonatal services.
This guidance helps the NHS improve the care provided for premature
and sick babies during their first days, with practical advice on
how to improve the areas that really matter to parents. The Toolkit
includes a set of eight principles for quality neonatal services
and a framework to assist commissioners. It implements the Neonatal
Taskforce's recommendations that neonatal care should become more
family-centred to ensure the psychological as well as physical
needs of babies and families are considered.
Children's services inspection by Ofsted with CQC. Ofsted have published their first inspection reports into safeguarding and services for looked after children, which include contributions by the Care Quality Commission (CQC) in the assessment of health partners. This three-year programme of inspection of services for children and young people within a local authority area commenced in June and will include all 152 English authorities. Details about the inspection framework are available on the Ofsted website. Reports are currently available for Devon, Staffordshire, Cambridge, Cornwall and North Yorkshire and York and can be found on the inspections section of the Ofsted website. More details of CQC’s involvement with inspection of health partners can also be found.
News
National Children’s Services Mapping Children’s Services
Mapping. CSM is a voluntary on-line data collection exercise
that has been in place since 2002. It is carried out annually and
from 2008 collects information from PCTs, NHS trusts and LAs on the
children’s services that they commission and provide. It describes
the nature of children’ services provision, their investment,
workforce and functions locally, regionally and nationally. It aims
to support good practice commissioning to deliver improved outcomes
for children, young people and their families. This year’s National
CSM data collection commenced on Sunday 1st November and the
website is now open for registration. PCTs and NHS Provider Trusts
will take part as in previous years by nominating a senior member
of staff to be the mapping lead. The mapping lead takes
responsibility for co-ordinating the exercise and must register
their individual organisation.
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
Legal issues relevant to non-heartbeating organ
donation. Sets out the DH's view of the legal position in
relation to the action that can be lawfully taken prior to death to
support non-heartbeating donation. The guide is produced in
response to Recommendation 3 of the Organ Donation Taskforce Report
which states that 'urgent attention is required to resolve
outstanding legal, ethical and professional issues in order to
ensure that all clinicians are supported and are able to work
within a clear and unambiguous framework of good practice'. The
intention is that those working in this area will be able to use it
to draw up more detailed guidance to support clinical practice.
This guidance is only applicable in England and Wales.
Managing patients' medicines after discharge.
This CQC report looks at how well patients' medication is managed
after leaving hospital. During its visits, the CQC saw some
evidence of good practice, but also found the following concerns:
GP practices and hospitals do not always share timely, complete
patient information on medication changes when people move between
services; reviewing and updating of GP records is sometimes left to
administrative staff; GPs do not routinely review new medication
with a patient after they leave hospital; and monitoring and
learning from serious incidents is patchy. From April 2010, all
trusts will be required by law to register with CQC and must meet a
new set of standards. Effective management of medicines will be a
requirement of registration, and CQC will take action where trusts
fall short of meeting this. The regulator therefore urges all
trusts and GP practices to use the findings of its study to
identify problem areas in preparation for registration.
Delivering same-sex accommodation (DSSA):
principles. Lists the 17 principles that have been developed to
ensure each organisation delivers the highest standards of privacy
and dignity within all areas of a hospital, other trusts and
providers. The principles support existing DSSA policy and guidance
and aim to further clarify DSSA clinical definitions amongst
leaders and staff within the NHS. It is intended for the principles
to be used in conjunction with other guidance to drive forward
improvement and ensure sustainability within each organisation.
Cases
Farraj v (1) King's Healthcare NHS Trust (2)
Cytogenetic DNA Services Ltd [2009] EWCA Civ 1203 (CA). The
Court of Appeal has held that a hospital did not owe a
non-delegable duty of care in respect of the genetic testing of a
tissue sample which was sent to be cultured by a reputable
independent cytogenetics laboratory.
News
Accident and Emergency attendances: total time
spent in A&E from arrival to admission, discharge or transfer;
and waiting for emergency admission through A&E, quarter ending
30 September 2009. Statistics for Q2 2009/10. The Health
Minister has issued a responses to A&E hospital episodes data
claiming that the data shows that the overwhelming majority of
A&E patients were seen within three hours, well within the
four-hour standard.
Bevan Brittan Updates
Litigants
in person. Managing the un-manageable: practical tips on
dealing with Litigants in Person by Laura Hartwell and Julie
Charlton.
Consent: Where are we now? Nicola Pegg reviews the recent case law post-Chester and suggests that the bar has been raised on Consent.
If you wish to discuss any of the items raised in this section please contact Jackie Linehan.
Clinical Research
Publications/Guidance
Making clinical research less of a trial: EU
consultation on the functioning of the Clinical Trials
Directive. The European Commission has launched a public
consultation seeking views on how to improve the functioning of the
Clinical Trials Directive. This consultation outlines the key
issues raised and seeks views from NHS organisations.
If you wish to discuss any of the items raised in this section please contact Claire Bentley.
Commissioning
Publications/Guidance
Directions about reports on consultation with
regard to commissioning decisions and relevant decisions 2009.
These decisions trigger the duty on PCTs and SHAs to produce
reports each year on consultation in relation to commissioning
decisions, with effect from April 2010.
Real accountability: guidance on the NHS duty to report on consultation. Guidance on s.24A and s.17A of the NHS Act 2006 that, as from April 2010, will require all PCTs and SHAs that commission services to explain how they have acted upon feedback from patients and the public. This report aims to help the NHS get ready for the legislation. The guidance explains the legal obligations and provides practical help and advice in terms of preparing and publishing reports.
Commercial and procurement skills for commissioners
of children's services. This page links to a set of guidance
documents designed to help commissioners understand and apply
commercial and procurement skills in their work. The documents
cover the key principles of procurement, an overview of both
strategic procurement and the contracting process, an overview of
resource mapping and a basic jigsaw tool designed to help
commissioners understand the key principles of change
management.
Outline Service Specification: personalised care
planning for people with long term conditions. This Outline
Service Specification has been developed to assist NHS
commissioners to put in place appropriate arrangements to ensure
people with long-term conditions have informed choice of, and
access to, services that best enable them to manage their
condition.
World-class Commissioning for the health and
well-being of people with learning disabilities. This is a
practical guide to support commissioners to meet the needs of
people with learning disabilities and ensure they are fulfilling
their duty to promote equality.
Beyond practice-based commissioning: the local
clinical partnership. This joint paper by the Nuffield Trust
and the NHS Alliance examines how practice-based commissioning can
be developed. While there may be many ways this could happen, this
paper considers one broad model – that of multi-specialty groups of
clinicians – for example GPs as well as hospital-based specialists
– taking responsibility for the provision and commissioning of
local healthcare.
If you wish to discuss any of the items raised in this section please contact David Owens.
Complaints
At Bevan Brittan we have set up an e-portal to assist complaints managers in the NHS. The portal is of use to all NHS complaints managers who are often handling very sensitive and complex work. It provides tailored access to a range of up-to-date knowledge and information enabling you to have a central, structured and focused source of information on complaints.
It also has a discussion forum for use by complaints
managers to share tips and knowledge with each other. Currents
topics are:-
Recording complaints and the PSHO
Managing a complaint and legal
proceedings
Complaints procedure and the 2009
regulations
Complaints training
Aggregated data on complaints
If you would like more information about the portal and the discussion forum please contact Claire Bentley.
Publications/Guidance
Nothing but the truth? a discussion paper. Sets
out important issues as the basis for discussion on how to ensure
data about local public services is fit for purpose. It asks if
citizens, along with frontline staff, managers, politicians,
central government and local public service regulators, can have
confidence in the data they rely on and, if not, what needs to be
done about it.
News
New accreditation scheme for health information
providers. The Information Standard has been launched as a
kite-mark scheme to enable consumers of health and social care
information (members of the public) to be assured that they are
accessing reliable trustworthy information sources. Rather than
assessing information materials separately, the scheme will operate
by assessing the processes that providers of information go through
to produce materials. Participation in the assessment is voluntary
for all types of information producers and some of the examples of
the types of criteria needing to be met to receive the quality mark
include: a commitment to producing high quality information that is
updated as needed and clear awareness and documentation of the
particular needs of the target audience and how these will be
met.
Summary Care Records launched in London. The DH has launched the Summary Care Record scheme in London. A Summary Care Record is a secure electronic summary of core information, such as medications, allergies, adverse reactions and key health information, derived initially from the patient’s GP record and added to as necessary by other healthcare staff treating the patient. It enables key medical information about the patient to be accessible wherever the patient is treated. The first records to be created in London are due to be uploaded in Southwark at the Princess Street Group Practice on 19 November. Everyone living in the capital will be written to, outlining the initiative, and offering them the choice to opt out of having a Summary Care Record created.
If you wish to discuss any of the items raised in this section please contact James Cassidy .
Employment/HR
Publications/Guidance
Improving staff engagement: a practical
toolkit. This briefing provides pointers on how to get staff
engagement rights and offers tips that have high impact at low
cost. In addition it also looks at the roles managers have to play
in ensuring staff are clear on what is expected of them as
identifying where employees know what is expected dramatically
improves performance and engagement levels.
Clinical Leadership Development Programme. This
letter to SHAs discusses the development of the Clinical Leadership
Fellowship programme.
NHS workforce and planning: limitations and
possibilities. This report recommends that the emphasis of
workforce planning should not be solely on ‘new’ recruits but on
how the system can develop new skills for those who are already
employed in the service. It concludes that the focus should be on
developing a flexible approach to workforce planning that doesn’t
seek long-term precision but can enable the current workforce to
evolve and adapt to the health care environment.
Leading the NHS workforce through to recovery.
This briefing looks at the way that employers who have worked
through past and present challenges adjusted their workforce and HR
strategies to meet them, and urges immediate action from workforce
leaders to meet the challenges ahead.
Pension choice? Career and retirement options for
the NHS. This briefing is for boards and human resource
directors in NHS organisations in England. It covers the strategic
issues and potential risks for boards in relation to the NHS
Pension Choice exercise. It outlines how good employment practice
during the Choice exercise will help organisations to support
staff, retain skills and prepare for the future.
Reaping the rewards: retraining refugee healthcare
professionals for the NHS. This briefing explores the benefits
for the NHS in supporting and employing refugee healthcare
professionals. It provides information about refugees’ right to
work in the UK, a framework for engagement for the NHS, as well as
showcasing the work of trusts in this area.
Guidance for employers on promoting mental wellbeing through productive and healthy working conditions. The guidance is for those who have a direct or indirect role in, and responsibility for, promoting mental wellbeing at work. This includes all employers and their representatives, irrespective of the size of the business or organisation and whether they are in the public, private, or voluntary sectors.
Medical Training Initiative (MTI) guide. This guidance
is designed to allow overseas doctors to undertake up to two years
of training and experience in the UK. It explains the benefits of
the MTI and signposts additional information.
Developing specialties in medicine: Protocol for
handling applications for new Certificate of Completion of Training
specialties, new sub-specialties and for decommissioning
specialties which are no longer needed. This document gives
information on training certificates for new and older medical
specialties. It lists the protocol for handling applications for
new CCT specialties, and for decommissioning specialties which are
no longer needed.
NHS health and well-being review. The DH has published the final documents of an independent review of the health and well-being of NHS staff that was commissioned in November 2008 to take forward Dame Carol Black’s review of the health of Britain’s working age population "Working for a healthier tomorrow". The review, chaired by Dr Steve Boorman, gathered and analysed evidence relating to health and well-being across the service, to provide the DH with a better understanding of health and well-being in the NHS, and its links to productivity, efficiency, and patient experience. If the report's recommendations are implemented, NHS organisations could see a reduction in staff sickness absence, an improvement in the quality of patient care and potentially save the NHS around £555m each year. This web page links to the final report, the interim report, Dr Boorman's letter to Secretary of State and the DH's response, which sets out a proposed action plan for implementing the recommendations from Dr Boorman’s report across the NHS.
Legislation
Criminal Justice and Immigration Act 2008
(Commencement No 13 and Transitory Provision) Order 2009. SI
2009/3074: Power to remove persons causing disturbance on English
NHS premises from 30 November 2009.
Bevan Brittan Updates
Belief in Climate Change can Constitute a Philosophical Belief.
The Employment Appeal Tribunal recently held in Grainger Plc &
Others v Mr T Nicholson that a belief in climate change can
constitute a philosophical belief for the purposes of the
Employment Equality (Religion or Belief) Regulations 2003. Mr
Nicholson has therefore been given the green light to take his
employer, Grainger Plc, to an Employment Tribunal for unfair
dismissal on the grounds of his belief in climate change.
Nicola Stibbs reviews the impact of this decision.
Double Win for Bevan Brittan in Redundancy Pay Judgments. Two recent unanimous decisions in the Employment Tribunal have seen Bevan Brittan successfully defending claims for redundancy payments made against two different South West NHS Trusts. In both cases, the Tribunals dismissed claims for redundancy payment, concluding that both individuals had unreasonably refused offers of suitable alternative employment. Mike Smith explains.
Employment Eye - News Round-up. Marie-Claire Boyle reports on the latest employment news.
Paying Small Pensions as Lump Sums - New Rules and Pitfalls. Beneficial changes are to be made from 1 December 2009 to the rules applying to the commutation of trivial pensions under the Registered Pension Schemes (Authorised Payments) Regulations 2009 (SI 209/1171). From that date, occupational pension schemes and public service pension schemes are authorised to make “de minimis” lump sum payments of up to £2,000 to new and existing pensioners aged between 60 and 75 instead of paying small pensions from the scheme.
The EAT and Court of Appeal give useful guidance in two important cases. From chamois leather to sham contracts... The Court of Appeal, in the recent case of Autoclenz Ltd v Belcher and Others has revisited the much discussed issue of the importance of express contractual provisions in determining an individual's status as an employee, worker or self-employed contractor. Jane Wallenstein explains more. Coleman v Attridge - EAT widens the scope of "associative" to any third party. Although the DDA prohibits discrimination in employment against a disabled person and harassment which relates to a disabled person’s disability, it does not expressly protect non-disabled individuals from discrimination or harassment based on their association with a disabled person. Chloe Edwards sets out the latest position in this long running litigation.
Finance
Publications/Guidance
Means to an end: Joint financing across health and
social care. This Audit Commission report finds that instead of
concentrating on the mechanics of joint financing and partnership
working, councils and the NHS should look at how their joint
funding can improve people's lives.
The Audit Commission has published two reports on the quality of the work of
its appointed auditors for its stakeholders. The first is the
Audit quality review process. The second is the Audit practice
annual quality report that summarises the results of the quality
review of the work of the Audit Commission's own staff as auditors
to local government and NHS bodies, including the views of the
Audit Inspection Unit that carried out an independent review.
Auditors' Local Evaluation overview 2009/10.
The Auditors' Local Evaluation assesses how well NHS trusts manage
and use their financial resources and highlights areas for
improvement.
Means to an end: Joint financing across health and
social care. The central message of this report is that when
using joint finance arrangements trusts need to have a clearer
focus on Value for Money (VfM) and how it will improve patient's
experience. Around 3.4 per cent of health and social care spending
is currently pooled in some way. However this is rarely linked to
any quantifiable outcome measures. From a limited evidence base,
the report finds there is little sign that increased pooling has
decreased lengths of stay, mental health admissions or falls among
older people. The Audit Commission is now working with the Care
Quality Commission to develop a tool with which trusts can apply a
consistent set out performance measures for their joint finance
arrangements.
The human factor: how transforming healthcare to involve the public can save money and save lives. This report examines the challenges faced by the National Health Service. It shows how radical new ways of innovating can reduce spending at the same time as increasing health and wellbeing.
More for less: Are productivity and efficiency
improving in the NHS? This Audit Commission briefing paper
looks at how NHS money has been spent, whether PCTs have been
successful in keeping more patients out of hospital and whether
hospitals have become more efficient. It highlights that the NHS is
treating more patients at lower cost and trusts are starting to
meet the challenges of the future.
If you wish to discuss any of the items raised in this section please contact Claire Bentley.
Foundation Trusts
Publications/Guidance
Toolkits on service line reporting. Service
lines are the units from which the Foundation Trust’s services are
delivered, each with their own focus on particular medical
conditions or procedures and their own specialist clinicians.
Service line management (SLM) uses the data from service line
reporting (SLR), to develop an organisation structure and
management framework within which clinicians and managers can plan
service activities, set objectives and targets, monitor their
service’s financial and operational activity, and manage
performance. Monitor has published five toolkits on SLM and SLR
that draw on evidence and best practice from UK pilot sites and the
experience of healthcare providers worldwide who use similar
principles and approaches within their healthcare systems:
1. Working towards service-line management: a how-to
guide: sets out the processes and structures necessary to
implement SLM within a trust setting using checklists, practical
tools and examples of good practice;
2. Working towards service-line management:
organisational change and performance management: looks at
having the right organisation structure and the use of service-line
data as a tool to manage performance, in order to maximise the
benefits of the service line approach. This guide can be used by
trusts who have already put in place SLR to gather financial and
operational data; and
3. Guide to developing reliable financial data for
service-line reporting: describes a process of seven steps
towards the implementation of SLR. It also describes how trusts can
overcome some of the obstacles that may arise when introducing SLR,
and includes an example work plan for implementation;
4. Working towards service-line management: a toolkit
for presenting operational service-line data: describes a range
of SLR tools and shows how they can be used to present data about
the performance of service lines; and
5. Working towards service-line management: using
service-line data in the annual planning process: explains how
trusts can work towards using SLR data in the annual planning
process, with examples and principles gained from working with
pilot trusts.
Consultations
Call for evidence - review of restrictions on
private patient income: the NHS foundation trust private patient
income cap. The Department of Health has launched a call for
written evidence to inform a review of the 'private patient income
cap' for NHS Foundation Trusts. Submissions must be made by 31
December 2009.
Consultation on additional annual reporting
requirements 2009/10. Monitor is seeking views on proposals for
additional annual reporting requirements for NHS foundation trusts
for 2009/10. The proposals cover five main categories of reporting:
Quality; Sustainability; Valuing people - Equality and diversity
and Staff feedback; NHS Constitution; and Regulatory findings. The
consultation document includes the examples of the proposed format
of reporting in each of the above five categories, and indications
as to how reporting requirements in each of these, and the related
assurance, may be likely to develop. The consultation closes on 25
January 2010.
Health and Safety
Publications/Guidance
Improving safety, reducing harm: children, young
people and domestic violence: a practical toolkit for front-line
practitioners. This toolkit provides specific information about
children, domestic violence and related issues; an overview of
Every Child Matters and the tiers of intervention; principles of
commissioning services; risk assessment and safety planning
information; guidance for schools; clear explanations of key
standards and policies; sample forms and key fact sheets.
Health Committee - first special report on patient safety. This report sets out the Care Quality Commission, Monitor, and Professor Sir Ian Kennedy's responses to the Health Committee's Sixth Report of Session 2008-09 on patient safety.
National confidential enquiry into patient outcome and death. A recent study by NCEPOD examines the care given to all patients older than 28 days who died within four days of admission to hospital between October 2006 and March 2007, in all hospitals in England, Wales and Northern Ireland. A total of 2,195 cases were included in the study, and the purpose was to identify where care could have been better and to recommend learning points. An expert panel judged that in 34 per cent of cases there was 'room for improvement,' and in nearly 5 per cent of cases care was 'less than satisfactory.' Some of their other key findings include: insufficient consultant involvement in assessments and diagnosis, interventional radiology equipment not being available 24 hours and low rates of interventions to prevent venous thrombo-embolism.
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 infection in
hospitals in England: 52nd report of session 2008-09. This is
the third report from the Public Accounts Committee on healthcare
associated infection. The report found that hospital cleanliness
has improved and the priority given to reducing C difficile and
MRSA has started to have an impact on overall infection prevention
and control. However, it does also find evidence to suggest that
progress has not been matched on other healthcare associated
infections.
The Max4Health hand hygiene campaign. This
report sets out the results of an evaluation of the Max4Health hand
hygiene campaign undertaken at Southampton University Hospitals NHS
Trust over a nine week period between February and April 2009.
If you wish to discuss any of the items raised in this section please contact Sian Morgan.
Inquests
Cases
Dowler v HM Coroner for North London (Unreported, 6 November 2009)
(QBD). The court has held that it was appropriate, pursuant to s.13
of the Coroners Act 1988, for a coroner's inquest to be quashed and
for a new inquest to be held before a different coroner where a
number of breaches of the Coroners Rules had occurred, and where
criticisms of a general practitioner made by the coroner meant that
it was inappropriate for the same coroner to hear the new
inquest.
Legislation
Coroners and Justice Act 2009. This Act has
received Royal Assent. It includes the first major reforms for over
100 years of the coroner system by creating a new framework for
England and Wales, establishing more consistent inspection and
quality standards, and incorporating new rights of appeal for
bereaved families who are unhappy with a coroner’s decision. The
new Coroners’ Service, with national leadership provided by a new
Chief Coroner, will reduce delays and improve the quality of
investigations and inquests through improved powers and guidance
for coroners. The Act comes into force on various dates, including
12 November 2009, 1 January 2010, 12 January 2010, and appointed
days.
If you wish to discuss any of the items raised in this section please contact Joanna Lloyd or Nadia Persaud.
Mental Health
Publications/Guidance
Report from the Ministerial Summit on dementia
research. One of the commitments made in the National Dementia
Strategy was to hold a ministerial summit on dementia research.
This took place on 21 July 2009. The independent report of the
event is now available. The DH has also announced, following the Summit, that it is
establishing a new ministerial group that will drive forward
research into the causes, cure and care of dementia. The new group,
chaired by Care Services Minister Phil Hope, will also focus on
increasing the volume, quality and impact of dementia research.
Applying the NHS performance framework to mental
health trusts. This document informs mental health trusts, PCTs
and SHAs of the criteria against which mental health performance
will be assessed. It should be read alongside Implementing the NHS
Performance Framework.
Preventing suicide: a toolkit for mental health
services. The toolkit, originally published in 2003, has been
amended to reflect recent policy changes and has had input from key
stakeholders, service users, carers and experts.
Swine flu H1N1: updated guidance for mental health
services in England. This is updated guidance for mental health
services and partners on planning and responding to the swine flu
H1N1 pandemic.
A civilised society: mental health provision for refugees and asylum-seekers in England and Wales. Mind has found evidence that the UK's complex asylum seeker process, detention centres and aspects of UK life are actively worsening the mental health of refugees and asylum seekers. This report claims that a lack of support and resources for refugees and asylum seekers is both exacerbating pre-existing mental health conditions and triggering them in the first place. In a related report, Mind worked with Refugee Community Organisations (RCOs) to examine the role they play in refugee and asylum seeker mental health and found that PCTs and Local Authorities need to do more to improve their engagement with RCOs and develop more culturally appropriate services.
Improving health, supporting justice: the national
delivery plan of the Health and Criminal Justice Programme
Board. This report contains the Government's national delivery
plan for health and criminal justice as developed by the Health and
Criminal Justice Programme Board. This builds on Lord Bradley's
2009 review of mental health and learning disability in the
criminal justice system. It contributes to key government
initiatives around protecting the public, reducing health
inequalities, reducing reoffending and health improvement and
protection.
Counting the cost: caring for people with
dementia. This report finds that people with dementia, who
occupy a quarter of all hospital beds, are staying in hospital far
longer than people without the condition who go in for treatment.
The report is based on research involving 2,400 people on hospital
wards and calls for all hospitals to reduce the average length of
stay for a person with dementia by at least a week.
Promoting
mental wellbeing at work. This NICE guidance is intended to
offer employers of all sectors evidence-based advice about what
they can do to promote mental wellbeing through 'productive and
healthy working conditions.' Such conditions encompass both the
emotional and physical aspects of work, including just reward,
satisfaction and prospects for development, level of control over
work, job stability, as well as noise, dust, and other hazards.
According to the guidance employers should: ensure a
whole-organisation approach to improving the mental wellbeing of
their employees, put systems in place for assessing and monitoring
their mental wellbeing and offer and support flexible working where
practical.
Report on the prescribing of anti-psychotic drugs
to people with dementia. Presents the findings of an
independent clinical review of the use of anti-psychotic drugs in
care for people with dementia. It concludes that the drugs are
being wrongly prescribed to around 145,000 patients a year. The
Minister for Care Services Phil Hope has pledged to appoint a Clinical Director for
Dementia who will carry out an audit of doctors' prescribing of
anti-psychotic drugs.
For those who served: Meeting the healthcare needs
of veterans in England. This leaflet (with accompanying poster)
has been produced by the Department of Health in partnership with
the Royal British Legion. It is aimed at military veterans and
provides information on accessing priority treatment (subject to
clinical need). It also signposts where additional help can be
provided in relation to mental health issues.
Mental health and the economic downturn. In
September 2009 a one-day meeting on mental health and the economic
downturn was held which explored the impact the downturn was having
on mental health, as well as where some of the solutions may lie
for those working at a local and national level in service
provision and policy. This briefing builds on the outcomes of that
meeting, outlining the challenges facing the sector and setting out
how policy makers, organisational leaders and health and social
care professionals should respond.
World-class Commissioning for the health and well-being of people with learning disabilities. This is a practical guide to support commissioners to meet the needs of people with learning disabilities and ensure they are fulfilling their duty to promote equality.
Legislation
Autism Act 2009. The Autism Bill has received
Royal Assent. The Act is the first ever disability-specific law in
England. It requires the Secretary of State to draw up an autism
strategy, along with guidance on the implementation of that
strategy which NHS bodies and local authorities must follow. The
Act comes into force on 12 January 2010.
News
Responding to media coverage regarding who has the authority to
manage a person's affairs if they lose their mental capacity, the
Government has agreed for Sir Mark Potter, President of the Court
of Protection, to set up a committee to review the current Court of
Protection rules to ensure that they provide an efficient and
effective service.
If you wish to discuss any of the items raised in this section please contact Simon Lindsay.
Primary Care Trust
Publications/Guidance
More for less: Are productivity and efficiency
improving in the NHS? This Audit Commission briefing paper
looks at how NHS money has been spent, whether PCTs have been
successful in keeping more patients out of hospital and whether
hospitals have become more efficient. It highlights that the NHS is
treating more patients at lower cost and trusts are starting to
meet the challenges of the future.
Real accountability: guidance on the NHS duty to report on consultation. Guidance on s.24A and s.17A of the NHS Act 2006 that, as from April 2010, will require all PCTs and SHAs that commission services to explain how they have acted upon feedback from patients and the public. This report aims to help the NHS get ready for the legislation. The guidance explains the legal obligations and provides practical help and advice in terms of preparing and publishing reports.
Legislation
Directions about reports on consultation with
regard to commissioning decisions and relevant decisions 2009.
These Directions are issued under s.17A, s.24A and s.8 of the NHS
Act 2006, and trigger the duty on PCTs and SHAs to produce reports
each year on consultation in relation to commissioning decisions,
with effect from April 2010. The first reports will cover the
period April 2009 to March 2010 and will be produced before the end
of September 2010.
If you wish to discuss any of the items raised in this section please contact David Owens.
Prison Health
Publications/Guidance
Action plan on offender health is launched. A
cross-government action plan to improve the health of offenders in
prison aims to: ensure there are liaison and diversion services
which assess individuals' health needs in all courts over the next
five years; train staff across the criminal justice system to
identify where health issues may need to be addressed and share
information across the different elements of the system that come
into contact with that individual; ensure that offenders have
access to the same levels of healthcare as everyone else; and
improve continuity of care by developing care pathways that enhance
health and social care provision and contribute to the delivery of
justice.
Bevan Brittan
Training
Medical
law: annual prison health update.10 December 2009 : 14:00 -
18:00. Location: Fleet Place House, 2 Fleet Place, Holborn Viaduct,
London, EC4M 7RF. 3 years has now passed since all Primary
Care Trusts took over responsibility for commissioning prison
health services in their local prisons.
If you wish to discuss any of the items raised in this section please contact Nadia Persaud.
Regulation
Publications/Guidance
Getting ready for registration. Legislation introducing a new
registration system for all regulated health and adult social care
services in England has now been laid before Parliament. To help
care providers get ready for registration, the Care Quality
Commission has published three short guides: a guide to the new system of registration;
the scope of registration; and NHS trusts: how to apply for registration
overview.
Care Quality Commission: A guide to the new system
of registration. This publication gives an overview of the new
system of registration for health and adult social care in England.
It describes the main features of the new system and highlights the
key dates involved.
Care Quality Commission: The scope of
registration. This publication is for people and organisations
that provide, or are intending to provide, healthcare or adult
social care in England. It is to help them understand whether they
need to register with the Care Quality Commission under the Health
and Social Care Act 2008. It is not a definitive description of the
law, but it aims to help those providing services and answer as
many of their questions as possible.
Care Quality Commission: NHS trusts - How to apply
for registration: overview. This is a short guide informing NHS
trusts how to apply for registration, which will become necessary
from 4 January 2010.
Response to the report and recommendations of the Review of the Conduct Function of the General Social Care Council. This document sets out the Government's response to the report and recommendations of the Council for Healthcare Regulatory Excellence's review of the General Social Care Council's conduct function. The review was commissioned following the discovery of a backlog of conduct cases at the GSCC.
General Social Care Council (GSCC) response to CHRE report into its conduct function.
Response to the consultation on draft regulations
for the framework for the registration of health and adult social
care providers. In spring 2009, the Department of Health
consulted on a set of draft regulations, which set out the detail
of a new registration system to be operated by the new Commission.
This document provides the response to the consultation.
Consultations
Regulatory fees – have your say: Fees for National
Health Service providers that are registered under the Health and
Social Care Act 2008 from April 2010. From April 2010, NHS
providers must pay fees for their registration with the Care
Quality Commission under the Health and Social Care Act 2008. This
consultation seeks views on proposals for an interim scheme of fees
for NHS providers while the registration system is being phased in
during 2010-11. The CQC will consult in late 2010 on a single long
term fee proposal for all health and social care, effective from
April 2011 onwards. The consultation closes on 26 January 2010.
News
Monitor's November Newsletter.
Bevan Brittan Updates
CQC Registration - step onto the level playing field. All NHS
provider organisations will need to submit applications for full
registration with the Care Quality Commission ("CQC") between 4 and
29 January 2010 as the regulator takes the next steps towards a
single regulatory system across both the public and
independent health sectors.
Bevan Brittan Training - January 2010
Neil Grant and Carlton Sadler are presenting at a Butterworth
conference on Thursday 21 January 2010 entitled "Regulation of Health and Social Care Providers : A Brave
New World." For more information click here.
Bevan Brittan Training - February 2010
Preparing for the New Regulatory System: Registration, Inspection,
Compliance and Enforcement. From April 2010 onwards, the Care
Quality Commission will extend the scope of its regulatory remit
over providers of health and adult social care services in both the
public and independent sectors. All providers who undertake
“regulated activities” will be required to be properly registered
under the Health and Social Care Act 2008. The key changes
will be:-
NHS Providers: registration
which, to date, has been based solely on compliance with the Code
of Practice on Healthcare Associated Infections (HCAIs), will be
extended and measured against a new set of requirements and
standards governing all aspects of the running of the
organisation. These requirements will replace the Standards
for Better Health.
Social Care and Independent Healthcare
Providers: from October 2010 services will require registration
under the 2008 Act, rather than the Care Standards Act 2000.
This will mean:-
A wider scope of services requiring
registration.
Applications having to be made for
registration to enter the new system.
A new set of registration requirements
and guidance to comply with.
Wider and more robust enforcement
tools for the regulator.
Following on from our successful September 2009 seminars on regulation, Bevan Brittan is running two additional free training sessions on the New Regulatory System at our London office from 10am -12.30pm on 17 February 2010 and at our Birmingham office from 10am - 12.30pm on 24 February 2010.
If you wish to discuss any of the items raised in this section please contact Neil Grant.
General
Publications/Guidance
Future health: sustainable places for health and
well-being. Drawing on examples and research, this report shows
how good planning can have a positive impact on public health, how
health trusts can cut carbon and costs by co-locating services, and
how designers can influence people's well-being. The report will be
of interest to health trusts, planners, policymakers and premises
providers.
Safe management and use of controlled drugs.
This letter highlights the recommendations in the recently
published annual report of the Care Quality Commission on the safer
management of controlled drugs and the responsibilities of trust
chief executives to support their accountable officers in their
day-to-day role in delivering these recommendations.
Wellcome Trust: The health benefits of tackling
climate change. Executive summary of a study prepared for The
Lancet that models the effects of different policies to reduce
greenhouse gas emissions in high and low-income countries. Case
studies focus on power generation, transport, household energy,
food and agriculture. The report calls on health ministers and
professionals across the world to recognise the danger that climate
change poses to health, in the run up to the UN conference in
Copenhagen in December.
Medical technology: can we afford to miss out?
In this report, the Medical Technology Group warn that any cuts to
NHS technology budgets would cost more in the long-run and risk
damaging the quality of life of thousands of patients with
diabetes, heart disease and other long-term conditions.
Integrated care and support plan (ICSP): high level
process. This document describes the collaborative approach
used to develop a high-level, generic model for integrated care and
support planning and specifically, how Common Assessment Framework
messaging would be used to support the sharing of care and support
planning information between health and social care systems.
Real accountability: guidance on the NHS duty to
report on consultation. Guidance on s.24A and s.17A of the NHS
Act 2006 that, as from April 2010, will require all PCTs and SHAs
that commission services to explain how they have acted upon
feedback from patients and the public. This report aims to help the
NHS get ready for the legislation. The guidance explains the legal
obligations and provides practical help and advice in terms of
preparing and publishing reports.
Choice at the point of referral. For the past
three years patients referred by their GP for a specialist
outpatient consultation have had a choice over where to be treated.
As part of a larger research project, a survey was sent to patients
in four case study areas of England to ask them about their
experience of referral and choosing a hospital for treatment. This
report summarises survey findings and shows that implementation of
the policy is not yet complete, and that most patients do not
experience referral as the policy envisaged.
Achieving age equality in health and social care. This review, undertaken by Sir Ian Carruthers and Jan Ormondroyd, takes into consideration the experiences of patients, service users and carers and supports the implementation of age provisions within the proposed Equality Bill.
Emergency planning: development of an integrated plan for the management of blood shortages. This paper updates the integrated plan for blood shortages released in 2004 and the NHSBT external document ESD/PCS/HL/001/012 released in January 2005. The original plan was prepared by the Chief Medical Officer's National Blood Transfusion Committees (NBTC) subgroup on contingency planning, and lists actions to be taken by both NHSBT then the National Blood Service, and hospitals in the event of a potential or actual red cell shortage.
Cases
R (Bristol-Myers Squibb Pharmaceuticals Ltd) v
National Institute for Health and Clinical Excellence [2009] EWHC
2722 (Admin) (Admin Ct). The court held that there had not been
a breach of Directive 89/105 where NICE had refused to recommend
using a drug in the NHS, in accordance with criteria notified to
the European Commission, as the drug was not cost-effective when
there was a high demand for it and resources were scarce.
Consultations
NHS Constitution: an consultation on new patient
rights. Seeks views on proposed new patient rights to treatment
within a maximum of 18 weeks from a GP referral and to be seen by a
cancer specialist within two weeks from a GP referral, or where
this is not possible, for the NHS to take reasonable steps to offer
a range of alternative providers. The proposed rights also include
NHS health checks for those aged 40 to 74 to assess their risk of
heart disease, stroke, diabetes and kidney disease. The
consultation closes on 5 February 2010.
Age equality in health and social care. This
consultation seeks views on preparing the NHS and social care in
England for the age requirements in the Equality Bill that affect
the provision of services and exercise of public functions. The
Scottish Executive and the Welsh Assembly Government are
considering separately what action to take to prepare the NHS and
social care in Scotland and Wales for implementation of the
Equality Bill. There will also be further consultation on a draft
Order in 2010. The consultation closes on 15 February 2010.
Legislation
Patient Transport Bill. This Private Members'
Bill has been introduced into Parliament by Baroness Greengross and
received its 1st Reading in the Lords on 23 November 2009. It
places a duty on PCTs, hospital trusts and local transport
authorities to co-operate with each other in order to co-ordinate
the provision of patient transport services provided by PCTs and
hospital trusts with the provision of other passenger transport
services within the areas over which the trusts have
responsibility.
Health Act 2009. The Health Act received Royal Assent
on 12 November 2009. It includes measures to:
strengthen tobacco control;
place a duty on all NHS bodies,
private sector and third sector providers of NHS services to have
regard to the NHS Constitution; and
pilot direct payments to give
patients greater choice and control over their health care;
enable the de-authorisation of
Foundation Trusts in certain, exceptional, circumstances;
increase powers of suspension;
establish a regime for unsustainable
NHS providers to protect patients and staff from failing services;
and
reform pharmacy services.
The Act comes into force on a day, or days, to be appointed.
News
Nursing set to become all graduate entry by
2013. The Health Minister has announced that the minimum level
for pre-registration courses for nurses will be raised from diploma
to degree level from 2013, putting in place the Nursing and
Midwifery Council (NMC) recommendation to make all courses for new
nurses degree level. The courses will meet new standards developed
by the NMC, the professional regulator for nursing.
If you wish to discuss any of the items raised in this section please contact Claire Bentley.
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