Code of practice for promotion of NHS services sets out rules around promotional material issued by providers of NHS services to ensure that: the information patients receive is not misleading, inaccurate, unfair or offensive, that the brand and reputation of the NHS is protected, and that expenditure on promotional activity is not excessive.

Personal Beliefs and Medical Practice from the GMC is guidance for medical staff that states  doctors must not allow their personal beliefs to compromise patient care. The guidance explores how doctors should deal with a range of dilemmas including abortion, the wearing of face-veils and male circumcision.  It also looks at patients’ own beliefs and how they can affect the doctor/patient relationship.  It aims to balance a doctors’ right to practise in accordance with their views and beliefs, and the patients’ right to receive timely and appropriate medical care.

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.

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

Organs for transplants - a report from the Organ Donation Taskforce has been in the news over the last week (15th January, 14th January, 13th January) and makes 14 recomendations, with the aim of creating a 50 per cent increase in organ donation in the UK within five years (equivilent to 1,200 transplants a year). These are:

• A UK-wide Organ Donation Organisation should be established.
• The establishment of the Organ Donation Organisation should be the
  responsibility of NHSBT.
• Urgent attention is required to resolve outstanding legal, ethical and professional
  issues in order to ensure that all clinicians are supported and are able to work
  within a clear and unambiguous framework of good practice. An independent UK-wide Donation Ethics Group should be established.
• All parts of the NHS must embrace organ donation as a usual, not an unusual
  event. Local policies, constructed around national guidelines, should be put in
  place. Discussions about donation should be part of all end-of-life care when
  appropriate. Each Trust should have an identified clinical donation champion
  and a Trust donation committee to help achieve this.
• Minimum notification criteria for potential organ donors should be introduced
  on a UK-wide basis. These criteria should be reviewed after 12 months in the
  light of evidence of their effect, and the comparative impact of more detailed
  criteria should also be assessed.
• Donation activity in all Trusts should be monitored. Rates of potential donor
  identification, referral, approach to the family and consent to donation should be
  reported. The Trust donation committee should report to the Trust Board through
  the clinical governance process and the medical director, and the reports should
  be part of the assessment of Trusts through the relevant healthcare regulator.
• BSD testing should be carried out in all patients where BSD is a likely diagnosis,
  even if organ donation is an unlikely outcome.
• Financial disincentives to Trusts facilitating donation should be removed
  through the development and introduction of appropriate reimbursement.
• The current network of DTCs should be expanded and strengthened through
  central employment by a UK-wide Organ Donation Organisation. Additional
  co-ordinators, embedded within critical care areas, should be employed to
  ensure a comprehensive, highly skilled, specialised and robust service. There
  should be a close and defined collaboration between DTCs, clinical staff and
  Trust donation champions. Electronic on-line donor registration and organ
  offering systems should be developed.
• A UK-wide network of dedicated organ retrieval teams should be established
  to ensure timely, high-quality organ removal from all heartbeating and nonheartbeating donors. The Organ Donation Organisation should be responsible
  for commissioning the retrieval teams and for audit and performance management.
• All clinical staff likely to be involved in the treatment of potential organ donors
  should receive mandatory training in the principles of donation. There should
  also be regular update training.
• Appropriate ways should be identified of personally and publicly recognising
  individual organ donors, where desired. These approaches may include
  national memorials, local initiatives and personal follow-up to donor families.
• There is an urgent requirement to identify and implement the most
  effective methods through which organ donation and the ‘gift of life’ can
  be promoted to the general public, and specifically to the BME population.
• The Department of Health and the Ministry of Justice should develop formal
  guidelines for coroners concerning organ donation.

The Organs for transplants - the supplement report provides the wider evidence behind the work of the Taskforce, explains the benefits, of each of the recommendations and explores some of the wider implications.

National Care of the Dying Audit generic report 2006/2007 considers the care of the dying in five key areas and finds that:

Physical Comfort of the Patient 

• Medication was assessed and non-essential medication was stopped in 93% of patients.

• Anticipatory prescribing was undertaken for pain relief in 91% of cases, for agitation in 84% of cases, for the prevention of respiratory tract secretions in 80% of cases, for nausea in 80% of cases and for breathlessness in 67% of cases.

• Inappropriate blood tests and antibiotics were discontinued in 87% and 91% respectively, and recording of ‘not for Cardio Pulmonary Resuscitation’ (where appropriate) documented in 93% of patients.

• In regard to ongoing care the presence or absence of symptoms could be recorded for patients during the last 24 hours of life. The status was not recorded for 18% - 19% of those assessments. Where the status was recorded patients were assessed as being symptom controlled in 95% for pain; 94% for agitation; 91% for respiratory tract secretions and 99% for nausea and vomiting of occasions.

Psychological and Spiritual Aspects of Care

On commencement of the LCP (Initial Assessment)

• Patient awareness of diagnosis and recognition of the dying phase was recorded as having been achieved in 57% and 45% of patients respectively. In one third of cases there was no documentation on the LCP suggesting a need for further education and training for healthcare staff.  Some hospitals, however, did achieve 100%.
• In over 80% of cases, carers were recorded as being aware of the diagnosis and dying phase, suggesting that healthcare staff find it easier to talk to carers
• The spiritual needs of patients and carers were recorded as being assessed in 34% and 53% (respectively) of appropriate cases

Communication with Patient,Carer and Healthcare Professionals

This is variable but carers were more likely to have had the care plan explained to them than the patient:

• At Initial Assessment, documentation confirmed that patients had the care plan communicated to them in over one third of cases, compared with 78% of carers.  It was recorded that 90% of those carers understood the care plan after it was explained to them.

• Communication with primary care (both on commencement of the LCP and after the death of the patient) was documented as having taken place in only about a third of cases, although there were pockets of good practice

Information Giving and Receiving

• Contact information about the most important person to contact in case the patient’s condition deteriorates was achieved at Initial Assessment in 79% of cases and Hospital information leaflets regarding facilities and access were given out in 59% of cases at that time
• Around the time of death or deteriorating condition of the patient (Initial Assessment), only half of families were recorded as having been given appropriate information about local and national procedures that may need to be followed.

Following Appropriate Procedures

• Following death, appropriate hospital procedures for laying out of bodies, storing of patient’s belongings and other activities were documented as having been followed in around half of cases.  However, the high level of care after death goals that are left blank at the point of delivery of care requires more investigation before firm conclusions can be made. 

The Mental Health Act 2007 (Explanatory Note), which received Royal Assent in July 2007, as well as amending the Mental Health Act 1983, was used as the vehicle for introducing deprivation of liberty safeguards into the Mental Capacity Act 2005 (Explanatory Note, Code of Practice).  This briefing sheet sets out information about the deprivation of liberty safeguards.

Key Elements are: 

• People who suffer from a disorder or disability of the mind, such as dementia or a profound learning disability, and who lack the mental capacity to consent to the care or treatment they need, should be cared for in a way that does not limit their rights or freedom of action.

• In some cases members of this vulnerable group need to be deprived of their liberty for treatment or care because this is necessary in their best interests to protect them from harm.

• The European Court of Human Rights (ECtHR) in its October 2004 judgement in the Bournewood case (HL v UK) highlighted that additional safeguards are needed for people who lack capacity and who might be deprived of their liberty.

• The Government is closing the “Bournewood gap” by amending the Mental Capacity Act 2005. The deprivation of liberty safeguards being introduced will strengthen the rights of hospital patients and those in care homes, as well as ensuring compliance with the European Convention on Human Rights (ECHR).

Useful Additional Document

Mental Capacity Act Code of Practice 

‘Public Health: Ethical Issues’ from the Nuffield Council on Bioethics (Executive summary, One page summary, Short Guide) considers the responsibilities of government, industry, individuals and others in promoting the health of everyone. It concludes that the state has a particular duty to help people lead a healthy life and to reduce inequalities. The Council propose a ‘stewardship model’, to achieve this.  Consideration of the acceptability of different public health measures, and the responsibilities of industries that promote products that affect our health are undertaken by the report. Recommendations for policy are made in four areas:

• Infectious disease

• Obesity

• Alcohol and tobacco

• Fluoridation of water

The media have picked up on the report here.

40 years ago legislation was passed enabling abortion. The House of Commons Select Committee on Science and Technology has set about reviewing Scientific Developments Relating to the Abortion Act 1967.  Since 1967 medical technology has had an impact on fetal viability and this raises serious ethical issues with regard to current legislation.

Naturally the media have covered this in great detail, 30th October ,31st October, 1st November,  3rd November,4th November, and 5th November.

National Library for Health - Palliative and Supportive Care Specialist Library brings together information on end of life and supportive care issues. As a result in addition to supporting palliative care it also focus’ on conditions like Chronic Fatigue Syndrome.

It is divided into seven sections that can be accessed from a menu on the left hand side of the screen (Conditions, Symptom management, Service provision, Populations and settings, Death, dying & bereavement, Policy and Ethics & law. Each is divided into more specific subsections which detail the Guidance & Pathways, Evidence, Education and CPD and Patient Information in the area.

For relevant information in this area the Specialist Library is a good place to begin, the library is chock full of valuable links.

For training in the use of NLH and other electronic information resources available to people from Liverpool PCT use the contact form below to contact the Fade Library.