Editorial
A number of things have happened in the past few
days all very important.
First, there has been the announcement, at long last,
by the Secretary of State for Health, Alan Johnson,
that there will be an immediate end to the ban on so
called co-payments and that those who chose to pay
for medicines not provided by the NHS will no longer
face the prospect of having to pay for all treatment
privately, including that previously provided by the
NHS. More on this next week.
Hurrah!
Next, deprivation of liberty, an issue which will come
to have growing significance in the consciousness of
care providers caring for people with impairment, or
lack of mental capacity has seen the first set of draft
forms published by the DH – 163 pages. Thats a
start. Much more to come. See item 61 in this issue.
The systems need to be in place for April 2009.
That is a tall order to expect everything to be in place
an operating smoothly by April – expect bumps along
the road.
Thirdly, the Care Standards Tribunal has been
replaced this week by the Health, Education and
Social Care Chamber. New rules, new judges. See
item 60.
Fourth, today is National Stress Awareness Day. I
think there is much to do to raise its profile.
Finally, although not of immediate or direct impact on
our sector, there is new President elect, Barack
Obama, to whom congratulations.
Abuse
Nothing to report
Business News
1. Priory in talks with buyout firms over Four
Seasons merger
1 November 2008 - Telegraph
The Priory Group is seeking massive funding for a
merger with Four Seasons the troubled care-homes
operator.
It was reported that there were talks between Philip
Scott, CEO of Priory since Jan 08, and bankers and
venture capitalists all week. There is thought to be
little appetite for such a deal now with so much uncertainty
in the markets.
2. Southern’s pact
1 November 2008 - Daily Mail
Report of the refinancing of £161m by Southern
Cross Healthcare – shares rose 48% to 98pence.
3. Four Seasons Health Care enters new
standstill agreement with senior lenders
31 October 2008
Contrary to recent speculation, negotiations with the
Group’s lenders have not failed. In this regard, the
Four Seasons Health Care Group has entered into a
new standstill agreement with its senior lenders until
22nd January 2009. The new standstill agreement will
enable existing negotiations to continue towards
agreeing a consensual restructuring of the Group’s
debt in a way that is in the best interests of the business
and all of its lenders. These talks are constructive
and our lenders are supportive in trying to reach
a robust capital structure solution for the Group.
The Group is generating significant operating profits
and it is in everyone’s interests, and particularly the
lenders’, to preserve the underlying value of the business.
We remain confident that there will be a consensual
restructuring of the Group’s debt in a way
that will have no impact on day-to-day operations, or
on our residents, customers or employees.
4. Avery boosted by £53m care home development
capital package
31 October 2008
Graphite Capital is providing significant equity capital
to fund the further development of premium quality
care home group Avery. A £53 million development
capital package is being provided to Willowbrook
Healthcare, a new company formed in partnership
with the highly experienced Avery care home management
team of John Strowbridge, Ian Matthews
and Roger Storey.
The move marks Avery out as being one of a handful
of companies able to continue developing large numbers
of new builds currently and is a further endorsement
of Graphite Capital’s support to the long term
care market.
The equity commitment to Willowbrook is made by
Graphite’s most recent fund, Graphite Capital Partners
VII, alongside equity capital from the management
team. A £30 million debt facility has been provided
by a banking syndicate led by Royal Bank of
Scotland alongside Allied Irish Bank and Bank of Ireland.
It is envisaged that additional capital facilities
will be raised as Willowbrook grows further.
Avery Group Managing Director John Strowbridge
said: “Our focus is on providing the highest quality of
nursing and dementia care in premium quality, purpose-
built homes. We believe that current market
conditions will provide opportunities to make selective
acquisitions alongside our core strategy of building
and developing new care homes on prime
sites. Graphite’s continuing financial support, its expertise
in the elderly care sector and its success in
rolling out property-related businesses has been invaluable
in helping us to establish and build up Avery
Healthcare, Optimum Care and now Willowbrook.”
5. Southern Cross Healthcare Grp PLC
31 October 2008
REFINANCING SUCCESSFULLY CONCLUDED
Southern Cross has replaced the four original
tranches of debt, two of which were used for operating
working capital and two (the B1 and B2 facilities)
for acquisitions, with three separate loan tranches,
including a term loan, a revolving credit facility and a
bridging loan.
The term loan has been increased to £70 million.
This consists of the existing £48 million term
loan facility, £14 million transferred from the previous
B2 facility (representing the shortfall in proceeds from
the sale of the Portland portfolio), and an £8 million
increase in the funds available to the Company. The
final repayment date is 30 June 2011, with the first
amortisation payment of £5 million due on 31 March
2009.
The revolving credit facility of £36 million finances
working capital and the amount of this facility, which
is available up to 30 June 2011, remains unchanged.
In addition, a £12 million revolving credit
facility has been put in place to cover the period from
22 December 2008 to 22 February 2009 to meet the
Company's expected seasonal working capital requirements
during the Christmas and New Year period.
Following the divestment of 16 freeholds during the
summer for a total of £51.8 million, borrowings under
the B1 and B2 facilities have been reduced to £33.4
million. As a result of the transfer of £14 million to
the term loan, the B1 and B2 facilities have now
been combined and replaced by one bridging loan
totalling £19.4 million. The bridging loan, which is
due for final repayment on 30 June 2010, will be repaid
from the proceeds of future sales of freeholds.
The £28.8 million development facility, put in place to
finance 5 developments, remains unchanged and is
currently drawn to £13.7 million.
A revised covenant package has been agreed as
part of the refinancing, based upon the Company
achieving a minimum Adjusted EBITDA of £70 million
for the financial year to 30 September 2009.
Following the payment of an interim dividend of
3.75p per share, the Directors have decided not to
recommend a final dividend for the year ended September
2008 and do not intend to declare an interim
dividend in respect of the six months to March 2009.
Thereafter the level of dividend payments will be decided
in the light of the cash and operating performance
of the business going forward.
In addition, Southern Cross announced the exchange
of unconditional contracts for the sale of the
freehold interest in Torrwood Care Centre to Sovereign
Property Holdings Limited for a cash consideration
of £7.8 million, which is equal to the book value
of the property. The annual rent payable in respect of
the property is £0.6 million and the transaction is expected
to complete on 13 November 2008. The proceeds
from the sale, when received, will be used to
pay down by £6.2 million the development facility and
the remainder will be used to part repay the drawings
on the Company's revolving credit facilities.
A pre-close trading update was issued on 9 October
which stated that occupancy at 28 September 2008 in
mature homes was 90.5% and in the Company's
homes as a whole was 89.9%. Occupancy rates today
remain at similar levels.
The Company expects to announce its preliminary
results for the financial year ended 28 September
2008 on Tuesday 9 December 2008.
6. Private health market 'shrinks'
29 October 2008 - Laing & Buisson
Analysts Laing and Buisson estimate that in the last
year, UK spending on non-cosmetic surgery, such as
knee and hips,- fell by nearly £30m to £345m.
The last significant downturn was in the recession of
the early 1990s.
7. Southern Cross Healthcare
28 October 2008 - 2008 The Times
Report that the company was in talks with banks to
reschedule debt.
8. Court Cavendish’s Dream Team
November 2008—Care Management Matters
An interesting look at 10 of the key individuals who
were part of Court Cavendish and where they are
now.
9. Village people?
November 2008—Care Management Matters
A look at the effect of the downturn in residential
housing which is proving a mixed blessing for the
care village concept.
Care Homes
10. C. diff deaths in care homes triple in 2
years
1 November 2008 Daily Mail
C. diff. Was mentioned on the death certificates of
438 care home residents last year, up from 144 in
2005.
11. Colliers CRE publishes Care Home Review
31 October 2008
This eighth report concludes that the “elderly long
term care sector remains resilient.” However, the
report observes “Care homes for the elderly will, however,
need to focus on residents with higher needs,
particularly dementia care, as public funding becomes
limited to those with the greatest care requirements.”
12. Care home staff forced to break up OAP
bust-ups
30 October 2008 – Daily Record
Statistics released by East Lothian Council show that
carers in old folk's homes are regularly forced to
break up physical fights between pensioners.
The figures show that the numbers of fights in care
homes was similar to that seen in schools, with almost
72 violent clashes already this year at the two
worst-hit homes - 44 at Eskgreen Old People's Home
in Musselburgh and 28 at Fa'side Lodge Old People's
Home in Tranent. Incidents ranged from cups
being thrown to people being hit with walking sticks.
For full report go to http://www.dailyrecord.co.uk/news/
scottish-news/2008/10/30/care-home-staff-forced-to-break-upoap-
bust-ups-86908-20852913/
13. Spotlight on care homes
28 October 2008 – Hartlepool Mail
Hartlepool Borough Council has launched an investigation
into local care home provision to examine
work being done to maintain and enhance standards
of care homes in the area and the quality of life for
their residents.
Residents, their relatives and care home managers
are being invited to contribute.
For full report go to http://www.hartlepoolmail.co.uk/news/
Spotlight-on-care-homes.4636159.jp
14. Care home residents inspire cookbook
26 October 2008 – Wiltshire Times
A new cook book has been created by residents and
staff of The Orders of St John Care Trust which runs
20 care homes for older people in Wiltshire.
The Book For Cooks Who Care will raise money for
a good cause and combines traditional family recipes
with more contemporary ones.
For full report go to http://www.wiltshiretimes.co.uk/news/
latestheadlines/
3790182.Care_home_residents_inspire_cookbook/
Case Reports
Law Reports
15. R v Meadows
Rosemarie Meadows, former owner of Tiddlywinks
nursery was fined £35,000 in addition to paying
£20,000 towards the cost of prosecution for a breach
of safety regulations which lead to the death of 16
month old Molly Cunliffe in 2005.
16. R (Haase) v Independent Adjudicator and
Another
The Court of Appeal held that in order to ensure a fair
trial under article 6 of the European Convention on
Human Rights does not require impartial prosecutors.
17. R (RJM) v Secretary of State for Work and
Pensions
The House of Lords held that the policy of disentitling
persons without accommodation from receiving disability
premium to which they would otherwise have
been entitled amounted to discrimination (under article
14 European Convention on Human Rights) but
was lawful as it could be justified on policy grounds.
Disciplinary cases
18. Nurse who put knickers up for sale on
eBay faces disciplinary panel
28 October 2008 - Telegraph
Sheena McMillan, 24, of Derriford Hospital, Plymouth
was referred to the NMC for advertising her new and
worn underwear for sale using her hospital email address
from which it was said to be clear that she was
both a registered nurse and a nurse working for the
NHS Trust.
Ms McMillan accepts that she used her work email,
that she sent and received sexually explicit material
but denies that her fitness to practice is impaired.
The NMC panel said it would not strike her off and
referred the matter to its health committee having
read private representations made in a letter from Ms
McMillan.
Cases in the news
19. Care workers cleared of neglect
31 October 2008 – BBC News
Michael Lurvey and Margaret Lewis, two care home
workers accused of wilfully neglecting a resident have
been cleared of all charges.
Alan Sayers, 52, who had dementia, died at the
Mountleigh care home in Newbridge, Caerphilly
county, on 27 September 2004.
The judge ruled that there was no case to answer
against Lurvey and Lewis. The trial continues at
Newport Crown Court against two other care workers,
two managers and a nurse.
The trial has heard that paramedics reported Mr
Sayers as having developed rigor mortis by the time
his body was found, indicating he had been dead for
several hours.
Prosecutors claim he was left alone in the hours before
his death which contravened his care regime.
For full report click here
MS sufferer loses battle on assisted suicide
30 October 2008 - The Times
Debbie Purdy’s attempt to get the Attorney General
to issue specific policy guidelines on assisted suicide
so that she may know whether her husband would
face prosecution if he helped her to travel overseas
in due course.
20. Separation fear led to OAP deaths
30 October 2008 – BBC News
Retired dentist Tom Hughes, 82, suffocated his wife
and then killed himself because he was afraid they
would be split up for the first time in their married
lives.
Their bodies were found at their home in Abergavenny,
Monmouthshire.
For full report click here
21. Doctor hid evidence from inquest
29 October 2008 – BBC News
Nigel Palmer, GP at Park Grove surgery in South
Yorkshire has been told he faces jail after failing to
provide evidence to an inquest into an elderly
woman’s death.
He admitted perverting the course of justice by not
producing the evidence to an inquest into Eileen
Gill's death, along with surgery receptionist Nancy
Wainwright admitting obstructing police by concealing
the existence of the book.
The inquest into 82-year-old Mrs Gill's death in a
house fire started at the Medico-Legal Centre in
Sheffield in June but was stopped by coroner Chris
Dorries over concerns about evidence.
For full report click here
22. Company fined after driver seriously injured
in fall
The Health and Safety Executive (HSE) warned of
the danger of not providing safe working conditions
after worker was seriously injured when he fell down
an unguarded and unlit stairwell.
The warning follows the prosecution of TDG UK Ltd,
a logistics company based in Grosvenor Place, London
which was fined £10,000 and ordered to pay
£2,400 costs, after pleading guilty at Halton Magistrates
Court to breaching Section 2 (1) of the Health
and Safety at Work etc Act 1974.
On 30 November 2007 a driver arrived for work at the
company's site in Preston Brook, Runcorn and was
sent to collect a trailer from the nearby Acton Grange
site, arriving at approximately 4.30am.
After reversing his cab onto the trailer, he was checking
the vehicle when he fell down an unguarded and
unlit stairwell. There were similar stairwells on the site
with steel railings to guard the opening and with operational
lights. The driver was taken to hospital and
underwent surgery to repair lung damage and was off
work for 10 weeks.
Ed. Do make sure that stairwells, fire escapes
etc. are appropriately guarded and illuminated.
23. Carer thief nabbed by cameras
29 October 2008 - The Sun
Relatives hid cameras in 77-year-old Joyce Nadin’s
living room and a bedroom, marked banknotes with
ultraviolet ink and as a result caught a carer stealing.
Police checked the cameras when money continued
to disappear.
Care worker, Michelle Bradshaw, has been sacked by
contractor Care4You, but escaped a jail sentence
after magistrates in Sheffield, South Yorks, heard she
committed the offences after developing depression
and mental illness.
She was given a six-month suspended sentence and
a 12-month supervision order.
24. Care home worker with faked visa is 'an
asset' says judge
24 October 2008 - The Herald
A Zimbabwean woman, Sharon Moosa, who came to
the UK on a six-month visitor visa in 2002 bought
fake papers so she could stay here and work, a court
has heard.
She worked illegally in care homes in London and
Plymouth until she was arrested. As a result she lost
her job.
Moosa, admitted possessing false identification with
intent, was told by Judge Francis Gilbert QC that if
she had applied for residency she might well have
been allowed to stay.
He said: "Everyone speaks extremely highly of you,
and you are a hard and conscientious worker.
"I hope you will be allowed to stay lawfully; you will be
an asset."
She was given a four-month prison sentence which
was suspended.
Children
25. Children's trusts 'not effective'
29 October 2008 – BBC News
A report by the Audit Commission says that the children's
trusts created by the government after the
death of Victoria Climbie have made little difference
to children's services.
The English trusts were one of the recommendations
made by an inquiry into the eight-year-old's death in
2003 but the report says they often lack clear direction
and have made slow progress. The Government
said the review is out-of-date.
For full report click here
26. CETAD Lancaster University offers an
opportunity to learn more about early years
professional status
28 October 2008
Early years workers from throughout the North West
will have the chance to learn more about a pioneering
new programme, being offered by CETAD, Lancaster
University on 04.11.08.
Early Years Professional Status will give nursery
workers the opportunity to achieve the national 'gold
standard' in early years childcare to become Early
Years Professionals - and give local children a strong
start in their development.
When they complete training Early Years Professionals
will be equipped with the expertise, skills and
confidence to nurture and develop children in the
crucial first five years of their life.
Supported by the Children's Workforce Development
Council (CWDC), this new status is the first step in a
Government drive to transform the early years workforce,
with a target of employing one Early Years Professional
in every child care setting by 2015.
On 4 November those interested in Early Years Professional
Status can attend a CETAD Open Day held
at Lancaster University. There will be representatives
from CETAD, Lancaster University as well as a number
of Early Years Professionals who have been
awarded the status on hand to answer potential candidates'
questions.
Early Years Professionals have the opportunity to
work in a range of facilities across Lancashire including
nurseries, pre-schools and day care centres.
They will have demonstrated that they meet a rigorous
set of graduate-level standards and will lead development
and learning during the important early
years.
If you are interested in achieving Early Years Professional
Status you can find out more at http://
www.cwdcouncil.org.uk/futures or call 0800 996600.
For further information please contact Tricia Kenny
on 01524 593 318 or e-mail t.kenny@lancaster.ac.uk.
27. Ofsted: Future care - Children's advice on
future care standards
27 October 2008 - Ofsted
Report setting out children's recommendations for
future care standards.
For full report go to http://www.ofsted.gov.uk/Ofsted-home/
Publications-and-research/Documents-by-type/Thematicreports/
Future-care-childrens-advice-on-future-care-standards
Conferences & Courses
To follow next week
Consultations
28. Consultation on direct payments regulations
Closing Date: 11 November 2008
Direct payments are crucial to achieving the Government's
aim to increase independence, choice and
control for service users and their carers. The Health
and Social Care Act 2008 extends the availability of
direct payments to those people who lack the capacity
to consent. In addition, Government is reviewing
the current exclusions from receiving direct payments.
Government is now consulting on regulations relating
to these two changes.
For full consultation click here
29. Have you booked your place at our next
forum event?
15 October 2008 – SCRC
The Scottish Care Commission still has places left at
their next consultation event which is taking place on
Thursday 27 November in Stornoway at the Cabarfeidh
Hotel.
For full report click here
30. Consultation on a Regime for Unsustainable
NHS Providers
Closing Date: 3 December 2008
Following publication of 'Developing an NHS Performance
Regime' in 06.08, the DoH has announced
proposals detailing the steps that would be taken if
an organisation failed, either for clinical or organisational
reasons.
The regime aims to:
* underpin the NHS performance regime;
* ensure the public receive high-quality services by
supporting quality regulation;
* reinforce the NHS Foundation Trust regime; and
* protect patients and staff from failing services.
The 'Consultation on a Regime for Unsustainable
NHS Providers' picks up at the point where an organisation
has failed to turn its performance
around. The regime is the last step for providers
who are subject to previous recovery actions by
Monitor or the NHS performance regime. It proposes
that a 'Trust Special Administrator' would be appointed
to take control of the Trust to ensure that it
continues to provide safe and effective services for
patients. They would also be required to produce a
report and consult swiftly on proposals for the future
of the trust.
For full consultation click here
31. Consultation on the European Commission's
proposals for a Directive on the application
of patients' rights in cross-border
healthcare
Closing Date 3 December 2008
On 2 July 2008 the European Commission published
a draft Directive on the application of patients’ rights
in cross-border healthcare. This draft Directive is
looking to clarify and codfiy existing European Court
of Justice case law on when a patients can exercise
their freedom to obtain health services to which they
are entitled to in the UK, in another European Union
Member State.
For full consultation click here
32. Consultation on public, patients', and
other interested parties' views on additional
uses of patient data
Closing Date: 12 December 2008
NHS Connecting for Health is gathering people’s
views to help it make important decisions about the
ways the NHS can use information it collects about
patients.
Patient data is mainly used to provide care and treatment
but can also have additional uses such as research,
auditing the quality and safety of care, management
planning, etc. This consultation is focusing
on additional uses.
For full report click here
33. Consultation on Minimum Frequency of
Inspection for certain Care Services provided
by The Care Commission
Closing Date: 31 December 2008
The Scottish Government wants responses to a consultation
on proposals to Reduce the Minimum Frequency
of Inspections of Certain Care Services by
the Care Commission from 1 April 2009.
For full consultation click here
34. Consultation on a National Framework
For Assessing Children and young people's
Continuing care
Closing Date: 31 December 2008
A consultation on proposals for a National Framework
for assessing children and young people’s continuing
care. The Framework intendeds to assist Primary
Care Trusts to apply a consistent and transparent
approach to assessing the healthcare needs of children
and young people and to work jointly with local
authorities to provide services in the light of those
needs.
For full consultation click here
35. Government consults on safeguarding
vulnerable adults
Closing date: 31 January 2009
Care Services Minister Phil Hope launched a consultation
on how to improve safeguarding policy - the
protection of vulnerable adults - and address abuse in
all its forms in the care system.
The 'No Secrets' guidance for local authorities, the
police and the NHS to work together to protect adults
is already in place. The Government now wants to
make sure it keeps up with changes in the social care
system, with the new emphasis on choice and control
and changing forms of abuse.
Key issues on which Government is seeking views
are:
* Whether there is now a need for legislation,
* The feasibility of a national database of recommendations
from serious case reviews where abuse has
occurred
* What new measures are needed in the face of increased
'personalisation' of care with more people
now being in charge of their own care instead of local
authorities
* What new measures are needed in the face of
changing forms of abuse, such as financial abuse
35. Government consults on safeguarding
vulnerable adults (continued…)
Phil Hope said:
"I am determined to improve safeguarding of vulnerable
people. We need a greater focus on prevention,
a greater emphasis on safeguarding in commissioning
services and support, and greater empowerment
of people to determine how they wish to be safeguarded.
The No Secrets guidance must be updated
to make sure everyone - individuals, police, care
agencies, the NHS and local authorities prevent
abuse, and also recognise it and stamp it out if it
does occur.
"The consultation is particularly relevant as more
people gain control of their own care. I want to help
people maintain this control and independence, free
from fear of abuse. I look forward to hearing people's
views and will not hesitate to take tough action to
improve safeguarding for those in vulnerable situations."
The consultation on the review of No Secrets will run
from 14th October to 31st January 2009.
Notes to Editors.
The consultation can be found on the Department of
Health website at http://www.dh.gov.uk/en/SocialCare/
Socialcarereform/Safeguardinganddealingwithabuse/
index.htm
36. Consultation on final dates for social service
workers to register with the SSSC
Closing Date: 31 December 2008
A consultation paper has now been issued for the
Introduction of final dates for prescribed descriptions
of social service workers to achieve registration with
the Scottish Social Services Council (SSSC).
For consultation click here
37. Reviewing the Mental Capacity Act 2005:
Forms, supervision and fees – Consultation
Closing Date: 15 January 2009
Consultation seeking views on proposed changes to
three areas of the work of the Office of the Public
Guardian and the Court of Protection following the
implementation of the Mental Capacity Act 2005 in
October 2007.
It aims to cover a redesign of the lasting power of
attorney forms, the restructuring of the supervision of
deputies by the public guardian and alterations to fee
structures.
For consultation go to http://www.justice.gov.uk/publications/
reviewing-mental-capacity-act.htm
38. Care Quality Commission unveils first
two initiatives aims at improving quality and
safety of services
Closing Date: 16 January 2009
The Care Quality Commission has published two
documents which set out how it aims to:
• drive further improvements in how the NHS
deals with healthcare associated infections,
such as MRSA
• use its new enforcement powers to improve
the quality and safety of health and
adult social care services for the people
who use them
The CQC is launching a 12-week consultation with a
wide variety of stakeholders on how it intends to use
its new enforcement powers, together with publishing
guidance to NHS trusts about additional requirements
for registering with the new Commission in relation to
healthcare associated infection (HCAI).
For full consultation go to http://www.cqc.org.uk/news/
hcai_and_enforcement_policy.aspx
39. Department of Health: Developing the
quality and outcomes framework - Proposals
for a new, independent process
Closing Date: 2 February 2008
Consultation seeking views on proposals for a new
independent and transparent process for recommending
quality outcome framework indicators.
For full consultation click here
40. Consultation on GP Quality Incentive
Scheme launched
Closing Date: 2 February 2009
Delivering the best possible care for patients and addressing
health inequalities will be at the heart of proposed
changes to the GP quality incentive scheme,
the Quality and Outcomes Framework (QOF), Health
Minister Ben Bradshaw announced today.
The QOF rewards GP practices for managing some
of the most common chronic diseases such as diabetes
or heart failure; improving health; organising practices
well; how patients view their experience at the
surgery and the quality of extra services offered such
as child health and maternity services.
Under new proposals set out in a public consultation
published today, the National Institute for Health and
Clinical Excellence (NICE) would in future oversee
the annual process of reviewing clinical indicators.
From April 2009, NICE would review the benefits
to patients and the cost effectiveness of the indicators
used to assess the quality of care provided by
GP practices. NICE would be responsible for developing
a more transparent and inclusive review process
with input from patients and carers, primary care
professionals and other stakeholders.
40. Consultation on GP Quality Incentive
Scheme launched (continued…)
The final choice of QOF indicators would remain a
matter for negotiation with the British Medical Association
(BMA), based on the advice produced by
NICE.
The 12-week consultation is seeking views on how
the new process for assessing evidence for QOF
indicators should work. The key elements that will be
considered in the consultation will be how best to:
* Review existing QOF indicators and develop new
indicators for clinical quality and health outcomes,
based on evidence of clinical effectiveness;
* Allow a range of stakeholders, including patients,
carers and clinicians to identify potential QOF priorities;
* Set up a panel of independent experts that will prioritise
areas for developing new indicators;
* Pilot new indicators with GP practices; and
* Give flexibility to the local NHS to select some indicators
to reflect local health needs.
Health Minister Ben Bradshaw said:
"We have come a long way in addressing health inequalities
thanks to the current GP scheme for quality
incentives and the UK leads the world in providing
incentives to GPs to improve quality of care for patients.
"The latest figures for the Quality and Outcomes
Framework show that practices have continued to
deliver improvements in services for patients. But we
want to ensure that GP practices continue to deliver
more improvements to patient care, and the system
needs to evolve to support practices in achieving
even better outcomes for patients.
"Asking NICE to manage a more independent, open
and transparent process for reviewing QOF indicators
will make sure that we make the best use of our annual
investment in the scheme and continue to support
GPs in delivering the best care possible for patients,
allowing the QOF to adapt and respond to the
latest medical advances."
A full explanation of how the current scheme operates
and details of how to become involved in the
consultation can be downloaded from: http://
www.dh.gov.uk/en/Consultations/index.htm
Ed. Future issues of BHCR will have this consultation
referred to under ‘CONSULTATIONS’ only.
41. NICE: Current consultations
To browse through consultations go to http://
www.nice.org.uk/page.aspx?o=consultations.current
CSCI/Care Quality Commission
(w.e.f. 2009), CSSIW,
Healthcare Commission &
Scottish Care Commission
42. National Residential Child Care Initiative
29 October 2008 – SCRC
The Scottish Institute for Residential Child Care is
hosting an initiative which aims to identify and advise
on key issues impacting on provision of residential
childcare and to agree a way forward for a step
change in quality provision for better outcomes.
For full report click here
43. Care Quality Commission unveils first
two initiatives aims at improving quality and
safety of services
The Care Quality Commission has published two
documents which set out how it will:
• drive further improvements in how the NHS deals
with healthcare associated infections, such as
MRSA
• use its new enforcement powers to improve the
quality and safety of health and adult social care
services for the people who use them
The CQC is launching a 12-week consultation with a
wide variety of stakeholders on how it intends to use
its new enforcement powers, together with publishing
guidance to NHS trusts about additional requirements
for registering with the new Commission in relation to
healthcare associated infection (HCAI).
http://www.cqc.org.uk/news/
hcai_and_enforcement_policy.aspx
Ireland, Scotland & Wales
Ireland
Scotland
44. Technology improves patient care
30 October 2008 – BBC News
Dundee researchers are currently developing an
electronic system to record details of patients, such
as when they should be turned or when to eat and
how often.
Audio and video can then be used to give medical
staff demonstrations of how the patient likes those
tasks to be done.
It is thought the system could help patients with conditions
such as cerebral palsy, Parkinson's Disease
or learning difficulties.
For full report click here
45. Patient data breach at hospital
30 October 2008 – BBC News
NHS Lanarkshire’s bosses have apologised after
sensitive patient documents were left unattended
and removed from Wishaw General hospital.
The apology follows a complaint for the relative of an
elderly patient who was able to lift files left lying on a
ward and take them home. The documents contained
the names, ages and medical information of
24 patients.
For full report click here
46. NHS Board Warns Of 'scary' Cuts In
GBP36m Cash Crisis
30 October 2008 – The Herald
Documents obtained under the Freedom of Information
Act show internal papers from a Scottish health
board revealing that managers are warning of painful
spending cuts, including options once regarded as
"scary or untouchable".
Planners at NHS Highland have suggested offering
staff redundancy in the fight to stop the service
ploughing £36.6m into the red.
The documents blame lower than expected funding
allocations from the Scottish Government, and higher
than anticipated pay rises for staff, have more than
doubled the projected cash shortage.
For full report go to http://www.theherald.co.uk/
display.var.2464324.0.0.php?utag=28804
47. Doctors win health visitor fight
29 October 2008 – BBC News
Doctors have won their battle with NHS Greater Glasgow
and Clyde to keep health visitors in the GP practices.
Originally, the health board wanted them to work with
social service departments, despite concerns that it
would break a valuable link with patients, with a compromise
agreement being reached on Thursday as a
22,000 signature petition was handed over to MSPs
at Holyrood.
For full report click here
48. Hospitals improving hand hygiene
29 October 2008 – BBC News
Hospital staff at NHS Lanarkshire have significantly
improved hand-washing standards according to statistics
for August, showing hand hygiene levels for
NHS Lanarkshire were 91% - which exceeds the national
target of 90%.
The health board is running a campaign aimed at
further increasing hand-washing levels and staff, patients
and visitors can test their hygiene levels using
special ultraviolet light boxes.
Figures published in April 2008 showed that NHS
Lanarkshire had the lowest hand-washing rating in
Scotland at just 75%.
For full report click here
49. Looked After Children (Scotland) Regulations:
Analysis of Responses to First Consultation
28 October 2008 – 4 Nations Child Policy Network
The Scottish Government has published a report analysing
the responses they received to the first consultation
on 'Looked After Children (Scotland) Regulations
2008'.
For full report click here
Wales
50. End to hospital junk food vending
1 November 2008 – BBC News
The Welsh Assembly Government has announced a
ban on hospital vending machines selling crisps,
chocolate and sugary drinks.
Reminders to eat five portions of fruit or vegetables a
day will replace logos on the sides of machines.
For full report click here
51. Fall in hospital beds in Wales
28 October 2008 – BBC News
The latest annual figures released by the Welsh Assembly
Government shows a fall in the number of
hospital beds in the health service. There has also
been a rise in the average time a patient stays in an
acute bed.
The figures show that the number of NHS beds in
Wales fell by 229 - or 1.7% - to 13,354 in the 12
months to April 2008, compared with the previous
financial year.
For full report click here
Learning Disabilities
52. Care services minister Phil Hope to reexamine
Valuing People Now
29 October 2008 – Community Care
Phil Hope, Minister of State for Care Services wants
to do more work on the delivery plan for Valuing People
Now which was originally expected this autumn.
This means that it might be put back by two or three
months and published in the New Year.
For full report click here
53. Elaine Hill appointed as the new specialist
advisor for autism
27 October 2008
Elaine Hill has been appointed as the new Specialist
Advisor for Autism at the Department of Health.
Working four days a week, Elaine's responsibilities in
her new role will be to lead the development of an
adult autism strategy. She will advise on the needs
of people with autistic spectrum conditions (ASC) in
policy work on projects for social care and health
services.
An important part of her role will be to engage and
build sustainable frameworks with key stakeholders.
Care Services Minister Phil Hope said:
"I am pleased that Elaine Hill has accepted this key
role as the new Autism Adviser. Her experiences in
working with people with autistic Spectrum conditions
(ASC), including assisting in commissioning and delivering
services to people with ASC, make her an
ideal candidate to develop an adult autism strategy.
I look forward to working with her."
Elaine Hill said:
"I am very excited about the prospect of being able to
take forward key developments for people with autism
and their families. The appointment of a Specialist
Advisor for Autism with the DH is a really vital
and positive step and one that is not without significant
challenges. In that role I am really looking forward
to addressing the obstacles that people with
autism and their carers experience in receiving the
help and the support they need in their daily lives. I
hope to be able to develop a key National Strategy
for people with autism that will help to realise personalised
support services and ensure prompt access to
that support."
Elaine Hill is currently the head of the North East Autism
Consortium (NEAC) which comprises 12 local
authorities and PCTs in the North East. Her role, as
the first head of this organisation, has been to provide
leadership to the PCTs, local authorities and other
key agencies in the region, and to assist in the strategic
planning, commissioning and delivery of services
to people with autistic spectrum disorders (including
Aspergers Syndrome).
54. The following are taken from bulletin of
the Foundation for People with Learning Disabilities
31 October 2008
Building community through circles of friends
A practical guide to making inclusion a reality for people
with learning disabilities. This book outlines practical
steps to developing circles of support that will result
in long-lasting friendships and on-going connections
in a person’s local community. It is a resource to
help understand the values that should underpin the
process of person-centred planning. The book contains
practical guidance and examples of good practice,
as well as real life case studies. For more information
visit: http://www.learningdisabilities.org.uk/
publications/?entryid=29215&EntryId5=22393&q=0%C2%
ACcircles%C2%AC
55. New Foundation Stones
Foundation Stones, our bi-annual newsletter, has
been redesigned and will be out in early Novemberember.
To receive Foundation Stones, contact us
at fpld@fpld.org.uk. If you would like to read some
b a c k c o p i e s p l e a s e v i s i t : h t t p : / /
www.learningdisabilities.org.uk/about-us/foundation-stones/
56. Support our work
The Foundation for People with Learning Disabilities
is part of the Mental Health Foundation. As a charity,
we rely on donations - 83% of our income comes
from voluntary sources. If you would like to find out
more about how you can support us or get involved,
please visit http://www.learningdisabilities.org.uk/getinvolved/
Legislation Update
57. No. 2789 The Medicines (Pharmacies)
(Responsible Pharmacist) Regulations 2008
29 October 2008 – OPSI
For full legislation click here
58. No. 426 The Health and Social Services
Trusts (Establishment) (Amendment) Order
(Northern Ireland) 2008
29 October 2008 – OPSI
For full legislation click here
59. No. 2788 (C.124)The Mental Health Act
2007 (Commencement No.9) Order 2008
28 October 2008 – OPSI
For full legislation click here
60. The Care Standards Tribunal swept
away
On 03.11.08 the CST will be replaced by the
Health, Education & Social Care Chamber headed
by President Judge Philip Sycamore. There are
Rules which replace the CST Regulations. The
Rules are not of universal application. However,
the concept of ‘overriding objective’ which was
introduced to civil litigation almost a decade ago
has been introduced to proceedings before this
new tribunal.
Current thinking is that to discontinue proceedings
in relation to an improved service will become
much more challenging.
We at Brunswicks extend our thanks to the CST
and all of its personnel for the care and courtesy
taken in relation to our clients and us over
the years, and we look forward to working with
the new HESC Chamber – no doubt, mostly the
same people – in the future.
Mental Capacity
61. Mental Capacity Act 2005: Deprivation of
Liberty Safeguards - draft standard forms
29 October 2008
Standard forms are being made available now in order
to facilitate best practice, training and preparation
in advance of April 2009, when the Deprivation of
Liberty Safeguards come into effect.
The forms can be adapted but as drafted they help all
those involved in the safeguards processes to fully
meet the requirements of the Deprivation of Liberty
legislation.
The first document, published on 29 October 2008, is
for supervisory bodies and contains all the forms,
developed to date, for both supervisory bodies and
for managing authorities.
The second document, that will appear here shortly,
will be for managing authorities but will contain only
the managing authority forms with guidance for care
homes and hospitals.
Over the coming months later versions will appear
here as the forms reach their final development e.g.
the inclusion of templates for supervisory bodies to
refer cases to assessors and templates for IMCA reports.
We do not expect there to be any major changes to
the content hereafter as the forms already include all
the fields required for supervisory bodies and managing
authorities to comply with the legislation but other
fields may be included e.g. to facilitate monitoring.
These are standard and not statutory forms but
supervisory bodies and managing authorities are
strongly encouraged to use them as their use will fulfill
not only their legal obligations but will bring a nationwide
consistency to the implementation of the
Safeguards.
You are advised to regularly check this website to
confirm that you are using a current version.
Download standard forms and guide for supervisory bodies in
England (primary care trusts and local authorities) DRAFT
FOR TRAINING - Gateway reference 10596 (PDF, 1743K)
Mental Health
62. Angela Greatley on the Mental Health Act
31 October 2008 - HSJ Mental Health Newsletter
From 03.11.08, most parts of the long-awaited and
often feared Mental Health Act 2007will be implemented.
For the NHS, the new Act presents major
challenges by extending the scope of compulsory
powers and by creating some new safeguards for
those subject to them.
63. Roll-out of mental health advocates may
be delayed
Delays at Department of Health leave councils
and NHS trusts unsure
30 October 2008 – Community Care
Delays at the Department of Health means that the
deadline for rolling out independent mental health
advocates across England could be missed.
MIND, the mental health charity said there is a lack of
funding and guidance from government, and that this
has left local authorities and NHS trusts working "in
the dark" as they struggle to prepare for the launch in
April 2009.
For full report click here
64. Charity says new compulsory treatment
powers excessive as Mental Health Act becomes
law
30 October 2008 - Mental Health Foundation
The Mental Health Foundation has warned against
the possible misuse of new powers of compulsory
treatment for people with mental health problems,
which come into effect today. Under changes to
mental health legislation, some patients discharged
from hospital may be placed under a Community
Treatment Order (CTO) that forces them to take their
medication.
Simon Lawton-Smith, Head of Policy at the Foundation,
said:
“There is no conclusive research to suggest that
CTOs help people with mental health problems to
stay well anymore than good local services. It will be
important to keep a very close eye on how these new
powers are being used - they must not become the
easy option or replace good mental health services
that people want to use.”
“CTOs may help a small number of individuals with
complex needs to stay well rather than lose touch
with services and become ill again. But taking away
anyone’s right to refuse treatment is questionable.
No-one with a physical health problem is compelled
to take their medication, even if not taking it might be
life-threatening.”
“Many people, including some mental health professionals,
have profound concerns about compelling
people to take medication that can often have very
unpleasant side effects and may be of limited effectiveness.”
Simon Lawton-Smith says that the benefits of compulsory
treatment are not proven:
“Sadly, the introduction of these new powers has
been driven by concerns about the threat some people
with mental health problems may pose to members
of the public if they become unwell. However,
the general risk to the public is grossly over exaggerated.”
Ed. The Act contains a power to convey a noncompliant
CTO patient to hospital and hold them
there for up to 72 hours for the purpose of treating
them, in effect as an out-patient. If they do
not comply with treatment in that time, the CTO
may be revoked and the patient would revert to
detained status. However the new SCT powers do
not allow patients to be forcibly compelled to take
treatment in a community setting - the ‘injection
over a kitchen table’ scenario.
SCT may only be authorised for a patient already
detained in hospital for treatment under the Act -
it cannot be used for patients admitted to hospital
only for assessment, or for patients under a restriction
order. CTOs are authorised for six
month period, and then may be renewed for a further
six months and then annually if considered
necessary. A patient under a CTO may appeal
against the imposition of SCT to a Tribunal in the
same way as a patient detained in hospital, but
cannot appeal to a Tribunal against the conditions
set out in their CTO.
The Mental Health Act also makes a number of
other changes to mental health legislation, including
expanding the responsibilities of professionals
under the Act to a wider group of professions,
introducing a statutory right for patients
subject to the Act to seek advocacy support, and
changes to the definition of “mental disorder”.
Miscellaneous
65. C. diff testing 'is often wrong'
1 November 2008 – BBC News
An analysis of 18 studies by St George's, University
of London has found that unreliable testing means
that many carriers of the potentially lethal Clostridium
difficile bug are missed.
Tests showed that one test wrongly gave the all-clear
to a quarter of those infected.
For full report click here
66. Should GPs be paid to cut hospital referrals
31 October 2008 - The Times
Dr Peter Moore at GP in Torquay and Prof. Martin
Roland Director, National Primary Care Research and
Development Centre put opposing views
67. Most people favour assisted dying
31 October 2008 - the Times, Letters to the Editor
Vice-Admiral Sir James Jungis advances the strong
view that Parliament is out of step with wider society
on the issue of assisted dying. Eddy Holt points out
what to him seem to be inconsistencies in the Suicide
Act 1961.
68. MSP with Parkinson’s tries to legalise assisted
suicide
31 October 2008 - The Times
Margo McDonald, Member of the Scottish Parliament
began the process of brining a Private Members Bill
before Parliament following the failure of Mrs Purdy’s
bid to have clarification of the English law on assisted
suicide.
69. Consultation on GP Quality Incentive
Scheme launched
30 October 2008
Delivering the best possible care for patients and
addressing health inequalities will be at the heart of
proposed changes to the GP quality incentive
scheme, the Quality and Outcomes Framework
(QOF), Health Minister Ben Bradshaw announced
today.
The QOF rewards GP practices for managing some
of the most common chronic diseases such as diabetes
or heart failure; improving health; organising
practices well; how patients view their experience at
the surgery and the quality of extra services offered
such as child health and maternity services.
Under new proposals set out in a public consultation
published today, the National Institute for Health and
Clinical Excellence (NICE) would in future oversee
the annual process of reviewing clinical indicators.
From April 2009, NICE would review the benefits
to patients and the cost effectiveness of the indicators
used to assess the quality of care provided by
GP practices. NICE would be responsible for developing
a more transparent and inclusive review process
with input from patients and carers, primary care
professionals and other stakeholders.
The final choice of QOF indicators would remain a
matter for negotiation with the British Medical Association
(BMA), based on the advice produced by
NICE.
The 12-week consultation is seeking views on how
the new process for assessing evidence for QOF
indicators should work. The key elements that will be
considered in the consultation will be how best to:
* Review existing QOF indicators and develop new
indicators for clinical quality and health outcomes,
based on evidence of clinical effectiveness;
* Allow a range of stakeholders, including patients,
carers and clinicians to identify potential QOF priorities;
* Set up a panel of independent experts that will prioritise
areas for developing new indicators;
* Pilot new indicators with GP practices; and
* Give flexibility to the local NHS to select some indicators
to reflect local health needs.
Health Minister Ben Bradshaw said:
"We have come a long way in addressing health inequalities
thanks to the current GP scheme for quality
incentives and the UK leads the world in providing
incentives to GPs to improve quality of care for patients.
"The latest figures for the Quality and Outcomes
Framework show that practices have continued to
deliver improvements in services for patients. But we
want to ensure that GP practices continue to deliver
more improvements to patient care, and the system
needs to evolve to support practices in achieving
even better outcomes for patients.
"Asking NICE to manage a more independent, open
and transparent process for reviewing QOF indicators
will make sure that we make the best use of our annual
investment in the scheme and continue to support
GPs in delivering the best care possible for patients,
allowing the QOF to adapt and respond to the
latest medical advances."
A full explanation of how the current scheme operates
and details of how to become involved in the consultation
can be downloaded from: http://www.dh.gov.uk/
en/Consultations/index.htm
The consultation closes on 2nd February 2009.
Ed. Future issues of BHCR will have this consultation
referred to under ‘CONSULTATIONS’ only.
70. Private health market 'shrinks'
30 October 2008 – BBC News
Figures released by analysts, Laing and Buisson, estimate
that in the last year, UK spending on noncosmetic
surgery such as knee and hips fell by nearly
£30m to £345m.
The last significant downturn was in the recession of
the early 1990s and experts suggest the latest trend
is probably down to the economic climate and the
ever-shortening NHS waiting lists.
For full report click here
71. Real involvement: working with people to
improve services
30 October 2008 – DoH
Document providing statutory guidance for NHS organisations
on the updated duty of involvement and
advice about the new duty of reporting on consultation
and best practice on embedding involvement in
organisations.
For full report click here
72. ADASS President warns of ’trouble
ahead’
30 October 2008 – NCF
Adult Social Services Departments were warned to
brace themselves for “significant and substantial”
increases in the number of people being referred to
them during the coming year.
ADASS President John Dixon said:
"all the pointers are showing red alert.”
"The impact of a swift, sudden and unexpected recession
is bound to affect the poorest worst. And the
most vulnerable hardest. Extreme economic depressions
always have led to serious social tensions
within families and communities - and this one will be
no exception.”
"There is very strong evidence that these circumstances
will inevitably have negative impacts on family
relationships, child development and overall
health and well-being. It goes without saying that
these severe additional pressures come at a time
when social care budgets have been squeezed, cumulatively,
over the past three years. And when
there is little prospect of additional funds from either
national or local taxpayers in the short to mid-term."
For full report click here