January 2014 bulletin complete copy by Robert Nisbet

EAST MIDLANDS ADULT SAFEGUARDING BOARD BULLETIN 37 DECEMBER 2013 / JANUARY 2014

Page 8 9 9 10 11 12 12 13 13 14 14 15 16 17 18 19 19 20 20 21 21 22

EMASB BULLETIN 37 DECEMBER 2013 / JANUARY 2014 INDEX

RESEARCH ABSTRACTS

A feasibility study of expert patient and community mental health team led bipolar psycho-education groups Building trust in multi-stakeholder partnerships Causes of medication administration errors in hospitals Clinical practice guidelines require scrutiny for quality Community capital and the role of the state: an empowering approach to personalisation Creating respect in couples Enhancing patient-centred care Estimating the impact of mental illness on costs of crimes Exposure to family violence and attachment styles as predictors of dating violence perpetration among men and women Falling into the depths of his mind Implementation of the care programme approach across health and social services for dual diagnosis clients Integrity Mental health service user involvement in research: where have we come from, where are we going? Personality traits and the sense of civic duty The impact of aggravating and mitigating factors on the sentence severity of sex offenders The influence of religiosity on violent behaviour of adolescents The new Muslims. The relationship between safety culture and patient outcomes Who is better at defending criminals? Does the type of Defence Attorney matter in terms of producing favourable case outcomes? Why are crime victims at risk of being victimized again? Substance use, depression, and offending as mediators of the victimization–Re-victimization link Differences in well-being by ethnicity Understanding aging and diversity: Theories and concepts

GP & PRIMARY HEALTH CARE 23

Third of GP practices failed to meet new CQC standards

HOUSING 25

Housing body warns on higher standard of proof for IPNA

INNOVATION & TECHNOLOGY 26 28 29 30

Building tech-powered public services Cyberstalking, cyber harassment and Internet Trolls Electronic word of mouth on Twitter about physical activity in the United States European healthcare sector goes virtual as NHS focuses on

3 31 33 34 34 35 37 38 38 39

How the Internet and social media are changing healthcare Ipswich puts iPads on wards JMIR - patients’ reported reasons for non-use of an Internet-based patient-provider communication service Patient reviews for improving care Social media can boost disease outbreak monitoring, study finds Buzzwords £260m tech fund approved We’d all be better off with our health records on Facebook What can I do to stop online abuse

NHS NEWS & UPDATES 42 43

Dying without due care and attention NHS failing to care for people with Parkinson's

LOCAL GOVERNMENT 44 44

Ealing woman neglected in care home Housing association secures ASB injunction at Court of Appeal

MENTAL HEALTH 47 50 50 51 51 52 54 55 56 56 57

10 ways the underfunding of mental health services is damaging patient care 'Mental health trusts are delivering better value' Co-production in mental health: A literature review Councils need better information to champion mental health Extracts & summary of the ten questions Improved safety measures by mental health services help to reduce suicide rates Inspecting and regulating mental health services Mental Capacity Act code of practice under review but progress slow due to lack of civil servants Mental health and community services Mental health dashboard New Mental Health Tribunal Practice Direction directs specific consideration of whether MCA would be less restrictive.

LEGAL 58 58 59 61 62 62 63 64 66 68 69 70 70 71 72 76 77 78

Amended regulations for commissioners Anti-social Behaviour, Crime and Policing Bill Clarifying entitlement to community care and health services Confidentiality of medical information after patient’s death Council pays out damages for defamation by social services team Court of Protection judge calls for its hearings to be thrown open to scrutiny from the Press Court of Protection Newsletter December 2013 Declaration of a 'non-marriage' Independent mental capacity advocates need more power to challenge social workers, House of Lords told Key case on proof of destitution heads to Court of Appeal Mental health and UK employment law – part 4 NHS England: are GPs getting a fair hearing? Public bodies rapped after failing to involve relative in care planning Solicitation in the age of LinkedIn To disclose or not disclose? What to do when faced with an Coroner’s Inquest Volume of evidence YLA v PM & MZ RGB v Cwm Taf Health Board & Ors

4 GENERAL 80 80 81 82 84 84 85 86 86 87 88 88 89 89 90 91 92 92 93 94 95 97 98 100 101 101 102 104 108 108 109 111 112 113 114 114 115 116 117 118 119 119 120 121 122 124 126 127 128 129 134 134 135 138 140 141 141

4 linguistic reasons to leave patient alone 5 Trends For Health CIOs In 2014 A quarter of women prisoners self-harm every year London MASH Project - The five core elements Nursing & Midwifery Council's progress 'fragile', warns watchdog Barring scheme for directors will do more harm than good BASW-backed MP inquiry lifts lid on serious pressures facing social workers Birmingham Basics Birmingham City Council Browne Jacobson Conference Calderdale Council Calls for council review over 'slavery' case Cambridgeshire County Council Care crisis Changes to defamation law from 1 January 2014 'Clare's Law' to be extended to all of England and Wales Clinical commissioning group (CCG) funding Clinical Commissioning Groups 'accountable to too many masters' Commissioners are you ready for the NHS provider licence? Compassionate care means rooting out staff stress Condition of Britain briefing 3: Getting older and staying connected Constant learning, continuous improvement – lessons from Francis Continence Waste - Care Home Briefing 128 - December 2013 Of Cops & Cookies Councils may have to outsource 'low-level' assessments to free up social workers, say sector leaders Councils must be more open about adult social care weaknesses and cuts Councils show financial resilience, but must continue adapting State of Care 2012/13 Creative Councils: 10 lessons for local authority innovators C-section case shows need for radical changes on transparency: Munby Detailed data on “never events” will help NHS care become even safer, says NHS England Disabled people hit hardest by welfare reforms, report finds Disputing a Will based on undue influence – a challenge for claimants? Domestic homicide review: lessons learned Domestic violence fees in the courts likely to be scrapped Essex County Council responds to C-section care case Eviction notices surge by 26% Fears for prisons as offender management stagnates Francis report: Jeremy Hunt has prioritised blame over support Free helpline for older people launched to tackle loneliness G8 governments must make dementia a 'global priority' World Alzheimer Report 2013 Genuinely challenging the system - Think Local Act Personal Global Use of Medicines: Outlook Through 2017 Goodwill hunting Gove's disgraceful attack on social workers is meant to soften us up for the private sector Government must invest urgently in social work training to deliver care law changes, warn councils Government to fund 270 local government fraud investigators Government to intervene "where councils fail to take extremism seriously" GP Improvement Notices Issued Hard truths: essential actions Health equality could be achieved for the first time in human history How early information sharing can help social workers manage the rising tide of safeguarding alerts How to fix the UK's broken homecare system How to improve patient engagement HSCIC extends monthly workforce data to include earnings estimates and sickness-absence rates I am not a disease, I am not a checklist

5 143 143 144 145 146 146 147 148 149 150 151 152 152 153 155 156 156 157 158 159 160 161 162 163 164 165 166 167 168 170 171 171 173 174 175 176 177 178 179 180 181 183 183 186 187 188 190 191 192 193 194 195 196 198 199 201 202 204 205 206

'Implicit' changes to eligibility criteria have driven substantial cuts in client numbers Improving patient flow across organisations and pathways Inadequate staffing and supervision at young people’s mental health unit, finds CQC Interactive map comparing adult social care services launched Patients' preferences for patient-centered communication IV fluids training required to prevent avoidable hospital deaths Keeping alive at all costs is not a sufficient justification to deprive a person of their liberty Labour should support the government’s action on slavery – by radically amending their new bill Beyond borders: Human trafficking from Nigeria to the UK Learning Matters: Reflective Practice in Social Work - Third Edition Let's turn the aspirations in the care bill into a reality List of Department of Health regulations to remove or improve South Yorkshire family excluded from care planning for elderly relatives Medics denied access to room m:Health – A check-‐up on consumer use Mind the (fiscal) gap Ministers to develop single public services ombudsman for England More than Medicine: New services for People Powered Health Motivational antecedents of incident reporting: evidence from a survey of nurses and physicians New advice on mental wellbeing of older people in care homes marks 'bold step forward' New COP3 Form DoLS - published New guidance on coma care published New Programme Director Appointed for the Winterbourne NHS on brink of crisis because it became 'too powerful' to criticise No Place to Call Home – One World Publications ‘The chronic underfunding of mental health care is a stigma proving hard to reverse’ – Offender management in prisons: 'worrying lack of progress' Older people are our forgotten addicts One Drug, Two Names, Many Problems Patient safety reporting overhaul Patients' preferences for patient-cantered communication. Personalisation Vs Profits – Who Wins? Peter Gilbert praised for his outstanding contribution to social work PM taskforce recommends new powers to tackle extremism Police & Crime Commissioners should be abolished, says review Polypharmacy and medicines optimisation Prison probation privatisation to cause mass disruption Putting patient safety first: how long will it take before the NHS learns from its mistakes? Radical overhaul of sentencing continues Risk assessment framework: addendum for assessing risk at independent providers of Commissioner Requested Se Rochdale serious case reviews find dysfunctional multi-agency working and social care failures Scrapping formula could raise billions for social care Sector looks on with dismay at lack of progress on transforming care post-Winterbourne Security share stories Serious case reviews 'politically abused' since death of Baby P, claims expert Sharon Shoesmith calls for 'honest', not 'destructive', accountability in social services Sharon Shoesmith- Vilification of social workers is profession's Achilles' heel Skills for Care calls for feedback on Principles for Workforce Integration Social Capital Is as Important as Financial Capital in Health Care Some Key Messages for Adult Safeguarding SCR’s Spending watchdog slams Charity Commission over regulatory work National Audit Office criticisms are unjustified, says regulator Take outpatient clinics out of the system Taking the pulse of health and wellbeing boards The Chancellor’s Autumn Statement 2013 – by practice area The Condition of Britain: Interim report The focus on patient satisfaction is enough to make you sick The Ombudsmen and DOLS- South Yorkshire family excluded from care planning for elderly relatives Three male 'slaves' rescued from Traveller sites Town halls 'failing to protect vulnerable' from higher council tax

6 207 208 209 211 211 212 212 214 215 217 218 219 219 220 221 222 223 224 228 229 230

TRACEing the roots: a diagnostic Transforming the Patient Experience: Insights from Patient/Family Advisors #Trolls & #trolling - online abuse Under one roof? Housing and public health in England Under the spotlight Update on investigations into Jimmy Savile and the NHS Urgent action needed for sex workers gypsies and travellers Inspections, restructuring or a challenging job market: what is behind the rise in agency social workers? Use of restrictive practices in health and adult social care and special schools Using clinical communities to improve quality Victims put first in the criminal justice system Views sought on draft patient safety alerts for medical device incidents and medication errors Volunteering in acute trusts in England What information can I get about hospitals? When Drug Abuse Affects Your Personal & Work Life When the buck doesn’t move: non-delegable duties of care Why Retail Clinics Failed to Transform Health Care Why The “Forced Caesarean” Story Was Wrong Women's Aid Annual Survey Domestic Violence Workers fail to report abuse Young Minds launches report on offending and mental health

EMASB Bulletin – December 2013 / January 2014 Edition

What do think about the East Midlands Adult Safeguarding Board? Have your say about the work of the board & future programmes. The EMASB is conducting a brief survey with regards to how locality safeguarding boards, other stakeholders, practitioners etc. experience the work of the EMASB & to consult on future work that the board may undertake. The survey questionnaire that can be completed either by individuals or collectively by a locality adult safeguarding board/team/group. The survey can also be completed directly on line by clicking on: https://adobeformscentral.com/?f=Lt-7MzaR7Y6QAjcct3grdQ It will take 5 mins max to complete. Please do encourage your board members/colleagues to participate in the survey & in suggesting future projects for the EMASB to consider undertaking. Programmes that by being undertaken on regional basis will give added value for local services. There is also a chance to win a £10.00 Amazon Voucher. Complete the survey & enter your email address. You will then be entered into our prize draw. We hope to complete the survey by the 21st February 2014 with the prize draw winner being announced on the 24th February. With best wishes & many thanks for your support in this matter. Robert.

ABSTRACTS A feasibility study of expert patient and community mental health team led bipolar psycho-education groups: implementing an evidence based practice ________________________________________________________________ Druridge Ward, St Georges Park, Morpeth, Northumberland NE61 2NU, UK Faculty of Applied Sciences, University of Sunderland, Room 105, Dale Building, City Campus, Chester Road, Sunderland SR1 3SD, UK Institute of Mental Health and CLAHRC NDL, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK Wolfson Unit, Campus for Ageing and Vitality, Institute of Neuroscience, Newcastle University, Newcastle NE4 5PL, UK Copyright © 2013 Coulthard et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service. Methods A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed. Results Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team’s control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial. Conclusion

9 Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830443/ Building Trust in Multi-stakeholder Partnerships: Critical Emotional Incidents and Practices of Engagement Organization Studies December 2013vol. 34 no. 12 1835-1868 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) David Oliver, HEC Montreal, Management Department, 3000 Côte-SteCatherine, Montreal, QC H3T 2A7, Canada. Email: david.oliver@hec.ca

Abstract This paper explores trust-building in multi-stakeholder partnerships. Through an analysis of the development of one multi-stakeholder partnership between a multinational corporation, two levels of government, and local indigenous peoples, we found that trust-building is a dynamic process in which emotionality plays a key role. Critical emotional incidents can unexpectedly punctuate the partnership process, serving as turning points in the development of trust. We also found that the practices used by the partners to navigate these incidents transformed negative emotions into positive ones. We theorize on the role that critical emotional incidents and emotional engagement practices play in multi-stakeholder partnerships. Causes of Medication Administration Errors in Hospitals: a Systematic Review of Quantitative and Qualitative Evidence University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT UK Manchester Pharmacy School, University of Manchester, Manchester, M13 9PT UK Infectious Diseases and Immunity Section, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, SW7 2AZ UK Richard N. Keers, Phone: +44-161-2752414, Fax: +44-161-2752416, Email: richard.keers@manchester.ac.uk Open Access:This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. Abstract Background Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence.

10 Objective This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings. Data Sources Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013. Study Selection Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail. Data Appraisal and Synthesis Methods A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason’s model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used. Results Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality), patient factors (availability, acuity), staff health status (fatigue, stress) and interruptions/distractions during drug administration. Few studies sought to determine the causes of intravenous MAEs. A number of latent pathway conditions were less well explored, including local working culture and high-level managerial decisions. Causes were often described superficially; this may be related to the use of quantitative surveys and observation methods in many studies, limited use of established error causation frameworks to analyse data and a predominant focus on issues other than the causes of MAEs among studies. Conclusions Limited evidence from studies included in this systematic review suggests that MAEs are influenced by multiple systems factors, but if and how these arise and interconnect to lead to errors remains to be fully determined. Further research with a theoretical focus is needed to investigate the MAE causation pathway, with an emphasis on ensuring interventions designed to minimise MAEs target recognised underlying causes of errors to maximise their impact. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824584/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824584/pdf/40264_2013_Article_90.pdf Clinical Practice Guidelines Require Scrutiny for Quality - NEJM Journal Watch

11 Allan S. Brett, MD Abstract In two critical evaluations, investigators have assessed the reliability of clinical practice guidelines. The first study concerned guidelines issued by the Endocrine Society, which uses the GRADE system (each recommendation is rated as strong or weak, and the quality of evidence supporting each recommendation is rated as high, moderate, low, or very low). Among 357 recommendations in 17 guidelines issued between 2005 and 2011, 121 (34%) combined a strong recommendation with lowquality evidence. Such guidelines require scrutiny because they strongly advocate a particular practice despite relatively weak supporting evidence. Using an explicit process, the authors found 33 instances in which no compelling justification for a strong-recommendation/low-evidence guideline existed. In a second study, researchers reviewed 169 guidelines on prostate, lung, breast, and colorectal cancer published between 2005 and 2010. To determine whether guidelines were trustworthy, each was scored according to 8 standards published by the Institute of Medicine. On average, guidelines fulfilled only 2.75 of the 8 standards. Comment The proliferation of practice guidelines by professional societies, advocacy organizations, and government agencies presents considerable challenges: They often conflict with each other, and as these two studies show, many are flawed. The analysis of Endocrine Society guidelines reminds me of one of the society's 2012 guidelines that I found problematic: a strong recommendation — despite low-quality supporting evidence — for glucose targets <140 mg/dL (premeal) and <180 mg/dL (random) for hospitalized patients with noncritical illness (J ClinEndocrinolMetab 2012; 97:16 ). Community capital and the role of the state: an empowering approach to personalisation – Third Sector Research Centre Series: Working paper; 112 Published: October 2013 Author(s): Jones, Patricia A ABSTRACT: Personalisation was a key element in reform to the Adult and Social Care system in England, exploring long-term funding options in response to demographic change where people are increasingly living longer with complex conditions and needs. Personal budgets are central to this reform to enable recipients of social care to choose and commission their own services. Reform was not expected to require structural reorganisation but local authority leadership to promote genuine partnerships between social care providers, users and their carers as well as the wider community. However, there is potential for a shift in power to service users, which goes beyond collaboration, especially where there is scope to build long-term relationships around long-term needs. This study is based on one local authority partner’s innovative development of local communities’ social capital around personal budgets for vulnerable adults, which took up the challenge that “personalisation has the potential to deliver services in new and different ways that are nearer to what service users and their carers want and need”. One of the gaps in research regards the crucial

12 role of carers, which is fundamental to the personalisation agenda reaching its real objectives. Taking an asset-based approach to informal care via social networks, the local authority was able to empower a community-run organisation in one of its most deprived and diverse wards by brokering support for vulnerable residents and embracing a neighbourhood perspective to examine collective as well as individual solutions. DOWNLOAD THE REPORT: http://socialwelfare.bl.uk/subject-areas/services-activity/social-work-careservices/thirdsectorresearchcentre/155791working-paper-112.pdf

Creating Respect in Couples The Family Journal January 2014 vol. 22 no. 1 98-104 Department of Psychology, Harold Abel School of Social and Behavioral Sciences, Capella University, Minneapolis, MN, USA Department of Psychology, Tennessee State University, Nashville, TN, USA Department of Behavioral Sciences, Saba University School of Medicine, The Bottom, Saba, Dutch Caribbean, The Netherlands Donna Eckstein, Department of Psychology, Harold Abel School of Social and Behavioral Sciences, Capella University, 225 South 6th Street, Minneapolis, MN 55402, USA. Email: decksteinsd@yahoo.com Abstract Respect is one of the cornerstones of healthy relationships. The article features the Couple’s Respect Questionnaire as a tool for couples to explore specific examples and qualities of respect in their relationship. The four Rs are presented as core components of respect. They consist of Respect for differences, Responsibility (ability to respond respectfully), Review (a willingness to review), and Release (a willingness to release). Following a profile of the assessed behaviors, a stepwise procedure is outlined to increase a couple’s respect and understanding of behavioral and personality differences.

Enhancing Patient-Centered Care West J Nurs Res January 2014 vol. 36no. 1 47-65 Source:2012 Journal Citation Reports® (Thomson Reuters, 2013) Enhancing Patient-Centered Care Case Western Reserve University, Cleveland, OH, USA Catherine E. Vanderboom, Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Email: vanderboom.catherine@mayo.edu

13 Abstract Health care reform focuses on primary care and development of Health Care Homes to improve patient-centered chronic illness care. This pilot study evaluated a community care team intervention that linked chronically ill older patients, support persons, and nurse care coordinators from a Health Care Home with community resources using an adaptation of the Wraparound process. A pragmatic clinical trial design was used. Patient-centered chronic illness care; physical, mental, and social health; service use; and study feasibility were evaluated. Differences between groups were compared using two-sample t, Wilcoxon rank sum, chi-square, or Fisher’s exact tests. At 3 months, the intervention group reported higher patient-centered chronic illness care (mean total Patient Assessment of Chronic Illness Care change scores were 0.39 for the intervention group and −0.11 for the control group, p = .03). Results indicate that the integrated community care team intervention is a promising strategy to support patient-centered chronic illness care. Estimating the Impact of Mental Illness on Costs of Crimes Criminal Justice and Behavior January 2014 vol. 41 no. 1 20-40 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) Estimating the Impact of Mental Illness on Costs of Crimes - A Matched Samples Comparison Abstract This study uses a propensity scoring and matching approach to compare the costs of crimes committed by former inmates with mental illness (MI) and without MI. Our findings indicate that the recidivism costs of those with MI over the course of 3 years of follow-up are nearly 3 times as large as similar reintegrating former inmates without MI. However, prior to matching on mental health indicators, the costs of the reoffense patterns of the average reintegrating individual with MI are less than half those of the average former prisoner without MI. Our discussion centers on the identification of relevant groups that corrections officials should focus their rehabilitative resources on and whether those with MI should be a group they focus on during this process. Exposure to Family Violence and Attachment Styles as Predictors of Dating Violence Perpetration Among Men and Women Journal of Interpersonal Violence - January 2014 vol. 29 no. 1 20-43 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) Exposure to Family Violence and Attachment Styles as Predictors of Dating Violence Perpetration Among Men and Women - A Mediational Model 1Illinois State University, USA Marla Reese-Weber, Department of Psychology, Illinois State University, Campus Box 4620, Normal, IL 61790-4620, USA. Email: mjreese@ilstu.edu Abstract

14 This study examined a multiple mediator model explaining how sibling perpetration and one’s attachment style mediate the relation between parent-to-child victimization and dating violence perpetration. A sample of undergraduate students (n = 392 women, n = 89 men) completed measures of the aforementioned variables on an Internet survey. For men, path analyses found no mediation; parent-to-child victimization had a direct association with dating violence perpetration, no association was found between sibling perpetration and dating violence perpetration, and attachment anxiety, but not attachment avoidance, was positively associated with dating violence perpetration for men. For women, the hypothesized mediation model was supported; parent-to-child victimization had a direct association with dating violence perpetration, and sibling perpetration and attachment anxiety served as mediating variables. Attachment avoidance was not associated with dating violence perpetration for women. Implications for future research and clinical practice are discussed. Falling into the depths of his mind: Action research as a way of maintaining a relationship with a loved one with dementia Action Research December 2013 vol. 11 no. 4 354-368 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) Max Stern Academic College of EmekYezreel, Israel DaniellaArieli, Department of Nursing, Sociology and Anthropology, Max Stern Academic College of EmekYezreel, Israel. Email: daniellaa@yvc.ac.il Abstract Maintaining a meaningful relationship with a loved one who is diagnosed with dementia and hospitalized is significant, both for the person with dementia and for his/her relatives and friends. Nevertheless, the process of dementia poses great challenges and obstacles for communication. This article’s aim is to discuss the potential contributions of action research (AR) as an effective way for managing these challenges. Based on the researcher’s personal experience of using AR cycles of action–reflection– action in interactions with a loved one with dementia, the study identifies and discusses four such cycles: 1) negotiating the diagnosis; 2) sliding between reality and delusion; 3) reflecting on the mental experiences of dementia; 4) positioning myself in relation to the loved one and the institutional setting. The article contributes to the development of AR theory in two major ways: first, it explores the possibility and challenges of conducting AR when the participants’ ability to conduct a dialogue cannot be taken-for-granted and is itself the topic of inquiry. Second, it explores the potential contributions of AR for coping with situations that are usually described and approached in medical terms. Implementation of the care programme approach across health and social services for dual diagnosis clients Journal of Intellectual Disabilities December 2013 vol. 17 no. 4 314-328 King’s College London, UK Michael Kelly, Department of Post-Graduate Research, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. Email: michael.kelly@kcl.ac.uk Abstract

15 Â Â Background: Care for clients with mental health problems and concurrent intellectual disability (dual diagnosis) is currently expected to be provided through the care programme approach (CPA), an approach to provide care to people with mental health problems in secondary mental health services. When CPA was originally introduced into UK mental health services in the 1990s, its implementation was slow and problematic, being hampered in part by problems occurring at a strategic level as health and social service organizations attempted to integrate complex systems. This article reports on a study of a more recent attempt to implement CPA for dual diagnosis clients in one mental health foundation trust, aiming to gauge progress and identify factors at the strategic level that were helping or hindering progress this time round. Methods: The study took place in a mental health National Health Service (NHS) Foundation Trust in a large English city, which was implementing a joint mental health and intellectual disability CPA policy across five of its constituent boroughs. Semi-structured interviews with key informants at Trust and borough levels focused on the Trustâ&#x20AC;&#x2122;s overall strategy for implementing CPA and on how it was being put into practice at the front line. Documentary analysis and the administration of the Partnership Assessment Tool were also undertaken. Data were analysed using a framework approach. Results: Progress in implementing CPA varied but overall was extremely limited in all the boroughs. The study identified six key contextual challenges that significantly hindered the implementation progress. These included organizational complexity; arrangements for governance and accountability; competing priorities; financial constraints; high staff turnover and complex information and IT systems. The only element of policy linked to CPA that had been widely taken up was the Greenlight Framework and Audit Toolkit (GLTK). The fact that the toolkit had targets and penalties associated with its implementation appeared to have given it priority. Conclusion: None of the contextual challenges identified in this study were specifically related to CPA as a policy or to the needs and circumstances of dual diagnosis clients. Nevertheless, they inhibited the types of organizational change and partnership working that implementing CPA for a client group of this kind required. Unless these more generic factors are acknowledged and addressed when introducing policies such as CPA, the chances of effective implementation will inevitably be compromised. Integrity Human Resource Development ReviewDecember 2013 vol. 12 no. 4 474-499 MirlendaNoelliste, Barry University, 11300 NE 2nd Ave, Miami, FL 33161, USA. Email: mnoelliste@mail.barry.edu Abstract Human Resource Development (HRD) incorporates an ethical paradigm to evaluate the standards of behavior that inform Human Resource (HR) practice. HRD professionals who stress principles of ethics and integrity as guidelines promote and foster an environment conducive to building productive teams and socially responsible organizations. However, integrity has been so diversely defined that the role of HRD practitioners as guardians of ethical conduct remains obscure. Meanwhile, ethical scandals continue to challenge organizations globally and the cognitive hurdles to behaving with integrity remain unknown. Thus, it is the purpose of this article to direct scholarly attention to the construct of integrity from an intrapersonal perspective and the pivotal role that it plays in the ethical decision-making process of the individual. Specifically, this article identifies,

16 defines, and distinguishes various types of integrity for the purpose of proposing models of alignment and incongruencies. Recommendations for HR theory, research, and practice are generated. Mental health service user involvement in research: where have we come from, where are we going? Title:

Mental health service user involvement in research: where have we come from, where are we going?

Author(s):

Helen Kara , (Director at We Research It Ltd, Uttoxeter, UK)

Citation:

Helen Kara, (2013) "Mental health service user involvement in research: where have we come from, where are we going?", Journal of Public Mental Health, Vol. 12 Iss: 3, pp.122 - 135

Keywords:

Carer , Identity , Involvement , Mental health , Research , Service user

Article type:

Literature review

DOI:

10.1108/JPMH-01-2013-0001 (Permanent URL)

Publisher:

Emerald Group Publishing Limited The author would like to acknowledge, with gratitude, the helpful comments of two anonymous referees. The author is also grateful for the support of the Acknowledgements: Third Sector Research Centre at Birmingham University, where the author is an Associate Research Fellow.

Abstract:

Purpose – The aim of the research is to assess the extent and value of mental health service user (MHSU) involvement in research in England. Design/methodology/approach – This is a knowledge review, including academic and “grey” literature, and documented testimonial evidence. Findings – The involvement of MHSUs in mental health research has become mainstream. There is clear evidence that involving MHSUs in research adds value. Four gaps in the literature were identified. First, a lack of evidence from non-service-user researchers about their experience of working with MHSUs. Second, a lack of recognition that anyone involved in research may hold more than one role. Third, failure to treat carers as separate from MHSUs, or – often – to include them at all. Fourth, a lack of understanding that MHSUs may have a useful role to play in research on topics other than mental health. Research limitations/implications – The literature would benefit from some evidence about non-service-user researchers’ experiences of working with MHSU researchers. Carers should be recognised much more widely as different from MHSUs and with a valid role to play in mental health research from their own perspectives. MHSU researchers, and carer researchers, should be offered opportunities for involvement in research on topics other than mental health. Practical implications – The evidence shows that involving service users in research can benefit everyone involved and the research itself. The process can be challenging for all concerned. However, there is now plenty of guidance about how to involve service users in research for maximum benefit to all (e.g. Faulkner, 2004b; SURGE, 2005; Morgan, 2006; Tew et al., 2006; Kotecha et al., 2007; Schrank and Wallcraft, 2008, pp. 243-247; Leiba, 2010, pp. 160-169; Armes et al., 2011; Morrow et al., 2012, p. 114). This guidance should be consulted by researchers, funders, ethics committees, and other stakeholders at the earliest possible stage of any relevant project. Social implications – It is essential to recognise and acknowledge that

17 anyone involved in research may hold more than one role. Embracing multiple and mutable identities is not an easy process, as the literature shows, and attempts to do so are likely to produce resistance at every level. Nevertheless, the example of the survivor researchers suggests that doing this has the potential to enrich our individual and collective experience, and therefore society as a whole. Originality/value –The paper is written by an independent researcher who is also a carer for people with mental health problems: a viewpoint which is rarely found in the literature. The literature suggests that power imbalances and identity issues are at the root of most difficulties and gaps. Social identity and categorisation theory offers a useful theoretical perspective. The paper will be of value to anyone interested in mental health research, whether as a student, service user/survivor, researcher or teacher.

Personality Traits and the Sense of Civic Duty American Politics Research January 2014 vol. 42 no. 1 90-113 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) University of Wisconsin, Green Bay, WI, USA Aaron C. Weinschenk, Department of Political Science, University of Wisconsin, Green Bay, 2420 Nicolet Dr, Green Bay, WI 54311, USA. Email: acw@uwm.edu Abstract Recently, a burgeoning literature has developed around the idea that personality traits influence political attitudes and orientations. There has also been increasing recognition that orientations like the sense of civic duty exert a powerful influence on voting behavior. Despite the theoretical and empirical importance of civic duty, little research has investigated its antecedents. This article turns to individual personality traits as a potential explanation for why some people feel a stronger sense of civic duty than others. The analysis shows that a number of the Big Five traits shape an individual’s sense of civic duty, with Agreeableness, Conscientiousness, Extraversion, and Openness having statistically significant (p < .05) effects. The effects of personality traits rival and, in some cases, exceed the influence of variables that have typically been used to explain the sense of duty, including income. In the end, this study provides new evidence that personality traits influence broad orientations toward political life. Social Media for the Promotion of Holistic Self-Participatory Care: An Evidence Based Approach. Contribution of the IMIA Social Media Working Group. Source Center for Medical Decision Making, Ono Academic College, Israel; Center for Medicine in the Public Interest, New York, NY, USA. E-mail: talyam@ono.ac.il. Abstract OBJECTIVES :

18 Â Â As health information is becoming increasingly accessible, social media offers ample opportunities to track, be informed, share and promote health. These authors explore how social media and holistic care may work together; more specifically however, our objective is to document, from different perspectives, how social networks have impacted, supported and helped sustain holistic selfparticipatory care. METHODS : A literature review was performed to investigate the use of social media for promoting health in general and complementary alternative care. We also explore a case study of an intervention for improving the health of Greek senior citizens through digital and other means. RESULTS : The Health Belief Model provides a framework for assessing the benefits of social media interventions in promoting comprehensive participatory self-care. Some interventions are particularly effective when integrating social media with real-world encounters. Yet not all social media tools are evidence-based and efficacious. Interestingly, social media is also used to elicit patient ratings of treatments (e.g., for depression), often demonstrating the effectiveness of complementary treatments, such as yoga and mindfulness meditation. CONCLUSIONS : To facilitate the use of social media for the promotion of complementary alternative medicine through self-quantification, social connectedness and sharing of experiences, exploration of concrete and abstract ideas are presented here within. The main mechanisms by which social support may help improve health - emotional support, an ability to share experiences, and non-hierarchal roles, emphasizing reciprocity in giving and receiving support - are integral to social media and provide great hope for its effective use. The Impact of Aggravating and Mitigating Factors on the Sentence Severity of Sex Offenders Criminal Justice Policy Review January 2014 vol. 25 no. 1 78-104 An Exploration and Comparison of Differences Between Offending Groups Simon Fraser University, Burnaby, British Columbia, Canada Eric Beauregard, PhD, Associate Professor, School of Criminology, Simon Fraser University, Centre for Research on Sexual Violence, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. Email: ebeaureg@sfu.ca Abstract The aggravating and mitigating circumstances that contribute to increased, or decreased, sentence severity for sex offenders have largely been unexplored. Although previous studies have evaluated offending groups who have targeted adult-only, or children-only victims, the current study compares the sentencing outcomes of both offending groups. Using a sample of 519 federally sentenced sex offenders in the province of Quebec the current study explores the extent to which the Canadian criminal justice system penalizes offender- and offense-based characteristics. The results indicate that offense-based characteristics increased sentence severity for offenders who victimized adults and offender-based characteristics influenced sentence severity for offenders who victimized children. Findings are discussed within the context of previous studies to empirically explore sex

19 offender sentencing and compare differences that aggravating and mitigating circumstances have on sentence outcomes. The Influence of Religiosity on Violent Behavior of Adolescents J Interpers Violence January 2014 vol. 29 no. 1 102-127 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) The Influence of Religiosity on Violent Behavior of Adolescents A Comparison of Christian and Muslim Religiosity Dirk Baier, Criminological Research Institute of Lower Saxony, Luetzerodestr. 9, D-30161 Hannover, Germany. Email: dirk.baier@kfn.de Abstract Different criminological theories assume that religiosity protects against violent behavior. Up to now, this assumption is tested empirically almost exclusively for the Christian religiosity. The study presented here questions whether such a relationship between religiosity and violent behavior could be found for Muslims, likewise. Using a German-wide representative school survey of 16,545 male students in the ninth grade, who belong either to a Christian or an Islamic denomination, it can be revealed that only for Christians a higher religiosity correlates with a lower rate of violent behavior. This influence of Christian religiosity can be explained by mainly control theory variables. For Muslims, there is no significant correlation between religiosity and violent behavior in a bivariate analysis. A multivariate analysis, however, reveals a suppression effect: Controlling for alcohol consumption, Muslim religiosity increases violent behavior. In addition, high religious Muslims agree more often to norms of masculinity and consume more often media violence, which are risk factors of violent behavior. Accordingly, it can be concluded that religiosity is not a violence-protecting factor in general; instead, a more differentiated view for separate religious groups is necessary. The New Muslims. Author(s): Alexander, Claire; Redclift, Victoria; Hussain, Ajmal Publisher: Runnymede Trust Published: July 2013 Subjects: Minority Groups ABSTRACT In this collection we have sought to challenge dominant representations of Muslims in Britain by gathering the views and insights of researchers who have been seeking to understand the contemporary identities of those racialized as Muslim in the UK and the politics which surrounds their presence. We hope in some small way to counter the dominant understandings of British Muslim identities where these are based on falsehoods and generalizations, and to highlight the complexities, nuances and diversity of identities among Muslims in Britain. We do this as part of our ongoing project to ensure that our public policy debates and civil society discussions are based on robust, evidence-based analysis rather than sensationalist, knee-jerk responses. DOWNLOAD THE REPORT

20 http://socialwelfare.bl.uk/subject-areas/services-clientgroups/minoritygroups/runnymedetrust/153744Runnymede_The_New_Muslims_Perspective.pdf

The Relationship Between Safety Culture and Patient Outcomes Western Journal Nursing Research January 2014 vol. 36no. 1 66-83 Source: 2012 Journal Citation Reports® (Thomson Reuters, 2013) Results From Pilot Meta-Analyses University of Iowa, Iowa City, USA Patricia S. Groves, Iowa City VA Health Care System, College of Nursing, University of Iowa, 472 College of Nursing Building (CNB), Iowa City, IA 52242-1121, USA. Email: patricia-groves@uiowa.edu Abstract Patient safety continues to be a serious health concern in acute-care hospitals. Safety culture has been a frequent target for patient safety improvement over the past decade, based on recommendations from the Institute of Medicine and its use in industry. However, the relationship between safety culture and patient safety in acute-care hospitals has yet to be systematically examined. Thus, a metaanalysis was devised to examine the relationship between patient safety outcomes and safety culture in that setting. Due to the limited empirical research reports available, five small pilot metaanalyses were conducted, examining the relationship between safety culture and each of the following: pressure ulcers, falls, medication errors, nurse-sensitive outcomes, and post-operative outcomes. No significant relationships of any size were identified. An assessment of the relevant literature is presented, offering potential explanations for this surprising finding and an agenda for future research.

Who is Better at Defending Criminals? Does Type of Defense Attorney Matter in Terms of Producing Favorable Case Outcomes Criminal Justice Policy Review January 2014 vol. 25 no. 1 29-58 Bureau of Justice Statistics, Washington, DC, USA Thomas H. Cohen, Bureau of Justice Statistics, 810 7th Street, NW, Washington, DC 20531, USA. Email: thomas.h.cohen@usdoj.gov Abstract The role of defense counsel in criminal cases constitutes a topic of substantial importance for judges, prosecutors, defense attorneys, scholars, and policymakers. What types of defense counsel (e.g., public defenders, privately retained attorneys, or assigned counsel) represent defendants in criminal cases and how do these defense counsel types perform in terms of securing favorable outcomes for their clients? These and other issues are addressed in this article analyzing felony

21 case-processing data from the Bureau of Justice Statistics. Specifically, this article examines whether differences in defense counsel representation matter in terms of the probability of conviction and severity of sentence imposed. Results show that private attorneys and public defenders secure similar adjudication and sentencing outcomes for their clients. Defendants with assigned counsel, however, receive less favorable outcomes compared to their counterparts with public defenders. This article concludes by discussing the policy implications of these findings and possible avenues for future research.

Why Are Crime Victims at Risk of Being Victimized Again? Substance Use, Depression, and Offending as Mediators of the Victimization–Revictimization Link J Interpers Violence January 2014 vol. 29 no. 1 157-185 Minnesota Department of Corrections, St. Paul, USA R. Barry Ruback, Department of Sociology, Penn State University, 211 Oswald Tower, University Park, PA 16802, USA. Email: bruback@psu.edu Abstract Using three waves of data from 5,165 male and 5,924 female teenagers surveyed in the National Longitudinal Study of Adolescent Health, this study tested whether drug use, alcohol use, depression, and offending mediate the link between a serious violent criminal victimization and a subsequent serious violent revictimization. Results indicated that victimization at Wave 1 significantly predicted changes in violent offending, delinquency, and drug use at Wave 2, even controlling for all other lagged mediators. Violent offending emerged as a robust and consistent mediator of the victimization–revictimization link for males. For females, all the mediators together produced a significant and large indirect effect that reduced the direct effect of prior victimization to nonsignificance, but no one single mediator was significant. This study demonstrates that revictimization is partially the result of behavioral changes following victimization. The fact that mediation between victimization and revictimization occurred through a cluster of changed behaviors and moods suggests that the impact of victimization is greater for females than males. This evidence that victimization changes behavior and increases risks and that these risks differ by gender has implications for both mental health care and law enforcement. Differences in well-being by ethnicity– Office of National Statistics ABSTRACT: This short report looks at people’s assessment of their own well-being by different ethnic groups using the April 2011 to March 2012 Annual Population Survey. As well as providing estimates for ethnic groups and ethnic group by sex, it provides further information that may explain some of the differences observed. People from the Black ethnic group were on average least satisfied with their lives out of all the broad ethnic groups in the UK (6.7 out of 10). Bangladeshi (7.0 out of 10) and mixed or multiple groups (7.1 out of 10) also gave lower ratings on average than the White ethnic group (7.4 out of 10). All other ethnic groups, gave on average, lower ratings than the White ethnic group when asked to assess the extent they feel the things they do in life are worthwhile. Bangladeshi gave the lowest average ratings (7.3 out of 10) compared with the White group (7.7 out of 10). The differences observed between ethnic groups in subjective well-being may in part be caused by the way that different people with different ethnic backgrounds respond to these questions, but also

22 Â Â the varied responses reflect the different circumstances that people find themselves in. For example, the unemployment rate for Pakistani, Bangladeshi and Black ethnic groups are amongst the highest for the different ethnic groups in the UK. DOWNLOAD THE REPORT: http://socialwelfare.bl.uk/subject-areas/services-clientgroups/minoritygroups/ons/155233dcp171766_308226.pdf Understanding Aging and Diversity: Theories and Concepts (Hardback) - Routledge Mental Health ABSTRACT The demographic phenomena of increased life expectancy, increasing global population of older adults, and a larger number of older people as a proportion of the total population in nations throughout the world will affect our lives and the life of each person we know. The changes will result in challenges and benefits for societies and people of all ages. These events need to be understood, explained, and their consequences addressed; sociological theories about aging are an essential part of this process. In Understanding Aging and Diversity: Theories and Concepts, Patricia Kolb presents important sociological theories and concepts for understanding experiences of older people and their families in a rapidly changing world. She explores concepts from phenomenology, critical theory, feminist theory, life course theory and gerotranscendence theory to explain important issues in the lives of older people. This book investigates similarities and differences in aging experiences, focusing in particular on the effects of inequality. Kolb examines the relationship of ethnicity, race, gender, sexual orientation and social class to international aging experiences. This book explores the relationships between older people and social systems in different ways, and informs thinking about policy development and other strategies for enhancing the wellbeing of older adults. It will be useful for students and scholars of sociology, gerontology, social work, anthropology, economics, demography and global studies. Contents 1. Introduction 2. Development of Gerontology and Sociological Theories of Aging 3.Phenomenological Gerontology 4.Critical Gerontology 5.Feminist Gerontology 6.Life Course Gerontology 7.Gerotranscendence 8. Theory, Diversity, and Policy 9. Conclusion. Bibliography Author Bio Patricia Kolb is Associate Professor in the Department of Social Work at Lehman College, City University of New York. http://www.routledgementalhealth.com/books/details/9780415678810/

GP & Primary Care Third of GP practices failed to meet new CQC standards | News | Nursing Times Inspectors have uncovered a catalogue of failings at some GP practices, with medicines stored in a way that puts children and patients at risk of infection and rooms so dirty they had maggots. The Care Quality Commission (CQC) health regulator carried out inspections at 1,000 practices across England and found examples of “very poor care” that put patients at risk. While many people received an excellent service, a third of surgeries (34%) failed to meet at least one of the required standards on good practice and protecting patients. In nine practices “there were very serious failings that could potentially affect thousands of people”, the CQC said, and in 90 practices follow-up inspections had to be ordered to ensure improvements were made. Some GPs left private medical files laying around, had medicines that were out of date, filthy treatment rooms and employed staff who had not undergone criminal record checks. In one of the better-performing practices, inspectors found maggots and dirty conditions, while in another consulting rooms had no doors and people could hear what was being said to the GP. In some surgeries, emergency drugs were out of date and fridges were not always checked to ensure they were at the right temperature. The CQC said this puts children in particular at risk because failure to store vaccines at the right temperature can reduce their effectiveness, leading to an outbreak of a contagious childhood disease such as measles. The reports come as Professor Steve Field, the CQC’s new chief inspector of general practice, set out his new approach for the inspection and regulation of GPs and GP out-of-hours services. “We found some surgeries where there were out of date vaccines in the fridge,” he said, adding that people who wrongly think they are immune could become “very, very poorly and then die”. He said a woman who thought she was immune to German measles due to vaccination could potentially give birth to a deaf and blind baby. “You are talking about problems which can damage this generation and the next generation,” he said. Professor Field said patients across the board had difficulties getting appointments. In one Birmingham practice, people were queuing outside in order to make an appointment, he added. At one practice, both GPs had referred each other to the GMC for incompetence. They were no longer working in the practice. In another practice in Leeds, the inspectors turned up but there were no GPs. At Dale Surgery in Sneinton in Nottinghamshire, inspectors found maggots and other insects, as well as dust and cobwebs.

24 The surgery immediately sorted out the problem but inspectors said there was “no regular, effective and on-going monitoring of these standards”. Professor Field said: “We can talk about the fact we found maggots in a treatment room. “And when we asked the question - and this is a good practice - the nurse said yes we do seem to have a bit of a problem. But they sorted it straight away.” Professor Field said there was a widespread belief that out-of-hours GP care was “risky” because GPs don’t have access to medical records and do not know the patient. Professor Field’s new-style inspections will start in April 2014 and will involve a CQC inspector, a GP, a practice nurse or practice manager and a trainee GP. Inspectors will visit every clinical commissioning group area in the England area once every six months, inspecting a quarter of the practices in that area. Every practice will have been inspected by April 2016 and given Ofsted-style ratings. From January, new inspections will also focus on GP out-of-hours services. Professor Field said: “We need to make sure that everyone, from the most well-off to the most disadvantaged, can get access to really good primary medical care; this is something which I intend to champion as chief inspector. “When something goes wrong in general practice, it has the potential to affect thousands of local people. “GPs don’t work in isolation, so we will also be considering the quality of communication between out-of-hours care and other local services, including GP practices, care homes and emergency services.” Some 37% of GP practices inspected on the standard relating to their workers failed to meet it, while 24% of practices inspected on the standard relating to safety and suitability of premises also failed. Some 23% of practices inspected on their management of medicines failed the standard, while 22% failed the standard on cleanliness and infection control. But just 5% failed a standard on the care and welfare of people who use the services and only 3% failed on respecting and involving people who use services. Dr Maureen Baker, chair of the Royal College of GPs, said: “Breaches of procedure cannot be condoned - even if they are isolated incidents - but the inspections were largely targeted at particular practices which had already been identified as having problems.” http://www.nursingtimes.net/nursing-‐practice/clinical-‐zones/practice-‐nursing/third-‐of-‐gp-‐practices-‐failed-‐ to-‐meet-‐new-‐cqc-‐ standards/5066400.article?cm_ven=ExactTarget&cm_cat=NT_Reg_News_EM3_12122013&cm_pla=NT+Subs &cm_lm=rock.nisbet@gmail.com&WT.tsrc=email&WT.mc_id=NTME57&&

HOUSING

Housing body warns on higher standard of proof for IPNA – Local Government Lawyer. Proposed amendments to the Injunction to Prevent Nuisance and Annoyance (IPNA) could have “catastrophic results” for some victims, the Chartered Institute of Housing has warned. The IPNA is a key part of the Anti-social Behaviour, Crime and Policing Bill, which is due to be considered by a House of Lords committee today (18 November). It will replace the Anti-social Behaviour Injunction when the Bill comes into force. However, the Chartered Institute has expressed concern at proposed changes that would mean organisations applying for an IPNA would have to prove beyond reasonable doubt that the subject’s behaviour had caused, or was likely to cause, harassment, alarm or distress. “[This] would be very difficult to do without victims giving evidence first hand,” the CIH said, adding that it feared this “would be impossible in cases involving fear and intimidation, meaning victims would not be protected”. The Chartered Institute argued that the ASBI had proved effective, demonstrated by the decrease since its introduction in the number of evictions for anti-social behaviour. “CIH believes that if the injunction requires a higher standard of proof, there is a risk that landlords would apply for possession rather than using the injunction, because possession orders only require matters to be proved on the balance of probability,” it said. “This could effectively lead to families being made homeless where only one person is causing the problems, and where the available evidence is only strong enough to satisfy the civil standard.” Chris Grose, the CIH's anti-social behaviour adviser, said: "We think it [the Bill] will help reduce some of the issues and complexity currently facing social landlords, and we also welcomed the central purpose of the Bill to better protect individuals and communities from harm. Protecting people from harm is after all central to the purpose of housing providers. "But we believe these amendments would severely hamper the ability of landlords and their partners to tackle anti-social behaviour and could have catastrophic results for some victims, particularly repeat and vulnerable victims. They would also increase the time and cost to organisations involved in attempting to make an intervention." http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16259 %3Achartered-institute-of-housing-warns-on-higher-standard-of-proof-foripna&catid=60&Itemid=28

INNOVATION && TECHNOLOGY TECHNOLOGY INNOVATION

Building tech-powered public services - Publication - IPPR Given the rapid pace of technological change and take-up by the public, it is a question of when not if public services become 'tech-powered'. This new paper asks how we can ensure that innovations are successfully introduced and deployed. Can technology improve the experience of people using public services, or does it simply mean job losses and a depersonalised offer to users? Could tech-powered public services be an affordable, sustainable solution to some of the challenges of these times of austerity? This report looks at 20 case studies of digital innovation in public services, using these examples to explore the impact of new and disruptive technologies. It considers how tech-powered public services can be delivered, focusing on the area of health and social care in particular. We identify three key benefits of increasing the role of technology in public services: saving time, boosting user participation, and encouraging users to take responsibility for their own wellbeing. In terms of how to successfully implement technological innovations in public services, five particular lessons stood out clearly and consistently: User-based iterative design is critical to delivering a product that solves real-world problems. It builds trust and ensures the technology works in the context in which it will be used. Public sector expertise is essential in order for a project to make the connections necessary to initial development and early funding. Access to seed and bridge funding is necessary to get projects off the ground and allow them to scale up. Strong leadership from within the public sector is crucial to overcoming the resistance that practitioners and managers often show initially. A strong business case that sets out the quality improvements and cost savings that the innovation can deliver is important to get attention and interest from public services. The seven headline case studies in this report are: Patchwork creates an elegant solution to join up professionals working with troubled families, in an effort to ensure that frontline support is truly coordinated. Casserole Club links people who like cooking with their neighbours who are in need of a hot meal, employing the simplest possible technology to grow social connections. ADL Smartcare uses a facilitated assessment tool to make professional expertise accessible to staff and service users without years of training, meaning they can carry out assessments together, engaging people in their own care and freeing up occupational therapists to focus where they are needed.

27 Â Â Mental Elf makes leading research in mental health freely available via social media, providing accessible summaries to practitioners and patients who would not otherwise have the time or ability to read journal articles, which are often hidden behind a paywall. Patient Opinion provides an online platform for people to give feedback on the care they have received and for healthcare professionals and providers to respond, disrupting the typical complaints process and empowering patients and their families. The Digital Pen and form system has saved the pilot hospital trust three minutes per patient by avoiding the need for manual data entry, freeing up clinical and administrative staff for other tasks. Woodland Wiggle allows children in hospital to enter a magical woodland world through a giant TV screen, where they can have fun, socialise, and do their physiotherapy. http://www.ippr.org/publication/55/11600/building-tech-powered-public-services Cyber-bullying â&#x20AC;&#x201C; what happens next? - Lexology The most recent case of cyber-bullying resulting in death was the tragic suicide of 14 year old Hannah, who hanged herself following months of abuse on the website Ask.fm. "Anonymity should never be used to ask questions that are mean or hurtful. Asking a question anonymously on Ask.fm hides your name from the person you're asking and from other users. We will never reveal your identity to the user. This can be useful if you're feeling shy or think that the recipient would be more comfortable answering a question without knowing who may have asked it." "If you break the rules, you are responsible - and we can supply identifying information to law enforcement if necessary." "The ask.fm service allows for anonymous content which ask.fm does not monitor. You agree to use the ask.fm service at your own risk and that ask.fm shall have no liability to you for content that you may find objectionable, obscene or in poor taste." As safety advice, the website tells users to consult a "parent, guardian or other trusted adult" and advises users that they can report and block other users for posting certain types of abuse or spam. This limited advice is in reality an attempt to limit the liability of the website owner and is neither useful nor actionable safety advice for victims. Additionally, more prominence is to be given to the ability of Ask.fm users being able to 'opt out' of receiving anonymous replies. And what could be a powerful tool for victims is this: users will also be required to register fully to access all areas of the site and to provide an email address upon signup. Ask.fm believes that this will allow them to "capture the email and IP addresses of users and be better equipped to deal with reports". But it does not go far enough. If Ask.fm 'captures' the identities and IP addresses of all users there is still no promise to reveal this to a legitimate complainant considering legal action. http://www.lexology.com/library/detail.aspx?g=164dd7a7-c7ed-4de5-b01da603658dc223&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body++General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily +Newsfeed+2013-11-22&utm_term=

28 Cyberstalking, cyber harassment and Internet Trolls ~ Lawyers- Collyer Bristow Solicitors Bullying and harassment has long been a problem in business and the workplace, in schools and in family and social groups. However, the massive rise in the use of electronic communication and social media has seen this abuse reach epidemic proportions, with more, easier and (seemingly) anonymous opportunities to harass colleagues, students, teachers and even family members or former spouses, whether through email, text, websites or blogs. Our lawyers advise individuals, as well as HR professionals in some of the UK's leading organisations and educational establishments, not only in how to stop this abuse but also in the protection of their own or their organisations' reputation. In 2012 we won the first case of 'Twitter-libel' representing New Zealand cricketer Chris Cairns following a comment posted falsely accusing him of match-fixing. § § § § § §

Unwanted and offensive emails or text messages to the individual, their friends and family, their work colleagues and/or associates; Posting of offensive and defamatory material on blogs, chat rooms and social networking sites (Internet Trolls); Fictitious online reviews; Publication of private and confidential information or commercially sensitive information online; Creation of bogus profile pages on social networking sites; Online workplace or schoolyard bullying, such as offensive emails, YouTube clips and doctored photographs; and Internet Trolling

How do you stop the abuse and protect your own and/or your organisation's reputation? § § § § § § §

Collect evidence Report it to the police Find out who is behind the abuse (if unknown) Issue "Cease and desist" letter Get online material removed Obtain compensation / damages Seek a court order

If you have been the victim of online harassment, bullying or abuse or are an affected organisation we may be able to act for you on a fixed fee rather than hourly basis. Please send an email with your contact details and a short summary of the problems you are facing to ciu@collyerbristow.com . We will then review the information and contact you within 24 hours. http://www.collyerbristow.com/Default.aspx?sID=825&lID=0 Other useful contacts: • • • • • • • •

Chaucer Forbes LLP CSP Academy The Suzy Lamplugh Trust The National Cyberstalking Centre NSS (Network for Surviving Stalking) National Centre for Cyberstalking Research National Stalking Helpline

29 • • • • • • • • • • • • • • • • • • • • • • • • •

Beat Bullying Redsnapper Training The Samaritans Digital Stalking Paladin - the National Stalking Advocacy Service Articles and useful information 19/11/2013 - Think before you tweet. Will Old Holborn ever learn? 18/11/2013 - J P Morgan's failed Twitter campaign: time for lolz 01/11/2013 - Tweeting Footballers - It's not all black and white 29/10/2013 - Unveiling the anonymous 28/10/2013 - Facebook's Volte-face 22/10/2013 - #Trolling 21/10/2013 - 'Sexting' - the new craze with often devastating consequences 10/10/2013 - New anti-stalking legislation slow to get convictions 30/09/2013 - The Perils of "Revenge Porn" 25/09/2013 - #Trolls & #Trolling - online abuse 18/09/2013 - Cyber-Bullying - What happens next? (Ask.fm) 13/09/2013 - What can I do to stop online abuse? 23/04/2013 - Cyber matters newsletter - Spring '13 31/10/2012 - Press Release - 'Twitter' libel case - Damages upheld on appeal. 17/05/2012 - Collyer Bristow succeeds in first Twitter libel trial 10/05/2012 - National Cyberstalking Centre launched 11/07/2011 - Force the facilitators to take responsibility for cyberstalking 07/07/2011 - Cyberstalking - A legal summary 23/08/2010 - Dealing with an employee who has posted negative comments about the organisation on a social networking site - a guide National Centre for Cyberstalking Research (NCCR) - ECHO (Electronic Communication Harassment Observation) Report Electronic Word of Mouth on Twitter About Physical Activity in the United States: Exploratory Infodemiology Study | Zhang | Journal of Medical Internet Research JMIR. The University of Iowa, Department of Community and Behavioral Health, Iowa City, IA, United States The University of Iowa, Department of Health and Human Physiology, Iowa City, IA, United States University of Strathclyde, School of Humanities, Glasgow, United Kingdom Kent State University, Department of Social and Behavioral Sciences, Kent, OH, United States The University of Iowa, Department of Epidemiology, Iowa City, IA, United States The University of Iowa, Department of Computer Science, Iowa City, IA, United States The University of Iowa alumnus, N400 CPHB, 105 River St, The University of Iowa Fax: 1 319 384 1474 Background: Twitter is a widely used social medium. However, its application in promoting health behaviors is understudied.

30 Objective: In order to provide insights into designing health marketing interventions to promote physical activity on Twitter, this exploratory infodemiology study applied both social cognitive theory and the path model of online word of mouth to examine the distribution of different electronic word of mouth (eWOM) characteristics among personal tweets about physical activity in the United States. Methods: This study used 113 keywords to retrieve 1 million public tweets about physical activity in the United States posted between January 1 and March 31, 2011. A total of 30,000 tweets were randomly selected and sorted based on numbers generated by a random number generator. Two coders scanned the first 16,100 tweets and yielded 4672 (29.02%) tweets that they both agreed to be about physical activity and were from personal accounts. Finally, 1500 tweets were randomly selected from the 4672 tweets (32.11%) for further coding. After intercoder reliability scores reached satisfactory levels in the pilot coding (100 tweets separate from the final 1500 tweets), 2 coders coded 750 tweets each. Descriptive analyses, Mann-Whitney U tests, and Fisher exact tests were performed. Results: Tweets about physical activity were dominated by neutral sentiments (1270/1500, 84.67%). Providing opinions or information regarding physical activity (1464/1500, 97.60%) and chatting about physical activity (1354/1500, 90.27%) were found to be popular on Twitter. Approximately 60% (905/1500, 60.33%) of the tweets demonstrated users’ past or current participation in physical activity or intentions to participate in physical activity. However, social support about physical activity was provided in less than 10% of the tweets (135/1500, 9.00%). Users with fewer people following their tweets (followers) (P=.02) and with fewer accounts that they followed (followings) (P=.04) were more likely to talk positively about physical activity on Twitter. People with more followers were more likely to post neutral tweets about physical activity (P=.04). People with more followings were more likely to forward tweets (P=.04). People with larger differences between number of followers and followings were more likely to mention companionship support for physical activity on Twitter (P=.04). Conclusions: Future health marketing interventions promoting physical activity should segment Twitter users based on their number of followers, followings, and gaps between the number of followers and followings. The innovative application of both marketing and public health theory to examine tweets about physical activity could be extended to other infodemiology or infoveillance studies on other health behaviors (eg, vaccinations). (J Med Internet Res 2013;15(11):e261) http://www.jmir.org/2013/11/e261/

European healthcare sector goes virtual as NHS focuses on innovation - The Information Daily.com Virtual desktop infrastructure is transforming the way clinicians access patient information at the point of care, unlocking the full potential of new technology investments in Europe. VDI reduces the cost of delivering IT services by provisioning entire desktop environments from the datacentre and makes it easier for clinicians to access applications and data from any device. A recent survey of European healthcare IT professionals, conducted by Imprivata, finds that virtual desktop solutions are used in 42 per cent of healthcare organisations today. Moreover, what is particularly eye-opening from the survey results, is the forecast use of these technologies – with desktop virtualisation expected to increase 74 per cent in Europe over the next 24 months.

31 With a workforce constantly on the move both in and out of the hospital environment, virtualised desktops suit the mobile working patterns of clinicians. As a clinician moves around wards or visit patients in their homes, a virtual, personal desktop can roam with them throughout their shift. With the desktop environment running remotely at the point of provisioning, data is not physically stored on the access device. This removes the risk of security violations through lost or stolen devices and makes it possible to support bring your own device programmes. When deploying VDI however, it is also important to takes steps to protect both the clinician’s experience and the patient data, which is where single sign technologies come into play. While desktop virtualisation ushers in more flexibility, single sign on technologies have made it possible for clinicians to gain secure access to different applications and systems provisioned in virtual and non-virtual environments, without being required to enter different logins/passwords. This adds significant value for clinicians considering that they may be accessing up to 10 different applications in any one session or working across different systems. Oxford University Hospitals NHS Trust, for example, one of the UK’s largest hospital Trusts utilises VDI and single sign on in its fast-paced A&E department. With clinicians constantly moving from location to location to treat patients in different areas of A&E and beyond – all while using different equipment – there was a vast amount of switching between workstations, which initially required clinicans to repeatedly enter the same authentication credentials to access applications and patient details. By removing the need for multiple passwords and usernames whilst ensuring that sensitive data is accessed securely, OUH has been able to improve A&E workflows within the hospital, in turn ensuring clinician satisfaction with its new technology initiatives. The solution has also made it possible for clinicians to simultaneously access different applications such as prescription systems from multiple locations, offering further efficiency savings. Like many sectors, the NHS is undergoing widespread transformation and it seems that the move towards a digital healthcare environment is starting to fall into place. Of course, there are a combination of factors behind this; the maturity of disruptive technologies such as desktop virtualisation and supporting infrastructure technologies, an increased focus on deploying solutions that deliver immediate value, and a leadership focused on innovation all play a role in creating a climate of progress. http://www.theinformationdaily.com/2013/12/03/european-healthcare-sector-goes-virtual-as-nhsfocuses-on-innovation How the Internet and social media are changing healthcare | Digital Trends Today, more and more members of the medical profession are embracing social media for sharing helpful medical information and providing patient care. A Pricewaterhouse Cooper conducted survey asked over a thousand patients and over a hundred healthcare executives what they thought of the way many healthcare companies are utilizing social media and the Web, and results show the most trusted resources online are those posted by doctors , followed by nurses , and hospitals .

32 Social media is becoming more and more utilized by hospitals and medical professionals as a means to convey general health information, sometimes even personalized help. The hospital does receive private messages inquiring about specific medical conditions, but they never address them publicly on their Facebook page, usually recommending patients to direct their questions to the hospital’s general contact form or contact them by phone. “When a family posts a comment about a medical issue, we like to encourage the family to email our general account. Social relationships between doctor and patient can also be easily muddled; many health institutions discourage staff from “friending” patients on Facebook and other social media platforms at the risk of jeopardizing treatment as well as reputations. The Wall Street Journal mentions a survey published in the Journal of General Internal Medicine back in 2011 that revealed 35 percent of respondents who are practicing physicians have received friend requests from patients on their personal social network accounts, and 58 percent of them always reject them. “I see Twitter as a higher-risk environment, as it’s basically an open forum.” Thomas Lee , M.D. of the Orthopedic Foot & Ankle Center in Westerville, Ohio raises a valid point: Social media is a difficult media for a physician because of HIPAA , the Health Insurance Portability and Accountability Act. “It is very difficult to talk about medical care without personalizing the content, and you can’t personalize content without violating HIPAA,” Lee explains. “In addition, the practice of medicine requires a thorough history of the patient’s current condition and a thorough physical exam before we can render a diagnosis and treatment plan. Lee avoids dishing out professional and medical advice on his Twitter and Facebook accounts, but admits that both help in making himself appear more accessible to his patients and staff. Although he posts frequently, it is unusual for him to engage in a dynamic conversation online. “I see Twitter as a higher-risk environment, as it’s basically an open forum,” Dr. Rob Lamberts says of his minimal use of the micro-blogging site for his own practice; he only utilizes it occasionally to float a medical question to his colleagues. The results reveal the program to be more effective in alleviating mild to moderate depression and cardiovascular ailments as well as physical health issues than other methods of searching for health advice online. “Essentially, online therapy will help serve the nearly 3 out of 4 people who have mental health problems but do not currently get any kind of help,” says Lawrence Shapiro, Ph.D., President of Talk to An Expert, Inc. , a HIPAA-compliant e-therapy company that launched quite recently. “It is particularly important for people who cannot get to an office for conventional help because they are housebound, in remote areas, physically disabled, and so on. Online therapy lowers the bar for people who need help.” “There are a few studies that have been done suggesting that online therapy is just as effective as in-office therapy,” Shapiro continues. “According to the American Psychological Association, almost 25 percent of people with mental health problems don’t get the help they need with the current mental health delivery system. Aside from using social networking sites to keep in touch with fellow patients, Baker also uses Google to look up prospective doctors, sites like WebMD to look up any prescription medication, as well as condition-specific sites like migraine.com and thyca.org. The trouble is, the wealth of information leaves too much room for guessing – patients can easily underestimate a medical condition, and too often they lean toward inaccurate and scary data. This is confirmed by research conducted by the Hong Kong University of Science and Technology, which reveals that the less familiar you are with the patient and the condition , the better the chance you have at finding out what’s really wrong. “I encourage patients to go online and inform themselves about their medical conditions.

33 The middle ground and the bottom line: social media and healthcare can go hand in hand “Social media isn’t always a secure forum; there’s no way to confirm whether the person on the other end is a legitimate patient or physician,” Pho says. Most hospitals and medical institutions provide healthcare social media policies for their physicians and staff, and as long as these guidelines are respected, social media is a great tool to bring patients and doctors together. Patients should use this same compromising policy as well. “I don’t mind informed and well educated patients at all,” says Dr.AmitMalhotra, M.D. of Smart Health Technology. “The problem arises [when] patients tend to believe that they have the worst diagnosis out of the many possibilities and create unnecessary anxiety within themselves. According to Lee Aase, Mayo Clinic ’s Director for Social Media, aside from posting general health information, it is also important to offer content that invites patient involvement. “We do a ‘Myth or Matter of Fact’ feature each week in connection with our Saturday radio program in which we post a frequently heard saying about a disease or condition, and then invite users to say whether they think the statement is true or whether it is a myth. The world today is technologically driven, and it’s in our best interest – whether you’re a physician catering to your patients’ queries or an individual seeking proper medical treatment – to keep up with these advancements, especially when it comes to accessing healthcare. But even the Internet needs to be taken with a grain of salt, and in the case of healthcare, it’s in everyone’s interest to proceed with caution and skepticism. http://www.digitaltrends.com/social-media/the-internet-and-healthcare/ Ipswich puts iPads on wards - E-Health Insider Clinicians at Ipswich Hospital NHS Trust are using iPads to access patient records at the bedside. The trust, which uses Kainos’ electronic document management system app, Evolve, has rolled out iPads to 80 clinicians so far. Neil Turnbull, head of programme delivery at Ipswich, told EHI that the trust planned to roll out a further 40 iPads by the end of the year. “There are about 80 clinicians using iPads at the moment, but we got plans to roll out 120 by the end of this year. We’re getting a new version of the EDM app before the end of the year,” he said. “The second version will give them read and write access and they can load up patient records and put in information as well out in the community.” As well as having access to Kainos, clinicians can also access their trust emails, calendar, pathology results and clinical apps. Turnbull added that if clinicians wanted certain apps on their iPads that did not pose a problem. “What we say to them is that if it’s free and it’s something they will use, we will load it on for them,” he said. Ipswich is one of eight trusts committed to taking the Lorenzo electronic patient record system under the government’s deal with CSC. Turnbull said that he hopes it will be possible to eventually get access to Lorenzo on iPads as well. “Lorenzo isn’t currently available on iPads but we’ve been speaking to CSC about this and waiting for confirmation from them.

34 JMIR-Patients’ Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study | Varsi | Journal of Medical Internet Research Background: The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrolment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. Objective: The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. Methods: This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Results: Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Conclusions: Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Trial Registration: ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW) (J Med Internet Res 2013;15(11):e246) http://www.jmir.org/2013/11/e246/ Patient Reviews for Improving Care | HealthWorks Collective Hospitals may have been slow to jump on the social media bandwagon, but it turns out these platforms may actually help to improve patient care. These patients and family members, referred to by many hospitals as “patient advisors”, are often asked for their opinions and advice via online questionnaires and surveys. This way, medical facilities can assess patient satisfaction, plan improvements in care and consider new services. A new hospital patient engagement guide released by HHS’s Agency for Healthcare Research and Quality offers “patient advisors” as one of four strategies to eliminate the communication gap between patients, families and healthcare providers. Dartmouth-Hitchcock Medical Center has hired a full-time social media coordinator to reach out to patients and their loved ones. And Concord Hospital is using social media to develop meaningful, two-way conversations with patients.

35 The University of Michigan Health System, which includes three hospitals, 40 outpatient locations and more than 120 clinics throughout Michigan and northern Ohio, now turns to a group of "eadvisors" to answer approximately 35 online surveys a year. And the Health System’s teen council provides feedback by responding to questions via a Facebook page dedicated specifically to them. But patient feedback is not always positive. Imagine Yelp reviews for your doctor or hospital. "Really, any organization is going to hear complaints, whether they're on social media or not," said Brian DeKoning, director of social strategy for digital agency, Raka, in an interview with the Concord Monitor. Patient feedback can contribute to the success and improvement of any hospital, but recent research published in the Journal of Clinical Oncology suggests that understanding the patient perspective is imperative to evaluating the effectiveness of some treatments as well- specifically, cancer treatments. "There is no way to adequately assess a treatment's impact on the patient without including their point of view, gleaned directly from asking about their experience in a consistent and scientifically validated manner," lead researcher Ethan Basch, M.D., director of the Cancer Outcomes Research Program at UNC Lineberger Comprehensive Cancer Center in a statement. http://healthworkscollective.com/node/139636?utm_source=hwc_newsletter&utm_medium=email& utm_campaign=newsletter&inf_contact_key=c6ac5ce9e206b29530f611eb5ce7df0afff2a32f1c599d3f dda55b22d9d8708f Social Media Can Boost Disease Outbreak Monitoring, Study Finds - iHealthBeat Monitoring social media websites like Twitter could help health officials and providers identify in real time severe medical outbreaks, allowing them to more efficiently direct resources and curb the spread of disease, according to a San Diego State University study published last month in the Journal of Medical Internet Research, Medical News Today reports. Study Details For the study, lead researcher and San Diego State University geography professor Ming-Hsiang Tsou and his team used a program to monitor tweets that originated within a 17-mile radius of 11 cities. The program recorded details of tweets containing the words "flu" or "influenza," including: Origin; Username; Whether the tweet was an original or a retweet; and Any links to websites in the tweet. Researchers then compared their findings with regional data based on CDC's definition of influenzalike illness. Study Findings The program recorded data on 161,821 tweets that included the word "flu" and 6,174 tweets that included the word "influenza" between June 2012 and the beginning of December 2012. According to the study, nine of the 11 cities exhibited a statistically significant correlation between an uptick in the number of tweets mentioning the keywords and regional outbreak reports. In five of the cities -- Denver, Fort Worth, Jacksonville, San Diego and Seattle -- the algorithm noted the outbreaks sooner than regional reports. Tsou in a release said that the social media monitoring program detected outbreaks daily, while "[t]raditional procedures" typically "take at least two weeks."

36 Â Â Tsou and his research team next will focus on detecting outbreaks through correlations between data on influenza-like illnesses and specific symptom-related keywords, such as "cough," "sneeze," "congestion" and "sore throat" (Medical News Today, 11/21). http://www.ihealthbeat.org/articles/2013/11/21/social-media-can-boost-disease-outbreakmonitoring-study-finds

38 £260m tech fund approved - E-Health Insider NHS England director of strategic systems and technology, Beverley Bryant, tweeted EHI this morning to say the first round of funding has been approved and letters will be sent to trusts from today. A document released in July said the key areas NHS England was looking to promote via the funding were; adoption of the NHS Number as primary identifier; integrated digital care records including information sharing within and between organisations; e-prescribing; and advanced scheduling. It’s going to allow trusts and suppliers to really engage and progress digitising healthcare, in particular in areas we are involved in which is e-prescribing. “A lot of applicants as well as those ‘in flight’ projects were waiting to see the outcome of this and are now hopefully going to be in a position to move forward.” Hampshire Hospitals NHS Foundation Trust IT director Andy Thomas said Treasury approval for the fund is “absolutely fantastic news”. “We are all in the middle of capital planning and financial planning so the sooner we know the better. Paul Jackson, diagnostics and therapeutics IT manager at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, said the trust applied for funding in both this financial year and next, with bids for its EPR project and for e-prescribing. “It’s great news. If our bids are successful, it’s good news for the trust and will allow us to move along with our projects a lot faster,” he explained. “It will be tight, especially because the decision has been so delayed, but we will make sure it’s achievable.” InterSystems UK marketing manager said he is “very enthusiastic” about the release of the funds. “IT will bring the productivity benefits that trusts so sorely need,” he said. “However, I’m concerned that it fragments innovation and collaboration because the business cases that have been put forward are very specific and that can isolate them from the rest of the business of the trust and the trust from the rest of the NHS.” http://www.ehi.co.uk/news/EHI/9085/%C2%A3260m-tech-fund-approved We’d all be better off with our health records on Facebook – Quartz A Facebook user’s timeline provides both a snapshot of who that user is and a historical record of the user’s activity on Facebook. There is no unified, single patient record—every doctor I’ve ever visited has his or her own separate copy of my records. And in an age where we can conduct banking transactions on my smartphone, many patients still can’t access or contribute to the medical records their doctors keep for them. To see what I mean, let’s explore some of Facebook timeline’s key features to see how each could map to features of the ideal medical record. “About” for Complete, Patient-Informed Medical History It should include the patient’s age, gender, smoking status, height, weight, address, phone number, and emergency contact information; the patient’s primary care provider; and insurance information. This section would include a summary list of the patient’s current diagnoses and medications, as well as family history. And importantly, both the doctor and the patient would be able to add details. “Privacy Settings” and “Permissions” for Controlled Sharing

39 When I visit a new doctor, rather than signing a form granting my previous doctor permission to fax over copies of my records, I could simply grant permission electronically within the record–and presto! The new doctor would have instant online access. And doctors could use “permissions” in lieu of the paper forms patients typically have to sign during office visits today–to get patient signoff on the sharing of their information with insurance providers or other doctors, in compliance with the latest HIPAA regulations for patient privacy. “Status Updates” to Document Diagnoses and Treatments Think of those drug commercials that warn, “Before using our drug, tell your doctor if you have any of the following conditions.” Similarly, the timeline medical record would prompt a doctor prescribing that drug to ask the patient about those conditions before prescribing. “Photos” for the Online Delivery of Test Results In medical records: Doctors could upload scans, X-rays, and other test results to a patient’s medical record timeline. In medical records: Providers can use tagging to alert other providers involved in a patient’s care of pertinent updates. In medical records: Patients would be notified when a provider uploads “photos” of them–i.e., lab results or scans. The medical record timeline should also notify both patients and providers when a patient is due for a preventive care visit or screening. “Check-Ins” to Denote Office Visits When medical staff check the patient in, this would automatically generate a note on the patient’s timeline recording the date and which provider the patient is visiting. In medical records: “Friendships” in medical records would really be relationships with medical professionals and caregivers. All providers could be accessed via a list of providers, similar to Facebook timeline’s “friends” list. This would serve as a record of all touch-points for care. “Events” to Track and Remind for Upcoming Appointments In medical records: “Events” in a medical record would represent upcoming doctor appointments or scheduled tests or procedures. Rob Lamberts –a practicing physician, speaker, blogger, and health IT evangelist–tells me his biggest complaint with today’s digital record: “It’s not a patient-centered [medical record]; it’s payment-centered.” This he credits to the way the US health system has historically paid for healthcare, which is based on the volume of treatments rather than the quality of outcomes, requiring doctors to log complex medical codes into their EHRs. Mine is to bring the magic of Facebook to medical records. But I’m open to other ideas that solve the patient-centric needs of tomorrow’s health ecosystem. http://qz.com/161727/wed-all-be-better-off-with-our-health-records-on-facebook/ What can I do to stop online abuse? - Lexology It is important to keep copies of all emails, text messages, and online activities of a blogger or troll, for example, screen shots of any offensive blogs, Tweets or fake profiles on social networking sites. This can be used as evidence in any subsequent court proceedings. If you wanted us to investigate

40 Â Â the matter for you and advise you as to your position we would ask that you send us copies of the relevant online activity and a short summary setting out any relevant background information. We have found over recent years that the Police are increasingly willing to investigate incidents of serious online bullying and harassment, and make arrests. If there is sufficient evidence to secure a conviction, the CPS may prosecute the individual(s) under the Protection from Harassment Act 1997 "PfHA" (it is a criminal offence to pursue a course of conduct which amounts to harassment or stalking), the Communications Act 2003 (it is an offence to send electronic messages publicly which are grossly offensive, or of an indecent, obscene or menacing character or send message which are known to be false for the purpose of causing annoyance, inconvenience or needless anxiety) or the Malicious Communications Act 1988 (it is an offence to send an electronic communication which conveys a message which is grossly offensive where the message is sent with the purpose of causing distress and anxiety to that person). It should be possible for us to find out who is behind the online activity either by asking the website to disclose the user's details or by finding out the IP (Internet Protocol) address which can be used to determine a computer's location. If the website does not readily provide this information we can apply to the court to obtain an order requiring the website or Internet Service Provider (ISP) to disclose the personal details of the subscriber. Once we know who is behind the online activity, we can take the steps outlined below. Can I take action against a blogger based outside the UK? Yes. It is possible to enforce a civil injunction or an order for damages against an individual blogging from outside the UK, provided the country they are in recognises UK judgments (many countries do). Depending on the seriousness of the online abuse a suitably worded letter from us asking the individual(s) concerned to stop or face legal action can often be enough to bring the online activity to an end. How do I get the material taken down from the internet? Offensive material posted online is likely to fall foul of defamation and privacy laws, the Malicious Communications Act and/or the Communications Act which will provide us with grounds on which to ask the websites to remove the content from their website. If the content is defamatory or private in nature this may also give rise to a separate legal action for damages to compensate you for the harm caused to your reputation and/or breach of your right to privacy. We can issue a civil claim against the individual(s) concerned under the PfHA for damages for the anxiety caused and any financial loss resulting from the online harassment/bullying. If the activity continues, we can apply on your behalf for a civil injunction under the PfHA, prohibiting the individual(s) concerned from contacting you and others (whether by email, social networking site or otherwise) or blogging/tweeting publicly about you or encouraging others to do so. You need only show that the individuals concerned have undertaken a course of conduct which amounts to harassment. Harassment includes alarming a person or causing a person distress there is no requirement of a physical threat or risk of physical harm. If the person carrying out the online activity is a family member (as we find can be the case in the context of an acrimonious break-up), we can apply for what is known as a 'non-molestation' order under the Family Law Act 1996 prohibiting that person from continuing with the offensive conduct or encouraging others do so. http://www.lexology.com/library/detail.aspx?g=40f3c8bd-6bbc-4a97-aa3afb94fea8135a&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body+-

41 +General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily +Newsfeed+2013-11-22&utm_term=

NHS NHS NEWS NEWS && UPDATES UPDATES Dying without due care and attention — NHS Networks The government is compelled to do something about Mid Staffs and other ugly failures of care, but legislation is not the answer. The new offence of wilful neglect under which careless or callous managers, doctors and nurses now face five years in jail will not save lives, improve care or instil compassion. Nor is it likely to result in a single prosecution. The recommendation in the Francis report on Mid Staffs to legislate against neglect was intended to fill the gap in the law between abuse of the kind caught on camera at Winterbourne View and the passive abuse that left patients to lie in soiled bedding or without a drink of water. With eyewitness accounts or secret filming, the former is relatively easy to prosecute, but the latter is much trickier. There is no defence for the physical abuse of a patient or care home resident, but standing up a case of failure of care in an understaffed ward will be fraught with problems. A car manufacturer who allows vehicles to leave the factory with defective brakes can be sued if someone dies as a result. That’s because the law and industry determine minimum standards for vehicle safety. If the brakes didn’t work, you can prove it and it’s clear who was at fault. The question of who fitted the brakes or failed to check them before they left the factory is largely irrelevant. The manufacturer is responsible and the reason for the failure must be addressed, first through recall of any vehicle affected and second by fixing the manufacturing process. The character and actions of the individual at fault are of little interest unless it was a deliberate act of sabotage. Their prosecution only serves to satisfy the natural desire for revenge, or what we like to call justice. It will be too little and too late for anyone who died or was injured as result of the negligence. The other question raised by the government’s action is why we need a new law at all. What is the difference between wilful neglect and criminal negligence? Are we seeking to punish the action, or failure to act, or the intent? Is it the neglect we most object to or the wilfulness? When the man in charge of the level crossing falls asleep on duty causing a train wreck, we know it was not his intention to fall asleep endangering the lives of others. He had nothing to gain nor did he intend to nod off. The ensuing disaster sets us off in a vain and dismal quest for blame. He should not have been tired in such a responsible job, we conclude. Perhaps a few of us also shudder at the memory of the last time we found themselves drifting across carriageways to the outraged honking of fellow motorists after a momentary lapse into unconsciousness. Wilful neglect or failure to get an early night? For such acts of negligence we have the offence of driving without due care and attention. Pray that it provides some comfort to the victims of the motorway pile-up. Peter Carter, head of the Royal College of Nursing told John Humphreys that has had “no problem” with the proposed legislation in principle. But he added that where he does have a problem is if one nurse is in charge of 17 patients. Julie Bailey, the Mid Staffs campaigner, made the same point. The legislation would not work, she said, without imposing minimum staffing levels on wards. This was one of the other recommendations of the Francis report. Without implementing this one too, the chances of bringing a prosecution for wilful neglect are remote and the only abuse the new law will halt temporarily is the abuse of ministers in newspaper headlines.

43 It only seems reasonable to punish someone for an offence they have a reasonable chance of avoiding. We have no sympathy for flagrant and deliberate acts of neglect or cruelty, but at what point does neglect becoming unwitting or impossible to avoid? Understaffed wards are a risk to patients. Now we have added a further risk for the doctors and nurses who work in them and the managers who run them – the risk of prosecution for failing to cope with circumstances beyond their control. There are three questions you need to ask about any new law: is it necessary, is it workable and will it do more good than harm? The government has already acknowledged that it expects only a very small number of prosecutions for wilful neglect, which suggests that the answer to the first two questions is no. The third question depends on how much you believe in the deterrent power of legislation in offences of this kind. At least the new law satisfies the need for proportionality. For the crime of doing nothing, we have a law that will also do nothing. Legal editor: Julian Patterson http://www.networks.nhs.uk/editors-blog/dying-without-due-care-and-attention NHS Failing to Care for people with Parkinson's - Parkinson's UK The first ever inquiry into NHS continuing care has uncovered huge failings in a system which leaves people with Parkinson's no choice but to pick up the cost of care they can't survive without. Our new report into NHS continuing care – a funding package to provide free health care for people with severe health needs – marks the launch of our new Failing to Care campaign. The inquiry - by the All-Party Parliamentary Group on Parkinson's - found that 59% of NHS continuing care assessments don't involve a professional with specialist expertise or knowledge in the applicant's condition. This leads to inaccurate and incorrect decisions on funding. And 40% of people going through the assessment process reported a lack of empathy and transparency from professionals. "It's a disgrace that people with Parkinson's and their families are being put through this kind of distress – and put in a position where they may have to sell their own homes to pay for care. It's a tragic NHS failing. "People in the advanced stages of Parkinson's are being put through hell by trying to access financial support they need, in a system so complex even health professionals struggle to understand it. "The Government must act now to overhaul this pitiful system, and bring in a simplified NHS continuing care process which supports those who need it most." David Goff, 40, went through a battle to receive the NHS continuing care funding when his father Leslie was admitted into a rehabilitation hospital with the advanced stages of Parkinson's. "My dad was so ill that initially it all seemed clear cut and all the health professionals said they felt he would be eligible for NHS continuing care, but the process took so long he died before we received a penny. "For several months the panel kept deferring a decision saying they needed more evidence, and he was made to stay in the hospital so we could prove that his needs were severe enough to receive the funding. "He was trapped there, his health was getting steadily worse and we were in this catch-22 situation where we just felt helpless. "The decision was deferred several times until a senior nurse quizzed my mum on her savings and told her we had to pay for my dad's care - even though NHS continuing care shouldn't be meanstested. DOWNLOAD THE REPORT: http://www.parkinsons.org.uk/sites/default/files/failingtocare_appgfullreport.pdf

LOCAL GOVERNMENT Ealing woman neglected in care home – Local Government Ombudsman.

_____________________________________________________ Date Published: 19/12/13 An elderly lady was forced to remain in an Ealing care home where she was neglected, the Local Government Ombudsman has heard. The woman, who suffers from dementia and Parkinson’s disease, was placed in a care home in the borough when she left hospital after a fall. The woman’s niece raised concerns about the care home and asked the council to move her aunt to a different home. But the council decided to make the placement permanent without any prior consultation. The council then took nine months to agree a move to the home chosen by the family. During the time she was in the care home, the woman suffered neglect. The woman and her room smelled of urine, and staff failed to properly administer her medication, which she was prescribed for her dementia and Parkinson’s Disease. In addition, the council’s finance team delayed telling the woman’s niece about, and invoicing her for, her contribution to the home’s fees. Dr Jane Martin, Local Government Ombudsman said: “I find that not only was the family denied the chance to make decisions about the care their relative received, but the care that was ultimately provided fell way short of what she should have expected and deserved. “Although these failings occurred in a care home, I find the council ultimately responsible. The law is clear on this: it says that the actions of the care provider shall be treated as actions of or on behalf of the council.” A copy of the investigation report has been shared with the Care Quality Commission. To remedy the situation, the council has agreed to apologise to the woman and her niece and pay the niece £500 to reflect the distress and time and trouble caused. The council has also agreed to pay the woman £2,350 (equal to 50 per cent of the charge) to reflect her distress in receiving poor care, offset against any money she owes the council.

DOWNLOAD THE REPORT http://www.lgo.org.uk/GetAsset.aspx?id=fAAxADkAMgA1AHwAfABUAHIAdQBlAHwAfAAwAHwA0 Housing association secures ASB injunction at Court of Appeal – Local Government Lawyer. A housing association has won an appeal over a district judge's refusal to order an anti-social behaviour injunction on the grounds of an assured tenant’s disability under the Equality Act 2010.

45 1. Had not been advanced by the respondent at any stage prior to the respondent's submission (and then only at the instigation and prompting of the district judge); and in any event 2. Were entirely unsupported by any proper evidence, much less medical evidence, that the respondent was disabled. Swan argued in particular the respondent's pleadings and written evidence were almost silent on the point and no reliance had ever been placed on them. 3. Overall, Swan argued that neither considerations of disability nor the 2010 Act played any part in the determination of the application. The respondent claimed to have Asperger’s syndrome and dyslexia. The Court of Appeal concluded that the district judge’s exercise of discretion had been vitiated by a number of legal errors. It therefore upheld the housing association’s complaint and substituted an injunction order for the decision of the district judge. According to Lord Justice Lewison, these were: 1. The district judge had found that Gill had a disability (and therefore a protected characteristic) even though that had neither been pleaded, nor alleged nor proven by evidence. A concession by Gill’s legal team – that without any medical evidence before him it was not open to the judge to find that the respondent suffered from a disability falling within s. 6 of the 2010 Act – was “plainly right”; 2. The judge was wrong to hold that there was any question of Swan Housing (as manager of the premises) having been in breach of its duty under s. 35 of the Act not to discriminate (as that expression is defined by s. 15); 3. The judge was under the misconception that the court itself was subject to the public sector equality duty under s. 149 of the Act. “But paragraph 3 of Schedule 18 to the Act says in terms that section 149 does not apply to a judicial function.” Gill’s counsel nevertheless sought to argue that the public sector equality duty was engaged and Swan was in breach of it. Lord Justice Lewison rejected, however, the application of passages from the previous Court of Appeal decisions in R (oao Greenwich Community Law Centre) v Greenwich LBC [2012] EWCA Civ 496 and Pieretti v Enfield LBC [2010] EWCA Civ 1104. The Court of Appeal judge also added: “Where, as here, Mr Gill does not have a relevant protected characteristic I cannot see in what respect Swan Housing can be said to have failed to have due regard to the need to eliminate conduct prohibited by the Act; or to the need to advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not; or to the need to foster good relations between persons who share a relevant protected characteristic and persons who do not. “But for the judge's belief that there had been discrimination and a breach of the public sector equality duty, he would have granted the injunction. Once that misconception has been cleared out of the way, there is no impediment to its grant.” Daniel Skinner, Head of the Social Housing Team at Batchelors Solicitors who acted for Swan, said: "The Equality Act is an important piece of legislation and rightly may require, amongst others, landlords to consider a person's disabilities in taking certain decisions such as the issue of possession or injunction proceedings. “Unfortunately it has become a 'refuge of last resort' in too many cases where there is simply no substance to the defence. We are delighted that the Court of Appeal allowed the appeal and rejected the approach of the district judge."

46 Andy Lane, counsel at Hardwicke who represented Swan, said: "We were always confident that the district judge would be found to have gone too far given the evidence before him, as indeed Mr Gill's lawyers ultimately in part conceded, but Lord Justice Lewison's comments on the application of the public sector equality duty are of particular importance. “He found that where there is no evidence that a relevant protected characteristic exists, it was hard to see in what respect a landlord could be said to be in breach of the section 149 duty. In other words if such a defence is run it should be done so based on appropriate and credible evidence." http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16567 %3Ahousing-association-secures-asb-injunction-at-court-of-appeal&catid=60&Itemid=28

MENTAL HEALTH 10 ways the underfunding of mental health services is damaging patient care Community Care

______________________________________________________ How patients are being hit by problems in community and crisis care 1. Overstretched crisis teams giving ‘dismissive’ advice Patients told Care Quality Commission inspectors that they received “dismissive” advice when they rang Cornwall Partnership NHS Trust’s home treatment team for crisis support. One patient who phoned for help was told: “I am the only one working, don’t kill yourself on my shift”. “One person told us they contacted the home treatment team three times and each time the advice was not helpful: “[have a] cup of tea”, “have a bath” and “I don’t know what to do”. The person told us they self-harmed following this advice.” Staff at the service told inspectors they were under pressure. Teams had less psychiatric nurses on duty and “expectations of people who used services could be much higher than they were able to deliver”. The report also found that problems accessing out-of-hours care from the home treatment team was impacting local police and ambulance services. The CQC heard how a duty team of one approved mental health professional and two nurses was expected to cover the whole of Cornwall, a region with a population of more than 500,000 people. Patients also told inspectors they felt they had “no allocated support” after being discharged from services. What the trust said: The trust said it had presented a “business case” to commissioners for improvements to home treatment team provision. “This seeks their support to bring the home treatment team staffing levels into line with best practice guidelines and provide a more responsive out-of-hours service. We are also working with the Samaritans and a locally commissioned telephone support service – Nightlink – to ensure our clients understand the full range of services which are available to them out of hours.” 2. People in crisis ‘only seen for 10 minutes’ At a September meeting of Ashford Clinical Commissioning Group , the chair of a local carers’ charity warned that the standard of care being provided by community mental health services was “unacceptable” and asked how the local crisis team, run by Kent and Medway Partnership NHS and Social Care Trust, was going to cope with growing demand. “At the moment, they are spending just 10 to 30 minutes with a patient who is in crisis,” she warned. Commissioners thanked the charity for “raising a number of very serious issues”. At the same meeting, a member of the public stated that the crisis team were not turning up at the point of crisis and would often turn up 24 hours later. Data provided by the trust to Community Care shows that crisis team budgets at the trust have increased by £1m compared to April 2011 but investment in community mental health teams dropped by £860,000 in the same period.

48 What the trust said: “Response times are always agreed with the patient. Our target response time is four hours with a maximum of up to 24 hours. Response times will only ever be longer with agreement from the referrer and the patient. “On average we spend between 30 to 60 minutes with a patient however, this can vary from 10 minutes to two hours. Most patients will usually be seen at least once a day and spending too long can be tiring for them.” 3. Patients in need of ‘urgent’ assessment not seen for five weeks An urgent GP referral to Barnet’s home treatment team had not been followed-up when CQC inspectors visited the service five weeks later. The issue was one of several problems flagged up by CQC inspectors in an inspection report into community services at Barnet, Enfield and Haringey Mental Health NHS Trust. The report, published in May, also warned that staff at the trust’s home treatment team in Haringey felt “the workload was too much for the number of staff available”. Service users complained about problems getting staff to visit them and “inconsistency in care” from services. What the trust said: The trust said it had taken “swift action” to resolve the issues identified by inspectors. “As a result, our home treatment teams no longer exist in their previous form, and have been replaced with our new crisis resolution home treatment service which went live on 4 November 2013. There has also been extensive work done around capacity modelling to make sure that workloads are manageable, and medicine management.” 4. ‘Unmanageably high’ caseloads Two community mental health teams run by Bradford District Care Trust have “unmanageably high caseloads”, board papers reveal. The situation risks service users not being seen often enough and “potential for increased risk to self and others”. What the trust said: “This is limited to two teams working within inner-city Bradford, where demand for services is greater and can prove challenging. We are taking the risk very seriously and have acted to introduce a single point of access and ‘stepped care model’. The model makes sure that patients are assessed by the appropriate team member and that their care is co-ordinated at the right level.” 5. Community team budgets cut despite promises of investment Data provided by the trust this month shows that the budget for home treatment teams fell from £4.5m in 2011/12 to £4.2m in 2013/14. The budget for community mental health teams dropped from £15.3m to £14.5m in the same period. What the trust said: “The majority of resources freed up from the closure of 33 working age adult mental health beds in 2011/12 were re-invested in staffing our remaining inpatient and rehab services. We ensured that all available resources were put back into in service redesign or that they contributed to cost improvements in our community services.” 6. Crisis team budgets cut by up to 17% Crisis resolution and home treatment teams at Birmingham and Solihull mental health trust saw their budgets fall from £6.3m in 2011/12 to £5.3m, a 17% fall (this was the largest percentage drop of the trusts that provided data). The trust’s budget for community mental health teams dropped from £13.4m in 2011/12 to £13.3m during the same period.

49 What the trust said: A trust spokesperson attributed the reduction in crisis team funding to “the merging of some our home treatment teams and implementing a slightly different skill mix within the new team in order to implement a new model of care.” On the fall in community team budgets the spokesperson added: “Our community teams have been working for the last couple of years on a fundamental redesign across the service pathway in order to better meet patient need and improve patient experience. Again, this has included a review of staff skill mix and in addition, as a result of the trust’s estates rationalisation we moved to fewer, more suitable buildings by consolidating some services.” 7. Crisis teams left ‘holding risk’ of acutely unwell people A ‘customer journey mapping exercise’ by Surrey and Borders Partnership NHS Trust that looked at care at its home treatment team identified a number of concerns. Staff felt “they had to hold the risk” of people in crisis after other services had failed to contain it. There was a “lack of clear standards” in the team and GPs’ “clearly reported dissatisfaction” with the ability to reach teams and key staff. What the trust said: “We are still in the process of reviewing these findings with our stakeholders but our clinical commissioning group has been pleased with our work so far. This is already resulting in improved relationships with, for example, accident and emergency services in our general hospitals. There have been specific actions for the local team this was trialled with and our next step is to use this feedback in our improvement plans for all our home treatment teams.” 8. Teams facing double the workload despite staffing cuts Board papers show that the crisis resolution teams at Coventry and Warwickshire Partnership NHS Trust delivered 893 home treatment episodes in the first quarter of this financial year, more than double the trust’s planned activity level of 389 episodes. The trust’s budget for crisis teams dropped from £3.26m in 2011/12 to £3.25m in 2013/14 and staffing levels fell from 82.43 funded posts to 77.1 funded posts in the same period. What the trust said: “We believe these and other figures show we have increased the cost effectiveness and productivity of our service, and continued to meet the needs of our patients. Like many trusts we are having to achieve more with less resource. As a result we are conducting a fundamental redesign of our secondary care mental health service to ensure people with most acute need receive the right service even faster.” 9. Services ‘unable to provide safe alternative to hospital’ In recent weeks frontline staff at Norfolk and Suffolk NHS Foundation Trust have launched a campaign protesting against cuts to services that, staff say, are “decimating” community services to the point that crisis teams can “no longer provide a safe alternative to hospital”. The trust says the claims are inaccurate ( read the full story, and the trust’s response, here ). 10. Staff sickness rates affecting care Board papers from a May meeting of Humber NHS Foundation Trust reveal a number of concerns around services. Directors who visited the trust’s Avondale service in February noted that community mental health team “sickness is affecting clients and difficulty in moving patients on due to social care issues”. Data provided to Community Care showed that the trust’s spending on community mental health teams dropped from £9.8m in 2011/12 to £9.3m in 2013/14. Staffing levels dropped from 272.8

50 full-time equivalent posts to 261.7 posts in the same period. The trust did not respond to a request for comment. http://www.communitycare.co.uk/2013/12/12/10-ways-underfunding-mental-health-servicesdamaging-patient-care/#.UqtQkGRdWpx 'Mental health trusts are delivering better value': NHS England responds to evidence of falling budgets - Community Care _____________________________________________________________________ Mental health trusts are “more productive” and “delivering better value for the NHS”, a NHS England director has said after figures showed that trusts were hit by real-terms budget cuts of more than 2% between 2011/12 and 2013/14. Care services minister Norman Lamb said it was “completely unacceptable” for commissioners to disadvantage mental health services. “This completely conflicts with the government’s clear position that there must be parity of esteem – equality – between mental and physical health. This must be a priority for NHS England to address,” the minister said. “There are pressures across all parts of the system, both financial and clinical and the NHS has responded really well to those. “If you look at the figures, mental health trusts have taken more work on, they’re more productive, they’re delivering better value for the NHS. There are other parts of the system that are delivering services that might have been delivered by mental health trusts, such as psychological therapies.” In a separate statement provided to Community Care, NHS England admitted that local commissioners “were given a real-terms increase in their available resources in 2013/14″ but said trusts had also faced a “range of additional costs”. The findings follow another Community Care investigation in October that highlighted the pressure on inpatient mental health services . It found that more than 1,700 NHS mental health beds have been closed since April 2011. At the time one of the country’s top psychiatrists said the mental health system was “unsafe” and “in crisis”. http://www.communitycare.co.uk/2013/12/13/mental-health-trusts-delivering-better-value-nhsenglands-response-evidence-falling-budgets/#.UqrRlxZ8vkx?cmpid=NLC|SCSC|SCDDB-2013-1213 Co-production in mental health: A literature review | new economics foundation Julia Slay , Senior Researcher and Social Policy Programme Co-ordinator In spring 2013, nef was commissioned by Mind to review the literature on how coproduction is being used in mental health settings. This report sets out the findings of that review, showing what evidence there is of the impact of co-production on mental health support, and which aspects of coproduction are being developed in the sector. The project has been developed within Mind’s national programme – the Network Personalisation Programme – to position the network of local Minds as market leaders of high quality, recovery focused, personalised services that individuals want to buy. This programme contributes towards the achievement of Mind’s Unstoppable Together strategy (2012–2016) with the ultimate aim of

51 increasing the number of people with mental health problems who are able to access timely and individual support to make their own choices via the Mind network. The need for this work on co-production within the Network Personalisation Programme emerged in a time of great financial challenge, as a way of exploring additional resources to tap in to for strengthening social care and promoting a better understanding of how to engage with communities in services that promote co-operation, equity, inclusion, and well-being. DOWNLOAD THE REPORT: http://s.bsd.net/nefoundation/default/page/-/publications/Co-Production_web.pdf Councils need better information to champion mental health – Centre for Mental Health. Local councils in England need better information about the mental health and wellbeing of the people they serve in order to close the gap between mental and physical health of their communities, say charities and health professionals. Publishing ten questions for councillors and health champions to ask their public health teams, organisations including the Royal College of Psychiatrists and Centre for Mental Health are asking every local authority in England to find out how many people in their area have mental health problems or poor wellbeing, how many are at risk and what proportion receive help. The ten questions aim to help local authorities promote the wellbeing of their population and improve the recovery of people with mental health problems by providing information about the size, impact and cost of the unmet need to both treat mental health problems, to prevent them from arising and to promote wellbeing. Recent reports from Centre for Mental Health and the Children and Young People’s Mental Health Coalition have shown that many local health and wellbeing strategies are not focusing on mental health. This is in part due to lack of information about mental health in their local needs assessments. The ten questions are being published as part of the local authority mental health challenge, a joint initiative from Centre for Mental Health, the Mental Health Foundation, Mind, Rethink Mental Illness, the Royal College of Psychiatrists and YoungMinds to support local leadership in mental health. Time to Change ambassador Alastair Campbell, who has also lent his support to the mental health challenge and the need for better information about the size of the intervention gap, said: “At a time when the importance of good mental health and the need for parity is finally gaining recognition, it is vital that people have the services they need at a local level. “By answering these questions, councils will go some way to having a better understanding of what the current state of play is and what can be done to improve services. We are asking all upper tier local authorities to take up The Mental Health Challenge, which sets out ten actions that will enable councils to promote mental health across all of their business. http://www.mentalhealthchallenge.org.uk/wpcontent/uploads/2013/08/LA_Challenge_10_questions.pdf

EXTRACTS & SUMMARY of the TEN QUESTIONS. This briefing provides mental health member champions with ten questions for your local

52 Â Â authority and public health service to ensure that relevant mental health information is included in the JSNA to support what is being done to promote good mental health and to prevent and treat mental health conditions in your locality.

1. How many people in your locality have different mental health conditions? 2. How many people from particular groups are affected? 3. How many people with mental health conditions receive timely treatment? 4. How many of people with mental health conditions receive support for their physical health, such as to stop smoking? 5. What is the local level of mental wellbeing? 6. What is the local level of protective factors for mental wellbeing? 7. What is the local level of risk factors for mental health conditions and poor wellbeing? 8. How many local people receive interventions to prevent mental health conditions and promote mental wellbeing? 9. What is the local annual spend on the treatment and prevention of mental health conditions as well as the promotion of mental wellbeing? 10 . What is the local annual cost of mental health conditions? Improved safety measures by mental health services help to reduce suicide rates | The University of Manchester 28 Nov 2013 Mental health service providers looking after patients at risk of suicide need to reduce absconding on in-patient wards and boost specialist community services like crisis resolution to reduce deaths, a report by The University of Manchester out today (28 November) shows. Improved treatments are also needed for patients who have mental health illness and drug or alcohol misuse (dual diagnosis) as well as for those with depression. Researchers from the Universityâ&#x20AC;&#x2122;s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), commissioned by the Healthcare Quality Improvement Partnership on behalf of the NHS England, the Health Department of the Scottish Government, the Welsh Government, DHSSPS Northern Ireland and the Channel Islands, examined patient suicide and the impact of services changes made by mental health service providers across the UK between 1997 and 2011. They looked at 17 key recommendations and service changes in relation to suicide rates. Mental health service providers which had implemented more than 10 recommendations for service change had lower suicide rates than those that implemented 10 or fewer. The top five changes mental health service providers could make to reduce suicide were:

53 • Provide specialist community services such as crisis resolution/home treatment, assertive outreach and services for patients with dual diagnosis; • Implement National Institute for Health and clinical Excellence (NICE) guidance on depression; • Share information with criminal justice agencies; • Ensure physical safety and reduce absconding on in-patient wards; • Create a learning culture based on multi-disciplinary review. Professor Louis Appleby, Director of the National Confidential Inquiry, said: “We found that the implementation of service changes and recommendations was associated with lower patient suicide rates in mental health service providers. “This shows that there are positive steps all mental health service providers can make. Providing specialist community services for patients is particularly important for trusts to implement.” Professor NavKapur, from the University’s Centre for Suicide Prevention based in the Centre for Mental Health and Risk one of the leading centres for research into suicidal behaviour internationally, said: “It is vital not to lose the benefits of the last 10 years. This study identifies service changes that seem to work in preventing suicide. Equally, it seems to suggest that service providers might wish to maintain specialist services for people who don’t engage or have a dual diagnosis.” The four UK countries, England, Northern Ireland, Scotland and Wales, each have a national suicide prevention initiative which includes the need to review health service strategies for suicide prevention and improve treatment of mental disorder, improved access to services and better aftercare. The NCISH team hope their latest findings will lead to increased implementation of national guidelines and recommendations. The findings follow a study published by the National Confidential Inquiry earlier this year which showed suicides among mental health patients increased with the current economic difficulties a likely factor. The findings, reported in the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) produced by The University of Manchester, suggested more needed to be done to help mental health patients with debts, housing and employment. The research team says safety efforts need to focus on patients receiving home treatment where there has been a rise in suicide deaths in recent years as there are now twice as many suicides under home treatment as in inpatient care. • • • • • • • • •

Removal of non-collapsible curtain rails Re-design/removal of low lying ligature points Community services include an assertive outreach team Community services include a crisis resolution/home treatment team Clinical staff receive training in management of suicide risk Policy regarding response to in-patients who ascond Policy of the follow up of post discharge patients Policy on patients who are not taking medication as prescribed Policy on the management of patients with dual diagnosis (mental health illness and drug or alcohol dependence or misuse)

54 • • • • •

Policy on information-sharing with criminal justice agencies Policy on multi-disciplinary review and information sharing with families Policy on the formal transfer of care from child and adolescent mental health services to adult services Mechanism for implementing NICE guidelines NICE self-harm guidelines

DOWNLOAD THE REPORT: http://www.bbmh.manchester.ac.uk/cmhr/research/centreforsuicideprevention/nci http://www.manchester.ac.uk/aboutus/news/display/?id=11183 Inspecting and regulating mental health services | Care Quality Commission We’re changing the way we inspect specialist mental health care services and putting a greater emphasis on inspecting the care that people with mental health problems receive in the community. A fresh start… The main changes to our inspection approach are: • • • • • • •

Including mental health specialists on all inspections of mental health services and bringing together our work under the Mental Health Act and how we regulate mental health services. Setting up inspection teams of specialist inspectors, Experts by Experience and professional experts. Rating mental health services with one of the following: Outstanding, Good, Requires improvement or Inadequate. Engaging with people who use services, their carers and families, during inspections and at other times in new ways. Making sure we have better information about mental health services and developing our intelligent monitoring system for these services. Looking at how people are cared for as they move between services. Recognising that mental health treatment and support is part of services in all sectors.

Putting the changes into practice We will pilot our new inspection approach with the NHS, with the aim of expanding this to other specialist mental health providers including the independent sector. We have selected five trusts that will take part in the first wave of the pilot. These trusts are: • • • • •

Coventry & Warwickshire Partnership NHS Trust Devon Partnership Trust Dudley & Walsall Mental Health Partnership NHS Trust South West London & St George’s Mental Health NHS Trust Solent NHS Trust.

Strengthening our approach Professor Sir Mike Richards, CQC’s Chief Inspector of Hospitals, said: “The needs of people with mental health problems run through all the areas that CQC regulates and we have recognised that we need to strengthen our approach to regulating specialist mental health services to ensure that people get care that is safe, effective, caring, responsive to people’s needs and well led. I regard this as every bit as important as the changes I am making to the way we regulate acute hospitals.

55 “Our new approach will bring together both strands of CQC’s work in relation to mental health – our work under the Mental Health Act and how we regulate mental health services. “I am appointing a Deputy Chief Inspector for Mental Health who will work with me, leading expert inspection teams who will spend more time listening to people who use services, carers and staff.” DOWNLOAD THE REPORT: http://www.cqc.org.uk/sites/default/files/media/documents/cqc_afreshstart_mental_health_2013_fi nal.pdf Mental Capacity Act code of practice under review but progress slow due to lack of civil servants - Community Care Care minister Norman Lamb says Department of Health has open mind on extending Deprivation of Liberty Safeguards to supported living The Mental Capacity Act 2005 (MCA) code of practice is under review but progress is being checked by a lack of civil service capacity, a minister has confirmed. Campaigners have long been calling for a review of the code, which sets out how social workers and other practitioners should implement the MCA, in order to take account of case law and provide more detailed practice guidance. No formal review has been announced by the government. However, in evidence to the House of Lords committee examining the implementation of the MCA, justice minister Lord McNally said civil servants had started reviewing the code but that there was a lack of capacity to make quick progress. “In a department [the Ministry of Justice] that has taken 25% cuts since 2010 and has lost in total some 20,000 staff, action this day is not the easiest thing for civil servants who are working under extreme pressure on a wide number of fronts,” he said. McNally said MoJ officials were giving priority to a parallel reform of the Office of the Public Guardian (OPG), which is responsible for registering and monitoring attorneys and deputies who take decisions on behalf of people who lack the capacity to do so. These reforms, the consultation on which have just closed, cover reducing bureaucracy for people applying for lasting powers of attorney, providing more services online and reforming the OPG’s supervision of deputies to deal with a large increase in caseloads. Review of MCA code underway On the review of the MCA code, McNally said work was underway but he could not give a date for its completion, though he suggested that the House of Lords inquiry may bring it forward. Also giving evidence, care and support minister Norman Lamb said the separate Deprivation of Liberty Safeguards (Dols) code of practice may also be reviewed in the light of a forthcoming Supreme Court judgement. In October, the court heard two cases - P&Q v Surrey County Council and P v Cheshire West and Chester Council - that hinge on what constitutes a deprivation of liberty and its judgement is expected to be far-reaching. Lamb also said that the Department of Health had not ruled out extending the Dols to supported living arrangements. The system, under which councils must authorise and monitor deprivations of

56 liberty in care of people who lack capacity to make decisions about their support or accommodation, currently applies only to care homes, hospitals and hospices. While Lamb said there were no immediate plans to extend it to supported living, he added: “I am conscious that we are aiming, particularly with learning disabilities, to effect a significant shift towards supported living in the community. There has already been a dramatic shift in that direction, but we want it to go further. As numbers increase further, should we look again? That is a question on which we should be prepared to keep an open mind.” Lamb also said that a steering group had been set up by the DH to examine the effectiveness of the implementation of the MCA. “I think that there is a recognition that there is still a long way to go in embedding this legislation in the lives of the people whom it is supposed to protect and to whom it is supposed to give rights.” http://www.communitycare.co.uk/2013/12/09/mental-capacity-act-code-practice-review-progressslow-due-lack-civil-servants/#.UqbKT-DRr0s?cmpid=NLC|SCSC|SCDDB-2013-1210 Mental health and community services – NHS Confederation.

Mental health organisations are delivering an increasingly diverse portfolio of services. This Briefing explores the opportunities and good practice currently developing in ‘combined’ or ‘integrated’ trusts, as well as the challenges. It considers whether this growing trend is good for mental health and community services and what the consequences might be. A Mental Health Network (MHN) survey of its members revealed that two thirds of respondents are delivering non-mental health services, with others interested in doing so in the future. The diversification of mental healthcare provision raises a number of questions for a sector that has historically argued the case for delivering ‘specialist’ mental health services. Key points from the Briefing: • • • •

There is a growing trend for mental health organisations to deliver an increasingly diverse portfolio of services. In some organisations, income from non-mental health services exceeds that from mental health service provision. MHN survey respondents talked about taking a stepped approach to integrating care pathways, starting with one clinical service or locality and then building on this. Boards need to be assured that both physical and mental healthcare is good and safe in proportionate measure.

Download Publication: http://www.nhsconfed.org/Publications/Documents/Mental-health-community-services.pdf Mental health dashboard - GOV.UK _____________________________________________________________________ Department of Health Published: 12 December 2013

57 Policy: Making mental health services more effective and accessible Applies to: England Brings together mental health outcomes data to show progress made in the ‘No health, without mental health’ strategy. Detail The first annual mental health dashboard gathers the best information available to show progress against the objectives set out in the ‘No health without mental health’ strategy . The dashboard provides a clear, concise picture of mental health outcomes. It includes information on: • • •

Mental health services The physical wellbeing of people with mental health problems Experiences of stigma and discrimination

The dashboard is for reference and use by anyone working in the care and support system.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265388/Mental_Hea lth_Dashboard.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265824/Mental_Hea lth_Dashboard-Tech_Appendix.pdf New Mental Health Tribunal Practice Direction directs specific consideration of whether MCA would be less restrictive. _____________________________________________________________________ A new Practice Direction has been issued in respect of statements and reports required for proceedings before the Mental Health Tribunal. This now requires that the reports prepared by Responsible Clinicians for in-patients specifically identify “in the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be appropriate and less restrictive” (para 12(m)). The same information is required in Social Circumstances Reports (para 14(t)). It would appear that this change has been brought in to respond to the AM case, albeit that it is unlikely save in the case of automatic referrals that any patient would be before the Tribunal who would not be considered to be objecting in some fashion to their treatment (and hence ineligible to have any deprivation of liberty authorised by way of a DOLS authorisation under the MCA 2005).

LEGAL Amended regulations for commissioners – Mills & Reeve. On 13 November 2013, the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013 were laid before Parliament. The 2013 Regulations amend the previous 2012 Regulations, which relate to the functioning and commissioning responsibilities of the NHS Commissioning Board (known as NHS England) and CCGs.So what’s new? The six amendments: 1. Provide for new duties for NHS England and CCGs in relation to NHS Continuing Healthcare (CHC) for example the discharge of patients from hospital. 2. Provide for greater choice for patients using mental health services as from April 2014. 3. Refer to the right to start consultant–led treatment within a maximum of 18 weeks of referral. 4. Create new duties for NHS England and CCGs in relation to the provision of personal health budgets for NHS CHC or continuing care for children. 5. CCGs continue to be responsible for commissioning NHS CHC for people whom they have placed in care homes or independent hospitals in the area of a Local Health Board in Wales. 6. Allow those individuals working for bodies, which provide commissioning support to CCGs to be eligible members of Independent Review panels (IRPs). IRPs review the assessment process followed and decisions as to eligibility for NHS CHC in cases where patients are dissatisfied. This is welcome news for those CCGs struggling to find appropriate members from within the CCG with sufficient expertise and experience to be panel members. The 2013 Regulations come into force in two parts. In relation to additional persons for whom a CCG has responsibility this comes into force on 16 December 2013, and the remaining provisions on 1 April 2014. The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2013 DOWNLOAD THE LEGISLATION http://www.legislation.gov.uk/uksi/2013/2891/pdfs/uksi_20132891_en.pdf Anti-social Behaviour, Crime and Policing Bill — Committee - Hansard Lord Ramsbotham (Crossbench) My Lords, the point I am about to make has been made in connection with a great deal of other legislation and concerns the abilities of those with learning difficulties and disabilities to understand the content and implications of notices such as those we are discussing. It is important to ensure that the legislation includes reference to the provision of appropriate adults or advocates or whatever sources are used to make certain that the full implications are explained to those who may have such difficulties to avoid them getting into yet further trouble, completely inappropriately.

Committee, 4th Report from the Joint Committee on Human Rights.

Clause 44: Remedial action by local authority

59 Amendment 22QG had been withdrawn from the Marshalled List. Clause 44 agreed.

Clause 45: Offence of failing to comply with notice Amendment 22QH not moved. Clause 45 agreed. Clause 46 agreed.

Clause 47: Forfeiture of item used in commission of offence Amendment 22QJ not moved. Amendments 22QK to 22QS had been withdrawn from the Marshalled List. Clause 47 agreed. Clause 48 agreed.

Clause 49: Fixed penalty notices Amendment 22QT Moved by Baroness Hamwee 22QT: Clause 49, page 28, line 30, leave out “14” insert “28”

Clarifying entitlement to community care and health services – Local Government Lawyer. [ARTICLE SUMMARY] Following the NHS reforms and the Health and Social Care Act 2012 the Department of Health has issued updated guidance on determining ‘ordinary residence’ for people requiring local community care services. Community care services are generally provided to those with relevant assessed needs by the authority of ‘ordinary residence’. So, ordinary residence has tended to be a question for local authorities considering the entitlement to community care services. This includes accommodation and domiciliary services under NAA 1948 and accommodation under the Children Act 1989 . Ordinary residence is also relevant for identifying which local authority is the supervisory body for the purposes of the Mental Capacity Act 2005 —conveniently, some of the deeming provisions from NAA 1948 apply to MCA 2005, Sch A1, para 183. However, the concept has wider relevance when combined with the idea that residence should be lawful. This has recently been applied in the context of access to student finance .

60 The Immigration Bill 2013 was published on 10 October. This extends the idea that services are provided to those lawfully ordinarily resident in an area – although it does not apply to local authority services, where there are other provisions. So, by far and away the most important application of ‘ordinary residence’ is for local authorities to determine which authority is required to provide services. CA 1989, s 105 disregards the time which the service user spent in accommodation provided by a local authority when determining ordinary residence for people under age 18. However, there comes a point at which it is artificial to say that someone is ordinarily resident in an area they have not been to for many years and where they may have no remaining family. One recent Court of Appeal case concerned the responsible authority for a baby born to a child placed outside the local authority of their ordinary residence. If that happens the accommodation may be provided under NAA 1948, Pt 3, meaning that the placing local authority remains the authority of ordinary residence . In general, independent living is arranged by a tenancy agreement paid for by housing benefit. This is unlikely to amount to ‘making arrangements’ and so someone moving out of residential care to independent living will usually acquire a new ordinary residence. However, there are circumstances in which a local authority may ‘make arrangements’, such as where the service user lacks capacity . The basic rule is that service users move from CA 1989 to NAA 1948 when they turn 18. However, leaving care services are provided by the authority which provided CA 1989 services, regardless of ordinary residence. Since adult services are provided by the authority of ordinary residence it is possible that two authorities will be involved . HSCA 2012 inserts new sections into the National Health Service Act 2006 providing that a CCG has responsibility for people who are: providing with primary care by a GP who is a member of the CCG; or usually resident in the area covered by the CCG and are not provided with primary care by a member of any CCG. The result is that "… a local authority and a CCG located several miles apart [may] need to work together to provide a joint package of health and social care" . NHSA 2006, s 175 already provides that the NHS may charge ‘persons not ordinarily resident in Great Britain’. This ties in with the cases mentioned earlier which deal with the concept of ordinary residence as a potential bar on services rather than merely the basis for deciding which state body provides them. In most cases local authorities can apply to the Secretary of State for a determination of which local authority is responsible. The guidance emphasises that services should continue regardless of disputes about ordinary residence and so, in theory, service users will not be affected by these disputes. However, disputes between local authorities can generally be referred to the Secretary of State . The single most important thing is to ensure that a consistent approach is taken to accepting service users and passing them on to other authorities. Otherwise a local authority runs the risk of retaining clients living in far flung places and with whom it has little contact as well as taking on new clients. http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16328 %3Aclarifying-entitlement-to-community-care-and-health-services&catid=52&Itemid=20

61 Confidentiality of medical information after patient’s death – Local Government Lawyer. There have been two recent Upper Tribunal decisions on the issue of confidentiality of medical information after a patient's death. Robin Hopkins analyses the rulings. The absolute exemption at section 41 of the Freedom of Information Act 2000 extends to information obtained by the public authority the disclosure of which would give to an actionable breach of confidence. Does the obligation of confidence survive the death of the confider? If so, would a breach of that obligation be actionable, even if it is not clear exactly who could bring such an action? These issues arise most notably in the context of medical records. The Upper Tribunal has had something to say on this in two recent decisions. In Webber v IC and Nottinghamshire Healthcare NHS Trust (GIA/4090/2012), the appellant had made a FOIA request for information (including hospital records) about the death of her son in 1999 when he was compulsorily resident at Rampton hospital. This was refused on section 41 grounds. The Commissioner upheld the refusal, as did the First-Tier Tribunal. In doing so, it somewhat unusually did not see the withheld information for itself, since it had not been asked to by anyone. Mrs Webber’s appeal to the Upper Tribunal has also been dismissed. Judge Williams considered that the Tribunal could not be faulted for not differentiating between different categories of withheld information (which it obviously could not do, as it had not seen the information): “it is the task of the tribunal to decide the case before it unless it sees reason to investigate further” (paragraph 30). He also confirmed the well-established principle that what matters under FOIA is information rather than documents: though the records were created by the NHS Trust, the information contained in those records came from the patient. In the section 41 context, “obtained” simply means “come to have”, which can be active or passive (paragraph 38). Judge Williams confirmed a further touchstone of FOIA, namely that whatever the particular interests of the requester, this “remained an application to put the information into the public domain” (paragraph 37), that being the effect of disclosure under FOIA. Disclosure would entail a breach of confidence which was actionable after the patient’s death, notwithstanding the argument that, in this case, the only person who could sue would be the personal representative (who was likely to have been the requester: thus it was submitted that she would in effect have been suing herself). Judge Williams also found that there would not have been a public interest defence to the breach of confidence. Here he gave weight to the fact that some of the information sought would or could come into the public domain or be obtained in another way: a coroners’ inquest, or through an application under the Access to Health Records Act 1990 (now largely supplanted by FOIA, but not as regards deceased persons) which allows for requests for access to information to be made by (inter alia) patients’ personal representatives. Such an application was outside the Upper Tribunal’s jurisdiction but it was “relevant to note that it exists as a specific if limited remedy for some aspects of the application made for the appellant in this case” (see paragraphs 23-24). In M v IC and Medicines and Health Products Regulatory Authority (GIA/3017/2010), Upper Tribunal Judge Lloyd-Davies allowed the requester’s appeal for information in a report held by the public information concerning a pharmaceutical trial of a drug developed by Pfizer. That information had again been withheld under section 41, with the Commissioner and First-Tier Tribunal agreeing – regardless of whether the participants in the trial were dead or alive at the time of the request.

62 The appeal was allowed because of a procedural error – the Tribunal had authorised more extensive redactions than were in fact being put to it. The remitted hearing is to include questions of identifiability of patients in the context of anonymised drug trial data. The line of authorities on statistical information (Common Services Agency, Department of Health) will no doubt be considered. The decision contained this obiter observation on actionable breaches of confidence in the case of deceased patients: “where the confidence arises in the context of a patient/healthcare professional relationship, I am minded to conclude that the obiter observations of Mr Justice Foskett in R (Lewis) v Secretary of State for Health [2008] EWHC 2196 (QB) are correct”.

Robin Hopkins is a barrister at 11KBW and acted for the Commissioner in the M case; his colleague Joe Barrett acted for the appellant in Webber. This article first appeared on the set’s Panopticonblog . http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16325 %3Aconfidentiality-of-medical-information-after-patients-death&catid=174&Itemid=99 Council pays out damages for defamation by social services team -Local Government Lawyer. A council has paid out “substantial” damages for defamation and apologised to a man about whom its social services department circulated false information, a leading claimant law firm has said. Deighton Pierce Glynn, which acted for the claimant, said: “Our client’s family came into contact with the local authority’s social services department on a number of occasions. On the first occasion a very serious error was made by the local authority when information supplied by a third party was misunderstood and mis-recorded. “Subsequently, the information was not checked and the false information was circulated both internally within the local authority and to external agencies but not to our client. When the social services file was reopened several years later the false information on the file was assumed to be accurate and tainted in a seriously detrimental way the social services department’s treatment of our client and his family.” Proceedings were brought in the High Court for defamation and under the Human Rights Act. Deighton Pierce Glynn said the apology, damages and a correction of the false information had finally brought to an end “a very difficult chapter” for the claimant. http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16261 %3Acouncil-pays-out-qsubstantialq-damages-for-defamation-by-social-servicesteam&catid=54&Itemid=22 Court of Protection judge calls for its hearings to be thrown open to scrutiny from the Press - Daily Mail __________________________________________________________________ • • •

Mr Justice Charles told peers that scrutiny of court would be beneficial Said it would improve the behaviour of everyone involved, including judges Controversial Court of Protection makes decisions about care, treatment and property of those who cannot decide for themselves

63 The judge who heads the secretive Court of Protection called yesterday for its hearings to be thrown open to the Press. Mr Justice Charles told peers that open scrutiny of the controversial court’s hearings would improve the behaviour of everyone taking part, including judges. He brushed aside arguments that the Court of Protection – which makes decisions about the medical treatment, care and property of those who cannot decide for themselves – has a first duty to protect the privacy of families and individuals who come before it. The Court of Protection, based in the Royal Courts of Justice, pictured, should be open to scrutiny from the press, the judge who heads it said yesterday ‘The impact of proceedings having more sunlight let in, more transparency, outweighs the difficulties that in some cases some people may have in having their privacy invaded,’ the judge said. He also told peers the court’s routine secrecy may break human rights laws, that judges have been reluctant even to let the public know the outcome of the court’s cases, and that some judges and legal figures remain firmly opposed to letting outsiders know what goes on in its hearings. The call for open reporting of cases follows months of growing controversy. Set up six years ago under Labour’s Mental Capacity Act, the court can order people to be confined to care homes or decide whether desperately sick patients should die or be treated. The controversial Court of Protection has the power to make decisions about the care, treatment and property of those who cannot decide for themselves In April, the Daily Mail revealed that a Court of Protection judge had sent Wanda Maddocks, 50, to jail in secret. Miss Maddocks was sentenced to five months for defying the court by trying to free her father from a care home where she thought his life was in danger. Sir James Munby, head of the family courts, has repeatedly called for more openness. Mr Justice Charles yesterday threw his weight behind Sir James at the Lords inquiry into the Mental Capacity Act’s workings. Greater openness would ‘improve the performance of all involved in the court process’, he told peers. ‘I don’t exclude judges from that.’

http://www.dailymail.co.uk/news/article-2514130/Court-Protection-judge-calls-hearings-thrownopen-scrutiny-Press.html

Court of Protection Newsletter December 2013 &October and November’s evidence before the House of Lords Select Committee on the Mental Capacity Act [2005] -39 Essex Street Welcome to the December issue of the Mental Capacity Law Newsletter. In this issue, we cover an important application under s.21A MCA 2005, a decision (re)affirming the ability of social workers to give evidence as to capacity and a decision as to the discretion of the Court of Protection to make declarations as to capacity. We also highlight developments including a new COP3 form, the move

64 of the Court of Protection, and a new dementia-friendly financial services charter. We also attach to this newsletter a bumper summary of October and November’s evidence before the House of Lords Select Committee, including that given by Alex as part of a panel addressing the Court of Protection. Readers will have noted that we have in the past covered some developments in Scotland, a trend continued in this month’s issue. We are delighted to announce that, with effect from the next – January – issue we will be expanding our coverage significantly to give monthly coverage of matters north of the Border, with the addition to the contributor team of Adrian Ward, of TC Young Solicitors, a leading figure in Scotland in the field of mental capacity law, there termed adult incapacity law, and Jill Stavert, Director of the Centre for Mental Health Law and Incapacity Law, Rights and Policy at Edinburgh Napier University. More details will follow in the next issue. There is a full table of contents for this month's newsletter below, or if you want to read it straightaway you can do so by following this link: http://www.39essex.com/docs/newsletters/mc_law_newsletter_december_20132.pdf To read the summary of October and November’s evidence before the House of Lords Select Committee please follow this link: http://www.39essex.com/docs/newsletters/update_on_house_of_lords_select_committee_on_t he_mental_capacity_act_2005.pdf Declaration of a 'non-marriage' – Local Government Lawyer. An Islamic “marriage” ceremony at home has been declared invalid by the Court of Protection. Rosalind English looks at the ruling, which followed an application by a local authority. In A Local Authority v SY [2013] EWHC 3485 COP (12 November 2013] a judge in the Court of Protection has ruled that a man who had “exploited and took advantage” of a young woman for the purpose of seeking to bolster his immigration appeal had engaged in an invalid marriage ceremony. The man, said Keehan J, had ”deliberately targeted” the respondent because of her learning difficulties and her vulnerability. The courts would not tolerate such “gross exploitation.” This was an application by a local authority in the Court of Protection in respect of the capacity of the respondent, SY, to litigate and to make decisions in relation to her life. Background to Case: SY, a young woman with an IQ of 49, had been known to the authority since March 2005 when she was 11 years old. There were concerns about her non-attendance at school, issues of domestic violence and the fact that SY was staying out at night at the homes of older males which resulted in SY and her siblings being placed on the At Risk Register. She was subsequently made the subject of a care order in 2007 which ceased to have effect upon SY attaining her majority in December 2011. Since then, she had a history of disrupted placements. Her foster placement broke down in June 2011 and she moved to supported accommodation. In August 2011 she moved to live in semiindependent accommodation, but whilst she was there she told her social worker that she was being sexually abused by other males, in particular a 23 year old man, TK. As a result of this she moved to supported lodgings.

65 A strategy meeting held in late 2011 concluded that SY lacked capacity to identify that she was being abused or exploited. In early 2012 her carers notified the authority that she had returned from TK’s property in a nearby city and told them that TK had locked her in his house when he went to work, she and TK had been visited by a ‘lawyer’ about a housing application, that they were to marry in six months time and that TK had taken her to a registry office to obtain a copy of her birth certificate. The authority and the police told TK that SY had a learning disability and was unlikely to have capacity to consent to sexual relations and marriage and that an offence would be committed. Notwithstanding this advice, on 10 June 2012 TK and SY entered into a purported Islamic marriage ceremony at his home. The evidence before the court was that TK was seeking this marriage in order to secure his immigration status, since he had been arrested for immigration offences pending his deportation. It appeared that he hoped his marriage to TK would buttress his asylum appeal. However, his case against the refusal to grant him asylum was dismissed on all grounds. The tribunal judge found that his relationship with SK, if there was one, did not have “the necessary qualities of commitment, depth and intimacy which would be necessary to demonstrate family life for the purposes of article 8 …”. He was deported in August 2012. In the light of the capacity assessments before him, Keehan J was “wholly satisfied” that SY lacked the capacity to litigate and the capacity to make decisions about her residence, her contact with others, her care needs and entering a contract of marriage. On the basis of expert opinion, he was also satisfied that SY has the capacity to consent to sexual relations. Accordingly he was prepared to make the orders sought by the authority in relation to the current placement of SY and the care package. Declaration of Non-Marriage Since there is no provision in the Mental Capacity Act 2005 to make a declaration in respect of the ceremony in which SY and TK participated on 10 June 2012, the remaining issue before the court was whether the Official Solicitor should make a freestanding application for a declaration or whether the court, of its own motion, should invoke the inherent jurisdiction of the High Court and make a declaration of non-marriage. After considering the authorities on validity of marriage, Keehan J applied the reasoning of Hughes J (as he then was) in A-M v. A-M (Jurisdiction: Validity of Marriage) [2001] 2 FLR 6, a case concerning the status of an Islamic marriage ceremony conducted in England. There the judge concluded that the marriage was invalid:

"The fact that it in no sense purported to be effected accordingly to the Marriage Acts, which provide for the only way of marrying in England. …It follows that I hold that the 1980 ceremony is neither a valid marriage in English law nor one in respect of which jurisdiction exists to grant a decree of nullity." On the basis of that, and similar authorities, Keehan J was satisfied that the ceremony which took place between SY and TK on 10 June 2012 did not comply with the formal requirements of the Marriage Acts 1947-1986. It was a “non-marriage”. It was within his jurisdiction to make this declaration even though the MCA was silent on such matters because

"The protection or intervention of the inherent jurisdiction of the High Court should be available to those lacking capacity, even where the remedy sought does not fall within the repertoire of remedies provided for in the MCA 2005." "It would be unjustifiable and discriminatory not to grant the same relief to incapacitated adults who cannot consent as to capacitous adults whose will has been overborne…..I am satisfied that once a matter is before the Court of Protection, the High Court may make orders of its own motion."

66 It is not surprising that the COP was so ready to use its inherent jurisdiction to declare the marriage invalid. Sham marriages for immigration purposes and the exploitation they bring with them may not have been within the range of abuses faced by vulnerable individuals when the mental health legislation was initially drafted, but by the time the Mental Capacity Act was passed in 2005 the practice had become rife across the country. That is no doubt why Keehan J felt that the common law had an important role to play in filling this lacuna; there were in his view “compelling reasons of public policy” why sham ‘marriages’ are declared non-marriages. It is vital that the message is clearly sent out to those who seek to exploit young and vulnerable adults that the courts will not tolerate such exploitation.

Rosalind English is a former academic who now edits 1 Crown Office Row's UK Human Rights Blog, which is where this article first appeared. DOWNLOAD THE FULL CASE: http://www.bailii.org/ew/cases/EWHC/COP/2013/3485.html

Independent mental capacity advocates need more power to challenge social workers, House of Lords told - Community Care IMCAs should be commissioned independently of local authorities to enable them to effectively support people under the Mental Capacity Act Independent mental capacity advocates (IMCAs) need more power to challenge social care professionals’ practice concerning people who lack the capacity to make decisions for themselves, a social worker has told the House of Lords. Elmari Bishop said IMCA services needed to be commissioned independently of local authorities to enable advocates to effectively challenge the decisions of council practitioners, for example where decisions are made to move people into care homes against their wishes. IMCAs must be appointed to advocate for people facing a change of accommodation or serious medical treatment, when they lack capacity to make these decisions and have no family or friends to speak on their behalf. They must also be appointed by councils to represent people being assessed under the Deprivation of Liberty Safeguards (Dols), where the person has no one else to consult, or to help family members represent their loved-ones. In some cases social workers have made complaints about IMCAs and the IMCAs have been told to back off.” Social worker Elmari Bishop Bishop, a consultant social worker at South Essex Partnership NHS Trust, said she had been involved in cases outside her organisation where IMCAs had challenged social workers’ decisions. ‘Social workers have made complaints about critical IMCAs’ “In some cases social workers have made official complaints about IMCAs and the IMCAs have been told to back off,” she said. “There are cases where IMCAs try to challenge, but the social workers just seem to be more powerful.”

67 Bishop linked this to the fact that councils commissioned IMCA services and that people were often referred to IMCAs by council-employed social workers. “The IMCAs should be commissioned completely independently and there should be easier ways of accessing them,” she said. “There are certain points where there should be access where there is none.” Her call for easier access to IMCAs was echoed by Mark Neary, whose son Steven was unlawfully deprived of his liberty in a care home by Hillingdon Council for nearly a year. Neary said that the IMCA appointed to support them was totally independent and was critical in enabling him to challenge Hillingdon’s decision-making through the Court of Protection. However, he said people needed direct access to IMCAs, without referral from the relevant council, so that they can challenge local authority decision-making under the Dols more quickly. “Steven was coming up for the fourth renewal of his deprivation of liberty before we got an IMCA. It took from April to November, and the judge said if we had had an IMCA back in April, Steven would have been home within weeks, but there was no access whatever forme or Steven to approach the advocacy service direct.” Clear definition of deprivation of liberty needed Both Bishop and Neary said that the government needed to produce a clear, statutory definition of what constituted a deprivation of liberty, particularly to help hospitals and care homes know when they need to apply to councils for a Dols authorisation. Currently there is no statutory definition and what constitutes a deprivation of liberty is shaped by case law. Bishop said that hospitals and care homes received “so many conflicting messages” about what constituted a deprivation of liberty, with case law specifying different criteria for care homes and psychiatric hospitals. Even among best interests assessors, whose role is to determine whether a person is being deprived of their liberty, “there are so many different ideas of what is and is not a deprivation of liberty”, said Bishop. She said this was leading to people not receiving the protection of the Dols when they should do. “It should still be left to the best interests assessor to decide in the end whether it is a deprivation of liberty or not, but from the start there needs to be much clearer guidance for the care home manager or the hospital manager,” she added. “They do not get the training in case law that best interests assessors receive, so they need much clearer guidance about when it needs to be requested.” Lack of legal penalties for breaching MCA Bishop also warned that councils lacked incentives to comply with the Mental Capacity Act because of the lack of consequent legal sanctions, a point also made by Alex Rook, partner in public law at legal firm Irwin Mitchell. Rook said the Court of Protection was primarily focused on determining what was in a person’s best interests, and less concerned with what had gone wrong previously with the way they had been treated by public bodies or services. It also normally did not impose costs orders on public bodies found to have breached the Mental Capacity Act in cases involving a person’s welfare.”

68 The unfortunate consequence of that is that where there is non-compliance, cost orders do not flow from that quite often,” said Rook. “That means that there is an element of getting away with it, rather than a brighter light being shone on that authority, saying, ‘look, that was not right’, and therefore encouraging better practice going forward.” http://www.communitycare.co.uk/2013/11/20/independent-mental-capacity-advocates-need-powerchallenge-social-workers-house-lords-told/#.Uo3VUHC9pJM?cmpid=NLC|SCSC|SCDDB-2013-1121

Key case on proof of destitution heads to Court of Appeal – Local Government Lawyer. The Court of Appeal has granted permission to two children to appeal in a dispute over a local authority’s decision on whether or not their family was destitute. The case of MN and KN v London Borough of Hackney relates to an overstaying family with two children. The parents and the eldest child entered the UK on visitors’ visas in 2000/2001 and had never left. The younger child was born in 2008 and has been diagnosed with autism. The parents approached the council for assistance in early 2012. They said they were about to be evicted from the property at which they had been staying and so about to be street homeless. Hackney conducted a s. 17 Children Act assessment which concluded that the family were not destitute. A social worker decided that the family had not provided him with sufficient information to enable him to verify what support had been available since their arrival in the country and why that support was no longer provided. A Human Rights Act assessment undertaken by the social worker also concluded that support for the family to return to Jamaica would not lead to a breach in their human rights under Article 3 or Article 8 of the European Convention on Human Rights. In the High Court in May this year Mr Justice Leggatt concluded that the council acted lawfully in declining to accept that as at 16 March 2012 the claimants were children in need. The judge said it followed that Hackney had no duty or power to provide the claimants or their parents with accommodation or support under s. 17 (or s. 20) of the Children Act 1989. According to the claimants’ solicitors, Deighton Pierce Glynn, the ruling has since been relied by other local authorities when refusing to support destitute migrant families because the parents could not provide sufficient evidence to prove they were destitute. A hearing in the Court of Appeal is expected to take place in 2014. For more detail on the High Court ruling, read ‘An issue of destitution’ by Ros Foster of Browne Jacobson, who acted for Hackney. http://www.brownejacobson.com/about_us/press_office/articles/an_issue_of_destitution_mn_an.as px

69 http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16282 %3Akey-case-on-proof-of-destitution-heads-to-court-of-appeal&catid=54&Itemid=22 Mental health and UK employment law – part 4 - Lexology For the next in our series on mental health in the workplace we take a look at some helpful guidance in ACAS’s booklet, “Promoting Positive Mental Health at Work” Chief among these is that the issues arising from mental ill health in the workplace are in many respects no different from those stemming from physical complaints. In each case, coping strategies include obtaining a diagnosis and medical treatment, some obligation of self-help on the part of the employee, amending the working environment or job design and flexible working. So why do managers sometimes run scared of tackling mental health issues? ACAS says this—”Our message is straightforward: managing mental health should hold no fear for managers – whether they realise it or not, they already have many of the skills needed to look after their employees’ wellbeing. A National Health Service survey in 2011 said that 77% of people surveyed believed mental illness to be an illness just like any other. However, the same survey suggested that 16% believed mental illness to be caused mainly by a lack of self-discipline and will-power, and that a breathtaking 75% considered that any woman who had ever been a patient at a mental hospital could not be trusted as a babysitter – about as logical as the view that anyone who had ever twisted her ankle was no longer fit to push a pram. Therein lies the problem, according to the booklet, i.e., that mental health illness “is often viewed as something disturbing or dangerous that lurks hidden beneath the surface of someone’s personality“. This can lead managers who are entirely adept dealing with staff with flu and broken bones to feel in mental health cases that they are treading through some hair-triggered mine-field, and that any mis-step in conversation or conduct could lead to an explosion – tears, violence, grievances, selfharm, nervous breakdown, etc. Giving an employee’s ill health an obvious wide berth can lead to his feeling isolated, rejected and unable to seek help from his employer. The UK’s Centre for Mental Health has calculated that “presenteeism” from mental health costs the UK economy some £15 billion per annum. The ACAS booklet refers to a self-perpetuating cycle with mental illness – “we don’t know much about it so we don’t talk about it so we are a little scared of it so we don’t talk about it, and so on”. Try to talk to him about:- the impact of his illness upon him personally; what adjustments might be made at work to accommodate this ; and what you can and cannot tell his line management and/or colleagues. It will be hard to set up a separate work station, introduce a work-coach or allow longer or more frequent breaks, re-assigned tasks, for example, without this becoming apparent to the employee’s immediate colleagues. Within limits, that is his prerogative. But if you can show as his employer that you have tried in a good faith and reasonable manner and without preconceptions to open a dialogue about his mental health condition, it will be very hard to fault you later.

70 http://www.lexology.com/library/detail.aspx?g=99ca12a0-7f3d-4584-92a722dd7b720ab0&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body++General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily +Newsfeed+2013-11-26&utm_term= NHS England: are GPs getting a fair hearing? GPs may not perform NHS services in England unless they are included in a national list (“the List”) held by NHS England. NHS England has powers to manage admission, suspension and removal from the List. If a GP’s name is not on the List he/she is prevented from practising. Evidently, therefore, NHS England’s list determinations have very serious ramifications for clinicians. However, the decision making process is treated as an internal proceeding and therefore operates in a similar fashion to disciplinary procedures in the employment context meaning, for example, that GPs are not entitled to be legally represented. Following Knowsley( R. (on the Application of S) v Knowsley NHS Primary Care Trust [2006] EWHC 26 (Admin)), the Courts have held that the procedural regulations governing list determinations (now the National Health Service (Performers Lists) (England) Regulations 2013, “the Regulations” ) should be read in such a way as to comply with Article 6 ECHR. NHS England List Decision Panels are ill-equipped to carry out the reinterpretation called for by the Courts. The Panels do not commonly include legally-trained members. Moreover, the Panels do not have the benefit of a legal assessor. There have been instances where, refusing to hear legal submissions from lawyers and in circumstances where the GMC has allowed a GP to continue to practise, the clinician has been prevented from working because a Panel has suspended him/her from the List. Faced with having to interpret the Regulations so that they comply with Article 6 ECHR, in the individual circumstances of the GP, it is not surprising if Panel determinations are procedurally unfair, in some instances. The question that arises is whether this is a problem of significance, warranting legal assistance to be provided to the Panels in all determinations. In light of the serious consequences to clinicians of list determinations, and the difficulty of determining procedural fairness, the issue should be given serious consideration. http://www.lexology.com/library/detail.aspx?g=f1f2fdfb-df8c-4f8a-922bd6293bcdd0de&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body++General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily +Newsfeed+2013-11-28&utm_term= Public bodies rapped after failing to involve relative in care planning – Local Government Lawyer A joint report by the Local Government Ombudsman and the Health Services Ombudsman has criticised a council and an NHS trust after they applied for a deprivation of liberty order for a dementia sufferer without telling his son. The Ombudsmen’s investigation followed a complaint about the assessment and care arranged by Kirklees Metropolitan Borough Council and the South West Yorkshire Partnership NHS Foundation Trust for Dr X’s parents, Mr and Mrs X. Mr X had been living in respite care while Mrs X, who also suffered with dementia, was being treated in hospital.

71 Dr X, the son, organised a care package to allow him to come home. However, the council and the NHS trust obtained a deprivation of liberty order, which prevented him from returning home. The two organisations failed to tell Dr X of their plans. Before the stay in respite care, Mr X was admitted to hospital with acute glaucoma in April 2009. Dr X told the two authorities that he believed the injury had been caused by a blow from his mother, who was beginning to show signs of dementia. However, the council and the NHS trust failed to raise a safeguarding alert. Mr X returned home for some months with an inadequate package of care, the report said. Mrs X’s symptoms started to deteriorate. In September 2009 she was admitted to hospital, and Mr X went into respite care. Mrs X stayed in hospital for six weeks while her son arranged a care package. Dr X told Kirklees and the NHS trust that he was employing a registered general nurse to provide care when his father came home. But the two organisations concluded that that this would be inadequate and applied for the deprivation of liberty order. They failed to involve Dr X in the decision. When the NHS trust wrote to Dr X recommending that his parents be placed in separate care homes, they sent a copy to his mother – “causing her a great deal of distress”, the report said. The Ombudsmen found that the NHS trust had also failed to reassess the father’s prescription for dementia drug, Aricept in line with NICE guidance. Following the Ombudsmen’s investigation, Kirklees and the NHS Trust have agreed to: • • • • • • •

Apologise to Dr X and his parents; Review the way they involve relatives in assessing and planning care for family members with dementia; Pay Mr and Mrs X £1,000 to acknowledge their distress; Pay Mrs X an additional £250 in recognition of the distress caused after she read the report into her future care; Pay Dr X £500 in acknowledgment of his distress; and Review their joint arrangements for responding to complaints. The NHS trust will also review the way it reassesses prescriptions for Aricept in line with guidance.

Dr Jane Martin, the Local Government Ombudsman, said: “As a result of actions by both the council and the trust, the couple were denied the chance of living at home together in a settled lifestyle for longer than they did. The couple suffered a needless loss of dignity, while their son felt ignored, undermined and excluded from any decision about their care.” Julie Mellor, the Health Service Ombudsman, added: “Involving their son could have led to better outcomes for the couple. Families and carers can have the key to understanding the needs of their loved ones. That’s why public services must, in law, involve families and carers in making life changing decisions for vulnerable people.” Solicitation in the age of LinkedIn I frequently tell people that while the Internet has opened up vast amounts of information to millions of people, the fundamental rules haven’t changed. By that I mean, just because a tweet can be posted and delivered in seconds, defamation is still defamation. And you can ruin someone’s

72 reputation in 140 characters. And just because it’s easy to cut and paste material from the Web, copyright laws still apply. But that is not to say that the rules are completely unaffected by new technology. Here’s an interesting piece about the intersection of LinkedIn with non-solicitation agreements. Nonsolicitation agreements have been around for decades, if not centuries. They’re very simple – an employee who signs one agrees that, upon leaving his current job, he won’t solicit his old customers for a period of time. And in the days before social media, things were a little more clear cut. That employee couldn’t send a letter or make a phone call to his old customers. Enter LinkedIn. Now the employee leaves and understandably updates his LinkedIn profile. The new profile details his new position, probably with a description of what he’ll be doing, along with contact information. And assuming the employee’s contacts include his old customers (and that seems like a very safe assumption) those folks are now notified about the employee’s new home. Is that solicitation? Maybe, maybe not. Check out the link for a discussion about how the courts have handled this. And the lesson? It’s time to update those non-solicitation agreements. Spell out the social media issues precisely. While a LinkedIn update may not be “solicitation” in the abstract – it is if you and the employee agree that it is. http://www.graydonhead.com/news/blog-jack-out-of-the-box-/jack-out-of-the-box/2013/11/15/solicitation-in-the-age-of-linkedin#page=1 To disclose or not disclose? What to do when faced with an Coroner’s Inquest – Mills & Reeve KEY POINTS” 1. Disclosure following patient deaths has become a “hot topic” in recent times and, particularly, since the events in Mid Staffordshire and Morecambe Bay. 2. There are more inquest hearings for health and care providers than ever before. Commissioners and regulators are being drawn into inquests where not previously the case. Proper preparation is vital. What’s it all about? Traditionally, coroners requested statements and reports from care providers and sometimes the notes, records and investigation reports as well. In fact, the power of the coroner was very limited. While, as a matter of good practice, care providers almost certainly complied with this request (as a matter of public policy), the actual and legal obligations were, at best, obscure.

The landscape has now changed so much in the last few months that not disclosing anything requested by a coroner is now untenable – irrespective of the “correct” legal position. Indeed, perhaps we should be considering a regime of “voluntary disclosure” to coroners more akin to preparing lists of documents in a civil trial or disclosure in criminal proceedings? Consequences • •

The inevitable consequence of this will be that many inquests will become a “trial” (in all but name) of the care provided. The public scrutiny of issues is becoming much more intense.

73 • • • •

•

You will need to prepare very carefully and have policies and procedures in place to deal with evidence collection. Witnesses will need a lot of support. This has the inevitable cost consequences in terms of both finance and manpower. In difficult cases you will need expert inquest lawyers dedicated to supporting you and your staff to ensure you give the proper assistance to the coroner and avoid censure or (at worst) falling foul of some new criminal offences. Proper management of inquests may no longer be a part time job – they can have a significant impact on your organisation and present a substantial reputational risk.

We are all well aware of the wide-ranging ramifications of Robert Francis QC’s report and his particular recommendation regarding full disclosure of all relevant information to the coroner. While the Government has, so far, stopped short of imposing a statutory duty of candour on healthcare professionals, there is a contractual duty of candour on NHS organisations.

Interestingly, the contractual duty is public sector specific and does not automatically have an impact or effect on the private sector. That is, unless a private sector provider enters into a contractual agreement with an NHS body, using an NHS Standard Contract, to provide public sector services. NHS bodies are required to commission clinical services using the NHS Standard Contract so, it is likely that independent health care providers will be impacted by this duty – or at least they should be. Of course, in the “court of public opinion” private providers would be open to significant censure if they acted otherwise and future NHS or other public authority contracts would surely be at risk (at best). It is now fair to say it will be extremely difficult for health and care providers to withhold anything documented from disclosure into the public domain, subject to the requirements of the Data Protection Act 1998 and Freedom of Information Act 2000 (although the grounds for disclosure under these Acts are now being widened in the public interest – so it will be difficult to rely on that in most cases). This should be borne in mind when anything is committed to record. This is not to say, of course, that less should be recorded. Full documentation is more important than it has ever been. However, the way in which something is recorded and how it is managed should be approached with future disclosure in mind. In particular, healthcare providers should carefully consider how they will approach taking and recording evidence from staff as part of incident investigations, without compromising on the thoroughness of the investigations. The Health Select Committee report on the principal recommendations of Robert Francis QC following the public inquiry into the Mid Staffordshire NHS Foundation Trust was prepared on 18 September 2013. The report makes it clear that legal accountability is important but it is even more important that legal advice based on defensive considerations is not allowed to impede the proper relationship between clinical professionals and patients. In addition, it is stated that:

“Defensive and overly legalistic considerations of the best interests of Trusts should not be allowed to override the duty to be open and transparent about adverse incidents. It is particularly important that NHS bodies provide full and candid explanations to relatives bereaved as a result of an adverse incident”. So, what should you be doing? How should the changing landscape affect your approach to preparing for an inquest?

74 •

•

• •

•

Once you are aware a patient’s death will be investigated by the coroner you should take all reasonably practicable steps to explore what information your organisation holds that may possibly be of relevance to the care of the deceased patient and the circumstances leading up to his or her death. The process of preparing the evidence and deciding what should be disclosed to the Coroner today is almost akin to the standards used in civil negligence claims or criminal proceedings. When interpreted into the inquest context, this essentially means anything that might assist the coroner, the family or other interested parties who have complaints or concerns or even, as is becoming increasingly common, any “position” or “argument” advanced by the family. Ultimately, it is for the coroner to decide what is relevant to his or her investigation and whether he or she will rely on the documents disclosed. However, disclosure to the coroner is effectively disclosure into the public domain as he will almost certainly share disclosure with the other interested persons and, indeed, if he considers the documentation relevant to his inquiry then he is obliged to do so. While it is important to bear in mind that the strict purpose of an inquest is not to apportion fault or blame and it certainly should not be a trial, inquests have become increasingly contentious and evidence such as reviews of the care and internal reports (the findings of which may not necessarily be accepted by your organisation) could be used by others to question, criticise and cast doubt on the quality of care provided and influence the conclusions drawn by the coroner.

Certainly, if the press are present, such criticism makes for a good headline. Where you find yourself in a position of being required to disclose such material to the coroner, you need to consider your approach carefully. While it is absolutely right that care providers are subject to transparency, it is equally right that such transparency should be fair and in context. For example, “if a review of the care was conducted and your organisation does not accept the findings, or some of the criticism, you may not wish for them to be accepted into evidence undisputed and further action will need to be taken. Careful wording will need to accompany the disclosure to the coroner to make your organisation’s position clear”. The coroner may decide not to rely or disclose the report (unlikely), or it may be necessary to prepare additional evidence to put the evidence in context – or even to dispute it, in extreme cases. It may also be necessary to ask the coroner to call additional senior management witnesses from your organisation to counter the evidence, or put it in context. In difficult (but thankfully still rare) cases you might want to consider seeking evidence from independent expert witness and request that the coroner adds them to the witness list. Of course, there will be cost consequences associated with the careful management required and the approach to take at each inquest needs to be considered in the context of the issues in that particular case, and other similar cases, and the risk to your organisation. Increasingly it is becoming a full time job. Coroners now have the power, under the Coroners and Justice Act 2009 (Schedule 5), to compel a person to produce any documents (or any other thing) in the custody or under the control of that person which relates to a matter relevant to the inquest within such a period as the coroner considers reasonable. A person can also be compelled to provide evidence about any matter specified in a notice issued by the coroner. Failure to comply with a summons (without reasonable excuse) can result in a £1,000 fine. Such a fine can be imposed on any individual who does not comply with the notice.

75 Now that there is pressure on coroners to complete investigations within six months of the date of referral of the matter to them, wherever possible, coroners are increasingly using the above powers to enforce deadlines for the provision of witness statements. Timeframes for compliance vary as it is dependent on what the particular coroner considers to be reasonable, but health and care providers should be aware that coroners have the power to impose such deadlines as set out in a notice and a fine if the notice is not complied with. If such a notice is issued against your employees and it is considered that the subject of the notice will not be able to comply or it is unreasonable to do so in the circumstances, this can be put to the coroner, but whether or not the notice should subsequently be revoked or varied is a matter for the coroner to determine, taking into account the public interest in the information in question being obtained and the likely importance of that information.

“Much will depend on the quality of the relationship between your organisation and the local coroner”. Could you end up in the clink? Criminal offences when obstructing full, open and honest disclosure There are now a number of new criminal offences in relation to disclosure, which can result in a fine of up to £1000, 51 weeks imprisonment or both. • •

•

Intend to distort or otherwise alter any evidence, document or other thing that is given, produced or provided for the purposes of a coronial investigation. Prevent any evidence, document or other thing from being given, produced or provided for the purposes of a coronial investigation, or to do anything that the person knows or believes is likely to have that effect. Intentionally suppress or conceal a document that is, and that the person knows or believes to be, a relevant document, or to intentionally alter or destroy such a document.

A document is relevant if it is likely that the coroner would wish to be provided with it, if aware of its existence.

“It is for this reason important that proper and reasonable investigations are made within your organisation to find out what information is held. All staff need to be aware of the obligation to assist. But how do you determine if a document might be relevant? One possible way out of that dilemma might be to list the documents and information you hold, send it to the coroner and then he can determine what he would like to see and from whom he might like to hear evidence”. That might be the safest way to avoid censure and any potential offence. The legal position in relation to disclosure from the coroner has also been strengthened. Coroners are now obliged to provide disclosure of a copy of the following documents (or make available for inspection) to an interested person as soon as is reasonably practicable after it is requested: • • • •

Any post mortem examination report. Any other report provided to the coroner during the course of the investigation. Where available, the recording of any inquest held in public. Any other document which the coroner considers relevant to the inquest.

This is subject to there being:

76 • • • • •

A statutory or legal prohibition on disclosure, The consent of any author or copyright owner not being reasonable obtainable, The request being unreasonable, The document relating to contemplated or commenced criminal proceedings, Or if the coroner considers the document irrelevant to the investigation.

However, speedy disclosure from the coroner should become the norm and you are entitled to expect it. The coroner may disclose the document in electronic format, redacted or simply make the document available for inspection at a particular time and place. The Chief Coroner is encouraging the use of electronic disclosure. The coroner may not charge a fee for any document disclosed to an interested person before or during the inquest (but can charge after an inquest has taken place).

http://www.mills-reeve.com/files/Publication/29d3b0e8-3140-4376-b5099a828b7eb282/Presentation/PublicationAttachment/be3996ca-1a35-4e06-8dcf0ac6811e3478/Briefing%20%20to%20disclose%20or%20not%20disclose%20Nov%202013_94472702_2.pdf#page=1 Volume of evidence | Opinion | Inside Housing Proposed changes to new anti-social behaviour laws could make it harder to obtain injunctions Under current proposals, in order to obtain a housing injunction, as well as showing that anti-social behaviour has affected its management of housing stock, a social landlord must show that it is more likely than not that nuisance or annoyance has been committed. This is the civil burden of proof. If the amendments are incorporated into the legislation, the test for an injunction to prevent nuisance and annoyance will become the higher criminal standard, which is beyond reasonable doubt. Crown court judges are often heard describing this standard to juries as ‘being satisfied so that you are sure’. This is a huge leap, and may lead to a decline in the number of applications brought, for fear of not meeting the relevant standard and then being hit with the costs of the defence if applications are unsuccessful. Another proposed amendment is to change the description of anti-social behaviour from ‘causing a nuisance and/or annoyance’ to ‘causing harassment, alarm or distress’. The two tests have originated from the two different existing tools that the government is seeking to combine. The anti-social behaviour order (which requires proof of harassment alarm and distress) and the housing injunction (which requires proof of nuisance and or annoyance). Breaching an ASBO is a criminal offence. Breaching a housing injunction is a contempt of court and does not leave a person with a criminal record, even if they have been sent to prison. If this amendment is incorporated, injunctions to prevent nuisance and annoyance will only be available to prevent harassment, alarm and distress, and not merely nuisance and annoyance. For example, it would be very difficult to show that noise nuisance and loud parties, commonly dealt with through the current housing injunction, cause a person harassment, alarm or distress.

77 A court must also decide whether it is right to grant an order bearing in mind the circumstances of both parties. At present, the test is whether it is ‘just and convenient’ to do so, which means that the court should balance the interests of both parties, and consider who will suffer the most detriment: the applicant if the order is not made, or the person that will be the subject of the injunction. If the amendments succeed, then this test will change to what is ‘necessary and proportionate’. Some terms that have been regular inclusions in orders in the past might not be judged to be proportionate if challenged on a human rights basis (for example, excluding someone from a particular area). While the amendments are only proposals at present, if any of them are incorporated into the legislation, they will make tackling anti-social behaviour much tougher when the new regime comes into force in 2014. It is NOT difficult to show that noise nuisance causes distress. Should you really be going to Court for any sort of Order if you cannot show that the behaviour caused HAD? If you are relying on 50/50 to get your case through then your evidence must be pretty week. Excluding someone from an area - necessary and proportionate to ensure that they don't move into a house across the road and to ensure that the victims have ongoing protection. http://www.insidehousing.co.uk/home/blogs/volume-ofevidence/6529629.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3377 479_IH-Legal-271113-JK&dm_i=1HH2,20E2V,82EKTS,78FXO,1 YLA v PM & MZ [2013] EWHC 3622 (Fam) Judgment in Court of Protection proceedings, brought by local authority, concerning vulnerable adult and care proceedings concerning child born to her. This judgment was made in Court of Protection proceedings regarding a vulnerable adult, PM, who had moderate to severe learning difficulties. PM was Islamically married to MZ. Prior to a civil ceremony the local authority registered a caveat against the marriage. The Registrar was satisfied as to capacity and the ceremony proceedings. At the ceremony PM was slapped by her mother to force her to smile for photographs. PM became pregnant. Shortly before the birth PM and MZ left PM's family home alleging abuse by PM's family. Following birth of their child, B, he was placed in a supportive foster placement with his parents. PM and MZ did not share a room in the placement. PM was unable to care for B even for short periods. MZ's attitude to PM caused concern in the placement. Parker J first considered the question of capacity. In relation to the capacity to consent to sexual relations she found that, despite PM understanding the mechanics of sex, she lacked the capacity to understand the health risks from such relations and the capacity to say 'no'. Parker J determined that she lacked capacity to consent to sexual relationship. Similarly while PM understood some basics concepts of marriage she did not have the capacity to consent to marriage. Parker J concluded by considering the question of capacity and forced marriage and guidance given to Registrars. She said that an incapacitous marriage is a forced marriage: if a person cannot consent he or she cannot give free and full consent. Protection could be effected by a forced marriage protection order. In future a court may need to decide whether such an order could be made against the Registrar General.

78 Â Â Mr Martin Downs (instructed by YLA Legal Services) for the Applicant at each hearing Ms AlevGiz (instructed by Harney& Wells) on 20 and 21 March 2013, Ms Lorraine Cavanagh on 10 April 2013 and Mr Anthony Hayden QC and Ms Lorraine Cavanagh on 3 May 2013 for the First Respondent by their litigation friend, the Official Solicitor Ms Janet Bazley QC on 20 and 21 March 2013 (instructed by Quality Solicitors, Howlett Clarke) for the Second Respondent with Mr Andrew Bagchi as junior counsel. Mr Andrew Bagchi alone on 10 April and 3 May 2013. Hearing dates: 20 & 21 March, 10 April and 3 May 2013 RGB v Cwm Taf Health Board &Ors [2013] EWHC B23 (COP) Application to the Court of Protection by a husband of an elderly woman with dementia, seeking a series of declarations that the Health Board had acted unlawfully by preventing his wife from living with him and having contact with him. Applications refused. This was an application to the Court of Protection by the husband (Mr B) of an elderly woman (Mrs B) with dementia. He sought a series of declarations that the Health Board had acted unlawfully by preventing his wife from living with him and having contact with him. The couple had ceased to live together in November 2010 when Mrs B left the family home, first to live with her son and later with her daughter from a previous marriage. The police were involved as Mr B alleged that she had been kidnapped by her children but two social workers who interviewed her concluded that she had capacity to decide where she lived. A consultant psychiatrist formed the same view when he assessed Mrs B for the purposes of an earlier application to the Court of Protection in February 2011. Later in 2011 Mrs B issued divorce proceedings. She subsequently completed an Advance Statement setting out that she did not wish her husband to be informed if she became unwell and that she wished to live with her daughter and not to return to the home she shared with Mr B. Mrs B was admitted to hospital in June 2012. Mr B visited her in August 2012. However, subsequently, he was prevented from visiting in accordance with the Advance Statement. In March 2013, Mr B instigated the application that led to this judgment. By this time the divorce proceedings had been stayed as Mrs B now lacked litigation capacity. Moor J felt it was necessary in the circumstances to make a series of findings of fact as to Mrs B's wishes and whether she had capacity at the time she indicated those wishes and feelings. He referred to the evidence of numerous witnesses that Mrs B did not wish to live with her husband and did wish to divorce him, evidence which he described as "overwhelming". He therefore found that these wishes were genuine and were not the result of the undue influence of Mrs B's children as alleged by Mr B. She had held these views consistently and over a period of time. He found that at all relevant times, Mrs B had the capacity to make these decisions. As Mrs B now lacked litigation capacity, the Court of Protection was able to rule on matters relating to her welfare. On the basis of the evidence, Moor J rejected Mr B's application for an order that he be permitted to have contact with Mrs B. This was in accordance with her Advance Statement and the evidence of a psychiatrist that there would be no benefit to her from such contact and it might be distressing for her.

79 Â Â Moor J concludes that the Health Board acted entirely correctly in refusing to let Mr B see Mrs B when she lost capacity. He therefore refused the application for the declarations sought by Mr B. His claims for damages, access to Mrs B and information about her well-being, and to be appointed as her welfare deputy were also refused. Mr James Gatenby for the First Respondent Mr Phillip Morris for the Second Respondent Mr Peter Wakeford appeared in person Hearing dates: 8th to 10th October 2013

GENERAL 4 linguistic reasons to leave patient alone – KevinMD – USA – Abridged Version For at least two decades doctors, caregivers, the people they care for, and advocates have deplored the term patient or have been exposed to the arguments of those who deplore it. “Patient” has few defenders in an age in which Western consumers of health care insist on an equal voice in the management of their afflictions, and loathe ceding all power to those who are dispensing relief. This blog recently published a thoughtful guest post by author Pat Mastors, who pleaded with us to coin a new term to replace the odious patient: We need a new word for patient. “Be careful what you wish for,” goes the saying. If you’re temporarily laid up in a hospital because you’ve taken a nasty fall on one of the trails, you’re a patient. Would anyone object to being called a person who could tough it out, who persevered in a task, who didn’t complain but simply got down to business, who didn’t give in or give up? Yet these meanings of the adjective patient were common in the medieval period. The term patient has thus fallen victim to unfavorable cultural bias. Nevertheless we’re awed by heroic patients who bravely carry on their lives — without complaint, without self-pity — even as they struggle with illnesses that would crush the spirits of many of us. At the same time, though, we’re frightened by the sight of the utter helplessness that attends serious illness or injury. Like it or not, there are times when one is thoroughly acted upon clinically, and lacks the agency implied in being a consumer, user, partner, client, or customer — all suggested alternatives to patient. The main criticism of patient is that it doesn’t connote the agency and control that real-world patients have, or hope to have. However, linguistic history shows that a term can survive with meanings that are radically different from those that earlier generations recognized. Because of growing arguments against patient, it’s possible that a hundred years from now, speakers may be surprised to learn, researching the 21st-century etymology of the term, that it ever carried the connotation of passivity. Several expressions co-occur with patient in context and along with patient, they contribute to the linguistic integrity of that context. How should we regard the following sentences? *The doctor is treating a consumer with diabetes. *We want to improve hospice care for dying users. *This drug doesn’t help all recipients. *The doctor ordered surgery for his partner’s injured knee. *”I’m not a patient with epilepsy, I’m a customer with epilepsy!”

Janet Byron Anderson is medical linguist and medical editor, and author of Sick English: Medicalization in the English Language . She can be reached at MedLinguistics. http://www.kevinmd.com/blog/2013/11/4-linguistic-reasons-leave-patient.html 5 Trends For Health CIOs In 2014 - InformationWeek

81 The potential impact of ICD-10 and Meaningful Use Stage 2, coupled with the transition to valuebased reimbursement and new-care-delivery models, promise to overwhelm their budgets and burn out their already overworked staffs. Nevertheless, there are some other trends healthcare CIOs should pay attention to in 2014, partly because of their bearing on the main events. KLAS Research, in a poll of 200 healthcare organizations , found that MU Stage 2 had made patient portals a "must-have" technology for doctors and hospitals. The government EHR incentive program requires providers to allow patients to access their health records electronically. In addition, providers must send care reminders and education materials to at least 10% of their patients. EHRs must include Direct capability to receive 2014 certification, and Direct messaging is also one way to satisfy the Meaningful Use Stage 2 requirement that providers exchange care summaries electronically at transitions of care. The health information service providers that enable providers to send and receive Direct messages are growing by leaps and bounds, partly because EHR vendors must partner with these entities or create their own HISPs. What most providers don't realize is that the spread of EHRs, patient portals, and health information exchanges are making them more vulnerable to attack at more points than ever before. 4. At the same time, financial pressures are forcing many of them to outsource their billing to cloudbased vendors. And a cloud-based EHR from Athenahealth beat products from eight bigger EHR vendors for usability in a recent KLAS poll. BYOD is a major concern for CIOs, as is insecure texting between clinicians, and those issues will continue. But 2014 could be the year when physicians start prescribing mobile health apps to patients. If there's a major increase in the use of these apps by patients with chronic diseases, monitoring data from patients' mobile devices might also start flowing into hospitals and practices. The mobile health app revolution poses two questions to CIOs: How do you ensure the security of the bidirectional flow of personal health info between doctors and patients? And how do you deal with the sheer volume of data so clinicians aren't overwhelmed? http://www.informationweek.com/healthcare/mobile-and-wireless/5-trends-for-health-cios-in2014/d/d-id/1113133 A quarter of women prisoners self-harm every year - The Information Daily.com One in four women prisoners in England and Wales self-harm every year, new research suggests. The study, published in The Lancet, found that female prisoners were 10 times more likely to self harm than male prisoners—with 20–24 per cent of female prisoners and 5–6 per cent of male inmates self-harming every year. Despite reductions in suicide rates over the 6-year study period, the research led by Dr Seena Fazel and Professor Keith Hawton from the University of Oxford revealed that incidents of self-harm had not decreased.

82 “Repetition rates were striking—if a female prisoner self-harmed, she would self-harm eight times per year, and there were 102 women (and two male) inmates who self-harmed more than 100 times per year”, explains Dr Fazel, a Wellcome Trust Senior Research Fellow. The researchers found that several factors increased the risk of self-harm in both sexes, including: younger age, being white, and being unsentenced or having a life sentence. Among female inmates, having committed a violent offence was also a factor. Cutting and scratching were the most common methods of self-harm in both sexes, followed by poisoning, overdose, or swallowing objects not intended for ingestion among men and teenage boys (9 per cent), and self-strangulation in women and adolescent girls (31 per cent). Self-harm in prison was also found to be a strong risk factor for suicide in prison, particularly among male inmates—with an annual suicide rate among male prisoners who self-harm (334 per 100,000) around four times that of the general male prison population (79 per 100,000). According to Dr Fazel, “While self-harm is a substantial problem across the board, it is a particularly serious issue for women in prison who make up only 5 per cent of the prison population but account for half of all self-harm incidents”. “Moreover, now we know the extent to which the risk of subsequent suicide in prisoners who selfharm is greater than the general prison population, suicide prevention initiatives should be changed to include a focus on prisoners who are self-harming, especially repeatedly”. Writing in a linked comment, Dr Andrew Forrester from Kings College London UK, and Dr Karen Slade from Nottingham Trent University UK, call for more research to address the questions of ‘why’ and ‘what works’ to reduce the stagnating self-harm rate in prisons. They said: “Despite clear gains in the care of prisoners and prevention of self-harm and suicide in prisons in England and Wales, much work remains to be done”. The available evidence “indicates a key role for multi-agency collaboration, in which “suicide is everyone’s concern”, rather than being the sole preserve of health-care staff”. “We need to invest in the wide inclusion of all people who, on the ground, can listen to prisoners who are experiencing distress, mobilise concern, and help to deliver joined-up care”. http://www.theinformationdaily.com/2013/12/16/a-quarter-of-women-prisoners-self-harm-everyyear London MASH Project - The five core elements

1. All notifications relating to safe—guarding and promoting the welfare of children to go through the hub. All concerns of whatever level must be routed through the hub to ensure that low level repeat concerns from a variety of partners can be identified in the MASH and prevent these from being masked through volume or lost in the bureaucracy of a partnership. This focuses on anything with regard to safe-guarding and promoting the welfare of children. This will enable effective interventions at the earliest opportunity. Having one route in and one decisionmaking process ensures a standard of risk assessment and decision-making that can be regularly base-lined and audited. This approach was strongly endorsed by the Ofsted report,

‘Good Practice by Local Safe-guarding Children Boards’ and ‘The Munro Review of Child Protection’. 2. A collocated team of professionals from core agencies* delivering an integrated service with the aim to research, interpret and determine what is proportionate and relevant to share. This is critical to ensuring all partners have the confidence and trust to engage fully in effective working. The duty of care for agency information remains with the ‘owner’ at all times and the decisions to share information are made on a case by case basis within the statutory frame-work to ensure information is available upon which to make the best decision. All information should be disclosed within the security of the hub. 3. The hub is fire-walled, keeping MASH activity confidential and separate from operational activity and providing a confidential record system of activity to support this. This provision is required to ensure sensitive information will remain in a confidential environment where only those who actually need to know get to see the information. Information is disclosed on a strictly ‘need to know basis’. 4. An agreed process for analyzing and assessing risk, based on the fullest information picture and dissemination of a suitable information product to the most appropriate agency for necessary action. Essentially, this is a partnership giving itself the best opportunity to make effective and efficient decisions through having the most complete information at the earliest stage. By utilizing a standardized risk-assessment and threshold model a consistency and clarity of decision-making will be achieved. MASH will provide proportionate and relevant information to the most appropriate agencies. 5. A process to identify victims and emerging harm through research and analysis. MASH provides a secure environment where information is subjected to ongoing research and analysis. This will identify victims and perpetrators by understanding repeat notifications and the identification of individuals who will suffer increasing levels of harm in the future. The identification of these individuals and the families around them will enable services to intervene at a much earlier time thereby providing opportunities to reduce harm and longterm costs. The provision of analysis within the MASH enables the commissioning and prioritization of resources to improve safe-guarding provision. Further to the five core elements, it is recommended that all areas identify a Project Manager and named agency leads for local MASH implementation and develop self-evaluation processes to contribute to the on-going pan-London evaluation.

* Core partners /agencies required as co-located in the MASH: •

Children’s social care

•

Police

•

Health

84 •

Education

•

Probation

•

Housing

•

Youth Offending Service

N.B.The assignation of‘ *Core’ to specific agencies/functions is not intended as a limit to further co-location or involvement of other key local partners or specialists from within pan London or local organisations. UKBA would be such an example and also the inclusion of Adult Social Care or information/sharing functions of specialist police units. It is entirely possible for MASH’s to operate from the start or incrementally develop with these units embedded to reflect local priorities, resources and opportunities. Nursing & Midwifery Council's progress 'fragile', warns watchdog - The Information Daily.com The Health Committee, in a report published today, calls on the NMC to raise its profile among registrants, patients and the public, warning that it must “not take its eye off the ball”. The NMC is a statutory body, set up in 2002, to protect the public by ensuring that nurses and midwives provide high standards of care to their patients. The body has, however, been at the centre of a media storm on various occasions, with the barring of whistle-blower Margaret Haywood in 2009 from practising nursing provoking a particularly antagonistic response from the public. A report by the Council for Healthcare Regulatory Excellence in 2012 critically examined the NMC’s leadership, whilst the Information Commissioner’s Office fined the body £150,000 this year for losing “highly sensitive” personal data. Today’s report praises the NMC for its commitment, from 2015, to toughen the target period for resolving fitness to practice cases to 12 months. However, it stresses that the NMC must ensure nurses and midwives understand their professional obligation to raise concerns when they see evidence of poor patient care. The body must also ensure that patients and public are made more aware of the role of the NMC as the regulator of professional and clinical standards, says the report. The Chair of the Health Committee, Stephen Dorrell MP, said: “The Committee will review the progress made by the NMC with its plans for revalidation during Spring 2014 and we shall conduct a further full review in Autumn 2014”. Barring scheme for directors will do more harm than good | Leader | Health Service Journal Using a fit a proper persons test to bar directors from the health service will put even more pressure on the Care Quality Commission, and the government should abandon the idea ‘The government is well practised in U-turns and we would not begrudge them one more’ The government has decided the Care Quality Commission will be the arbiters of a fit and proper person. Because the test is now linked to potentially depriving someone of their livelihood it is bound to involve significant effort on behalf of the overstretched regulator.

85 When the “testing” of directors begins, HSJ predicts very, very few NHS directors will fail. This will disappoint those from a wide range of interest groups who believe disagreeing with them is an indication of unfitness. The CQC will spend most of the time defending its decisions to give a board a clean bill of health and the rest in industrial tribunals. That is the last thing its slowly recovering image needs. Zombie policy When it is better understood that the scheme is unlikely to extend to non-board directors, commissioners or to those in system management roles at NHS England, Monitor or the Trust Development Authority, the approach will be further undermined − and the zombie policy of regulation for NHS managers will return. Last week, the Department of Health’s own leadership standards group urged caution in implementing a barring scheme , suggesting the same result would be achieved by better use of existing disciplinary procedures. The government is well practised in U-turns and we would not begrudge them one more. The government’s full response to the Francis report offered little new. Jeremy Hunt feels the reform of the CQC and the new scrutiny regime overseen by three chief inspectors is the most significant change of 2013. HSJ would not argue with that, but would point out that these reforms were well in train before the Francis report thudded on to the doormat http://www.hsj.co.uk/5065583.article?WT.tsrc=Email&WT.mc_id=EditEmailStory#.Uo4cWWTfxKU BASW-backed MP inquiry lifts lid on serious pressures facing social workers– BASW & All Parliamentary Group on Social Work. The ability of social workers to keep children safe from harm has diminished, not improved, in the five years since the convictions in the case of Baby Peter Connelly in Haringey, the All Party Parliamentary Group on Social Work says today. The Inquiry into the State of Social Work report based on expert testimony from frontline social workers, heard evidence of unmanageable caseloads, rising numbers of children entering care and IT systems that are preventing social work professionals from spending time with at risk young people. Social workers told MPs about their concern that caseloads in excess of 60 children could mean they fail to detect indications of abuse in a household. Referring to a particular case he was working on at the time, one practitioner told MPs: “I have niggling concerns about the mum and her two children but I don’t have the time to go back frequently to tease out the situation”. MPs raised concern that the reform agenda which emerged from the Baby P tragedy is not having sufficient impact on frontline social workers. MPs are also worried that a 70% rise in care applications since 2007, combined with challenging local authority budgets, have left social workers less able to protect vulnerable children than five years ago – the opposite outcome the public would have hoped for when those responsible for Baby Peter’s death were convicted in November 2008. Ann Clywd, Chair of the APPG on Social Work, said: “Children living in chaotic households or where concerns have been expressed about their welfare need to know that there are professionals out there with the time and support to be able to come and make a difference to their lives, and above all to keep them safe from harm. “What MPs heard during this inquiry is that all too often social workers do not have the capacity they need to be able to concentrate on that vital duty of ensuring the safety of as many young people as possible.” The APPG report contains a series of recommendations to help address the obstacles to good practice, including proposals to get social workers out from behind their desks and located in the heart of communities, as well as the introduction of paid overtime to reflect the amount of evening and weekend hours practitioners currently spend trying to keep up with huge caseloads.

86 The inquiry followed a survey into the State of Social Work carried out by the British Association of Social Workers in May 2012, in which 1,100 social work professionals revealed unmanageable caseloads and fears that service cuts would lead to avoidable deaths. Commenting on the inquiry report, BASW’s Chief Executive Bridget Robb said: “Social workers will welcome this recognition by MPs of the fact that five years on from the Baby Peter tragedy hitting the headlines, the situation simply has not improved. Worse still, it appears for some social work professionals, to have deteriorated, making it even harder to safeguard young people than it was before. “The profession, and in turn those who rely on social work services, is struggling with vast caseloads that are continuing to grow as care applications continue to soar – a direct result of councils becoming more risk averse since Peter Connelly’s death – yet they are doing so at a time when downward pressure on local authority budgets has never been more severe.” See full Inquiry into the State of Social Work report http://cdn.basw.co.uk/upload/basw_90352-5.pdf Birmingham Basics:

Birmingham Safeguarding Children Board · Always see the child first · Never do nothing · Do with, not to, others · Do the simple things better · Have conversations, build relationships ·Outcomes not inputs

Birmingham City Council (12 015 642 ) Local Government Ombudsman Antisocial behaviour Fault found causing injustice and recommendations made Complaint from a lady that the council consented to an application from a man for a mutual exchange to a property next to her home despite having evidence of his antisocial behaviour. The lady also complained that the council failed to tell the Housing Association, who owns the neighbouring property about the man's past behaviour. The Ombudsman found maladministration causing injustice. Recommended remedy The council has apologised to both the complainant and the Housing Association. However the Ombudsman recommends that the council pay the lady £1,500 to acknowledge its failures.

87 http://www.lgo.org.uk/GetAsset.aspx?id=fAAxADkAMAA0AHwAfABUAHIAdQBlAHwAfAAwAHwA0 Browne Jacobson Conference – Liabilities in Elderly Care – Reducing Legal Risk in an Ageing Britain – 11th March 2014 – Nottingham. Leading experts will discuss and exp lain: • • •

Common and growing causes of litigation in an elderly care setting Liabilities and legal issues you will face How you can protect yourself, your organisation and your service users

Date:11March2014 Location: Nottingham Conference Centre Audience: Board/senior management, public & private, health and social care Cost: £150.00 Flat fee rate To register–please email charlotte.smith@brownejacobson.com For More Information: http://www.bjhealthlawyers.com/liabilities-elderly-care-conference-2014/ Top ics: In addition to the plenary sessions, you will be able to attend streamed workshops suited to your own interests, covering: • • • • •

Claims, inquests and liabilities Capacity and decision making Access and funding issues Service delivery and integration Medical treatment issues

Speakers: In addition to experts from Browne Jacobson, confirmed speakers include: Dr Suzette Woodward, Director of PatientSafety, Learning and People, NHS Litigation Authority Dr Glen Mason, Director of People,Communities and Local Government, Department of Health Miss Mairin Casey, HM Coroner, Nottinghamshire Dr Jonathan Treml, University Hospitals Birmingham NHS FoundationTrust Paul Hodgkin, Chief Executive, Patient Opinion Professor Peter Bartlett, Nottingham University Bridget Dolan, 3 Serjeant’s Inn Rachel Griffiths, National MCA and DoLS lead for the Care Quality Commission David Lock QC, no.5 Chambers Lucy Bonnerjea, Department of Health MCA lead Professor Rowan Harwood, Nottingham University Hospitals NHS Trust Bryan Higgins,Associate Director, Grant Thornton Professor Sube Banerjee, University of Sussex Dr Clive Bowman, former Medical Director, BUPA Karen Frankland, Deputy Chief Executive, Nottingham City care Dr Dennis Cox, RCGP Professor David Oliver, President elect of the British Geriatrics Society

88 Calderdale Council (12 015 328) Local Government Ombudsman Two parents complained about the support the council provides to care for their disabled daughter. Specifically they complained that the council: • • • •

Has not properly assessed their daughter's needs; Does not provide enough support; Has not properly considered their needs as carers; and Has decided that it will no longer pay the father as carer for his daughter.

The Ombudsman found maladministration causing injustice. • • • • •

Appoint an independent social worker to assess the daughter's needs, and the needs of the parents as carers and produce a care plan that complies with statutory guidance within 35 days; Review its decision not to pay the father to provide care for his daughter; Pay £5,000 to the parents for the significant distress, time and trouble they have experienced; Make an additional payment at a level to be agreed with the Ombudsman if, following assessment, the council identifies services the family were entitled to but have not received; and Review its practices so that its assessments of disabled children fulfil the council's statutory duties and meet the requirements of government guidance.

http://www.lgo.org.uk/decisions/children-s-care-services/disabled-children/calderdale-council-12-015-328/ DOWNLOAD THE REPORT: http://www.lgo.org.uk/GetAsset.aspx?id=fAAxADkAMAA1AHwAfABUAHIAdQBlAHwAfAAwAHw A0 Calls for council review over 'slavery' case | News | Inside Housing A London council is under pressure to reveal why it did not intervene sooner in a case where three women were allegedly held as slaves in a flat owned by the local authority. Over the weekend police identified 13 locations in London linked to a couple that are believed to have held three women as slaves for at least 30 years, including an address in Brixton, south London. Police are undertaking inquiries into the area around a flat where the household is said to have lived. A spokesperson for the Labour-led council said yesterday evening: ‘Lambeth Council worked closely with the police in the weeks leading up to the three women leaving the house and continues to do everything to assist with the police investigation. ‘This is an extremely complex case involving a number of individuals going back decades. It is too early at this stage to provide the detail of any contact we may have had with them.’ The council refused to supply further details on the case, but it is understood officials are trawling records to see what communication the local authority had with the household over the thirty year period. ‘Right now the security, confidentiality and well-being of those involved is paramount,’ the spokesperson added. Ashley Lumsden, the leader of the Lambeth Liberal Democrats, said: ‘We are extremely concerned at the reports we have seen and are looking to the council to explain its involvement from a housing, educational and social services perspective. ‘‘We want a review conducted promptly and to be published so that we can consider it and so that lessons can be learnt.’

89 Steve Rodhouse, commander for the Metropolitan Police, last week described the household as a ‘collective’ and that the police believed two of the victims met the male suspect in London through a shared political ideology. ‘The people involved, the nature of that collective and how it operated is all subject to our investigation and we are slowly and painstakingly piecing together more information,’ he said. A couple have been bailed arrested and bailed. http://www.insidehousing.co.uk/calls-for-council-review-over-slaverycase/6529670.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3377479_IH-Legal271113-JK&dm_i=1HH2,20E2V,82EKTS,78FXO,1 Cambridgeshire County Council (12 015 730) - Local Government Ombudsman Complaint from a father that the council delayed in assessing their son's needs and there were faults in the assessment process. The council also failed to progress the complaint to the second stage of the statutory complaints process. This meant that the son's needs were not fully met for 17 months. The Ombudsman found maladministration causing injustice. 1. Apologise to the father for the faults identified; 2. Pay £800 to reflect the period of nearly three months when the family didn't receive a payment to meet the son's needs (based on the sum of £3,200 assessed at the end of June 2012); 3. Review the son's needs and provide the necessary resources to meet them. If the review concludes the son's needs are greater than £3,200 a year, they should pay the difference between the amount assessed and the payments already received - allowing for the £800 already paid. This payment and the £800 is not subject to being spent on items agreed by the council; 4. Pay the father £250 for his time and trouble in having to approach the Ombudsman rather than progressing his complaint to the second stage of the statutory process; and 5. Ensure complaints involving children are dealt with in accordance with statutory guidance and without delay. The council has already carried out the review referred to above. It has concluded that the son's needs equate to £6,539.90 a year. http://www.lgo.org.uk/GetAsset.aspx?id=fAAxADkAMAAzAHwAfABUAHIAdQBlAHwAfAAwAHwA0 Care crisis | Analysis | Inside Housing In an unusual move, last month, the Care Quality Commission published a damning report on Sue Starkey House, a Notting Hill Housing-run extra care sheltered housing unit in east London. A report published on 14 November revealed that its care arm, Sanctuary Care, which owns and runs 60 care homes, had put residents ‘at risk of receiving unsafe care and treatment’ because of staff shortages. Professor Martin Green, chief executive of the English Community Care Association, a representative body for community care providers, warns that the gap between funding and the cost of care is forcing providers to choose between walking away from local authority contracts or carrying on with a ‘squeeze on quality’. ‘Some authorities are paying less than £400 a week [for care],’ he says. ‘This is working out about £2-something an hour [per resident]. Caroline Abrahams, charity director at Age UK, says service standards are being threatened by local authority funding pressures. ‘With budgets being stripped to the bone the [social care] system is on the verge of

90 collapse,’ she says. ‘Providing safe and dignified services must be the first priority of any organisation and there must be a zero-tolerance attitude to poor, neglectful care whether in a hospital or care home.’ Kath King, group director at Notting Hill Housing says ‘the commissioning process and the emphasis on price has cut care to the absolute essentials, so delivering care in this environment is very challenging’. ‘It’s tough for us and for our commissioning partners,’ she adds. ‘This was the first time in more than 20 years of providing care services that we have received a report like this, so we have commissioned an independent review to look at what went wrong.’ Jane Ashcroft, chief executive of Anchor, which owns and manages nearly 100 care homes across England, says it is feeling the pinch. ‘Local authorities fund a significant number of people living in our care homes and their budgets are under pressure… Adult social care isn’t a ring-fenced budget so it is pulled in all different directions,’ she says. Tony Stacey, chair of 100-housing association group Placeshapers, says the low commissioning price at which councils ask housing associations to bid means the care home business is ‘running high up our risk register’. ‘Some of the Placeshapersgroup are deciding that care and supported housing is not for them anymore,’ he says. http://www.insidehousing.co.uk/home/analysis/carecrisis/6529831.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3428861_Copy+of +New+Care+%26+Support+Template&dm_i=1HH2,21HQ5,82EKTS,7CQ9K,1 Changes to defamation law from 1 January 2014 - Local Government Lawyer. [SUMMARY of ARTICLE] It introduces a number of new statutory defences, including a new defence for those organisations that host user generated content on their website, and it abolishes the old common law defences of justification, fair comment and Reynolds privilege. It is worth pointing out that the Defamation Bill included a sub-provision which extended the rule in Derbyshire to cover all "non-natural legal persons performing a public function" and which would have prevented those entities from bringing a claim in relation to that function. However, Parliament declined to include that provision in the Act preferring the courts to develop the Derbyshire principle as they consider appropriate and necessary in the light of individual cases. This means that a number of entities that provide public services or perform a public function and that do not obviously fall within the scope of the rule in Derbyshire may be entitled to bring a defamation claim in their own name provided the requirement of serious harm is shown. This section replaces the common law defence of justification with a new statutory defence of truth. The defence of honest opinion will apply where the defendant can show that the following three conditions are met: that the statement complained of was a statement of opinion; that the statement complained of indicated, whether in general or specific terms, the basis of the opinion; and that an honest person could have held the opinion on the basis of any fact which existed at the time the statement complained of was published. Publication on a matter of public interest this section creates a new statutory defence of publication on a matter of public interest where the publisher reasonably believed that publication of the statement was in the public interest. Those intending to make available material that is likely to contain statements that defame an individual or organisation will need to carefully consider not only whether the material is on a matter of public interest but whether publication of the statements is in the public interest. Section 5 of the Act and the Defamation Regulations 2013 create a new defence for website operators who did not "post" the statement complained of. This defence is intended to assist those operators who engage in light moderation of UGC, although the point at which "moderation" becomes "posting" is unclear and will no

91 Â Â doubt be the subject of litigation. Although the regulations are "designed to be straightforward", they are not; it is very likely that disputes will arise over whether a complainant, the website operator or respondent has discharged their respective obligations under the regulations. Where the author of the statement is not identifiable, and where the website operator receives a complaint about the statement, in order to keep the defence the website operator must comply with steps and timeframes set out in the regulations. The purpose of s.5 is to allow the claimant to deal directly with the author of the statement although the court has the power to require a website operator to remove a defamatory statement where it gives judgment for the claimant in a claim involving only the claimant and the author. In those cases, the website operator is obliged to remove the offending material. However, in some cases, the poster will respond but the process might end in frustration for the complainant as the author of the statement can refuse his consent to the statement being removed and his contact details being provided to the complainant. Where an author re-posts the same material on the same website on two or more occasions, the website operator is obliged to remove the material from the website within 48 hours of receiving the complaint. This avoids the need for the complainant to follow the same process repeatedly in situations where the poster persistently re-posts defamatory material. Prudent website operators who host UGC will need to urgently update their processes to ensure that they can respond quickly to any complaints made under the regulations within the very short timeframes set out in the regulations. This may include setting up a designated complaint email address and providing complainants with access to a template complaint form. DOWNLOAD THE FULL ARTICLE: http://www.localgovernmentlawyer.co.uk/index.php?view=article&catid=59%3Agovernance-a-riskarticles&id=16571%3Achanges-to-defamation-law-from-1-january2014&format=pdf&option=com_content&Itemid=27 'Clare's Law' to be extended to all of England and Wales Legislation to take effect from March 2014 'Clare's Law', which enables a person to ascertain from the police whether their partner has had a history of domestic violence, will be extended to cover all of England and Wales from March 2014. Pilots in Greater Manchester, Wiltshire, Nottinghamshire and Gwent commenced in September 2012. The initiative, termed Clare's Law by the press, follows the campaign launched by the father of Clare Wood who was murdered in February 2009 by George Appleton whom she met through Facebook. It transpired that, unknown to her; he had a record of domestic violence against previous partners. The Home Secretary, Theresa May said in October 2011: "This scheme would be based on recognised and consistent processes that could enable new partners of previously violent suspects to know more about their partner's history of abuse. "They could then make informed choices about how and whether they take that relationship forward." Theresa May, speaking to The Sun, said that 88 women were killed by their partners last year.

92 Clinical commissioning group (CCG) funding - Commons Library Standard Note - UK Parliament Published 13 December 2013 | Standard notes SN06779 This note provides information on the resource allocation formula for distributing funding for health services in England to local commissioning groups: clinical commissioning groups (CCGs). It includes the historical use of allocation formulas; the formula that was proposed and rejected for the 2013-14 funding round; and information about the proposed new formula for 2014-15. The funding formula for 2014-15 is currently under review by NHS England. A decision is due to be made on 17 December 2013: This note will be updated as soon as possible following any announcement. Funding allocation formulas use information about local populations, such as age, gender, levels of deprivation and the size of a population, in order to predict the level of funding needed in each area to meet existing need. Funding formulas have been developed independently of ministers, most recently, by the Advisory Committee of Resource Allocation (ACRA). Many areas do not receive the full amount of funding allocated to them because increasing funding to one area within a limited budget would require reductions for another and significant funding reductions could destabilise health provision or provoke local opposition. The overall aim of allocations policy has been to—over time— secure ‘equal opportunity of access for people with equal need across the country’. The formula used for the 2013-14 allocations to CCGs is the same as was used to allocate funding to primary care trusts (PCTs). Library Standard Note, Primary Care Trusts: Funding and expenditure, provides a description of the allocation process as it was for PCTs in England. http://www.parliament.uk/briefing-papers/SN06779.pdf Clinical Commissioning Groups 'accountable to too many masters' - The Information Daily.com Clinical Commissioning Groups are “accountable to too many masters with potentially competing agendas”, a new report warns. CCGs, which came into existence in April, are new family doctor-led bodies responsible for commissioning healthcare in England. A new report published in the online journal BMJ Open argues, however, that the new bodies “are at the centre of complex web of accountability relationships, both internal and external”. The government’s decision to replace primary care trusts was intended to boost the accountability of those responsible for commissioning care for patients whilst allocating greater autonomy for the new bodies. The study, based on evidence from just under 100 GPs, managers and governing body members, warns that whilst CCGs appear to be more accountable than PCTS, there are concerns that the change has led to the bodies being less responsive. CCGs are externally accountable to NHS England, Monitor, Health and Wellbeing Boards, the local Health Watch, the public, local medical committees and the local authority Overview and Scrutiny Committee. The accountability relationship with NHS England is the only one that is clearly defined and where sanctions apply, the authors point out. However, the accountability to other external bodies, such as Health and Wellbeing Boards, is, by contrast, “much weaker,” they add. http://www.theinformationdaily.com/2013/12/12/clinical-commissioning-groups-accountable-to-too-manymasters Code of practice for victims of crime

93 Corporate Author: UK. Ministry of Justice Publisher: TSO Published: October 2013 Subjects: Criminal Justice Services

Abstract This revised Code of Practice for Victims of Crime forms a key part of the wider Government strategy to transform the criminal justice system by putting victims first, making the system more responsive and easier to navigate. Victims of crime should be treated in a respectful, sensitive and professional manner without discrimination of any kind. They should receive appropriate support to help them, as far as possible, to cope and recover and be protected from revictimisation. This Code sets out the services to be provided to victims of criminal conduct by criminal justice organisations in England and Wales.

DOWNLOAD THE CODE OF PRACTICE: http://socialwelfare.bl.uk/subject-areas/services-activity/criminal-justice/criminaljusticeservices/155757codeof-practice-victims-of-crime-oct13.pdf

Commissioners are you ready for the NHS provider licence? All providers of NHS health care services including those in the independent sector will need to hold a Monitor licence from April 2014 onwards, unless they are exempt. Monitor has published a Briefing for commissioners on the NHS provider licence outlining the action commissioners need to take to be ready for 1 April 2014. The information is for CCGs, NHS England Specialised Commissioning and Area teams, and CSUs. It includes a checklist of actions commissioners need to take before and from 1 April 2014. NHS commissioners have a pivotal role to play in the reformed commissioning landscape – they have primary responsibility with support from NHS England for ensuring the continuity of Commissioner Requested Services for patients in their local area should any provider be at risk of financial failure. Before 1 April 2014 commissioners need to: Check that providers they contract services from are aware of Monitor’s licensing requirements. Providers delivering NHS services will require a Monitor licence as from 1 April and failure to hold one will mean the provider is in breach of the rules. The sanction: Monitor can take enforcement action against providers including imposing regulatory requirements and fines. Consider the services that should be designated as Commissioner Requested Services . All providers of Commissioner Requested Services will need a licence. Monitor’s register of licence holders will be available on their website from 1 April 2014. Commissioners will be able to check whether a provider has a licence. For more information on Monitor’s NHS provider licence please visit www.Monitor.gov.uk/licence. DOWNLOAD THE MONITOR BRIEFING: http://www.monitor-nhsft.gov.uk/sites/default/files/publications/Commissioner%20briefing%20%20FINAL.pdf

94 Compassionate care means rooting out staff stress | Opinion | Health Service Journal Following the government’s response to the Francis report, Michael West argues why fostering compassion should not be about threatening criminal sanctions but about relieving stresses on staff These are symbolically powerful. The first is designed to deter those who might otherwise mistreat people in their care and the second to provide hard evidence of safe staffing levels. ‘Healthcare by its nature involves a high level of negative emotion and staff need high levels of positive emotion at work’ The context of these proposals is a vast sector, staffed by an overwhelming majority whose work is − or originally was − a vocation. They want to dedicate their working lives to helping other people in pain, distress or need by using evidence and knowledge to provide the best quality of care possible. This potentially creates powerful cultures of compassion and professionalism. Interventions should therefore be evaluated in terms of whether compassion and professionalism are enhanced or undermined. The context is also one in which stress levels are unacceptably high among staff. After teachers and welfare professionals, nurses are the most stressed group in the UK working population. It is swimming against the tide to try to be compassionate when we feel stressed, especially when doing so leads to further stress. Toxic combination Stress is not some self-generated discomfort that requires us to tough it out. It kills people. It leads to emotional exhaustion and the de-personalisation of self and others. The primary predictor of stress in the NHS is workload. The toxic cocktail of high work demands and low control is what harms people. Many NHS staff report feeling overwhelmed by unnecessary bureaucracy, inefficient systems, initiatives and priority thickets. ‘The more we focus on enabling NHS staff to fulfil their visions and live their vocations, the higher the quality and more compassionate the care’ This is compounded by leadership failures to deal with these problems. The failures begin in government and extend through the system down to some frontline supervisors. Healthcare by its nature involves a high level of negative emotion – patients feel out of control, afraid, in pain and miss their homes and loved ones. For staff to be attentive, feel empathy and take intelligent action for patients (the key elements of compassion), they need high levels of positive emotion at work. Optimism, cohesiveness, humour, support and a sense of efficacy all contribute to this. Balancing negativity with an atmosphere of positivity and support enables staff to be compassionate, make better diagnostic decisions, be attentive to patients and deliver high quality care. Staffing levels Ensuring safe staffing levels should help because there is evidence that nurse staffing ratios can help predict outcomes. Public information about staffing levels in each area is one instrument to help achieve this. But on its own, it is a blunt instrument without considering the following: § § § §

Leaders must focus on providing high quality care as their top priority; Directorates, wards, teams, departments and individual staff must be clear about their objectives and have the support and resources they need to deliver; People management must be positive, enlightened, supportive and enabling; Team working must be effective and collaboration across boundaries reinforced continually to ensure patients receive integrated, high quality care; and

95 § § § § § § § § § § § § §

Patient experience and involvement must be at the core of compassionate practice. Fundamentally, we need to build the cultures and leadership necessary to deliver high quality patient care. This means staff need leadership that: Reinforces an inspiring vision of the work; Seeks and acts on high quality intelligence to help them deliver; Listens and responds to patient experience; Is fair, transparent and trustworthy; Promotes positivity, staff health and wellbeing; Empowers staff to solve problems and innovate; Gives helpful feedback, supports learning and celebrates people’s contributions; Takes action to address system problems; develops and models excellent teamwork; Ensures staff feel safe, supported, respected and valued; and Models values that inspire those in the organisation.

New leadership focus At the King’s Fund, we are currently working with the Care Quality Commission to consider how such cultures and leadership can be assessed, thereby focusing the sector on these fundamental elements. ‘The threat of criminal sanctions will not increase compassion and professionalism’ Regulatory agencies should also model the cultures they seek to promote in healthcare organisations; their processes should promote optimism, efficacy, empowerment, cohesion and celebration. Compassion will increase as a consequence. The more we focus on enabling NHS staff to fulfil their visions and live their vocations, the higher the quality and more compassionate the care our communities will receive. What then of the proposal to introduce a new criminal offence of wilful neglect? While the urge to use the force of the law in the very worst failures in care is understandable, the threat of criminal sanctions will not increase compassion and professionalism. Far better to create the conditions in which failures of this kind never occur and to provide staff with the resources and time to deliver the best possible care within available budgets.

Michael West is senior fellow at the King’s Fund http://www.hsj.co.uk/5065611.article?WT.tsrc=Email&WT.mc_id=EditEmailStory#.UpOcJGRdWpw

Condition of Britain briefing 3: Getting older and staying connected - Publication - IPPR The third briefing paper of our Condition of Britain series considers what life is like for older people in Britain today, and what issues are making it harder for them to sustain strong relationships and involvement in community life. What would it take for every older person to feel independent, valued and connected to those around them? Getting older in Britain no longer necessarily means being poor, thanks to sustained improvements in older people’s living standards and significant falls in pensioner poverty over the last 30 years. However, longer life expectancy, the breakdown of extended families and the growing number of older people living alone is making it harder for them to sustain strong relationships and connections to community life. Furthermore, despite having a rising employment rate and devoting a relatively high proportion of their time to volunteering and caring, older people often find that their knowledge, experience and hard work are not fully recognised, or that their need for companionship is overlooked.

96 This paper draws together testimony and evidence from a variety of sources to give a comprehensive assessment of the most pressing issues facing older people in the UK. It then sets out the main questions and alternative approaches that policymakers at all levels need to consider and address to ensure that older generations are engaged with and supported by their communities. Among the questions posed by this paper are: • • • •

How could employment support in Britain be reconfigured to help older people stay in work? How can we strengthen local institutions that help older people to sustain friendships and stay connected to those around them? How can we harness the energy and experience of older people to offer support and companionship to others experiencing loneliness? What new democratic arrangements would allow older people and their families to have more of a say about how formal care is organised?

The five briefing papers in this series are brought together with a new introduction by Nick Pearce, Graeme Cooke and Kayte Lawton in the Condition of Britain interim report , published in December 2013. Garforth Neighbourhood Elders Team – an extract The Garforth Neighbourhood Elders Team (Garforth NET) is a local charity supporting older people in Garforth, a small town on the edge of Leeds, and in 13 nearby villages. Garforth is a relatively affluent town, but many of the surrounding villages are former mining communities that have experienced problems with unemployment and antisocial behaviour. Garforth NET was set up in the mid-1990s by four churches that were concerned about isolation and loneliness among older people. The charity now has around 2,000 people using its services, which include a varied programme of social activities and a befriending service for those who find it hard to leave their house. The organisation is one of 37 ‘neighbourhood networks’ that Leeds city council has helped to build up over the last 20 years. These are independent and locally-rooted organisations that support older people to take part in a range of social and cultural activities, and to make long-lasting friendships with people living nearby. Like all neighbourhood networks, Garforth NET relies heavily on volunteers, many of whom are older people themselves, but also has paid workers who support volunteers and manage programmes. Dorothy is in her seventies, and has been volunteering at Garforth NET for five years. Before that she volunteered at a local school helping children with their reading. She likes having the opportunity to ‘give something back’ and make a difference in people’s lives. At Garforth NET, she makes drinks at coffee mornings and talks to guests, making sure that no one is left by themselves. She also makes calls to people they haven’t seen for a while to make sure they are alright. Dorothy has a busy social life: she sees her sister each week and goes for lunch with friends every Wednesday, and is also a member of a local walking group. http://www.ippr.org/images/media/files/publication/2013/12/Condition-of-Britain-brief03-Getting-olderstayingconnected_Dec2013_11608.pdf Constant learning, continuous improvement – lessons from Francis - Health Foundation 2013 will go down as a year when the NHS did a lot of soul searching. In February, Sir Robert Francis QC published his report following the Mid Staffordshire Public Inquiry. The Inquiry uncovered a trust board that ‘failed to tackle an insidious negative culture involving a tolerance of poor standards’, and a plethora of organisations that failed in their job to detect and remedy the safety concerns that patients and the public had been trying to raise for years. The Inquiry triggered investigations into 14 other NHS organisations that had been persistent outliers on mortality indicators. Led by Sir Bruce Keogh, they found some unique problems in individual organisations, and concluded all had become ‘trapped in mediocrity’ to the detriment of patients.

97 It also led to the government setting up six independent review groups, all of which searched for answers as to how to make sure the tragic events at Mid Staffordshire never happened again. Most recently, in November, the government produced its full response to the Inquiry, accepting - at least in principle - all but 9 of the 290 recommendations. Of the many actions being taken, there will be a tougher approach taken to the inspection and regulation of NHS organisations; additional duties on providers and professionals to be open with patients in the event of a serious mistake; and a range of initiatives designed to develop the capability of organisations and the system as a whole to improve safety. There has, and will continue to be, much debate around the focus and practical application of these actions ( download our briefing on the government’s response ). But of greater significance than the nuance and complexity of the arguments around a duty of candour, or the proposed registration scheme for healthcare assistants, is the issue that bubbles beneath all of this. An issue which arises whenever the NHS is faced with a significant failing in care – that of properly and fundamentally learning and changing from experience. Our new interactive timeline of milestones in patient safety over the last 50 years demonstrates this ongoing challenge with learning and adapting. So will we look back in another 10 years and be faced with another crisis in care? I am hopeful that we are beginning to have the system of learning we need to break the cycle, but I wonder if the focus of that learning is yet adequate to avoid future crises. The NHS has made great progress on specific high profile and discreet causes of harm, such as healthcare associated infections and falls. However, looking back at the work that has dominated approaches to improving safety, beyond isolated examples of advanced practice, have we yet developed the right sort of learning to tackle the more complex, system wide challenges such as those at Mid Staffordshire? As part of the government’s response to the Francis report, Don Berwick was asked to undertake a review with the aim of making zero harm a reality in the NHS. This review quite rightly corrected the ambition to be the ‘continual reduction’ of harm; where the battle for safety is never won, but rather always in progress. It concluded that rules and regulations have a role in making care safer, but they pale into insignificance when compared to the power of constant learning. I believe that by committing ourselves to creating a system of constant learning, we will be able to break the cycle of scandal followed by inquiry followed by legislation, and instead continually improve. Constant learning should manifest itself in a number of ways: Frontline professionals changing their practice following the poor experience or outcome of a patient, or as they understand the hazards in their services Executive teams creating an environment in which people at all levels feel able to discuss risks and mistakes knowing that it will lead to improvement The government, national agencies and regulators leaving healthcare providers empowered to own their safety data, detect and remedy their risks and problems first, and learn from mistakes when they do happen. This learning should be geared not just to understanding and addressing specific causes of harm encountered in the past, but increasingly the wider underlying challenges and latent hazards that make care unsafe and will continue to do so. In 2014, the Health Foundation will remain focused on a programme of work to support improvements in safety that has an ethic of learning at its heart. In particular, we will work to make the measurement and monitoring of safety more comprehensive, inviting NHS organisations to put the framework developed by Charles Vincent and colleagues into practice so that they can target their efforts on areas in most need of improvement.

98 By making this contribution we hope to play a part in achieving the changes needed to fulfil Don Berwick’s overarching goal that the NHS should 'continually and forever reduce patient harm by embracing wholeheartedly an ethic of learning'. Penny is Assistant Director at the Health Foundation, http://www.health.org.uk/blog/constant-learning-continuous-improvement-lessons-fromfrancis/?utm_source=charityemail&utm_medium=email&utm_campaign=december2013&pubid=healthfoundation&description=december-2013&dm_i=4Y2,2227A,B4Z9MV,7EZ2C,1 Continence Waste - Care Home Briefing 128 - December 2013 - RadcliffesLeBrasseur Classifying incontinence pads correctly and separating them out is probably the biggest saving that can be made in waste management according to “The Health Technical Memorandum 07-01-Safe Management of Healthcare Waste”. This highlights wasted energy in unnecessary treatment of non-infectious wastes and the potential for significant costs savings. To effectively manage waste generated as a result of healthcare activities, those responsible for the management of the waste should understand and must comply with the requirements of the various regulatory regimes, which include: environment and waste; In the UK the requirements and responsibilities for waste management are largely contained in the Environmental Protection Act 1990 and regulations made thereunder ie The Environmental Protection Regulations 1991; The Waste Regulations 2011; The Environmental Permitting Regulations 2010; The Hazardous Waste Regulations 2005 and The List of Wastes Regulations 2005 .The definition and classification of waste is carried out in accordance with guidance from the Environment Agency.”WM2” is a guidance document based on supporting European Directives. Where it is considered to be healthcare waste it will be necessary to assess each element of the waste for medicinal chemical and infectious properties as appropriate. The waste item will be classified as clinical or non clinical and hazardous or non hazardous with reference to the definitions in the Controlled Waste Regulations 2012 and Waste Framework Directive . This must be done before considering offensive properties unless where otherwise directed by the assessment process advised by the Department of Health. Care homes that provide nursing or medical care are considered to produce healthcare waste and are assessed as such through the assessment framework referred to above including determination of whether the waste is dangerous for carriage. Offensive/hygiene waste is healthcare waste or similar waste from municipal sources which meets the following criteria: It is not clinical waste; It is not dangerous for carriage; The producer has identified, after segregation at source, that it is suitable for disposal at a non-hazardous land fill site without further treatment; It may cause offence to those coming into contact with it. Potentially offensive/hygiene waste may include: Incontinence and other waste produced from human hygiene; Sanitary waste; Disposable medical veterinary/medical veterinary items and equipment that do not pose a risk of infection, including PPE; Animal faeces and soiled animal bedding. Waste items classified as offensive/hygiene waste are classified as non-hazardous and non- clinical waste under the following EWC codes: 18 01 04; 18 02 03 ; or 20 01 99. Healthcare waste generated as a result of activities undertaken by healthcare workers who provide services outside of the hospital to: · Patients in their home; · Householders who are self-medicating and self-caring is dealt with in accordance with community healthcare guidance in The Health Technical Memorandum 07-01: Safe Management of Healthcare Waste. “Patients in their own homes” is stated to include those living in

99 assisted living premises where there is onsite monitoring of residents’ activities to help to ensure their health, safety and wellbeing. Unless infectious community healthcare waste should be segregated and managed as offensive/ hygiene waste and segregated at source and packaged and treated as offensive/hygiene waste. FULL ARTICLE: http://www.rlb-law.com/care-home-uploads/care-home-briefing-128---continence-waste---december-2013.asp

100

have 'lowfree sector

Only by will able to the their that is the funding would an setting council their would “care The

care of the £200m the warned to and publish costings “as quickly as possible” so that the sector can analyse the implications.

Councils may to outsource level' assessments to up social workers, say leaders Community Care having their needs assessed and regularly reviewed self-funders be take advantage of £72,000 cap on eligible care costs the centrepiece of government’s reforms. This provide them with “independent personal budget”, out what their would spend on care if it were meeting it, which accumulate in a account” until they reached the cap. government has previously estimated that the assessment and management costs changes would be a year. However, three associations that it was “extremely difficult model this cost” called on the government to as much detail on

101 The associations also strongly criticised draft government proposals for national eligibility criteria, which they said were rooted in a “deficit model” that provided support to people on the basis of what they were unable to do. This was in “inherent tension” with the rest of the Care Bill’s focus on building a care system that focused on promoting independence and well-being, for example through new duties on councils to provide preventive services, information and advice. With councils having taken £2.68bn out of adult social care since 2011 , the system is substantially under-funded and the reforms will be difficult to implement without improving baseline funding levels. However, current government funding plans will not address this, as council budgets are set to fall year-on year. The £335m provided for councils to prepare for the funding reforms in 2015-16 is not sufficient, nor is it new money as it is simply taken from from the government’s funding settlement for councils for that year. Councils will be exposed to significant risks from the establishment of a universal deferred payments scheme to enable homeowners to retain their homes after moving into residential care by taking out a low-interest loan from their council against the value of the house. There is no definition of ‘care and support’ in the Care Bill, meaning that councils could become liable for providing a wide range of support through the social care system as a result of legal challenges that effectively lower the threshold for eligible needs. http://www.communitycare.co.uk/2013/11/21/councils-may-outsource-low-level-assessments-freesocial-workers-say-sector-leaders/#.Uo4zm3C9pJM?cmpid=NLC|SCSC|SCDDB-2013-1122 ADDAS Submission on the Care Bill – October 2013 http://www.adass.org.uk/images/stories/Resources/funding%20reform%20consultation%20lgaadass-solace%20final.pdf Councils must be more open about adult social care weaknesses and cuts - Community Care Local accounts are designed to provide residents and service users with information on their council’s adult social care performance, activity and objectives. Local accounts are not compulsory, however 93% of councils had published one since 2011 and 89% are due to publish one this year reflecting on their performance in 2012-13. However, the review raised concerns that 19 councils had not updated their initial local account from 2010-11, a problem linked to cuts in the number of staff in performance monitoring roles. Just 11 of the 25 councils studied in detail contained hard data comparing performance with the previous year, and there was rarely a clear read across from one year’s local account to the next. The review said this reflected the fact that councils were still experimenting with local accounts and were still coming to terms with accounts being a regular part of their performance cycle. ‘Selective use of data’ It said councils had to negotiate the tension between making their local accounts accessible and including hard performance data. But it said this should be managed by making accounts a “publicfacing summary” that had accessible links to hard data on performance. Positively, it said councils were increasing the volume and quality of their engagement with local residents on adult social care and this was reflected in local accounts. However, only a minority of

102 councils had involved their local involvement network, the statutory service user representative organisation, in the development of their local account. Links were replaced by local Healthwatch branches in April 2013 and the review said councils were at an early stage of engaging them in local accounts. There is a 'statement of purpose' for 2013/214 which describes what the programme seeks to achieve this year. http://www.local.gov.uk/c/document_library/get_file?uuid=d60ceb0c-a843-4c4d-a8a1d39bd53d7fe6&groupId=10180 See more at: - http://www.local.gov.uk/media-centre//journal_content/56/10180/3374265/NEWS#sthash.gwbYlIOh.dpuf Councils show financial resilience, but must continue adapting | Audit Commission The Audit Commission’s latest research, Tough Times 2013: Councils’ Responses to Financial Challenges From 2010/11 to 2013/14, shows that England’s councils have demonstrated a high degree of financial resilience over the last three years, despite a 20 per cent reduction in funding from government and a number of other financial challenges. But, the Commission says, with uncertainty ahead, councils must carry on adapting in order to fulfil their statutory duties and meet the needs of local people. Some nine out of ten councils experienced no significant difficulties in delivering their agreed budgets in 2012/13 and the same proportion are well placed to deliver their budgets this year. But the financial challenges for councils are continuing. About two-thirds of councils were well placed, in the view of auditors, to deliver their medium-term financial plans. However, auditors have concerns about the medium-term financial prospects of one third of councils. When the Audit Commission has closed down, it will be for the government and others to find alternative ways to bring together auditors’ insights into the finances of English councils and to keep watch for signs of financial stress.’ [i] From 2010/11 to 2013/14, government funding to councils reduced by £6 billion in real terms. [ii] Auditors were asked if councils had experienced significant difficulties in delivering their budgets in 2012/13. The previous reports are available on the Commission’s website. Like its predecessors, Tough Times 2013 sets out the scale and impact of reductions in central government funding to councils from 2010/11 to 2013/14 based on analysis of data in councils’ budgets and a survey of the appointed auditors for all 353 single-tier, county and district councils in England. Reductions in funding to single tier and county councils from 2010/11 to 2013/14 equal 12.1 per cent of their 2010/11 spending, on average. One in five councils saw reductions in funding from 2010/11 to 2013/14 that were greater than 15 per cent of their planned revenue spending in 2010/11. From 2010/11 to 2013/14, council tax income fell by £0.3 billion in real terms after the government’s council tax freeze grant is taken into account. The report identifies three groups of councils, based on auditors’ views about how well placed they were to deliver their agreed budget in 2013/14 and their medium-term financial plans.

103 A low-risk group, comprised of councils that were well placed to deliver both their 2013/14 budget and their medium-term plans. This group included the majority of councils, 63 per cent, in both years. Savings from adult social care services make up the largest share of the total spending reductions from 2012/13 to 2013/14, compared with 14 per cent of the total spending reduction from 2010/11 to 2011/12. Download the Report: http://www.audit-commission.gov.uk/wp-content/uploads/2013/11/Tough-Times-2013e41.pdf NOTES: This is the third and final report by the Audit Commission on councils’ financial resilience since 2011. The previous reports are available on the Commission’s website. Like its predecessors, Tough Times 2013 sets out the scale and impact of reductions in central government funding to councils from 2010/11 to 2013/14 based on analysis of data in councils’ budgets and a survey of the appointed auditors for all 353 single-tier, county and district councils in England. • • • • • • •

•

From 2010/11 to 2013/14, government funding to councils reduced by £6 billion (19.6 per cent) in real terms. [See Figure 5] Metropolitan district councils saw the largest aggregate reduction in funding of 22.5 per cent. County councils saw the smallest reduction over this period of 16.4 per cent. Funding reductions have been proportionally greater for councils that are more dependent on government income to fund spending. Reductions in funding to single tier and county councils from 2010/11 to 2013/14 equal 12.1 per cent of their 2010/11 spending, on average. For district councils, reductions equal 10.5 per cent of their 2010/11 spending. One in five councils (20 per cent of single tier and county councils and 23 per cent of district councils) saw reductions in funding from 2010/11 to 2013/14 that were greater than 15 per cent of their planned revenue spending in 2010/11. [See Figure 6] From 2010/11 to 2013/14, council tax income fell by £0.3 billion (1.7 per cent) in real terms after the government’s council tax freeze grant is taken into account.

Auditors were asked if councils had experienced significant difficulties in delivering their budgets in 2012/13. For the 1 in 10 councils that did experience significant difficulties, examples of the main reasons for these difficulties included failure to deliver planned savings (affecting one fifth of councils in this group), overspending in one or more service areas (affecting two-thirds of councils in this group), or shortfalls in income (affecting three in ten councils in this group) that had a large financial impact on the budget or required a lot of management effort to resolve. The report identifies three groups of councils, based on auditors’ views about how well placed they were to deliver their agreed budget in 2013/14 and their medium-term financial plans. These groups were: 1. An on-going-risk group, comprising of councils that were not well placed to deliver their budgets in 2013/14 or their medium-term plans. The proportion of councils in this group fell from 12 per cent in 2012 to 8 per cent in 2013. 2. A future-risk group, comprised of councils that were well placed to deliver their budget in 2013/14 but not their medium-term plans. The proportion of councils in this group rose from 25 per cent in 2012 to 28 per cent in 2013.

104 3. A low-risk group, comprised of councils that were well placed to deliver both their 2013/14 budget and their medium-term plans. This group included the majority of councils, 63 per cent, in both years. Savings from adult social care services make up the largest share (52 per cent) of the total spending reductions from 2012/13 to 2013/14, compared with 14 per cent of the total spending reduction from 2010/11 to 2011/12. [See Figure 9] CQC prosecutes doctor for providing services without registration The Care Quality Commission (CQC) has successfully prosecuted Dr Hassan Abdulla, a doctor based in Leicester, has been fined £2,700 and ordered to pay over £30,000 in court costs after he admitted to performing circumcisions without being registered. Fiona Allinson, compliance manager for the CQC, said: “This sends a clear message to any health care professionals that they not only need to ensure they are registered with CQC but we will take action against those who fail to do so”. http://www.cqc.xgenics.com/images/Documents/Case_study__Doctor__successfully_prosecuted.pdf State of Care 2012/13 - Care Quality Commission - SUMMARY Adult social care Despite some improvements, the care many people receive was still poor throughout 2012/13. Our inspectors uncovered problems in more than 10 per cent of inspections across all types of adult social care services. Nursing homes One in five nursing home inspections revealed safety concerns – including failure to give out medicines safely or not carrying out risk assessments when starting to care for someone, and ongoing staffing pressures. Out of all three types of adult social care settings, nursing homes need to make the most improvements around quality and safety of care. Residential homes We found a link between death notifications (sent to us by providers when a person dies in their care) and high staff turnover, which may result in gaps in care. More than 10 per cent of inspections uncovered problems with either safeguarding and safety, staffing, or the care and support received by residents (for example, people not being helped to eat and drink enough). Home care services Problems with staffing and quality monitoring were uncovered in 10 per cent of inspections. Home care managers must do more to prevent late and missed visits, support staff to carry out daily tasks and improve care planning.

105 Community social services More than 10 per cent of inspections revealed issues around staffing in services like Shared Lives and supported living. Pressure on A&E As part of our State of Care report for 2012/13, we looked at the number of older people who have been admitted to hospital in an emergency for conditions that are generally avoidable. Avoidable conditions are illnesses and sicknesses like: • • • •

Bone fractures. Dehydration. Pneumonia. Respiratory infections.

We call them ‘avoidable conditions’ because they can be treated in the community (in homes or in community settings) or caused by poor care or neglect. Avoidable admissions are rising • •

• • • • • •

Growth in total emergency admissions among older people. The number of people aged 75 and over who have been admitted to hospital in an emergency at least once during the year increased from seven per cent in 2007/08 to almost 10 per cent in 2012/13. Increase of avoidable conditions Pneumonia: 64 per cent increase Inhaling food or liquid: 52 per cent increase Urinary tract infections: 45 per cent increase People with dementia Among people living in care homes, hospital admissions for avoidable conditions were 30 per cent higher for people with dementia.

Avoidable admissions and waiting times At the same time, waiting times in A&E have also risen. Annually, the proportion of people waiting more than four hours in A&E increased from two per cent in 2008/09 to four per cent in 2012/13. There are similar trends between the increase of avoidable admissions and the increase in waiting times. They share the same quarterly and seasonal fluctuations and both substantially increased during the second half of 2012/13.

NHS Our inspectors’ biggest concern around NHS hospitals in 2012/13 was that hospitals were not making improvements in assessing and monitoring the quality of care provided. No improvements had been made in safety or in hospital patients being treated with dignity and respect.

106 Â Â Throughout the year, we carried out more than double the amount of enforcement action against services that were not meeting standards. It increased from three per cent in 2011/12 to seven per cent in 2012/13. NHS hospitals Our inspectors found poor care in around one in 10 of all hospital inspections. The number of patients with dementia who died in hospital was more than a third higher (36 per cent) than patients in similar circumstances who did not have dementia, and they also stayed in hospital more than a quarter longer (27 per cent). NHS Community health care Staffing was also an issue, with one in 10 inspections finding a problem. NHS mental health, learning disability and substance misuse services Improvements were made to meet the care and welfare of people with a mental health problem or a learning disability, but we still uncovered problems in one in eight inspections. Staffing problems still continued, with no improvement compared to 2011/12 and one in 10 inspections raising concerns. Independent health care During 2012/13, our inspectors saw a slight drop in the way hospitals assessed and monitored the quality of care. Overall, safety remained the biggest issue for hospitals â&#x20AC;&#x201C; with almost one in 10 inspections revealing standards not being met. While mental health and learning disability services made improvements in 2012/13, they still lagged behind other independent services and there is still some way to go before they catch up. There were significant differences in the care provided by private ambulance services. They were treating people effectively and with respect and dignity, but one in seven inspections raised problems around safety, staffing and monitoring. Independent hospitals Overall, hospitals did not improve the way they monitored quality. Independent Community health care Safety was still an issue, with almost one in 10 inspections raising concerns. Independent mental health, learning disability and substance misuse services Improvements were made in all five of our main areas of focus - and independent services almost matched the performance of their NHS equivalents. Problems still remained in a number of areas, with safeguarding and safety being the biggest concern.

107 Independent ambulance services 2012/13 was the first year we inspected all private ambulance services, so this sets a benchmark for the sector going forward. Our inspectors found that services provide effective care and treatment, and in every case we looked at, treated people with dignity and respect. One in eight inspections uncovered problems around safeguarding and safety, staffing and assessing and monitoring the quality of the service. Primary dental care We have fewer concerns with the quality of dental care providers. They are generally safe and most surgeries are clean with good infection control procedures. Staff also know how to protect patients from the risk of abuse. However, some services still need to make improvements as our inspectors saw safety problems in seven per cent of inspections. Dental care services • •

Almost 99 per cent of inspections found that surgeries were very good at treating people with respect, listening to them and involving them in decisions about their treatment. 40 per cent of the problems that our inspectors uncovered had either a ‘major’ or ‘moderate’ impact on patients.

FULL REPORT http://www.cqc.org.uk/sites/default/files/media/documents/cqc_soc_report_2013_lores2.pdf State of Care 2012/13: Avoidable admissions (Annex 1) 1.59 MB State of Care 2012/13: Adult social care funding (Annex 2) 1.76 MB State of Care 2012/13: Dementia thematic review (Annex 3) 1.2 MB State of Care 2012/13: Adult social care statistical analysis (Annex 4) INFOGRAPHIC http://www.cqc.org.uk/node/773848?cqc Creative Councils: 10 lessons for local authority innovators | Nesta Key findings

108 1. New approaches are needed for costly social challenges posed by long–term youth unemployment and vulnerable families often living in places that feel as if they have been going backwards for decades. 2. To create the space for alternative solutions to emerge, an essential first step is to adopt different vantage points. 3. Unless councils can think differently and more creatively about risk, the odds of even the best idea making it from a Post–it note and into reality are not high. 4. Local government is in a trap. It needs to do more with less. The only way to pull off this trick is by working very differently with public services, communities and users to achieve better outcomes. And yet the radical innovation this implies often excites opposition – from users, citizens, politicians and staff – and that in turn entrenches the status quo. Yet strategies for escaping the trap are emerging all over the sector, and some of the best examples can be found in the Creative Councils programme that has been run jointly by Nesta and the Local Government Association over the past three years. We can draw insights about the main ingredients needed for a successful innovation journey. Some of these ingredients will be familiar – the right kind of leadership, the ability to manage risk – but some less so. We have presented these insights in the form of ten lessons about innovating in the sector. These lessons aren’t the last word – but we hope that the insights they contain will act as a spur to innovators up and down the country who are trying to escape the trap. DOWNLOAD THE REPORT: http://www.nesta.org.uk/sites/default/files/creative_councils_10_lessons.pdf C-section case shows need for radical changes on transparency: Munby – Local Government Lawyer. The high-profile case involving an enforced Caesarean section stands as a “final, stark and irrefutable demonstration” of the pressing need for radical changes in the way in which both the family courts and the Court of Protection approach transparency, the President of the Family Division has said. He had directed no hearing. “All I had done was to direct that any further application was to be heard by me,” Sir James said. “In other words, if any application was made either in the Court of Protection or in the family court, I would hear it. It was also a fact that other solicitors had been instructed by the Italian government. “Be all that as it may, the fact is that, as at the date of the hearing before me on 13 December 2013, no application of any kind had been made on behalf of either the mother or the Italian authorities, whether to the Court of Protection, the Chelmsford County Court or the Family Division, nor had any application been made to the Court of Appeal. The only application that had been made by anyone in relation to either P or the mother since the date of the last hearing in the Chelmsford County Court, 25 October 2013, was the application by Essex County Council for a reporting restriction order”; The public had an interest in knowing and discussing what had been done in this case, both in the Court of Protection and in the Chelmsford County Court. “Given the circumstances of the case and the extreme gravity of the issues which here confronted the courts – whether to order an involuntary caesarean section and whether to place a child for adoption despite the protests of the mother – it is hard to imagine a case which more obviously and compellingly requires that public debate be free and unrestricted”;

109 Conducting a balancing exercise, the Family President said P’s welfare demanded “imperatively” that neither she nor her carers should be identified. “On the other hand…..neither the compelling public interest in knowing about the case nor the mother’s compelling claim to be allowed to tell her story, would be advanced by identifying P or her carers.” Sir James said he agreed entirely with the approach of Mr Justice Charles, who granted Essex County Council’s first application for a reporting restriction order but was not prepared to grant any injunction restraining identification of either the mother or P’s father. Detailed data on “never events” will help NHS care become even safer, says NHS England – NHS England. NHS England today (12/December/2013) publishes more detailed data than ever before about “never events” – the serious errors in care that put patients at risk of harm and that should not happen if full preventative procedures are in place. For the first time, provisional quarterly data on the number of never events happening at each hospital trust in England will be published, for patients, healthcare professionals, managers, stakeholders and the public to see and understand. Until now, data has been published only annually, and only at national, aggregated level. The data is available on the NHS England website, and will be updated in three months’ time. From April 2014, the data will be updated every month. Professor Don Berwick, the US expert who earlier this year led a landmark review into patient safety in England, has hailed the publication as an admirable and important step. Never events include such incidents as wrong-site surgery, items like swabs and other medical equipment being accidentally left inside a patient, and strong drugs like chemotherapy being administered in the wrong way. The provisional data shows: • • •

102 NHS trusts had at least one never event between April and September this year 8 independent hospitals had at least one never event between April and September this year There were 37 instances of wrong-site surgery in the six months from April to September, and 70 incidents of foreign objects being mistakenly left inside patients.

Not all never events result in serious harm to patients. Wrong-site surgery incidents, for instance, range from an incision being made in the wrong place at the beginning of surgery then instantly spotted and corrected, to the wrong tooth being removed, to very severe incidents like the wrong limb or organ being operated on. Information breaking down the types of incidents recorded is available on the website. There are 4.6 million hospital admissions that lead to surgical care every year in England, and 500,000 non-Caesarian births. There are also tens of thousands of other interventional procedures like internal radiology and cardiology catheter procedures that are also classified as “surgical” in terms of never events. So the incidence rate is less than 0.005% or 1 never event in every 20,000 procedures. The data shows that the number of never events recorded is broadly similar to last year. NHS England expects that reporting of these incidents will continue to increase as the NHS becomes a more transparent and learning system, and as the types of incidents that are classed as “never events” continue to increase in line with developments in patient safety practices.

110 Dr Mike Durkin, National Director of Patient Safety at NHS England, said: “Awareness in the NHS of these issues has never been greater and the quality of our surgical procedures has never been better. It follows that the risk of these things happening has never been smaller. “Every single never event puts patients at risk of harm which is avoidable. People who suffer severe harm because of mistakes can suffer serious physical and psychological effects for the rest of their lives, and that should never happen to anyone who seeks treatment from the NHS. “But is time for some real openness and honesty. There are risks involved with all types of healthcare. And one of those risks – with the best will in the world and the best doctors, nurses and other healthcare professionals in the world – is that things can go wrong and mistakes can be made. This has always been the case, and it is true everywhere in the world. “This publication is not about ‘naming and shaming’ – it is about telling the public about mistakes, and further ensuring that we talk about and learn from them. That is the way to minimise errors and take every step we can to drive avoidable harm out of the NHS. “By making this detailed data fully open to public scrutiny, we are fulfilling a key recommendation of the Francis Review, but more importantly we are making a big step towards further reducing these events. As Professor Don Berwick made clear in his report on patient safety earlier this year, these incidents can only be truly minimised if we talk about them in an open and honest way, and all work together to make sure every effort is being made to stop whatever went wrong from happening again.” The NHS in England has made significant strides in improving patient safety in recent years, and its reporting and alert systems are credited as being some of the best in the world. But there is always more that can be done, and the safety and quality of care for NHS patients is a key priority for NHS England. Currently, further work is under way to develop new, easier-to-use reporting systems. In addition, a Surgical Safety Task Force is undertaking an in-depth review of surgical never events and is due to report in the New Year, presenting even further insight into how we can make surgery safer across England. Key proposals will focus on the adoption of a more systematic approach to surgical safety. This will include standardising operating theatre procedures, new standardised education and training, and work to ensure professional and organisational incentives support safe procedures and working cultures. Professor Don Berwick said: “No one who works in any hospital wants to see patients come to any harm at all. When serious errors occur, it is a tragedy for both patients and staff, so the courage and commitment shown by the NHS in publishing this data are admirable. “One way to help improve safety is by openly and honestly recognizing, discussing, and examining mistakes in care. That helps us create continually better systems and procedures. “Blame and punishment have no productive role in the scientifically proper pursuit of safety. But openness and transparency do. They are the front door to learning and improvement. I applaud NHS England for this important step toward better knowledge and better support to both staff and patients.”

DOWNLOAD THE REPORTS: Never Events Summary 2013/14 for Q1 & Q2

111 http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-data-sum-q1-q2-1213-v2.pdf Never Events Summary for 2012/13 http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-data-sum-1213.pdf Never Events List 2013/14 Update. http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf Disabled people hit hardest by welfare reforms, report finds | News | Inside Housing Disabled people are being hit hardest by the coalition government’s welfare reforms, a report by a housing association has found. Habinteg Housing Association’s What price independent lives? report looks at the impact of benefit changes, including the bedroom tax. It found that two-thirds of Habinteg’s tenants affected by the bedroom tax are disabled – which is line with the picture nationally according to the Department for Work and Pensions. It said of these, only a third have been exempted from paying by local authorities. Fifty-six per cent of Habinteg tenants living in wheelchair standard properties have not been exempted from the bedroom tax. Fifteen per cent of tenants who receive disability living allowance but live in general needs properties have been exempted from the tax. The ‘localised criteria’ for bedroom tax exemption has created a ‘postcode lottery’ for disabled people. The shortage of wheelchair-standard and accessible properties has made downsizing simply not an option for most affected tenants. Inconsistency in councils’ decisions about who is eligible for discretionary housing payments makes it difficult for housing providers to manage their response and support tenants. Habinteg is calling on the government to repeal the bedroom tax, review its stance on universal credit, which will not cover service charging on disability-related adaptations, and revise their plans to cut benefit payments under the transfer to Personal Independence Payments. Labour peer Baroness Rosalie Wilkins, vice-chair of the all-party parliamentary disability group, said: ‘Habinteg’s new research provides a rallying cry for choice, independence and equality. Independent living is a right not a privilege. ‘The way in which the bedroom tax cuts the incomes of disabled people at a stroke and impinges on their ability to live independently is something that must be challenged.’ DOWNLOAD THE REPORT: http://www.habinteg.org.uk/documentHandler.cfm?dld=826&pflag=docm93jijm4n826. Disputing a Will based on undue influence – a challenge for claimants? - Lexology

112 We use cookies to customise content for your subscription and for analytics. If you continue to browse Lexology, we will assume that you are happy to receive all our cookies. For further information please read our Cookie Policy . Disputing a Will based on undue influence – a challenge for claimants? In England & Wales, you have the right to leave your estate to whoever you choose – but a surprise beneficiary or unexpectedly large gift may cause alarm bells to ring for those left behind.At a time when emotions are high, suspicions surrounding the reasons why a Will may have been changed to add a new beneficiary or alter significantly the size of a gift, are likely to be rife. However, while there may be elements of mistrust, it can be very hard to effectively prove that the deceased’s decision making process in executing the Will was undermined by the influence of another person and that the Will is invalid on the grounds of undue influence. When evaluating disputes over the validity of Wills, the Court always seeks to ensure that the Will is an expression of the wishes of the person making the Will and not someone else’s. In the case of Craig v Lamoureux [1920], the Judge said that “[It is] not enough to show that someone has the power unduly to overbear the will of the testator. It must be shown in the particular case the power was exercised and that it was, by means of that power, that the will was obtained.” If you are challenging a Will, you therefore have to prove that the person making the Will was influenced to the extent that their free will was completely oppressed. In a later case, Edwards v Edwards [2007], the Court held that there is no presumption of undue influence and that it is a question of fact whether undue influence has affected the execution of a Will. Moreover, the burden of proof is high and it falls on the person challenging the Will to prove undue influence. The Judge said that “it is not enough to prove that the facts are consistent with the hypothesis of undue influence. What must be shown is that the facts are inconsistent with any other hypothesis.” In this case, the deceased had initially executed a Will leaving her residuary estate in equal shares to her three sons. The deceased had a close relationship with two of her sons, yet shortly before her death she made a new Will leaving her entire estate to her third son, despite an obviously strained relationship with him. At the same time, she also started making false allegations against the son to whom she was closest, accusing him of stealing things. The Judge asserted that there was “no other reasonable explanation” for the deceased’s behaviour other than her mind had been deliberately poisoned by her third son and he concluded that the deceased’s purported last Will had been affected by her third son’s undue influence. The Court set out the following criteria for proving undue influence: The facts are inconsistent with any other hypothesis; Undue influence means influence exercised by coercion (the deceased’s own discretion and judgment is overborne) or fraud; Coercion is pressure that overpowers the testator’s own wishes without actually changing their mind; The physical and mental strength of the testator are relevant factors in determining how much pressure is necessary in order to overpower the Will; The person making the Will has not acted as a free agent in making their dispositions.

113 Direct evidence of undue influence is unusual, given that the very nature of the act means that it happens behind closed doors, which is an obstacle that was addressed in part by the Court’s recent decision in Schrader v Schrader [2013]. In this case, the court inferred that the deceased’s execution of her Will must have been the result of undue influence despite no direct evidence of coercion. The deceased originally left her entire estate to be divided equally between her two sons, Nick and Bill, but later executed a new Will leaving her house, the main asset in the estate, in its entirety to Nick. The Judge was persuaded that undue influence had been present by a series of factors including Nick’s involvement in the preparation of the later Will; his forceful personality; his view that he had not been treated equally to his brother; the deceased’s vulnerability and her dependence on Nick and the lack of any other identified reason for changing her Will. Nick had also waited six months to disclose the original Will and was found to have given a false reason as to why the family solicitors were not engaged to prepare the Will. Claims for undue influence in disputes over Wills are notoriously difficult to prove. The Schrader case has perhaps opened doors for a greater number of successful claims, but the quality of evidence, be it direct or circumstantial, should be considered carefully when considering whether to issue a claim alleging undue influence. In the absence of sufficient evidence to prove undue influence, prospective claimants may wish to consider whether there could be causes for the Court to state that the deceased did not know and approve the Will contents. Provided there are suspicious circumstances about how the Will came to be made, a claim for want of knowledge and approval may have higher prospects for success than a claim for undue influence, particularly given that the burden of proof will be shifted onto the party who has to rely on the disputed Will to satisfy the Court that the Will was reflective of the deceased’s intentions. http://www.lexology.com/library/detail.aspx?g=e983df2d-6ec9-4325-9261a0c52d536619&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body++General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily +Newsfeed+2013-12-13&utm_term= Domestic homicide review: lessons learned - GOV.UK __________________________________________________________________ Paper includes common themes, such as risk assessment, information sharing and multi-agency working, and suggestions for what can be done locally. Detail Domestic homicide review reports received up to March 2013 have been analysed and some common themes identified. Although these themes are not new, this paper reinforces the work that is being done nationally, and can be done locally, to strengthen the response to domestic violence and abuse. Police crime commissioners and community safety partnerships should be aware of these common themes and the lessons learned. DOWNLOAD THE REPORT https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/259547/Domestic_h omicide_review_-_lessons_learned.pdf

114 Domestic violence fees in the courts likely to be scrapped - The Information Daily.com The £75 fee for domestic violence injunctions could be scrapped under government plans to support vulnerable women. The move could mean fees for civil cases will be increased so that taxpayers will no longer be left footing the £100m running costs of the courts every year. The plans would set the civil case fees at a maximum of £1,870, with a view to moving in future to a system where the fee is calculated as a percentage of the amount under dispute in the court case. Other proposals include the introduction of a percentage-based system for commercial proceedings, as well as charging a daily rate for the time spent in court. The government said that fees would stay the same for cases involving sensitive family issues including child contact, divorce financial disputes and adoption applications. Courts Minister ShaileshVara said: “We have the best court system in the world and we must make sure it is properly funded so we keep it that way. “Hard-working taxpayers should not have to subsidise millionaires embroiled in long cases fighting over vast amounts of money, and we are redressing that balance. “Vulnerable groups must also be protected, which is why we are keeping the fees the same for sensitive family issues including adoption applications and child contact and scrapping the application fee for victims of domestic violence seeking injunctions to protect themselves.” The consultation will run until 21 January 2014, and the government expects to make changes to the fees, depending on the outcome of the consultation, in Spring and Summer 2014. http://www.theinformationdaily.com/2013/12/03/domestic-violence-fees-in-the-courts-likely-to-bescrapped Essex County Council responds to C-section care case - Family Law Week: Essex County Council has responded to the media reports concerning the delivery, without the mother's consent, of a baby by caesarean section and the child's removal into care of the local authority. Essex County Council said that here have been lengthy legal proceedings in this case over the past 15 months. On 13 June 2012 the mother was detained under Section 3 of the Mental Health Act. On 23 August 2012 the Health Trust, which had been looking after the mother, applied to the High Court for permission to deliver her unborn baby by caesarean section because of its concerns about risks to mother and child. The mother was able to see her baby on the day of birth and the following day. On 24 August 2012 Essex County Council's Social Services applied for and obtained an interim care order from the county court because the mother was too unwell to care for her child.

115 Care proceedings ended on 1 February 2013. The mother applied to the Italian courts for an order to return the child to Italy in May 2013. Those courts ruled that child should remain in England. In October 2013 Essex County Council obtained an order from the county court to place the child for adoption. It is understood that the mother has two other children which she is unable to care for due to orders made by the Italian authorities. Essex County Council has said that its Social Services practice social workers liaised extensively with the extended family before and after the birth of the baby, to establish whether anyone could care for the child. A spokesman for the Council said: "The long term safety and wellbeing of children is always Essex County Council's priority. Adoption is never considered until we have exhausted all other options and is never pursued lightly." The judgment in the care proceedings has now been published. It can be read here: http://www.judiciary.gov.uk/Resources/JCO/Documents/Judgments/re-p-a-child-approvedjudgment.pdf Eviction notices surge by 26% | News | Inside Housing _____________________________________________________________________ The number of eviction warning notices issued to social tenants because of rent arrears has soared by more than a quarter in a year. An exclusive Inside Housing survey of 113 social landlords across Britain reveals councils, arm’slength management organisations and housing associations are increasingly using the threat of eviction to protect their income in the face of welfare reform and the squeeze on living standards. The survey shows the landlords issued 99,904 notices seeking possession for rent arrears in April to November this year, compared with 79,238 for the same period in 2012 - a 26 per cent increase. Sam Lister, policy and practice officer at the Chartered Institute of Housing, said the tougher approach was ‘sadly not surprising’ as ‘welfare reform is causing real difficulty’. He added that landlords have to recover rent owed to them. ‘To not do so would be unfair to tenants who are paying their rent… and would leave landlords unable to meet their commitments,’ he said. An NSP is the first step towards eviction and informs a tenant the landlord intends to take legal action to recover the property. Berneslai Homes had the highest increase in NSPs issued. The number of NSPs issued by the 18,900-home ALMO nearly trebled from 760 to 2,184. A spokesperson for Berneslai said the increase was due to rent arrears ‘as a result of changes to benefit entitlement and tenants in work who don’t receive housing benefit but are feeling the pressure on household budgets’. Housing association Longhurst Group issued 1,559 NSPs, compared with just 576 last year. A spokesperson said: ‘We recognise the difficulties for some of our tenants given the impact of low

116 wages, rising living costs, increases in personal debt and welfare reform.’ She stressed however the group needs to protect its income. Birmingham Council issued 10,814 NSPs - an increase of 82 per cent. A spokesperson said: ‘Welfare reforms have undoubtedly had an impact.’ However, 22 organisations reported issuing fewer NSPs this year. The number of tenants ultimately evicted following court action hardly changed, from 2,488 last year to 2,530, indicating impacts from welfare reform have yet to feed through into evictions. http://www.insidehousing.co.uk/tenancies/eviction-notices-surge-by26/6529938.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3461101_C opy+of+New+Care+%26+Support+Template&dm_i=1HH2,226LP,82EKTS,7FFTC,1 Fears for prisons as offender management stagnates - The Information Daily.com The lack of progress seen in the management of offenders in prisons casts doubt on the service’s ability to implement the reforms required, the Chief Inspector of Prisons has said. Little progress has been made in the assessment, planning and implementation of working with offenders to reduce reoffending rates, states a third joint report on the inspection of offender management in prisons. Liz Calderbank, Chief Inspector of Probation and Nick Hardwick, Chief Inspector of Prisons have today expressed concerns that this lack of progress casts real doubt on the Prison Service’s ability to reform under the Transforming Rehabilitation strategy. Some common problems were observed during the inspection of 21 prison establishments in 2012 and 2013, the report states, including mistrust between prison departments, lack of guidance, and too few structured programmes available to challenge behavioural patterns. The report also noted that provision for offender management was especially poor at two prisons accomodating foreign nationals. Calderbank and Hardwick said: “We have come to the reluctant conclusion that the offender management model, however laudable its aspirations, is not working in prisons. “The majority of prison staff do not understand it and the community-based offender managers, who largely do, have neither the involvement in the process or the internal knowledge of the institutions to make it work. “It is more complex than many prisoners need and more costly to run than most prisons can afford". “We therefore believe that the current position is no longer sustainable and should be subject to fundamental review”. Sadiq Khan MP, Labour's Shadow Justice Secretary, said the report depicts "a shocking picture" of how bad things have got in the criminal justice system over the past three years. He said: "David Cameron came to office in 2010 promising a rehabilitation revolution yet today this is in tatters, with the Inspectors confirming this a failure". “The government’s plans to recklessly privatise probation have been shredded", he said. "It’s time that Chris Grayling broke the habit of a lifetime, listened to the experts, and abandoned his dangerous and half-baked probation privatisation before he puts the public’s safety at risk".

117 http://www.theinformationdaily.com/2013/12/17/fears-for-prisons-as-offender-managementstagnates Francis report: Jeremy Hunt has prioritised blame over support | Healthcare Professionals Network | Guardian Professional The government's response fits in with the wider political strategy of blaming individuals for shortcomings in the system 2013 has been quite a policy year for NHS care standards – there has been the Francis Report, the Keogh and Berwick reports, Cavendish on support staff, Clwyd on complaints, and the government's final response to the 290 Francis recommendations. The latter runs to almost 400 pages over two volumes. The answer is a raft of solutions largely modelled upon a marketised view of the NHS in which "consumers" are "empowered" and a failure regime is in place to deal with "imperfections". New proposals are for a hospital safety website – ambitiously aimed at "putting the truth about care at the fingertips of patients" – and the creation of an army of 5,000 patient safety tsars within five years. There are a wave of proposals including a new duty of candour on provider organisations to tell patients about medical errors – and a threat to remove indemnity cover if the rule is broken; more robust inspections by the Care Quality Commission; new barring regimes to determine if board directors of NHS provider organisations are "fit and proper persons"; and new criminal offences of wilful neglect and the provision of false or misleading information. Spurred on by lurid headlines about "50,000 too many people" dying under Labour governments, this will doubtless strike a chord with the public. It also fits in with the wider political strategy of blaming individuals for shortcomings in the system – people without jobs failing to look for work, people with disabilities holding the wrong mindset, people with too many rooms who are selfish. Now we can add NHS staff who simply don't care enough. The Francis report had much to say about the miserable record of the NHS in its relationship with local people, observing that the high tide had been reached with Barbara Castle's Community Health Councils, which Labour abolished in 2003. His proposals on strengthening the role of foundation trust governors, improving public and patient participation in Monitor and strengthening the role of Local Healthwatch have all been downplayed. Notwithstanding recent guidance from NHS England on improving public and patient engagement the reality is that local people – individually and collectively – have little or no say in how their healthcare is commissioned and provided. The government seems to have largely turned its back on Don Berwick's advice to "abandon blame as a tool" and "make sure pride and joy in work, not fear, infuse the NHS". The registration of untrained Health Care Assistants, as recommended by both Francis and the Health Select Committee, is rejected along with legal protection for the whistle blowers who put their careers on the line. What we are left with is an imbalanced response to the issue of harm-free care – one that prioritises blame and recrimination over learning and support, inspection over participation and the imparting of information over accountability to local people.

118 http://www.theguardian.com/healthcare-network/2013/nov/27/francis-report-jeremy-hunt-nhspolicy?CMP= Free helpline for older people launched to tackle loneliness – Information Daily. _____________________________________________________________________ A 24 hour free helpline for older people has been launched across the UK. The Silver Line, funded by a £5 million grant from the Big Lottery Fund, aims to combat loneliness for the over 65s by offering information, advice and a befriending service. In a poll conducted to mark the national launch of The Silver Line, 90 per cent of older people said “a chat on the phone” is the most helpful solution when they feel lonely, but 1 in 4 older people say they never or seldom have someone to chat to on the phone. According to the Campaign to End Loneliness, there are almost one million people who suffer from "chronic loneliness". The campaign also found that over half of all health and wellbeing boards in England have not recognised loneliness as an issue that needs addressing in their published strategies. Health Secretary Jeremy Hunt recently blamed the "public isolation of our ageing population" for the "chronic loneliness" of many older people living in the UK. http://www.theinformationdaily.com/2013/11/25/free-helpline-for-older-people-launched-to-tackleloneliness Future perfect, designer labels for an ageing society This Housing LIN Viewpoint no 53 is the latest in a selection of resources that consider in detail the built environment and the physical design criteria that can meet the housing needs and lifestyle choices of older people. However, this thought-provoking viewpoint takes wider a look at designing for inclusion and, in particular, how by focussing on clever, accessible design, this too can accommodate the needs and aspirations of older people. In short, what is required is for designers to focus on the ageing population but not to produce products solely for older people. Documents http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Viewpoints/HLIN_View point53_FuturePerfect.pdf G8 governments must make dementia a 'global priority' - The Information Daily.com Leading charities have described this predicted dementia epidemic as a “global phenomenon”, with new data suggesting that the current burden of dementia is much higher than the 2009 World Alzheimer Report originally expected. Today’s report, conducted by Alzheimer's Disease International, says that all nations, not just the G8 countries, must agree to increasing their research into dementia as well as introducing a comprehensive plan to tackle the expected epidemic.

119 In general, dementia cases are disproportionately concentrated in the world’s richest but most elderly populated countries. However, the global burden of dementia is expected to shift towards much poorer countries. Over half of dementia sufferers live in low and middle income countries and the increase in dementia patients is set to rise through to 2050 in these regions. Alzheimer’s Disease International says that research into the disease must become a global priority if the quality and availability of care is to improve. With the rise in dementia up to 2050 expected to be based mainly in low and middle income countries, the authors call for diagnostic technologies and drug treatments to be made much more affordable to the poorest victims of th disease. Similarly, the authors of the report request that dementia patients in the countries that are involved in ‘global trials’ should benefit from treatments at a subsidised cost, alongside adequate standards of care being made available. Worryingly, research shows that only 13 countries have ready funding and have begun to implement a national dementia plan. DOWNLOAD THE REPORT: Executive Summary http://www.alz.co.uk/research/WorldAlzheimerReport2013ExecutiveSummary.pdf Full Report: http://www.alz.co.uk/research/WorldAlzheimerReport2013.pdf

World Alzheimer Report 2013 | Alzheimer's Disease International Journey of Caring: An analysis of long-term care for dementia The World Alzheimer Report 2013 ‘Journey of Caring: An analysis of long-term care for dementia’, reveals that, as the world population ages, the traditional system of “informal” care by family, friends, and community will require much greater support. Globally, 13% of people aged 60 or over require long-term care. Between 2010 and 2050, the total number of older people with care needs will nearly treble from 101 to 277 million. Long-term care is mainly about care for people with dementia; around half of all older people who need personal care have dementia, and 80% of older people in nursing homes are living with dementia. The worldwide cost of dementia care is currently over US$600 billion, or around 1% of global GDP. The report which was researched and authored by Prof Martin Prince, Dr Matthew Prina and Dr MaëlennGuerchet on behalf of the Global Observatory for Ageing and Dementia Care which is hosted at the Health Service and Population Research Department, King’s College London. Recommendations • •

Governments around the world should make dementia a priority by implementing national plans, and by initiating urgent national debates on future arrangements for long-term care Systems should to be in place to monitor the quality of dementia care in all settings – whether in care homes or in the community

120 • • •

•

Autonomy and choice should be promoted at all stages of the dementia journey, prioritising the voices of people with dementia and their caregivers Health and social care systems should be better integrated and coordinated to meet people’s needs Front-line caregivers must be adequately trained and systems will need to be in place to ensure paid and unpaid carers receive appropriate financial reward in order to sustain the informal care system and improve recruitment and retention of paid carers Care in care homes is a preferred option for a significant minority – quality of life at home can be as good, and costs are comparable if the unpaid work of family caregivers is properly valued The quality of care in care homes should be monitored through the quality of life and satisfaction of their residents, in addition to routine inspections, as care homes will remain an important component of long-term care.

Genuinely challenging the system - Think Local Act Personal - Aisling Duffy, chief executive of Certitude. In my opinion the strength of Think Local Act Personal (TLAP) is its partnership approach, people working together as positive exemplars of personalised, community based support. Individuals, families, providers, local and central government, commissioners, regulators and other improvement agencies coming together as equal partners to demand, shape and celebrate genuine choice and control for people with disabilities. Such a collaborative approach really matters and never more so than at a time when money is tighter and there is a natural propensity to 'batten down the hatches' and hold firm to our bit of the system that validates discrete roles and organisations. Collaboration the TLAP way is characterised by genuinely challenging the whole system, holding each other to account to be as ambitious as possible in the drive to personalisation and offering practical and expert support to deliver on agreed priorities. This is what makes TLAP special - therefore I believe that a top priority for TLAP going forward must be to remain as focussed and committed to the 'how' of facilitating change, as it does on the what. Whether you choose to put integration in the 'too hard box' or 'a pipe dream' it's a 'must and can do' if people using services are to have genuine control. Until people with disabilities, with quality advocacy support as required, are able to determine and purchase the support they need [whether that be health, social care, housing related] they aren't genuinely in control. TLAP worked with National Voices on developing a really helpful person-centred 'narrative' on integration. There are also a number of recently selected pioneers in areas across the country seeking to lead the way in taking forward integration. TLAP is very well placed to be the conduit for gathering experience and learning - good and bad on integration - to be the critical friend that uses the strength and diversity of its partners to share learning, develop resources and practical support to genuinely further integration. As a provider I have seen first hand the really big difference building community connections and capacity can have on the lives of individuals and families. People making new connections and friends, finding purpose and being valued for their contributions. While TLAP has already done some great work with partners developing ideas and resources to build community capacity, TLAP must be relentless in this regard - the benefits to individuals, families and communities, as well as to the public purse are increasingly persuasive. I would go so far as to say it is our duty as passionate believers in the strength of people with disabilities to continue this as a top priority for TLAP going forward.

121 Without doubt the current challenges are grave, people with personal budgets and social care providers across the country are facing continuing and sadly often arbitrary cuts to funding. While it's impossible to ignore the real concern that this brings I am optimistic that we can use TLAP's collective strength to evidence the high quality outcomes achieved by integrated, personalised and community based support. In fact we can't afford not too. http://www.thinklocalactpersonal.org.uk/Blog/article/?cid=9859 Global Use of Medicines: Outlook Through 2017 – Institute of Healthcare Informatics – USA. _____________________________________________________________________ IMS Institute for Healthcare Informatics has published its latest report: Global Use of Medicines: Outlook through 2017. This annual report from the IMS Institute finds that greater access to medicines by the world's rapidly expanding middle class, together with stronger economic prospects in developed nations, will bring total spending on medicines to the $1 trillion threshold in 2014 and to $1.2 trillion by 2017. Some highlights from the report findings include: Structural changes are creating divergent trends in geographies and therapy areas: 1. In the U.S., uncertainties with the implementation of the Affordable Care Act could result in a number of potential outcomes, ranging from disparate enrollment levels of uninsured and under-insured populations; the extent to which there is a shift in focus on preventive medicines versus acute care; changes from fee-for-service to a performance/outcomesbased payment mode; and the degree of cost shifting to patients via higher deductibles and/or co-pays. 2. With the aging population in Japan driving a rapid increase in medicines demand, the government has mandated that 60% of all prescribed off-patent drugs are to be dispensed as generics by 2018 - an action that would double current levels and is unprecedented in any country. 3. In Europe, patients' ability to utilize innovative medicines will be influenced by the impact of potential new austerity measures and the extent to which countries generate savings through greater use of generics. 4. China is in the midst of a massive expansion of its healthcare system, and with its goal of universal coverage by 2020 will transform the medicines market, as that country will represent 34% of total growth in global medicine spending over the next five years. 5. A gradual acceleration in global medicine spending growth will unfold during the next five years, with absolute growth similar to the last five years. 6. Specialty and biologic segments of branded medicines will be the key drivers of growth and of affordability concerns in developed markets, raising the stakes for companies who will need to demonstrate the value of their medicines to increasingly cost-sensitive payers. 7. An average of 35 new medicines with the potential to transform disease treatments are forecast to be launched annually over the next five years. 35 New Molecular Entities (NMEs) are forecast to be launched each year and will include a wide array of treatment areas with extreme unmet need. http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20In stitute/Reports/Global_Use_of_Meds_Outlook_2017/IIHI_Global_Use_of_Meds_Report_2013.pdf Goodwill hunting | Analysis | Inside Housing

122 Cuts to government funding for homelessness services mean charities are increasingly dependent on the generosity of the public to continue providing services to rising numbers of vulnerable clients. Keith Cooper reports The business of helping the homeless should be booming, if official figures are anything to go by. The latest statistics show demand hit its highest level since the coalition took power - with almost 13,500 households accepted as homeless between April and June this year. That’s 33 per cent more than the same period in 2010. Yet this growth has failed to net extra public cash for charities with a mission to help homeless people. An Inside Housing analysis of the balance sheets of six such organisations reveals quite the reverse. From large national organisations like Shelter to more modest operators like London-based Thames Reach, official cashflows into homelessness charities have been squeezed. The former’s ‘statutory’ funding - funding from public bodies, such as central and local government - has dropped by almost £1 million over the past three years from £11.6 million in 2010/11 to £10.7 million in 2012/13. Some, such as St Mungo’s and Broadway, are considering merging because of the changing environment. Rachel Coffey, research lead for umbrella body Homeless Link, says 50 per cent of homelessness services experienced a fall in investment last year - and that services such as day centres are ‘turning to fundraising as a way of financing their work’. But she adds that the sector is ‘still very reliant on council funding. ‘This is why it is so critical that councils think through the impact further disinvestment could have on homeless people,’ she adds. So with these statutory supports so weakened, how well braced are those straining to serve this extra demand? Alternative Sources. Our analysis reveals that many homelessness charities have sought alternative funding sources for some time. Most are turning to so-called ‘voluntary’ income, such as gifts and donations - the kind of cash raised through corporate donations, chuggers, tin rattlers and through more sophisticated means. More goodwill from the public, in other words. The largest charity in terms of income generated in 2012/13, Shelter, is also hoping to bolster its cashflow through an ambitious plan to grow its charity shop chain with a net increase of 17 new stores in 2012/13. All this re-jigging is, however, creating significant drains on charities’ resources. This stress has already pushed some organisations into the red. Others are seeing the financial cushion of their cash reserves deflated, putting at risk their capacity to keep services ticking along uninterrupted. One charity whose reserve has shrunk as its dependence on public goodwill has risen is Londonbased Centrepoint, a charity committed to helping homeless young people. Half of its £19.1 million income in 2012/13 came from voluntary income compared with 35 per cent of £18.2 million three years previously in 2010/11. This increased dependence on donations and gifts is driven in part by cuts in the cash value of official contracts, with Supporting People contracts feeling the squeeze across the board. The national SP budget has dropped from £1.8 billion in 2003 to £1.6 billion in 2014/15 but because it is no longer ring-fenced councils have been slashing their budgets even further.

123 ‘Statutory income has decreased’, a spokesperson for Centrepoint says. ‘And we have increased our support work. Young people need more than just a safe place to stay to leave homelessness behind.’ Using Reserves. Signs of financial stresses are seen in Centrepoint’s figures. While aiming to hold £2.6 million in reserve to ensure ‘uninterrupted’ services, its actual cashflow cushion deflated to £1.4 million in 2012/13, according to its annual accounts. ‘Although reserves are in a satisfactory position overall,’ the charity states, ‘we shall continue our efforts to strengthen them.’ Crisis, a national charity which serves single homeless people, is also leaning more heavily on voluntary income as official sources of funding dry up. Almost 70 per cent of its £22.2 million income in 2012/13 came from benevolent donations. This compares with 55 per cent of its £17.1 million income in 2010/11. As a £11 million government contract came to an end, its voluntary income inched up by £3.5 million between 2011/12 and 2012/13. Like Centrepoint, Crisis also expects demands on its services to rise. To prepare, the charity has embarked on an ‘ambitious’ five-year strategic plan to double its staff and swell expenditure by more than 50 per cent. This involves ‘significant investment’ in fundraising activities and a fall into the red for the immediate future. This is a move to which Crisis is resigned, saying in its 2012/13 accounts: ‘We anticipate financial deficits over the next four years and to have a strong financial base is critical.’ Leslie Morphy, chief executive of Crisis, says its expansion is driven by the rising tide of homelessness, resulting from the economic downturn and public spending cuts. ‘To meet this challenge we are expanding to help more people,’ she adds. Merger Talks Elsewhere, as revealed last month, St Mungo’s is having merger talks with Broadway (Inside Housing, 18 October). St Mungo’s surplus fell from £3.4 million to £1.3 million in the 2012/13 financial year. Our analysis shows that Broadway has increased its voluntary income from £253,285 in 2010/11 to £549,364 in 2012/13. Although raising more overall, St Mungo’s voluntary income dropped by 5 per cent from £2.4 million to £2.3 million over the same period. Other homelessness charities have sought more commercial means of raising income than fundraising - for example Shelter’s shop expansion plan. But as in all lines of business, growth can tie up significant resources in the short-term. Last year Shelter fell into deficit as it accelerated its expansion plan amid tough market conditions. Investment in its retail arm was ramped up 22 per cent as it opened 31 new shops and closed 14. This plunged its commercial operation £389,000 into deficit, its first loss for five years and helped pull Shelter £5.3 million into the red. Its retail chain returned to profit this year, a spokesperson says. Shelter is also ploughing more cash into fundraising, another increasingly significant source of its income. According to our analysis, voluntary income made up 43 per cent of its £53.5 million income in 2012/13 compared with 40 per cent the previous year. This is reflected in an increased spend in fundraising activity, from £8.4 million in 2011/12 to £10.4 million last year.

124 All this extra investment is likely to keep Shelter’s finances in the red for at least one more year, its 2012/13 accounts reveal: ‘We anticipate that next year there will be a small deficit as the programme of investment comes to an end and income continues to rise.’

Primary Source Analysis from Homeless Link, in its annual SNAP report published earlier this year, revealed that fundraised income has increased as a primary source of income from 5 per cent of homelessness projects to 7 per cent over the past few years. However, Supporting People funding continues to be the most significant source, with 67 per cent of homelessness projects listing it as their primary funding source in 2013 - down from 71 per cent the previous year. The challenge of dealing with decreased public funding amid soaring demand is one common to all the charities we examined. Their expansion plans are unlikely to be bolstered with extra statutory funding in the future. They will instead depend on the goodwill of the general public to keep up with escalating demand. As Crisis’ Ms Morphy says: ‘[People] understand that in hard times their support is all the more important in preventing homelessness. Individual donations have risen… and we’re incredibly grateful for that.’ But it all points to an uncertain future for homelessness organisations. As their balance sheets come under increasing pressure with service demands rising, they are entering their most treacherous financial territory for years. Any government recognition of this danger, in the form of increased official income, would be received gratefully. The business case is there in the facts and figures. http://www.insidehousing.co.uk/home/analysis/goodwillhunting/6529621.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=33722 87_IH-Care+and+Support-261113-JK&dm_i=1HH2,20A2N,82EKTS,780GW,1 Gove's disgraceful attack on social workers is meant to soften us up for the private sector – Comment – Politics.co.uk Bridget Robb: 'The DfE made sure Frost was hung out to dry' When assessing Michael Gove's outer demeanour, few would liken him to Gordon Gekko, infamous villain of 1980s paean to greed Wall Street. Yet when it comes to systematically dismantling entire professions, he is a ruthless and slick as any City shark. He's successfully savaged teachers, and now he's circling around social workers. As any good corporate raider knows, a successful takeover requires manipulating the target’s worth. Trashing reputations drives down share prices and results in little resistance when you then mount your attack. When it comes to our public services, Gove's tactics are simple, yet done so skilfully that your average citizen is unaware that they are being bombarded with very sophisticated propaganda. Let’s look at Gove's spin operation in this week alone. [11 - 15th November 2013] On Monday, children's minister Edward Timpson delivered a speech to the Association of Independent LSCB chairs in which he sympathised with their often controversial positions "it might

125 feel like media attention makes discussion of child protection impossible: that calm debate suffers under the intense glare of a media frenzy". These soothing sentiments from the minister were then immediately followed by an anti-social worker media frenzy, carefully crafted by his own department and run over several days. The very next day, press were alerted to a "major speech on children's social care in England" from Gove. He opened by likening child protection social work to a battle between those on the left and those on the right, despite saying that wasn't what he was doing. Besides being secretary of state, Gove was quick to assert his credentials in child protection, saying, "As someone who started their life in care…this is personal". Other disclaimers were used to good effect, with the school-masterly "it is the mark of a mature profession that instead of rejecting criticism, it embraces challenge", ie - if the profession disagrees with me, then it is proof of its immaturity, a criticism often levelled at a profession that is barely 40 years in existence. Gove may have been adopted but he has never been a social worker. What he has been, however, is a journalist at The Times. He may not know much about social work but he understands very well how the press works. While the speech was undoubtedly lengthy and did contain some words of praise for this most "noble" of professions, its real agenda was buried within the rhetoric, "idealistic" students being encouraged by leftist academics to view the people they work with as "victims of social injustice" who are to be pandered to. Any social worker doing the job knows that it's a career in which many people work long days in stressful situations trying against the odds to bring about real changes in people's lives – often making huge demands on reluctant people. Gove then aimed his sights at council directors of social services, explaining he had been forced to introduce controversial adoption league tables because "the leadership was not there at the local level, and there is still an insufficient sense of urgency among too many local government leaders". Thank heavens then for the plucky private sector, which holds all the answers to this current malaise. Referring to the "marketplace" of residential children's homes, Gove explained: "We are working with competition experts and economic regulators, as well as private and local authority providers, to improve the commissioning system in this market." He was equally fulsome in his praise for new social worker training initiative Frontline, which itself is co-founded by city financier charity Ark. The reason that the social work profession has reacted with such ire to this particular Govian speech is not that social workers cannot take criticism - far from it given the constant pummelling from politicians - but because it is so utterly dishonest. Gove cannot ignore the social impact of the austerity agenda. It has nothing to do with ideology and everything to do with the reality of families who have no money, no food, and often very little hope of improving their circumstances. Members of the British Association of Social Workers do not contact us to say they're worried that they have absorbed a left-wing bias, but that they have more children on their books than they can possibly hope to deal with.

126 The Department for Education (DfE) began the week with a pledge of support for Independent Chairs of Local Safeguarding Children's Boards. They must have meant everyone apart from professor Nick Frost, independent chairman of the Bradford Safeguarding Children Board, which published the Hamzah Khan serious case review. The DfE made sure Frost was hung out to dry by briefing Sky News that the contents of the Hamzah Khan serious case review was "rubbish" -while the conference was actually taking place and being televised live by all the major media outlets. This was followed by an announcement from the minister that he had a series of hard-hitting questions that he wanted Bradford to answer, as the serious case review had failed to do so. What possible chance did Bradford LSCB have of getting a fair hearing after that? As any government press officer will tell you, these things do not just happen by accident. They are orchestrated and timed for maximum media impact. The DfE had sight of that document well in advance. Of course, any missing information should be addressed, but making it known via the Sky News ticker during a live press conference is not how such a request should be communicated. Today, the DfE has Birmingham City Council in its sights, threatening to take services away from them if they do not improve. Again, nothing that isn't already known.So why today? How strange that BBC Radio 4 is running a documentary about Birmingham's failing services this very evening. Coincidence? I think not. So bravo then to the DfE press office; a great week for them and a lousy one for demoralised social workers. Greed is not good when applied to child protection. Buy shares in the Post Office if you choose, but please don't buy into this dangerous attack on the social work profession. Every child death is a tragedy, but thousands of children in the UK are made safe every day by supposedly incompetent social workers. When was the last time we saw a media feeding frenzy about a child who didn't become the next Baby Peter because skilled social workers made the right call?

Bridget Robb is the chief executive of the British Association of Social Workers (BASW) and a former frontline local authority social worker herself. http://www.politics.co.uk/comment-analysis/2013/11/14/comment-gove-s-disgraceful-attack-onsocial-workers-is-meant Government must invest urgently in social work training to deliver care law changes, warn councils - Community Care Authorities will need sufficient numbers of well-trained staff to manage increase in caseloads and practice changes, says London Councils The government must invest urgently in training for social workers to ensure councils have sufficient competent practitioners to implement changes to adult care law from April 2015. Councils would need “additional experienced staff” to cope with a large increase in case numbers on the back of the bill’s funding changes, particularly the £72,000 ‘cap’ on the reasonable care costs incurred by individuals.

127 To qualify for the cap, self-funders would need to approach their council for an assessment, with those with eligible needs given an “independent personal budget” setting out what their councils would spend on meeting their needs if it were doing so; this sum would accumulate in a “care account” until the cap is reached. This means councils must carry out hundreds of thousands of extra assessments of people wanting to be considered for the cap in the run-up to, and soon after, the implementation of the funding changes, in April 2016. In their response to the consultation, the Local Government Association and Association of Directors of Adult Social Services said this may have to be managing by outsourcing responsibility for lowerlevel assessments to providers and third sector bodies . However, London Councils said at least part of the solution would have to be councils having to take on “additional experienced staff”, in a context where authorities have had to make “significant budget cuts and staff reductions”. “We believe that there is a need for the government/skills sector to be investing in increased training so that by 2016 the workforce will be large enough to handle the new system,” said London Councils. It said the government needed to start investing in social work training “urgently” so that the workforce is large enough to handle the new system by 2016. However, as well as needing extra staff, it said existing staff would need to be retrained in the practice and system reforms that the legislation will initiate. London Councils said the government should also fund councils to meet this training gap, potentially on a regional basis to provide economies of scale. http://www.communitycare.co.uk/2013/11/25/government-must-invest-urgently-social-worktraining-deliver-care-law-changes-warn-councils/#.UpRxYhZ8vkw?cmpid=NLC|SCSC|SCDDB-20131126 Government to fund 270 local government fraud investigators – Local Government Lawyer. The Government is to make £16.6m available to fund an additional 270 fraud investigators for local government over the next two years. The move follows the Chancellor of the Exchequer’s confirmation in the Autumn Statement 2013 last week that the Department for Work and Pensions would proceeed with establishing the Single Fraud Investigation Service (SFIS). The SFIS, which will come into being in 2014, will investigate all welfare fraud across all benefits administered by the DWP, HMRC and local authorities. But concerns had previously been expressed by local authorities such as Craven District Council over the potential loss of benefit fraud investigation expertise. The Department for Communities and Local Government insisted that the Government would work closely with the Local Government Association and councils to “ensure that the best data, powers and incentives are in place”. The DCLG said that in addition to providing the £16.6m funding, it would also initiate a project with local government to ensure data was “shared between SFIS and councils and ensure SFIS and councils have the ability to jointly investigate and prosecute fraudsters”. A separate £9.5m was allocated recently by the Department to help 62 local authorities tackle social housing fraud. Communities Minister Baroness Stowell said: “This Government is determined that those who do the right thing are rewarded and those who don’t are not. This £16.6m of funding is just the start in our

128 continued fight against fraud. The Government has worked hard to help local government and I want to see a renewed drive and commitment in tackling this problem. “Local government fraud costs this country £2bn every year – money straight from the pocket of hard working taxpayers. Councils must do everything in their power to ensure they recover this money and we will do everything in ours to help them.” Government to intervene "where councils fail to take extremism seriously" – Local Government Lawyer. The Government will take steps to intervene in cases where local authorities are not taking the problem of extremism seriously, a taskforce set up by the Prime Minister has announced. In its final report, published last week, the Extremism Taskforce said this was intended to “to show unequivocally the importance we attach to tackling extremism and the role of local authorities in delivering it”. The Government will also make delivery of: • •

‘Prevent’ – its counter-radicalisation and counter-extremism strategy – a legal requirement for local authorities in those areas where extremism is of particular concern; and The ‘Channel’ programme, which supports individuals at risk of being radicalised, a legal requirement in England and Wales.

The taskforce said the Government should consider if there was a case for new civil powers to target the behaviours extremists used to radicalise others. These new powers would be similar to the revised powers for dealing with anti-social behaviour. The report proposed consideration as well of whether there was a case for new types of order to ban groups which sought to undermine democracy or use hate speech, “when necessary to protect the public or prevent crime and disorder”. •

•

• • •

•

Consultation on new legislation to strengthen the powers of the Charity Commission. “These powers will help us tackle extremism, as well as other abuses of charitable status such as tax avoidance and fraud”; Working with internet companies to restrict access to terrorist material online which is hosted overseas but illegal under UK law, as well as helping them with their continuing efforts to identify what material to include in family-friendly filters; Improvement in the process for the public to report extremist content online; Ensuring prisoners who have demonstrated extremist views in prison receive intervention and support on release; Making sure organisations have the support and advice they need to confront and exclude extremists: “they will get expert advice from specialist charities if they have to resort to legal action to exclude extremists”; The police sharing information with other countries to identify individuals with extreme rightwing views coming to the UK, as they do with Islamist extremists.

The taskforce insisted that the proposals were “not intended or designed to restrict or prevent legitimate and lawful comment and debate”. The report also set out a definition of Islamist extremism as a distinct ideology that “should not be confused with traditional religious practice”.

129 Prime Minister David Cameron said: “This summer we saw events that shocked the nation with the horrific killing of Drummer Lee Rigby in Woolwich and murder of Mohammed Saleem in Birmingham. These tragedies were a wakeup call for government and wider society to take action to confront extremism in all its forms, whether in our communities, schools, prisons, Islamic centres or universities. “I have been absolutely clear that this is not something we should be afraid to address for fear of cultural sensitivities. We have already put in place some of the toughest terrorism prevention controls in the democratic world, but we must work harder to defeat the radical views which lead some people to embrace violence.” The members of the taskforce were: the Prime Minister (chair); the Deputy Prime Minister; the Chancellor of the Exchequer; the Secretary of State for the Home Department; the Secretary of State for Business, Innovation and Skills; the Lord Chancellor and Secretary of State for Justice; the Secretary of State for Education; the Secretary of State for Communities and Local Government; the Minister for Schools; the Minister for Faith and Communities; and the Minister for Government Policy. A copy of the report, Tackling extremism in the UK, can be read here. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263181/ETF_FINAL. pdf

GP Improvement Notices Issued – Everything CQC Below is the list of outcomes, which practices are failing during an inspection.

Outcomes

Frequency (%)

Outcome 12: Requirements relating to workers

Outcome 8: Cleanliness and infection control

Outcome 16: Assessing and monitoring the quality of service provision

Outcome 7: Safeguarding people who use services from abuse

Outcome 9: Management of medicines

Outcome 10: Safety and suitability of premises

130 Outcome 1: Respecting and involving people who use services

Outcome 21: Records

Outcome 4: Care and welfare of people who use services

Outcome 14: Supporting workers

Outcome 11: Safety, availability and suitability of equipment

Outcome 2: Consent to care and treatment

Outcome 6: Cooperating with other providers

Outcome 17: Complaints

Outcome 13: Staffing

Outcome 5: Meeting nutritional needs

Outcom e 1: Respect ing And Involvi ng People Who Use

Services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Reason(s) for Improvement Notice: 1. Patient Participation Group was not used effectively • • • • • •

PPG Group set up in June 2012 No record of minutes of meetings since initial set up PPG has not been consulted about the annual patient survey Provider confirmed that no meetings held with PPG Change of practice email address not communicated to PPG group Emails sent by PPG members to old address remained unanswered

2. People's privacy and dignity were not respected Interviewing patients on the day of the inspection confirmed that: • •

Patient’s medication requirements, etc. were discussed at reception On occasion staff did not knock before entering the room during a consultation

Outcome 7: Safeguarding People Who Use Services From Abuse

131 People should be protected from abuse and staff should respect their human rights Reason(s) for Improvement Notice: 1.

Staff had not received updated safeguarding training for children • • • •

The practice declared non-compliance on registration o Their action plan to be compliant by 01 October 2013 was accepted by the CQC Staff training on Adult safeguarding was declared as up to date On questioning, staff lacked insight into the protection of vulnerable persons who were unknown to them Staff also appeared unconcerned about their lack of understanding on safeguarding

2. CRB Checks [Now DBS checks] • • •

Evidence of a CRB check was missing No risk assessment of whether CRB checks were necessary CRB action plan not put into place

Editor's Comment: Inspectors are picking up on action plans submitted as part of registration with the CQC not having been put into place. If you had submitted any action plans it would be wise to stick to the timetable or send CQC an update as to why things have not been achieved, rather than being caught out on the day of the actual inspection. At another inspection the GP practice failed Outcome 12 for not having CRB/DBS and other appropriate checks carried out for their staff. Outcome 12: Requirements Relating To Workers People should be cared for by staff who are properly qualified and able to do their Job Reason(s) for Improvement Notice: Editor’s Comments: The area of Suitability of staffing (Outcomes 11, 12 & 13) has a great overlap in the criteria for compliance for each of the outcomes. Failings in one of these could potentially prompt an inspector to review the other related outcomes, leading to a worse compliance report. Also note that another provider got an improvement notice for Outcome 7 for not having carried out CRB/DBS checks on staff.

GP Practices in the East Midlands Where a CQC Improvement Notice Has been Served

GP Practice Postal Code 67

Howard Medical

Date of Inspection

24/06/2013

Improvement Notice Issued

Download Inspection Report

East http://www.cqc.org.uk/directory/1Midlands 576407530

SK13 7DE

132 Practice Arden House Improvement 62 Medical 02/05/2013 Notice Issued Practice

East http://www.cqc.org.uk/directory/1- SK22 Midlands 571536976 4AQ

Arden House Improvement 63 Medical 08/05/2013 Notice Issued Practice

East http://www.cqc.org.uk/directory/1- SK22 Midlands 571573273 2JG

Dr ClaireImprovement 21/07/2013 Louise Hatton Notice Issued

East http://www.cqc.org.uk/directory/1- NG14 Midlands 560520808 7BG

Newhall Improvement 13/08/2013 Surgery Notice Issued Dr Heappey Improvement 38 11/07/2013 and Partners Notice Issued 42

Dr Vishnu Parmar

Dr Mohamed Improvement Mourtada 19/07/2013 Notice Issued Sultan

24/05/2013

Improvement Notice Issued

East Midlands East Midlands

http://www.cqc.org.uk/directory/1549406380 http://www.cqc.org.uk/directory/1543861004

DE11 0HU DE23 3TX

East http://www.cqc.org.uk/directory/1- DE12 Midlands 535451896 6JF East http://www.cqc.org.uk/directory/1- LN1 Midlands 493902429 2XF

GP Practices in the East Midlands Where a CQC Improvement Notice Has been Served

GP Practice Code Howard 67 Medical Practice

Date of Inspection

24/06/2013

Improvement Notice Issued

Download Inspection Report

Postal

East http://www.cqc.org.uk/directory/1Midlands 576407530

SK13 7DE

Arden House Improvement 62 Medical 02/05/2013 Notice Issued Practice

East http://www.cqc.org.uk/directory/1- SK22 Midlands 571536976 4AQ

Arden House Improvement 63 Medical 08/05/2013 Notice Issued Practice

East http://www.cqc.org.uk/directory/1- SK22 Midlands 571573273 2JG

Dr ClaireImprovement 21/07/2013 Louise Hatton Notice Issued

East http://www.cqc.org.uk/directory/1- NG14 Midlands 560520808 7BG

Newhall Surgery

Improvement Notice Issued

East http://www.cqc.org.uk/directory/1- DE11 Midlands 549406380 0HU

Dr Heappey Improvement 11/07/2013 and Partners Notice Issued

East http://www.cqc.org.uk/directory/1- DE23 Midlands 543861004 3TX

Dr Vishnu Parmar

East http://www.cqc.org.uk/directory/1- DE12 Midlands 535451896 6JF

Dr Mohamed Improvement Mourtada 19/07/2013 Notice Issued Sultan

13/08/2013

24/05/2013

Improvement Notice Issued

East http://www.cqc.org.uk/directory/1- LN1 Midlands 493902429 2XF

GP services for older people: a guide for care home managers – SCIE Guide 52

133 Published: December 2013 Review date: December 2016 The health and wellbeing of older people in care homes depends on them accessing GP services in a timely way. Effective joint working between GP and care home management, the involvement of residents and their relatives and the engagement of care staff are factors that can affect the outcome and lead to quality improvements. This guide is primarily written for managers and senior staff of care homes but it has also been written with GPs in mind, as well as members of clinical commissioning groups and joint health and wellbeing boards.

Recommendations Recommendations from this guide.

Introduction Why it’s important for older people in care homes to access GP services in a timely way.

Residents’ entitlements and requirements People should be involved as fully as they wish in discussions about their health care and treatment.

Managers’ responsibilities Care home managers should establish ways of listening to and regularly checking the views and experience of residents

GPs’ role in relation to the resident A GP’s primary relationship is with the resident rather than the care home.

Workforce development, standards and regulation Staff need the confidence, knowledge and communication skills to initiate and handle relationships with GP.

DOWNLOAD THE GUIDE: http://www.scie.org.uk/publications/guides/guide52/files/guide52.pdf

Hard truths: essential actions - Health Foundation On 19 November 2013, the government published Hard Truths , its full response to the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry by Robert Francis QC.

134 The focus of this Health Foundation briefing is on bridging the gap between the actions set out by the government in Hard Truths and their practical application by people working in the service. We use the experience gained from our research and improvement programmes to suggest to policy makers how the continual reduction of harm can be achieved by measuring safety comprehensively and by building the capability of individuals, organisations and systems. Key Recommendations: 1. A learning environment is necessary to achieve the profound cultural change being asked of the NHS. There is a pivotal role for the government and NHS England in creating this. 2. A large-scale safety collaborative programme has the potential to provide benefit, but NHS England needs to strike the right balance between providing accountability and achieving genuine ownership from front-line teams. 3. The focus on measuring safety is welcome, but measures should be developed to assess the future risk of harm, not just the occurrence of past harm. 4. The government also needs to be clear how the publication of data will improve safety. http://www.health.org.uk/publications/hard-truths-essentialactions/?utm_source=charityemail&utm_medium=email&utm_campaign=december2013&pubid=healthfoundation&description=december-2013&dm_i=4Y2,2227A,B4Z9MV,7EZ2C,1# Health equality could be achieved for the first time in human history - The Information Daily.com A report, compiled by 25 leading world health experts and economists, illustrates how governments and donors could reach health equality within a generation with an ambitious but entirely possible investment plan. Chair of the report, Lawrence H. Summers, said: “We are on the verge of being able to achieve a milestone for humanity: eliminating major health inequalities, particularly inequalities in maternal and child health, so that every person on earth has an equal chance at a healthy and productive life. The authors estimate that if the recommendations for an increase in the global investment in health are followed, around 10 million lives in low and middle-income countries could be saved in 2035. This would provide huge social and economic benefits for the countries most affected. Today’s report in the Lancet provides details of an investment framework for low and middle-income countries. This shows that spending should be prioritised on introducing and increasing methods to tackle HIV, TB, malaria, neglected tropical disease and maternal and child health. The report highlights that investment into research and development needs to be increased in order to develop new drugs, vaccines and health technologies. The report argues that if the goal of universal health coverage is implemented with the poor in mind it could lead to a sharp reduction in the high levels of impoverished individuals as a result of out-ofpocket health spending. Richard Horton, Editor-in-Chief of the Lancet and one of the report’s authors, said: “Investing in health is also an investment in prosperity, social and financial protection, and national security. “What our Commission underlines, in an original and compelling way, is that investing in health means investing in a quality human beings value deeply, but which we do not capture well in our usual measures of development. http://www.theinformationdaily.com/2013/12/03/health-equality-could-be-achieved-for-the-firsttime-in-human-history

135 Homeless women lack access to social workers despite multiple and complex needs Community Care Housing support workers taking on roles that previously would have been carried out by social workers, finds study Homeless women lack access to social workers despite having multiple and complex needs including childhood abuse, domestic violence, mental ill-health and substance misuse problems. Housing support workers appear to be taking on roles previously carried out by social workers in relation to this group, such as co-ordinating services for them. Researchers spoke to 38 women using homelessness services over the course of 18 months, tracking progress through an initial interview, a further one six months later and a third at the end. They also spoke to 15 practitioners, generally and in relation to 11 of the clients. Half of the women reported having at least six of the following issues: substance misuse; mental health problems; domestic violence; past experience of domestic violence; sexual violence in their past; current experience of sexual violence; childhood abuse; criminal justice involvement; or sex work. Despite this, none reported having a social worker as an adult and associated social services with their own childhoods or with involvement with their own children. They did mention involvement with other staff including mental health teams, housing and voluntary sector support staff. “This finding suggests that other workers, often housing support workers, are fulfilling functions that in the past social workers would have carried out, for example by providing and co-ordinating services,” found the study. That women found having to re-tell their services several times humiliating and something that added to their trauma, but were willing to tell their stories if they felt valued and listened to; Service users preferred practitioners who took time to build relationships with them and genuinely listened to them, but practitioners felt that their services lacked the resources to enable them to do this; Stable and emotionally and physically safe environments are essential in addressing the needs of homeless women given their often traumatic histories; Workers should give women multiple opportunities to disclose information of what has happened to them and about their needs; Many women felt vulnerable to relapse meaning that ongoing low-level support would be useful. http://www.communitycare.co.uk/2013/12/06/homeless-women-lack-access-social-workers-despitemultiple-complex-needs/#.UqGbH-DRr0s?cmpid=NLC|SCSC|SCDDB-2013-1206 DOWNLOAD THE REPORT: http://sscr.nihr.ac.uk/PDF/SSCRResearchFindings_13_.pdf How early information sharing can help social workers manage the rising tide of safeguarding alerts - Community Care

136 Safeguarding investigations in one county are becoming more focused thanks to the establishment of a multi-agency safeguarding hub Adult safeguarding alerts are rising year-on-year putting ever greater pressure on the social work teams charged with looking into them. While the number of referrals requiring investigation is also rising, many alerts do not involve likely abuse or neglect for a vulnerable adult, but other types of need or situation. Sifting the latter from the former can divert valuable social work resource away from investigating abuse or neglect. At the same time, social workers can often find themselves investigating safeguarding referrals with limited information on levels of risk – despite valuable intelligence on this often being available from other professionals and partner agencies. In Nottinghamshire, a solution has been in place to address both of these problems since January in the shape of the county’s Multi-Agency Safeguarding Hub (Mash). The Mash takes all incoming reports of adult safeguarding – and children’s social care – concerns during standard working hours – mainly from professionals, but also from the public. Reports from the public come mainly by telephone, but also through email, fax or letter. At that point, two processes kick in, one of risk assessment and triage by social workers, and a second, where required, of information sharing with key partner agencies. Crucially, professionals from those agencies – including police, health, and probation – work alongside social care colleagues at the Mash’s offices. This means they are available to social workers for informal consultations on cases, as well as able to draw on their agencies’ information systems and fellow professionals for valuable intelligence. As a result, community social care teams should only receive safeguarding referrals worthy of investigation, and with as much relevant information as possible. While it remains early in the lifespan of the Mash, the impact on community teams’ work is evident from the number of referrals they have received this year. From 28 January, when the Mash started work on adult safeguarding, to 15 November, it received 7,889 reports of adult safeguarding concerns, of which 1,625 were sent to operational teams as a safeguarding referral. Previously, when adult safeguarding alerts were largely picked up by Nottinghamshire Council’s customer contact centre many more would have ended up on operational teams’ desks. Previously social workers would have been straggling around to get basic information but now they have all this information from our partners” Claire Bearder, group manager, safeguarding adults “All the cases that wouldn’t have made it through to a strategy meeting are not being passed on and stay within the Mash,” says Mash approved social work practitioner Jim Hanson. Safeguarding investigations have become more focused as a result of the Mash process. “Previously, social workers would have been straggling around to get basic information but now they have all this information from partners,” says Claire Bearder, the council’s group manager, safeguarding adults. “The real difference between the Mash and previous referral systems is that we ask our partners. We say: ‘This is the safeguarding concern that we have, this is the information we have, do you have any knowledge about this adult that we can use?’.” How the Mash works The Mash is based on a single open-plan floor of a council office on an industrial estate in Annesley, outside Nottingham, one floor below the authority’s customer contact centre. It houses 111 staff, who work on a full-time, part-time or rotating basis, equivalent to 75 whole-time posts. While most

137 are from the council or the police, there is significant representation from health, as well as an education, early years, probation and, since September, a trading standards presence. Practitioners contacting the Mash do not deal with social workers but with Mash officers – nonprofessionally qualified staff from a range of backgrounds, including social care and contact centre work. All have received a month’s induction training in safeguarding. Their role is to take down details, according to a standard script, and feed the information on to the council’s electronic care management system. Three of the 13 Mash officers are specialists in adult safeguarding, though all take both children’s and adults’ cases. Their work is co-ordinated by senior Mash officers, whose role also includes ensuring that there are enough people on the phones to deal with incoming calls, and to initially prioritise cases in order of severity. They are then passed on to an adult social work team - consisting of a manager, three advanced social work practitioners (ASWPs) and a social worker – for triage. Using their professional judgement, existing information on the care management system and informal discussions with partner professionals within the Mash or the referrer themselves, they risk assess each of the 50-70 adult safeguarding alerts that come in each day. There are four possible outcomes:§ § § §

The report definitely does not meet safeguarding thresholds, in which case signposting information is provided to the referrer; The case does not meet safeguarding thresholds but information sharing with partners would be useful (green case); It is not clear whether it is a safeguarding case and more information is needed from partners to determine this (amber case); It is definitely safeguarding (red case).

Green, amber and red cases are then passed to staff from relevant partner agencies in the Mash, so that they can seek further information from their agencies’ computer systems or from colleagues outside the hub. Information must be returned back to the Mash within four hours for red cases, a day for amber cases and three days for green cases. In red cases, the hub’s adult social work practitioners will often pass the case straight to community teams for investigation, with the additional information from partners supplementing the initial referral and providing valuable intelligence. “If I’m clear that someone is at immediate risk of harm I will make an immediate decision and shortcircuit the Mash process,” says Hanson. In other cases, when all information is returned, the adult social work team decide whether these should be referred for a safeguarding investigation. All partners in the Mash are signed up to rules on information sharing. Non-sensitive information can be shared with community teams carrying out safeguarding investigations; however, sensitive information that would be useful must be kept within the Mash and not passed on without the data owner’s permission. Sixty four per cent of local areas in England had an arrangement for multi-agency information sharing in safeguarding, found a survey for the Home Office earlier this year. But these arrangements vary in terms of the level of co-location of staff from different agencies, the range of agencies involved and the level of information sharing. Nottinghamshire is one of few areas to have a Mash that covers children’s social care and adult safeguarding enquiries. “I’d be quite confident in saying that the Nottinghamshire Mash is the most rolled out across all the areas,” says Mash operations manager Simon Holmes, who oversees the running of the hub and formerly managed England’s first Mash, in Devon.

138 It is relatively early days in the life of the Mash, which launched last December for children’s social care, a month before its start for adult safeguarding, following a year of prior development work. But positive effects are being felt by the staff working there. Through working alongside each other, they have learnt much about each other’s ways of working, legal powers, thresholds for action and how they can help each other. “The Mash means we are getting to see cases that we otherwise wouldn’t have seen,” says trading standards officer Sharon May, who says vulnerable adults are often at particular risk of the scams and rogue traders that her service investigates. “Also, we often visit vulnerable people who have not been in contact with services and previously we used to say, ‘this person needs help, what do we do?’. Now we can pick up the phone to Mash and say, ‘we are faced with A, B and C, can we refer this to you?”. Sgt Colette Phillips, of Nottinghamshire Police, adds: “We get a lot of notifications from divisional officers that are about vulnerable adults in need of services, not safeguarding. Prior to the establishment of the Mash, officers would not have known where to go.” She also welcomes the links with trading standards, who are often able to take action in cases where the police lack sufficient evidence to bring criminal charges. Bearder says that while there were formal information sharing processes prior to the establishment of the Mash, having staff working alongside each other makes these much more effective. The Mash staff also provide an example to other professionals. “We model how to work together for our colleagues in the community,” says specialist health practitioner Margaret Cheetham. “People need to pick up this way of working on the outside.” How to fix the UK's broken homecare system | Social Care Network | Guardian Professional Outcome-based commissioning will lead to more motivated care workers and more stable providers There is no doubt the homecare system in the UK is not working – as shown by the latest Guardian survey and numerous other articles. What is more important is why the system is broken and how to fix it. At Atlantic, we have worked with a number of local authorities' homecare services in the past five years. It has become increasingly clear that homecare faces a systemic problem. As with all systemic challenges, the solution must be a change in the structure or policies rather than tinkering with individual elements such as price per hour. Everyone is aware that shrinking budgets and increasing demand has put pressure on the system. The reaction has been to squeeze provider margins through pricing and minimise service time to service users. The result is that care workers have limited time with customers and the best they can ever do is comply with their specific duties such as to help feed or dress or medicate. For brevity, I am ignoring the other loop of financial and time pressure on care workers causing dissatisfaction and high staff turnover. The system increases the dependency of users and so further increases demand. We do little to help the user become independent outside of the reablement service. The fact that the term "support plans" is used is evidence of that. If this is the underlying problem, what might be the solution? Any attempts to squeeze more efficiencies out of the system would increase the probability of providers going out of business, increase the tension between providers and local authorities and increase the safeguarding risk to service users.

139 We believe that there are four key elements that should be addressed: • Focus on helping users become independent • Align all the players within the system to work towards this independence • Use technology to optimise the solution • Integrate more closely with health. Granted this is easy to say – but it does not answer the question of how. In our research and work, we see outcome-based commissioning as a way of addressing these elements. The underlying principles are: • Understanding and working towards the desired outcomes of individual service users • Applying a reablement-ethos to the whole of the homecare service • Paying providers for achievement of these outcomes – not rewarding them for undertaking timeand-task activities. To enable this, some fundamental changes are required. A portion of the risk is transferred to the provider – with a concomitant payment and increased level of autonomy. The provider develops the support plan (which we now call an "independence plan") in conjunction with the user. A second fundamental change is using a far broader range of services to assist the user in becoming more independent: community services, equipment and telecare are some examples. This can be significantly improved by integrating health services with social care to provide a more joined-up approach, all focused on improving independence and preventing hospital admission. Another aspect is the use of technology such as sharing of data, using smartphones to support care workers in the field and improving communication between different players in the system. Outcome-based commissioning will lead to more independent and more satisfied users. Other benefits include more motivated care workers, more stable providers and efficiencies gained through integration with health. We accept that this is still a novel idea and few local authorities are far down the track of real implementation, which adds an element of risk as the pioneers of this service. However, interest is high among local authorities and providers. Perhaps the time has come to stop moaning about the problems of homecare and take some action to fix it. Outcome-based commissioning may be that action. http://www.theguardian.com/social-care-network/2013/nov/26/how-fix-broken-homecaresystem?CMP= How to improve patient engagement – KevinMD.com - USA Much is being made of the meaningful use requirement to use secure online messaging to communicate with patients about relevant health information. The new Stage 2 measure requires that more than 5% of unique patients seen by the eligible professional during the reporting period were sent a secure message using the electronic messaging function of certified EHR technology. But to meet that goal, we have to get our patient population engaged and using our patient portal. Worries about that very thing abound in medical practices of all specialties across all communities.

140 Like so much in life, we think about the “other guy” in an adversarial role — what we can control and how we can influence others. We complain about patients who just won’t do what we tell them. We get annoyed when patients won’t take the medicines we prescribe for them. We get frustrated when patients don’t show up for follow-up appointments or don’t follow through on ancillary tests we’ve scheduled for them. But those attitudes, as natural as they might be, don’t help us get to where we need to be. We need to figure out how providers and staff at medical practice can engage our patients. How can we help them? We can start by acknowledging that our patients are vulnerable. We need to respect their position to gain their respect, and that happens when we act to make something better or easier for the patient. That something can be as simple as getting through on the phone; we need to answer phones promptly. That something can be as simple as keeping the patient informed when their appointment is delayed because we are behind schedule. That something can be asking them to explain their treatment plan to us after we’ve instructed them, so that we can be sure they understand our medical jargon. In a Gallup poll done in 2011 of 1,037 adults surveyed nationwide, nurses earned the highest marks for honesty and ethical standards — higher than doctors, pharmacists, police officers, and clergy. Why are nurses ranked so high? If your practice is like most, your nurses may spend more time with your patients than you do. The nurse performs the intake, the nurse talks to the patient on the phone when they call in, the nurse follows your encounter with the patient to instruct the patient and answer any questions. Patients often ask the nurse rather than “bother” the doctor. Nurses will take more time with the patient. In a Press Ganey report of over 2 million survey responses from 675 facilities, the top two priorities that patients judge us by are our sensitivity to their needs and the overall cheerfulness at our practice. That tells us how to engage with our patients. That’s where nurses excel and we can enhance that. Sensitivity and cheerfulness, respect and kindness are the keys. Sensitivity is demonstrated by respect, and for patients that means listening. Make eye contact. Easy and nothing to buy! Cheerfulness and kindness start when we greet every patient with a smile every time. That’s an easy thing to do, too, and there’s no additional cost to the practice. Remember the communication rule of 7%-38%-55%? Our spoken words contribute 7% to the understanding of our message; our tone contributes 38% to that understanding; and our body language (primarily facial) contributes 55% to understanding. There are plenty of things in healthcare that we can’t control: federal regulations, billing requirements, patient behaviors. But we can use our knowledge power and relationship power to deliver information to make things easier and better for our patients.

141 We have the power to make a difference and to engage every patient we encounter. Our engagement enhances our patients’ experience, and that is engaging to our patient.

Rosemarie Nelson is principal, MGMA Health Care Consulting Group and blogs at Practice Pointers. http://www.kevinmd.com/blog/2013/11/improve-patient-engagement.html HSCIC extends monthly workforce data to include earnings estimates and sicknessabsence rates - Health & Social Care Information Centre December 19, 2013: The Health and Social Care Information Centre (HSCIC) has extended its monthly release of provisional workforce statistics to include staff earnings estimates and sickness absence rates. For the first time today, HSCIC's regular monthly report about the number of staff working for NHS hospital and community health services (HCHS) in England is published alongside new monthly reports on HCHS earnings and sickness-absence, which were previously published quarterly. The move reflects HSCIC's work to offer a broader range of regular, timely information on related topics, towards building greater understanding and public awareness of statistics. All three reports will now offer a monthly update of information, with provisional workforce and earnings estimates information to September 2013 inclusive and provisional sickness-absence information to August 2013 inclusive. They can be accessed at: Workforce: http://www.hscic.gov.uk/pubs/hchsworksep13prov Earnings: http://www.hscic.gov.uk/pubs/staffearnsep13prov Sickness absence: http://www.hscic.gov.uk/pubs/sickabsrateaug13

I am not a disease, I am not a checklist

I am not a disease. Although when I enter your hospital, or office, or outpatient centre, you may refer to me as one. You may lump me together with an odd set of symptoms, or signs. You will define me with those antiquated terms. You will pretend that you will know how I, my body, will react when placed under certain stressors. You will prescribe treatments for my disease, and yet leave me out of the equation. You know, the me that the rest of the world sees when I am outside the obtuse boarders you have created. Only a fraction of my life occurs in your realm. The labels you give, the actions you take, have consequences. They may determine my physiologic or economic well being. Are you listening?

I am not a checklist.

142 You may use one when deciding whether my treatments are covered. You may question my doctor, read him the riot act. You will say that I don’t fit your algorithms. I do not adhere to your guidelines. Diseases follow a pattern, unlike every other aspect of human behavior, they are quite predictable. Why should I be different from any other? Why should my pain and suffering be unique? Require unique solutions?

I am not a mark. My suffering was not meant for your exploitation. I see your commercials on television. People with my disease run through angelic fields with smiles on their faces. I do not live here. I do not run when my body aches and my mind is numb. You ride in like a saviour and ride out with my wallet strapped on your back. You offer false prophecies. Some of your drugs, injections, and sprays truly save lives. Others are crap. Must you treat them as one and the same? Just to make money?

I am a human being. My disease is part, not the whole, of me. Lift your eyes from your tired misconceptions, your white-washed guidelines, and your marketdriven economies.

And look at me. Jordan Grumet is an internal medicine physician and founder, CrisisMD .He blogs at In My Humble Opinion. Impact of changes to social care funding/charging on extra care housing post Dilnot. This Housing LIN Briefing considers the impact that the proposed new care funding system will have on housing choices made by older people, including extra care housing. The key question addressed in the paper is what effect, if any, will the new system have on the demand by older people for extra care housing? It seeks to anticipate whether the new funding system contains financial incentives or disincentives to make particular choices. It is not intended to be guidance for commissioners and providers but summarises what is known about proposed systems, highlights issues and suggests how different stakeholders may behave. DOCUMENTS: http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Briefings/HLIN_Briefin g_ECHpostDilnot.pdf\ 'Implicit' changes to eligibility criteria have driven substantial cuts in client numbers Community Care Large reductions in the number of people receiving council-arranged care, particularly since 2009/10, are “significantly more acute” than explicit changes in Fair Access to Care Services eligibility thresholds made over that time. “It seems that “implicit” eligibility policies might have

143 shifted significantly through time without an equivalent reflection in terms of changes in the “explicit” local eligibility thresholds,” said the research by the Personal Social Services Research Unit, commissioned by campaign coalition the Care and Support Alliance . From 2005/06 to 2012/13, the number of people receiving formal packages of care from their council fell by 320,000, found the PSSRU team at the London School of Economics. Researchers calculated that, given the rising numbers of older and disabled people in the population over that time, 453,000 fewer people were receiving care in 2012/13 than would have done in 2005/06 given a consistent level of eligibility. The vast majority of the reduction – 281,000 of the 320,000 cut in the actual number of service users, and 382,000 of the 453,000 needs-adjusted cut – happened after 2009/10, when the government’s programme of deficit reduction began. However, councils tightened formal eligibility criteria more significantly from 2005/06 to 2009/10, when the proportion of authorities setting a ‘substantial’ threshold rose from 59% to 76%, than from 2009/10 to 2011/12, when the proportion of ‘substantial’ councils rose from 76% to 80%. Today’s research, whose publication coincides with the second reading of the Care Bill in the House of Commons, also found that the cuts in the number of service users were concentrated among users of community-based care – contrary to the policy imperative of shifting services out of care homes into people’s homes. Since 2009/10, the number of users of community services on councils’ books fell by 27% from 980,000 to 711,000, while the number of residential and nursing home clients fell by 4%, from 229,000 to 219,000. “This is likely to reflect the fact that people with the lowest levels of need, who generally live in the community, have been disproportionately affected by the hardening of local eligibility thresholds,” said the report. When adjustments are made for rising levels of need in the population, 5% fewer people with learning disabilities were receiving services in 2012/13 than in 2005/06, compared with 48% fewer people with mental health problems, 39% fewer older people and 33% fewer adults with physical disabilities. DOWNLOAD THE REPORT. http://www.pssru.ac.uk/archive/pdf/dp2867.pdf Improving patient flow across organisations and pathways – The Health Foundation.

Poor patient flow increases the likelihood of harm to patients and raises healthcare costs by failing to make the best use of skilled staff time. This evidence scan compiles examples, from published empirical research, of strategies used to help improve patient flow across organisations or pathways of care. The scan addressed the question: §

What empirical literature exists about methods to analyse or alter patient flow across organisations or pathways of care?

The empirical evidence reviewed by the scan suggests that healthcare teams wanting to analyse and alter patient flow should note the following key learning points:

144 § § §

§

§ §

§

Analysing patient flow and putting in place steps to address bottlenecks can have a measureable impact on throughput and length of stay. It is possible to transfer improvement techniques to a healthcare context, but it is essential to recognise contextual factors and adapt the methods. It is important to undertake detailed ‘diagnostic’ work to understand patient flow, rather than moving straight into redesigning services. Real-time demand and capacity management may be important. Flow issues may best be addressed by exploring processes across an entire hospital or a wider system comprising primary care, ambulance, hospital, social care and community services, rather than in specific departments. It can take time for new processes and systems to embed. Adequate time, resources and management support are needed to facilitate change. The most successful redesign initiatives include extensive staff engagement and training. If people are being asked to change the way they work, it is important that they understand why and what the benefits will be for themselves and patients. There is no ‘one size fits all’ approach. Many different methods have been used with the potential to improve healthcare.

http://www.health.org.uk/publications/improving-patient-flow-across-organisations-andpathways/?utm_source=Email+Alert&utm_medium=email&utm_campaign=New+content+on+Healt h+Foundation+website%3A+Improving+patient+flow+across+organisations+and+pathways DOWNLOAD THE REPORT: http://www.health.org.uk/public/cms/75/76/313/4519/Improving%20patient%20flow%20across%2 0organisations%20and%20pathways.pdf?realName=YUR6ej.pdf Inadequate staffing and supervision at young people’s mental health unit, finds CQC Community Care St Andrew’s Healthcare adolescents service failed to meet all eight standards of care it was assessed against A mental health provider has been told to improve the way it supports frontline staff at one of its young people’s units after a highly-critical inspection report revealed a series of problems at the service. The Care Quality Commission took ‘enforcement action’ against St Andrew’s Healthcare after inspectors found that the provider’s adolescent service in Northampton failed to meet all of the eight standards of care it was assessed against at an inspection in September of this year. St Andrew’s Healthcare said it had “challenged” the accuracy of some of the inspector’s conclusions but was “awaiting feedback” from the CQC on the improvements it had made in response to several concerns identified by inspectors. One staff member told inspectors: “The main problem is lack of support; the management don’t care about staff, and we are just numbers.” The CQC’s report said: “We have taken enforcement action against St Andrew’s Healthcare – adolescents service to protect the health, safety and welfare of people using this service.” A St Andrew’s Healthcare spokesperson said: “It is important to highlight that none of the inspector’s comments to us following their previous visit suggested poor quality of care for our

145 patients and we remain confident that the young people are receiving high standards of care from qualified and dedicated staff. “We have challenged a number of the the inspector’s conclusions in their November report regarding some factual inaccuracies and some of these have been accepted. “We regret that some of their concerns involved actions we had previously agreed with the commission which had not been completed at the time of their visit. READ THE CQC REPORT: http://www.cqc.org.uk/sites/default/files/media/reports/1-121538276_St_Andrews_Healthcare__Adolescents_Service_INS1-721386990_Scheduled_19-11-2013.pdf Interactive map comparing adult social care services launched – Health & Social Care Information Centre. ____________________________________________________________________ Adult Social Care Outcomes Framework (ASCOF) data is being presented in a map that allows people to find out more about care services. You can select your local authority from the map or drop-down menu, or type in your postcode to find out how carers and people receiving local authority funded care and support in your area rate factors such as: • • •

Quality of their life Satisfaction with care services Feeling safe

The Department of Health has worked with the Health and Social Care Information Centre to produce the map that allows people to access, understand and use the ASCOF data. Care and Support Minister Norman Lamb said:

We want people to be able to know how well their local authority is performing. This will highlight those councils doing really well, but it will also enable people to hold their council to account if it fails to deliver good results from adult social care services, such as helping people to live independently or giving them genuine choice and control over their care and support. This online tool will provide people with the information they need to do this in a clear, accessible format. We want everyone to get better care and I hope this website will help to drive improvement across all local authorities so that this is a reality. The data is based on HSCIC data sets published from 2012 to 2013. Final data for 2012 to 13 for all ASCOF measures will be added on 17 December 2013, and provisional data for 2013 to 14 is expected to be available in summer 2014. http://ascof.hscic.gov.uk/Outcome/508/3D

146 Patients' preferences for patient-centered communication. [Patient EducCouns. 2013] PubMed - NCBI To investigate patients' preferences for patientcentered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone. A survey was conducted using an adapted version of the Patient-Practitioner Orientation Scale (PPOS) as a structured interview guide. The study population was drawn from the population of all adults attending for treatment or treatment for their children. 144 patients were included in the analysis. Factors, such as doctor's friendly approach, the interpersonal relationship and information-sharing were all scored high (patient-centered) on the PPOS. Factors associated with shared-decision making had a lower (doctor-centered) score. A high educational level was associated with a more patient-centered scoring, an association that was most pronounced in the female population. The results provide an insight into the patients' preferences for PCC. Patients expressed a patientcentered attitude toward certain areas of PCC, while other areas were less expressed. More research is needed in order to fully qualify the applicability of PCC in resource-poor settings. Stakeholders and healthcare professionals should aim to strengthen healthcare practice by focusing on PCC in the medical encounter while taking into considerations the patients' awareness and preferences for PCC. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. http://www.ncbi.nlm.nih.gov/pubmed/23906648 IV fluids training required to prevent avoidable hospital deaths - The Information Daily.com Healthcare professionals receive scarce formal training in intravenous fluid therapy, leading to complications and even fatalities, the National Institute for Health and Care Excellence warns. Doctors and nurses across NHS England and Wales must become “better educated” in treating patients who require the intake of fluids via a drip, the guiding body NICE has warned. Intravenous fluid therapy is provided to thousands of hospital patients who, as a result of their condition, have too much or too little fluid in their bodies. NICE estimates that around 1 in 5 of all patients receiving such therapy suffer complications related to improper or inappropriate administration, with some fatalities recorded.

147 In response to this grave need for better education in the field, NICE has put together a series of recommendations to bring clarity to the process of decision making and training. The organisation’s key recommendation is for healthcare professionals to be taught the new ‘five Rs’ of intravenous fluid therapy management. These are Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment. NICE also urges hospitals to appoint an “IV fluids champion”, who will lead in ensuring that best practice is delivered. This ‘champion’ could be responsible for all the key elements of practice related to the therapy, including training, clinical governance and the auditing of prescriptions. To ensure the correct dosage of IV fluids for every patient, NICE calls on hospitals to set up properly recorded management plans, detailing the fluid and electrolyte prescription of every patient for the succeeding 24 hours. And to prevent fatalities, NICE recommends that hospitals always report incidents of fluid mismanagement and their consequences, including dehydration or fluid overload. Dr Mike Stroud, Chair of the Guideline Development Group (GDG) that developed the recommendations, said: “It is generally recognised throughout the NHS that little formal training relating to intravenous fluid therapy exists for healthcare professionals. “This needs to change since prescribing, administering and monitoring intravenous fluids correctly is a basic aspect of care. “This new NICE guideline has training and education at its heart and will play a vital role in making sure that staff at all levels in the NHS deliver consistent, high-quality care for all patients”. http://www.theinformationdaily.com/2013/12/10/iv-fluids-training-required-to-prevent-avoidablehospital-deaths Keeping alive at all costs is not a sufficient justification to deprive a person of their liberty – 39 Essex Street. A rti cl e 5 ECHR – DOLS authorisations This successful s21A appeal was brought by M, a 67 year old woman, through her IMCA as litigation friend, who had been resident in a care home since June 2012. M suffered from diabetes which was poorly controlled and lacked capacity due to her “inflexible but mistaken belief that she can manage her own diabetes” which resulted in her being unable to weigh up the serious risks to her health that would be posed by returning home, with an inevitable reduction in the level of supervision. The two options for M’s care were continued residence in the care home, or a return home with a “standard care package” which involved twice daily visits from district nurses to supervise M’s insulin regime, and regular visits each day from carers. The CCG did not support a return home, relying on the historical evidence that at home, M had refused support, resulting in a serious deterioration in her condition and subsequent hospitalisation on around 7 occasions. In the view of the CCG, M required 24-hour care to manage the risks to her health, but 24-hour care at home would not be funded, and in any event, it was unlikely M would accept it.

148 MCA 2005 took the view that it was in M’s best interests to return home despite the risks to her health, and that all options to achieve this had not been fully explored. A return home carried with it a real risk of death as a result of M’s diabetes and her noncompliance. Remaining at the care home carried a real risk that M would self-harm because of her strongly held wish to return home. Concluding that it was in M’s best interests for the standard authorisation to be terminated , the judge stated that considerable weight had to be attached to M’s wishes, bearing in mind that her incapacity extended only to one area of her life – her diabetes management – and that she was otherwise very aware of her circumstances. The right to life and the state's obligation to protect it is not absolute and the court must surely have regard to the person's own assessment of her quality of life. In M's case there is little to be said for a solution that attempts, without any guarantee of success, to preserve for her a daily life without meaning or happiness and which she, with some justification, regards as insupportable. ” This decision seems to the editors to be a model of best interests decision-making which reflects the guidance of Baroness Hale in the recent decision in Aintree v James [2013] UKSC 67, significant weight is given to the actual and likely views of P, with the focus on what P’s own view of his or her quality of life is, rather than an assumption that life should be preserved at all costs. In so many DOLS cases, there are real and serious risks to P’s physical wellbeing if the less restrictive option is taken, and the emotional impact on P of being forced to comply with a care regime that she or he strongly objects is given much less weight. The judge endorsed the approach taken at an earlier stage in the proceedings when the District Judge visited M in her care home. The visit has therefore had the dual purpose of informing the court of M's views and of making M feel connected to the proceedings without putting her into the stressful position of having to come to court in person.

DOWNLOAD THE FULL CASE REPORT: http://www.bailii.org/ew/cases/EWHC/COP/2013/3456.html Labour should support the government’s action on slavery – by radically amending their new bill - Article - Institute of Public Policy Research [IPPR] Earlier this week, the Home Secretary published a draft bill that aims to strengthen the UK’s response to modern slavery. Yet while the objectives of the bill are commendable, the narrow way it has been framed means that it fails to address the real reasons that prosecutions are so low. In January this year IPPR published a report [SEE BELOW] on the experiences of 40 people who had been trafficked to the UK. What they shared with us was truly alarming: many of the interviewees had been (wrongly) detained and imprisoned for offenses they had been forced to commit by their trafficker. Yet at the time of research, none of their perpetrators had faced charges.

149 The bill aims to do two things – introduce oversight to policy making and target perpetrators. The oversight components are strong. The appointment of a commissioner to support policy development and hold agencies to account in is a major step forward. The main thrust of the bill is to prosecute offenders and prevent them from offending again. Some of its proposed changes will help this. For example, the introduction of trafficking prevention orders will enable law enforcement to control repeat offenders after they have been prosecuted for trafficking. However, the real problem is not the lack of tough punishments – but the lack of prosecutions in the first place. In order to increase these, three things need to change. First, in order to increase prosecutions – the police need to receive more reports of trafficking. Our research identified that this was particularly because people were afraid to report to the authorities. However the system does not acknowledge this at all. People trafficked from the EU report their experiences to trained police. Those from outside of the EU are treated differently and required to report their experiences to immigration authorities, often in hostile circumstances. In order to prosecute more traffickers, the UK needs to ensure that all trafficked people are able to report their experiences following best practice. Second, in order to pursue prosecutions, the police need to be able to collect evidence. This requires secure protection for victims and witnesses: following years of hostile treatment by the authorities and fearful that they would be returned to a region where their traffickers operated with impunity many of our research participants were unsure about engaging with the police. Children are particularly fearful of disobeying their trafficker. The bill does not improve this. In other European countries trafficked children are assigned a guardian to support them through the process of rebuilding their lives. In Italy, trafficked people who participate in prosecutions are provided with longer term support. Introducing similar measures would help to keep people safe and could also increase the number of prosecutions. Finally, although the bill streamlines an area of messy legislation around slavery, the bill does not target all perpetrators of exploitation. Slavery and trafficking crimes have high thresholds. People who exploit workers through not paying the minimum wage or applying unreasonable terms and conditions are unlikely to be affected by these changes. This is particularly troubling at a time when safeguards for vulnerable workers are being reduced. Using the bill to increase the penalty for not paying the minimum wage or changing the terms of domestic workers visas so that workers could change employers would go further to clamp down on exploitation and modern slavery in the UK. Addressing such a complex and hidden issue is hard and the bill has many strong points. But even its narrow objectives will be missed if it is passed in its current state. Labour should throw their weight behind the aims of the bill. But in order to ensure that these aims can be achieved – they must continue to push to amend it.

Jenny Pennington is a Researcher at IPPR. Beyond borders: Human trafficking from Nigeria to the UK - Publication - IPPR This in-depth case study report presents the findings from new research into the causes, processes and effects of human trafficking from Nigeria to the UK. Taking a 'whole of journey' approach, it identifies gaps in understanding, policy, support and response in both countries. The report focuses on trafficking from Nigeria to the UK as part of a wider programme of research on irregular migration from sub-Saharan Africa and the Maghreb to Europe. Although some of its recommendations are specific to Nigeria and the UK, others have wider implications for dealing with trafficking in sending, transit and receiving countries.

150 Looking beyond an anti-trafficking response based on border control, the report provides recommendations for policy and practice in the areas of: • • • •

Preventing trafficking Protecting trafficked people Prosecuting traffickers Maximising cooperation within the anti-trafficking network.

Gigi is one of 40 people we interviewed as part of our research involving people who had been trafficked from Nigeria to the UK: Like many victims of trafficking, as a child Gigi had high hopes for the future. ‘When I was younger, I wanted to do well in school and make my parents proud and get a good job.’ However, her life was changed by a sudden destabilising event: the death, aged 12, of her parents in a religious riot. Crucially, this tragic event also heightened her vulnerability. Months later, now orphaned, a stranger appeared claiming to be a relative of the girl. ‘I had never seen her before but initially I believed this. She told me she would look after me as no one could find my family.’ Instead, she was soon forced by her ‘aunty’ into domestic servitude and her education was abruptly ended. Though sudden, the move abroad was in many ways a continuation of her situation in Nigeria. Having relocated to London with her exploiter to join the rest of the family, the workload became even worse, and her isolation more complete. ‘I was kept locked in the house for approximately six years. I never left the house from 2003 until 2009. I had to look after the children all day and also at night. I had to prepare their food every two hours and make sure that their nappies were dry. I had to sleep on the floor in the children’s room. I hardly slept and was never given enough food.’ Physical and psychological abuse from her trafficker was a daily reality. ‘Aunty used to beat me regularly. She would use different things: her hand, a belt, wooden cooking spoon, the pipe of the hoover. I had to kneel down in front of her and she would often slap me and beat me on my back.’ Gigi escaped and sought support at a hairdresser. However, this was not the end of her experience of vulnerability. She was afraid to go the police: ‘Aunty said they would arrest me and beat me.’ She drifted between staying with different people she met on the street and in church, but this was unsustainable. ‘There was no room in her house – she was trying to help but I couldn’t stay there.’ She was left homeless and slept out on the streets for six months. Since receiving support, Gigi has had to rebuild her life slowly after years of trauma and lack of access to education or healthcare. Now her focus is on finally completing the education she was denied for so long, and potentially helping other victims like herself to rebuild their lives. ‘I would like to finish my education and probably get a job and be able to look after myself. And maybe one day [I would like to work] around trafficking, with women who travel back to Nigeria.’ For now, she is awaiting a decision as to whether she can stay in the UK. Her trafficker has not been arrested. http://www.ippr.org/images/media/files/publication/2013/01/nigeria-trafficking_Jan2013_10189.pdf Learning Matters: Reflective Practice in Social Work - Third Edition: - Christine Knott& Terry Scragg – SAGE Publications. Reflective practice is a key element of learning and development on social work courses and it is an important aspect of social work practice. This accessible and introductory text explores a range of approaches to reflective practice that will help students become more confident in answering the question 'what is reflective practice?' There are sections on writing reflective journals, communicating well with service users and carers and reflective practice while on placements.

151 Written in three parts, this essential guide starts with a broad exploration of reflection, drawing on key texts that have informed its development. It then moves on to real practice issues including the management of social work practice and interprofessional working. Finally, part three looks at maintaining reflective practice and how to use these skills during your time as a social worker. Fully updated with the Professional Capabilities Framework, this third edition is a must-have for all social work students at the beginning of their careers. http://www.uk.sagepub.com/books/Book240982?subject=M00&publisher=%22Learning%20Matters %22&sortBy=defaultPubDate%20desc&fs=1 Let's turn the aspirations in the care bill into a reality | Social Care Network | Guardian Professional The health and social care system is just not good enough for the older and vulnerable people who rely on services With the care bill progressing through parliament and the annual concerns in the media about the NHS's inability to cope with the surge in winter demand - both bringing into sharp focus the need for system wide change across health and social care services – it seems timely that we are holding the United Kingdom Homecare Association 's England conference 2013 next week. There is a strong emphasis in the care bill on improving people's overall wellbeing, which shifts the emphasis from a remedial, "deficit" based system, to one which seeks to take pre-emptive, preventive and supportive measures. There is a related vision of putting people's combined health and social needs at the centre of decisions about the shape of the services put in place to support them. There is, in turn, a recognition that this will necessitate a move towards a more integrated approach to the design and delivery of social and health care services. But we can't just wish the changes needed into place – we need to make change happen. And, understanding that there are finite resources, it's not just about making more money available, but it certainly is about spending the money that is already in the health and social care budgets smarter. People over 65 accounted for 7 million (46%), of the 15 million adult hospital admissions in England last year. It doesn't take a great stretch of the imagination to work out the potentially significant cost savings that could be made in the health budget, if even a small proportion of these admissions, which often become unnecessarily extended periods in hospital, could be avoided, or discharges brought forward, by the use of appropriately deployed, community-based social care. The current separate health and social care budgets, with fragmented responsibilities for planning, commissioning and funding services are systemic barriers to the design and delivery of integrated services. Almost by definition, integrated services require integrated thinking from the outset, with this strategic level planning then flowing through to the operational, workforce and budget planning, which in turn can be translated into a coherent, integrated commissioning and delivery policy . This kind of approach will require the players in the supply chain for previously separate elements of people's care solutions to come together at an earlier stage and collaborate in new ways, in order to enable them to support improvements in people's overall wellbeing more effectively. This is why we constructed a programme for the forthcoming conference, which brings together a broad spectrum of stakeholders responsible for defining the agenda for the provision and regulation across health and social care. With speakers from central government, local government, workforce development, the NHS, and the care regulator – alongside our membership of homecare providers, we're hoping to have a really

152 good debate about what needs to be done to turn the aspirations within the care bill into practical realities, to meet our shared goal of making a positive difference to people's wellbeing. One thing's for sure, we can't afford to continue to do the same things, the same way we've always done them, or we will surely fall foul of Henry Ford's oft quoted, self-fulfilling prophecy - "If you always do what you've always done, you'll always get what you've always got." And that's just not good enough for the older and vulnerable people who rely on our health and social care services.

Bridget Warr is chief executive of UKHCA , the professional association for homecare providers. http://www.theguardian.com/social-care-network/2013/nov/21/turn-aspirations-care-billreality?CMP= List of Department of Health regulations to remove or improve _____________________________________________________________________ The proposed list of the Department of Health Red Tape Challenge measures to be removed or improved. Detail This document provides an overview of all the regulations that were looked at as part of the Department of Health’s Healthy Living & Social Care Red Tape Challenge theme. The document lists the regulations that the department is proposing to remove or improve to help reduce regulatory burden placed on businesses and other organisations.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/266540/RTC_list_of _regulations.pdf Local Government Ombudsman • South Yorkshire family excluded from care planning for elderly relatives- Local Government Ombudsman. A dementia sufferer had to stay in respite care, despite his son arranging a private care package that could have allowed him to stay at home, a joint investigation by the Local Government Ombudsman (LGO) and the Parliamentary and Health Service Ombudsman (PHSO) has found. The man had been living in respite care while his wife, who also suffered with dementia, was being treated in hospital. His son organised a care package to allow him to come home. But two local authorities – Kirklees Metropolitan Borough Council and the South West Yorkshire Partnership NHS Foundation Trust – applied for a Deprivation of Liberty Order, forcing the man to stay in care, apart from his wife, without informing his son of their plans. Before the stay in respite care, the man was admitted to hospital with acute glaucoma in April 2009. The couple’s son - himself a doctor - told the authorities that he believed the injury had been caused by a blow from his mother, who was beginning to show signs of dementia. This report was not followed up, and a safeguarding plan was never implemented. Instead the father’s discharge from hospital was hastily arranged and he returned home without any protection. Then over time, the couple’s needs increased. The woman’s symptoms were deteriorating and in September she was admitted to hospital, and her husband went into respite care. The woman stayed in hospital for six weeks while her son arranged a care package.

153 Despite the son telling the authorities that he was employing a registered general nurse to provide care when his father came home, the two authorities agreed that that this would be inadequate and applied for the Deprivation of Liberty Order – without involving him in the decision. In addition to this, when the Trust wrote to the son recommending that his parents be placed in separate care homes, they sent a copy to his mother – causing her a great deal of distress. The investigation also found that the Trust failed to reassess the father’s prescription for dementia drug, Aricept in line with NICE guidance. “As a result of actions by both the council and the Trust, the couple were denied the chance of living at home together in a settled lifestyle for longer than they did. The couple suffered a needless loss of dignity, while their son felt ignored, undermined and excluded from any decision about their care. “I am pleased that both the council and the Trust have agreed to our recommendations and hope they go some way to remedy the poor treatment and upset the family has endured.” “Involving their son could have led to better outcomes for the couple. Families and carers can have the key to understanding the needs of their loved ones. That’s why public services must, in law, involve families and carers in making life changing decisions for vulnerable people.” Both the council and the Trust have agreed to apologise to the man and his parents. They have also agreed to review the way they involve relatives in assessing and planning care for family members with dementia and review their joint arrangements for responding to complaints. The Trust has also agreed to review the way it reassesses prescriptions for Aricept in line with guidance. DOWNLOAD THE REPORT: http://www.lgo.org.uk/GetAsset.aspx?id=fAAxADkAMAA2AHwAfABUAHIAdQBlAHwAfAAwAHwA0 Medics denied access to room - Nottingham | News | Inside Housing The family of an 89-year-old sheltered housing resident who died after paramedics were prevented from entering his room is to call on the Care Quality Commission to investigate. Leslie Coombs suffered a stroke on and collapsed in his room at Jubilee Court, in Nottingham, owned by housing association Places for People. An AA telephone operator, who had been talking to Mr Coombs about his car when he suffered the stroke, alerted paramedics who arrived to find Mr Coombs’ door locked. They phoned Jubilee Court’s on-call service to grant them access to the onsite key safe. Nottingham City Homes, which runs the on-call service, told the paramedics permission to access the key safe could not be granted over the phone and that they would have to wait for a member of staff to open the door. Twenty-six minutes passed before a member of staff arrived. Mr Coombs died of a heart attack in hospital nine days later. Glenis Riley, Mr Coombs’ daughter, said she was ‘shocked and disgusted’ by the thought of ambulance workers being unable to access her father’s room to give him medical assistance.

154 Her husband, Mike Riley, said they would seek legal action and ‘definitely’ contact the CQC. ‘We want changes to policy and someone identified as the culprit, be it a body or a person,’ he added. Both PfP and Nottingham City Homes said they will carry out a review of procedures. However Mr Riley is sceptical these will take place, as he is dissatisfied with the way his complaints have been dealt with by both organisations to date. ‘[The promise of a review] is just to pacify everybody,’ he said. ‘I don’t believe anything will happen.’ A spokesperson for PfP said: ‘We are reviewing the current process together with Nottingham City Homes and the emergency services and changes will be made as a priority.’ A spokesperson for Nottingham City Homes said it was reviewing the events of 12 October ‘with a view to amending current practices and procedures if necessary’. http://www.insidehousing.co.uk/care/medics-denied-access-toroom/6529594.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3372287 _IH-Care+and+Support-261113-JK&dm_i=1HH2,20A2N,82EKTS,780GW,1

155 Â Â

Mind the (fiscal) Bulletin.

gap - Reform

Reform today research arguing pensioners will

publishes new that tax breaks for become

156 increasingly unaffordable due to demographic change. Mind the (fiscal) gap: direct taxes, public debt and population ageing is available at www.reform.co.uk . The report finds that the UK’s dangerous level of public debt means new personal tax cuts must remain off the table. It shows that even with the forecast average increase in taxes of £380 per family by 2033, debt will still be heading towards clearly unsustainable levels. This will make the economy vulnerable to interest rate rises and hurt economic growth. In July, George Osborne told the Treasury Select Committee that taxes would not have to rise in the next Parliament to bring down the deficit. The Chancellor expects to eliminate the deficit around 2020 but according to the Office for Budget Responsibility the UK’s fiscal position will worsen after that as the population ages. As a result the report argues that there is “no fiscal headroom for large reductions in tax revenue.” The authors warn that targeting tax increases on people of working age could “place a heavy burden on many people at the key productive stage of the life cycle and have serious effects on incentives and on economic growth.” Governments must avoid the temptation to raise tax burdens on working aged people through fiscal drag or higher National Insurance Contributions. The report praises the Government for phasing out the higher personal allowances for pensioners (“age-related allowances”), but urges Ministers to go further and review the exemption from paying National Insurance Contributions above State Pension Age. This tax break does not reflect the modern labour market in which age is now a less reliable indicator of need. Ending the exemption would raise £735 million per year and only affect the richest (by income) 6.3 per cent of people aged over 65. The report also questions the future of tax relief for pensions, on the grounds that it is “expensive, poorly targeted and fails to achieve its policy objectives.” The net cost of pension tax relief has been estimated at nearly £24 billion per year. Yet the authors calculate that any reform will impact on younger taxpayers. Most of the relief (61.2 per cent) is received by people aged 35 to 55 and nearly 20 per cent of the relief is received by people below 35. The report warns that the Conservative and Liberal Democrat focus on increasing the personal allowance would fail to address concerns over living standards. An immediate increase in the allowance to £12,500 would cost £15.9 billion per year, but only 1.3 per cent of that would go to people who earn below the equivalent of the minimum wage for 35 hours a week. An immediate increase in the allowance of £500 would cost £2.5 billion, and only 4.9 per cent of that would go to minimum wage workers. http://reform.us1.listmanage.com/track/click?u=41d28ea8f95de08278cdf0eb3&id=1af8850641&e=5be20f622e Ministers to develop single public services ombudsman for England – Local Government Lawyer. The Government is to develop plans for a single public services ombudsman for England, it has been announced. The move follows an independent governance review of the Local Government Ombudsman Service led by Robert Gordon, a former director general in the Scottish government. In addition to suggesting that in future there should be one Local Government Ombudsman presiding over an integrated process, the Gordon report also recommended that: an early opportunity should be found

157 to make the limited legislative changes to provide for a single local government ombudsman in England; “in recognition of actual, proposed and likely future changes to public service delivery and taking account of pressure on public finances”, consideration should be given to the creation of a unified public services ombudsman in the medium term; the LGO Service and the Parliamentary and Health Service Ombudsman should continue to build on their current commitment to closer joint working “proactively engaging in substantial initiatives to achieve economies, to harmonise processes and to provide the public with a clearer route to redress”; the Commission for Local Administration in England should be strengthened by administrative action. The Department for Communities and Local Government said: “In the short term, the Government accepts the conclusions of the review that the governance arrangements of the Local Government Ombudsman service should be modernised, moving to a single Local Government Ombudsman for England, providing robust and consistent leadership, driving up performance and ensuring that the public can obtain swift redress when things go wrong.” Local Government Minister Brandon Lewis described the old ombudsman structure as “outdated and not up to the task”, adding that modernisation of the organisation was “essential”. He added: “In the longer term, creating a single ombudsman service for England may well provide us with the opportunity to deliver an excellent service to the public into the future. “When things go wrong the public need to know they have an effective redress service that deals with complaints about local government in a speedy and cost effective way.” Dr Jane Martin, the Local Government Ombudsman, said: “The legislation that created the accountability structures of the LGO is now nearly 40 years old and no longer reflects the principles and practice of modern, effective governance. "Over the last 18 months we have implemented considerable organisational change to deliver a service that is lean, effective and provides value for money. I look forward to working with government and Parliament to deliver the long overdue changes to provide appropriate governance for a modern ombudsman service.” Dr Martin added that she had previously called for a single Public Services Ombudsman for England in her evidence to the Public Administration Select Committee’s inquiry into complaints about public services. “I believe that this would provide the public with a more accessible route to redress when they are let down by public services and would ensure greater local accountability of those services,” she said. DOWNLOAD THE REPORT: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/262089/131128_Go vernance_Review_of_the_Local_Government_Ombudsman_Service.pdf More than Medicine: New services for People Powered Health | Nesta Key findings Three elements help the process and are described in detail in the report: 1. Social prescribing - a clear, coherent and collaborative process in which healthcare practitioners work with patients and service users to select and make referrals to community-based services. 2. Signposting - new roles and support for people who help patients and service users understand, access and navigate community-based services that will improve their health. 3. A balanced and healthy ecosystem of community-based services and providers so that a wide range of opportunities are available

158 Â Â The People Powered Health approach recognises the social as well as medical aspects of long-term conditions. It creates a set of tools for clinicians to use with patients to address the behavioural and social aspects of long term conditions - helping people to exercise more, eat more healthily, build strong social networks and feel supported and in control of their lives. This can be through direct, formal prescribing by the clinician or the clinician referring patients on to link workers who support them. This approach recognises the importance of systematically linking to a variety of services that provide 'more than medicine'. These services mobilise communities and networks to support people on their terms. They are co-designed and co-delivered by patients, enabling them to meet not only bio-medical needs but wider social, physical and mental wellbeing goals. Alternative provision is not intended to replace traditional planned medical care, but to complement it by developing an infrastructure to reliably and consistently deliver social models of support to enable people to live better. Watch the video looking at different ways to integrate and promote community-based services into health and social care.

DOWNLOAD THE REPORT: http://www.nesta.org.uk/sites/default/files/more_than_medicine.pdf Motivational antecedents of incident reporting: evidence from a survey of nurses and physicians - Swiss Medical Weekly Cite this as: Swiss Med Wkly. 2013;143:w13881 Motivational antecedents of incident reporting: evidence from a survey of nurses and physicians Yvonne Pfeiffera, Matthias Brinerb,c, Theo Wehnera, TanjaManserd ETH Zurich, Centre for Organisational and Occupational Sciences, Zurich, Switzerland University of Applied Sciences and Arts, Northwestern Switzerland, University of Applied Psychology, Olten, Switzerland Lucerne University of Applied Sciences and Arts, Lucerne School of Business, Switzerland University of Fribourg, Department of Psychology, Switzerland Summary QUESTIONS UNDER STUDY: Underreporting is a major issue when using incident reporting systems to improve safety in hospitals. Based on a psychological framework, this study investigated the motivational antecedents of the willingness to report into incident reporting systems in healthcare. Individual, organisational and system-related influences on the willingness to report incidents were investigated in a survey of physicians and nurses from five Swiss hospitals. METHODS: The motivational antecedents were tested using structural equation modelling. The sample consisted of 818 respondents, 546 nurses and 230 physicians; the response rate was 32%. The willingness to report was assessed by using a self-report scale, validated with the self-reported number of reported incidents during the previous year.

159 Â Â RESULTS: The most important influence on the willingness to report was the transparency of the incident reporting system procedures to potential users, such as. knowing how and what kind of events to report. At the individual level, the perceived effectiveness of reporting was a relevant antecedent. At the organisational level, management support positively influenced the willingness to report. Different antecedents were found to be relevant for nurses and physicians. CONCLUSIONS: Implications are discussed that open up alternatives for the design and implementation of incident reporting systems in healthcare. For example, the results of the study point to opportunities for making incident reporting systems more transparent and participatory and to allow for experience of how they actually improve patient safety. Key words: incident reporting systems in healthcare; patient safety; willingness to report; motivation to report incidents; underreporting http://www.smw.ch/content/smw-2013-13881/ New advice on mental wellbeing of older people in care homes marks 'bold step forward' - NICE New advice on mental wellbeing of older people in care homes marks "bold step forward" NICE's new quality standard on the mental wellbeing of older people in care homes marks a "bold step forward" in terms of improving care, according to experts. More than 400,000 older people currently live in care homes, a figure set to rise given the UK's ageing population. While many older people in care homes are well looked after, recent high-profile cases have highlighted instances of substandard care, which suggests standards can vary. A reason for this is the prevalence of mental health issues among older people, which can often complicate care. With loneliness, depression and low levels of life satisfaction widespread among residents in care homes, it can be hard for staff to offer the support they need. NICE's 50th quality standard on the mental wellbeing of older people in care homes aims to address these issues through six measurable statements. The first statement calls for older people in care homes to be offered opportunities during their day to participate in meaningful activity that promotes their health and wellbeing. NICE recommends that older people should be encouraged to take an active role in choosing and defining activities that are meaningful to them. These can range from reading, gardening and arts and crafts, to group activities that involve family, friends and carers. Another statement says that older people in care homes should have the symptoms and signs of mental health conditions recognised and recorded as part of their care plan. While mental health conditions such as dementia are very common among older people in care homes, they are often not recognised, diagnosed or treated. Consequently, NICE recommends that symptoms and signs of mental health conditions should be recognised and recorded by staff who are aware of GPs' roles in the route of referral. This can help ensure early assessment and access to appropriate healthcare services.

160 The positive impact of enabling people to maintain and develop their personal identities is also highlighted in the quality standard. NICE says that staff working with older people in care homes should be aware of the personal history of the people they care for and respect their interests, beliefs and the importance of their personal possessions. Older people should be involved in decision-making and supported and enabled to express who they are as an individual and what they want. They should also be able to make their own choices whenever possible. Furthermore, older people should be enabled to maintain and develop personal identities during and after their move to a care home, as this promotes dignity and has a positive impact of their sense of identity and wellbeing. George Macfarlane, Head of Policy at the Alzheimer's Society, said: "We welcome this quality standard, as it will help care home staff respond to the needs of people with mental health conditions such as dementia. "Given the significant population of people residing in care homes with dementia or severe memory problems, it's a bold step forward." Professor Gillian Leng, Director of Health and Social Care at NICE, said: "Throughout the year, many people are looked after extremely well, but others may not be so fortunate. "For instance, some care home workers may find it hard to look after someone who appears disengaged or depressed when actually all they might need is a little extra support to lead a more fulfilled life. A decline in mental wellbeing should not be viewed as an inevitable part of ageing." She added: "We hope the standards we have published will give care homes the help they need to ensure they're providing consistent, high-quality support for every person in their care." http://www.nice.org.uk/newsroom/news/NewAdviceMentalWellbeingOlderPeoplePareHomesMarksBo ldStepForward.jsp New COP3 Form DoLS - published The most important changes are: •

•

• • •

Rewording the form to make clear that the range of practitioners appropriate to complete assessments of capacity for the purposes of proceedings before the COP is not limited to medical practitioners (as was sometimes – erroneously – assumed to be the case). In particular, the new form makes clear that social workers are recognised as appropriate professionals for these purposes; Rewording the form to make clear (section 5.3) that the important information that the Court requires in terms of assessing the quality of the assessment includes not just the professional qualifications of the individual concerned but their ‘practical experience with making assessments of capacity in accordance with the Mental Capacity Act 2005 and associated Code of Practice’; Removal of the reference to charging at the front of the form, as the majority of professionals do not charge to carry out assessments of capacity; Adding (in section 7.1) a requirement that, where there is a specific diagnosis giving rise to the impairment of or disturbance in the mind or brain, this is expressly set out; Removing an anomaly in section 7.2 that appeared to treat difficulty in communication differently as a ground for incapacity, by making it clear that it can stand alongside the

161 other three limbs of s.3 MCA 2005 as an additional/alternative basis upon which the functional test is satisfied;

“We welcome these changes (not least because they reflect, in part, the input of one of the editors, Alex!). We would, however, emphasise that they should not be seen as limiting the ability of the Court to receive evidence from any appropriate person as to capacity (including not solely professionals but also family members and P themselves: see, above all, CC v KK [2012] EWHC 2136 (COP)”. 39 Essex Street New guidance on coma care published | News | Nursing Times The guidelines, which are also intended for families, set out how doctors diagnose prolonged disorders of consciousness, which include coma, vegetative state and minimally conscious state. The guidance, launched by the Royal College of Physicians, makes clear that decisions about care planning and end-of-life management are “ultimately made by the responsible senior clinician on the basis of the patient’s best interests”. However, it urges medics to seek the opinions of the family and other loved ones when deciding on the best course of action. Patients in a vegetative state are said to be in a state of wakefulness but with a “complete absence of behavioural evidence for self or environmental awareness”. Meanwhile, those in a minimally conscious state show signs of self or environmental awareness. There are examples of behaviour for each state, such as somebody in a minimally conscious state laughing, crying or smiling in response to emotional stimuli. On the other hand, for somebody in a vegetative state, there is no evidence of awareness of self or environment, or the ability to interact with others. Professor Lynne Turner-Stokes, a consultant in rehabilitation medicine at Northwick Park Hospital in London, said: “The guidelines address some highly emotive and topical areas in which there is currently a dearth of formal research-based evidence to guide practice. “In this rapidly-changing field the recommendations are likely to need updating as new evidence emerges and as international consensus develops. “In the meantime, we have aimed to provide a practical and useful source of advice for clinicians who work with this complex group of patients.” Derick Wade, professor of neurological rehabilitation at University College London, and co-chair, said: “This guideline is much more than an update on the previous guideline on the vegetative state. “It has the potential to improve dramatically the experience of care and treatment as seen by both patients and families, and also to improve significantly the outcome for patients, and thus for society.” Professor Jenny Kitzinger, co-director of the Cardiff-York Chronic Disorders of Consciousness Research Centre, said: “The new guidelines have been informed by in-depth research into family experiences which highlighted the need for clarity about the role of families in decision-making. “The guidelines provide clear summaries of the legal situation and, I hope, will help family members to represent the wishes of their relative, and ensure clinicians gather this information, and take it into account, when making ‘best interests’ decisions about vegetative and minimally conscious patients.” http://www.nursingtimes.net/nursing-practice/clinical-zones/neurology/new-guidance-on-comacarepublished/5066399.article?cm_ven=ExactTarget&cm_cat=NT_Reg_News_EM3_12122013&cm_pla= NT+Subs&cm_lm=rock.nisbet@gmail.com&WT.tsrc=email&WT.mc_id=NTME57&&

162 New Programme Director Appointed for the Winterbourne View Joint Improvement – Local Government Association. The Department of Health, NHS England and the Local Government Association are pleased to announce that Bill Mumford has been appointed as Programme Director for the Winterbourne View Joint Improvement Programme (JIP) and will join the programme with immediate effect.This is positive news for all JIP partners who are keen to make rapid progress on the transformation ahead. Bill's role is funded by the Department of Health and he will be seconded into the Local Government Association where he will report directly to the LGA and NHS England. New programme director, Bill Mumford said: "I am delighted to be asked to oversee the Winterbourne View Joint Improvement Programme: everybody should have hope for a good future and that must include people with learning disabilities who find themselves confined inappropriately in assessment and treatment units. All of us in the sector need to work with more urgency and focus to provide proper local support to the individuals and their families. As CEO of the charity MacIntyre I have longstanding experience of the complexities that create barriers to best practice but also have direct experience of how to create better futures for people and their families. Our common endeavour must be to quickly restore confidence that this will be the norm everywhere." Care and Support Minister Norman Lamb said "The Joint Improvement Programme has a crucial role to play in transforming care for people with learning disabilities and or autism and challenging behaviour or mental ill health and making sure those who are able to can live in their own community with support by June 2014. "We know that some progress has been made – but I am impatient to see real cultural change. There is still a long way to go. "Bill Mumford will provide strong leadership at a critical time to drive this work forward and I welcome his appointment." The appointment involved an interview panel which included representatives from DH, LGA, NHS England and family carers and self advocates Further information on Bill Mumford is available upon request New resources: the full report of our Annual Statement – Nuffield Trust

163

New report: is care getting better? The first annual assessment of the quality of care in England from the QualityWatch programme has now been published. Is the quality of care in England getting better?, provides an overview of our initial research into the quality of care services. We published a summary of our findings in October and have now published the full report. Follow the link below to read and download the extended version, which contains more in-depth analysis of the state of care quality.

DOWNLOAD THE REPORT: http://www.qualitywatch.org.uk/sites/files/qualitywatch/field/field_document/131127_QualityWatch _Annual-Statement2013_Report.pdf?utm_medium=email&utm_campaign=131129_Full+report+of+our+Annual+State ment++Focus+On+promo&utm_content=131129_Full+report+of+our+Annual+Statement++Focus +On+promo+CID_c94bc8a39e4701242adc311f610d7269&utm_source=Email%20marketing%20sof tware%20QualityWatch&utm_term=READ%20FULL%20REPORT NHS on brink of crisis because it became 'too powerful' to criticise - Telegraph Head of health and social care regulator David Prior says NHS has been damaged because criticism was not tolerated THE NHS should not be treated as a “national religion” while millions of patients receive a “wholly unsatisfactory” service from GPs and hospitals, the official regulator has warned. David Prior, the chairman of the Care Quality Commission, said the health service had been allowed to reach the brink of crisis because it was “too powerful” to be criticised. He said parts of the NHS were “out of control” because honest debate about the weaknesses of the health service was not tolerated. In an interview with The Daily Telegraph, Mr Prior also criticised the target culture at the NHS. He said it was “crazy” that the Health Secretary Jeremy Hunt was directly telephoning hospital chief executives who had missed A&E targets.

164 Failings that put patients at risk had been allowed to continue for years, he said. “It became too powerful to criticise,” he said. “When things were going wrong people didn’t say anything. If you criticised the NHS – the attitude was how dare you? “No organisation should be put on such a high pedestal that it is beyond criticism. Now it is getting more honest about our failings — which I think makes it more likely that we will address them.” Mr Prior said priority must be given to reform of an “out of control” system of emergency care, overloaded by patients who cannot get decent care outside hospital. It was “wholly unsatisfactory” that so many patients struggled to get an appointment with their GP. Mr Prior suggested that some hospitals should take over these services. “Their opening times have to be geared around the patients,” he said. “It’s no surprise that Sainsbury and Tesco do most of their business outside office hours because that’s when people can get to shop. Working people need to be able to see their GP in the evening or at the weekend.” Mr Prior suggested that the “target culture” imposed by Labour a decade ago fundamentally damaged the culture of the NHS, creating a “chillingly defensive” operation in which the truth was often sacrificed. “The whole culture of the NHS became so focused on targets that it obscured what real quality was about,” he said. “The voice of the patient wasn’t in those targets.” In April the CQC will publish “Ofsted-style” ratings for all hospitals, with a similar system to be introduced for GP practices by 2016. Mr Prior said he expects about 30 trusts to receive the lowest rating. He said many hospitals needed radical reform. Mr Prior said he would like to see “chains of hospitals” across the country where successful organisations take over failing ones, stripping out administrative and management costs, and rationalising services. He said: “I think the isolated district general hospital will be increasingly seen as a relic of the past.” In some cases, hospitals should take over community and GP services. If one organisation offered all the services, it would have a stronger financial incentive to prevent patients becoming acutely ill. He said: “I think this could be huge.” http://www.telegraph.co.uk/health/nhs/10531183/NHS-on-brink-of-crisis-because-it-became-toopowerful-to-criticise.html No Place to Call Home – One World Publications. Inside the Real Lives of Gypsies and Travellers Katharine Quarmby The shocking, poignant story of rejection, eviction and the fight for a home. They are reviled. For centuries the Roma have wandered Europe; during the Holocaust half a million were killed. After World War II and during the Troubles, a wave of Irish Travellers moved to England to make a better, safer life. They found places to settle down – but then, as Occupy was

165 taking over Wall Street and London, the vocal Dale Farm community in Essex was evicted from their land. Many did not leave quietly; they put up a legal and at times physical fight. Award-winning journalist Katharine Quarmby takes us into the heat of the battle, following the Sheridan, McCarthy, Burton and Townsley families before and after the eviction, from Dale Farm to Meriden and other trouble spots. Based on exclusive access over the course of seven years and rich historical research, No Place to Call Home is a stunning narrative of long-sought justice.

Author Details: Katharine Quarmby is a writer, journalist and film-maker specialising in social affairs, education, foreign affairs and politics, with an investigative and campaigning edge. She has spent most of her working life as a journalist and has made many films for the BBC, as well as working as a correspondent for The Economist, contributing to British broadsheets, including the Guardian, Sunday Times and the Telegraph. She also freelances regularly for other papers, including a stint providing roving political analysis for The Economist, where she has worked as a Britain correspondent. Her first book for adults, Scapegoat: why we are failing disabled people (Portobello Press, 2011), won a prestigious international award, the Ability Media Literature award, in 2011. In 2012 Katharine was shortlisted for the Paul Foot award for campaigning journalism, by the Guardian and Private Eye magazine, for her five years of campaigning against disability hate. Katharine and her fellow volunteer co-ordinators of the Disability Hate Crime Network, were honoured with Radar’s Human Rights People of the Year award, for their work on disability hate crime in 2010.

https://www.oneworld-publications.com/books/no-place-to-call-home ‘The chronic underfunding of mental health care is a stigma proving hard to reverse’ Community Care We’re getting better at combating high profile examples of mental health stigma but a funding crisis in mental health services continues, writes Alex Langford The pain, incapacity and losses involved in being ill can pose the biggest challenge many of us will ever face, but if your illness happens to be mental, the associated stigma is often what hurts the most. This discrimination can take many forms. Mental health charities stood on the shoulders of the misleading headline’s bigotry to provide context – that people with mental illness are five times more likely to be assaulted than average and more than 50 times more likely to kill themselves than someone else. Though The Sun’s eventual “apology”, a small clarification buried inside the newspaper , was cowardly, no newspaper will be publishing a similar headline again soon. Likewise, Tesco and Asda were forced to withdraw offensive ‘mental patient’ fancy dress costumes after triggering a largescale public backlash which showed that mental illness is not for anyone’s amusement anymore. How can we announce that mental illness is worthy of equal respect and understanding when the meagre resource allocated to services by those in control of budgets perpetuates the notion that mental health care is less deserving, an optional extra that can muddle along on a pittance? Eventually I believe the theme park will cede their position along with a significant chunk of their reputation and through their ignorance they will have given mental health some valuable publicity. These glaring examples are an important sign that superficial shows of stigma perpetrated in the public eye can, ultimately, be used by us to combat discrimination. Yet there is a very different,

166 pervasive factor driving stigma that is proving harder to combat – namely the chronic lack of resources for mental health services that would be an embarrassment in any other area of health and social care. Couple this with a pressured economic climate that is driving a growing demand for care and you’re left with a widespread crisis. The pressure on beds means that, daily, doctors like myself and other mental health professionals are forced in desperation to send patients hundreds of miles away from their families to find a bed , often to private hospitals that are making millions of pounds a year from the arrangements. When beds are closed, we’re often told that the cost savings will be invested in community teams. Yet whatever investment in community services is happening, it isn’t stemming the increase in demand for crisis care – Mental Health Act detentions topped 50,000 for the first time in 2012/13. The ‘institutional bias’ against mental health in the NHS, as the care minister Norman Lamb eruditely calls it, is no less apparent in outpatient care. Trying to reduce the stigma surrounding mental illness while grossly underfunding psychiatric services during a time of growing demand is like asking children to play nicely but dressing one of them in rags. How can we announce that mental illness is worthy of equal respect, care and understanding, when the meagre resources allocated to services by those in control of budgets perpetuate the notion that mental health care is less deserving, an optional extra that can muddle along on a pittance? If mental health was funded as deservingly as physical health, maybe people would start treating it as such. Dr Alex Langford is junior psychiatrist at the South London and Maudsley NHS Foundation Trust. You can tweet him at @psychiatrySHO http://www.communitycare.co.uk/2013/11/20/chronic-underfunding-mental-health-care-stigmaproving-hard-reverse/#.Uo4zpHC9pJM?cmpid=NLC|SCSC|SCDDB-2013-1122 Offender management in prisons: 'worrying lack of progress' | Justice Little progress has been made in offender management in prisons and a fundamental review is needed, said Liz Calderbank, Chief Inspector of Probation, and Nick Hardwick, Chief Inspector of Prisons. Today they published the report of a third joint inspection into offender management in prisons. The lack of progress is concerning, they added, as it casts doubt on the Prison Service's capacity to implement the changes required under the Transforming Rehabilitation strategy designed to reduce reoffending rates, especially for short-term prisoners. Offender management is the term used to denote assessment, planning and implementation of work with offenders in the community or in custody to address the likelihood of them reoffending and the risk of harm they pose to the public. Community-based offender managers and staff in prison Offender Management Units have joint responsibility for undertaking or co-ordinating work with prisoners to address the attitudes, behaviour and lifestyle that contributed to their offending. Today's report reflects findings from 21 prison establishments inspected during 2012 and 2013. Inspectors found that, even taking account of the different nature of the establishments, some common themes emerged:

167 Â Â organisational changes to offender management units have failed to address the culture of poor communication or mistrust between prison departments that undermines the potential of offender management, illustrated by their failure to use one central electronic case record; there have been some modest improvements in practice but these are inconsistent; prison officer offender supervisors continue to lack guidance and supervision; community-based offender managers still have insufficient involvement overall to be able to drive sentence planning and implementation; there are too few structured programmes available within prisons designed to challenge offending behaviour and promote rehabilitation; while some prisons offered a reasonable range of accredited and non-accredited programmes for their population, some offered no programmes at all whereas others were running down their provision; and provision for offender management was particularly poor at two of the prisons accommodating foreign national prisoners. The chief inspectors said: "We have come to the reluctant conclusion that the offender management model, however laudable its aspirations, is not working in prisons. The majority of prison staff do not understand it and the community-based offender managers, who largely do, have neither the involvement in the process or the internal knowledge of the institutions to make it work. "It is more complex than many prisoners need and more costly to run than most prisons can afford. Given the Prison Service's present capacity and the pressures now facing it with the implementation of Transforming Rehabilitation and an extension of 'through the gate' services, we doubt whether it can deliver future National Offender Management Service (NOMS) expectations. We therefore believe that the current position is no longer sustainable and should be subject to fundamental review."

DOWNLOAD THE REPORT: http://www.justice.gov.uk/downloads/publications/inspectorate-reports/hmiprobation/jointthematic/offender-management-in Older people are our forgotten addicts | Opinion | Health Service Journal Having made the recording of alcohol and drug use mandatory within the mental Health of older adults clinical academic group, detection, intervention and referral for older people with dual diagnosis became incorporated into all care pathways and all service lines. As well as developing a bespoke training package for health professionals in dual diagnosis, there are plans to create champions within each clinical team and for more robust partnerships to be established with statutory and voluntary agencies. The publication of Our Invisible Addicts in 2011, led by Professor IlanaCrome, represented the impetus for driving changes in policy, public health interventions, service delivery, training, research and integrated care. Although some aspects were seemingly controversial at the time, viewing alcohol as a drug that may have the potential for greater harm in older than in younger people led to the governmentâ&#x20AC;&#x2122;s alcohol strategy making recommendations for routine screening of 40-74 year olds for alcohol misuse in primary care .

168 There are also plans to convene a working group to revisit the theme of recommended limits and how these might apply to older people. ‘The impact of integrated care in delivering both specialist alcohol and old age psychiatry expertise within a single service has paid dividends’ Addressing older people’s drinking within my own mental health service has been challenging. Between 2005 and 2012, there has been a 90 per cent reduction in alcohol-related hospital admissions for older people from my catchment area of north Southwark. However, alcohol harm still appears to be rising in that there has been an 80 per cent increase in the number of patients with dual diagnosis on my community team caseload. A 12-month randomised controlled trial of primary care intervention for patients aged 55 and over found a reduction in the overall amount of alcohol consumed over the previous seven days, when comparing the provision of a booklet on health behaviours to a larger package involving counselling and telephone advice. Mental health services cannot operate in silos and the voluntary sector has a major role to play in complementing the delivery of health-based interventions. Using a summary of older focus client outcomes from October 2010 to March 2012, Addiction Northern Ireland found a 60 per cent overall reduction in alcohol misuse accompanied by an improvement in quality of relationships, emotional health and use of time following one on one counselling. Addaction in Glasgow implemented a similar model but also included peer-led counselling and found that 80 per cent of service users had reduced their alcohol intake and showed similar improvements in mental and physical health. Positive outcomes were found using interventions such as offering a drink diary, providing health information, monitoring medication compliance, structuring meal times and using brief advice and motivational interviewing. ‘What was once a group that was hidden and forgotten is now one that can and should be very much on the political, clinical and public health agenda’ As part of Drug and Alcohol Service for London, a three year project in Bexley called Last of the Summer Wine identified similar themes to Foundation 66 in common risk factors for drinking. The provision of services for older people with alcohol misuse have transformed the face of patient care over the past five years and there will naturally be further growth in this area of expertise. What was once a group that was hidden and forgotten is now one that can and should be very much on the political, clinical and public health agenda. This cannot happen with integrated care models with partnerships that involve primary and secondary care, social services, housing and the voluntary sector. http://www.hsj.co.uk/5065595.article?WT.tsrc=Email&WT.mc_id=EditEmailStory#.UpSOVWRdWpw One Drug, Two Names, Many Problems The New York Times – November 2013 _____________________________________________________________________

My patient was shaking uncontrollably. People say such shaking feels unbelievably bad, but rigoring, as the medical profession calls it, is treatable with the narcotic Demerol. I hurried to the computer to order some from the pharmacy, thinking “rigors = Demerol.”

169 But the computer listed drugs by their generic names only, and Demerol is a brand name. In the heat of the moment my mind went blank; I couldn’t get the medicine my patient needed.An embarrassed call to the pharmacy yielded the correct name — meperidine — and my patient got relief. Still, it was a reminder of how needlessly dangerous our drug-labeling system is.

In the context of what’s at stake in health care, the practice of giving drugs two names, a brand name and a generic name, makes no sense. Is there any other industry in which thousands of component parts are insistently given two dissimilar names, even though people can suffer, be hurt, possibly even die, if a mistake in names is made? Every drug with two names — and that means practically every drug in use — is a medication error waiting to happen. Worldwide, almost all medications have a brand name that remains patent protected for 20 years, meaning the patent holder is the sole manufacturer and distributor. That allows the holder to charge more for it. When drugs go generic (for example, Tylenol to acetaminophen), anyone can make them and the price tends to drop, meaning company profits drop, too. But the companies keep the brand names, and insist they be used wherever they can, because they know people tend to trust brand names more, even when there is no difference from the generic. Others can argue whether drug companies’ profit margins actually serve the public interest or enrich their shareholders, but that’s not my quarrel here. The patent protections can stay in place. The dual-name regime shouldn’t. To make things even more confusing, we have recently seen a proliferation of look-alike, soundalike meds. For example: Zantac is used to treat heartburn, while Xanax is an anti-anxiety medication. A list of these sound-alikes fills a full eight pages on the Institute of Safe Medication Practices website. Data on medication errors is not collected systematically in the United States, so it is impossible to say accurately how many errors result from such confusion. Whatever the number, and the attendant misery the most serious mistakes generate, it seems undeniable that the potential for error is increased by the dual naming of all drugs. Though we in the health professions learn to be disciplined in a crisis, the human mind, especially in stress, can remember only so much. In a 2009 survey a group of Australian nurse-anesthetists accurately identified only 29 percent of the trade names for common drugs.And I am hardly alone among my colleagues in momentarily forgetting a generic’s name in the heat of the moment. And whether or not a nurse or doctor can flawlessly recall the dual names of every drug ever learned, those two names take up mental space that none of us in health care can spare. A hospital is not a place for single-track minds: Nurses are interrupted on average every six minutes, and sometimes much more often. Doctors face constant distraction from pages and cellphones. Throw the completely unnecessary complication of drugs’ having two names into the mix and we all move inexorably closer to error. Fortunately, the solution is obvious and easy. All drugs now being sold could use either their brand name or the generic name. That name, and the manufacture of that medication, would be patentprotected for 20 years. Thereafter, any other producer of that drug would append it with a “-G,” indicating that it is a generic formulation. Acetaminophen sold as a generic would become Acetaminophen-G, and Plavix, a brand name blood thinner, would be sold as Plavix-G in its generic form. Combination drugs like the brand name inhaler Duoneb might have to use generic names (albuterol and ipratropium) to avoid confusion. The Russian names in Tolstoy’s “War and Peace” drove my high school debate coach crazy. A character’s first name, patronymic, family name, diminutive name and shortened patronymic might

170 all be used at different times. In the last section of the novel Tolstoy introduced some new characters, all with their several names. My debate coach, fed up, slammed the book shut and never finished it. Mentally pulling up drug names in the hospital can make me feel stuck in the pharmaceutical version of a Russian novel: cyclophosphamide is Cytoxan. Velcade is the brand name for bortezomib. Percocet is oxycodone and acetaminophen, but Vicodin is acetaminophen and hydrocodone. Multiply that short list of drugs by 500, and it’s clear what nurses and doctors are up against. It makes no real difference if a determined reader stops before the end of a great book. But a patient’s being hurt because we insist on giving drugs two distinct names is a different matter.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.” LIST OF CONFUSED NAMES: http://www.ismp.org/Tools/confuseddrugnames.pdf Patient safety reporting overhaul - E-Health Insider The NHS is developing the National Reporting and Learning System to become an integrated reporting route for patient safety incidents. The system was previously run by the National Patient Safety Agency and is used to report and analyse patient safety incidents such as falls or surgical errors. However, it has taken a back seat since the closure of the agency in June 2012, when responsibility was transferred to NHS England. There are two national reporting systems for patient safety in the NHS; the NRLS and one run by the Medicines and Healthcare Products Regulatory Agency. This causes inconsistency as some incidents will be reported to both systems, while others will only be reported to one of them. NHS England and the MHRA are working together on the new development, which will join these two systems via an integrated reporting route, meaning all reporting, information and feedback on incidents will go through the same system locally and nationally. The organisations have also drafted two new Patient Safety Alerts documents; one on ‘improving medical device incident reporting and learning’, and one doing the same for medication errors. “Further integration of local and national systems for reporting and learning about medical device incidents in the NHS, will improve the early detection of risks and enable actions to reduce harm to patients,” says the paper. “Essential reporting information will only need to be entered once at local level and it will then be available to local and national learning systems.” The integration means information on the incidents will need to be gathered and included in local risk management systems and sent immediately to the NRLS. The draft alerts are out to consultation until 8 December. NHS England is looking for responses from healthcare professionals before they are issued.

171 The government’s full response to the Francis Inquiry, released last week, made a strong commitment to a new patient safety improvement programme. The programme is led by NHS England and includes re-launching the patient safety alert system by the end of this year. This will include greater clarity about how NHS bodies can assess compliance with alerts and ensure they are implemented properly. NHS England and the MHRA are also developing enhanced governance systems, improved feedback systems and a National Medical Devices Safety Network. The network will provide a new forum for discussing potential and recognised safety issues, identifying trends and suggesting actions to improve patient safety,” the response says. “The network will also work with new Patient Safety Improvement Collaboratives that will be setup during 2014” http://www.ehi.co.uk/news/EHI/9064/patient-safety-reporting-overhaul Patients' preferences for patient-cantered communication. [Patient EducCouns. 2013] PubMed - NCBI To investigate patients' preferences for patient-cantered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone. A survey was conducted using an adapted version of the Patient-Practitioner Orientation Scale (PPOS) as a structured interview guide. The study population was drawn from the population of all adults attending for treatment or treatment for their children. 144 patients were included in the analysis. Factors, such as doctor's friendly approach, the interpersonal relationship and information-sharing were all scored high (patient-centered) on the PPOS. Factors associated with shared-decision making had a lower (doctor-centered) score. A high educational level was associated with a more patient-centered scoring, an association that was most pronounced in the female population. The results provide an insight into the patients' preferences for PCC. Patients expressed a patientcentered attitude toward certain areas of PCC, while other areas were less expressed. More research is needed in order to fully qualify the applicability of PCC in resource-poor settings. Stakeholders and healthcare professionals should aim to strengthen healthcare practice by focusing on PCC in the medical encounter while taking into considerations the patients' awareness and preferences for PCC. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. http://www.ncbi.nlm.nih.gov/pubmed/23906648 Personalisation Vs Profits – Who Wins? | Love, Belief and Balls – Mark Neary. I’m entering an interesting and unexpected phase in my relationship with the Council. I’m about to do them a massive favour and save them an absolute fortune. I wrote on Tuesday that Steven had his FACS reassessment. There was an undertone throughout the meeting that things after the assessment won’t be as good as before. Cuts to his package seem an inevitability. Reference is often made to Steven being “expensive” and in court, I had to listen to

172 one of the care managers say many times that Steven has a “gold standard care package”. Those phrases induce a feeling of guilt and embarrassment in me, which I suppose is the intention. The same thing happened on Tuesday – talk of “high needs” and “very expensive commissioned services” left me squirming. That’s the way it is in social care – the person with the needs becomes the problem, the expensive problem for having the needs they have. We spent a lot of time in the meeting discussing an invoice from the firm commissioned to supply Steven’s transport. There was a hidden suggestion that I am ripping the council off. The social worker made notes of every journey Steven goes on and questioned the costs of each journey. I was in the dark – the council commission the cab firm – I had no idea what the charges are. The same threat was there with contract they have with the support agency. Some talk of the agency having to charge high fees because of Steven’s “high needs”. Once again – Steven is seen as the cause of the problem, in this case, the large cost of his care package. Since Tuesday I have had my Poirot head on because I’ve been determined to sort this out. I had an instinct that the package would be substantially cheaper, if they paid the whole lot through direct payments. But I needed evidence to justify my stance. I had the idea of submitting a proposal to the council whereby they cover the package through direct payments but needed firm figures to support my argument. Through a mixture of dogged detective work and two flukey chance encounters, I’ve got all the figures I need and the result is truly shocking. I want to point out that I’m not going to mention the overall, big figures here. Partly out of preserving Steven’s confidentiality but also out of respect for the support agency and the cab firm. I am not being critical of them. They are both businesses and their first priority is to make a profit for their shareholders or directors. I am being critical of a system that allows such abuse of the vulnerable to take place. Besides there is only one figure that really matters in terms of showing how screwed up the system is. Hang on to your hats……. 52% of Steven’s monthly care package budget currently goes directly as profits to the support agency and the cab firm. That’s 52 sodding %. We are talking four figures here. 52% of Steven’s gold standard package has got nothing to do with his care and meeting his needs and is all about the profit making of two businesses. I’ve checked that figure over 20 times because I still can’t quite believe it. Steven doesn’t need that 52% – his needs are completely met by the other 48%. And by nudging over 50%, it demonstrates a stark truth about the social care world – the person at the heart of the care package is quite secondary to the many people who can make a tidy sum out of him. Is it just me or is this a huge scandal? Of course it’s not just happening to Steven. Is every single support package that includes directly commissioned services weighted in the favour of the provider rather than the person needing the service. And let’s not even go into the constant bleating about the lack of money in the pot. There’d be a bloody sight more money if it wasn’t being trousered by so many people after a quick, easy and reliable profit. There’s a fundamental greed in all this too – the agency charge the council more for the weekend shifts but don’t pay a penny more to the workers who do a weekend shift. I struggle to see how you justify moves like that. So, I’m going to submit a full costed proposal to the council, which will slash Steven’s current package by over a third. All the support, respite and transport to be paid by direct payments. Hillingdon have a set rate of £10.72 per hour. If they accept my proposal, I will save them £6 per hour for support and be able to afford to give each of the current team of support workers a significant pay rise from the present rate the agency pays them. Same with the cabs – the account fares are double (sometimes 150%) more than a cash fare from the likes of you and I. And the cab driver gets the full cash fare, rather than them seeing a reduced rate after the profits have been creamed off the account payments. A win for the support workers.A win for the cab drivers. A win

173 for Steven as he will be able to maintain exactly the same level of support he currently gets. And a massive win for the council who get to save an enormous amount of money. This is surely what Personalisation is all about. This surely what In Control is all about. Me, on Steven’s behalf, has had an active part in compiling the support package, costing it, chosing who provides it, and managing it once it’s in place. And it should please the efficiency savings brigade as it reduces the budget by over a third. Any flies in the ointment? Well, Hillingdon currently have a purely arbitrary ceiling on their level of direct payments. I’ve scowered their website and can’t find anything in writing about it but I’ve been told several times in the past that they only allow direct payments to cover up to X hours of support each week. Steven’s hours exceed X. Will they relax this local rule if it means it will save them a fortune? Or will they put policies and power before common sense and financial savings. And before taking a strong ethical position about the funding of care. I’m reasonably confident that my proposal will be accepted. We have form on this. Do you remember my 2 year battle to get a respite budget? For a year, the council avoided paying anything by insisting Steven’s respite had to take place in the same unit they detained him for a year in 2010 – it was their only respite facility. Then I persuaded them to pay for a support worker to do an overnight shift at home, so I could get a night out. They agreed to this but pulled the plug after six months. The support agency milked it and charged them £165 for an overnight but only paid the worker £55 – the council were unhappy paying those sort of rates. I proposed they pay me £65 (all of which could go to the support worker) from the direct payment budget and save themselves £100. They agreed in minutes. Money talks – Needs and Care doesn’t. Once again people – a vulnerable person has their needs assessed to enable them to have a decent quality of life. Nothing outrageous – just good day to day support and activities. But in accepting that, you have to accept that the agencies involved in providing the support will receive a huge chunk of the budget for their pockets. 52% of Steven’s care budget goes directly into their pockets. I’ll lay my cards on the table. This is financial abuse of the vulnerable. Mark Neary blogs on: http://markneary1dotcom1.wordpress.com/2013/11/23/personalisation-vs-profits-who-wins/ Peter Gilbert praised for his outstanding contribution to social work - Community Care Worcestershire’s former social services director Peter Gilbert has been recognised for his outstanding contribution to the profession at the Social Worker of the Year Awards 2013. Gilbert won the Outstanding Contribution award in recognition of his sizeable influence on social work thinking on mental health, learning disabilities, spirituality and leadership. Professor Ray Jones, a trustee of Social Worker of the Year Awards, said: “At a time when we’ve all been asked to focus much more on performance indicators and data, Peter always reminded us that what is also important is the personal contribution we make as people and that’s important for those who are marginalised.” These many posts included being a national facilitator of the National Social Care Strategic Network, chair of the National Development Team for Inclusion, emeritus professor of social work and spirituality at Staffordshire University, and joint fellow for mental health at NICE and SCIE.

174 Throughout his career Gilbert has been willing to champion what he believed was important regardless of mainstream thinking within the profession. “One of Peter’s big contributions is, at a time when it was not quite so fashionable, he was a strong advocate and champion within the field of mental health and gave that a high-profile in both the organisations in which he was working but also through the British Association of Social Workers,” says Jones. Believing that social work’s origins in Freudian and Marxist thinking had made the profession suspicious of religion and faith, Gilbert – himself a Roman Catholic – advocated a vision of social work that recognised the benefits that spirituality, in its broadest sense, could bring to social care practice. “Peter’s ability to transmit what spirituality means lies in his disarming honesty about his own need for spiritual help in his life; his prodigious and generous networking skills and his charm, warmth and kindness towards those who meet him,” says Dr Janice Clarke, senior lecturer at the University of Worcester. “His own experiences led him to an acute awareenss of the importance of humane and spiritual leadership, which comes across in his teaching and speaking, capturing the minds and hearts of students. Gilbert also wrote many books about social work practice including Managing to Care with Terry Scragg in 1992 and, most recently, Spirituality and End of Life Care. “Peter is a man of tremendous integrity and considerable energy and commitment, but at the end of the day he has always been someone who related to people very well and is a very human person,” says Jones. http://www.communitycare.co.uk/2013/11/29/peter-gilbert-praised-outstanding-contribution-socialwork/#.UpxTpcRdX1E?cmpid=NLC|SCSC|SCDDB-2013-1202 PM taskforce recommends new powers to tackle extremism - GOV.UK _____________________________________________________________________ New measures to tackle extremism and radicalisation across the UK have been proposed by the Prime Minister’s Extremism Taskforce. The taskforce was set up this summer to identify areas where the current approach was lacking and agree practical steps to fight against all forms of extremism. The final report states that challenging and tackling extremism is a shared effort and includes a definition of Islamist extremism as a distinct ideology, which should not be confused with traditional religious practice. The proposals include: • •

• •

• • •

Considering if there is a case for new civil powers, similar to the new anti-social behaviour powers, to target the behaviours extremists use to radicalise others Considering if there is a case for new types of order to ban groups which seek to undermine democracy or use hate speech, when necessary to protect the public or prevent crime and disorder Consulting on new legislation to strengthen the powers of the Charity Commission Working with internet companies to restrict access to terrorist material online which is hosted overseas but illegal under UK law and help them with their continuing efforts to identify what material to include in family-friendly filters Improving the process for the public to report extremist content online Making delivery of the Channel programme, which supports individuals at risk of being radicalised, a legal requirement in England and Wales Ensuring prisoners who have demonstrated extremist views in prison receive intervention and support on release

175 Prime Minister David Cameron said:

This summer we saw events that shocked the nation with the horrific killing of Drummer Lee Rigby in Woolwich and murder of Mohammed Saleem in Birmingham. These tragedies were a wakeup call for government and wider society to take action to confront extremism in all its forms, whether in our communities, schools, prisons, Islamic centres or universities. I have been absolutely clear that this is not something we should be afraid to address for fear of cultural sensitivities. We have already put in place some of the toughest terrorism prevention controls in the democratic world, but we must work harder to defeat the radical views, which lead some people to embrace violence. The taskforce I set up has proposed a broad range of measures to counter the extremist narrative and I will make sure they are taken forward. The implementation of these practical steps to tackle extremism in all its forms will be closely monitored.

DOWNLOAD THE REPORT: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263181/ETF_FINAL. pdf Police & Crime Commissioners should be abolished, says review - The Information Daily.com Police and Crime Commissioners (PCCs) should be abolished as the initiative has "fatal systematic flaws", a review into policing in England and Wales has said. Ex-Met Police Commissioner Lord Stevens, who led the review, said more power should be given to local councillors and local authorities. He also suggested that some police forces merge as the current police structure is “untenable”. The review, which was commissioned in 2011 by Labour, suggests that the Independent Police Complaints Commission and the Inspectorate of Constabulary should also be replaced. Labour leader Ed Miliband and Shadow Home Secretary Yvette Cooper welcomed the review. Miliband said: “This review is the first step in setting a new direction for policing in the 21st Century. Cooper added: “As Lord Stevens has made clear, people want to see the police working with communities, bobbies out on the beat, not beating a retreat”. The review, which has been described as the most comprehensive analysis of policing for half a century, included 37 “radical” recommendations. It described neighbourhood policing as “the building block of fair and effective policing”, and calls for nationally recognised qualifications for officers, a code of ethics for police officers to be introduced, and new media guidelines. It recommends that there should be restrictions on the use of private companies for policing functions, and a national procurement strategy for IT and equipment.

176 Miliband added: “Neighbourhood policing was pioneered by Labour. It wasn’t just a slogan, it was a different philosophy of policing: policing rooted in local communities, doing more than reacting to crimes by also preventing them, and working in partnership with local authorities, schools and the NHS". “So it is of profound concern to me that the independent Commission concludes that neighbourhood policing is under threat. We don’t want to see services retreating back to their silos, becoming more remote from communities.” http://www.theinformationdaily.com/2013/11/25/police-crime-commissioners-should-be-abolishedsays-review Polypharmacy and medicines optimisation | The King's Fund Polypharmacy – the concurrent use of multiple medications by one individual – is an increasingly common phenomenon that demands attention at clinical policy and practice level. Driven by the growth of an ageing population and the rising prevalence of multi-morbidity, polypharmacy has previously been considered something to avoid. It is now recognised as having both positive and negative potential, depending on how medicines and care are managed. This report proposes a pragmatic approach, offering the terms ‘appropriate’ and ‘problematic’ polypharmacy to help define when polypharmacy can be beneficial. Drawing on literature from predominantly Western countries, the report traces the occurrence of polypharmacy in primary and secondary care, and in care homes. It explores systems for managing polypharmacy and considers it in the context of multi-morbidity and older people, offering recommendations for improving care in both cases. Key findings • •

•

• • • • •

For many people, appropriate polypharmacy will extend life expectancy and improve quality of life. Their medicines use will be optimised and prescribed according to best evidence. In problematic polypharmacy there can be an increased risk of drug interactions and adverse drug reactions, together with impaired adherence to medication and quality of life for patients. Many clinical trials and practice guidelines do not consider polypharmacy in the context of multi-morbidity. It is important that pragmatic clinical trials are conducted that include patients with multi-morbidity and polypharmacy. Multi-morbidity and polypharmacy increase clinical workload, so doctors, nurses and pharmacists need to work coherently as a team with a balanced clinical skill-mix. People often do not take medicines as they are intended. Evidence shows many dispensed medicines remain unused or are wasted. During medication reviews, prescribers should consider if treatment should be stopped and ‘end-of-life’ care be offered for certain chronic conditions or cancer-related illness. Patients with multi-morbidity could have all their long-term conditions reviewed in one visit by a clinical team responsible for co-ordinating their care. Patients may struggle with complex drug regimens; their perspective on medicine-taking must be taken into account when prescribing.

Policy implications •

•

More training is needed in managing complex multi-morbidity, polypharmacy and other aspects of medicines management, involving GPs, older care clinicians, orthogeriatricians, clinical pharmacologists, nurse specialists and clinical pharmacists. Systems are needed that optimise medicines use where there is polypharmacy so that people gain maximum benefit from their medication with the least harm and waste.

177 •

There are numerous evidence-based guidelines for the treatment of single conditions, but there is a need for guidelines on the treatment of multi-morbidity.

http://www.kingsfund.org.uk/publications/polypharmacy-and-medicines-optimisation DOWNLOAD THE REPORT http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicinesoptimisation-kingsfund-nov13.pdf Prison probation privatisation to cause mass disruption - The Information Daily.com The lack of contingency planning in the government’s upcoming prison probation privatisation programme could cause massive disruption in 2014. The government’s Transforming Rehabilitation will transfer the supervision of the UK’s former offenders from 35 probation trusts to 21 private companies in 2014. However, experts have warned that there is not enough contingency planning in place to effectively manage the move from pubic to private management. Evidence suggests that the ensuing fallout could have a negative impact on reoffending rates across the country. Disruption to the rehabilitation service could also affect local communities and endanger the general public, argue probation performance managers. “The biggest challenge coming up is the Transforming Rehabilitation agenda”, warns John Parkin, the Performance Manager of the West Yorkshire Probation Trust. “It’s a massive change within the criminal justice sector, and what’s difficult to anticipate is the ensuing disruption: how long that will be for and what impact that might have on reoffending rates”. “It is whether that transition can be managed without affecting the ability to be able to provide interventions for these offenders”, he told The Information Daily. The latest figures suggest that over 70 per cent of the government’s probation caseload will be taken over by private sector or third sector voluntary organisations. A spokesman for the Ministry of Justice said that “the rehabilitation programme will transform the way we manage offenders in the community”. "The government are confident that the scheme will reduce re-offending rates whilst continuing to protect the public". But experts are worried that offenders will be disadvantaged and suffer under the transformation of the government rehabilitation contracts, with poor management of data exchange potentially causing massive disruption. “It is managing that transition", said Parkin. "The probation service has done its job for 100 years, and next year that is going change completely”.

178 http://www.theinformationdaily.com/2013/12/17/prison-probation-privatisation-to-cause-massdisruption Probation privatisation plans will put 'public at higher risk' | Society | The Observer Plans to put private companies such as G4S in charge of supervising tens of thousands of criminals on licence in the community have a "very high chance" of putting the public at greater risk and will result in a poorer service for victims of crime, according to an internal assessment presented to the Ministry of Justice and seen by the Observer. The probation service's risk assessment, written last month, spells out in detail how the government's high-profile programme for allowing the private sector and voluntary groups to run its offender management programme is in danger of going off the rails. Almost three-quarters of all probation work, now overseen by 35 probation trusts, will be moved to a National Probation Service and outsourced to 21 community rehabilitation companies. All but the most high-risk offenders – some 140,000 a year – will be placed under the supervision of private sector companies, but the probation union, Napo, is warning that they will not have the skills to assess whether the risk patterns of offenders they are monitoring are changing. High-profile murders committed by offenders while on licence, notably the killing of two French students in 2008 by Daniel Sonnex , have highlighted the complex nature of risk assessment. "The private sector is likely to miss cases which need recalling to custody, because of their inexperience," said probation expert Harry Fletcher. "This plan will compromise public protection." The timetable for the rollout of the universal credit scheme had to be scrapped recently, and in November plans to privatise three prisons were abandoned. However, the justice minister, Jeremy Wright, insisted the government was "on track" to deliver its probation reforms. "These will see the best of the public, private and voluntary sectors working together to break the depressing cycle of reoffending," he said. "With more than 600,000 offences committed last year by those who had broken the law before – despite spending £4bn a year on prisons and probation – the status quo is not an option. Public safety remains our top priority and the department is working with probation trusts to ensure this will not be compromised." http://www.theguardian.com/society/2013/dec/15/probation-reforms-put-public-at-higher-risk Putting patient safety first: how long will it take before the NHS learns from its mistakes? | The King's Fund One of the most powerful contributions to our Annual Conference was a presentation by James Titcombe, the father of Joshua, a baby boy who died aged only nine days after signs of his deteriorating condition were missed by the staff at Morecombe Bay NHS Trust. What was remarkable about James’s story is that he was able to draw valuable lessons from it about how the NHS could improve patient safety by learning from mistakes. James presented data from a regional confidential inquiry into 25 cases of perinatal death. Only 24 per cent of the 140 possible contributory factors identified by the inquiry team had been identified in local investigations at the time of the incidents. So 76 per cent of the learning from the incidents had been missed; a situation that there is an urgent need to improve.

179 James said that we would only achieve Don Berwick’s ambition for the NHS to ‘place the quality of patient care, especially patient safety, above all other aims’ if we have candour when mistakes happen and acknowledge all medical errors. All mistakes/serious incidents must be properly investigated, with audited action plans that address the root causes. James said that if an NHS organisation makes a mistake that causes preventable harm to patients for a second time, it should be regarded as a ‘never event’. James also argued for the Care Quality Commission (CQC) to make greater use of investigations into serious untoward incidents in its assessments. Since James presented to us, the government has issued its response to the Francis Inquiry report. But to what degree does this response address James’s recommendations? There is a lot that is relevant – as well as the new statutory duty of candour, the ‘cultural aspects of care’ will now form part of CQC’s inspection regime. Greater use will be made of incident data, including a commitment for CQC to consider each hospital’s review of serious untoward incidents as part of its pre-inspection activity. NHS England will also launch a programme of new patient safety collaboratives, which will be expected to provide expertise on learning from mistakes and help to provide a ‘rigorous approach to transforming patient safety’. The key to success will be the degree to which these national aspirations are owned and adopted at local level, to create a culture that rigorously uses data to monitor quality and progress. Immediately before James spoke at our Annual Conference, we heard an inspirational speech from Dr Brent James , who talked about the systemic approach to quality improvement at Intermountain Healthcare and gave examples of initiatives that had made significant improvements in survival rates. At Intermountain all senior clinical and administrative staff are expected to be skilled in quality improvement. Brent stressed that ‘We count our successes in lives’. How far is the NHS from this culture? In places like Salford Royal NHS Foundation Trust it feels not far. The trust has worked hard to skill clinical and non-clinical staff, specifically in quality improvement, systematically reviews its quality performance data and has managed to significantly reduce the incidence of avoidable harm. Sadly, this is a long way from the position in many trusts. I spent yesterday at an event called Medicine Unboxed. It was a fascinating day. One of the most startling presentations was from Professor Roger Kneebone, a trained surgeon, who showed an anonymised film of an operating theatre. Loud music was being played, so much so that the words of those conducting the operation were not being heard or properly understood, a sharp contrast to the requirement for aircraft cockpits to be silent at take-off and landing. To me this exemplified a culture that does not put patient safety above all else. A graphic example of the distance the NHS has to travel before we see making the same mistake twice as a ‘never event’. http://www.kingsfund.org.uk/blog/2013/11/putting-patient-safety-first-how-long-will-it-take-nhslearns-its-mistakes Radical overhaul of sentencing continues – GOV.UK _____________________________________________________________________ From this month community sentences will have to include an element of punishment, as the radical overhaul of sentencing continues Justice Secretary Chris Grayling said today. In a move to improve public confidence in community sentences, adult sentences will now have to include some form of punishment. Last year more than 130,000 community sentences were handed down by the courts. Around onethird of community sentences contain no punitive element but from 11 December this will

180 change. Most sentences will contain an element of formal punishment such as a fine, unpaid work, curfew or exclusion from certain areas. This could affect around 40,000 offenders per year. This is the latest step in a wide range of sentencing reforms ranging from restrictions on the use of cautions for more serious offences to the introduction of a mandatory life sentence for the most serious repeat offenders. One year ago this week a range of tougher sentences and new offences, introduced in the Legal Aid, Sentencing and Punishment of Offenders Act 2012, came into effect including: • • •

•

‘Two-strikes’ — mandatory life sentence for anyone convicted of a second very serious sexual of violent offence Tough new sentence — Extended Determinate Sentence where offenders spend at least two-thirds of their sentence behind bars and extra time being monitored in the community Aggravated knife possession — new offences of using a knife to threaten and endanger someone in a public place or school. Anyone convicted of these offences faces a mandatory custodial sentence of at least six months for adults and a four month Detention and Training Order for 16 and 17 year olds. Clampdown on dangerous drivers — new offence of causing serious injury by dangerous driving which carries a maximum sentence of five years in prison.

We anticipate more than 2000 offenders per year will be affected by these changes: • • • •

‘Two-strikes’ mandatory life — 20 offenders per year Extended Determinate Sentence — 1,200 offenders per year Aggravated knife possession — up to 1000 offenders per year Causing serious injury by dangerous driving — 20 offenders per year.

Chris Grayling said:

From my first day in this job I have been clear that punishment must mean punishment. A community sentence shouldn’t just consist of a meeting with an offender manager, prisoners shouldn’t spend their time in prison watching satellite television and the worst offenders should get the very toughest sentences. Step by step we’re overhauling sentencing and sending a clear message to criminals that crime doesn’t pay. We’re on the side of people who work hard and want to get on and my message is this - if you break the law you will be punished. Currently, only around two-thirds of community orders contain punishment such as a curfew or unpaid work. Under the reforms that will come into effect this month we expect this to rise significantly. In very exceptional circumstances judges will have the power not to include the element of punishment. Research suggests the inclusion of a punitive requirement alongside supervision in community sentences, can be more effective in reducing reoffending than supervision alone. https://www.gov.uk/government/news/radical-overhaul-of-sentencing-continues

Risk assessment framework: addendum for assessing risk at independent providers of Commissioner Requested Services - Monitor.

181 Published on: 19 December 2013

About the Risk assessment framework Since October 2013, we have used the Risk assessment framework to monitor financial and governance risks at NHS foundation trusts. The financial parts of the Risk assessment framework will also apply to all independent sector providers of Commissioner Requested Services from 1 April 2014. This consultation puts forward our proposed approach to monitoring financial risk at those organisations.

Download - Risk assessment framework: addendum for assessing risk at independent providers of Commissioner Requested Services - (1.01 MB) Rochdale serious case reviews find dysfunctional multi-agency working and social care failures - Community Care Two serious case reviews highlight numerous problems across all agencies involved in the Rochdale child sexual exploitation case. Dysfunctional multi-agency working and a policy of hiring non-qualified social work staff are among the many problems identified by two serious case reviews into the sexual exploitation of young people in Rochdale. The highly critical serious case reviews (SCRs) published today examined the events surrounding the sexual exploitation of seven young women by a gang of nine men over a period of years. They highlight how disagreements over funding between agencies delayed attempts to create an effective specialist child sexual exploitation team, how a lack of communication resulted in a disconnect between strategic objectives and frontline operations, and a widespread lack of understanding about child sexual exploitation in all agencies including children’s social care. Children’s social care was found to have failed to act appropriately on multiple occasions. When it was first alerted to the problem in 2006 by sexual health workers who told them of their belief that a gang of men were sexually exploiting young people, the service concluded that no strategy meeting or assessment was needed due to inadequate evidence, despite it being “incumbent” on the service to inform the police and start a Section 47 enquiry. The council’s policy of investing in non-qualified social work staff, born of a desire to save money and a belief in moving towards a more diversely qualified workforce, meant that initial assessments were not carried out by highly experienced and qualified social workers as required by statutory guidance. Social workers and other professionals were also found to have focused on the behaviour and lifestyle expectations of the young people and not their safeguarding needs and so “allowed themselves to be reassured by family members that they would protect their children, even when previous reassurances had proved to be ineffective”. That managers failed to challenge this suggested “that the problem was an organisational one”.

182 The culture of children’s social care in Rochdale was also criticised for not valuing other organisations, believing itself to have “seniority” over other partners and failing to share important information with other agencies. High workloads within social care in Rochdale, a problem that had been identified in Ofsted inspections, was also noted as a factor that undermined the quality of practice. Social workers also told the SCR team that a focus on younger children following the death of Baby P was another contributory factor. The council’s “non-accommodation policy”, which was in place from September 2006 to October 2012 and emphasised keeping children with their families, also significantly limited safeguarding options even though it was in line with national policy at the time. And when young people did become subject to child protection processes, the work done by social care was of “poor quality, marked by drift, poor adherence to procedures intended to act as checks and balances, a lack of planning or review, and poor recording”. “The most critical weaknesses lay in the quality and timeliness of statutory assessments undertaken by children’s social care,” one of the two reports noted. “There were too many occasions when despite significant information having been provided by the young people or by others, children’s social care failed to meet basic standards of practice in assessment and as a result were unable to understand their experience or establish trust and confidence in the young people.” Other agencies also faced stiff criticism, including the police who were found to have not provided extra resources when the scale of the abuse began to become clear – a failure that slowed the investigation’s progress. The SCRs found “no direct evidence” that the race of the predominately ‘Asian’ men who carried out the exploitation led to an unwillingness by agencies to respond to the abuse, as some commentators have suggested. However, the SCR team noted that research has suggested that attitudes to race within communities does affect the way services are provided. It noted that the fact that the men were predominately of South East Asian backgrounds “points towards the need for further analysis and research as to what significance this did or not hold” although such an analysis lies outside the remit of a SCR. Jane Booth, the independent chair of Rochdale Borough Safeguarding Children Board, said: “In reviewing the work of the agencies between 2003 and 2012 the reviews have identified a widespread pattern of weaknesses and failings, across all agencies at an organisational level but also in terms of some individual practice. The reports conclude that the repeated nature of these failures exposes fundamental problems and obstacles at a strategic level over a period of years and that this undermined the agencies’ ability to protect and safeguard young people.” The SCRs’ many recommendations include: •

•

Rochdale Borough Safeguarding Children Board to create a framework for direct communication between it, service users and frontline practitioners and to review knowledge and priority partner agencies afford to working with adolescents. Children’s social care must continue to make sexual exploitation a top priority and all practitioners, including first and second line managers, must receive training on the issue of child sexual exploitation. Social care should also ensure young people can participate in the safeguarding process and that they are seen and spoken to in a timely manner.

http://www.communitycare.co.uk/2013/12/20/rochdale-serious-case-reviews-find-dysfunctionalmulti-agency-working-social-care-failures/#.UrQaIBZ8vkw?cmpid=NLC|SCSC|SCDDB-2013-1220

183 DOWNLOAD THE REPORT: http://www.rbscb.org/UserFiles/Docs/YP1-6%20SCR%20RBSCB%2020.12.13.pdf http://www.rbscb.org/UserFiles/Docs/YP%207%20SCR%20RBSCB%2020.12.13.pdf Scrapping formula could raise billions for social care - Health Service Journal. More than £4bn could be raised to pay for adult social care in England by scrapping an outdated funding formula, the Local Government Association has said. It claimed the Barnett Formula, used since 1979 to allocate public spending across the four UK nations, left England short-changed by £4.1bn because of a bias to Scotland, Wales and Northern Ireland. The formula was intended to be temporary in the run-up to the abortive devolution referendums in the late 1970s, but has remained in use. Barnett is based on population rather than need and has locked-in the proportionally higher spending per person used in Scotland and Wales 35 years ago, the LGA said. It called for the £4.1bn to be returned to England for use as seed funding to establish a government-backed scheme for loans to help people pay for care in their old age. This would work in a similar way to student loans, with people able to borrow against their estate to pay for care. Demand for councils’ adult social care services is increasing by 3 per cent each year, meaning councils have to find an extra £400m a year while their central funding is being cut by 43 per cent, equivalent to £20bn. The LGA said this placed social services “under enormous strain” and led to service reductions and tighter eligibility criteria. LGA chair Sir Merrick Cockell said: “The crisis engulfing adult social care demands a shift to a needs based formula for distributing funding. “The government also has to take action to ensure people can plan with confidence for the financial needs of old age. “A national care loans scheme would provide peace of mind to people and put financial sustainability into a system which is creaking at the edges.” The LGA is working on proposals for an alternative funding allocation mechanism to replace the Barnett Formula, which it will publish next summer, and will press the political parties to include the introduction of a needs-based formula in their manifestos. http://www.hsj.co.uk/5065674.article?WT.tsrc=Email&WT.mc_id=EditEmailStory&referrer=e2#.Uob3WRdWpw Sector looks on with dismay at lack of progress on transforming care post-Winterbourne - Community Care

184 One year on from the government's commitment to end inappropriate hospital placements for learning disabled people, optimism has turned to pessimism Twelve months ago care and support minister Norman Lamb vowed to end inappropriate placements of people with learning disabilities in mental health hospitals by June 2014, as part of the government’s response to the Winterbourne View scandal. In future, stays in hospital would be restricted to short spells in local, small-scale units that provided assessment and treatment to deal with breakdowns in health and support: community-based support, close to home would be the norm. Lamb’s words were backed up by action. He gave the Local Government Association and NHS England £2.86m to set up a programme – the Winterbourne View Joint Improvement Programme (WVJIP) – to help local commissioners transform care in line with the vision. He set tough timescales for commissioners to review the care needs of learning disabled inpatients and develop personalised care plans to help move all those who could do so back to their home communities by next June. And 51 organisations – representing health and social care commissioners and providers, leading charities and professional bodies – signed up to delivering the vision. Optimism was in the air. But 12 months on, that optimism has turned to pessimism. On Wednesday, Rob Greig, the person who led the implementation of the landmark 2001 Valuing People white paper as the Department of Health’s learning disabilities director from 2001 to 2008, wrote the following in a blog post for the Think Local Act Personal partnership: The post Winterbourne View agenda has had a seriously disappointing year, with the nationally led programme involving a lot of talk but little evidence of real action.” This is a damning indictment on the past year from a leading voice in learning disability care. Speaking to me earlier today, Greig said that the WVJIP had spent insufficient time working alongside commissioners to help guide them in reshaping services, which was the only way to achieve real change. Greig’s comments were followed by news that the WVJIP’s director, Chris Bull, had left the programme, with his number two, Ian Winter, due to follow suit next week . A spokesperson for the programme said that Bull was working part-time and it was felt the programme needed a full-time head, and that Winter was coming to the end of his contract. Though both had made “valuable contributions to the programme in its initial phase”, the spokesperson added: “As the focus of the programme changes, the opportunity has been taken to review the structure of the team in order to ensure that it reflects the requirements of the next stage.” This suggests that, at some level, it had been decided that a change in leadership was required. That change has now happened with the appointment, today, of Bill Mumford, as programme director, today. Mumford, chief executive of learning disability provider MacIntyre, has been seconded to lead the programme for 18 months. If the government and local areas don’t stop dithering, we will miss this unique opportunity. In so doing, they continue to fail not only people with a learning disability, but everyone who saw or heard about what happened at Winterbourne View and demanded change.” Vivien Cooper and Jan Tregelles, chief executives of The Challenging Behaviour Foundation and Mencap The scale of the challenge facing him was made clear today. A census of inpatient provision by the Health and Social Care Information Centre found that there were 3,250 people with learning disabilities in units as of September – virtually the same figure as when the last census was carried out in March 2010. Sixty per cent of this group had been on hospital wards for over a year. Though the Winterbourne transformation programme was only launched in December 2012, ending

185 inappropriate hospital provision for people with learning disabilities had been government policy for over a decade and numbers had come down from 2006 to 2010. This lack of progress was described as a “national disgrace” by respected commentator and former Department of Health (DH) personalisation lead Martin Routledge, now operations manager at In Control. Specialist charities Mencap and the Challenging Behaviour Foundation said the “distressingly slow” progress was undermining the confidence of families of people in inpatient units that the government process would improve their loved-ones’ lives. Alongside the census, the DH delivered its own verdict on progress to date. Unsurprisingly its one year on report was less bleak than sector leaders’ comments. For instance, it found that most of the 75 commitments in the concordat have been delivered or are on track. However, a foreword from Lamb illustrated the scale of the challenge ahead. It listed a number of achievements from the programme to date but all of these were either procedural (for example, the establishment of a new inspection framework for learning disability services coming into force next year), related to information gathering (the census) or largely irrelevant (the publication of legislation to put adult safeguarding boards on a statutory footing from April 2015). More tellingly, he said, repeatedly, that the pace of progress will need to be accelerated if the June 2014 target is to be met. He also pointed out that there is still doubt over the number of people whom the Winterbourne programme should be seeking to help. Of the 3,250 people identified by the census, most of the 585 in high or medium-secure settings are likely to be ineligible on the grounds of being placed in hospitals for reasons of public protection. But do all of the 2,665 others on general wards or in low-secure settings count? And are these 2,665, broadly, commensurate with the 2,621 people with learning disabilities identified, separately, by NHS commissioners as being placed in hospital settings? In his foreword Lamb said that these figures needed to be reconciled. But with less than six months to go until the June deadline, how realistic is it to do this and also deliver changes to people’s care and lives? Some of the other findings in the census are also concerning. Of the 3,250 patients, providers could not provide a valid home postcode for 910 of them – a key gap given the ambition of people receiving services as close to home as possible. While the researchers were able to find postcodes for most of the 910 by using their unique NHS number, this raises significant questions about the extent to which some providers – and commissioners – are geared towards supporting people to return home. The next six months should see faster progress. For one thing, the WVJIP has spent only £400,000 of its £2.86m so far and is due to use the coming period sending improvement advisers into local areas to provide tailored support to commissioners in reshaping services. This is the sort of support that Greig thinks is crucial to delivering real change and, in his blog for TLAP, he said he could see evidence that the programme was starting to make an impact. Greig himself is optimistic that progress will be made, particularly given the appointment of Mumford to lead the programme. Mumford is incredibly well-respected across social care for his strong commitment to personalisation, service user involvement and workforce development, and his appointment has been widely welcomed. Lamb said: Bill Mumford will provide strong leadership at a critical time to drive this work forward and I welcome his appointment.” At the same time an enhanced quality assurance programme, under the auspices of NHS England, is sending social workers and nurses to review the cases of a sample of patients, including those formerly placed at Winterbourne View, to assess how well they are being supported to return to the community. This should also accelerate progress, as should the introduction of key performance

186 indicators for commissioners from April 2014 to help hold them to account for progress in transforming care. All of this is coming rather too late to come close to meeting the June 2014 target. But that would not be a tragedy if, six months from now, true progress is being made in helping the people concerned return to living a normal life, in a home they can call their own, alongside family and friends. Let us hope that health and social care leaders – and government – rise to this challenge, or a significant opportunity to bring some good from one of social care’s darkest hours will have been lost. More from Community Care Martin Routledge December 13, 2013 at 4:59 pm # When I spoke of a national disgrace today I was referring to one that has been years in the making for which many of us must take some responsibility. It is notable though that progress was made in the 2006-10 period and it is no coincidence that this was when the Valuing People Team had a targeted and supported programme to drive change, building on the success in getting people out of long stay hospitals. Keeping a “priority” while removing the team delivering it was never going to work. We must look forward though. The June 2014 target is never going to be met and it would be a mistake in my view to insist on it as this could have unfortunate, unintended consequences. In Control and partners have just started working with a collaborative in one region and it is clear that there are many who really want values-driven and rapid action to better support people with complex needs. They have asked for help with this. There are some quite significant system inhibitors though – health commissioners are going to be have to prepared to transfer the cash currently used in the assessment units for better local use. Some providers of the current services are going to have to stop seeing people as sources of revenue. Staggeringly I heard informally recently of one very senior provider manager planning to expand their “business” in this area. The minister and new programme director are going to need to have an early sit down and come up with a new plan – building on the good things that have happened, with some challenging but realistic targets and timescales and then both provide support to and put pressure on the key system managers – programme managing them through. http://www.communitycare.co.uk/2013/12/13/sector-looks-dismay-lack-progress-transforming-carepost-winterbourne/#.UrBtXmRdWpx DOWNLOAD THE REPORT: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265752/Winterbour ne_View_One_Year_On_Report.pdf Security share stories - E-Health Insider Dame Fiona Caldicott’s second review of information governance will need some nuts and bolts IT work to implement, Fiona Barr discovers. Over the next few months, the NHS will be called to account for the progress it has made in implementing information governance recommendations from Dame Fiona Caldicott’s second review of information governance. The recommendations in what is commonly called Caldicott2, but which is formally titled ‘ Information: to share or not to share’ , seek to shift the balance in favour of greater sharing of information in the NHS. However, Dame Fiona is clear that the NHS must also work to ensure that

187 patient data is only shared for the purposes of direct care and hat providers must ensure sharing is “effective and safe”. Those safeguards include a recommendation that all organisations have a leader on information governance; that NHS organisations respond to a data breach honestly and immediately; and that health and care staff are trained in information governance. Peter Batchelor, regional manager for UK, Ireland and Africa for network security specialists ForeScout, believes that organisations looking at network security need to start by find out how many devices are connected to their networks, something he believes 99% of NHS trusts would currently struggle to do. These risks are acknowledged in the Caldicott2 report, which recommends that NHS organisation ensure that mobile and telehealth devices meet best practice on information governance. Most commentators focused on the report’s call for more information sharing, particularly with social care. But extending information sharing in ways that are also safe will call for some specific approaches. What it cannot do, of course, is guarantee that anyone reading the information at either end does not do so inappropriately. Andrew Jutson, senior risk consultant with information security consultancy Information Risk Management, argues that the missing element in the Caldicott2 report is an overarching information governance programme that enables the recommendations to become a business as usual task. He adds: “In my opinion a wider governance programme needs to be established, aligned to the health service requirements. “This needs to construct the controls, and go beyond issuing recommendations in the hope that a care trust is mature enough in terms of governance to accept and understand the underpinning demands each recommendation places on the trust, its staff and associated third parties.” http://www.ehi.co.uk/Features/item.cfm?&docId=414 Serious case reviews 'politically abused' since death of Baby P, claims expert Community Care There has been a “political abuse” of serious case reviews since the death of Baby P, with authors forced to criticise the council to avoid ministerial disapproval, a leading safeguarding expert has claimed. Edi Carmi, an independent safeguarding consultant who led the first serious case review into the Peter Connelly ( Baby P ) case, said serious case reviews were “an internal process” and seen as “local lessons for a local professional audience”, prior to the high-profile tragedy. She was speaking at a Community Care conference held to mark the fifth anniversary of the political and media fallout that followed the 17-month-old’s death. Carmi’s original 140-page report into Haringey’s involvement in Peter Connelly’s life was found to be ‘inadequate’ by the then Labour government. Ministers criticised former Haringey director Sharon Shoesmith for reviewing her own children’s services department, even though this was consistent with practice and political recommendations at the time.

188 Politicians were poorly briefed about the case and influenced by the media, Carmi told delegates, pointing out that comments on her review were positive before the media became involved. The fallout from the case has had a negative effect on serious case reviews, Carmi said, claiming that review authors now feel under pressure from politicians and are consequently sometimes reluctant to take on the work. “When something goes wrong, we need to look beneath individual responsibility to what’s going wrong in the system,” Carmi said. “But if you want to avoid ministerial disapproval, you have to say how bad the work being done is and how bad the local authority is doing – then you’re safe.” Professor Nick Frost of Leeds Metropolitan University, whose serious case review into the death of four-year-old Hamzah Khan in Bradford was heavily criticised by the government , also spoke at the event. He told delegates that the negative experience had made him more determined to stand up for social work and say what he thinks. Frost’s review was criticised by the children’s minister who said it did not fully explain social workers’ actions. He said the review was very clear that the child’s death could not have been predicted, and found many of the problems concerned national systems, such as education and health. Peter Connelly was 17 months old when he died in August 2007. His mother, Tracey Connelly, her boyfriend Steven Barker and his brother Jason Owen were all jailed for their part in the toddler’s death. http://www.communitycare.co.uk/2013/12/13/serious-case-reviews-politically-abused-since-deathbaby-p-expert-claims/#.UrJEdWRdXjA?cmpid=NLC|SCSC|SC019-2013-1219 Sharon Shoesmith calls for 'honest', not 'destructive', accountability in social services Community Care. “Destructive accountability has created a form of cultural trauma around child protection… and we must find a way out of it.” That was the message from Sharon Shoesmith when she addressed social workers and managers at a Community Care conference, held last week to mark the fifth anniversary of the fallout from the Peter Connelly ( Baby P ) case. In a considered, honest and forensically-researched speech, the former Haringey director reflected on her difficult experiences over the last five years, sharing what they have taught her about public accountability in England’s children’s services. The public aspects of her life are well known – the media appearances after Baby P’s death, being ousted from her post by then education secretary Ed Balls on live TV, winning a High Court appeal against her sacking – but she also revealed the private torment she and her colleagues have endured: death threats, professional isolation, indefinite unemployment and a battle to maintain their mental health in the face of press intrusion and public vilification. No evidence of gross misconduct It was torment to which they should never have been subjected. Despite being treated as culpable by politicians and some elements of the press, none of the inquiries into Peter Connelly’s care found evidence of gross misconduct by any Haringey social worker or manager. Not because of a conspiratorial cover up, but because there was none to find.

189 “Colleagues in social care at the time had told me there was only one way out of it – to sack the social workers,” Shoemsith admitted. “But there was no evidence [to sack them]. The General Social Care Council agreed, but some elements of the press disagreed. “I put those social workers through a proper system, totally independent of me, and there was no evidence. The leader of the council, the head of HR, the chief executive, all agreed there was no evidence of gross misconduct.” Yet this was never reflected in political speeches or press coverage at the time. Instead, Shoesmith argued, they set out to construct “the narrative of a rogue person and a rogue local authority”. Why? Because it was easier for everyone to accept. It abstracted us, the public, from the reality that some people are determined to inflict horrific abuse on children and allowed politicians to utter false assurances – that children will never be murdered or horrifically abused and neglected again. She told delegates: “Politicians talk about never letting another child die because harm to children touches us so profoundly. They want and I want and you want to reassure the public – we want to tell them that we can save children. It is our natural inclination and we can’t resist getting into these no-risk reassurances that we simply can’t deliver on.” It would seem politicians didn’t have the courage, or possibly the facts, to speak the truth when interviewed after Baby Peter’s death. The truth being that child homicide is complex and can’t be explained away by sackings and serious case reviews alone – and that 54 other children died in 2007, as well as Peter Connelly. And 500 children died since the death of Victoria Climbie (600 by the end of Ed Balls’ term in office). Lack of candour and serendipity “Why do we protect the public from these facts?” Shoesmith asked. “Why did no one have the guts to say it? With the rhetoric from five years ago it’s possible that many members of the public and many professional people thought only two children had died and they had both died in Haringey. Our way of dealing with child homicide has led us to a lack of candour at the very highest levels.” In the short-term, of course, that reactive agenda suits everyone but the people involved. But in the long-term it’s dangerous and social workers know it. It’s what caused many directors to contact Shoesmith after the tragedy, admitting, “it could have been any of us”. “Here we are as professional people, who protect thousands and thousands of children year on year, left depending on serendipity,” she said. “Every social worker who retires thinks, ‘thank God I got here without any of that’. This is the stuff that’s there at 4am. “Public accountability is very important, it is your route to outstanding reputations and excellent services,” Shoesmith told delegates. “But at the same time it is your Achilles heel…We cannot progress further than, ‘some social worker didn’t bother, wasn’t up to it, didn’t care’. We cannot get out of this blame culture and we all indulge in it.” And these selective narratives still dominate after high profile child deaths. Just look at what happened to former Coventry director of children’s services Colin Green, forced to resign in the wake of the Daniel Pelka case . As Cafcass chief executive Anthony Douglas pointed out when he spoke later, “in social work you’re only as good as your last 24 hours”. “[Media and politicians] need the honourable resignation,” Shoesmith said, “the humble apology, the rogue element, the opportunity to offer oneself up for the greater good, to allow everyone else to breathe a sigh of relief and get on with the job they were doing. I’m speaking about the symbolic

190 resignation of a person who’s made no personal transgression. That is the nature of the public accountability that we are subject to.” She also noted the difference between accountability for those working in social services, who are usually unable to overcome the personal and professional indictment, and politicans, for whom such an event generally means a “temporary stepping out of role”. Local government must fight back Her route to it was not, but her call to action is simple. Well, simple to say, somewhat less simple to achieve. It is for “honest accountability” in public services, rather than “destructive accountability” – that marred by inaccurate information and/or political and media agendas. “Public accountability is founded on some misplaced socially constructed notion of reality, a failure to understand the nature of risk management, political opportunism, gender politics and absolute pure serendipity. Without some form of challenge from local government, accountability will continue to exist in this culture that predetermines its own failure. “The sector will forever allow itself to be forced to parade so-called failing staff at all levels in public in a relentless message of ‘mea culpa’: ‘we’re not up to the job’. Destructive accountability has created a form of cultural trauma around child protection ,” she said. The long round of applause that followed her speech, and the evident support from delegates, suggested she is far from alone in this view. http://www.communitycare.co.uk/2013/12/16/sharon-shoesmith-calls-honest-destructiveaccountability-social-services/#.UrBvDWRdWpw Sharon Shoesmith- Vilification of social workers is profession's Achilles' heel Community Care The automatic vilification of social workers in the wake of a child death is still the profession’s Achilles’ heel, Sharon Shoesmith has warned. The former Haringey director, who was in charge of the council’s children’s services when Peter Connelly ( Baby P ) died in 2007, issued the warning at a Community Care conference held yesterday to mark the fifth anniversary of the fallout from the Baby P case. Reflecting on the many inaccurate media reports on the case and her unlawful sacking by then secretary of state Ed Balls, Shoesmith accused Balls of using the child’s death as a “party-political football” and called for “honest accountability” in public services. She acknowledged the clear need for accountability in public services, but said the process has become clouded by an “absolutely institutionalised” culture of blame, political agendas and “aspirational” messages from politicians and public servants. “Routes of accountability come from the human need for certainty,” she said. ”Politicians talk about never letting another child die…our natural inclination is to say we can save all children. But we can’t risk getting into no-risk assurances that simply can’t be delivered.” Erroneous media reporting, a culture of blame and the lack of a strong sector voice has left social workers and the public traumatised, she said.

191 “We’ve embedded mistrust in the next generation. The public are traumatised because they think social workers can’t do [the job] properly. Social workers are traumatised too. Automatic vilification is your Achilles’ heel. We have to find a way out of this.” Shoesmith also condemned the treatment of her former colleagues at Haringey council, Baby Peter’s social worker Maria Ward and Ward’s manager Gillie Christou. Both women were sacked in the wake of the case and subjected to a trial by media, despite no investigation – internal or by the General Social Care Council – ever finding them guilty of gross misconduct. Shoesmith warned that this culture of fear and blame carries on, with many directors contacting her to say, “it could have been any of us”. She told delegates: ”The best the sector can do is hope it doesn’t happen to them.” Peter Connelly was 17 months old when he died in August 2007. His mother Tracey Connelly, her boyfriend Steven Barker and Barker’s brother Jason Owen were given prison sentences for their roles in his death after a trial at the Old Bailey. The case became public news on 11 November 2008 and the following month Shoesmith was removed from her post by Balls. In May 2011 the High Court ruled she had been unfairly dismissed. http://www.communitycare.co.uk/2013/12/13/sharon-shoesmith-vilification-social-workersprofessions-achilles-heel/#.UqrdYhZ8vkw?cmpid=NLC|SCSC|SCDDB-2013-1213 Skills for Care calls for feedback on Principles for Workforce Integration Skills for Care are looking for feedback on the draft version of The Principles of Workforce Integration that are designed to bring together services that interact with people who need care and support. The draft principles were created in a unique cross sector partnership with Think Local Act Personal, Skills for Health, Local Government Association, NHS Employers and the Association of Directors of Adult Social Services. Underpinning the six principles is the idea that workers who deliver different services need to work together so that people who need care and support can live as independently as possible and that there are different ways for workforce integration to be successful. As well as being designed for people working in social care, health and housing the principles aim to support other workers who interact with care and support including leisure, transport, police and retail. Skills for Care CEO Sharon Allen said: "We are really grateful to all the partners who brought their vast knowledge to the table to create these draft principles and now we want to hear what the sector thinks. The strength of these principles is they accept that local circumstances means there will be different approaches to service integration, but underpinning them is a clear understanding that people who need care and support want joined up services that work round their individual needs." Dr Sam Bennett, Director, Think Local Act Personal said: "These principles of workforce integration embrace the philosophy behind 'Making it Real', which encourages organisations to check progress based on what people carers and families say is

192 important to them. This will clearly help anyone working in social care, health and housing in any role develop the confidence, knowledge, capability, motivation and enthusiasm to deliver the very best care and support focused on the outcomes people want to achieve in their lives." Please send all feedback to Skills for Care's programme head of workforce innovation Jim Thomas at jim.Thomas@skillsforcare.org. uk The draft version of the Principles of Workforce Integration will be reviewed over the next four months and revised on the basis of your feedback. A revised version will be published in spring 2014. http://www.thinklocalactpersonal.org.uk/News/PersonalisationNewsItem/?cid=9883 Social Capital Is as Important as Financial Capital in Health Care - Alexandra Norrish, Nikola Biller-Andorno, PadhraigRyan , and Thomas H. Lee - Harvard Business Review For a discipline so fundamentally altruistic, health care is oddly dysfunctional around relationships. That’s changing fast, of course, as providers are finding that cooperation is as critical to caregiving as cutting edge tests and therapeutics. But effective cooperation, particularly in a setting as complex as health care, requires more than a resolve to play well together; it requires leadership to explicitly recognize the need to build social capital across the organization, and implement a strategy accomplish it. Yet building social capital — the trust and reciprocity among individuals and between groups — is rarely a specific focus of organizational leaders, though we believe it is as essential as financial resources for health care delivery systems. More than a decade of research on social capital in healthcare has found that higher levels are associated with improved coordination, increased job satisfaction and greater commitment among the staff, faster dissemination of evidence-based medicine — and better patients outcomes. As high performance on these measures is as important to organizational health as having a solid bottom line, leadership needs to invest in social capital and cultivate its growth with the same focus and discipline that it has applied to financial capital in the past. Our full article describing social capital, its roles in health care, and strategies for building it in health care organizations is available here (PDF) . The paper draws on the broad social capital literature and the toolkit for building social capital developed by Harvard’s Kennedy School of Government. The strategy at its core depends on nurturing five features of high-social-capital organizations: trust, reciprocity, shared values, shared norms, and openness. Among the tactics leaders can use to encourage these are communicating honestly (which should go without saying, but doesn’t always), building opportunities for interaction, establishing formal statements of responsibility and reciprocity, creating incentives for working together, establishing shared processes, engaging the staff in developing a statement of shared values, and using powerful stories about successes — and failures — in patient care to motivate staff and reaffirm organizational values. To give just one example of storytelling, consider how the Cleveland Clinic made its decision to ask every patient seeking an appointment whether they would like to be seen today. That policy did not come from the marketing department, even though it is prominently advertised today. It came from one patient who sought an appointment, was given one in two weeks, and ended up in the emergency department that night. The patient didn’t die, and wasn’t harmed in terms of any of the classical “outcome measures.” But the leadership of the Cleveland Clinic had enough of a sense of “we” that they could decide “we find this intolerable,” and they began asking every patient if they wanted to be seen that day. You can only make this kind of decision if you have social capital in the bank.

193 Ultimately, the key to success is authenticity. Though social-capital building can be nurtured, it can’t be mandated. As Don Cohen and Laurence Prusak, former director of the IBM Institute for Knowledge Management, wrote in their book In Good Company: How Social Capital Makes Organizations Work, “Social capital thrives on authenticity and withers in the presence of phoniness or manipulation…[Leaders’] interventions must be based on a careful understanding of the social realities of their organizations and (even more difficult) a willingness to let things develop, even if the direction they take is not precisely the one envisioned.” Our more detailed paper provides a framework organizations can use to begin building their social capital. http://static.hbr.org/hbrg-main/resources/pdfs/leading-health-care-innovation/Norrish-Biller-RyanLee%20Social%20Capital%20PDF.pdf http://www.hks.harvard.edu/saguaro/pdfs/skbuildingtoolkitversion1.2.pdf http://blogs.hbr.org/2013/11/social-capital-is-as-important-as-financial-capital-in-healthcare/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+% 28HBR.org%29&cm_ite=DailyAlert112113+%281%29&cm_lm=sp%3Arock.nisbet%40gmail.com&cm_ven=Spop-Email

Some Key Messages for Adult Safeguarding SCR’s - Bradford Safeguarding Children Board has defended its serious case review into the death of four-year-old Hamzah Khan The Bradford Safeguarding Children’s Board has defended its serious case review into the death of four-year-old Hamzah Khan in response to concerns raised by children’s minister Edward Timpson. The Minister had said that he had “deep concerns” about the quality of the review, which he said had “glaring absences”. In a letter of response to the Minister the BSCB’s Chair,Professor Nick Frost, said the review had been carried out in accordance with advice from the Social Care Institute for Excellence.

I wish to explain that the methodology utilised by the Independent Author in the writing of theHamzah Khan Serious Case Review [SCR]reflected thinking at the time it was commissionedin 2012. The Independent Author followed advice fromthe Social Care Institute of Excellence(SCIE) that moved away from a tick box, action-planning approach to one that leads to agreater understanding of why certain actionswere taken and what needs to be changed as aresult. He had been trained by SCIE in this approach: The methodology aims to addressissues and raise challenges in order to stimulate sustainable changes. Also questioned was the minister’s focus on the role of children’s social services.

Clearly, an additional aspect of any SCR is toassess if there were missed opportunities byany agencyin the period of a child’s life and tosee if the death could have been predicted orprevented. In Hamzah’s case, this focuses onthe period of 2005 to 2009. Your questions inthe main focus on the role of Children’s Social Care during this time: Children’s Social Carehad limited involvement in the family due to a lack of reporting of any serious concerns. Noinjuries or evidence of significant harm have ever been seen or reported in relation to any ofthe children

194 The assertion that the threshold for a child protection investigation had not been met:

The independently authored SCR cautioned against applying current knowledgeretrospectively and making judgements on responses that were taken with the knowledgeavailable to agencies at that time. A constant theme throughout the SCR is that the thresholdof concern was not reached within agencies to trigger a child protection investigation, underSection 47 of the Children Act, 1989. If expectations are changing and agencies are expectedto significantly lower this threshold, this willhave a great impact on resources nationally The board’s response to the Minister also included more information in response to the 10 questions raised by the Minister in his original letter to the board. This brought a ‘caveat’ or ‘warning’ from the board’s chair in providing such:

Onereason for what you perceived asa lack of detail in the SCR was a requirement to follow thecourt’s instructions about protecting the children’s anonymity. Themore detail that is providedin the answers the greater is the danger of the children being identified. It may be that furtherconsideration is required as to the exact form in which the answers are made public.

NOTE: The EMASB is continuing it’s programme on supporting locality adult safeguarding boards in the East Midlands in the commissioning of an SCR or SILP & of knowing ‘what good looks like’ in a SCR. Spending watchdog slams Charity Commission over regulatory work – Local Government Lawyer. The National Audit Office has published a damning report on the Charity Commission’s effectiveness as a regulator. It also said the Commission’s independent status and expertise were highly valued. However, the spending watchdog said: There was a gap between what the public expected of the Commission and what it actually did; It had found some cases where the Commission was slow to recognise the gravity of the case, gave trustees regulatory advice in serious cases rather than opening a statutory inquiry, and allowed a lack of cooperation by trustees to delay statutory inquiries and operations cases for periods of more than a year. The spending watchdog recommended, amongst other things, that the Charity Commission should: think radically about alternative ways of meeting its objectives with constrained resources; make greater use of its statutory powers in line with its objective of maintaining confidence in the sector; and develop an approach to identify and deal with those few trustees who deliberately abuse charitable status. Amyas Morse, head of the National Audit Office, said: “The Charity Commission has responsibility for protecting the good name of the charity sector as a whole, as well as other specific duties. "We welcome the early plans for a reset of its approach and strategy being proposed by its new Board, and encourage them not to fall short of the radical change of pace and rigour which is evidently needed.” A copy of the NAO report can be viewed here . In its response to the report, the

195 Charity Commission said it accepted the NAO’s recommendations. “We recognise our approach to tackling problems in charities has been too cautious at times, especially where there is a suspicion of deliberate abuse,” it admitted. “We also recognise the need to use and analyse our own data more effectively.” The Commission did, though, claim that the spending watchdog did not review many areas of its core responsibilities, such as holding charities to account through the public register of charities, publishing guidance on the legal and accounting framework, and working to improve standards of governance in charities. “The Commission considers this essential work, critical to preventing abuse and to driving public trust and confidence, and required by our statutory objectives,” it said. “We do not therefore believe the NAO's conclusions on the effectiveness of our regulation and value for money as a whole are justified by the evidence.” The Commission insisted that it was committed to an urgent programme of reform. It said it had also taken steps to improve its approach to serious cases of abuse, including by investigating and using legal powers against charities that have repeatedly defaulted on their reporting requirements. The Commission also said it had stepped up its serious casework, with 26 statutory inquiries opened during the six months from April 2013. This compares to 15 such inquiries for 2012/13. Sam Younger, the Commission’s chief executive, said: "I recognise what the NAO report says about the need for improvement in registrations and our compliance and investigations work, and we have already made progress in implementing their recommendations. I agree that we must sharpen our approach to handling the most serious cases that involve deliberate abuse or mismanagement of a charity…. “The Charity Commission has complex tasks - as registrar, enabler and tackler of abuse in a large, diverse and almost entirely voluntary sector.

DOWNLOAD THE REPORT: Executive Summary: http://www.thirdsector.co.uk/Governance/article/1223652/national-audit-office-criticismsunjustified-says-charity-commission/ Full Report: http://www.nao.org.uk/wp-content/uploads/2013/11/10297-001-Charity-Commission-Book.pdf

National Audit Office criticisms are unjustified, says regulator | Third Sector The National Audit Office ’s conclusions that the Charity Commission is not an effective regulator and does not provide value for money are unjustified, the regulator has said. The spending watchdog’s report on the commission, published today, says the regulator makes little use of its statutory enforcement powers, can be slow to act when investigating regulatory concerns and does not take tough enough action in some of the most serious cases. But a statement from the commission, released today, said that although the regulator accepted many of the recommendations and had already begun work on addressing some of its shortfalls, it rejected the conclusion that it did not offer value for money. The commission said that the NAO did not review many areas of the commission’s core responsibilities, such as holding charities to account through its register or the guidance it provides, which the regulator said was essential for preventing abuse and improving public trust and confidence in charities. "We do not therefore believe the NAO’s conclusions on the effectiveness of our regulation and value for money as a whole are justified by the evidence," the statement said.

196 The commission said it had already stepped up its serious case work and had opened 26 statutory inquiries in the first six months of 2013/14, compared with 15 in the 12 months to the end of March this year. The regulator said it had also agreed a new memorandum of understanding with HM Revenue & Customs that updated its existing information exchange protocols and "makes a renewed commitment to ensuring necessary safeguards are in place that allow effective investigation and the exchange of information". Sam Younger, chief executive of the Charity Commission, said he agreed that the commission should improve its approach to handling the most serious cases involving deliberate abuse or mismanagement of a charity and make better use of its own data to carry out more proactive work. "The Charity Commission has complex tasks – as registrar, enabler and tackler of abuse in a large, diverse and almost entirely voluntary sector," he said. "The challenge before us is to identify which areas of activity should be reduced further to free up the extra resources to meet the NAO’s recommendations on registrations and investigations." Younger said he would also welcome a wider debate about the implications of the report for the commission’s priorities and approach. http://www.thirdsector.co.uk/Governance/article/1223652/national-audit-office-criticismsunjustified-says-charity-commission/ Take outpatient clinics out of the system | Resource centre | Health Service Journal Mental health outpatient clinics are an inadequate model of care, say Laura Dunkley and colleagues, who explain how services can be brought into the 21st century People waiting to be seen in outpatient clinics are usually looking forward to specialist insight into their problem as they pursue the road to recovery. However, mental health outpatient clinics are an out-dated model of care delivery, existing in a twilight zone between inpatient admission and community based models of care. To understand this, it is worth knowing a little bit about the origin of the current model of mental health care. When the asylums were being closed in the 1980s, mental health services were relocated to district general hospitals. As a result, these services initially adopted a model more similar to other hospital disciplines − inpatient wards and outpatient clinics. More recently, outpatient services have been somewhat “usurped”, owing to plethora of community based mental health services. These range from the formation of community mental health teams to other models of community based mental health care, including primary care liaison and the Care Programme Approach. ‘Mental health services are currently commissioned in a way that does not require detailed data on outpatient clinic activity’ Currently, mental health services are commissioned in a way that does not require detailed data on outpatient clinic activity. Unlike the payment by results system in the acute sector, NHS commissioners contract mental health trusts through a block contract; this takes no account of the number or length of inpatient admissions, nor the frequency at which patients are seen. This is also true of the diagnoses and interventions given. As a result, there is little robust activity data within mental health, since there has never been a need to collect it. Beacon UK recently studied an English mental health trust that had asked for help in understanding what was happening in its outpatient clinics. These were being operated at more 70 sites, with little

197 insight into which patients were being seen and why. The trust was also concerned about its “did not attend” rate (more than 30 per cent, though this is not uncommon for psychiatric outpatient clinics).

Patient survey Between December 2009 and December 2012, we worked with trainee psychiatrists to review the notes of 400 adults who attended outpatient clinics with mental health problems. Using a custom built online survey tool, we captured data on patient demographics, diagnosis, appointment purpose, mental state risk assessment, employment status, rate of non-attendance, inpatient admissions, Mental Health Act assessments and more. Analysis of 1,302 separate appointments over the three years surveyed showed: 1. Routine follow-up appointments accounted for nearly nine out of every 10 outpatient appointments, with a seven-fold difference between lowest and highest new-to-follow-up ratios when analysing by individual consultant, and a sixteen-fold difference in the overall number of appointments seen. 2. People with mood disorders had the highest rate of outpatient appointments per person (6.4 over three years). 3. The patient was seen by a consultant psychiatrist in 62 per cent of appointments. 4. In the opinion of the reviewing doctors, only half of all appointments were conducted by the most appropriate healthcare professional. 5. Half of all surveyed outpatient attendees had at least one chronic physical health problem. This is likely to be an underestimate as our review was based only on what was documented in the patient notes. Next steps As a result of the survey, here are a number of recommendations, several of which are relevant to other mental health trusts: 1. Invite the clinical body to innovate new practices for following up on patients with mood disorders and neurotic, stress related and somatoform disorders to potentially reduce the outpatient use rate for these specific diagnostic groups. Through segmenting the diverse range of mental health conditions seen in outpatients’ clinics, this enables clinical expertise to be developed to improve overall outcomes and drive value. 2. Introduce “single point of access” triage, using protocols developed by clinicians, to ensure that consultant psychiatrists only see patients when their input is medically indicated. Input from the most senior clinicians should be reserved for the most complex cases, rather than for routine follow-up appointments. 3. Investigate whether alternative care pathways exist for patients who are both being seen frequently in outpatient settings and still being admitted. Ensuring this small group of “high users” of inpatient services are engaged with community care coordination is critical.

“There was almost universal dissatisfaction with outpatient clinics. The doctor is isolated from the team and patients frequently do not attend. Patients may present very differently in the artificial

198 environment leading to differences with staff who see the patient at home. Patients are brought back routinely so as not to lose touch with them rather than out of necessity.” 4. The fourth recommendation is supported by efforts around the country to develop new contracting and care delivery models, based on outcomes, which aim to improve care for people with long term physical and mental health comorbidities. Such individuals have worse outcomes and cost the system more than twice as much as those with long term physical conditions alone. By continuing to work with the mental health trust to implement the full set of recommendations and by aiming to deliver improved outcomes for the trust’s patients by looking at new models of care delivery, we hope to dramatically reduce the need for outpatient clinics.

Laura Dunkley is analyst, David Cox is head of strategy and Emma Stanton is CEO at Beacon UK http://www.hsj.co.uk/5065240.article?WT.tsrc=Email&WT.mc_id=EditEmailStory&referrer=e23#.Uo 4zamTfxKU Taking the pulse of health and wellbeing boards | Opinion | Health Service Journal One aspect of the Health and Social Care Act that has proved remarkably uncontroversial is the creation of health and wellbeing boards to drive closer working and integration between the NHS, social care and public health. ‘In some places the profound differences in culture and ways of working between the NHS and local government have yet to be mutually understood’ The results of the King’s Fund’s national survey of health and wellbeing boards offer grounds for cautious optimism, but they face a steep learning curve if they are to demonstrate a real impact on the tough challenges facing their local health and care system. ‘Unless NHS England is a more active partner in its commissioning role, it will be hard for the boards to lead the development of integrated care locally’ Our survey respondents − usually local authority board leads − reported that relationships between the authority and local CCGs are very good, with over two thirds saying this has improved over the last year. This is reinforced by an emerging pattern of senior elected members chairing the board and the vice chair coming from the CCG. Surprisingly, given this is their raison d’etre, very few mentioned integrated care. And while most respondents thought their boards would have a real influence on the commissioning plans of their local partners, most had no confidence in their ability to influence the commissioning decisions of NHS England in relation to local primary care services. Nearly two thirds said they wanted a greater role in commissioning services in order to do this. ‘NHS engagement in the boards will be rekindled by money − notably the £3.8bn integration transformation fund’ But this would have major implications for their composition, size and the professional support they would need. NHS engagement in the boards will be rekindled by money − notably the £3.8bn integration transformation fund and the local plans for its use that must be signed off by the boards by April next year. Boards will need to work hard with their NHS partners to agree how the tough conditions attached to the fund can be met in ways that alleviate local pressures on acute hospitals, as well as social

199 care. This is a big ask but a great opportunity for boards to demonstrate they can rise to the challenge of playing a bigger role in the planning and commissioning of all local services.

Richard Humphries is assistant director of policy at the King’s Fund http://www.hsj.co.uk/5065610.article?WT.tsrc=Email&WT.mc_id=EditEmailStory#.UpOdUmRdWpw The Chancellor’s Autumn Statement 2013 – by practice area - Local Government Lawyer _____________________________________________________________________ General Resource DEL budgets will be reduced by 1.1% in 2014-15 and 2015-2016 to generate savings of £1.1bn in 2014-15 and £1bn in 2015-2016. Health, schools and Official Development Assistance budgets will continue to be protected. Local government is excluded from the reduction “to help local authorities freeze council tax in 2014-15 and 2015-16". The Government will support local areas “that want to deliver services differently if they can show it will save money”, including by: allowing local authorities some flexibility to spend their receipts from new asset sales on the one-off costs of service reforms, following a recent consultation (Total spending of £200m will be permitted across 2015-16 and 2016-17 and local authorities will be able to bid for a share of this flexibility); welcoming service reform proposals made by local enterprise partnerships as part of the Growth Deals process; making sure pooled funding is an enduring part of the framework for the health and social care system beyond 2015-16; working with departments to give local public services the same long-term indicative budgets as departments from the next Spending Review. Housing and Property • •

•

• • • • •

A £1bn, six-year investment programme will be created to fund infrastructure “to unlock new large housing sites, supporting the delivery of around 250,000 homes”. A £2bn Local Growth Fund will be maintained. Local authority Housing Revenue Account (HRA) borrowing limits will be increased by £150m in 2015-16 and £150m in 2016-17, allocated on a competitive basis and agreed by LEPs. The government will also make £110m of Regional Growth Fund available for the Local Growth Fund. A further £50m of funding will be made available to LEPs through the Large Sites scheme. £70 million of the New Homes Bonus will be pooled within the London Local Enterprise Partnership chaired by the Mayor of London. The New Homes Bonus will not be pooled to LEPs outside of London. The Government will introduce Right to Buy agents to help buyers complete their home purchase, and provide £100m to increase Right to Buy sales by improving applicants’ access to mortgage finance. Options are to be explored “for effectively kick-starting the regeneration of some of the UK’s worst housing estates through repayable loans”. A Right to Move for working households in social housing will be introduced. A consultation will be held during the spring of 2014. The availability of the Private Rented Sector Guarantee Scheme will be extended until December 2016. A review into the role local authorities play in supporting overall housing supply will be launched. Local authorities will be able to access cheaper borrowing at the Public Works Loan Board (PWLB) project rate over the period 2014-15 and 2015-16. The government will allocate

200

•

• • • •

• •

nearly £800m on a competitive basis alongside the Local Growth Fund. “This will enable LEPs in partnership with local authorities to submit bids to borrow at the PWLB project rate as part of Growth Deals”. The government will also extend access to the PWLB project rate of up to £400m for local authorities in Scotland and Wales. “This will allow local authorities to invest in priority projects subject to agreement with the devolved administrations on the precise mechanics and conditions.” The government is “committed to delivering an ambitious City Deal for Glasgow” by working with the Scottish Government and local delivery partners to identify a package that boosts Glasgow’s economy. The Government said it was also committed to delivering with Greater Cambridge their proposals on 'Gain Share' – a payment by results mechanism whereby the local area will be able to keep a larger proportion of the proceeds of economic growth generated in, and around, the city of Cambridge. This is intended to recognise the growth potential that exists in Greater Cambridge and will drive economic growth and accelerate transport and housing infrastructure by unlocking over £1bn of investment. Details on how this proposal will work will be announced alongside Budget 2014. An additional £90m of funding will be provided for public sector energy efficiency projects. A national council tax discount of 50% for property annexes will be implemented from April 2014. The government will make a range of changes to the Energy Companies Obligation. The funding available for discretionary housing payments will be increased by £40m in both 2014-15 and 2015-16. “This will ensure the pot of DHPs available to support those affected by under-occupancy deductions will not be reduced for the next two years, giving councils discretion to make longer term awards.” Businesses will be allowed to pay business rates over 12 months rather than 10 months,, with effect from 1 April 2014. A consultation will be held on reforms to the business rates appeals process. The Government has also committed to clearing 95% of the September 2013 backlog of appeals before July 2015.

Procurement and Contracts. •

• •

A new tax relief for equity and certain debt investments in social enterprises will be introduced with effect from April 2014. Organisations which are charities, community interest companies or community benefit societies will be eligible. Following consultation, investment in social impact bonds issued by companies limited by shares will also be eligible. A roadmap for social investment will be published in January 2014.

Children’s and adult social services •

•

• •

•

A programme will be launched to increase the level of innovation in children’s services to help local authorities improve outcomes and increase value for money. Details will be announced ahead of Budget 2014. The Department for Education and the Department for Communities and Local Government will work with local government to enable local authorities to benchmark and compare their costs and outcomes in children’s services. Funding will be provided to support universal free school meals for children in reception, year 1 and year 2 and disadvantaged students in sixth form colleges from September 2014. Controls on the number of students who can attend higher education institutions will be removed in 2015-16. In 2014-15, an additional 30,000 student places will be created at publicly funded institutions. See also above the announcements in relation to social impact bonds and tax relief, and pooled funding for health and social care beyond 2015-16.

201 •

Following consultation, new measures will be introduced to reduce the illicit trade in alcohol products. These will include a registration scheme for alcohol wholesalers that will start to take effect in 2016. There will also be a requirement from early 2014 for alcohol traders to take reasonable steps to ensure that their suppliers and customers are legitimate. http://www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id= 16553%3Athe-autumn-statement-2013-by-practice-area&catid=59&Itemid=27

The Condition of Britain: Interim report - Publication - IPPR The Condition of Britain programme is considering how politics, institutions and policies need to change to respond to the major currents in British society after the crash. In this report we set out the findings from the first stage of our work. 'Britain is a deeply impressive country, with a rich history, successful institutions and compassionate, resourceful people. Yet British society is facing a set of new challenges that were not on the political agenda a decade ago. Growth is uncertain, and more cuts in public spending are to come regardless of who is in power after 2015. Many people have not had a decent pay rise in the last 10 years, while the price of essentials continues to grow faster than wages. Family time is increasingly squeezed between work and caring for young children or elderly relatives. Young people in Britain face an uncertain future, while older people struggle to stay connected to those around them.' Introduction – Graeme Cooke, Kayte Lawton and Nick Pearce The central question that the Condition of Britain programme aims to address is: How can we come together to build a better society in these uncertain and austere times? In this interim report, we seek to identify the central strains and social problems in people’s lives, and examine how the politics and policies of both left and right have often failed to get to grips with the real challenges facing British society. A second report, to be published in early summer 2014, will outline an agenda for reform to build a better society. Bringing together the five earlier Condition of Britain briefing papers, the interim report looks at: • • • • •

Childhood and raising a family Growing up as a young modern Briton Homes and neighbourhoods Finding a decent job and achieving financial security Older people and the challenges of staying connected

As with all of our Condition of Britain work, the new report is informed by the stories we've heard from people across the country. During our visits to key services and innovative community schemes and via our 'story-telling' blog, Voices of Britain , people have been telling us about the pressures they face and about the people – family, friends, community groups and services – who help them through. The insights we have gained from these conversations and stories are supported by a range of empirical evidence, including academic research, robust opinion-polling, and new analysis of national household surveys. We have found a wealth of energy, creativity and resilience in families and neighbourhoods across Britain. Many people are committed to helping themselves and others, and to working together to build a better society. However, although the people we met during our research did not tell us that British society is ‘broken’, it is clear that parts of society are under enormous strain. We have identified a set of

202 pressures on Britain’s social fabric that are making it harder for people to keep striving to improve their lives and those of the people around them. The vast majority are problems that affect most of us at one time or another, not just a minority of people. The key findings can be summarised as follows: •

Household finances are squeezed

•

Family life is under growing strain

•

Young people’s prospects are increasingly uncertain

•

Some neighbourhoods remain blighted by crime

•

A minority of people remain excluded from society

•

Many people have lost faith in the benefit system

•

More and more older people are facing loneliness and isolation.

DOWNLOAD THE REPORT: http://www.ippr.org/images/media/files/publication/2013/12/Condition-ofBritain_interim_Dec2013_11645.pdf The focus on patient satisfaction is enough to make you sick – KevinMD - USA We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. The reasons for a patient being dissatisfied with a particular healthcare encounter can be very complex. It’s not so simple as to just include a line in a survey such as, “Were you satisfied with your doctor?” The question we really need to be asking is: Why is the obsession with patient satisfaction in the ED so soul-crushing to those that work there? 1. The patient gives a “1 star out of 5″ review after discharge, but writes in the comments, “Doctor and nurse were great, though!” He gets a patient satisfaction survey and throws it aside. You can save a life, walk out of the trauma bay drained but proud, and be pulled aside and told that on last months survey, you didn’t get a patient a coffee “like they do at the car dealership.” Sometimes a patient voices frustration in a survey despite your best efforts to be nice, helpful, professional and clinically astute. This may be due to factors out of your control regarding ER wait times, a large hospital bill, dirt on the waiting room floor, or a rude staffer that wasn’t you. I think it was said best by commenter Doctor Amy , a hospitalist, in the comments section after a previous post I wrote on the subject, Hospitalists feel much the same way as you do … The patients are essentially asked if the doctor ‘always’ did everything perfectly — the vagueness of the question should automatically invalidate

203 the response … the hospitalist may well have spent a great deal of time doing just that — making sure all the home meds are correct, arranging rehab, taking care of the fall at 3am, controlling pain meds, actually addressing code status etc. While only being only one person and only one component of any given patient’s perception of their hospital encounter, Doctor Amy has obviously felt the weight of being held responsible for the dozens, if not hundreds of intangible factors that make up a patient’s overall satisfaction, or lack thereof. Bad for patients This is definitely the biggest and least acceptable reason, and the one that bothers me the most. This is the one that leaves us no excuse for looking the other way: our patients. Then you find out, that according to the Journal of the American Medical Association, the patient “satisfaction” obsession you’re coerced to participate in not only increases health care costs, but is associated with higher death rates with the purpose of increasing corporate profits, not for yourself as an emergency physician, but for “the men in suits.” There is unwelcome pressure to treat viruses with antibiotics to keep patients happy, irradiate the brains of children with unnecessary CT scans to satisfy anxious parents and prescribe medications to people seeking to fuel dangerous addictions. If you think this is just opinion without evidence, read: “Conclusion: In a nationally representative sample, higher patient satisfaction was associated with … increased mortality.” It forces doctors to consciously and regularly make this decision, “Should I do what I think is best for my patient and possibly lose my job, or violate my oath and practice bad medicine to boost survey scores, to avoid being fired?” Patient satisfaction-obsessed medicine has been linked to higher mortality rates, and as currently modelled, should be banned. The one’s who are being harmed, and who could change it are the patients, but they don’t seem to know they are being harmed. After all, the system is designed to keep them “satisfied” first, and healthy, second. But often, what makes a patient most “satisfied” isn’t what is best for their health. The loss of a “customer” isn’t tolerated, for any reason. “Sick, but satisfied” comes back to the ED. “Sick, but satisfied” is good for business. “Healthy and dissatisfied” takes their business elsewhere, and is a lost customer. Again, we all want our patients leaving our care happy, healthy and satisfied, if at all possible. But there is a tremendous sense of a lack of control among those held responsible for these patient satisfaction survey results. As doctors, we place much greater value on our own sense of control, basic fairness, and helping our patients over making our bosses wealthier. This can make some feel very demoralized, and even cause some to leave the specialty of emergency medicine or medicine in general. Unfortunately, so far, the system which is linked to higher patient death rates has been perpetuated due to the great power imbalance between hospital-based physicians and their much more powerful corporate employers.

“BirdStrike” is an emergency physician who blogs at: Dr. Whitecoat. http://www.kevinmd.com/blog/2013/11/focus-patient-satisfaction-sick.html

204 The Ombudsmen and DOLS- South Yorkshire family excluded from care planning for elderly relatives - Local Government Ombudsman A dementia sufferer had to stay in respite care, despite his son arranging a private care package that could have allowed him to stay at home, a joint investigation by the Local Government Ombudsman (LGO) and the Parliamentary and Health Service Ombudsman (PHSO) has found. The man had been living in respite care while his wife, who also suffered with dementia, was being treated in hospital. His son organised a care package to allow him to come home. But two local authorities – Kirklees Metropolitan Borough Council and the South West Yorkshire Partnership NHS Foundation Trust – applied for a Deprivation of Liberty Order, forcing the man to stay in care, apart from his wife, without informing his son of their plans. Before the stay in respite care, the man was admitted to hospital with acute glaucoma in April 2009. The couple’s son - himself a doctor - told the authorities that he believed the injury had been caused by a blow from his mother, who was beginning to show signs of dementia. This report was not followed up, and a safeguarding plan was never implemented. Instead the father’s discharge from hospital was hastily arranged and he returned home without any protection. Then over time, the couple’s needs increased. The woman’s symptoms were deteriorating and in September she was admitted to hospital, and her husband went into respite care. The woman stayed in hospital for six weeks while her son arranged a care package. Despite the son telling the authorities that he was employing a registered general nurse to provide care when his father came home, the two authorities agreed that that this would be inadequate and applied for the Deprivation of Liberty Order – without involving him in the decision. In addition to this, when the Trust wrote to the son recommending that his parents be placed in separate care homes, they sent a copy to his mother – causing her a great deal of distress. The investigation also found that the Trust failed to reassess the father’s prescription for dementia drug, Aricept in line with NICE guidance. “As a result of actions by both the council and the Trust, the couple were denied the chance of living at home together in a settled lifestyle for longer than they did. The couple suffered a needless loss of dignity, while their son felt ignored, undermined and excluded from any decision about their care. “I am pleased that both the council and the Trust have agreed to our recommendations and hope they go some way to remedy the poor treatment and upset the family has endured.” “Involving their son could have led to better outcomes for the couple. Families and carers can have the key to understanding the needs of their loved ones. That’s why public services must, in law, involve families and carers in making life changing decisions for vulnerable people.” Both the council and the Trust have agreed to apologise to the man and his parents. They have also agreed to review the way they involve relatives in assessing and planning care for family members with dementia and review their joint arrangements for responding to complaints. The Trust has also agreed to review the way it reassesses prescriptions for Aricept in line with guidance.

205 Both the council and Trust have agreed to make a payment of £1,000 to the couple to acknowledge their distress. The Trust will also give the woman an additional payment of £250 in recognition of the distress caused from reading the report about her future care. The authorities have also agreed to make a payment of £500 to the son to acknowledge his distress. DOWNLOAD OMBUDSMANS REPORT: http://www.lgo.org.uk/GetAsset.aspx?id=fAAxADkAMAA2AHwAfABUAHIAdQBlAHwAfAAwAHwA0 DOWNLOAD THE REPORT: http://socialwelfare.bl.uk/subject-areas/services-clientgroups/minoritygroups/editionsblair/155801BLAIR_ShapingBlackLondon.pdf Three male 'slaves' rescued from Traveller sites | News | Inside Housing Three men have been rescued from Traveller sites in Bristol, after police raids in a new case of alleged slavery. Officers carried out a series of raids yesterday as part of an investigation into forced labour and human trafficking. The three alleged victims have been taken to a place of safety, after Avon and Somerset Police raided three traveller sites, a residential property and a business unit. Police arrested two people on suspicion of slavery offences. Julian Moss, chief superintendent and head of CID, said: ‘This is an ongoing and dynamic inquiry; our primary aim is to safeguard and protect vulnerable victims. ‘We know from talking with other police forces and charities… that victims in such cases are often forced to live and work in poor and unsanitary conditions, sometimes with little or no pay.’ The police joined South Gloucestershire Council, the NHS, the National Crime Agency and specialist charities, including anti-trafficking organisation Unseen, the Red Cross and The Salvation Army in planning the operation. Five other people were arrested for a variety of offences, including failing to appear, cannabis production, money laundering and handling stolen goods. A ‘significant quantity’ of cash and cannabis plants were also seized in the raids. Six of the seven people arrested have since been bailed. In May, a father and son were jailed for a total of 13 years after recruiting homeless men to work as slaves at a Traveller site near Leighton Buzzard in Bedfordshire. "Julian Moss, chief superintendent and head of CID, said: ‘This is an ongoing and dynamic inquiry; our primary aim is to safeguard and protect vulnerable victims. ‘We know from talking with other police forces and charities… that victims in such cases are often forced to live and work in poor and unsanitary conditions...".... How come no one is rescuing us social tenant then?... Surely we should not live in those conditions either?

206 http://www.insidehousing.co.uk/legal/three-male-slaves-rescued-from-travellersites/6529878.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3432435_ Copy+of+New+Legal+Template&dm_i=1HH2,21KHF,82EKTS,7D17K,1 To what degree is the governance of Dutch hosp... [Health Policy. 2013] - PubMed NCBI Changing health care systems and market competition requires hospital boards to shift their focus towards a systematic governance of the quality of care. The objective of our study was to describe hospital governance and the quality orientation in the Netherlands. Also we wished to investigate the relationship with hospital performance. The chairs of both the boards of trustees and the management boards from all 97 Dutch hospitals were asked to participate in a cross-sectional study between November 2010 and February 2011. In this period data on their quality orientation were collected using a web-based survey. Data on hospital performance over the year 2010 were obtained in July 2011. A mixture of reforms and national guidelines increased the emphasis on quality governance in Dutch hospitals. Our results show that boards of trustees and management boards had a reasonable quality orientation. Boards were familiar with quality guidelines, received a reasonable amount of information related to quality and used this for monitoring quality and policy-making. However, we found no association between their quality orientation and hospital performance. There was a growing awareness of the quality of care among boards of trustees and management boards; yet some boards still lagged behind. Quality orientation is an important asset because receiving, reviewing and responding to the quality of their performance should provide opportunities to improve quality. However, we were not able to find a relationship between quality orientation and hospital performance. Future research should investigate how boards can develop quality management systems which in turn could enable medical professionals to optimise their delivery of care and thus its quality. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved. http://www.ncbi.nlm.nih.gov/pubmed/23953878 Town halls 'failing to protect vulnerable' from higher council tax | News | Inside Housing It is ‘not clear’ if the cut to council tax credit will meet the government’s objectives to protect vulnerable people from tax increases, the National Audit Office has said. In a report published on Friday, the government’s spending watchdog said nearly half of English local authorities were failing to protect working-age vulnerable people from the government’s reduction of council tax benefit. In April, ministers saved £414 million by scrapping council tax benefit and replacing it with a local grant, set at £3.7 billion – a 10 per cent reduction in central government funding. Town halls are left to decide who qualifies for the localised council tax support but are not allowed to cut support for certain groups such as pensioners and war pensioners. Despite the government’s stated objective to protect vulnerable people from the cut, the NAO’s report said 133 local authorities (41 per cent) had introduced minimum payments of council tax with no protections for vulnerable groups, other than protections for pensioners and war pensioners.

207 ‘It is not clear if all of the longer term objectives outlined by the department before localisation will be met, particularly the protection of vulnerable groups from increases in council tax,’ the report said. The report found most local authorities were using their new powers to offset the cut in funding by charging additional council tax on properties such as second homes and short-term empty buildings, raising an additional £178 million. It added that local authorities’ scope for raising income on these properties varied between areas, with London councils able to cover 73 per cent of the funding reductions through these powers, compared to district councils, which could cover 142 per cent. The report also warned that another key objective – for councils to increase work incentives for claimants – was being neglected by some local authorities, which had introduced schemes that had reduced incentives to work. ‘The [Communities and Local Government] department considers scheme design to be a local decision and accepts that this could mean that not all local authorities’ schemes will deliver against the full range of the reform’s objectives,’ the report said. ‘In the light of this, the department is not in a position to ensure that it will achieve value for money in the longer term.’

DOWNLOAD THE REPORT: http://www.nao.org.uk/wp-content/uploads/2013/12/10316-001-Council-Tax-Book.pdf TRACEing the roots: a diagnostic "Tool fo... [Patient EducCouns. 2013] - PubMed - NCBI The lack of interdisciplinary clarity in the conceptualization of medical errors discourages effective incident analysis, particularly in the event of harmless outcomes. This manuscript integrates communication competence theory, the criterion of reasonability, and a typology of human error into a theoretically grounded Tool for Retrospective Analysis of Critical Events (TRACE) to overcome this limitation. A conceptual matrix synthesizing foundational elements pertinent to critical incident analysis from the medical, legal, bioethical and communication literature was developed. Vetting of the TRACE through focus groups and interviews was conducted to assure utility. The interviews revealed that TRACE may be useful in clinical settings, contributing uniquely to the current literature by framing critical incidents in regard to theory and the primary clinical contexts within which errors may occur. TRACE facilitates a comprehensive, theoretically grounded analysis of clinical performance, and identifies the intrapersonal and interpersonal factors that contribute to critical events. The TRACE may be used as (1) the means for a comprehensive, detailed analysis of human performance across five clinical practice contexts, (2) an objective "fact-check" after a critical event, (3) a heuristic tool to prevent critical incidents, and (4) a data-keeping system for quality improvement. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved. http://www.ncbi.nlm.nih.gov/pubmed/23891421

208 Transforming the Patient Experience: Insights from Patient/Family Advisors – IHI – Abridged Article. The Partnership for Patients’ Patient and Family Engagement Contractor, Weber Shandwick, allocated resources for patient or family leaders/advocates to attend the IHI Person- and FamilyCentered Care: Transforming the Patient Experience seminar in Chicago, Illinois, on October 15–16, 2013. The following excerpts were written by patient or family leaders/advocates who shared their insights from the seminar. The crucial role of leadership in transforming the patient experience was a central theme noted by a number of patient family advisors who attended the seminar. • Jesse Bernstein, an experience advisor at St. Joseph Mercy Health System in Ann Arbor, Michigan, felt that the efforts at St. Joseph compared favorably with other successful patient- and familycentered care initiatives. Joseph CEO and other top executives attend patient and family advisor council meetings and make sure that advisors are asked to present their stories at resident orientation, new staff orientation, first year seminars, and leadership and department retreats and planning sessions. • According to Doris Grant, volunteer patient advocate at Maury Regional Medical Center in Columbia, Tennessee, “Senior leadership support is essential and the patient-centered care model must be incorporated into the organization’s strategic plan to ensure success.” • Steven Duty, patient advocate at Logan Regional Medical Center in Logan, West Virginia noted that to deliver the highest level of safe, reliable care “engaging leadership is crucial” because it “defines the vision.” Many of the patient family advisors wrote about the culture change needed to truly transform the patient experience. • Lisa Freeman, a board member from the Connecticut Center for Patient Safety and patient advisor from Patient Advocacy of Connecticut, stated that “change is not about isolated practices, it is about culture change that comes from the top. It is accomplished, he wrote, “through having a clear, action-oriented and pervasive practice or set of behaviors that provides a foundation for partnering with patients and families, actions that will assure optimal patient experiences and an ongoing commitment to patient- and family-centered care.” • Sarah Harris Barry, patient advocate at Maury Regional Medical Center in Columbia, Tennessee, wrote, “The days of random acts of kindness are over. Attendees noted optimism regarding the potential for partnerships between health care providers and patients and families to improve health care. • Gail Panoff, patient advisor and chair of the patient and community engagement council at St. Joseph Mercy Health System in Ann Arbor, Michigan, found it heartening that “the medical community is truly embracing [patients] as true partners in transforming patient-centered care.” • Chrissie Blackburn of Rainbow Babies & Children’s Hospital, noted, “I realize the more I get involved in the work of patient and family engagement that it is not just about patients and families, but also how we can engage medical and frontline staff in the enhancements and changes that are occurring in the culture of health care.”

209 • According to Steven Duty of Logan Regional Medical Center, “Clear, action-centered, and persistent practices or behaviors provide a foundation for partnering with patients and their families” and pointed to Always Events as a helpful strategy for creating these. • Bob Hallman, a patient and family advisory council member at Southern Hills Hospital & Medical Center, in Las Vegas, Nevada, noted that to help ensure “a successful outcome of any procedure, there must be total collaboration between doctor, hospital leadership/staff, patient and family.” The experience, she noted, left her with “an intensified desire to transform health care in ways that will allow patients and family members to be meaningful partners in their care.” • As a result of the seminar, Teresa Younkin, a patient advocate from Danville, Pennsylvania, wants care providers to conduct bedside huddles “to allow patients and family members the opportunity to be involved in the conversation,” especially with regard to information that should be included in the electronic health record. http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a474ccd-4e9e-89d914d88ec59e8d&ID=37&utm_campaign=tw&utm_source=hs_email&utm_medium=email&utm_conte nt=11298507&_hsenc=p2ANqtz--z9uq_8snU7YolgtMT11W48r9EUy2kS24nC3ZVZ4pgCGO-mbjkbE49DAc6xs-dvc_QGIdt7zypl128aY64atF-niuUw&_hsmi=11298507#.UpzuSLloZHI.email #Trolls & #trolling - online abuse - Lexology Social media remains an engaging way to be entertained and educated and has many positives. We are increasingly living our lives online and, for some, it is all about forging real life friendships, building business contacts and sharing information (or pictures of their cats). But as with any community - whether online or in real life - there is a dark side. This article has its genesis in a Soho Skeptics event 'They see me trolling: What can we do about online abuse' where Helen Lewis took a semi-serious look at the 'trolling' phenomenon. She wasn't to know that the summer months would see an explosion of online abuse, involving TV academics, politicians, journalists, campaigners and troubled teenagers. Given the nature of social media, everyone has had an opinion and the amount of material generated around this largely appalling abuse is staggering. What is a 'troll'? 'Troll' is a contentious term because it is a media, and increasingly academic, construct. There are nearly as many types of troll as there are people interacting on the internet. These individuals have different motivations, online experiences and, most of the time, they don't know when to stop typing and walk away. Wikipedia has a usefully wide definition; 'a troll is a person who sows discord on the Internet by starting arguments or upsetting people, by posting inflammatory, extraneous, or off-topic messages in an online community'. Or as Helen said, a troll is 'the lesser known of two people in a twitter argument'. Helen outlined types of troll according to academic research, namely, 'abuse', 'sub cultural', 'grief' and 'professional' trolls. But any potentially controversial subject - politics, religion, sport, celebrities, academia - will attract trolls. 'Abuse trolls' are ones we have seen most of recently. Already these categories are problematic because there are many types of 'abuse - or harassing - troll'. Cases of 'low level' harassment have warranted proportional punishments such as formal warnings and restorative justice and/or apologies to victims. The recent arrest of John Nimmo for suspected harassment of Stella Creasy

210 Â Â and Caroline Criado-Perez has been widely reported. If, however, he is convicted, the more extreme threats made against them and others will no doubt lead to stronger penalties. As of early September, he had been released on bail and will be interviewed by London's Metropolitan Police at a later date. 'Sub cultural trolls' are generally anonymous and make a career out of shock and controversy. One extreme example is Reddit troll, Violentacrez (Violent Acres) who was outed in Oct 2012 as Michael Brutsch .Reddit is a user generated content site that simply aggregates information - pictures, news, blog posts etc. - already published on the internet. Brutsch was collating images in subfolders or subreddits, variously called /jailbait, /picsofdeadbabies, /beatingwomen, amongst others. Reddit initially took a lenient view with outraged users complaining about loss of freedom of speech. However, news investigations lead to the demise of these tasteless collections. 'Grief trolls' are particularly repugnant. They are a problem on Facebook memorial pages set up by grieving friends and families. Hannah Smith tragically committed suicide due to severe bullying on social media site Ask.fm but the original Facebook tribute page that her family set up received so many abusive messages they closed it and opened another one. Her father is now campaigning to change the laws regarding online abuse. One so-called 'grief' troll, Sean Duffy, was found guilty under malicious communications legislation and jailed for 18 weeks. Magistrates also gave him an Asbo and banned him from using social networking sites for five years. 'Professional trolls' are usually journalists and they fit within the definition of troll given above because they write deliberately controversial pieces to provoke reader response. It drives outraged traffic to their newspapers' websites and the advertisers are kept happy. The inevitable result is bad journalism and cynical readers who would prefer not to be trolled in this way. Why do people troll? There is an online disinhibition effect, which is 'a loosening (or complete abandonment) of social restrictions and inhibitions that would otherwise be present in normal face-to-face interaction during interactions with others on the Internet'. Essentially, people write things online that they wouldn't dream of saying to strangers, face to face. People show off online; they use the internet to air views they know are socially unacceptable and revel in any attention, positive or negative, they get. There has been a suggestion recently that some people are just bored and winding up people online is an easy outlet. Terry Pratchett once said 'the IQ of a mob is the IQ of its most stupid member divided by the number of mobsters', so competing individuals in a group can be encouraged amongst their likeminded peers. So called 'Gamification' is the result. This summer has seen women being threatened with rape, then bombing, what is the next new offensive thing? In the aftermath of the Syria vote, is it images of dead people? How do we deal with trolls? Twitter recently introduced a report tweet button which was the result of an e-petition campaign over the summer. People can now report individual offensive or harassing tweets to twitter, potentially getting the offending user suspended. Whether this will work remains to be seen. One reported unintended consequence has led to complaints that harmless accounts have been suspended. The problem remains unsolved where it is a sustained, targeted attack by many people on one person; for instance, the high profile women targeted recently complained that you could spend a lot of time blocking and reporting multiple, mostly anonymous accounts. The block button doesn't

211 always work because of ongoing abuse across different social media - a huge problem if you are also being targeted on Facebook, Youtube, blogs and other sites. http://www.collyerbristow.com/Default.aspx?sID=825&cID=1183&ctID=43&lID=0#page=1 Under one roof? Housing and public health in England – Housing LIN Housing LIN Case study no 55 - What is the case for housing as keystone of local public health strategies across England in next year? Following its move into local government, what is the state of play in linking the two sectors, and how can we strengthen such partnerships to improve health and wellbeing? With an increasing focus on integration, this viewpoint sets out to develop a rapid initial assessment of these questions, and highlights important issues facing housing and public health to stimulate further debate, drawing on the thoughts of leading commentators from both public health and housing sectors in order to shape healthy homes and communities. http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Viewpoints/HLIN_View point55_PublicHealth.pdf Under the spotlight | Opinion | Inside Housing Is it a housing worker’s job to report abuse? At a National Housing Federation safeguarding seminar a fortnight ago, the consensus seemed to be ‘yes’. Frontline housing staff, it was agreed, are often the most frequent visitors of vulnerable tenants and so have the most opportunity notice signs of abuse or neglect. As one speaker at the seminar mentioned, the audience was mostly made up of people who worked with supported or sheltered housing, or had a speciality of working with vulnerable people. Consequently, the speaker admitted, the seminar may have been a question of ‘preaching to the converted’. Housing staff who dealt with vulnerable people in their day-to-day work hardly needed reminding of the importance of reporting safeguarding incidents to the social services or police. It was noted that the challenge was to spread the word to staff working with general needs stock. General needs housing staff might not be working with the elderly or those receiving support, but may be dealing with those who unbeknown to them are victims of domestic violence, mental health problems, or other kinds of abuse. This split was apparent when Inside Housing published statistics from Imogen Parry last week revealing a ‘massive’ amount of under-reporting of abuse and risk cases in the housing sector. One of the commenters asked: ‘Are housing workers meant to be omniscient now?’ Another queried: ‘How on earth are front line housing staff going to have the time to notice and evaluate incidences of suspected abuse anyway?’ With lower wages in the sector and the need to work with more people with less staff and less money, perhaps it is no surprise that hard-pressed housing workers expressed frustration at yet another task to be responsible for. But there is evidence that the case for taking responsibility for reporting abuse or harm is picking up traction well beyond the traditional safeguarding world. Contractors, for example, know that their staff who might be undertaking repairs or window cleaning, might be the only people who go to see a tenant during a week. A repair man might unwittingly see signs of child abuse if they see a bare

212 room without any toys, just like they may see evidence of illegal subletting if they see locks on interior doors. Wilmott Dixon is one of the contractors overhauling its training to make sure its repairs staff report it if something doesn’t feel quite right about a house they have visited. Mears, which provides care and repairs, is looking at joining up both operations so that safeguarding cases are more easily spotted. Incidents such as the three woman slaves allegedly held at a council house address, or the spate of serious case reviews involving Birmingham council show that the spotlight is on any company or authority that has contact with vulnerable people. The split between staff already ‘converted’ to helping report abuse is already be starting to fade. http://www.insidehousing.co.uk/under-thespotlight/6529678.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=33722 87_IH-Care+and+Support-261113-JK&dm_i=1HH2,20A2N,82EKTS,780GW,1 Update on investigations into Jimmy Savile and the NHS – GOV.UK Today [29/11/2013] the Department of Health has laid a Written Ministerial Statement about the investigations into Jimmy Savile and the NHS. The Metropolitan Police Service has completed a document review and transferred material concerning Jimmy Savile and the NHS to the Department of Health. The information has been passed onto the relevant hospital trust for further investigation as appropriate. The list of additional hospitals that will be undertaking investigations has been laid in Parliament . A Department of Health spokesperson said: As part of the recent Metropolitan Police Service document review in connection with Jimmy Savile, the Department of Health has passed on information relating to 19 further hospitals in England. The information has been passed to the relevant hospital trust for further investigation as appropriate. Kate Lampard will provide general assurance of the quality of the final reports of all the NHS investigations on behalf of the Department of Health. We expect the final reports of these investigations to be completed by June 2014, with publication sooner if that is possible. It is essential that all the information is considered and investigations are thorough in order to learn the lessons about Jimmy Savile’s pattern of offending. https://www.gov.uk/government/news/update-on-investigations-into-jimmy-savile-and-the-nhs Urgent action needed for sex workers gypsies and travellers – Royal College of General Practitioners. Urgent action needed to stop sex workers, Gypsies and Travellers and homeless people falling through gaps in healthcare system Radical changes are needed to meet the healthcare needs of vulnerable groups – including sex workers, Gypsies and Travellers and homeless people – according to new commissioning guidance for GPs. The paper, Improving access to health care for Gypsies and Travellers, homeless people and sex workers, written by the Royal College of General Practitioners and Department of Health says that

213 GPs who commission services in England, under the Health and Social Care Act 2012, should consider paying for mobile units and clinics, and other outreach facilities. Cultural awareness training for frontline NHS staff dealing with Gypsies and Travellers is another key recommendation in new guidance, aimed at improving access to healthcare for vulnerable groups. The report also calls for: • • • • •

More ‘one-stop’ healthcare hubs where vulnerable groups can receive multiple services in one place at one time. Greater community engagement to allow vulnerable groups to have their voice heard and develop support networks. More localised decision making for commissioners, who should seek greater collaboration with vulnerable groups to deliver mutual health and financial benefits. More communication and joined up working between health, social care and voluntary services targeted at marginalised groups. Greater integration between health and housing services to identify and treat health problems associated with poor living conditions.

Sex workers According to the report, sex workers are gradually moving off the streets making them harder to contact. General practitioners who commission health services in England should consider paying for mobile units, dedicated clinics and one-stop shops in urban areas, to allow the thousands of people who work in the sex industry to have better access health services. Bringing services directly to sex workers, will often be an effective strategy to ensure they undertake the first step to address their health needs, for example on-site testing, says the report. Homeless people On the issue of providing health services for homeless people, the paper says that the impact of rough sleeping on the wider health and life expectancy of individuals is well recognised. A recent evaluation by Crisis assessed the average life expectancy as being 47, as opposed to 77 for the general population. The report says that to help tackle the health needs of homeless people, GP commissioners should put an emphasis on outreach services, stating that outreach ‘is a very important element, as it not only provides an opportunity for initial engagement on the streets, but also supports new rough sleepers before they become entrenched in the lifestyle.’ Gypsies and Travellers On the issue of providing health services for Gypsies and Travellers, the report says that 42% of English Gypsies are affected by a long-term condition, as opposed to 18% of the general population. The paper adds that there a range of contributing factors to the poor health outcomes of Gypsies and Travellers, and the difficulties in accessing services. These include low levels of literacy, together with stigma, poor access to health information and some widespread health-beliefs which increase the likeliness that they will not seek treatment. RCGP Chair Dr Maureen Baker, said:

214 “Under the Health and Social Care Act 2012, commissioners of healthcare in England now have a duty to reduce health inequalities in access to services and outcomes. “It is vital that commissioners put the needs of forgotten and disenfranchised groups at the heart of their commissioning strategies.” A Department of Health spokesperson said: “With the implementation of the 2012 Health and Social Care Act, we have a unique opportunity to try to get things right and break the circle of exclusion for some of the most vulnerable in society. “In this changing landscape, with GPs becoming commissioners as well as providers of care, we need to make sure that some of the most vulnerable in society remain high on the agenda.” Download the guidance Improving access to health care for Gypsies and Travellers, homeless people and sex workers [PDF] http://www.rcgp.org.uk/news/2013/december/~/media/Files/Policy/A-Z-policy/RCGP-SocialInclusion-Commissioning-Guide.ashx Inspections, restructuring or a challenging job market: what is behind the rise in agency social workers? - Community Care Our latest investigation into local authority social worker recruitment and retention has found that councils are relying more heavily on agency social workers, but are they being used to paper over the cracks or are there other factors behind the rise? In 2012, local authorities were using an average of 16 agency social workers across both children and adult social services. This year, the average has climbed to 22. Ofsted noted that each of these councils is making concerted efforts to address workforce instability, but it seems progress is slow. Andrew Webb, president of the Association of Directors of Children’s Services , says many local authorities get trapped in a “vicious cycle”, whereby their children’s services are seen to be failing, so they struggle to recruit and retain good quality, permanent social workers. A combination of permanent staff leaving in the wake of the inspection and the need to increase the number of social workers on hand to drive forward improvements meant the council had to employ more agency staff. As Jonathon Coxon, managing director of social work recruitment consultancy Liquid Personnel, puts it: “Use of agency social workers will vary significantly across different councils, depending on the particular conditions that they are facing at the time – there will always be a need for a flexible and skilled temporary workforce to address areas of increased need.” However, when levels reach 4050%, alarm bells start ringing. Anne Mercer, professional advisor for the College of Social Work, warns against becoming overreliant on agency staff. “It is important that the children and adults who depend on social workers are given consistent support, and this is best provided by permanent staff with solid experience of working in that community.” Ofsted’s chief inspector Sir Michael Wilshaw has already publicly recognised that the new inspection framework presents a “very real challenge” to local authorities. But the inspectorate’s director of social care, Debbie Jones, adds: “Naturally it is the role of the ADCS to champion and protect the

215 staff in their services, but they should also recognise that Ofsted inspections are a catalyst to help promote improvement. “Inspectors will continue to report their findings objectively based on the evidence to hand, while striving to help local authorities deliver a good service to all their most vulnerable children and young people.” In the meantime, Webb says councils that are trying to reduce their reliance on agency staff must take a methodological approach: “Local authorities need to take a long-term workforce development view, creating a workforce strategy, working with training providers and thinking about career paths and development. “You can make short-term gains by offering golden hellos and poaching staff from your neighbours, but the sustainable way to improve things is to go back to the Social Work Reform Board’s recommendations and enhance the working environment for social workers.” http://www.communitycare.co.uk/2013/11/26/inspections-restructuring-challenging-job-marketbehind-rise-agency-social-workers/#.UpYbLXC9pJM?cmpid=NLC|SCSC|SCDDB-2013-1128 DOWNLOAD THE SPREADSHEET: https://www.communitycare.co.uk/wp-content/uploads/sites/7/2013/11/Agency-social-worker-rates2013.xlsx Use of restrictive practices in health and adult social care and special schools - RCN The RCN is leading a multidisciplinary team to review guidance around the issue of restrictive practices in health and adult social care. As part of the programme of actions set out in Transforming Care: a national response to Winterbourne View Hospital a multi-professional team led by the Royal College of Nursing was commissioned by the Department of Health to lead a review and develop new guidance on the use of positive behaviour support and the minimisation of restrictive practices across health and adult social care. This consultation and draft guidance which has been developed in conjunction with a range of professionals, patients, service users, their families and carers is the result of that initial review. The Royal College of Nursing is seeking further views to help it strengthen and refine the proposed guidance, including particularly ensuring ways that the rights of individuals and their families can be promoted and examples of best practice in PBS and de-escalation techniques. 2. The Mind review on the use of physical restraint in mental health trusts showed considerable differences in the use of physical restraint. In Transforming Care, the department committed to reviewing the existing guidance on the use of restraint, and other physical interventions and PBS, how these were reported and to issue new guidance so that physical interventions are only ever used as a last resort where the safety of individuals would otherwise be at risk and never to punish or humiliate. A range of actions were agreed to take this forward, with the Royal College of Nursing being specifically asked to update the existing, and out of date, 2002 Department of Health/Department for Education guidance on use of physical interventions and the development of high level principles on the appropriate use of physical intervention. 4. The Tizard Centre is developing a service specification on the use of PBS; Skills for Care and Skills for Health are jointly developing a framework for commissioning training in positive behaviour support and the minimisation of restrictive practices; NICE is developing quality standards on managing violence and aggression; and NHS England, the NHS Information Centre, the Care Quality

216 Commission and others are working to improve the data and information that is reported on the use of restrictive practices. This consultation is on the guidance developed by the Royal College of Nursing-led group rather than these other related projects. For example: the draft guidance does not provide information on what training should be commissioned and the standards of this. This work is being developed by other organisations and is therefore not included as part of this consultation. 5. The guidance considers approaches to different methods of physical intervention, including different methods of restraint, however, it does not put forward advice in relation to which positions or techniques may be preferable. It makes clear that alternative practices such as rapid tranquilisation, seclusion or the use of mechanical restraints are also inherently risky and should also only be used as a last resort, as part of an agreed care plan and for the shortest possible time. The guidance makes clear that the best way of avoiding dangerous or degrading practice is to promote culture, environments and training which enable staff to make the right decisions in a given situation, de-escalate at an early stage, keep both patients and staff safe and promote dignity and respect at all times. 6. This new guidance, in line with Winterbourne View stakeholders’ wishes, is intended to focus not on technical descriptions or guidance on particular different restraint techniques but on improving the therapeutic milieu of different settings, the ethical governance framework, and, most importantly, reducing risk and the need for physical interventions. The proposed guidance takes account of other existing guidance eg from Royal Colleges, NICE, NHS bodies, Government and research, which has been published since 2002, international best practice and the theoretical and practical literature on the use of both PBS and the use of physical interventions. A set of agreed values to promote change and raise standards to minimise the use of physical intervention, including the use of pain compliance, forms the overarching basis for the proposed guidance. This is based on person/patient-centred principles and a strong ethical framework to underpin the use of physical intervention for all people in health and social care settings, and as appropriate in educational settings, eg special schools, including particularly children and those with a mental illness and/or learning disability. The draft guidance is intended to cover all health settings for both children’s and adults and all social care settings for adults, and special schools, in England. This includes acute, mental health, care home, supported living, day service and community-based settings. It also covers healthcare provided for adults and children and social care provided for adults delivered in other locations, including in transport to hospital, police cells, young offender institutions, detention and removal centres, prison, an individual’s own home or any other location where a health or social care professional may deliver care. It does not cover actions provided by the police, prison officers or other National Offender Management Service professionals or contractors working in health and or adult social care settings or special schools, including those health settings based in prisons, young offender institutions or high secure hospitals. The RCN is also exploring how these principles may also be applied to health and social care professionals working in Wales, Scotland, Northern Ireland and other parts of the United Kingdom. 9. This work is also being aligned with the current review of the Mental Health Act Code of Practice and the guidance that includes on physical interventions, seclusion and segregation.

217 We are aware that the guidance in relation to children in health settings needs to be strengthened, to reflect the additional needs, safeguards and legislation relevant to children. We would however appreciate your views on whether the guidance should be extended to cover children’s social care settings and services for children with special educational needs , including any additional information that the guidance should contain to support this, and how best to facilitate a transition from children’s to adults services.’ 12. This guidance is not a final product. To assist it with implementing the guidance and spreading best practice, the department has also asked the Royal College of Nursing to include a number of questions on the potential impact and implementation of the new guidance. DOWNLOAD THE REPORT: http://www.rcn.org.uk/__data/assets/pdf_file/0004/554044/Use_of_restrictive_practices_in_health_ and_adult_social_care_and_special_schools_-_draft_guidance.pdf http://www.rcn.org.uk/__data/assets/pdf_file/0005/554009/Use_of_restrictive_practices_in_health_ and_adult_social_care_and_special_schools_-_consultation_-_EasyRead.pdf http://www.rcn.org.uk/__data/assets/pdf_file/0015/554010/Use_of_restrictive_practices_in_health_ and_adult_social_care_and_special_schools_-_consultation_answers_booklet_-_EasyRead.pdf Using clinical communities to improve quality - Health Foundation Gaps are often found between how healthcare should be delivered, as defined by high-quality evidence, and the care that patients actually receive. Closing these gaps is an important priority for health systems everywhere. But finding the right structures to facilitate improvement is not easy. This report introduces an approach – the clinical community – used by the Health Foundation’s Closing the Gap through Clinical Communities programme to support and secure improvements in health systems across multiple sites. The programme supported 11 clinical communities to come together around shared goals, to learn from each other but with the latitude to develop and apply local solutions. The programme has led to a range of improvements in the quality of care which continue to be sustained today. Drawing on the evaluation of the programme, the report outlines ten key lessons for getting the approach to work in practice and avoiding potential pitfalls: • • • • • • • • • •

Choose the right challenge for a clinical community approach Build a strong core team Recruit a community Resource the community properly Start with a clear ‘theory of change’, but review and adapt in light of learning and experience Foster a sense of community and belonging Recognise and deal with conflict and marginalisation Find a balance between ‘hard’ and ‘soft’ tactics Use data wisely Recognise the contextual influences on improvement and the need for customisation

At a time when working through networks and across organisational boundaries is becoming increasingly important, this report provides valuable insights for those wanting to improve the quality of care.

218 http://www.health.org.uk/publications/using-clinical-communities-to-improve-quality/# Victims put first in the criminal justice system – GOV.UK ____________________________________________________________________ People who fall prey to criminals will now receive more support than ever before to help bring offenders to justice and move on with their lives, Justice Secretary Chris Grayling has announced. Coming in to force today, the new Victims’ Code sets out in plain English what people should expect from the moment they report a crime to the end of a trial. For the first time there is tailored advice in the Code for under-18s and their guardians on attending court and giving evidence. The Code will make sure that victims of the most serious crimes, including hate crime, domestic violence, terrorism and sexual offences, persistently targeted victims and all vulnerable and intimidated victims get access to vital services, like pre-trial therapy and counselling. Justice Secretary Chris Grayling said : “Victims deserve the best possible support to cope and recover from the effects of crime. From today they will have more help than ever before to help bring offenders to justice, with the highest level of service at every stage of the system for those who need it most. “I want to create a fairer criminal justice system where victims have a louder voice and those who break the law are more likely to go to prison for longer. I also want to ask everyone working with victims to help deliver the promises in the new Code and make sure their needs are put first.” The statutory Victims’ Code will also: • • • •

Entitle victims to say whether they want to read out their Victim Personal Statement in court, subject to the court’s discretion Ensure all victims are automatically referred to victims’ service by the police so that all victims receive consistent and immediate access to support services Give victims a clearer means of redress if they are not given the support they deserve For the first time give businesses, who are victims of 9.2 million crimes committed each year, will be able to have their say by writing an Impact Statement to explain to the court how a crime has affected them.

Victims’ Commissioner Baroness Helen Newlovesaid : “The new Victims’ Code is a step in the right direction. The Victim Personal Statement will - if used to the degree we hope – provide victims with a say in court. “I will report on the delivery of the Victims’ Code, including clear assessments of whether victims have got redress when the code has been breached, and whether a victims’ right to read their statements personally in court is being delivered in practice by the end of 2014. “There is more to do. Over the next nine months, I will work with an expert team to shine a light on areas of the criminal justice system which is still failing victims, including teams dealing with domestic violence and anti-social behaviour.” Javed Khan, chief executive of charity Victim Support, said:

219 “From today, victims are promised more support than ever before - from the moment they report a crime and as they journey through the criminal justice system. “We know from speaking to more than a million victims each year, the impact crime can have on their lives, particularly vulnerable groups such as children and those who have suffered domestic violence or hate crime. Getting timely access to information is key for victims, so they are reassured from the outset that an often traumatic experience will be made as easy as possible. “We must all work together so that those working in criminal justice roles are fully aware of the Code, and those affected by crime know their rights. Ongoing vigilance, to ensure that all agencies take their responsibilities under the Code seriously, is vital. Victim Support will be monitoring its implementation closely to make sure that victims get the most out of these new measures.” Also being published today is the new Witness Charter, which has been revised in line with the Victims’ Code. It sets out what witnesses can expect from criminal justice agencies, from reporting a crime to the court trial, and highlights the types of special measures that could be used to support vulnerable and intimidated witnesses give their best evidence. The new Victims’ Code is part of the Criminal Justice Strategy and Action Plan. This was launched in June this year to help speed up the justice process through a range of actions including, the digitalisation of the courts process, easier access for victims and witnesses to give evidence in court, and a more transparent and responsive criminal justice system.

https://www.gov.uk/government/news/victims-put-first-in-the-criminal-justice-system Views sought on draft patient safety alerts for medical device incidents and medication errors – Regulating Medicines & Medical Devices – Medicines & Healthcare Products Regulatory Agency. _____________________________________________________________________ NHS England and the Medicines and Healthcare Products Regulatory Agency (MHRA) are working together to improve the reporting and learning in two important areas. It is proposed to increase and improve reporting of medical devices and medication errors via an integrated reporting system and enhanced governance (control) systems. In partnership we have drafted two Patient Safety Alerts which, before we issue, we are seeking views from healthcare professionals or anyone who has an interest in these areas. The engagement period runs from 19 November to 10 December 2013. http://www.mhra.gov.uk/home/groups/comms-po/documents/news/con341182.pdf http://www.mhra.gov.uk/home/groups/comms-po/documents/news/con341186.pdf http://www.mhra.gov.uk/home/groups/comms-po/documents/news/con341187.pdf Volunteering in acute trusts in England – The Kings Fund. This paper addresses the gap in local knowledge that was highlighted earlier this year in a related report by The King's Fund on Volunteering in health and care .

220 As part of a project funded by the Department of Health, the authors gauge the scale and value of volunteering in NHS acute trusts in England by analysing survey results received from 99 of the 166 acute trusts contacted. Their independent research aims to help local providers and system leaders understand the contribution of volunteering and provide organisations with benchmarking information, including possible returns on investment in volunteering. Key findings 1. The acute trusts surveyed have on average 471 volunteers. Scaled up, this equates to more than 78,000 volunteers across all acute trusts in England, contributing more than 13 million hours per year. 2. There is a wide variation in the numbers of volunteers, with only a weak link between trust size and volunteer numbers. Some trusts report as few as 35 volunteers, while others have 1,300. 3. The volunteer profile has changed over the past five years, with new volunteers tending to be younger and more ethnically diverse (according to 66 per cent and 56 per cent of respondents respectively). 4. All the respondents see volunteering as a growth area with 87 per cent expecting the number of volunteers to increase over the next three years. 5. Respondents feel that volunteers play a critical role in improving patient experience. But most trusts recognise that they were not doing enough to measure this impact more formally. 6. Analysing our survey data analysis suggests that for the average trust, every pound invested in volunteering could yield around £11 in added value. But trusts need a more sophisticated approach for measuring the value of volunteering, to include patient experience and quality of care. Policy implications It appears that some trusts do not have enough information on volunteering to enable them to exploit the full potential of volunteering services. More research is needed to understand how organisations receive information and make decisions on their volunteer services; failure to feed information in at board level will make it hard for volunteering services to be strategically aligned to trusts’ ways of working. Our examples of best practice show how hospitals are supporting and developing their volunteers and managing the tension at the boundary between volunteer and staff roles. More clarity is needed for acute trusts on the extent of checks required and for potential volunteers on how volunteering affects benefits entitlements. DOWNLOAD THE PAPER: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/volunteering-in-acute-trusts-inengland-kingsfund-nov13.pdf What information can I get about hospitals? - USA – Medicare System. You can get a “snapshot” of the quality of hospitals in your area and across the nation by looking at the following aspects of healthcare:

221 1. Timely and effective care: How often and quickly each hospital gives recommended treatments for certain conditions like heart attack, heart failure, pneumonia, children’s asthma, and for surgical patients. 2. How likely patients will suffer from complications while in the hospital. 3. How often patients in the hospital get certain serious conditions that could have been prevented if the hospital followed procedures based on best practices and scientific evidence. 4. Use of medical imaging: How a hospital uses outpatient medical imaging tests (like CT scans and MRIs). 5. Survey of patients’ experiences: How recently discharged patients responded to a national survey about their hospital experience. For example, how well did a hospital’s doctors and nurses communicate with patients and manage their pain? 6. Number of Medicare patients: How many people with Medicare have had certain procedures or have been treated for certain conditions at each hospital. 7. Medicare payment: Information about how much Medicare pays hospitals. Measures displayed on Hospital Compare http://www.medicare.gov/hospitalcompare/Data/Measures-Displayed.html

http://www.medicare.gov/hospitalcompare/About/Hospital-Info.html When Drug Abuse Affects Your Personal & Work Life | CAREEREALISM If you have problems with drugs, alcohol, or any other addictive substances, you’ll find that your work life will be affected negatively. It is time to look into options to get help and treatment for your addiction, even if it means taking a few months out of your busy professional life to attend rehab. Although taking this time off will probably affect your job, it’s important to get treated. So, you’ve already taken the step to let your employers know about your problems, and they’ve graciously agreed to give you a few weeks (or months) to deal with the issues. It’s time to look for places where you can get help with your problem. Treating substance abuse in the workplace is often beyond the abilities of your employers, so you’ll need to take it to the professionals for help. Here are some options to consider when drug abuse affects your personal and work life: Steps Programs For those who need structure in their lives and in dealing with their addictions, 10 or 12-step programs can definitely be a help for them. They’ll spend the first few days or weeks of their treatment in a rehab clinic, where they’ll start the first few steps that will lead them down the road to recovery. When they leave the clinic, they’ll need to continue with the other steps on their own. Those uncomfortable with faith-based rehab clinics often find that these steps-based programs work well for them. Faith-Based Programs There are many Christian and faith-based programs run by churches and religious organizations around the country, and they have been effective in many cases. The ability to combine faith with recovery is often what makes these programs effective for true believers. However, they’re not always popular among those who espouse different beliefs – or no beliefs. However, if you’re a

222 believer, you’ll want to consider these programs for your rehab. As a busy professional, these are decent options simply because they don’t usually require as much time as some of the others. Gender Specific. Many men and women have a hard time making progress in their addiction when members of the opposite sex are around. This isn’t just the case with sex addicts, but it could be any number of problems that are just compounded when attraction to others is thrown into the mix. LGBT. For those who are struggling with an addiction as well as their alternative sexuality, there are rehab clinics that cater specifically to lesbians, gays, bisexuals, and transsexuals. These programs are often ideal for those that have taken up an addiction in response to the threats they feel aimed at their lifestyle and sexuality. It’s a safe space where men, women, and transgenders can express their feelings, in any way they choose. Executive Rehab For those who need long term drug rehabs or other forms of rehab, executive rehab presents a long-term solution that is comfortable and accommodating. It tends to be more costly than outpatient rehab (where patients only stay for a short time), but patients in this type of rehab live in the clinic or facility for extended periods of time. This type of rehab is often recommended for those with more serious addictions, as it gives them time to focus on healing and recovering without distractions from the outside world. This may make you worry that you’re putting your career on hold, but the truth is that spending the time and focusing on your problem is the best move for your career. Co-Occurring Disorders Rehab Mental health problems are surprisingly common, and many of those struggling with mental disorders often develop addictions as a result. There are facilities that are equipped to treat both mental disorders and addictions, and they specialize in these problems. The name “co-occurring” means that both addiction and mental disorders often take place at the same time, and both require specialized treatment. http://www.careerealism.com/drug-abuse-personal-work-life/ When the buck doesn’t move: non-delegable duties of care - Lexology The general law has it that an organisation is liable for its own acts or omissions and vicariously liable for the acts or omissions of its employees. An organisation is not usually responsible for the negligence of a third party such as an independent contractor. However, the concept of such “nondelegable” duties arise either where the activity is inherently hazardous (or “extra hazardous” as the case law has it) or where the nature of the relationship between the organisation and the victim of the negligence is particularly close. It is this second situation that arose in Woodland v Essex County Council. In Woodland, a ten-year-old girl suffered a serious brain injury as a result of an accident during a swimming lesson organised by her state school but provided by a private contractor. The issue before the Supreme Court was whether the Council (the Local Authority responsible for the school) could be held liable for the negligent actions of the contractor (it had not been decided whether the

223 contractor had in fact been negligent). The Supreme Court reviewed the law on non-delegable duties of care and set out the criteria when a non-delegable duty arises (see below). The Supreme Court’s conditions for when a non-delegable duty arises: • •

• •

The claimant is a patient or a child or is especially vulnerable to the risk of injury. There is a relationship between the claimant and the defendant which places the claimant in the custody, charge or care of the defendant and that relationship imputes a positive duty on the defendant to protect the claimant from harm. This is likely to arise if the defendant has an element of control over the claimant. The claimant has no control over how the defendant undertakes its obligations. The defendant has delegated to a third party a function which is an integral part of its duty to protect the claimant so that the third party is exercising the defendant’s care of the person.

The Court was careful to limit the circumstances when a non-delegable duty arises. It noted that non-delegable duties of care are an exception to the usual principles of tortious liability and that courts should be sensitive about imposing them as they carried potentially significant financial burdens on those providing critical public services. The judgments make it very clear that this is not an open ended liability and that liability for the negligence of independent contractors only falls on the organisation if the contractor is performing functions that the organisation has assumed for itself a duty to perform. Why Retail Clinics Failed to Transform Health Care - Jason Hwang, and AteevMehrotra Harvard Business Review Retail clinics have demonstrated that they are a sustainable business model and clearly fit a patient need: Today, there are more than 1,600 clinics across the country, which have had a total of 20 million patient visits. Because they employ nurse practitioners rather than physicians and offer care in locations such as pharmacies and grocery stores, retail clinics can provide services at a lower cost per encounter than traditional medical practices . In addition to lower cost, convenience has also been a key attraction, since patients are not required to make appointments and the clinics are often co-located with pharmacies. The disruptive-innovation model predicts that retail clinics would garner an initial following among “nonconsumers” — especially those without health insurance or who live in communities not adequately served by incumbent institutions. However, the convenience of retail clinics has been a selling point primarily in higher-income communities , where patients have health insurance and access to a physician. Although retail clinics are more affordable than physician practices, they have not been effective in attracting the largest population of nonconsumers: the poor, who paradoxically continue to rely on costlier sources of care such as emergency departments. 1. First, the expectation based on the disruptive innovation model was that traditional providers would view the simple acute problems treated at retail clinics as low-margin services they would give up. However, due to a disconnect between reimbursement and actual costs of care, these incumbent providers view simple acute problems as high-margin work that offsets the losses from caring for more complex problems. 2. Second, these clinics are often staffed by nurse practitioners. But regulatory limitations on nursing scope of practice, which vary significantly from state to state, and regulation that fixes reimbursement to nurse practitioners at 85% of physician reimbursement for providing the same care, have impeded more rapid expansion of retail clinics.

224 3. Third, due to antiquated payment models, Medicaid plans that serve the poor have been reluctant to cover care in retail clinics and therefore shun the very market segment that may benefit the most from the convenience of retail clinics. In summary, retail clinics exemplify both the potential of and challenges for disruptive innovators to improve value in health care. But clearly, the impact of such disruptive innovations will be limited unless the regulatory and reimbursement barriers are dismantled. http://blogs.hbr.org/2013/12/why-retail-clinics-failed-to-transform-healthcare/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+% 28HBR.org%29&cm_ite=DailyAlert122613+%281%29&cm_lm=sp%3Arock.nisbet%40gmail.com&cm_ven=Spop-Email Why The “Forced Caesarean” Story Was Wrong – BUZZFEED

“We have seen in last few days the dangers of the media and politicians using half truths and misinformation to undermine the confidence of the public in human rights and the judicial process”. Peter Edwards - Law The case is complicated, unusual and tragic. But social services did not force a woman to have a caesarean so that they could take away her baby. The adoption judgement in story has been released , and it shows that a lot of the claims made about the original case were wrong.

The Telegraph had originally reported that “Essex social services obtained a High Court order against the woman that allowed her to be forcibly sedated and her child to be taken from her womb.” The woman was from Italy, and was staying in the UK on a short-term basis. In fact, as the judgement makes clear, social services did not start legal proceedings until after the baby – referred to as “P” – was born.

judiciary.gov.uk This backs up a statement made by Essex County Council that said the decision to perform a caesarean was made by the local Health Trust – for which they had to apply to the court, because the mother was not in a state to consent to treatment. It also adds weight to the (pre-judgement) suggestion by several legal writers, including barristers Adam Wagner and Lucy Reed , that the initial reports of the case were inaccurate. Updated, Dec 4: The ruling and transcript of proceedings for the earlier Court of Protection judgement on the mother’s caesarean have also now been released :

225

judiciary.gov.uk An explanatory note at the beginning summarises the basics: the caesarean was at term, and for a medical reason (the risk of uterine rupture) rather than prompted by a desire to remove the child from the mother; the mother’s own QC did not oppose the procedure. As the other judgement strongly suggested, Essex County Council and social services played no part in the proceedings, confirming that the Telegraph’s original report was incorrect. However, it’s also worth noting is that the ruling suggests the local authority were planning to use police powers to take the child into protection once it was born; the judge advises them (although they were not present in court) that this would be heavy handed, and that they should instead go through the courts - which, as the other judgement states, they subsequently did. We will update this post further as we look at the ruling in more detail. The Telegraph’s Christopher Booker, who wrote the original column from which the story was taken, also seems to have significantly mis-stated the severity of the woman’s illness when he wrote :

…she had something of a panic attack when she couldn’t find the passports for her two daughters, who were with her mother back in Italy. Via telegraph.co.uk

226 The judgement says that at the time she was “profoundly unwell”, and that when not taking medication for her bipolar affective disorder, she suffers “very intrusive paranoid delusions ”:

judiciary.gov.uk The mother had been sectioned for five weeks when the decision to perform a caesarean was taken. The Telegraph report also suggested that social services had not consulted with either the child’s extended family or Italian social services. In fact, the judgement makes clear that both a social worker and the baby’s guardian visited Italy, and documents from Italian social services played a major role in the judge’s decision. The mother’s two other children are currently being cared for by their grandmother, and both the family and the Italian courts had for some time restricted the mother’s contact with them due to her illness, which caused “considerable conflict” with her parents. The judgement says that one child in particular had been “traumatised” and “terrorised” by what they had witnessed. However, relations between the mother and her parents have subsequently improved – along with her health – and the mother now has “the support of her family”. This is what makes the case both tragic and controversial. The mother’s health has got much better since the birth of her child – indeed, she feels the baby “saved her” by making her accept her need to deal with her illness:

227

judiciary.gov.uk The judge was faced with a dilemma based on the uncertainty of whether the mother’s condition would remain stable, which conflicted with the need to see the child placed in a stable environment early in its life. The judge cites well-established evidence that “a child’s best chances are by being in a secure placement by the time he or she is nine months old, whether that be within the birth family or otherwise.” The mother’s suggestion of the child being in foster care for a year was “well outside that timeframe”. The judge makes it clear at the start of the ruling that it is the child’s best interests which should comeforemost:

judiciary.gov.uk The ruling says “the best place for any child is to grow up within his own family if it all possible”. But given the uncertainty of the mother’s health, the judge decides this is not in the child’s best interests :

228

judiciary.gov.uk This is a decision, which is still controversial - as many decisions about the care of a child are - and there is a large amount that remains unknown and uncertain about the case. But it does seem that a significant amount of the initial reporting on the case was factually inaccurate. The final paragraph of the judgement, in which the judge addresses the baby herself later in life:

judiciary.gov.uk Women's Aid Annual Survey Domestic Violence - Women's Aid The Women’s Aid Annual Survey of domestic violence services across England has become an institution and is the most comprehensive collection of such data in the country. The data and information it provides about domestic violence services, the thousands of women and children they support and the challenge they face every year is invaluable for Women’s Aid, the sector and decision makers. Key findings from the Women’s Aid Annual Survey 2013 include the following:

229 > 9,577 women and 10,117 children were supported during the year through refuge accommodation by responding organisations. > On the census day (Thursday 27 June 2013) 155 women with 103 children were turned away from the first refuge they approached by responding organisations. > Over 82,000 women and 14,000 children were supported during the year in non-refuge services. > The number of women staying in refuge accommodation on Thursday 27 June affected by mental health issues was 47% (this has increased by over 10 percentage points since 2012). > One in five children staying in refuge on Thursday 27 June 2013 have had to move schools. > When asked if they were running services without dedicated funding, of 167 respondents answering the questions, 82 (48%) said that they were. Most of these services were children and young people (CYP) or services for black and minority ethnic (BME) women, but six refuge services were being run without dedicated funding. > Of 80 respondents running services without dedicated funding, 47 (59%) were using their reserves to fund services. > Of 145 respondents expecting to receive local authority funding during 2013/2014, 30% expected to get less compared to last year – 17% did not know if they were getting local authority funding (even though the survey was conducted three months into the financial year). > Numbers of specialist CYP workers in refuge services, and BME workers in services reduced over the year – whereas the numbers of volunteers increased. The history of Women's Aid Annual Survey Reports Women's Aid conducts a survey of our national network of services each year in order to ascertain the use of domestic violence services within England. From 2006 we have also undertaken a Residents' Survey to provide socio-demographic information about a sample of women residents within refuge services on one day. These surveys provide us with information about services provided, and the number of women and children supported by Women's Aid national network, and also give us a more detailed snap shot of those using domestic violence services on a specific day. We are currently conducting the 2013 survey. http://www.womensaid.org.uk/core/core_picker/download.asp?id=4252 Workers fail to report abuse | News | Inside Housing Housing workers are failing on a ‘massive’ scale to report instances of tenant harm or abuse to councils, research suggests. Analysis due to be published next year by safeguarding adults consultant Imogen Parry reveals housing staff were responsible for 3,000 referrals - when a report of alleged abuse or neglect leads to an adult protection investigation or assessment - per year between 2010 and 2012. This is just 0.04 per cent of the 8 million adults living in social housing. Ms Parry concluded there was a ‘massive under-reporting’ of ‘safeguarding’ instances. She compared her analysis of experimental NHS statistics for referrals with Department of Health research published in 2007 suggesting 4 per cent of older people are abused every year.

230 Ms Parry said: ‘If we know that 4 per cent of older people are abused each year, then the 0.04 per cent referral rate from social housing providers for all client groups is surely massive underreporting. The housing sector could do more to safeguard adults at risk of harm or abuse.’ Laura Weddell, registered social landlord community safety coordinator at Birmingham Social Housing Partnership, said housing associations were ‘certainly’ starting to realise they needed to improve reporting procedures. http://www.insidehousing.co.uk/care/workers-fail-to-reportabuse/6529610.article?utm_medium=email&utm_source=Ocean+Media+&utm_campaign=3372287 _IH-Care+and+Support-261113-JK&dm_i=1HH2,20A2N,82EKTS,780GW,1 Young Minds launches report on offending and mental health Very few improvements have been made in relation to services for young people in the criminal justice system with mental health problems over the last two decades, according to a report published today by YoungMinds and the Transition to Adulthood Alliance, finds that despite a plethora of policy initiatives designed to improve services for young people with mental health problems at risk of or engaged in offending behaviour, very little improvements have filtered through to young people who report many of the same problems that were experienced by young people 20 years ago.

“Despite the numerous reports, enquiries, policy documents, expert reference groups, working parties, consultations, white papers, Bills, Acts of Parliament, changes of government, we are still repeating the same old story - that the provision of mental health services for young people at risk of or engaged with offending behaviour is woefully inadequate,” said the report, which was funded by the Barrow Cadbury Trust. Young people and professionals interviewed for the report told us that waiting lists are still too long for young people to access mental health services which meant young people often self-medicated with drugs and alcohol, exacerbating their mental ill health and offending behaviour. Rigid criteria for mental health services meant young people had to be severely ill before they could access any support, and if they did get help it was usually in the form of medication. However, following prescription, young people often went long periods of time with no review or ongoing support. In the rare occasions where intervention extends beyond medication, professionals had little time for young people and a high turnover of staff meant a lack of staff continuity made it difficult for the young person to establish rapport or trust. The ‘Same Old…’ report identified six critical issues: 1. The need for consistency in relationships between young people and professionals; 2. Professionals working with young people need better training in identifying mental health problems; 3. One named individual or agency should hold responsibility for the young person’s care; 4. Co-ordination and collaboration between services needs to improve; 5. There should be easily accessible information available about mental health and support and 6. If one agency is going to co-ordinate care, who is going to hold that agency to account? The report recommends existing strategy namely the Mental Health Strategy Implementation Plan is implemented to mitigate against some of these issues and all professionals need better training in mental health problems.

231 Â Â The report notes GPS are in a position to fulfil this role. Finally the report concludes that there should be a shared point of information for young people, their families and professionals on mental health information and local government should appoint a mental health champion to raise awareness of mental health. http://www.youngminds.org.uk/ DOWNLOAD THE REPORT http://www.youngminds.org.uk/assets/0000/9472/Barrow_Cadbury_Report.pdf