Healthcare Features
- Details
- Written by: Sean Clement
- Category: Healthcare Features
- Hits: 1380
Doctors believe that local authority cuts to care services and tightened eligibility criteria are making it more difficult for older patients to leave hospital even though they are fit enough to do so, a poll conducted for The Guardian newspaper has suggested.
Half of the 502 doctors surveyed for the paper by Doctors.net.uk said so-called “bed-blocking” was worse than a year ago. A further 40% suggested the situation had not improved in that time.
Senior doctors told the paper that councils were making it harder for older people to access home help and that budget cuts had seen many authorities redefine eligibility criteria.
Dr Mark Porter, chairman of the British Medical Association's hospital consultants committee, claimed that some patients with pressing medical conditions cannot be admitted immediately because healthy patients are occupying beds.
He told The Guardian: "I would estimate that several thousand such patients are in the NHS at any one time – that's a fairly significant problem. It's very distressing for individual patients, of great concern to the medical profession and an organisational problem for the NHS.
"If you have a core of people who should be moving on but aren't, your capacity to respond to new admissions is diminished and that leads to inefficiency and increased cost. There's definitely a feeling [among doctors] that it's difficult to move patients out of hospital who are medically fit but can't be discharged because there's nowhere else to go where they'll be adequately supported."
Nigel Edwards, acting chief executive of the NHS Confederation, said the issue was something NHS hospitals had been increasingly concerned about.
He added: “There was a big improvement in this four or five years ago. But over the last few years there's been a feeling that in some places the situation has deteriorated again. People [hospital managers] who haven't had this problem before are starting to find quite large numbers of people that they are having trouble discharging because it's hard to arrange to get them back home or into a residential home.".
The Department of Health announced earlier this month that it was making an extra £162m available between now and the start of April to help patients live independently at home.
Health Secretary Andrew Lansley said: "It's really important, particularly at this time of year, that we help people to leave hospital as quickly as they can, when they are ready. The latest figures show that 2,575 beds are unavailable due to delayed transfers of care."
- Details
- Written by: Sean Clement
- Category: Healthcare Features
- Hits: 3051
The Department of Health has published its draft Public Health Outcomes Framework, setting out the criteria by local authorities and their partners will be appraised under their proposed new responsibilities for public health.
The framework, which is now the subject of a consultation process ending on 31st March, focuses on five key areas of responsibility:
- health protection and resilience
- tackling the wider determinants of ill health
- promoting healthy choices and healthy lifestyles
- preventing ill health
- focusing on premature mortality and the health of the most vulnerable.
The government described the The Public Health Outcomes Framework as “outcomes focused” rather than prescriptive and aimed at “enabling and incentivising” local government, the NHS and the wider public sector to respond to local health needs and insisted that it is not is not a performance management tool and will not replicate the approach of the previous National Indicator Set.
Instead, it said that framework will provide “a context for public health activity across the whole of the public health system”. The government's plans for public health will see the establishment of a new body, Public Health England, as part of the Department of Health, and the transfer of public health leadership and responsibility to local government.
The government said that the framework would have three purposes:
- to set out the government’s goals for improving and protecting the nation’s health, and for narrowing health inequalities through improving the health of the poorest, fastest;
- to provide a mechanism for transparency and accountability across the public health system at the national and local level for health improvement and protection and inequality reduction; and
- to provide the mechanism to incentivise local health improvement and inequality reduction against specific public health outcomes through the ‘health premium’.
Data relating to the public’s health at national and (where possible) at local level will be collated by Public Health England and analysed against a set of national indicators before being made publicly available.
The consultation paper proposes that these indicators would focus on health improvement relating to the causes of the greatest burden on disease and death (such as obesity, smoking, alcohol and level of physical activity), health protection and preventative services.
The Department of Health insisted that it was open to suggestions from local government and wanted its input to shape the final form of the framework.
“This will not just be about central government inviting public health and local government to join in the consultation process, but about a real shared endeavour, which reflects localism,” the consultation paper said. “We are seeking views on the overall structure and scope of the framework and the range of outcomes and measures within it, including views on those measures that should be incentivised. We want to go further and co-produce the final set of outcomes with our partners in the public health sector and local government, to ensure that we arrive at a robust set of indicators.”
The framework will be used in conjunction with a new framework for the NHS , which was also published this week, and a third framework, covering Adult Social Care, which is expected to be published shortly.
The consultation also emphasised the need for second tier councils to be involved in the process, despite the fact that the new Directors of Public Health will sit at county level in two-tier parts of the country. It also said that child protection indicators may be added to the framework, subject to the conclusions of the Munro review of Child Protection which is due to report in April 2011.
Health Secretary Andrew Lansley said: ‘Public Health is everyone’s business and through this consultation, people have the chance to comment on our plans for how success will be judged. These are important changes that will be far reaching and I urge everyone who has a view to take part.’
The consultation paper is available at the following link: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122966.pdf
- Details
- Written by: Sean Clement
- Category: Healthcare Features
- Hits: 1787
The government has published statutory guidance for councils and local NHS bodies on how health and social care services should implement the autism strategy Fulfilling and rewarding lives.
The National Autistic Society said the final guidance was much clearer in terms of what local authorities and health bodies are expected to do, and what individuals can expect from them.
It praised the guidance for categorically stating that local authorities and the NHS:
- should provide autism awareness training for all staff
- must provide specialist autism training for key staff, such as GPs and community care assessors
- cannot refuse a community care assessment for adults with autism based solely on IQ
- must appoint an autism lead in their area
- have to develop a clear pathway to diagnosis and assessment for adults with autism
- need to commission services based on adequate population data.
Paul Burstow, Minister for Care Services, said: “It is unacceptable that adults with autism have not been getting the full and appropriate care and support that they need from health and social care services. [This] is a vital step forward in changing that picture.
“This government has set the direction of travel and it is now important that local commissioners and providers recognise this and identify where improvements need to be made. We will continue to review progress and will also look to publish key quality outcomes to drive improvements across the public sector shortly. This will build on today’s statutory guidance for health and social care services and will address employment, housing and other public service issues for adults with autism”.
Mark Lever, chief executive of The National Autistic Society, warned that as councils set their budgets, they need to take account of the new legal duties coming into force under the Autism Act. People with autism should not be allowed to continue to fall between the gaps in services, he added.
Lever said: “Now more than ever, they and their families need support. One third of adults with autism have developed a serious mental health problem as a result of a lack of support, and families tell us that they are often left struggling to cope. We are now at a pivotal point and must push to see this strategy turned into action”.
The NAS has developed a central online resource to support health and social care professionals in the implementation of the strategy. This information can be found here. www.autism.org.uk/autismstrategy
- Details
- Written by: Sean Clement
- Category: Healthcare Features
- Hits: 1130
The Legal Services Commission breached the Public Contract Regulations 2006 during its tenders for public law and high security mental health hospitals work but will not have to re-run the exercise, a High Court judge has ruled.
Two law firms, Public Interest Lawyers and RMNJ, had brought the challenge, backed by ten other practices.
Mr Justice Cranston ruled that:
- The verification carried out by the LSC to check the quality standards of those firms awarded contracts was flawed. “In particular the process has not allowed the Legal Services Commission to verify that firms meet these criteria in relation to the employment of appropriate supervisors set out in the 2010 Standard Civil contract,” which offends against the principle of equal treatment under the 2006 Regulations
- It was appropriate – to ensure that unfairness caused to successful tenderers who do meet the relevant criteria is remedied – for the LSC to ensure that, within a limited period, all firms holding contracts in public law and mental health comply with the supervisions standards. “Those that found not to comply must have their contract removed. Any new matters starts need to be redistributed pro rata to those firms who do meet the verification requirements”
- There could be no challenge under the general disability equality duty to the process of awarding the contracts for legal advice for mental health patients in high security hospitals, but that duty was engaged because of the outcome of the process. The fact that many patients may need to switch advisers as a result of the tender may “have an adverse impact on those already vulnerable”. Under s. 49A of the Disability Discrimination Act 1995, the LSC must have due regard to whether they need to take steps to ameliorate that result of the contracting exercise
- There was no legal flaw in the way the LSC conducted the tender for the award of public law contracts – there was no breach of its duty under section 4 of the Access to Justice Act 1999. Those specialist public law firms that are no longer able to open the advice cases they did under the 2007 Standard Civil contract, are not precluded from undertaking under certificate publicly funded litigation “which they have done in the past, and which has been such a notable feature of the work of this court”.
A Legal Services Commission spokesman highlighted the fact that the challenges had failed to overturn any of the LSC’s tender decisions.
He added: “The judge found that the LSC’s tender process did not breach the Disability Discrimination Act, and his judgment confirms that we met our legal obligations under the Access to Justice Act. We are pleased that the uncertainty caused by this litigation has ended.
“However, we accept the court’s criticism of the verification process for our supervisor standards in public law and mental health. We are currently reviewing what additional verification needs to be undertaken as a result and will publish details on our website in due course.”
Saimo Chahal, partner at Bindmans, claimed the judicial reviews had highlighted “once again” the shortcomings in the LSC’s tender processes.
She said: “These two firms with 10 firms standing behind them had always made clear that they were concerned with the impact of the tendering processes on their vulnerable clients and that they were litigating in the public interest. This was accepted by the Court when it granted a protective costs order to the claimants – the first PCO involving law firms in this type of situation. The court observed that these firms were not motivated by commercial interests but were litigating on issues of significant public interest.
“I hope that the LSC will now see sense and agree the steps which have to be taken in order to rectify the flaws highlighted in the tendering processes. If the LSC does not agree to rectify the flaws, then we will be seeking appropriate orders on 21 December."