Employment Support for People with Mental Health Problems

People with mental health problems will be provided with extra support to enable them to secure and retain employment, Jim Knight, Minister for Employment and Welfare announced on 7^th December 2009.

Work, Recovery and Inclusion is a new government delivery strategy that sets out a series of actions that will help meet the aspirations of people in contact with secondary mental health services who want to work.

Equality Bill - Key Amendments

The Equality Bill, passed by the House of Commons on 3rd December 2009 will now be scrutinised before the House of Lords, and is expected to become law in 2010.

Two major amendments have been added to the bill.  Firstly, the new socio-economic duty for public sector organisations will now also apply in Scotland.  Secondly, the bill will restrict employers' use of pre-employment questionnaires about health or disability during the recruitment process.  This restriction will address concerns raised by disability organisations that, because there is no restriction under the Disability Discrimination Act, there is a fairly widespread use of such enquiries by employers to discriminate against people who declared a disability by not selecting them for interview or other selection stages.

The amendment will prevent employers form asking candidates questions about their health until after they have shown they meet some of the non-health criteria of a job.  There are some exceptions however, such as where enquiries are in order to make reasonable adjustments to the recruiting process, are for diversity monitoring or to support positive action.

CBE Honour for Head of Equality, Diversity and Human Rights

Professor Carol Baxter, Head of Equality, Diversity and Human Rights at NHS Employers, received a CBE from Prince Charles on 3rd December 2009.

Professor Baxter's role includes providing legal guidance and publications, representing the combined views of NHS trusts to government and sharing the knowledge and techniques of the NHS' best exemplars of equality.  Passionate about equality, diversity and human rights, she is currently building a body of evidence for how they make businesses more effective, with the aim of making these issues more prominent in the boardroom.

NHS Winner of Britain's Best Boss

Debbie Hinton, a Country Audiology Services Manager at Worcestershire Acute Hospitals NHS Trust, has won this year's Britain's Best Boss Award for her exemplary skill at encouraging flexible working patterns and job roles.

Ms Hinton was nominated by several of her 48-strong team, who provide services for people with hearing problems in four hospitals and several satellite clinics across Worcestershire.  Accepting the award on 26^th November, 2009, she said, I have promoted a culture where my staff feel comfortable requesting a change to their hours and working patterns.  This has been a 'win-win' strategy for everyone and we have been able to offer extra clinics to our patients as a result.  Staff retention, timekeeping, productivity and general levels of motivation have all significantly improved.

Britain's Best Boss is run by Working Families.

Legislation Guide Published by NHS Employers

NHS Employers published a new online guide to equality and diversity legislation for employers on 26^th November 2009.

Equality and Diversity Legislation: at a glance summarises what the current key UK legislation is, what employers need to do and the potential issues for organisations.  It also has shared learning from trusts and sources of further information, including the full legal texts.  Practical tools and tips to support trusts on key implementation issues such as diversity monitoring, carrying out equality impact assessments and developing single equality schemes are included, all from the employment perspective.

EHRC to assess SHAs and PCTs

In November 2009, Healthcare Equality Partners learned that the EHRC was seeking to commission work to assess the compliance and performance of Strategic Health Authorities and Primary Care Trusts in implementing the equality duties.  The focus for assessment is to be the equality of equality schemes, equality impact assessments and data collection, as indicators of whether the bodies are meeting its general duties.

The assessment methodology moves the focus from the content of equality schemes to the achievement of equality outcomes through sufficient actions as key measures of performance.  This well include health equality outcomes such as increasing the reate of early diagnosis of diabetes within Asian communities, the number of men attending GP surgeries, or the percentage of patients with a learning disability receiving health checks, as well as reducing the gender pay gap.  Causal links between equality schemes and mainstream plans and actions, for example, service quality reviews and estate planning, will also be assessed.

Data gathering and reporting is expected to take place from January/February 2010, with reports on individual authorities and trusts to be submitted to the Commission on an ongoing basis.

Violence Against NHS Staff in England

On 16^th November 2009, The NHS Security Management Service published the annual reported physical assault figures against NHS staff.  It reports, a total of 54,758 physical reports were reported during 2008-9 on NHS staff working in all care sectors.  This represents a decrease of 1,235 reported assaults compared with the figure for 2007-8.

The report states that the NHS is not complacent about the improvement in the figures as it is believed there are still incidents which go unreported.  NHS staff are told they should not accept violence as part of their job and are encouraged to report physical assaults and support action against offenders.

NHS Doctors' Gender Pay Gap: 21%

Women doctors earn, on average, 18% less than their male counterparts, according to the report, Pay Gap for Women in Medicine and Academic Medicine, published by the Medical Women's Federation on 13^th November 2009.

This translates as £15,245 per year and reflects the impact of the much larger proportion of male doctors with salaries in excess of £100,000, in a group consisting mainly of trainees and consultants on NHS and academic contracts.  In academia, women earn 17% less than men whereas women in the NHS earn 21% less than men, but disparities also exist within grades for consultants the gender pay gap is 13%.

Factors that influence and may explain the pay gap include grade, hours worked, experience, administrative roles and specialty.  The report states that control for confounding factors, so that one doctor is compared with another of a similar background, suggest a true gender pay gap amongst consultants of 5.6%, worth £5,500 per annum.

Actual salary data in UK clinical medicine is scarce and this report may help trusts to benchmark their own gender pay gap. 

Improving Medical Careers for Women

Proposals to improve access to childcare, introduce flexible training and improve career guidance are some of the keys outlined in a report looking at ways to help improve the future career prospects of female doctors.

The National Working Group on Women in Medicine, which has its inaugural meeting last month, published a report, Women Doctors Making a Difference, on 14^th October 2009, which highlights current barriers that prevent female practitioners in the medical profession from reaching senior positions and leadership roles.

Baroness Deech, chair of the group, said, There are now more women entering medical school than men.  Our report looks at the obstacles to the full exercise of every doctor's potential - from the decision at school to study medicine, through training, work, maternity leave, childcare, progress through to leadership, retirement and pensions - with special emphasis on the choices and problems that women face.

Beyond Tolerance Report Issued

On 12^th October 2009, The Equality and Human Rights Commission have published Beyond Tolerance, the result of 18 months of research into the experiences of lesbian, gay and bisexual people.  The report includes a section on access to healthcare, describing it as a hit and miss experience based on prejudice, stereotyping and invisibility.  It outlines the new public sector requirements in the Equality Bill, which will promote equality and tackle discrimination based on sexual orientation, and makes some commitments towards helping organisations to improve the experiences of LGB people accessing healthcare services.

First Deaf Male Nurse

A student from the University of Salford has become the first deaf male nurse to enter the nursing register using British Sign Language (BSL). Andrew Maxim graduated from the School of Nursing and Midwifery this September with a Diploma in Mental Health Nursing - only the tenth deaf nursing graduate nationally.

The University reports that one of the biggest challenges deaf people face is a lack of interpreters in practice as well as at university.  Deaf people need to use sign language and lip-reading skills to access the information crucial to their work. 

Safeguarding Vulnerable Groups

The Safeguarding Vulnerable Groups Act 2006, which introduced a centralised vetting system for people working with children and vulnerable adults came into force on 12^th October 2009.  Vulnerable adults are defined to include most disabled people and any adult receiving any form of healthcare.  The full definition can be found in the Government's guidance to the legislation.

The new Independent Safeguarding Authority (ISA) is now operational.  Employees and volunteers who have contact with children and/or vulnerable adults in a regulated or controlled activity will need to apply to register with the ISA and will be assessed using data gathered by the Criminal Records Bureau.  NHS employers need to review their procedures and ensure that the necessary checks are carried out on existing staff and new recruits.  Registration and checking will become mandatory in November 2010.

Guidance For The Care of Older People

The Nursing and Midwifery council has received requests for over 200,000 copies of its documents, Guidance for the care of older people and Care and respect everytime, published in March this year and available free of charge.  The publications, first published in draft form for consultation last year, were produced to help nurses and other healthcare workers to improve standards of care for older people and to inform the public about what they should reasonably expect and what actions they can take to improve poor care.

Abolition of GP Practice Boundaries

On 17^th September 2009, Health Secretary, Andy Burnham, announced plans to abolish GP practice boundaries during a speech about the future of the NHS at the King's Fund.  He said, I want the best to be available to everyone , not according to where they live.  This means extending choice within primary care.  Too often, people's choice of GP practice is unnecessarily limited by practice boundaries.  So, with the profession, I want to open up real choice in primary care.  Within the next twelve months, I want to abolish practice boundaries for patients to allow people to register with the surgery of their choice.

That may mean a practice near work, or in their local neighbourhood from which they are currently excluded by dint of their postcode.  But it means that their practice is based on their needs, not by lines on a map or what is easiest for PCTs.

Extension of Paternity Leave

From April 2011, we will give fathers the right to take up to three months additional paid paternity leave during the second six months of a child's life, if the mother has returned to work.  Announced Gordon Brown during his speech to the TUC's annual conference on 15^th September 2009.

If the plans come into force, fathers -currently entitled to a maximum of two weeks' paid leave - will be able to have up to three months' paid and three months' unpaid leave, and gay couples will also be able to share maternity leave.  The Department for Work and Learning assessed the impact of extended paternity rights and raised concern about the possible poor take-up by fathers.

The Government has postponed provisions to extend statutory maternity pay from 39 to 52 weeks.

Future Funding for Healthcare Students

On 15^th September 2009, The Department of Health launched a consultation on future funding for healthcare students, which has the potential to create a fairer system and ensure support for those in most need.

Only a high quality workforce can deliver high quality care and we need to act now to ensure that future financial support for healthcare students does not produce any barriers to attracting and retaining sufficient, high quality applicants from a diverse range of backgrounds.  Said Ann Keen, the Health Minister.

Currently the NHS offers bursaries to potential nurses, midwives and doctors studying diplomas and degree level courses.  However, the current system provides an incentive for students to opt for an diploma over a degree because they can receive additional funding, which is not means-tested.

Trevor Phillips to Relinquish Some Power

The Times has reported that Trevor Phillips is to relinquish some of his power at the Equality and Human Rights Commission.  The organisation is to be restructured, with a senior leader appointed as a spokesperson on each of the equality strands, meaning Phillips will lose authority over some of the views promoted.

Six of the bodies 17 commissioners resigned this year and Phillips has been criticised for his leadership style.

NMC Steps Up Diversity Monitoring

The Nursing and Midwifery Council is calling on more nurses and midwives to help them with research on the diversity of the profession.  The regulatory body already monitors for age and gender but, from this year, will also be collecting information on ethnicity, disability, sexual orientation and religion or belief.

Equality and Diversity Council Created

On 4^th August 2009, The Department of Health announced the creation of a new Equality and Diversity Council to strengthen the national focus on improving quality in the National Health Service.  Lay members are being asked to join the council which will be chaired by the NHS Chief Executive, David Nicholson.

The council is to provide leadership on Equality and Diversity issues, including reporting on Equality and Diversity to the NHS Management Board, championing improvement and campaigning for change.  The first meeting is to take place in October and adverts for Council lay members who can provide a wider perspective and challenge traditional thinking will appear in the national and trade press in early September.

Report Into Mental Health Trust

It is the responsibility of mental health trusts to promote the health and welbeing of inpatients, protecting them from harm and promoting good outcomes through high quality care, but a Care Quality Commission report into West London Mental Health NHS Trust catalogues various failures in these areas.

Patients with mental health problems are covered by discrimination legislation but the report published on 21^st July 2009, which follows a year-long investigation into high-secure inpatient services at Broadmoor Hospital, as well as community and other inpatient services in Houslow, Ealing, Hammersmith and Fulham, exposed some serious concerns.  These included a failure to properly investigate suicides or to learn from serious incidents, a poor environment with overcrowding and poor physical healthcare and insufficient numbers of staff.  Recommendations are made on a national basis, in addition to those for the Trust concerned.

Addressing Sexual Orientation, Religion and Belief at Work

In July 2009, the CIPD and Acas published work commissioned from the Qualitative Research Unit at NatCen to carry out a deliberative research study on how organisations respond to issues relations to sexual orientation and religion and/or belief in the workplace.  The report focuses on strategies and policies, management issues, conflict resolution strategies, and advice and information needs.  It is illustrated with examples of good practice from various organisations, including one from the DoH.

Dual Discrimination is Recognised by Equality Bill

Conservative MPs have backed the new dual discrimination clause in the Equality Bill tabled as an amendment by the Government.  The clause protects people who experience direct discrimination because of a combination of two protected characteristics, whereas currently people may only bring separate discrimination claims, one for each diversity strand.  The new amendment would mean, for example, that a disabled lesbian who has been discriminated against because of a stereotyped attitude towards disabled lesbians, rather than disabled people or lesbian people as a whole, can bring a single claim.

The Equality Bill finished the committee stage on 9^th July 2009 and will now go through the report stage before its third reading.

New National Number for Non-Emergency Care

On 9^th July 2009, The Department of Health has asked Ofcom (the Office Of Communication) to consult on providing a new national three-digit number - 111 - for urgent, non-emergency healthcare.  This is the next stage in the process that follows Lord Darzi's report on his review of the NHS and is intended to increase accessibility to healthcare advice and information.  It will not replace existing local telephone services or NHS Direct, and 999 will remain the number to call in an emergency situation.

NHS Required to Support LGBT Staff More Effectively

Health sector employers need to do more to improve working practices and create more supportive workplaces for lesbian, gay, bisexual and transgendered staff according to a motion from the CSP (Chartered Society of Physiotherapy) which was unanimously passed by the TUC LGBT conference at the beginning of July.

The motion stated concern that the public sector organisations' performance in Stonewall's Top 100 Employers' Index 2009 was comparatively poor.  In particular, the NHS performed badly, with only one NHS employer (Tower Hamlets PCT) making it into the top 100.  It called on the TUC to work with Stonewall and other public sector affiliates to bring greater pressure to bear on NHS employers to improve this performance.

Violence Towards NHS Staff in Wales

While progress has been made in tackling violence towards NHS frontline staff in Wales, there are still areas where more work is needed according to a report published by the National Assembly for Wales Audit Committee on 1^st July 2009.  Protecting NHS Staff From Violence and Aggression concluded that broad areas of concern include the need to improve systems for collecting and monitoring data on incidents, complete implementation of actions to prevent and control such incidents and develop better ways to suport staff.  Underreporting is also seen to be a problem.

The Committee has requested a progress report from the Welsh Assembly Government by the end of the year.

EHRC - Three-Year Strategic Plan

The Equality and Diversity Commission published its three-year strategic plan in June 2009, setting out priorities and programmes for work to March 2012.  The priorities are:

• Build a society without prejudice - promoting good relations and fostering a vibrant equality and human rights culture in Britain.
• A fairer Britain for all - reducing the gap in outcomes to secure fair life chances, access to services and dignified treatment.
• Secure and implement an effective legislative and regulatory framework for equality and human rights.
• Promote awareness and understanding of rights.
• Build an authoritative and responsive organisation.

The Commission has attracted controversy after a number of senior staff, including the Chief Executive, Nicola Brewer, resigned from the organisation.  Trevor Phillips, the chair, has stepped down as a director of a specialist consultancy in race issues after criticism that his public role was compromised by private business activities.

Most Trusts Compliant with EWTD

On 26^th June 2009, The Health Secretary, Andy Burnham declared that the overwhelming majority of junior doctor rotas will be compliant with the Working Time Directive by 1 August 2009.  The directive requires working time for doctors in training to be no more than 48 hours per week, having initially restricted them to 58 hours in 2004, and then 56 hours from 1 August 2007.  The decreased hours are expected to improve patient safety and the work-life balance of staff.

An independent scrutiny panel, chaired by Dr Judith Huff, reviewed all services requiring derogation.  The panel included representatives from the Royal Colleges, BMA, SHAs and NHS Employers.  A small number of services, currently 3%, will need more time to implement the Directive.  These include services delivering 24-hour immediate patient care, supra specialist services and units in rural and isolated areas.

New Psychometric Test Reveals Prejudice

A new psychometric test has been developed by Shire Professional chartered psychologists to reveal unconscious prejudice on the grounds of race, gender, sexual orientation, disability and age.

Licensed by psychologists, Hogrefe, and released on 24^th of June 2009, Implicitly is a series of tests that present the subject with pictures of people which they must match with positive or negative words as they appear in quick succession.  The unconscious mind processes information far more quickly than we can do so consciously, enabling prejudices to be revealed by how long subjects take to accomplish the task correctly, and by how many mistakes are made.

Everyone has prejudices or bias towards certain people and the test is intended to enable individuals and employers to be aware of them so that they are able to challenge them and reduce discrimination.

Robust testing confirms that the tests can be assumed to be accurate but there have been ethical issues about Implicitly raised, such as whether employers have the right to test unconscious impulses when they do not constitute discriminatory behaviour.

Cervical Screening Age Will Not Be Lowered

In June, 2009, the Advisory Committee on Cervical Screening reviewed the policy of starting screening at age 25 and agreed unanimously that there should be no change to the current policy.  Public pressure to lower the screening age to 20 mounted this year, following a campaign led by Jade Goody, a reality TV star, who died of cervical cancer in March.  Screening is carried out from the age of 20 in Scotland, Wales and Northern Ireland.  However, the review concluded that screening the under-25s would do more harm than good as smear tests are not so easily read in young women and unnecessary treatment can cause damage to the neck of the womb, leading to premature births. 

Members of the Committee were, however, concerned that young women who present to their GPs with gynecological symptoms are not always being given appropriate advice.  They strongly recommended that the DoH take further action in this area and also recommended that more effort is made to increase the uptake of cervical screening in women aged 25-34.

Guidelines To Identify Forced Marriage

In June 2009, the Government's Forced Marriage Unit published a document entitled Multi-agency practice guidelines: Handling cases of forced marriage.  It has a section to support healthcare professionals to uphold the human right of patients that marriage shall be entered into only with the free and full consent of the intending spouses.

Forced marriage - which is not the same as arranged marriage - is a form of domestic abuse which is known to have a particulary adverse impact on women, and can lead to violence, rape, forced pregnancy and childbearing, and restrictions placed on education, employment and social opportunities.  The guidelines detail how to go about disseminating information, recognising cases, making enquiries, offering advice and making referrals.  They also include what action should be taken where the patietn is under 18 or about to travel overseas.

Bullying Helpline Used Extensively By NHS Employees

A statistical review of the national bullying helpline run by the Andrea Adams Trust has revealed that 42% of all calls are from NHS Employees and 75.5% are from the public sector as a whole.  The review covers the three month period from January to March 2009 during which the helpline received 2,400 calls.

Possible explanations for this disproportionate usage include staff shortages, pressure to achieve targets, workplace stress, poor cross-cultural communication and the continuation of old hierarchical structures within the NHS.  The Andrea Adams Trust points out that policies and proceedures alone are insufficent to achieve cultural change, and that anti-bullying measures need to be led by senior management and should include staff training.

The Trust have been forced to close the helpline through lack of funding and suggest that in future employees use the Acas helpline: 08457 47 47 47.

The Equality Bill - Second Reading

The Equality Bill underwent its second reading in the House of Commons on 2^nd June 2009.  An opposition move to block the bill was voted down by 278 to 181 and the bill will now proceed to the committee stage which should be completed by 7^th July 2009.

Women Doctors Become Agents of Change

On 3^rd June 2009, The Royal College of Physicians published the results of a two-year study on women in medicine, relating to various aspects of a medical career.  Women and Medicine: The Future reveals that currently 40% of doctors are women and within eight years there will be more female than male doctors.  It concludes:

Two findings from our research are of central importance.  First, the far greater preference of women doctors, compared with men, for part-time or other forms of flexible working.  Second, women doctors' comparative preference, on average, for working in specialties that offer more 'plannable' working hours and a relatively greater amount of patient interaction.  These preferences will affect the future organisation and delivery of patient care.

Women are more likely to elect to be GPs, pediatricians, psychiatrists or public health doctors in preference to specialising in surgery or cardiolody, but increasing numbers are going into, traditionally male-dominated, emergency medicine and anesthetics.

Female doctors are changing the nature of the delivery of medical practice, bringing both advantages and challenges.  The challenge has shifted from enabling and encouraging women to enter to profession to ensuring that the increasing proportion of women is effectively, economically, and fairly incorporated into the workforce while preserving the highest quality of care.

Paternity Leave Extension Suspended

It was widely reported at the beginning of June 2009, that plans to give fathers six months of paternity leave have been shelved by the government to support employers during the recession.  The proposal, originally announced in 2005, was expected to be introduced this year to allow mothers and fathers to share a year of parental leave, with fathers able to take six months of leave after the mother's first six months.  The provision was also to be made available to same-sex couples caring for newborns.

The Chartered Institute for Personnel and Development (CIPD) has welcomed the delay, expressing concern over the imposition of the "bureaucratic burdens" involved in allowing mothers and fathers (who in most cases work for different organisations) to share parental leave, during the current economic climate.  However, it remains broadly in support of the proposals and said the issue "should not be kicked into the long grass."

NHS: Top Family-Friendly Employer

The NHS has secured a place among the inaugural list of the Top Employers for Working Families, published by Working Families, a work/life balance charity on 28^th May 2009.

The NHS, ably represented by Worcestershire Acute Hospitals NHS Trust, was praised for flair and innovation in implementing policies such as the Improving Working Lives Framework.  Work/life balance options at the Trust include a range of flexible working patterns, an innovative flexible retirement scheme, childcare support and support for carers.  Embedding flexible working has included running events such as Maternity and Paternity sessions and Mind, Body and Soul days which enable staff to access health checks.

BMA: Draft Immigration Law to Deprive UK of Doctors

On 14^th May 2009, The Chairman of the British Medical Association (BMA), Dr Hamish Meldrum, wrote to the Secretary of State for Health to request that he intervene to ensure that the UK does not lose further doctors as a result of changes to the immigration system.  The changes restrict international medical students, who are studying in the UK, from continuing with their medical training beyond the two-year postgraduate Foundation Programme.

Currently, about a third of doctors in the NHS originate from non-EEA countries.  Five percent of medical training posts remained vacant at the close of medical training recruitment in 2008 and the NHS is facing understaffed workforce rotas in a range of medical specialties.

Inadequate Data Security in the NHS

The Information Commissioner's Office (ICO) warned, on 30^th April 2009, that it is a matter of serious concern that in the last six months it has been necessary for it to take regulatory action against 14 NHS organisations for breaches of data security.

Protecting the personal data of patients is a part of upholding human rights and becomes ever more important as trusts increasingly store and process sensitive equality monitoring data alongside medical records.  Trusts that have been found to have breached data protection legislation have signed formal undertakings to take immediate remedial action by implementing a number of security measures.  The ICO has threatened to take enforcement action if the terms of these undertakings are not met.

The latest breaches have included staff members accessing patient records without authorisation and a failure to protect records in transit, including encrypting a portable media device and then attaching the password to it.  The ICO stresses the importance of physical safeguards, passwords and encryption, systems to restrict access and staff training.

Draft Equality Bill

The Draft Equality Bill, published on 27^th April 2009, details the UK government's intentions to combine all of the existing equality legislation into one single statute and to strengthen the law to support progress on equality.

The Bill creates a new equality duty on public bodies, bringing together the three existing duties (race, disability and gender) and extending it to gender reassignment, age, sexual orientation and religion or belief.  It will also introduce a new duty for some key public bodies, including the NHS, to pay due regard to socio-economic disadvantage in making strategic decisions.  The duties will be extended to public procurement, harnessing the public sector's annual £175 billion of purchasing power.

The definition of positive action will be extended to allow discrimination during recruitment in favour of disadvantaged groups when faced with candidates who are otherwise equally qualified.  In addition, the bill gives effect to recent European case law by outlawing discrimination by association and it extends age discrimination legislation to include the provision of goods, facilities and services.

The Equality Bill includes clauses to tackle the gender pay gap by outlawing employment contracts from imposing secrecy obligations stopping employees discussing their pay packages and by allowing the Secretary of State to order public sector employers with more than 150 employees to publish information about disparities in pay between male and female employees.  Public bodies will also be required to publish annually the percentage of disabled employees in their workforce.

The Equality Bill is currently in "trial format" and is likely to be subjected to amendment before becoming law.

European Parliament Proposes Enforced "Co-Maternity Leave"

Under proposals tabled in the European Parliament, partners of mothers who have given birth will be given mandatory rights to a minimum of two weeks off work.  The Women's Rights Committee amended the Commission's proposals on 27^th April 2009, in order to reflect "different types of family structure" so that these rights would also apply to lesbian partners.

The proposals will be voted on my MEPs in May 2009.

Fair Parking at Hospitals

On 6^th April 2009, The NHS Confederation released its top five principles for hospital parking in England, one of which concerns the fair control of parking.  The Confederation rejected the policy, which is being implemented in Scotland and Wales, of free parking for patients and visitors at all hospitals.  It said that hospitals should remain entitled to recoup the costs of running car parks and be able to spend any surpluses on direct patient care.

The NHS Confederation recommended that those who have the greatest need be prioritised.  It states that free or concessionary parking should be openly offered to those who need to visit regularly, such as dialysis or cancer patients, or parents of children receiving treatment.  It should also be offered to those who are unable to use public transport, such as disabled people.

Macmillan Cancer Support has responded to the Confederation's conclusions by arguing that it is morally wrong to make cancer patients pay for parking while receiving treatment.

Care Quality Commission Takes the Helm

On 1^st April, the Care Quality Commission (CQC) became the new health and social care regulator in England, taking over the roles of The Healthcare Commission, The Commission for Social Care Inspection and The Mental Health Act Commission.  It also has new duties, including controlling the registration of NHS organisations by ensuring those registered are fit to practice.

The CQC Chairman, Barbara Young, said, we'll be a modern, proportionate and responsive regulator.  We will work with the providers and commissioners of services to encourage improvement.  That doesn't mean we'll be an easy touch.  We will have a range of tough new enforcement powers and we won't be afraid to use them when it is appropriate.  But our first aim will be to prevent problems through encouraging improvement.  We will act nimbly and flexibly to spot problems early and work with providers of services and their commissioners to tackle issues of quality early.

Healthcare Inspectorate Wales is the NHS regulator for Wales.

Promoting Race Equality

In its final report before going out of existence on 31^st March 2009, The Healthcare Commission has published a review of race equality, Tackling the Challenge - Promoting Race Equality in the NHS in England, describing the results as "a mixed picture".

In addition to literature reviews and audits of Trusts' websites, a more in-depth review was carried out using 39 Trusts.  Of these, 72% provided evidence of up-to-date Race Equality Schemes (which 54% had published), 26% monitored and published workforce statistics, 33% were able to provide evidence of impact assessments, and 72% had sought the views of their local population.

Examples of leading practice were provided by a further 11 Trusts and included engagement programmes and language translation provision.

The report concludes that NHS trusts must take immediate action to address any shortfalls in meeting their legal duties under the race relations legislation.  We expect the boards of all NHS trusts to review their performance in meeting their legal duties on all aspects of equality, as part of their declaration on the Department of Health's core standards for the 2008/09 annual health check, and to take all necessary action if they are not fully compliant.  We expect NHS trusts to provide the Care Quality Commission with clear assurance when they make their declaration for 2008/09 that they consider themselves to be compliant with those statutory requirements.

Professor Helen Hally, National Director for Race for Health, responding to the report, said, It is unacceptable that some trusts are still not meeting minimum requirements for tackling race inequality.  The is not a bureaucratic exercise - it has real impact in terms of saving lives and improving health for large numbers of people.  

Sixth Annual Staff Survey

The Healthcare Commission has published its National NHS Staff Survey for 2008.  The survey shows high, and rising, staff satisfaction with 90% of staff feeling that they can make a difference to patients and the majority feeling supported by their colleagues and line managers.

The number of staff reporting that they have experienced discrimination at work has remained about the same, at 8%, and 89% of staff feel that their Trust acts fairly with regard to career progression and promotion.  Just over half of staff have received training in Equality and Diversity during their NHS employment.

There has been a reduction in the proportion of NHS staff experiencing harassment, bullying and abuse down to 23% experiencing them from patients and 18% from either their line manager or other colleagues during the year.  However, experience of physical violence from patients or relatives has failed to improve and on average 12% of staff experienced violence during the course of their duties last year.

Age Discrimination in Mental Health Services

The Healthcare Commissions's publication of 31^st March 2009, Equality in Later Life, reports that there is a lack of quality national data in respect of mental health services for older people in England.  However, six Trusts were visited as part of the investigation for the report which concluded that older people were denied access to the full range of mental health services that are available to younger adults.  In particular, there was poor access to out-of-hours and crisis services, psychological therapies and alcohol services.  The Commission also reported on a number of areas of good practice.

Mental health problems are thought to be present in 40% of older people who attend their GP and 50% of older adult inpatients.  The report makes a number of recommendations for improving data and the quality of mental health care for older patients.

Mental Health Practitioners Attempt to Change Sexual Orientation

On 26^th March 2009, BMC Psychiatry published a paper exploring the response of mental health professionals to clients seeking help to change, or redirect, same-sex sexual orientation.  The study, carried out by University College Medical School, University College London, concluded that a significant minority of mental health practitioners are attempting to help lesbian, gay and bisexual clients/patients to become heterosexual despite lack of evidence for the efficacy of such treatments and the risk that they might cause harm.

Four percent of over 1,400 psychiatrists, psychologists, psychotherapists and chancellors who took part reported that they would attempt to change a client's sexual orientation if the client requested it.  17% described having assisted at least one client to reduce or change his/her gay or lesbian feelings, 48% of whom were seen under the NHS.  28% of these cases were not followed up beyond the period of treatment.

Reasons given for offering such 'treatment' to clients included religious, cultural and moral values causing internal conflict and enabling clients to avoid homophobia or the perceived physical risks of gay sexual activity.

The Equality Bill will place a new duty on NHS organisations to pay due regard to the need to promote equality for gay, lesbian and bisexual people, including equality in service provision and clinical practice.

Ombudsman Reports on Six Deaths

On 24th March 2009, The Parliamentary and Health Service Ombudsman published the results of its investigation into the six deaths of people with learning difficulties while receiving NHS and social care. The report was in response to the complaint brought by Mencap that was previously mentioned on these pages.

In Six Lives, the Ombudsman concludes that people with learning difficulties have experienced "prolonged suffering and poor care", that one of the six had died as a direct result of public service failure, and there had been significant and distressing failures across health and social care with public bodies failing to live up to human rights principles.

The Ombudsman recommends that the NHS and social care organisations urgently review the effectiveness of the systems they have in place to enable them to understand and plan to meet the full range of needs of people with learning disabilities.  They should also review the capacity and capability of the services they provide and/or commission for their local populations to meet the additional and often complex needs to people with learning difficulties.  Recommendations have also been made for the Care Quality Commission, Monitor, The Equality and Human Rights Commission and The Department of Health. 

BMA Calls For a Major Overhaul of Prescription Charges

The British Medical Association has responded to the Department of Health's proposal to extend free prescriptions to those with long term health conditions (LTCs) by calling for a major review and overhaul of the current prescription charges and exemption categories system.  Its formal response was published on 3^rd March 2009.

The BMA state that the current exemption categories are often illogical and unfair; extending these categories to include those with LTCs would simply add to the inequities in the system and invariably create a new set of arbitrary 'winners' and 'losers'.  It believes that any review should be combined with a fundamental reconsideration of the purpose and value of prescription charges in the wider context of health care within the NHS.

The BMA has taken the position that charging should be abolished entirely.  Currently only 11% of prescriptions attract a charge.  Charging has already been abolished in Wales and is shortly to be abolished in Scotland and Northern Ireland.

Launch of 'Premier League Health'

On 25 February 2009, The Premier Football League and the New Football Pools announced a partnership with local health agencies, including Primary Care Trusts, to help improve men's health.

Premier League Health, a £1.63m programme funded by the New Football Pools, will see 17 Premier League clubs target 4,000 men, aged 18 and over, with specific health improvement projects to respond to local needs.  For example, Tottenham Hotspur "will go into schools and target fathers of children in Enfield - in the bottom 8% most income deprived in the country, and bottom 15% for unemployment.  The project will promote knowledge of nutrition, oral health and physical activity and involve cooking sessions so the dads can put their learning into practice and improve their social skills and family cohesion."

Other projects include the provision of sport coaching sessions, MOT health testing and educational programmes.