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.

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. 

The Department of Health has developed an implementation tool (XL spreadsheet) (covering letter) that local Mental Capacity Act implementation networks may wish to use when estimating the number of assessments and staff that are likely to be required in 2009 / 10.

Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit aims to support the corresponding programme and has one principal aim - to help PCTs implement NICE Guidelines for people suffering from depression and anxiety disorders. The Government is committed to improving access to psychological therapies and announced additional funding to increase services over the next three years. This Commissioning Toolkit is designed to help PCTs improve or establish stepped care psychological therapies following NICE guidelines. The toolkit is structured around the commissioning cycle and is specifically linked to the World Class Commissioning competencies.

More than one in four adults admitted to hospitals, care homes or mental health units are suffering from malnutrition, the Nutrition Screening Survey and Audit of Adults on Admission to Hospitals, Care Homes and Mental Health Units has found. Women and the elderly were at greatest risk, says the report from the British Association for Parenteral and Enteral Nutrition (Bapen). More than 11,000 patients were screened for signs of being under-fed and 28 per cent were found to be malnourished.

It recommends:

• Screening should be undertaken in all institutions and repeated at interval according to care setting, using accurate and reliable instruments
• Results of screening should be included in care plans.
• Nutrition advice and nutrition support teams should be routinely available.
• Strategies to detect, prevent, and treat malnutrition should be in place in all care settings, including the community, where most malnutrition originates.

• 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.

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

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.

New e-journals available via Ingenta Connect you’ll need an Athens password from Liverpool PCT to access them (You can register here if you work for the PCT and don’t have one)

• Clinician in Management 2001 –
• Diversity in Health and Social Care 2004 -
• Education for Primary Care 2001 -
• Primary Care Mental Health 2003 -

If you need any training in the use of these or any other electronic resources and you work for Liverpool PCT you can contact us using the form below.

The Links Between Diet and Behaviour: The Influence of Nutrition on Mental Health from Associate Parliamentary Food and Health Forum (FHF), an all-party independent forum for the exchange of views and information on food policy in the UK Parliament.

The report makes the following 19 recommendations:

• The Government – principally the Department of Health, the Department for Children, Schools and Families and the Ministry of Justice, working with the FSA and the Medical Research Council – commission and support further research in the areas highlighted in this report.

• The Scientific Advisory Committee on Nutrition (SACN) should be asked to define further the optimum intake of omega-3 polyunsaturated fatty acids (PUFAs) in different stages of life, especially for pregnant women and children.

• The FSA should reconsider its advice to pregnant women about fish consumption, with a view to encouraging them to eat two portions of oily fish, or the equivalent in omega-3 PUFAs, a week.

• The FSA continues to monitor closely levels of mercury, dioxin and dioxin-like polychlorinated biphenyl (PCB) in the different species of oily fish available in the UK.

• The Royal Medical Colleges and the GMC consider upgrading the role of nutrition in the medical curriculum.

• Primary Care Trusts (PCTs) should increase the number of posts for dietitians working in the community and that GP practices should be fully reimbursed if  they employ a dietitian to whom patients can be referred for nutritional advice.

• The Government should take further action to raise public awareness of the significance of good nutrition in pregnancy and to tackle the incidence of low birth-weight in the UK.

• More research to test the effect of selected essential fatty acids on the cognitive skills, mood and behaviour of both “healthy” children (that is, children suffering from no known disorders), as well as children suffering from a range of behavioural disorders should be undertaken.

• Regulations should be introduced to prohibit all artificial colours and on-essential preservatives in food products and soft drinks.

• The Government should include financial support to School Breakfast Clubs as part of the package set up to improve school meals. We strongly recommend that all children entitled to free school lunches should be entitled also to a free school breakfast whose content, like school lunches, should be subject to quantified nutritional standards.

• The Department of Health encourages NHS Trusts to adopt an approach similar to that pursued by the Doncaster and South Humber Healthcare NHS Trust which undertakes a nutritional assessment of patients suffering from depression and patients with early symptoms of psychosis and provides dietary advice to them.

• Consideration of the outcome of the next trial of nutritional supplements in Young Offender Institutes should be a priority for the National Offender Management Service (NOMS) given that our prisons are overcrowded and there is continuing concern about the mental health of prisoners, particularly young offenders at risk of self-harm and suicide.

• Aany dietary intervention that can be used to improve the behaviour and mental well-being of offenders held in custody should be given serious consideration by the NOMS.

• NOMS should look positively at the case for introducing nutrient-based standards for meals in prisons, similar to those introduced for schools, but based on recommended daily intakes for adults.

• Effective measures should be taken in all prisons to inform prisoners about the benefits of a good diet and to enable them to make healthy choices both while they are in custody and after their release.

• In all women’s prisons national nutritional standards should be introduced to ensure that the basic dietary needs of pregnant women prisoners are achieved.

• More research is urgently needed in the area of nutrition and behaviour because of the major potential benefit for the fields of education, crime, health and the well-being of vulnerable sections of society and we recommend that the Government devotes more resources to this, especially in corrective institutions and care homes.

• Department of Health messages on a healthy diet should emphasise the importance of a balanced diet for optimum mental as well as physical health.

• While research continues to identify and produce alternative sources of omega-3 PUFAs, the report recommends that all people in the UK should be encouraged to eat more fish, some of which should be oily fish, or its equivalent in omega-3 PUFAs.

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

Dementia is a term for a range of progressive, terminal organic brain diseases. 560,000 people in England have dementia and it costs the economy some £14 billion a year. The House of Common’s Committee of Public Accounts have produced ‘Improving Services and Support for People with Dementia’ following ‘Improving Services and Support for People with Dementia’ from the National Audit Office and examines the prevalence and costs of dementia, diagnosis and early intervention, access to and quality of support services, and experiences of people with dementia in hospital and care homes.

Recmmendations and findings include:

• Dementia has not been an NHS priority, the Department of Health is developing a National Dementia Strategy.
• There is no single individual with responsibility or accountability for improving dementia services.
• Between a half and two-thirds of people with dementia never receive a formal diagnosis.
• There is poor awareness amongst the public and some professionals of dementia.
• People with dementia and their carers should be given a single health or social care professional contact point to improve the coordination of their care service.
• Between half and two-thirds of all carers do not receive the carer’s assessment to which they are entitled.
• 62% of care home residents are currently estimated to have dementia but less than 28% of care home places are registered to provide specialist dementia care.
• Hospital care for people with dementia is often not well managed, increasing the risk of longer hospital stays, admission to a care home, and a deterioration in the patient’s health.

Crisis Resolution Home Treatment teams are having a positive impact on local acute mental health services, providing an alternative to hospital admission for people experiencing a short-term mental health crisis.

But Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment services (Executive Summary, Crisis Resolution Home Treatment Services: Report from a Survey of Referring Clinicians) from the National Audit Office found that services are being limited by a lack of input from specialist health and social care professionals, variations in staffing levels across the country and too few admissions to hospital being assessed by CRHT teams. These teams have been implemented across most areas of the country, there are wide variations between areas in the extent to which teams are staffed and resourced but where they are working they are making a significant impact. CRHT teams have reduced pressure on beds and the teams have been successful in reaching many service users who would otherwise have needed admission to hospital. CRHT teams are also supporting people in early discharge from hospital.

Only three regions achieved the Department’s estimate for a full functioning service of 14 or more whole-time-equivalent CRHT staff per 150,000 population. Staffing in the least well resourced region (North West) is 25 per cent lower than that in the best (South Central) and the national headcount for staff is only 90 per cent of the number estimated by the Department as required.

The report concludes that there is still more to do. To maximize the impact of CRHT and improve value for money the Department and the NHS need to ensure that CRHT teams are properly resourced, fully functional and integrated within local mental health services. National data on services must improve, and better use of feedback and data made at the local level. Local NHS organizations need to improve links between CRHT teams and other mental health services, and Mental Health Trusts should enforce written policies and procedures requiring every inpatient admission to be preceded by a CRHT assessment.

The NHS has improved dramatically over the last few years, but still cannot guarantee that basic minimum standards are being met for patients throughout England and Wales, according to State of Heatlhcare 2007: Improvements and challenges in services in England and Wales. More than a quarter of NHS hospitals failed to provide adequate emergency services for children and 48% could not provide children with a satisfactory service in outpatient clinics, the Healthcare Commission said in its annual report on the state of the nation’s healthcare.

Key findings are:

The health of the population is improving with significant increases in life expectancy, but there are major disparities around the country, particularly in poorer areas where there are often fewer GPs.

• Men are living over four years longer than they were 20 years ago, while women are living three years longer.
• Men from more deprived areas live for a decade less than those in wealthier areas. Looking at local authority areas, for example, Kensington and Chelsea has the highest life expectancy for both men and women, at 82.2 years and 86.2 years respectively. The lowest life expectancy for men is in Manchester at 72.5 years, and for women in Liverpool at 78.1 years.
• In poorer areas, where people tend to experience worse health, there are 18% fewer GPs than in the least deprived areas (54 per 100,000 people compared to 66).

Patients are positive about hospital services overall but some organisations perform poorly. Beneath the headline figures there are concerns about aspects of care such as dignity and privacy.

• National analysis of the Commission’s survey of 80,000 inpatients at acute hospital trusts shows that 89.2% (149) were ranked “satisfactory” on patient experience, 7.8% (13) were “below average” and 3% (5) were “poor”. Eleven of those in the latter two groups were rated as “below average” or “poor” for the second year running. The survey also shows concern about specific issues such as help with eating - one in five patients who wanted help eating did not get it.
• Almost a third of the complaints about hospitals referred to the Commission for independent review relate to dignity and respect, nutrition and other aspects of basic personal care. They included: patients left in soiled bedding and clothing; no regular baths or showers or oral hygiene; inappropriate or inadequate clothing.

There have been dramatic improvements in waiting times but there are hidden waits for some services, which are not measured and therefore difficult to address.

• Government standards say no patient should wait longer than 26 weeks for a hospital appointment. In 2006/07, 83% of trusts met this, leaving some 350 patients with longer to wait than 26 weeks. This is a vast improvement on figures for 2000 when 264,000 patients waited this long.
• Waiting time targets do not apply fully to some services, making it difficult for problems to be addressed and patients needs to be met. Evidence suggests that a two-year wait for those referred for psychological therapies is not uncommon. People in some areas are still waiting between 12 and 24 months to have hearing aids fitted.

NHS trusts are performing better overall on quality of services, but the performance of primary care trusts (PCTs) has declined, with many not getting to grips with the needs of their communities so as to provide services to match.

• Overall, the quality of NHS services is improving with 46% of trusts rated ‘excellent’ or ‘good’ in 2006/07, compared to 40% in 2005/6. But for PCTS, only 26% were ‘excellent’ or ‘good’ in 2006/7 compared to 33% in 2005/6. Many PCTs went through a reorganisation over the period but this does not provide a complete explanation for the underperformance.
• The Commission says PCTs form the bedrock of healthcare. They control more than three-quarters of the budget, purchasing services from other providers, including hospitals. They are directly responsible for providing services handling more than 80% of NHS contact with patients, including those carried out by GPs and dentists.
• The report says that many PCTs do not fully understand the health needs of their local people, making it difficult for them to buy targeted services. For instance, last year 2.3 million people did not have their BMI index recorded as planned, with GPs not recording the data, which provides vital statistics on levels of obesity. The number of people diagnosed with heart failure is also considerably less (140,000) than expected, indicating that GPs may not be picking up on signs of serious illness. There is also a poor understanding of the sexual health of local populations at a time when sexually transmitted infections are rising rapidly.
• Where there is a known need, PCTs are not always providing the services required. Some 60,000 people with serious long-term conditions did not get the care from community matrons that was originally planned. Forty-one per cent of PCTs failed to purchase sufficient crisis services for people who are seriously mentally ill, resulting in 5,000 fewer people receiving the service than planned. Some 85% of PCTs did not have arrangements for providing education programmes for patients with diabetes in their area. And 2,000 GP practices did not fulfil their PCT’s plans to establish registers for those people at risk of coronary heart disease, designed to help prevent these patients from becoming seriously ill.

There is progress towards a stronger culture of safety and grounds for cautious optimism in reducing healthcare-associated infection. But trust boards need to show stronger leadership.

• On safety more generally, there has been an encouraging increase in reporting of incidents. Reported figures show more than 229,000 known incidents causing low or moderate harm and more than 9,400 incidents causing severe harm or death.
• Only 58% of NHS trusts complied with all the government’s nine core standards on safety, with infection control, decontamination of medical devices and medicines management the biggest areas of concern.
• Infection control is arguably of greatest public concern; latest figures suggest grounds for cautious optimism. Cases of MRSA fell from 7,096 in 2005/2006 to 6,381 in 2006/2007. There are early signs that increases in cases of Clostridium difficile are slowing. Between 2005 and 2006 the number of cases increased 7% to 55,620, compared to a 16% rise from 2004 to 2005.
• By the end of October 2007 the Commission had visited 87 trusts to check their performance in meeting the requirements of the hygiene code. Only one trust needed to be issued with an improvement notice, suggesting that organisations are taking the issue seriously. But there was a need for stronger leadership from trusts’ boards to improve monitoring, isolation facilities, training, and compliance with policies and procedures.

New figures show that more independent healthcare providers meet core standards, mirroring a similar trend among NHS trusts. But there are concerns about compliance among independent providers of mental healthcare.

• The proportion of independent healthcare establishments that met the government’s national minimum standards - including those that were not inspected as they were considered not to be at risk - was 63% in 2006/07 compared to 50% the year before. Five per cent of independent establishments failed five or more of the standards.
• Although NHS trusts must meet a different set of standards, the broad picture is similar. The number of trusts that were “fully met” on government core standards rose from 49% in 2005/06 to 55% in 2006/07. Six per cent of trusts were judged “not met” on core standards overall.
• In the independent sector, non-compliance was greatest on national minimum standards covering: monitoring of quality of treatment (C4); ensuring patients get care from appropriately recruited, trained and qualified staff (C9); and taking account of patients’ views (C6).
• Independent mental health providers, which mostly look after NHS patients, performed worse than others in the sector. Non-compliance was greatest in relation to national minimum standards for: ensuring patients receive care from appropriately recruited, trained and qualified staff (C9); providing treatment in safe and appropriate premises (C17); and ensuring patients are resuscitated appropriately (C27).
  Independent providers of mental health services need to focus on ensuring patients are appropriately and safely restrained. In 2006/7, 17% of establishments failed a standard in this area compared with under 9% in 2005/2006.

The NHS often fails to meet the needs of children and young people and there are concerns about other groups requiring specialist care, such as people with mental health problems and with learning difficulties.

• Paediatric hospital services are generally good at looking after children, but other more general services are not. Some 70% of specialist inpatient services were rated “good” or “excellent” by the Commission, but 28% of emergency and day case services were “weak”. Transition from children to adult services is not managed well in services for people with mental health problems, diabetes and disabilities, and those requiring palliative care services. Vulnerable children such as those with disabilities, those in care and young offenders face particular problems in getting appropriate care. One in 20 NHS trusts are not yet compliant with child protection standards.
• On specialist wards for people with mental health problems and people with learning difficulties, more than half of the inpatients were found to be in mixed-sex accommodation.
  Levels of violence in mental health services remain high, although there are signs of it being dealt with better. The report includes new data from an audit into violence in the sector, which found that almost one in 20 patients reported being assaulted. Forty-six per cent of nurses reported being physically assaulted, and 72% said they had been threatened or made to feel unsafe. On older people’s mental health wards, almost two-thirds of nurses reported physical assault by patients.

There have been dramatic improvements in responding to the big killers - cancer, circulatory and respiratory disease - but five-year survival rates for cancer, and mortality rates for respiratory disease, are worse than in other comparable countries.

• The mortality rate for people under 75 diagnosed with cancer fell by almost 17% between 1996 and 2005, which suggests that some 60,000 fewer people died prematurely.
• Despite this improvement, the UK survival rates do not compare favourably with most of Europe. For instance, the survival rate for lung cancer in Holland and Spain is around double that in England, which stands at 6.5% for men and 7.6% of women.

The Queen’s Nursing Institute have produced ‘On The Ground: Mapping Homeless Healthcare’ a report on nursing care for the Homeless.

Key findings are:

• One in three homeless young people have attempted suicide.

• Mental health problems are eight times more likely if you are homeless.

• Homeless people are four times more likely to use A & E Services.

• If a homeless person is injured it is four times more likely to be because they have been assaulted.

• The life expectancy for those sleeping rough is 42 – down from 47 a decade ago.

Just into the library this special issue of Sociology of Health and Illness focus’ on Diversity, Inequalities and Ethnicity. You’ll need your NHS Athens password to access the full text articles. If you haven’t got one and you work for Liverpool PCT you can apply for one here.

Locating ethnicity and health: exploring concepts and contexts

Waqar I. U. Ahmad and Hannah Bradby

pages 795–810

• Abstract
• References

The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference?

James Nazroo, James Jackson, Saffron Karlsen and Myriam Torres

pages 811–830

• Abstract
• References

Race and nutrition: an investigation of Black-White differences in health-related nutritional behaviours

Peter Riley Bahr

pages 831–856

• Abstract
• References

Describing depression: ethnicity and the use of somatic imagery in accounts of mental distress

Sara Mallinson and Jennie Popay

pages 857–871

• Abstract
• References

Hospice or home? Expectations of end-of-life care among white and Chinese older people in the UK

Jane Seymour, Sheila Payne, Alice Chapman and Margaret Holloway

pages 872–890

• Abstract
• References

Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents’ accounts of diabetes causation

Julia Lawton, Naureen Ahmad, Elizabeth Peel and Nina Hallowell

pages 891–906

• Abstract
• References

Long-term health conditions and Disability Living Allowance: exploring ethnic differences and similarities in access

Sarah Salway, Lucinda Platt, Kaveri Harriss and Punita Chowbey

pages 907–930

• Abstract
• References

Interpreted consultations as ‘business as usual’? An analysis of organisational routines in general practices

Trisha Greenhalgh, Christopher Voisey and Nadia Robb

pages 931–954

• Abstract
• References

Retraction

Clive Seale

pages 955–955

• Summary

‘Racism, ethnicity, identity, and health: UK and US comparative perspectives’

Nancy Krieger

pages 956–956

• Summary

If you need some training to make the most of this or any other electronic resource available via the Fade Library and you work in Liverpool PCT, please contact us using the form below.

Pandemic influenza: guidance for infection control in hospitals and primary care settings replaces the infection control guidance published in October 2005. The changes and amendments in this edition are detailed on page 4 and include updated advice on aerosol- generating procedures. This advice takes into consideration and addresses the categorisation of such procedures in the recently published interim guidance from the World Health Organization on ‘Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care’.