Healthcare Features
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Directors of social services have "strongly urged" the government to give the proposed health and well-being boards statutory powers to sign off local commissioning plans and to hold commissioners to account.
In a joint response to the government’s Public Health White Paper, the Association of Directors of Adult Social Services (ADASS) and the Association of Directors of Children’s Services (ADCS) said they welcomed an enhanced role for councils in public health.
But they called on ministers to clarify how this proposed greater role would be funded. The two organisations also expressed concern about the structures emerging from the Health and Social Care Bill, with the submission saying it was unclear what the relationship between Public Health England, the NHS Commissioning Boards, Monitor, HealthWatch, the health and wellbeing boards and GP consortia would be.
In addition to seeking statutory powers for health and well-being boards, the submission seeks reassurance that a “potential dilution” of the priority given to vulnerable children, families and adults, and of “further fragmentation” in health services for children and families do not take place.
It said: “We are particularly concerned that there appears to be potentially inadequate representation of the needs of children and young people in the planning and commissioning arrangements in the proposed system.” The response cites the limited reference to the critical role of schools in the public health agenda as a particular concern.
ADASS’ National Lead on Public Health, Sandie Keene, said: “The decision by central government to return public health to local government in which it can be appropriately connected to a wide range of other issues and services is profound, and right. ADASS welcomes this move despite continuing concerns about the structural shape the NHS and local government will take in future. And, of course, important matters concerning the accountability and funding of this important service.”
Ann Baxter, chair of the ADCS Health, Care and Additional Needs Policy Committee, said: “There is a massive potential for local authorities and health partners to have an impact on some of the more intractable public health challenges within these new arrangements, particularly in providing a renewed focus on the health needs of children.
“Local authorities will want to make the most of the new health and wellbeing boards, and we believe that in order to do so, the boards must retain oversight of the commissioning of all health services to ensure coherence and consistency in services for children and young people and their families.”
The joint response can be viewed here.
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The Information Commissioner’s Office has criticised a health trust in Cornwall for disclosing third-party personal data on two occasions in 2010.
The watchdog’s head of enforcement, Sally-anne Poole, said: “More and more people today want to find out exactly what information their GP or hospital holds about them, making subject access requests an increasingly popular tool.
“However, just because staff are busy with requests, this does not mean they can stop doing adequate checks before information is sent out.”
The ICO said the Royal Cornwall Hospitals NHS Trust had breached the Data Protection Act in July and December last year.
On the first occasion, an individual had submitted a subject access request for information the trust held about them. In addition to sending the requested information, the trust send someone else’s information.
A further disclosure six months later also saw the requester – the same individual – receive third party information.
Royal Cornwall’s chief executive, Peter Colclough, has now signed an undertaking “to ensure that procedures for dealing with subject access requests are clearly defined and managed, and that all staff receive appropriate training and support in how to follow them”, the ICO said.
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The Law Commission’s consultation on reforming adult social care law found “overwhelming support” for the retention of key legal rights, the law advisory body has said.
Publishing a summary of the responses today, the Law Commission said there was also strong backing for maintaining duties to co-operate between social services and other agencies and for the proposal to introduce a duty to investigate in adult protection cases.
Frances Patterson QC, the Public Law Commissioner in charge of the review, said there was strong agreement that adult social care law should be reformed as a matter of priority.
“Many people have been keen to tell us about the difficulties they are experiencing as a result of the complexities of the law, and how they have been confused by, or even completely unaware of, their basic legal entitlements,” she said.
Patterson added that the Law Commission would review its scheme as a whole to make sure it could “accommodate policies such as personalisation, self-directed support, prevention and the universal services, while also maintaining the strong legal rights that were overwhelmingly supported by consultees.”
The Law Commission is set to publish its final report in May 2011. The government will then review its recommendations with a view to introducing new legislation in 2012.
Overall the Commission received 231 formal responses, including submissions from 26 local authorities, the Local Government Association, the Law Society, and the Association of Directors of Adult Social Services. It also held 72 events across England and Wales.
The consultation paper and analysis of responses can be read here.
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Many detained mental health patients who have been certified as consenting to treatment appear to be refusing to give consent or lack the capacity to do so, the Care Quality Commission has warned in its second annual report.
The Commission said the issue was a particular area of concern and that many services needed to substantially improve their practices. It suggested that some mental health services applied security measures in ways that placed unnecessary restriction on autonomy or compromised privacy.
The State of Care report revealed that the Commission had observed “over-occupied inpatient wards, lack of one-to-one work with patients, or unnecessary restrictions of liberty”. It also said people from minority ethnic groups continued to be over-represented among those detained under the Mental Health Act.
The watchdog’s community mental health survey added that there was significant variation in the extent to which mental health services involved patients in planning their care and reviewing their treatment.
Other key findings from the report, which looked at the state of health care and adult social care in England, included:
- Health and social care services improved in the years leading up to the implementation of the Health and Social Care Act 2008. However, “there are still some areas which have not improved fast enough”.
- There has been a steady increase in the number of councils which are performing “well” or “excellently”. Similarly the proportion of NHS trusts scoring “excellent” or “good” for the quality of their services has risen from 41% in 2005/06 to 63% in 2008/09. Waiting times for NHS hospital treatment have shown progress.
- People now have greater control over their care as a result of more choice in areas such as appointment times, choice of location of care and choice of providers. However, the report said there was still wide variation in progress in giving people access to personalised services through direct payments or personal budgets
- The quality of private-sector run care services “is generally lower” than those run by councils or voluntary organisations. However, council and voluntary organisation run services represent a fraction of the market
- There has been a substantial increase in the number of care homes and home care services meeting safe care standards. But further improvements in medicine management are still needed
- The quality of care arranged by councils between September 2008 and September 2009 improved. Councils also made significant improvements in adult safeguarding and in maintaining the dignity and respect of vulnerable people
- Some organisations “still lag behind the pack”. Key areas of concern include: safe care; choice and control (particularly in mental health); person-centred services; and standards of care and support
- Councils find it challenging to extend further options for independent living, and community-based services have been reduced. “The rapid growth of demand for support, especially due to the rising number of older people, has not been matched by growth in the availability for more person centered support,” the CQC said, adding that the number of people over 75 who had repeated emergency admissions increased, “suggesting a lack of effective community support”
- Only 31% of councils were monitoring how well they were meeting targets on equalities
- 91% of NHS organisations are meeting the minimum standard for challenging discrimination, promoting quality and respecting human rights. “But all organisations should have met this standard in 2004, and performance is low in comparison to most other minimum standards”.
CQC's chairwoman, Dame Jo Williams, said: “There have been significant improvements in outcomes for people who use services and these services should be congratulated for the work they have done. However, the overall picture is far from perfect and it will be vital for all parts of the health and social care system to continue this upward trend and consolidate the best of what has worked well for people who use services.”
“The next few years will be a crucial time for health and social care in England. There will be important changes such as the creation of HealthWatch, Monitor as the economic regulator for health and social care, GP led commissioning consortia, Health and Well Being Boards and the National Health Service Commissioning Board.”
Dame Jo added that the new system of regulation under the 2008 Act worked much more in real time, allowing the CQC to respond more quickly to poor standards of quality and safety where they are identified.
The CQC is to publish another report later in 2011 examining the care system after registration under the 2008 Act.