Public perceptions of privacy and dignity in hospitals is research, conducted by Ipsos MORI, involved 2,000 interviews with members of the public across the country. It was designed to explore perceptions towards privacy and dignity in hospitals, with particular emphasis on the importance of single-sex accommodation. Key findings are that cleanliness and staff attitudes are the most important factors for patients to feel they are treated with privacy and dignity in hospital.

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. 

This is the third quarterly practice survey (National summary of results), covering a sample of practices from each primary care trust (PCT). The aims of the survey are to get feedback from practices on their perception of the support offered by their PCT and on the clinical and financial engagement of practices with PBC.  The survey is part of a group of indicators that will be assessed together to give a picture of PBC implementation.

Key findings:

• There has been a rise in the number of practices commissioning new services through PBC (+8 percentage points since Wave 1 and +5 percentage points since Wave 2). 41 percent have commissioned new services through PBC.
• The percentage of practices who have agreed a commissioning plan with their PCT has continued to increase (+11 points since Wave 1 and +3 points since Wave 2). 57 per cent of practices have now agreed a commissioning plan.
• 62 percent of practices support the policy of PBC (a rise of 5 percentage points since Wave 1, and 3 percentage points since Wave 2).
• The percentage of practices agreeing that PBC has improved patient care has marginally increased from 12 percent in Wave 2 to 16 percent in Wave 3. The proportion who disagree that PBC has improved patient care is in line with that of the previous two waves (31% in Wave 3, 30% in Wave 2, and 31% in Wave 1).
• 71 percent of practices claim to have a good relationship with their PCT, a decline of 3 percentage points on Wave 2.
• The proportion of practices who have received a financial incentive scheme has marginally declined since Wave 2 to the levels recorded in Wave 1 (down 4 percentage points since Wave 2 - now 62 percent).
• There has been a rise in the proportion of practices who engage with their local population from 61 per cent in wave 2 to 70 per cent in Wave 3 (an increase of nine percentage points).
• Around 4 in ten practices continue to rate their PCT’s managerial support for PBC as good (40 per cent in Wave 3, 42 per cent in Wave 2 and 37 per cent in Wave 1), however, half continue to rate managerial support for PBC as poor (49 per cent in Wave 3).
• As in previous waves, around a third of practices continue to rate the quality, format and frequency of information provided by their PCT as being good

Patients will be able to choose where they are treated from any provider meeting Healthcare Commission standards from 1 April, but Free Choice at the Point of Referral a King’s Fund’s briefing on the latest official data finds the policy has some way to go before it is likely to drive improvements in the quality of hospital services.

One of the ambitions of free choice is to create incentives for hospitals to drive up quality standards as they compete for patients, but official data shows that:

• use of ‘Choose and Book’ — the computer system designed to facilitate choice — whilst increasing still falls short of the government’s target, with only 50 per cent of referrals from GP to hospital being made using the system
• although increasing numbers of patients say they remember being offered a choice of hospital by their GP since the policy began in 2006, the proportion is still only 45 per cent
• of those 45 per cent, only 27 per cent said their GP gave them a booklet containing comparative information on hospital performance to help them make a decision.

The Report of the Office of Health Economics Commission on NHS Outcomes, Performance and Productivity identifies that the collection and use of outcomes measures in the NHS is both practical and essential.   In order to do so effectively the report makes the following recommendations:

• Measurement of patient outcomes and use of that information to drive better commissioning of services should be made an explicit element of the Government’s vision of “world class commissioning”.

• Mortality and survival data should be collated and published for all condition/treatment areas at the same time as collection of other outcomes data is initiated. Data on casemix must be collected, so that the crude mortality/survival data can be adjusted for the casemix treated. Confidence intervals should be estimated and reported to permit comparisons to be made over time and between providers.

• For elective surgery, condition-specific measures should be collected beforeand after surgery simultaneously with the generic EQ-5D for all NHS patients undergoing common procedures.

• Measurement of mental health outcomes in secondary care should be reinvigorated with collection of HoNOS data being incentivised in addition to mental health providers being reminded of its mandatory nature as part of the Mental Health Minimum Data Set. Routine collection at annual intervals of the CORE-OM measure for all patients receiving community based mental health services be piloted in a range of NHS Trusts at the earliest practical opportunity in 2008/09.

• Research is required to identify a generic measure of health related quality of life that is suitable for application to mental health patients as well as recipients of other kinds of health care.

• The practicality and value of collecting and using measures of outcomes for COPD patients should be piloted by a range of commissioners and their secondary and primary care providers, commencing in 2008/09. The preferred disease specific measure is either the Chronic Respiratory Disease Questionnaire (CRDQ) or the St George’s Respiratory Questionnaire (SGRQ).

• For colorectal cancer patients, mortality data (1 year and 5 years after diagnosis) should continue to be monitored and assessed as an important but partial measure of health service productivity in this disease area given its relatively high rate of mortality. But at the same time instigation in 2008/09 of pilot programmes of routine use of the EORTC QLQ-CR38 instrument to measure outcomes in colorectal cancer patients simultaneously with the EQ-5D or an SF- series generic measure should be undertaken.

• Collection of data about the wider benefits from health services by addition of questions on patients’ experience of care to the patient questionnaires used to measure health outcomes. Aspects covered should include: access, care co-ordination, autonomy, choice, communication, confidentiality, dignity, quality of amenities and support for carers.Further research is needed into the relative values of the wider benefits referred to in recommendation 8 and by compassion with health outcomes.This should be commissioned during the course of 2008/9.

• Information on wider benefits is already collected in national patient surveys. Building on its ‘customer experience information’ project, the Department of Health should work with its counterparts in Northern Ireland, Scotland and Wales on a UK-wide stock-take of patient surveys in process and planned, and then use this as the basis for discussion with all the interested parties how to co-ordinate those surveys in future.

• After a short period of research to identify the most practical way of collecting such data, including working days lost, measurement of productivity effects should be commenced for patients being treated for mental health problems, diseases of the nervous system and diseases of the musculo-skeletal system should be identified.

• Modification of existing national surveys of a sample of the general population should be investigated as one way of collecting at a general level data relevant to the wider societal impacts of health care interventions, including impacts on carers.

• Health care professional bodies, including the Royal Colleges, should explicitly and actively support the collection and use by their members of patient outcome measures, including the provision of training in their collection and use for both existing and new clinicians.

• Training in understanding and using outcome measures should be provided to NHS commissioner and provider managers.

• Investment should be made in IT and appropriately trained staff to enable user-friendly information collection, collation and analysis of outcome measures.

• The NHS should, commencing as early as possible in 2008/09, pilot, monitor and evaluate explicit incentives to collect, collate, analyse, feedback and use patient outcome measures. Initially at least this would not be extended to rewarding providers for the measured levels of outcomes achieved, although that could be considered once experience with use of outcomes measures has accumulated.

• There should be an expectation that within 5 years (i.e. by the end of 2012/13) routine measures of patient outcomes comprising the impact of an NHS intervention in terms of patient survival, quality of life, and experience of care, are collected for the majority of NHS activity. Within 10 years it should be the exception rather than the rule to find an area of NHS activity that is not assessed and actively managed according to the outcomes achieved.

• The NHS should work with the ONS Centre for the Measurement of Government Activity to ensure that the health outcomes data used by the NHS can also used by ONS in its periodic assessments of NHS productivity and, subsequently, in the National Accounts.

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

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Standard Podcasts [6:22m]

The Government’s Response to the Health Select Committee’s First Report of Session 2007-08 on the National Institute for Health and Clinical Excellence sets out the Government’s response to the Health Select Committee’s report on the National Institute for Health and Clinical Excellence (NICE). It welcomes and endorses the Committee’s expression of support for and confidence in NICE. Separate reports by the World Health Organisation on NICE’s technology appraisal and clinical guidelines programmes have commended the way in which it discharges its vital responsibilities.

Safe Births: Everybody’s business: An independent inquiry into the safety of maternity services in England from the Kings’s Fund makes the following recommendations:

• Teams themselves should:
  • agree safety-focused objectives
  • identify clear roles and responsibilities
  • utilise clear communication standards and protocols
• Safety should be placed at the heart of shared objectives for maternity services in quality joint working The Royal College of Midwives (RCM) and Royal College of Obstetricians and
• Regular reviews of demand and staffing should be conducted with an emphasis on deliveringthe right skill mix todeliver safe services
• Trust boards and managers should regularly receive information employment levels, skill mix and deployment achieved across all shift.
• Simple and effective tools to help maternity managers to manage employment and deployment, to map demand, capacity and patient flow and to provide timely feedback on levels achieved across all shifts and locations should be developed using work used in other specialties.
• A designated maternity unit manager should keep information on all training completed and planned.  Managers and Boards should reveive regular reports on training.
• RCOG, the Nursing and Midwifery Council (NMC) and the Postgraduate Medical Education and Training Board (PMETB) should spread expertise on skills training and emergency drills to all maternity units by adapting elements of existing simulation based training models and turning them into high-quality training tools that can be
  used locally at minimal cost and disruption
• Safety awareness training must be mainstream professional education at all levels.
• A single set of evidence-based guidelines that are backed by professional organisations, National Institute for Health and Clinical Excellence (NICE) and other organisations shoulddeveloped.
• Guidelines must be supplemented by short one page summaries and usable, consistent protocols.
• All disciplines should be encouraged to familiarise themselves with using guidelines in a local setting and should be trained to use the relevant protocols.  Their use should be regularly audited.
• Annual evidence digests and a national briefing system, tools like Map of Medicine should reinforce use of guidelines.
• A small set of reliable, safety-critical information measures should be collected.
• Simple systems for capturing local information on safety should be designed, implemented and maintained locally.
• Boards must prioritise safety, communicate that to staff and patients and make data on safety publicly available.
• Board members should be trained to strengthen advocacy for maternity safety.
• Governance structures must be in place to assure safety, this should strengthen safety committees and systems for collecting and reporting safety information.
• Regular executive walk-rounds, analysis of claims data, incident reports and other safety indicators, and by reviewing safety incidents in detail should be undertaken.
• Safety must be recognised as a business imperative.
• Standards for the safety of maternity services should be set and monitored only by the Healthcare Commission (in future the Care Quality Commission), with approarpiate advice received by professional bodies.
• Existing standards hould be distilled into a smaller number that are critical to safety, and can beconnected to data that can be collected by teams.
• Strategic health authorities and others providing regional leadership for maternity services should be primed to offer specific support to trusts undergoing reconfiguration.
• DH shouldensure financial incentives are aligned to promote the safest care and to galvanise boards into prioritising safety commissioning and patient choice should act as drivers for improvement.

Latest guidance from NICE.

• Prostate cancer
• Osteoarthritis
• Ventilation tubes (grommets) in children with OME
• Irritable bowel syndrome
• Liposuction for chronic lymphoedema
• Laparoscopic mobilisation of the greater omentum for use in breast reconstruction
• Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal metastases
• Psychosis (first onset) - neuroimaging
• Follicular non-hodgkins lymphoma (recurrent or refractory stage III or IV) - rituximab
• Community engagement
• Smoking cessation

In the Know  (Executive Summary) from the Audit Commision aims to encourage people to think about the information they use whenever they make decisions. It has examples, drawn from many different sources, of how information has been used in improving public services. It notes:

When decision makers use information well, local public services improve.

• The quality and cost of our local public services depend upon the decisions that many people make: users make choices; professionals exercise judgement; managers prioritise; and politicians allocate resources.
• Using information well in decision making leads to better local public services. Examples vary from reducing the number of young people not in education, employment or training to increasing the number of ambulances reaching incidents quickly; improvements include reducing fly-posting by 90 per cent, and increasing library membership by 58 per cent.
• Two-thirds of 3 and 4 star councils use information well, but only a tenth of 1 and 2 star councils do.

Information needs to be relevant for the decision at hand.

• Different decisions require different information, and judging what information is relevant for a decision is not easy.
• Performance indicators alone will not be adequate for important decisions.
• Aggregating information (for example over geography or time), using a range of information from different sources, and sharing information, will generate a fuller picture.

Good quality data are the foundation of good quality information.

• Data should be captured once and used numerous times.
• Data should be sufficiently accurate for the intended purpose. Highly accurate data are often neither cost-effective nor possible for many decisions.
• Decision makers need to judge how quickly and frequently they need information. Some information may need to be updated and available immediately, in real-time, but for many political, financial and strategic issues, understanding trends over time is more important than immediacy.

The way information is presented is important for accurate interpretation.

• Relevant, good quality, information will not help decision makers if they cannot understand it.
• How information is presented, and what story it helps to tell, can affect the decisions based upon it.
• The way information is presented, therefore, needs to be tailored for both the audience and the decision at hand.

Using information well requires decision makers and analysts to have particular skills.

• Decision makers need to be able to identify the information they need and to interpret it accurately.
• Those providing information need strong analytical and presentation skills.
• Evidence suggests that these skills are in short supply.

People need to think carefully about the information they use whenever they make decisions.

• Those who make important decisions about local public services should demand better and clearer information.
• Public bodies need to evaluate whether their information is fit for purpose and used to best effect.
• Relevance, quality and presentation, summarised as RQP, are the key characteristics for useful information.

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

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The World Class Commissioning initiative provides a major opportunity for Trusts to transform care services and develop new ways of maximising the value of limited healthcare budgets.

While Trusts wait for the WCC Assurance Framework, there are many ways to start planning the transition to World Class Commissioning. Evidence-based analysis of population requirements, how money has been spent and how other organisations are approaching commissioning is a key starting point.

In this interview, Andrew Beale, Executive Director of Matrix Knowledge Group consultancy, discusses how evidence-based analysis can help Trusts to better understand their current position, population healthcare patterns and to maximise the benefit of their investments within the available resources.

Medical care for the Armed Forces: Seventh Report of Session 2007–08: Report, together with formal minutes, oral and written evidence identifies that clinical care for servicemen and women injured on military operations is now “world-class” but the government needs to do more to look after families and veterans, especially in providing mental health care.  Emphasise support had to go beyond the period of an individual’s service, and should form part of the compact between the services and society.

The Health and Social Care Bill 2007-08 has it’s third reading today.  The Bill aims to enhance professional regulation and create a new integrated regulator, the Care Quality Commission, for health and adult social care.  This body will provide assurance about the safety and quality of care for patients and service users.

• Assures the safety and quality of care and creates a new regulator, the Care Quality Commission
• Equips the new regulator with tougher powers, backed by fines, to inspect, investigate and intervene where hospitals are failing to meet hygiene standards
• Strengthens clinical governance and reforms the system of professional regulation to ensure it earns and sustains the confidence of patients, professionals and Parliament
• Extends financial support to mothers-to-be from the 29th week of pregnancy
• Ensures all healthcare professional regulatory bodies use the civil, rather than criminal, standard of proof
• Creates an independent adjudicator to undertake independent and objective formal adjudication for the professional regulatory bodies
• Ensures that all healthcare organisations employing or contracting with doctors appoint a ‘responsible officer’ to work with the GMC to identify and handle cases of poor professional performance by doctors
• Updates the Public Health (Control of Disease) Act 1984 with the aim of providing a more effective and proportionate response to infectious disease.

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World Class Commissioning is set to transform Primary Care and promises to drive unprecedented improvements in patient outcomes. But what should World Class look like, how is it different from current commissioning approaches and what must PCTs do to make the transition?

In this interview from HealthExec TV, Gary Belfield, Director of Commissioning at the Department of Health, outlines the vision for World Class Commissioning, the skills and capabilities PCTs will need to get there, as well as examples of how PCTs might transform their existing ways of working to reach World Class status.

Also reviews:

• how Trusts can assess their readiness for World Class Commissioning
• Bridging skill gaps through sharing best practice and procuring external support
• the Assurance Framework as a tool to drive performance and development
• the DH Development Framework to support Trusts in their transition

The GMC has producted an interactive web resource for its Good Medical Practice guidance. Good Medical Practice in Action opens with four patients in a waiting room and users can click on each patient to watch and listen to their consultation with a doctor. The user is then invited to decide on the best course of action from a range of options.

Topics covered include

• Communication Skills
• Conscientious objection
• Advertising
• Professional Discipline and Whistleblowing

Consultations from NICE seeking views on a clinical practice guideline developments for:

• Familial hypercholesterolaemia: consultation
• Lipid modification: Consultation on section 4.3 - Cardiovascular risk assessment

and requesting views on the use of erlotinib to treat small-cell cancer.

• Lung cancer (non-small cell) - erlotinib (appraisal consultation)

The Reform think tank have produced NHS reform: national mantra, not local reality uses recent academic studies to show that the performance of the NHS across the lifespan is well behind other countries. Improving patient care will need new investment in many areas, but taxpayer funding is (and should be) restricted in coming years. The solution is improved productivity. The report finds that the internal market has altered to favour producers rather than patients. Patient choice and independent sector treatment of NHS patients are in decline.

The report defines two scenarios:

1. Current trends will lead to the negative scenario where the NHS delivers substandard quality and access for 11-12 per cent of GDP (c.£110 billion – c.£120 billion). In this scenario key staff leave the NHS increasing its problems.
2. Alternatively reform delivers immediate access to excellent quality services at a cost of 9-10 per cent of GDP (c.£90 billion – c.£100 billion). Fundemental to this reform is an economic constitution which requires value for money and guarantees patient choice and a diversity of providers. The report believes this would deliver significant improvement within 18 months.

Key findings are:

• In 2007, seven international clinical benchmarking exercises revealed a cradle-to-grave performance gap compared to peer group countries.
• The medium term requirement is investment in many areas. Funding will be restricted given the immediate pressures of a slowing economy and longer term concerns over economic competitiveness. The NHS must redesign and improve services within a ceiling of 9-10 per cent of GDP.
• NHS reform is increasingly a national mantra rather than local reality. Primary Care Trusts, practice-based commissioning and patient choice have failed to drive significant change in the interests of patients. There is no level playing field for independent sector provision. The short-term focus of policy from the Department of Health has prevented a focus on the medium term challenge.
• The return of the service to financial surplus does not signify a better position in which investment can take place. The surplus is due to a temporary combination of the last years of major funding increases and a pause in centrally-prescribed cost increases.
• Current trends therefore point to the scenario of decline. This could be altered with an economic constitution for the service that defines the duty to create value at all levels.

Learning from investigations from the Healthcare Commisson highlights the following issues that have been consistently highlighted as a result of their investigations.

• Leadership and management: Poor leadership was a problem in nearly all of the investigations carried out by the Commission.

  Some boards had been focused on mergers or targets at the expense of their broader activities.

  Lack of continuity in leadership was a problem in some trusts, where frequent changes in management were a factor in poor care. Bullying and harassment by managers was a factor in two cases investigated. The Commission found there was a fine line between promoting change vigorously and bullying.

  Investigations often uncovered a breakdown in leadership and management, with a lack of clarity on responsibilities from board to ward. Poor teamwork, either between management and clinicians or between clinicians themselves was another common factor in failings.

• Use of information: The Commission was surprised that most of the trusts investigated did not have adequate systems in place to routinely inform the board of trends or potential problems. Board members must assure themselves about the quality of services for which they are responsible and need data to do this professionally.
• Mergers and restructures: Seven of the trusts investigated had recently undergone mergers or significant organisational change. The message from the Commission’s investigations is that where significant change is taking place, the management task should not be underestimated.
• Safeguarding vulnerable adults: Poor understanding of adult protection procedures and responsibilities was a serious problem in the two investigations into learning disability services and also a number of interventions in trusts. The Commission said staff need good training to understand their crucial role in protecting vulnerable adults.
• Poor care on general wards: When its investigations looked at acute hospital care, the Commission noted that care on general wards fell well below the care provided on specialist wards. Older patients were most at risk as they were often most dependent on good nursing care. The Commission will monitor this aspect in future investigations to identify whether this is an emerging common theme.

Mental Health Act Commission Eleventh Biennial Report (In Place Of Fear) questions whether all inpatient mental health services provide their patients with acceptable levels of security, care, or a sense of being treated as  someone who matters. It welcome the Government’s announced refocus on inpatient services and call for it to concentrate on building up these aspects, in place of the fear that many patients have of services and that many people have of mentally disordered people.  The importance of breaking such ‘circles of fear’ for Black and minority ethnic patients are particularly welcomed.

There is evidence that inpatient services are losing staff and resources to community
services, but that pressures on inpatient beds remain high. Over half of all wards are full or have more patients than beds, with staffing shortages and unpleasant ward environments undermining the therapeutic purpose of inpatient admission.

The report highlights the dangers inherent in devolved service commissioning for ensuring adequate levels of specialist provision, and note the vulnerability of mental health services as Trusts face financial crises.

The extension of patient ‘choice’ across health service provision should not be allowed further to disadvantage or ostracise patients who are unable to exercise choice because of their mental incapacity or because of legal powers of compulsion held over
their treatment.

Boundaries of current mental health law under stress, with discussion of about forty cases
in court, and a more general observation of legal powers being used in ways that may not have been intended by Parliament, often for pragmatic reasons where professionals are keen to intervene in what they perceive to be a person’s best interest or as measures of social order.

It also discusses aspects of the use of present mental health powers in relation to civil detention and police powers, including an extended discussion on the detention of mentally disordered offenders.We provide analysis of deaths of detained patients; seclusion incidents notified to the Commission; and Second Opinion activity during this period.

The report has a strong focus on measures to encourage and support the empowerment of all patients, including those without mental capacity to make certain decisions about their care.

It finally reviews the proposed future arrangements for monitoring detention of mentally disordered persons and suggest ways in which the forthcoming Mental Health Bill might be improved to ensure acceptability to mentally disordered persons and the effective protection of their rights.

Mental Health Act Commission Eleventh Biennial Report - Errata and Addendum