| Medical
directors' bulletin
Welcome to the latest e-bulletin for medical directors. It aims to provide
a practical summary of NHS developments, with access points for further
information. Please tell us of any improvements you’d like to see.
Please send feedback to jeffrey.graham@doh.gsi.gov.uk
Problems accessing information
CONTENTS
Take action
1. Health care-associated infections
2. Clinical negligence
3. Chlamydia screening
4. Multiple sclerosis specialist nurses
5. Patient choice - information about consultant-led services
on www.nhs.uk
Recent news
6. Department of Health annual report
7. Department of Health restructuring
8. Earned autonomy freedoms
9. Consultant contract
10. GMS contract
11. Public health
12. Tackling health inequalities
13. Change agent team annual report
14. Organ retention
15. Diagnosis and treatment centres
16. Action On projects
17 New emergency care web pages
18. Programme budgeting
19. Mental incapacity
20. Mental Health Review Tribunal
21. Learning and research review
22. Domiciliary oxygen provision
23. Walking talk
24. Neurological services
National standards and guidance
25. Doctors' hours
26. Consultant appraisals
27. Patient choice
28. Pharmacy vision
29. Dignity at work
30. Latest NICE guidelines
31. Transplant framework
32. International recruitment
33. Humanitarian toolkit
34. Diagnosis tool for cancelled operations
35. Diabetes technology appraisals
36. Exploitation of NHS intellectual property
Safety notices
37. Medical devices
38. Medical device alerts
39. Safety notice
Diary
40. Reducing cancelled operations
TAKE ACTION
Health care-associated infections
Chief nursing officer (CNO) Sarah Mullally and chief medical officer (CMO)
Sir Liam Donaldson have written to all trusts to extend monitoring to
serious bloodstream infections caused by glycopeptide-resistant enterococci.
They also request that serious infection-related incidents, such as hospital
outbreaks of gastroenteritis, are reported. From July, surveillance information
on methicillin-resistant staphylococcus aureus (MRSA) are being used as
a basis for a performance management indicator. The CNO/CMO letter (PL
CNO 4 2003) is at www.doh.gov.uk/cmo/letters/cmo0304.htm
Top
Clinical negligence
Chief medical officer Sir Liam Donaldson has recommended the establishment
of an NHS Redress Scheme to be managed by NHS trusts. Details on the proposals
and how to respond to the consultation are at www.doh.gov.uk/makingamends/
Contact: shain.marr@doh.gsi.gov.uk
Top
Chlamydia screening
Expressions of interest for phase II of the programme are being invited.
Phase I - outlined in the national sexual health strategy - is already
underway.
The second phase will look at extending screening to young women as well
as promoting greater uptake of testing amongst men in non-traditional
settings.
More at www.doh.gov.uk/sexualhealthandhiv/chlamydia.htm
Closing date for applications is 29 August.
Contact: sally.anderson@doh.gsi.gov.uk
Top
Multiple sclerosis specialist nurses
A central budget to support implementation of the MS risk-sharing scheme
2003-2006 is available for the period 2003-2006. The central budget will
provide additional MS specialist nurses and other nursing support. PCTs
and their designated prescribing centres are invited to bid for funding.
Further information regarding the application process is at www.doh.gov.uk/cebulletin/msnurse.htm
Contact: pat.noons@doh.gsi.gov.uk
or 0207 972 4200
Top
Patient choice - information about consultant-led
services on www.nhs.uk
Delivering the NHS Plan describes how explicit patient choice will be
progressively introduced across the NHS. Since September 2002 the nhs.uk
web site has provided online access to:
- prospective information on waiting times
- from all acute trusts
- by consultant
- by inpatient, outpatient and day case
- by specialty
- updated on a weekly or monthly basis
The database has now been extended to include non-acute trusts (mental
health, community and PCTs) that provide consultant-led services.
Consultants in these trusts should be reminded that information about
them is being used this way. We would be grateful if you could make sure
that your consultants are reminded.
Further information is available on the Department of Health website
at www.doh.gov.uk/nhsplanbookingsystems.
Alternatively please contact Corinne McDonald at the Department of Health
on 0113 254 7359 or corinne.mcdonald@doh.gsi.gov.uk
RECENT NEWS
Department of Health annual report
The 2002-2003 report sets out the aims and objectives of the department.
It covers business areas for which the department is responsible: public
health, the NHS, social care and departmental management, the resources
committed to each area, results being achieved and priorities for the
future.
More at www.doh.gov.uk/dohreport/
Contact: jonathan.hey@doh.gsi.gov.uk
or karl.payne@doh.gsi.gov.uk
Top
Department of Health restructuring
The department has embarked on a change programme designed to provide
more effective leadership to the NHS and social care. The department's
overall purpose remains unchanged - to support the Government to improve
the health and well-being of the population. The department's new structure,
board of directors and a timetable for change, are at www.doh.gov.uk/cebulletin/change.htm
Contact: andrew.millward@doh.gsi.gov.uk
Top
Earned autonomy freedoms
Earned autonomy freedoms have been announced by the Department of Health,
following the publication of annual NHS performance ratings in July. These
are available to three and, in some cases, two-star acute, specialist,
primary care, mental health and ambulance NHS trusts. These freedoms are
a package of rewards for NHS organisations that are performing well. These
include an additional capital bonus of between £250,000 and £1
million for all three star trusts, depending on turnover.
More at www.doh.gov.uk/performanceratings/2003/
(click on the bottom link Performance Ratings 2002-2003 background
information).
Contact: david.stocks@doh.gsi.gov.uk
Top
Consultant contract
An agreement over the future introduction of a new contract for consultants
in the NHS has been reached. The British Medical Association (BMA) and
the Department of Health have agreed a way forward for introducing the
contract which was rejected by consultants last year. There is now a formal
agreement that consultants will not be forced to do non-emergency work
at evenings or weekends. Rules will also be standardised on the extra
hours consultants will work for the NHS before taking up private practice
work.
More at www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0271?OpenDocument
Top
GMS contract
GPs have voted to accept a new general medical services (GMS) contract.
PCTs need to prepare now to ensure the contract is fully implemented in
all GMS practices from April 2004, with some elements in place beforehand.
A letter to PCT chief executives sets out what the contract means for
PCTs. It is at www.doh.gov.uk/gmscontract/implementation.htm
More at www.doh.gov.uk/gmscontract
Contact: Susan Devlin on 0113 254 6881 or gmscontract@doh.gsi.gov.uk
Top
Public health
Chief medical officer Sir Liam Donaldson's annual report highlights five
areas of concern - the health risks from passive smoking; West Nile virus;
obesity; poor clinical performance; and safe injections. He also reviews
progress made in tackling health inequalities, high blood pressure, E.coli
0157, epilepsy and alcohol and liver cirrhosis. On the State of the
Public Health is at www.doh.gov.uk/cmo/annualreport2002
Top
Tackling health inequalities
A programme for action sets out a three-year plan to tackle health inequalities,
improve life expectancy and cut infant deaths.
More at www.doh.gov.uk/healthinequalities/programmeforaction/
Copies of the programme can be ordered by e-mail at doh@prolog.uk.com
quoting reference number 32366).
Top
Change agent team annual report
The first annual report has been published on the work of the health and
social care change agent team in reducing the number of delayed discharges.
In 25 areas where the team has been working, there has been an average
drop of 24 per cent in delayed discharges against a national average reduction
of 14 per cent. The report includes areas of good practice.
More at www.doh.gov.uk/changeagentteam/changingplaces.pdf
Contact: change_agent_team@doh.gsi.gov.uk
Top
Organ retention
The CMO has published his response to the Isaacs Report which investigated
the case of the Cyril Isaacs, whose brain was retained for research without
consent after a post mortem. In April, the Department of Health published
an interim framework on organ removal and retention. Following consultation
on the framework the Government will be bring forward a new Human Tissue
Bill.
The CMO's response is at www.doh.gov.uk/cmo/isaacsreport/response
Interim guidance and support published in April is at www.doh.gov.uk/tissue
Top
Diagnosis and treatment centres
A report detailing the progress of the diagnosis and treatment centre
programme has been published. Diagnosis and Treatment Centres - A New
Service Model is at www.modern.nhs.uk/dtc
Top
Action On projects
A series of pilots are to explore ways of modernising and speeding access
to general surgery in the NHS. Sixteen sites across England have been
awarded Action On pilot status and will each receive £90,000
over the next 18 months to redesign services.
More information at www.modern.nhs.uk/action-on
Top
New emergency care web pages
The Department Of Health's emergency care web pages have been updated
to reflect current work programmes and to provide a useful source of reports,
guidance and toolkits.
The site is at www.doh.gov.uk/emergencycare/
Please send feedback on what you think about the website to emergencycare@doh.gsi.gov.uk
Top
Programme budgeting
The national Programme Budget Project, launched last year, aims to provide
information which can be used to give a greater understanding of 'what
we are getting for the money invested in the NHS.'
This will be achieved by mapping all PCT expenditure to programmes of
care based on medical conditions.
More at www.doh.gov.uk/natprogbudget/index.htm
For further information e-mail andrew.clapperton@doh.gsi.gov.uk
Top
Mental incapacity
A draft bill has been published by the Department for Constitutional Affairs
for pre-legislative scrutiny by a joint committee of both Houses of Parliament
over the summer. More at www.doh.gov.uk/cebulletin/mibillletter.htm
Top
Mental Health Review Tribunal
Proceedings for judicial review and complaints will be handled at MHRT
headquarters at Wellington House rather than regional offices. The secretariat
will be responsible for a central database of complaints and judicial
reviews. Address for correspondence is Mental Health Review Tribunal Secretariat,
Room LG04, Wellington House, 133-155 Waterloo Road, London SE1 8UG. Tel:
020 7972 4577 Fax: 020 7972 4884.
Top
Learning and research review
A joint ministerial review provides an opportunity to gather opinion on
the responsibilities of PCTs in supporting learning and research across
health care professions in the NHS.
More at www.doh.gov.uk/hrinthenhs/learning/section4a/jointminreview.htm
and www.matrixrcl.co.uk/survey/
Contact: helen.jenkins@doh.gsi.gov.uk
Top
Domiciliary oxygen provision
PCTs have been asked to review the number and provision of oxygen 'sets'
in their locality. This follows plans to introduce an improved service
for the provision of domiciliary oxygen.
More at www.doh.gov.uk/oxygen/oxygensets.htm
Contact: peter.dunlevy@doh.gsi.gov.uk
Top
Walking talk
Department for Transport has issued a discussion paper - On the Move:
By Foot - emphasising the role of walking in improving health and
preventing disease.
More at www.local-transport.dft.gov.uk/consult/walking/index.htm
Top
Neurological services
The Neurological Alliance has published a patient information booklet
Getting the best from neurological services: a guide for people affected
by conditions of the brain, spine and nervous system.
It is at www.neurologicalalliance.org.uk
Top
NATIONAL STANDARDS AND GUIDANCE
Doctors' hours
New guidelines to help NHS trusts comply with the European Working Time
Directive (EWTD) by next summer have been issued. Strategic health authorities
have been asked to ensure that every hospital prepares local action plans
by the end of the year. Under the new regulations, junior doctors should
work a maximum 58 hours a week by August 2004. New restrictions on rest
periods are also being introduced. The NHS Modernisation Agency will be
providing support to trusts. Priority will be given to hospitals facing
EWTD challenges when 1,500 additional locally funded specialist registrar
training opportunities are allocated later this year.
More at www.doh.gov.uk/workingtime/
Top
Consultant appraisals
In response to demand from the NHS, a consultant-specific online appraisal
toolkit has now been launched.
The toolkit represents an interim version of the fully interactive toolkit
launched for GPs last November and offers a guide to appraisal and an
electronic version of the appraisal forms.
The fully interactive toolkit for NHS consultants will be available in
the autumn. Similar appraisal toolkits for other groups of doctors will
be available in due course.
The toolkit is at www.appraisals.nhs.uk
Contact: John Cowles on 0113 254 5910 or e-mail apprcom@doh.gsi.gov.uk
Top
Patient choice
New guidance on providing patients with a choice of hospital has been
published.
This will help the NHS to achieve the target of ensuring, by summer 2004,
that all patients waiting more than six months for elective surgery will
be offered the choice of moving to another hospital for faster treatment.
By December 2005, patients should be offered four to five choices of hospital
at the point of GP referral. Strategic health authorities are being asked
to prepare implementation plans by September.
More at www.doh.gov.uk/choice/
Contact: jonathan.marron@doh.gsi.gov.uk
Top
Pharmacy vision
The Government has announced a new package of measures to improve the
quality of services offered by pharmacists. Under the proposals, pharmacists
will have the opportunity to review medication and advise on the best
use of prescriptions.
A Vision for Pharmacy in the NHS is at www.doh.gov.uk/pharmacyvision
Top
Dignity at work
From December, it will be illegal to discriminate on grounds of sexual
orientation in the workplace. Guidelines are at www.gladd.dircon.co.uk/iwl.htm
Top
Latest NICE guidelines
The National Institute for Clinical Excellence (NICE) has published guidelines
on:
- infection control - prevention of health care-associated infection
in primary and community care
- head injury - assessment, investigation and early management of head
injury in children and adults
- pre-operative tests - the use of routine pre-operative tests for
elective surgery
- heart failure - the management of chronic heart failure in adults
in primary and secondary care
The guidance is at www.nice.org.uk
Contact: martin.teff@doh.gsi.gov.uk
or 0113 254 5972
Top
Transplant framework
Saving Lives, Valuing Donors - a Transplant Framework for England
sets out key aims for organ and tissue transplantation over the next ten
years. NHS organisations may wish to review their services in line with
national and international good practice.
More at www.doh.gov.uk/transplantframework/
Contact: triona.norman@doh.gsi.gov.uk
or on 020 7972 4921
Top
International recruitment
A Code of Practice for ethical overseas recruitment has been published
by the Department of Health. It is essential that international recruitment
fills its proper place in staffing the NHS and is not done to the detriment
of countries experiencing staffing difficulties. The NHS does not recruit
from countries that cannot afford to lose staff.
More at www.doh.gov.uk/international-recruitment/index.htm
Top
Humanitarian toolkit
A toolkit aimed at NHS staff who wish to carry out vital humanitarian
work overseas has been produced.
International Humanitarian and Health Work: Toolkit to Support Good
Practice raises awareness of the issues surrounding the release of
NHS health professionals to work in developing countries.
It also shows benefits that such work can bring to individuals' professional
development, the NHS and its patients. Case studies of NHS staff involved
in such projects are also being published.
More information at www.doh.gov.uk/internationalhumanitarianandhealthwork/index.htm
Top
Diagnosis tool for cancelled operations
A tool to diagnose why operations are cancelled is available. The tool
produces reports with run charts for use by boards, theatre management
groups and clinical directorates. Detailed analysis on the main reasons
and sources of cancellations is possible.
More at www.modern.nhs.uk/theatreprogramme
Top
Diabetes technology appraisals
Management guidance has been issued on how to implement the recommendations
in:
- NICE Appraisal No 57 - guidance on the use of patient-education models
for diabetes
- NICE Appraisal No 60 - guidance on the use of continuous subcutaneous
insulin infusion for diabetes
The guidance is available at www.doh.gov.uk/nice/fundingdirections/index.htm
Contact: jaimie.cross@doh.gsi.gov.uk
or on 0113 2545624
Top
Exploitation of NHS intellectual property
The Office of Science and Technology has published guidelines for applications
to the second round of the public sector research establishments fund.
A total of £15 million is available to create and enhance capacity
in intellectual property management. More at www.ost.gov.uk/enterprise/knowledge/index.htm
Contact: tony.bates@north-bristol.swest.nhs.uk
or tony.bates@doh.gsi.gov.uk
or on 0117 9595387
Top
SAFETY NOTICES
Medical Devices
MHRA DB2003 (05) - management of medical devices prior to repair, service
or investigation. The bulletin updates the information previously provided
in HSG (93) 26 and MDA SN9516. More at www.mhra.gov.uk
In vitro diagnostic medical devices (IVD) directive: in house manufacture
- applicability of IVD directive and regulations to IVD test kits manufactured
and used within health institutions. More at www.mhra.gov.uk
(under latest news). Contact: Steve.Owen@mhra.gsi.gov.uk
Top
Medical device alerts
MDA/2003/017 - Vygon intravenous extension lines with a white slide clamp-octopus
and single bionector with extension, issued on 8 July for immediate action.
MDA/2003/018 - expanding haemostatic agents and expanding tissue sealants,
issued on 17 July for action
MDA/2003/019 - re-useable stainless steel vaginal specula, issued on 18
July for action
MDA/2003/020 - central venous catheters, including dialysis catheters,
dilators and guidewires, issued on 21 July for action
More at http://devices.mhra.gov.uk/
Top
Safety notice
Fire extinguishers risk safety notice NHSE SN (2003) 04 - loss of fire
fighting capability due to internal component failure. More at www.nhsestates.gov.uk/healthcare_eng_science/index.asp
(click on safety & hazard notices)
Top
DIARY
Reducing cancelled operations
A one-day conference will be held on 12 November for all staff who have
an interest in operating theatres and pre-operative assessment. This will
introduce delegates to fresh thinking on optimising capacity for day and
inpatient surgery. Plenary sessions and workshops will explore the benefits
of employing teams from abroad, effective use of day and inpatient surgery,
increasing bed capacity through pre-operative assessment and the theory
of constraints.
Contact: kelly.giles@npat.nhs.uk
or on 0116 2225146
This conference is organised by the NHS Modernisation Agency's operating
theatre and pre-operative assessment programme.
More at www.modern.nhs.uk/theatre/
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