Health and Social Care Update - November 2012

Legal intelligence for professionals in health and social care

This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

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

 

Care

Publications/Guidance
Where the heart is: a review of the older people's home care market in England. This report offers a picture of the current home care market, some of the challenges it faces and a model for its future development. It aims to provide a basis for dialogue between commissioners, consumers and providers about what home care services might look like in the future. It was written during the period of consultation on the proposals put forward by the government in the 2012 care and support white paper.

Joint personal budgets: a new solution to the problem of integrated care? This briefing introduces the concept of joint personal budgets for health and social care and gives the context behind their development. It explains how they might work and lists some of the issues that need to be considered before they could be used at scale to assist in the delivery of integrated care. It also outlines the use of a new tool which gives individual service users control of a single joint budget.  

Hospital 2 Home This resource pack contains essential information for all the professional sectors that have a role in hospital discharge for older people in England. It contains information, suggestions for action, case studies and checklists for considering older patients’ housing situations in hospital discharge and transfer of care and for improving integration of housing and support into the process for discharging older people. 

End of life care strategy: fourth annual report. This is the fourth annual report on progress in delivering the end of life care strategy, published in 2008. The strategy states that, wherever possible, people should be able to spend their last days in the place of their choosing. This report confirms that almost 30,000 more people have been able to die where they usually live, whether this is at home or in a care home.

Understanding patterns of health and social care at the end of life. This report presents the findings of a study tracking the ways that more than 73,000 people used publicly funded health and social care services during the last months of their lives. It reveals variation between local areas in the care people receive at the end of life and suggests that social care may prevent the need for hospital admission.

Advance Care Planning (ACP): it all ADSE up. This toolkit aims to assist care providers in empowering individuals to discuss and plan the care that they would prefer to receive at the end of their lives, including where they would like to die. The ADSE of the title stands for 'ask, document, share and evaluate', and through the use of these steps care providers are enabled to gather the information and guidance they need to be adequately prepared and confident in supporting the ACP process.

News
Liverpool Care Pathway: Relatives 'must be informed.' Relatives of terminally-ill patients would have to be consulted before a decision to withdraw food or water is taken, under new government proposals. See also Liverpool Care Pathway: Minister will listen to concerns.

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

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Children

Publications/Guidance
OCC response to the consultation on proposals for the joint inspection of multi-agency arrangements for the protection of children. In response to the consultation on proposals relating to the new joint inspection of multi-agency arrangements for the protection of children in England, the Children's Commissioner recommends: that young victims should receive early intervention at the earliest possible point; and children and young people should engage in the inspection process. The Commissioner also emphasises there is a generous definition of the category of "at risk" and recommends that barriers are removed for children and young people who have referred themselves for help.

Patient Reported Experience Measure (PREM) for urgent and emergency care. These tools have been developed to measure the experience of paediatric patients 0-16 years in all urgent and emergency care settings including GP practices, out-of-hours centres, A&E departments and the ambulance service. The survey was developed with input from paediatric patients, ensuring that their views were captured early in the design process. It aims to help emergency departments, GP surgeries, walk-in or urgent care centres and the ambulance service to identify areas that are important to paediatric patients, as well as areas for improvement.

Bevan Brittan Updates
The responsibilities of doctors in protecting children and young people GMC Guidance - Protecting Children and Young People: The Responsibilities of all Doctors came into effect on 3 September 2012 and provides an advice framework for doctors. This article by Claire Bentley and Deborah Jeremiah examines that guidance in overview. 

R (on the application of RB) v Devon County Council and Devon Primary Care Trust. On 19 October 2012 HHJ Vosper QC handed down judgment in the case of R (on the application of RB) v (1) Devon County Council and (2) Devon Primary Care Trust.  The case highlights the difficulty public bodies face in avoiding legal challenge, but shows that the courts will adopt a pragmatic approach where it is in the interests of good public administration to do so. 

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

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Clinical Risk     

Publications/Guidance
Acute care toolkit 4: delivering a 12-hour, 7-day consultant presence on the acute medical unit. This toolkit provides practical guidance to senior hospital managers and clinical staff on how to organise acute medical services to ensure that the 12-hour consultant presence delivers consistent high-quality care to acutely ill patients, as recommended by the the RCP and the Society of Acute Medicine. It covers issues such as required consultant staff numbers, number of patients to be reviewed per shift, and optimum organisation of services in order to deliver this successfully. 

Falls and fractures declaration. This declaration is the result of a commitment from the National Osteoporosis Society and Age UK to reducing the rate of hip fractures and falls related injuries in older people over the next five years through adhering to six steps including better partnership working and patient involvement. Both organisations are now calling for this same commitment from health professionals, NHS commissioners and the government. 

Patient and Public Involvement (PPI) e-learning tools and resources These resources aim to help organisations achieve successful PPI in clinical audit, and provide tools that organisations can adapt for their own use.

Ten Years of Maternity Claims, an Analysis of NHS Litigation Authority Data. This report analyses maternity claims reported to the NHS Litigation Authority and finds that on the whole, NHS maternity care is safe but more training could reduce the risk of accidental injuries. It is designed to help NHS health professionals responsible for the care of women and their babies to improve safety by learning lessons from the claims that have been made.

The updated never events policy framework. The never events policy framework has been reviewed and updated in order to address areas of uncertainty and provide greater clarity about never events and the recommended response to them following feedback from stakeholders. It offers a useful reference for boards, clinicians, other staff and patients.

News
Breast cancer patients recalled after test error. The Care Quality Commission has launched an urgent inspection of Sherwood Forest hospitals NHS foundation trust as 79 women in Nottinghamshire were recalled after mistakes were found in the testing of breast cancer tissue samples between 2004 and 2010, which may have led to inappropriate treatment.

Bevan Brittan Updates
Patient safety and clinical governance - The vital importance of robust record keeping. This article by Claire Bentley and Georgia Ford looks at some of the key issues that health professionals need to be familiar with in order to properly fulfil their duties to patients and to protect themselves and their employer. 

NHS Litigation Authority 10 Years of Maternity Claims Report. Many will now hopefully have seen the NHS Litigation Authority 10 Years of Maternity Claims Report released on 26th October 2012 and had an opportunity to reflect on the considerable press coverage which followed. Described by David Richmond, RCOG Vice President (Clinical Quality) as "a serious wake-up call to all with responsibilities in providing maternity care" the report analyses maternity claims reported to the NHS LA as at 1 April 2010 (from incidents which occurred between 1 April 2000 and 31 March 2010) and is essential reading for those involved with the delivery of care.

Autumn 2012 Cases Review. Our usual review of interesting cases that have caught our attention.

The Jackson reforms: where are we now? In nomine Patris, et Filii, et Spiritūs Sancti. Musketeers. Bee Gees. Wise men. Whether it is the Trinitarian formula, Dumas’ swashbuckling heroes, the brothers Gibb or gift-bearing Magi from the East, many good things undeniably come in threes. With this in mind, what follows should be read as the third - and final - instalment of my series of articles on the progress of the Jackson reforms, tracing developments from the publication of Sir Rupert’s final report in December 2009 to the cusp of implementation.  

Damages - the discount rate. The Ministry of Justice has launched a consultation into how the discount rate used to determine the amount of future losses in personal injury claims should be set.   The fundamental issue at the heart of the consultation is the extent to which seriously injured Claimants should be regarded as a special class of citizens who require a higher level of financial protection than the rest of society.

Meet the NHS LA Chief Executive Catherine Dixon. Joanna Lloyd, puts a number of questions to the new Chief Executive of the NHS Litigation Authority, Catherine Dixon. Catherine was previously General Counsel and Company Secretary at the NSPCC, working as part of the Executive Team.

Bevan Brittan Events
Seminar: Emergency Response in the Healthcare Setting. 06 December 2012 : 10.00am - 12.30pm (Registration 9.30am). Location: Bevan Brittan LLP, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF.  Since the introduction of the Corporate Manslaughter & Corporate Homicide Act 2007 (“CMA”), there has been a sharp increase in the number of police investigations into deaths following serious incidents in the healthcare setting.  To date, there have been two successful prosecutions under the CMA and around 50 investigations underway throughout the UK. The purpose of this Seminar will be to provide an update on the CMA by reviewing the 2 successful prosecutions and reviewing the likely circumstances that may lead to an investigation.

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

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Commissioning

Publications/Guidance
Co-production and participation: older people with high support needs. This summary of research literature identifies benefits and barriers to co-production and participation among older people with high support needs, and highlights examples of good practice. It will be relevant to commissioners of social and health care services, and service users developing the co-production and participation agenda in care provision and service development.

Commissioning person centred end of life care: a toolkit for health and social care professionals. This guide identifies the main elements involved in commissioning end of life care services, explains the commissioning cycle in practical terms and offers a four-stage approach across all sectors. It provides a wide range of links to tools and sources of support for both commissioners and providers of services. It also showcases good practice and seeks to indicate what a well-commissioned end of life care service looks like.

Sessional GPs in commissioning. This report surveyed sessional GPs and those involved in emerging CCGs in order to find how engaged sessional GPs are with commissioning and to find examples of best practice, models of inclusion, engagement and leadership including the necessary conditions for their success, along with any barriers preventing these.

Bevan Brittan Updates
R (on the application of RB) v Devon County Council and Devon Primary Care Trust. On 19 October 2012 HHJ Vosper QC handed down judgment in the case of R (on the application of RB) v (1) Devon County Council and (2) Devon Primary Care Trust.  The case highlights the difficulty public bodies face in avoiding legal challenge, but shows that the courts will adopt a pragmatic approach where it is in the interests of good public administration to do so. 

Bevan Brittan Events
Health and wellbeing boards and the new integration agenda: London Seminar. 08 November 2012 : 10.00am - 12.30pm (Registration at 9.30am). Location: Bevan Brittan LLP, Fleet Place House, 2 Fleet Place, Holborn Viaduct, London, EC4M 7RF. This seminar will help you to understand the new and complex relationship between Health and local government, and in particular the key role of Health and wellbeing boards in driving the co-operation between and where appropriate the integration of services and how this can fit withint the overall objectives for an area.  This is of particular interest as the government is apparently considering using its forthcoming Care and Support Bill to require clinical commissioning groups to pool part of their budgets with local authorities. register your interest in this event.

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

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Employment/HR

 

Publications/Guidance
Evidence submissions to the NHS Pay Review Body. These evidence submissions to the NHS Pay Review Body make recommendations around pay for Agenda for Change staff from various professional organisations.

A fair route to revalidation This guidance aims to provide an easy-to-follow checklist that encourages reflection on where equality and diversity issues may arise in preparing for and implementing the appraisal process that will support a doctor’s revalidation. It offers examples and signposts to more detailed information. It is aimed primarily at Responsible Officers who will be making recommendations about revalidation.

NHS pay review body’s remit for 2013/14 This letter outlines remit of the the NHS Pay Review for 2013/14 in respect of NHS staff on Agenda for Change pay, terms and conditions. The independent Pay Review Bodies (PRBs) make recommendations to the UK Governments on changes to pay and other subsidies eg cost of living supplements, for public sector staff within their remit groups. For those years that PRBs are invited to make recommendations, they receive a remit from the Governments. 

Mitigating equal pay risks following the end of the Computer Aided Job Evaluation system (CAJE) This guidance describes the equal pay risks for organisations, and how to mitigate these risks, once CAJE provision comes to an end on the 31st December 2012. It sets out what employers should seek from any replacement computer aided job evaluation tool, sign posts specific advice about consistency checking of job matching and evaluation outcomes and advises on how to manage the data currently within the CAJE system once it has been returned to employers. It is aimed mainly at English employers, but its principles apply to all NHS employers in the UK. 

Regional pay in the NHS - Commons Library Standard Note. A House of Commons Library Standard Note provides background to the House of Commons Opposition-day debate on regional pay in the NHS on November 7, 2012.

News
Doctors want changes to EU rules restricting working hours. The Presidents of the Royal Colleges of Surgeons and Physicians have warned that the restrictions on doctors' hours need to be changed and patient care is being put at risk by the European Working Time Directive. The Royal Colleges say patients in hospitals see a 'conveyor belt' of doctors on different shifts and trainee doctors are not receiving the same hands-on experience as before.  

Bevan Brittan Updates
Establishing the meaning of establishment. The Employment Appeal Tribunal has revisited the definition of ‘establishment’ in the context of collective consultation over redundancies – can a school be a separate ‘establishment’ or is the correct establishment an education department?  This particular case concerned a local authority, but the principles set out by the EAT around the approach to be taken in defining establishments, are of general relevance.  Victoria McMeel reports.

News round up. This ‘Halloween edition’ of our employment news bulletin is all treat and no tricks, as Mike Smith explains October’s key developments, including: new social media guidelines; some practical points on harassment from the Employment Tribunal; the new ‘shares for rights’ proposals and an update on draft legislation on equal pay audits and equalities.

Trigger points - an update on starting collective consultation.When is the obligation to consult on collective redundancies triggered?  When an organisation is considering a proposal that will inevitably lead to redundancies (such as complete closure of a workplace); or only when that decision has been made and consequential redundancies are proposed?  It had been a settled position since 2007, that consultation should start when an employer has made a firm (albeit provisional) proposal that will result in redundancies; but this had been thrown into some doubt recently and, this month, the ECJ declined to provide some much needed clarity.  Julian Hoskins traces the case law developments and summarises where we are now.

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

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Finance 

Publications/Guidance
Department of Health annual report and accounts 2011-12. This report provides parliament and the public with an account of how the Department of Health has spent the resources allocated to it. It provides commentary on departmental performance, structural and transition changes and progress against the structural reform plan.

All together now: competitive integration in the NHS. This report argues that NHS funding arrangements encourage acute hospitals to admit patients to hospital to service high fixed costs for staff and property rather than trying to treat patients at a community level or in the home. It also finds that by international standards patients in England with chronic diseases are more likely to be admitted to hospital and stay much longer once admitted.

Hospital quality competition under fixed prices. This interim report investigates the relationship between quality of health care and competition amongst providers in three sectors: hospital care, primary care (general practice) and social care (nursing and residential homes).

Driving improvements in A & E services. This benchmarking study found that A&E departments are seeing increasing numbers of patients but, despite improving their efficiency and innovating, seven out of ten trusts were shown to lose money on their A&E patients. It emphasises that fundamental problems remain on the funding of A&E and emergency services.

Securing the future financial sustainability of the NHS This report examines the financial sustainability of the NHS, and states that ensuring a viable financial future for healthcare providers is vital if the public are to have confidence in the delivery of their local services. It argues that there is a lack of clarity around critical details of how the system introduced by the NHS reforms will work so that services remain available to patients in their locality.

Finance transition planning. This draft checklist covers the key year end finance transition areas that SHAs and PCTs will need to plan for in 2012/13. PCTs and SHAs are encouraged to use this document to ensure they have considered and addressed the main elements of finance transition in their planning.

Payment by Results: how can payment systems help to deliver better care? This report reviews the role and objectives of payment systems in the English NHS, focusing on Payment by Results (PbR), which accounts for around 30 per cent of the total English NHS budget. It also considers the experiences of other countries using similar payment systems. It explores whether such systems are still fit for purpose, given changing policies and priorities, such as the need for disease prevention, the prevalence of long-term conditions, the changing economic environment. It argues that more flexibility should be encouraged in payment systems to accommodate change and offer the right incentives for cost-effective, high-quality care, and considers the policy implications of this.

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

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Guidance /Publications
NHS foundation trusts: review of three months to 30th June 2012 This first quarterly report for 2012/13 summarises the key trends drawn from individual reports of the 144 trusts authorised up to 30th June 2012. It emphasises that focus to drive improvement for patients through effective regulation. It also considers in more detail, the reconfiguration of services.

Legislation
The Health and Social Care Act 2012 (Commencement No.3, Transitional, Savings and Transitory Provisions and Amendment) Order 2012. This Order brings into force provisions of the Health and Social Care Act 2012 (c. 7) (“the Act”). It is the third such Order to be made under the Act. It also amends the Health and Social Care Act 2012 (Commencement No.2 and Transitional, Savings and Transitory Provisions) Order 2012. See explanatory note.

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

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Consultations
Consultation on the regulation and governance of NHS charities. This consultation seeks feedback from NHS bodies, their charities, patient groups and other interested organisations on final proposals to revise the governance of NHS charities. These proposals will: remove regulation by ministers; enable NHS charities to establish and operate more flexibly and independently, in the interests of donors and patients; and preserve the close relationship with the providers of NHS services that the charities support. Comments are invited until the 31st January 2013.

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

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Guidance/Publications
Not the Francis Report. This report calls for greater urgency in improving patient safety and care quality. It warns that delays to the Francis Report could also create delays on improvements in care quality in the NHS and the report makes a number of recommendations for improving patient safety and the quality of patient care. These recommendations include greater patient and public involvement; the reorganisation of hospital services; and a drive towards integrated primary care.

Safe staffing for older people’s wards. This toolkit provides practical help when assessing nursing staff levels on older people’s wards, or wards where the large majority of patients are older people, and when checking whether they meet recommendations for safe care. It can be used to support a review of staffing on hospital wards where older people are cared for; to help address any associated leadership and workforce issues; and to guide the development of an action plan to identify how, and to whom, actions should be addressed.

The updated never events policy framework. The never events policy framework has been reviewed and updated in order to address areas of uncertainty and provide greater clarity about never events and the recommended response to them following feedback from stakeholders. It offers a useful reference for boards, clinicians, other staff and patients.  

News
For sale: an EU licence for faulty medical implants. The Secretary of State for Health has asked the Medicines and Healthcare Products Regulatory Agency to examine what it can do to ensure the high quality of medical devices. The move follows an investigation by the British Medical Journal and Daily Telegraph that exposed loopholes in the EU system for approving devices.

Walsall health trust fined over patient death. Walsall Hospital NHS Trust has been ordered to pay almost £107,000 in fines and costs after a pensioner died following a fall from a first floor window at Walsall Manor Hospital.

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

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Publications/Guidance
Determining whether information is held. This is part of a series of guidance that goes into more detail than the Guides, to help public authorities to fully understand their obligations and promote good practice. 

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

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Mental Health

 

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

The extranet also contains a forum for use by members to share knowledge and information. Forum issues currently being discussed are:-
  Approving doctors working under the Mental Health Act
 The Mental Health Act and Health and Social Care Act 2012
  ECT - fluctuating capacity
  Tribunal - Discharged from liability to be detained
  37/41 patient then detained on s3 who has s117

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

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

Publications/Guidance
Technical change to the process for approving doctors working under the Mental Health Act. Letter outlining a technical issue that has been identified in the way some strategic health authorities have been administering the process for approving doctors to work under the Mental Health Act.

A guide to interpreting and engaging with local change. This guidance aims to assist professionals in their understanding of NHS commissioning, to encourage staff to feel confident when engaging with other practitioners, to promote services and raise the profile of counselling and psychotherapy within the NHS.

Analysis of the consultation on allocation options for the funding for independent mental health advocate services and the treatment of armed forces’ compensation in charging for social care. This consultation response summarises views received on options for distributing funding to local authorities for Independent Mental Health Advocate (IMHA) services and the treatment of armed forces’ compensation in charging for social care. The IMHA service will be funded by Department of Health grant from April 2013 onwards. Further details about the allocation of the grant will be made available in late 2012, alongside the provisional 2013/14 local government finance settlement.

My life until the end: dying well with dementia This report reveals that many people with dementia are not dying in the place they want to, with their families unaware of their end of life wishes because of a double stigma around dementia and death. It highlights the importance of planning end of life care in advance to help make the final days of more people with dementia as good as possible and in the place they want to be.

Out of sight This report is part of a campaign to end poor care and abuse at large, institutional-style services for people with a learning disability. It expresses concern that government proposals in the interim report of the Winterbourne review don't go far enough, and calls for the phased closure of such services, and their replacement by appropriate local services.

Application of the Mental Health Act 1983 This letter announces that the Department of Health is taking action to correct an irregularity in the application of the Mental Health Act 1983. A technical issue has been identified in the way some strategic health authorities have been administering the process for approving doctors to work under the Act. The advice is that this irregularity should be resolved through emergency retrospective legislation, which will be in force this week. This will retrospectively validate the approval decisions that were made and will apply in principle to the approval of all doctors under the Mental Health Act from its introduction in 1983 up until Friday 26th October. Patients assessed from now on will continue to be assessed under the current provisions.

Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment, Annual figures, England, 2011/12.The latest data for 2011/12 suggest that the number of people subject to detention under the Mental Health Act continues to rise. There is increasing use of Community Treatment Orders (CTOs) with nearly half ending with the reinstatement of the underlying detention. Section.

Social and emotional wellbeing for children and young people This guidance aims to help to strengthen home visiting and early education services, and recommends that health professionals are alert to any factors that may pose a risk to a child's social and emotional wellbeing. It recommends that each health and wellbeing board should ensure that the social and emotional wellbeing of vulnerable children features in its health and wellbeing strategy, as one of the most effective ways of addressing health inequalities.

Recovery, public mental health and wellbeing This paper argues that local councils and the new health and wellbeing boards can support the commissioning of recovery-oriented services, as well as promoting good mental health and wellbeing in communities. It outlines the ways in which health and wellbeing boards can influence commissioning to promote and protect mental wellbeing and support recovery.

A report by the Health Service Ombudsman and the Local Government Ombudsman about the provision of section 117 aftercare This report outlines findings from a joint investigation into a complaint made about the standard of mental health care provided in a specific case, and particularly about the necessity for the patient in question to fund their own placement in a residential care home.

Thematic report by HM Inspectorate of Prisons: The use of the person escort record with detainees at risk of self-harm: A thematic review. An HM Inspectorate of Prisons report sets out recommendations to improve the processes by which information about a person's risk of self-harm is transferred and used as they move between police custody, court and prison and on other external journeys. Recommendations include: improving the training of staff involved in recording self-harm information; improving quality assurance by police forces; and changes in the design of the person escort record.

Dementia guide: commitment to the care of people with dementia in hospital settings. This guide aims to help nursing staff care for people with dementia in hospital. It supports further implementation of the RCN’s five principles for improving the quality of care for people with dementia. It also aims to enable the best possible support for carers.

Mental health discharge summary collaboration. This project was conducted with the Royal College of Psychiatrists and aimed to create and help implement a standard discharge summary from mental health in-patient care, to be sent to general practitioners. The approach involved the development of a collaboration website in order to generate rapid consensus and ensure transparency of the work undertaken. The final mental health discharge summary headings have been agreed and can be viewed on the collaboration site with a guest login.

Mental health and the market. This briefing by the NHS confederation summarises the main findings of a Department of Health commissioned report on the current landscape for mental health service provision in England. It aims to provide CCGs with a clearer understanding of the way in which the market currently operates in the mental health sector, and will assist in the development of effective commissioning arrangements.

No health without mental health: guides for local services. This series of briefings aim to help develop better local mental health services. Following the publication of the implementation framework for the government’s mental health strategy, these briefings set out the steps that local authorities, CCGs, and those involved with Healthwatch and health and wellbeing boards can take to improve mental health care, treatment and support.
 CCG briefing
 Local Healthwatch briefing
 Health and wellbeing board briefing
 Directors of Public Health briefing
 Local authorities briefing
 Overview and scrutiny committees briefing
 Centre for Mental Health - press release

Improving the health and wellbeing of people with learning disabilities: an evidence-based commissioning guide for clinical commissioning groups The guide is intended to help CCGs commission high quality, cost effective general and specialist health services for people with learning disabilities; jointly commission services for people who challenge services and those with complex needs; and work with health and wellbeing boards, local authorities and others to address the social factors which affect the health of people with learning disabilities.

Incorporating mental health and employment in your joint strategic needs assessment and health and wellbeing strategy. This guidance highlights the importance of health and employment to CCGs, HWBs, directors of adult social service and other partners responsible for promoting public health and delivering personal responses to people at risk of long-term illness and social exclusion. It aims to help local commissioners and planners incorporate mental and employment considerations into their joint needs assessment and health and wellbeing strategy.

Protecting adults at risk in London: Good practice resource. A new easy-to-use online resource will help people who work in adult social care to carry out their responsibilities to safeguard adults at risk. It gives practical pointers to help staff to assess the risk of abuse, to recognise it when it does occur and to respond to it appropriately. It also gives quick and easy access to the pan-London "safeguarding protocol". This helps frontline safeguarding staff across the capital to carry out cross-borough and cross-agency work to prevent and investigate abuse. Although the resource focuses on London, it will be of interest to a wider audience.

Talking self-harm. This report argues that there is a need for more awareness about self-harm amongst young people, parents and professionals. It makes recommendations for more training for healthcare professionals and places emphasis on the need for guidance for GPs on how assessment tools such as NICE guidelines can support the consultation and referral process.

Next steps in developing a payment mechanism in mental health. The HFMA mental health faculty have produced this discussion paper on the development of mental health payment by results.

Legislation
Amendments to the high security psychiatric services directions 2012. These directions apply to the 3 trusts which provide high secure mental health services at Ashworth, Broadmoor and Rampton Hospitals. They should be read alongside the High Security Psychiatric Services (Arrangements for Safety and Security at Ashworth, Broadmoor and Rampton Hospitals) Directions 2011 and associated guidance.

Mental Health (Approval Functions) Act 2012 published on 1 November 2012. This Act authorises retrospectively the exercise of functions relating to the approval of registered medical practitioners and clinicians under the Mental Health Act 1983. It comes into force on 31 October 2012. It retrospectively gives powers to those people who exercised 'approval functions' under the Mental Health Act 1983, s 12 in order to approve doctors as eligible to assess whether certain patients need to be detained or hospitalised. The Mental Health (Approval Functions) Bill was moved by Earl Howe, the Parliamentary under-secretary of state, Department of Health. It was necessary in order to correct a technical irregularity which had arisen involving the approval process of doctors who make assessments of patients to see if they need to be detained or hospitalised. Doctors who assess patients, and make recommendations under the Mental Health Act 1983, are required under section 12 to be ‘approved’ to do so. The Act requires the approval to be by the Secretary of State and the Secretary of State delegated that approval function to Strategic Health Authorities in 2002. However, four out of the ten SHAs (including North East, Yorkshire and Humber, West Midlands and East Midlands) asked mental health trusts to carry out the validation and approval process for them, but did not ask for it to be referred back to them for final confirmation.

News
Ministry of Justice consultation Transforming the Services of the Office of the Public Guardian: Response of the Law Society of England and Wales. Responding to a Ministry of Justice consultation on the digital transformation of the Office of the Public Guardian (OPG) service, the Law Society states that any new lasting powers of attorney (LPA) form developed by the OPG should be simple and straightforward as the LPA form is designed to be completed by members of the public and if the current form is made more complicated or becomes confusing, this will increase the chances of individuals filling out the form incorrectly.

Guide to councils' new deprivation of liberty duties in hospitals. From next April councils will have to assess and authorise Deprivation of Liberty Safeguards applications in hospitals. Rachel Griffiths, co-author of forthcoming guidance on the change, explains its implications in Community Care.

Mental Health sectioning error. Health Secretary Jeremy Hunt says urgent retrospective legislation is needed to correct a "technical error" affecting up to 5,000 patients sectioned under the Mental Health Act since 2002. 

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

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Primary Care

Publications/Guidance
Sessional GPs in commissioning. This report surveyed sessional GPs and those involved in emerging CCGs in order to find how engaged sessional GPs are with commissioning and to find examples of best practice, models of inclusion, engagement and leadership including the necessary conditions for their success, along with any barriers preventing these.

Consultations
Consultation on national performers list for GPs, dentists and ophthalmologists. A consultation proposing that in future, there is one national list of general practice doctors, dentists and ophthalmologists approved to provide NHS primary care services has been launched. Closing date is 14.12.12.

Bevan Brittan Updates
CQC registration for GPs. Much work has been undertaken by CQC, in conjunction with GPs across the country, to simplify and test the application process.  The application forms are submitted online and CQC anticipates that they should take providers less than 2 hours to complete.  However, although completion of the form itself may be straight forward, the whole process of ensuring providers are properly prepared to make the application, and geared to deal with ongoing monitoring of compliance following the grant of registration, raises important questions for GPs to consider: 

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

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Public Health

Publications/Guidance
The real cost of alcohol: a map of alcohol harm across England. This map reveals the cost of alcohol abuse to local health services. It provides regional data on hospital admissions, deaths and costs relating to alcohol.

The Slope Index of Inequality (SII) in life expectancy: interpreting it and comparisons across London. This briefing is intended to aid London’s public health professionals by explaining how to interpret the SII; comparing 2006-2010 SII scores across London; illustrating SII trends across local areas; and demonstrating how to use an SII to drive local area improvement.

Protecting People, Promoting Health – A public health approach to violence prevention in England. A public health approach to preventing violence is set out in a new report which draws on the latest evidence to show that many of the key risk factors that make individuals, families and communities vulnerable to violence are changeable. The report also contains new figures on the cost of violence, estimating national costs to the NHS and a wider cost to society.

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

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Regulation

  

Legislation
Monitor takes on new powers to protect patient services at failing hospitals. Monitor has taken on a series of new powers under the Health and Social Care Act 2012 to enable the regulator to protect patient services at failing hospitals. The new Trust Special Administration regime enables Monitor to appoint administrators to work with local commissioners to ensure that services are protected if a trust becomes insolvent. This regime is designed to protect patient services ahead of creditors if trusts break down financially. Under the Trust Special Administration system, options for the continued provision of services include restructuring the existing service provider, using other providers to continue services at existing sites, relocating services to other local providers, or bringing in new providers such as an out-of-area provider wanting to expand.

News
Wrinkle treatments should be regulated, says British Association of Aesthetic Plastic Surgeons. Injectable anti-wrinkle treatments should be classed as medicines so they can be properly regulated, the British Association of Aesthetic Plastic Surgeons (Baaps) said.

Bevan Brittan Updates
CQC registration for GPs. Much work has been undertaken by CQC, in conjunction with GPs across the country, to simplify and test the application process.  The application forms are submitted online and CQC anticipates that they should take providers less than 2 hours to complete.  However, although completion of the form itself may be straight forward, the whole process of ensuring providers are properly prepared to make the application, and geared to deal with ongoing monitoring of compliance following the grant of registration, raises important questions for GPs to consider. 

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

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General

Publications/Guidance
Health service reconfiguration debate briefing This briefing argues the urgent need for a full and open debate between politicians, the public and the health sector about the future of the NHS over the next ten to fifteen years. It recognises the need to better engage with local populations to explain how proposals for reconfiguration and service change will improve patient care and listen to what communities say in response. It asks that local politicians, including MPs and councillors, support open public discussions by engaging with the clinical evidence about patient outcomes, convenience and care quality.

Quality with Compassion: the future of nursing education. The Willis Commission has now published its full report into the future of nursing education. See the key findings from the report below:-
 Patient centred care should be at the heart of all pre-registration nursing education and continuing professional development.
 There were no shortcomings found in nursing education that could be directly responsible for poor standards of care or a decline in care standards.
 Nurses and their organisations must stand up to be counted on the challenge of poor care and loss of public confidence in order to restore professional pride.
 Nursing education needs to imbed patient safety and dignity as a top priority.
 Better evaluation of and research into nursing education programmes is necessary to ensure a programme that is fit for purpose.
 The future nursing workforce requires nurses to work in a variety of settings.
 Recruitment campaigns need to widen their diversity in order to encourage the widest, best possible range of applicants.
 Health care service providers must fully support nursing education.
 Universities need to recognise nursing as a practice and research discipline
 Attention needs to be paid to developing a strategic understanding of the nursing workforce as a whole and as a UK-wide resource.

NHS Property Services – estates operating information. As indicated in the baseline spend exercise of June 2012, further operating information is now needed in order for NHS Property Services (NHS PS) to build a finance ledger and to maintain continuity of estates services from April 2013. This requires an exchange of operational estates information between primary care trust (PCT) and strategic health authority (SHA) finance teams and NHS PS.

Survey on public perceptions of the NHS. This annual survey provides a useful check on public sentiment and experience relating to the NHS.

Driving improvements in A & E services. This benchmarking study found that A&E departments are seeing increasing numbers of patients but, despite improving their efficiency and innovating, seven out of ten trusts were shown to lose money on their A&E patients. It emphasises that fundamental problems remain on the funding of A&E and emergency services.

A guide to the OFT's investigation procedures in competition cases. The OFT has issued updated guidance on its investigation procedures in competition cases that sets out new decision-making processes and procedural enhancements to boost the speed and robustness of Competition Act 1998 investigations and increase engagement with parties involved.

Letter to NHS bodies on the report of the Hillsborough Independent panel. In light of the Hillsborough Independent Panel's reports, NHS Chief Executive, Sir David Nicholson, has written to NHS organisations to ask them to review their arrangements for responding to major incidents and take appropriate action to ensure their current practices and processes are robust. The NHS Commissioning Board is working closely with local agencies and its partners to establish new arrangements for emergency preparedness, resilience and response (EPRR) from April 2013.

Speaking up charter. This charter outlines a commitment by those signed up to working together to promote cultural change in the NHS. 28 organisations have signed the charter, recognising their separate but linked responsibilities for key aspects of the provision and regulation of care, and for supporting members to provide high quality, safe care. It aims to send the message that leadership must come from national organisations to promote a cultural shift in the NHS where staff can report concerns with confidence. 

Engage toolkit for black and minority ethnic (BME) family carers. This toolkit is a resource to address barriers BME family carers face when accessing services. It is available to practitioners and a wide range of organisations who work in adult and children services. It will provide practical support and opportunities for joint working between community groups, multi-agencies and the families themselves to ensure family carers are given the best practical support available. As a live toolkit, the website will share resources of events, community projects and appropriate policy and practice when working with BME family carers.

Handover and close down guidance for transition to the new health and care system. This guidance is published primarily for strategic health authorities (SHA) and primary care trusts (PCT) transition directors, lead and governance leads. This guidance fits with the transition communications planning for a secure transition to the new health and care system.

Multi-agency public protection arrangements annual report 2011/12. This multi-agency public protection arrangements annual report sets out how the arrangements to assess and manage the risk posed by sexual and violent offenders in their area. These arrangements are known as MAPPA (Multi-Agency Public Protection Arrangements). These reports cover the period 1 April 2011 to 31 March 2012.

Access all Ages: Assessing the impact of age on access to surgical treatment. A report from the RCS and Age Concern warns that decisions on whether older people are put forward for surgery must not be based on out-dated assumptions of age and fitness.  

Evaluation of NHS 111 pilot sites: final report. This is the final report of the evaluation of NHS 111, a new telephone based service designed to help people access appropriate healthcare for urgent medical problems. It assessed the first year of operation of NHS 111 in four pilot sites, and examined the extent to which the service has achieved its objectives, as well as its usefulness and cost-effectiveness.

House of Commons Science and Technology Committee Regulation of medical implants in the EU and UK: Fifth Report of Session 2012-13: Report, together with formal minutes, oral and written evidence: Additional written evidence is contained in Volume II. A Science and Technology Committee report recommends that the Government presses for greater transparency and a more evidence-based approach to the regulation of medical devices, particularly implants.

Consultations
Consultation on licensing: small providers. This consultation seeks views from NHS providers on what type of services they provide, how many staff they employ, and what annual turnover they get from providing NHS services. This is in order to further understand the impact of proposals exempting small providers from the need to have a licence from Monitor. Views on this are welcomed until 22 October 2012.

Intellectual Property Office: Proposals to exempt clinical and field trials using innovative drugs from patent infringement - A consultation This to get stakeholders’ views on proposals to amend section 60(5) of the Patents Act 1977 to provide an exception to patent infringement for activities involved in preparing or running clinical or field trials which use innovative, or non-generic, drugs. 

A consultation on strengthening the NHS Constitution. Proposals to strengthen the NHS Constitution are set out for public consultation , with the NHS, patients and public are all being asked to respond. The main changes proposed cover:
 a new responsibility for staff to treat patients not only with the highest standards of care, but also with compassion, dignity and respect
 a new pledge making it explicit that patients can expect to sleep in single-sex wards
 a new pledge to patients that NHS staff must be open and honest with them if things go wrong or mistakes happen – this ‘duty of candour’ will become a condition in the NHS Standard Contract from April 2013. 
The changes also make it clearer that:
 patients, their families and carers should be fully involved in all discussions and decisions about their care and treatment, including their end of life care
 patients who are abusive or violent to NHS staff could be refused treatment
 the NHS is equally concerned about physical and mental health.

Protecting patients’ interests – ensuring continuity of NHS services: a consultation on proposals for a health special administration procedure for companies. This health special administration consultation sets out how safeguards to protect the services that patients need will be extended to NHS services provided by social enterprises and other companies. For the first time, the services provided by these organisations will be secured if they become insolvent. This will ensure that, regardless of the type of provider, patients will receive an uninterrupted service they can rely on. It gives an overview of the proposed health special administration procedure and seeks views on the overall design of the regime. Views are welcomed until the 4th January 2013.

Legislation
The Health and Social Care Act 2012 (Commencement No.3, Transitional, Savings and Transitory Provisions and Amendment) Order 2012. This Order brings into force provisions of the Health and Social Care Act 2012 (c. 7) (“the Act”). It is the third such Order to be made under the Act. It also amends the Health and Social Care Act 2012 (Commencement No.2 and Transitional, Savings and Transitory Provisions) Order 2012. See explanatory note

News
One step further in cross-border organ traceability. The European Commission has adopted legislation to increase cross-border exchanges of information regarding organs and their donors. The intention is to increase the traceability of organs, in particular for cases where patients suffer adverse reactions.

NHS London guidelines state doctors must register any foreign-born patient, giving them access to primary NHS care, and that practices cannot insist on seeing passports. The stated aim of the guidance is to "promote human rights and public health". However, the guidance has attracted criticism from doctors and MPs

New principles set out for hospital food. New standards setting out what patients should expect from NHS hospital food have been announced by Health Secretary Jeremy Hunt.

Winterbourne View care staff jailed for abuse. 

Over-65s heart death inequality. The gap in heart disease deaths for over-65s in the richest and poorest areas has widened since the 1980s - despite general improvements over that time.

On 31 October 2012 the Advertising Standards Authority (ASA) upheld a complaint against cosmetic surgery clinic Lasercare Clinics (Harrogate) Ltd, trading as Sk:n, regarding claims for a treatment to remove stretch marks. 

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

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