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Medical
directors' bulletin: April 2002, Issue 10
Welcome to the latest edition of the bulletin for Medical Directors. It provides a practical summary of the latest developments in the implementation of the NHS Plan and in your area of work in the NHS - keeping you up to date as well as providing access points for further information. Please help us make this bulletin as useful as possible by telling us of any improvements you'd like to see. Please send feedback to jgrahao@doh.gsi.gov.uk Contents N.B. Items marked * have not previously appeared in other Department of Health bulletins. Guest editorial by Prof Mike Richards, national clinical director for cancer* Trust issues:
The new NHS:
For information:
Safety issues: Events: Guest editorial From Prof Mike Richards, National Clinical Director for cancer The NHS Cancer Plan was published in September 2000 and builds on the recommendations of the Calman-Hine report (1995). The Plan has four key aims: to save lives; to improve patients' experience of care; to reduce inequalities and to build for the future. It sets out the actions that are needed to improve prevention and screening services, reduce waiting times, improve diagnostic treatment and palliative care services and enhance research. I hope that medical directors will seek to encourage the on-going implementation of the Cancer Plan. In particular, I am keen to encourage you to become involved in the work of the Cancer Networks. There are 34 established cancer networks across the country, helping organisations improve work on cancer across institutional boundaries; the full involvement of both Primary Care Trusts and Acute Trusts will be essential to the success of these networks. Reducing waiting times between referral and treatment for cancer patients is a major focus of current activity. The two week target for first assessment of patients referred urgently is now being achieved in around 95% of cases. The Cancer Services Collaborative project is showing how much can be achieved in terms of streamlining the pathway through diagnosis to treatment. It is an excellent example of 'reforming the NHS'. One of our key priorities now is to collect information on waits for all patients with cancer. I would ask for your assistance and support in achieving this. The guidance (HSC 2002/005) is available at http://www.doh.gov.uk/cancer/ Within the next few weeks we will be publishing two important reports on cancer. The first is a national overview of the findings from the peer review assessments of cancer services undertaken last year. The second is the National Cancer Patient Survey, which follows on from previous surveys on primary care and coronary heart disease. There is no doubt that we are making progress on cancer, but it is equally true that we still have a long way to go. Thank you for your support. The NHS Cancer Plan is available at: http://www.doh.gov.uk/cancer/cancerplan.htm Trust issues All tissue banks that store or process human tissue for therapeutic use within the UK health service must be accredited by the Medicines Control Agency by 31 March 2003. The MCA is currently inspecting banks to determine whether they comply with the standards set out in A Code of Practice for Tissue Banks: providing tissues of human origin for therapeutic purposes (www.doh.gov.uk/humantissuebanking/). There is no fee for tissue banks joining the accreditation scheme up to March 2003. To date, however, applications have been slow. Since the MCA will not be able to process a large number of last-minute applications, and since many banks will have to make some changes to comply with the code, all tissue banks are being asked to contact the MCA for an application form immediately. Forms and further details are available from Tissue Bank Accreditation, MCA, Room 17/101 Market Towers, London SW8 5NQ. Action on cancer waiting times New guidance focuses on further action that needs to be taken towards delivering the targets of the NHS Cancer Plan. It describes the new locally-driven approach; sets out the timescales and arrangements for the introduction of monitoring waiting times for cancer treatment; and sets out action for Trusts and their partners. See Health Service Circular 2002/005 Consultants' fixed and flexible sessions The Department of Health has been asked to clarify the circumstances under which additional payments may be made to consultants for extra work - for example, waiting list initiatives. Essentially this covers work not covered by the consultant's standard contract of employment.
Any queries should be directed to jonathan.firth@doh.gsi.gov.uk State-registered pathology staff Clinical Pathology Accreditation (UK) Ltd, which conducts peer-review inspections of medical laboratories to assess compliance with quality standards, has raised a worrying trend: the employment of non-state registered staff to undertake duties associated with a registered title. CPA has the right to refuse a laboratory accreditation on these grounds. Trusts are therefore reminded to ensure that all new staff in state registered posts have their CPSM numbers and respective registration documents checked, and be found suitably fit to practise. For further information, please contact Paul Clegg in the Department of Health's Pathology Modernisation team, tel 020 7972 4302 or email paul.clegg@doh.gsi.gov.uk A guide to implementation of the government's plans for extending prescribing responsibilities to more nurses has been published. See www.doh.gov.uk/nurseprescribing/implementationguide.htm The new NHS The merged health authorities (soon to be Strategic Health Authorities, subject to legislation) came into being on 1 April, together with other structural changes brought about through Shifting the Balance of Power. Full details of key changes can be found on the NHS Web at nww.doh.nhsweb.nhs.uk/shiftingthebalance/arrangementsapril2002.htm The following items in this section concern these changes and their impact on other services. Interim arrangements are in place to ensure a smooth continuation of the complaints procedure during the transition period of structural reform in the NHS. See www.doh.gov.uk/complaintshandling.htm Role of older people's regional taskforces The chairs of the Regional Older People's Taskforces have issued a note to clarify the current position. It has been agreed that: Members of the regional taskforces will, where possible, remain as champions for the older people's programme Regional taskforces will remain in existence until at least October 2002, when membership and function will be reviewed The model for the future will be for regional taskforces to cede to Strategic Health Authorities, from whom they will receive support. Other models might develop, depending on local circumstances. For further details, contact Veronica Monks, tel 020 7972 4280, email veronica.monks@doh.gsi.gov.uk Joint investment plans for older people/intermediate care The NHS will no longer be required to produce older people's or intermediate care joint investment plans (JIPs). This change reflects the new accountability arrangements under Shifting the Balance of Power, as well as the Department of Health's commitment to reduce the health and social care planning burden. For further information contact Kevyn Austyn, tel 020 7972 4829, email kevyn.austen@doh.gsi.gov.uk The first four Care Trusts were launched on 1 April in Northumberland, Bradford, Manchester and Camden & Islington. These new organisations are able to commission and/or provide all health-related local authority functions, including some aspects of housing and education. They support the government's objective of a single strategic approach across health and social care to the management of individual care. Anyone interested in joining a collaborative group exploring the Care Trust option should contact John Mann at John.Mann@doh.gsi.gov.uk. Further details at www.doh.gov.uk/caretrusts For information Nationally commissioned services Three additional services were brought into the National Specialist Commissioning Advisory Group portfolio from April. They are:
These services will be nationally planned, funded and monitored by the Department of Health. Each service will be provided from designated NHS Trusts. Patients requiring these services should not be treated elsewhere unless in a shared care arrangement with a designated unit. Further details at www.doh.gov.uk/nscag/newservices.htm Responsibility for assessing the safety and efficacy of new interventional procedures has been moved to the National Institute for Clinical Excellence (NICE). This change was part of the Department of Health's response to the Kennedy report recommendations. NICE is consulting on the process for assessment and how this new function will sit within its structure. The consultation exercise will continue till July. Details at www.nice.org.uk NICE has issued the following guidance over the past three weeks:
This rapid sequence of guidance is the result of appeals and the need for additional evidence, which delayed some appraisals. Health authority drugs education and prevention funding 2002/3 Health authorities are to receive a one-off addition to their drugs education revenue resource limit. The boost is to help authorities implement the NHS Plan requirement to work with other local agencies to reduce by 25% the number of under-25s reporting the use of class A drugs by 2005. See www.doh.gov.uk/drugs/preventionfundingmar02.pdf Ten health and social care communities have been selected for inclusion in the first six months of the work programme of the Change Agent Team on delayed discharges. New expressions of interest or re-submissions have now been invited from directors of social services and chief executives of strategic health authorities for the second phase in the autumn. Diabetes National Service Framework The Department of Health is developing a generic proforma for baseline assessment of population need, in readiness for implementation of the Diabetes National Service Framework. The proforma could be adapted for local use. It will be available on the Diabetes NSF website (www.doh.gov.uk/nsf/diabetes) from May. Any queries should be addressed to E.Goyder@sheffield.ac.uk In response to a demand from healthcare professionals, the Department of Health has recently issued the latest version of the Performance Analysis Toolkit (PAT) to NHS Trusts, Primary Care organisations and Health Authorities. PAT is a benchmarking tool that provides analysis of national inpatient data and has been designed to support primary care organisations in the commissioning of secondary care services. Version 2.0 of PAT is available on CD-ROM and holds anonymised practice level data on separate diskette. For further information on the toolkit, please contact Dr Shaleel Kesavan on 0113 2545954, email: shaleel.kesavan@doh.gsi.gov.uk To obtain a copy of the latest version, please contact Tamara Newman by email at tamara.newman@doh.gsi.gov.uk For technical queries, please contact Mark Light at the NHS Information Authority, tel 01962 810719, email Mark.Light@nhsia.nhs.uk Mental Health Review Tribunal biennial report The biennial report of the Mental Health Review Tribunal outlines the number of applications received and heard, details of the membership and a report on service costs. See www.doh.gov.uk/mentalhealth/mhrtreport.htm Protection of vulnerable adults list The implementation of the new Protection of Vulnerable Adults (PoVA) list has been delayed from April 2002 till August 2002. PoVA is being set up to ensure that people who have abused or mistreated vulnerable adults in their care do not find their way back into such positions again. Full guidance on the operation of the list will be issued before August 2002. Screening: promoting informed choice for women The NHS Cancer Plan stated that people invited for screening need to understand the potential benefit and harm, so as to be able to make an informed choice about whether to proceed. In October 2001, the NHS Cancer Screening Programmes launched information leaflets to this end on breast and cervical screening. Talking Newspapers have now helped to transcribe these leaflets into an audio format, and the Royal National Institute for the Blind has developed an English Braille version. The leaflets have also been translated into five languages: Gujarati, Punjabi, Urdu, Bengali and Chinese (Cantonese). Italian, Spanish, Vietnamese, French, Farsi, Arabic, Hindi, Somali, Polish, Turkish, Greek and Ukranian versions of the leaflets will be available from the screening programme's website shortly at www.cancerscreening.nhs.uk Dr David Graham, Postgraduate Dean of Merseyside Deanery, has been appointed chair of a steering group to oversee the implementation of appraisal for all doctors in the NHS. The steering group will ensure that the appraisal process is uniform for the different groups of doctors and across NHS organisations. Safety issues Safe administration of intrathecal chemotherapy Several questions have been raised since the publication last year of national guidance on the safe administration of intrathecal chemotherapy. To ensure national consistency, a Q&A has now been prepared. The Q&A is at www.doh.gov.uk/intrathecalchemotherapy/qa.htm The original guidance is at www.doh.gov.uk/intrathecalchemotherapy/ The National Blood Service has produced a video to highlight the most common causes of error in blood transfusion. Hugh Laurie plays six different hospital characters and Imelda Staunton plays two different patients. Both donated their services. The video is intended as a training vehicle for all hospital staff, ideally for use at induction. All hospitals supplied by NBS have had a copy sent to their blood transfusion department. To buy further copies at £10 each, contact usha.mistry@nbs.nhs.uk Trust chief executives have been reminded to ensure that arrangements for disseminating urgent hazard notices are robust. The warning follows a review by the Medical Devices Agency of arrangements for getting such information to individual clinicians and others. The MDA also carried out an audit to see how quickly a hazard notice on single-use electrosurgical (diathermy) forceps for tonsil and adenoid surgery was seen by liaison officers and others. It found that arrangements in some Trusts did not work as well as they ought.
MDA safety warnings are no longer sent to health authorities for onward distribution, following the disestablishment of the existing health authorities on 1 April. Distribution of warnings to medical device users in primary care will continue to be the responsibility of Primary Care Trusts. The National Care Standards Commission has taken over responsibility for distributing safety warnings to private and voluntary healthcare providers.
For full details of these recent safety notices, see www.medical-devices.gov.uk
Events The milestones for physical activity and exercise in the National Health Service are the subject of a special conference for chief executives and directors of public health in London on 20 May. A programme and invitation letter are at www.health-links.co.uk/physicalactivity Resource pack at www.doh.gov.uk/drugs/resourcespack.htm 360 degree feedback in the NHS The 360.co.uk are planning a forum on 360 degree feedback in the NHS, to be held in central London in late May. The forum will explore the possibilities for 360 degree feedback in the NHS, and will give delegates the opportunity for input into the development of their internet-based 360 system. See www.the360.co.uk/nhs/ To book a free place, email Jane Coomber at jec@the360.co.uk. To find out more visit www.the360.co.uk/forum.html. For ideas and advice on 360 degree feedback, including best practice, email info@the360.co.uk.
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