The revised Code of Practice Mental Health Act has been prepared in accordance with section 118 of the Mental Health Act 1983 by the Secretary of State for Health after consulting such bodies as appeared to him to be concerned, and laid before Parliament. The Code will come into force in November 2008.

The addendum guidance sets out the process for assurance of the delivery of the capital development programme for inpatient and residential substance misuse (drug and alcohol) services 2007/08 and 2008/09, including guidance on the reallocation of funds. The National Treatment Agency (NTA) via Regional Forums is managing this process.

Guidance on transfers between places of safety provides information on the use of SI(2008)800 Mental Health Act 2007 (Commencement No. 5 and Transitional Provisions) Order 2008. Which brings section 44 of the Mental Health Act 2007 (the 2007 Act) on places of safety into effect on 30 April 2008.

Under sections 135 and 136 of the Mental Health Act 1983 (the 1983 Act) a police officer may remove a person who is believed or appears to be suffering from a mental disorder to a place of safety. Section 44 of the 2007 Act amends these sections of the 1983 Act to allow a person to be taken from one place of safety to one or more other places of safety during the 72 hour maximum overall period during which they may be detained under either of these two sections. They may be taken between places of safety by a police officer, an approved social worker (until approved social workers are replaced in this role by approved mental health professionals in due course) or someone authorised by either of them.

Patient Experience Scores for the PSA target – April 2008 updates the patient experience scores published on 29 January 2007. They include scores derived from survey results published by the Healthcare Commission for 2006/07. There are new data points for ‘adult inpatients’ and ‘community mental health’ in 2006/07. These figures report on progress against the PSA target for sustained improvement in patient experience.

• The overall patient experience score for adult inpatients in 2006/07 has increased slightly to 76.4 from the score of 76.2 in 2005/06. The score is 0.7 points higher than in the earliest fully comparable year of 2003/04 (75.7).
• The overall patient experience score for community mental health services in 2006/07 has increased to 75.2, up 0.7 points from the score of 74.5 in 2005/06. 
• Scores for ‘involvement in decisions about healthcare’ cannot be compared across sectors.  The baseline scores for emergency services (2004/05) is 77.1.  The baseline score for outpatients (2004/05) is 81.7.  For adult inpatients, the latest score of 70.9 is unchanged from 2003/04.  Results for community mental health services show a slight increase to 63.7 in 2006/07 (from 63.3 in 2003/04) whilst primary care results are slightly lower at 81.9 in 2005/06, compared to 82.1 in 2003/04
• The baseline score for ‘choice of provider’ is 27.3 from the 2005/06 DH survey of PCTs.  This score represents the baseline position in the last year before the choice of provider policy was introduced. 

Individual responsibility for health and self-care are key themes in recent health policy development in England. The King’s Fund have addressed the issue with three papers:

• Paying the Patient: Improving health using financial incentives identifies programmes based on both positive and negative incentives, finds that financial incentives are effective in encouraging people to perform clearly defined, time-limited, simple behavioural tasks, and also in encouraging participation in lifestyle programmes.However, healthier behaviour is not maintained and financial incentives are not effective when the behaviour change required is complex, for example, giving up smoking.
• Low-income Groups and Behaviour Change Interventions: A review of intervention content and effectiveness considers interventions targeted specifically at low-income groups, this paper asks which interventions are effective in getting people to quit smoking, eat healthily and exercise. It reveals that the most frequently used techniques are providing information and encouraging people to set goals, which can be particularly effective at changing behaviour in disadvantaged groups.
• Using Information to Promote Healthy Behaviours looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes. Information-based health campaigns are a major part of the government’s health promotion strategy. A £75 million marketing programme has recently been announced to encourage healthy behaviour in children. This paper looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes.

Two more papers are due in the Kicking Bad Habits series before a final report is drafted.

Trailed in today’s media the report Risky drinking in North West school children and its consequences: A study of fifteen and sixteen year olds is a study of 9,833 15-16 year old school children in the North West, examining relationships between risky drinking behaviours (binge drinking, frequent drinking, drinking in public places) and demographics, income, leisure activities and access to alcohol. Negative consequences of risky drinking such as violence and regretted sex are also investigated.

• Antenatal care
• Diabetes in pregnancy
• Prophylaxis for Infective Endocarditis
• Maternal and child nutrition
• Mental wellbeing of children in primary education
• Sleep apnoea hypopnea syndrome (obstructive) - continuous positive airway pressure
• Asthma (in adults) - corticosteroids
• Intraoperative nerve monitoring during thyroid surgery
• Suburethral sling insertion for stress urinary incontinence in men

Following the national consultation, Reviewing the Care Programme Approach 2006 - A consultation document (CPA), and having considered the issues identified, Refocusing the care programme approach: Policy and positive practice guidance updates policy and sets out positive practice guidance for trusts and commissioners to review local practice to refocus CPA within mental health services.

How the Care Programme Approach can work for you provides information for service users on the Care Programme Approach: the process of how mental health services assess users’ needs, plan ways to meet them and check that they are being met. Users should always feel able to ask mental health workers to explain this process clearly.

Reducing Drug Use, Reducing Reoffending (summary)  from the UK Drug Policy Commission considers whether the evidence supports programmes in the UK for problem drug-using offenders in the criminal justice system (CJS).  It finds:

• The principle of using CJS-based interventions to encourage engagement with treatment is supported by the evidence.
• Following a period of expansion and a focus on quantity, attention should now focus on quality.
• “Net-widening” to include additional groups of drug-using offenders in CJS‑based interventions may have negative consequences.
• Community punishments are likely to be more appropriate than imprisonment for most problem drug-using offenders.
• Prison drug services frequently fall short of even minimum standards.
• Given the sizeable investment in CJS interventions for drug-dependent offenders, we know remarkably little about what works and for whom.

Some Evidence
There is evidence to support the use of drug courts; community sentences such as DTTOs and DRRs; prison-based therapeutic communities; opioid detoxification and methadone maintenance within prisons and the community; and the RAPt 12-step abstinence-based programme.

Mixed Evidence 

Mixed evidence exists for Criminal Justice Integrated Teams; Restrictions on Bail; and the added value of drug testing as part of a community order.

No Evidence 

CARAT interventions; drug-free wings; programmes based on cognitive behavioural therapy, such as short-duration programmes and ASRO (Addressing Substance Related Offending) programmes; conditional cautions; diversion from prosecution schemes; and Intervention Orders have no evidence to support their effectiveness.

From the Ministry of Justice, A Survey of Buprenorphine Misuse in Prisons looks at drug use in prisons, as measured by random mandatory drug tests. The findings support the Government’s plan to institute universal testing for the opiate substitute buprenorphine.

	Rates for Misused Drugs
	Drug		rMDT Rate		No. of Prisons
	Opiates		4.2%		101
	Cannabis		4.0%		101
	Buprenorphine		1.9%		63
	Benzodiazepines		0.9%		53
	Methadone		0.4%		25

Top tips for health in Local Authorities commissioned by ChaMPs (Cheshire and Merseyside Public Health Network) and from the Liverpool Public Health Observatory offers practical tips on joint working between the NHS and Local Authorities in the areas of:

• Reducing health inequalities

• Tackling obesity: Creating opportunities for healthy eating

• Tackling obesity: Creating opportunities for physical activity

• Improving mental health and well-being

• Promoting sexual health

• Encourage the sensible drinking of alcohol

• Creating a smokefree environment

The Commissioner Volume 3 Issue 3 from the North West Primary Care Librarian’s Group was published today with its podcast ( Standard Podcasts [6:22m]) contents are:

• PBC: Personalise your Improvement with the No Delays Achiever

• Dental Commissioning and Contract Monitoring - Tendering, Procurement & Contracting

• Evaluation of One-Stop Shop (Oss) Models of Sexual Health Provision

• Improving Access to Psychological Therapies implementation plan

• National Infarct Angioplasty Project (NIAP) interim report

• Practice-based commissioning : tips for preparing and pitching a proposal

• Strategic commissioning for older people

• Apply for Beacon Status

• Other documents and conferences

Feed for Podcast

Standard Podcasts [6:22m]

The press have had a field day (reports from 5th March, reports from 4th March) with Evaluation of the Impact of the Licensing Act 2003 from the Department for Culture, Media and Sport the report finds that:

• There is no evidence of 24 hour drinking, with only a minority of premises securing 24 hour licences and very few actually utilising those hours. Only limited changes to actual opening hours.

• The overall volume of incidents of crime and disorder has remained stable and not risen.

• There is no evidence of increases in overall alcohol consumption.

• There has been no serious adverse impact on the provision of live music.

Positives

• Transfer of alcohol licensing to local authorities is viewed as a success.

• The alcohol licensing system is more democratically accountable and residents are better able to influence licensing decisions.

• There is much better partnership working between local authorities, the police and other responsible authorities and licensees.

• The new powers, including the ability to review licences, have been welcomed by local authorities and the police, and are being used to good effect.

• Administrative arrangements for the new regime appear to have delivered the administration cost savings to businesses, third sector and other licence holders of around £99m a year.

Negatives

• There is no clear picture of consistent improvements in all areas.

• There is evidence of displacement of violent offences into the small hours.

• Use of the new legislation, in conjunction with other interventions and as part of a coherent strategy, may vary between different authorities and areas.

• There has yet to be a discernible change in the diversity of evening and late night venues, although there is some evidence of good practice and success in certain areas.

• While benefits in terms of bureaucracy and red tape have been delivered, some stakeholders are experiencing difficulties, which suggest that the regime could be more proportionate in its application.

• Reform has not led to the increases in events hoped for by Ministers, and the regime may be disproportionate for some types of live music events and other types of events.

The impact of the Licensing Act 2003 on levels of crime and disorder: an evaluation (Executive Summary) from the Home Office looks at the impact of 24 hours licensing onviolent crime. Key findings are:

• In the run-up to implementation, there was widespread concern that the legislation would lead to ‘24-hour drinking’ and an increase in associated problems. This hasn’t happened.

• No clear signs yet that the abolition of a standard closing time has significantly reduced problems of crime and disorder.

• Variable opening hours and show small uptake, while the majority of pubs have extended their hours, most of these extensions have been short.

• Limited evidence suggests that alcohol consumption has fallen slightly, although some people are drinking until later into the night.

• The overall volume of incidents of crime and disorder remains unchanged, indcation is that crimes involving serious violence may have reduced. However, the small proportion of violent crime occurring in the small hours of the morning has grown.

• Alcohol-related demands on Accident & Emergency (A&E) departments appear to have been stable in aggregate

• Police, local authorities and licensees generally welcomed the changes, the new powers it gave them, and the Act’s partnership philosophy. They did not report significant problems with implementation.

• Local residents were less likely to say that drunk and rowdy behaviour was a problem after the change than before it, and the majority thought that alcohol-related crime was stable or declining.

• The main conclusion to be drawn from the evaluation is that licensing regimes may be one factor in effecting change to the country’s drinking culture – and its impact on crime – but they do not appear to be the critical factor. The key issue is how they interact with other factors.

‘Drugs: protecting families and communities’ - 2008-2018 strategy and the Action plan 2008-2011 from the Home Office offers a four strand approach to tackling use of drugs of abuse:

• protecting communities through tackling drug supply, drug-related crime and anti-social behaviour
• preventing harm to children, young people and families affected by drug misuse
• delivering new approaches to drug treatment and social re-integration
• public information campaigns, communications and community engagement

It’s key policies are:

• embedding action to tackle drugs within the neighbourhood policing approach, to gather community intelligence and to increase community confidence
• targeting the drug-misusing offenders causing the highest level of crime, improving prison treatment programmes and increasing the use of community sentences with a drug rehabilitation requirement
• strengthening and extending international agreements to intercept drugs being trafficked to the UK
• extending powers to seize the cash and assets of drug dealers, to demonstrate to communities that dealing doesn’t pay
• focusing on the families where parents misuse drugs, intervening early to prevent harm to children, prioritising parents’ access to treatment where children are at risk, providing intensive parenting guidance and supporting family members, such as grandparents, who take on caring responsibilities
• developing a package of support to help people in drug treatment to complete treatment to to re-establish their lives, including ensuring local arrangements are in place to refer people from Jobcentres to sources of housing advice and advocacy and appropriate treatment
• using opportunities presented by the benefits system to support people in re-integrating into society and gaining employment, with a commitment to examine further how claimants can be incentivised to engage with treatment and other services
• piloting new approaches which allow a more flexible and effective use of resources, including individual budgets to meet treatment and wider support needs

Guidance on nominating a consultee for research involving adults who lack capacity to consent  establishes how to identify an appropriate consultee for the purposes of section 32 of the Mental Capacity Act 2005.  Researchers are required by the Act to take reasonable steps to identify a person who, as a result of an existing relationship with the person who lacks capacity, can advise the researcher about that person’s participation in the project. Where no such person can be identified, the Act requires another person who can provide this advice to be appointed in accordance with guidance.

Alcohol misuse: tackling the UK epidemic from the BMA, considers the problematic levels of alcohol misuse in the UK and is not aimed at those who enjoy consuming alcohol in moderation. It examines the patterns and trends of alcohol consumption and goes on to review the range of adverse effects both on the individual and society that are associated with its misuse.

Alcohol consumption is causes a wide range of medical conditions and is a significant cause of morbidity and premature death worldwide. It contributes to a range of acute and chronic health consequences, from alcohol poisoning and injuries resulting from traffic crashes to cancer and cardiovascular disease. The more an individual consumes, the greater the risk of harm.

Alcohol misuse is associated with crime, violence and anti-social behaviour, and can impact significantly on family and community life. The cost of alcohol misuse in the UK is substantial, both in terms of direct costs (eg costs to hospital services and the criminal justice service) and indirect costs (eg loss of productivity and the impact on family and social networks).

Updated from Prodigy to new CKS Format:

• Anaemia - iron deficiency
• Immunizations - childhood
• Leg ulcer - venous
• Opioid dependence
• Palliative cancer care - constipation

Clinical summaries of the Topic Reviews issued in February 2008 please follow the links below:

• Clinical summary: Iron deficiency anaemia – assessment
• Clinical summary: Iron deficiency anaemia - management
• Clinical summary: Immunizations childhood programme
• Clinical summary: Immunizations childhood – children up to 1 year of age
• Clinical summary: Immunizations childhood – children 1-2 years of age
• Clinical summary: Immunizations childhood – children 2-10 years of age
• Clinical summary: Immunizations childhood – children over 10 years of age
• Clinical summary: Immunizations childhood – additional immunizations
• Clinical summaries: Leg ulcer venous – uncomplicated venous leg ulcer
• Clinical summaries: Leg ulcer venous – infected venous leg ulcer
• Clinical summaries: Leg ulcer venous – healed venous leg ulcer
• Clinical summaries: Leg ulcer venous – persistent venous leg ulcer
• Clinical summaries: Opioid dependence – new presentation
• Clinical summaries: Opioid dependence – Considering substitution therapy
• Clinical summaries: Opioid dependence –Starting and stabilizing on maintenance therapy
• Clinical summaries: Opioid dependence – Continuing maintenance therapy
• Clinical summaries: Opioid dependence – Detoxification – from maintenance therapy
• Clinical summaries: Opioid dependence – Detoxification – not on maintenance therapy
• Clinical summary: Opioid dependence – Missed or vomited doses
• Clinical summary: Opioid dependence – Acute withdrawal syndrome
• Clinical summary: Opioid dependence – Collapse due to opioid overdose
• Clinical summary: Opioid dependence – Travelling abroad
• Clinical summary: Opioid dependence – Unknown patient
• Clinical summary: Palliative cancer care – constipation

Mental health and ill health in doctors looks at mental health and ill health in doctors and the factors that influence them. It outlines ways in which the NHS can provide appropriate services and encourage doctors and other health care workers to seek early advice and support for mental health problems.

The Report identifies that if doctors are to receive appropriate mental health care, they, their colleagues, their employers, commissioners of services and key national organisations must have a shared view of what is needed. This should cover:

• Access to information
• Designated care pathways and services
• Role of occupational health services
• Need for confidentiality and privacy

Mental Health Act Commission Twelfth Biennial Report - Risk, Rights, Recovery finds that there are severe funding issues faced by providers of mental health services in that:

• Patients deemed to be a threat to themselves or others are being denied hospital beds while commissioners disagree with regard to funding.

• The Mental Health Act Commission has found practitioners are being told to delay sectioning people with urgent mental health needs until primary care trusts ascertain who should pay for their treatment.

• The problem is caused by high bed occupancy levels and the need for PCTs to balance budgets.

• This has encouraged PCTs not to detain patients who have travelled from other areas until the home PCT has agreed to pay.

Thse practices are unsuprisingly condemned in this report.