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This Command Paper sets out the Government's response to the Committee's 4th report, session 2003-04 (HCP 454-I, ISBN 0215018699)
Palliative Care : Fourth report of session 2003-04, Vol. 2: Oral and written Evidence
"Children's palliative care is an evolving specialty and as such our knowledge base cannot remain static. This book constantly challenges the reader to critically analyze their own practices and beliefs within an evidence-based framework and as such makes a valuable contribution to the growing body of knowledge on this important subject." - Susan Fowler-Kerry, in the Foreword. This book caters for readers from different working environments and levels of experience. It is ideal for paediatric nurses with no specialist palliative care knowledge, and also for palliative care nurses with no specialist paediatric experience. Other healthcare professionals and therapists working with children, young people and their families will also find this book invaluable. It will also be ideal for undergraduate and postgraduate health and social care students, and professionals involved in children's hospices, community services and charity groups. "This book captures not just the rapidly evolving evidence base, but also as many current developments as possible and applies them in a meaningful way to the care of infants, children, and young people living with life-limiting illness, and their families. It offers an overview of contemporary issues and helps to stimulate the type of dialogue that can bring about the actions that will make a real difference for the children, young people and families in our care." - Rita Pfund, in the Preface.
In England, implementing Electronic patient record (EPR) systems is one of the main aims of the 10-year National Programme for Information Technology (NPfIT). The main plank of the NPfIT programme is the NHS Care Records Service (NCRS) which will create two separate EPR systems: a national Summary Care Record (SCR), containing basic information, and local Detailed Care Records (DCRs), containing more comprehensive clinical information. NCRS will also include a Secondary Uses Service (SUS) which will provide access to aggregated data for management, research and other 'secondary' purposes. On the SCR, this report finds: a lack of clarity about what information will be contained; consent arrangements for creating and adding information have not been well communicated to patients or clinicians; important components have not yet been completed; maintaining security is a serious challenge. The DCR systems are to replace local IT systems across the NHS, but the report points to delays in trials and implementation, difficulty in establishing either the level of information sharing that will be possible, or how sophisticated local IT applications will be. There has also been a lack of local involvement in delivering the project, with hospitals often left out of negotiations between Connecting for Health (the body delivering NPfIT) and suppliers, leading to a lack of enthusiasm for deploying the systems. The Committee recommends Connecting for Health focuses on setting and ensuring compliance with technical and clinical standards for NHS IT systems, allowing local users the final say over which system is procured and how it is implemented. The report points to some notable successes too: agreement on a universal coding language for the NHS, and a single unique patient identifier, the NHS number; and the potential for the SUS and health research is significant.
Work of the Committee 2007 : Second report of session 2007-08, report, together with formal Minutes
With allergies affecting about 30% of the adult population, and 40% of children, the need for a skilled primary care service is essential. The Committee, though, found serious problems in provision of such services. To combat this, the Committee recommends; setting up a network of primary care allergy providers; improved incentives for GPs to treat allergies; a system for better training in understanding and dealing with allergies; developing a framework that introduces allergies into the GPs Special Interest programme, so giving their treatment higher priority. Besides the deficiencies highlighted in the primary care services, the Committee also recommends improvements to secondary and tertiary care, and that at least one specialist allergy centre should be located in each of the former NHS regions, serving populations of between 5-7 million, and with a minimum of four allergy consultants. The Committee thinks that in the longer term, allergies should be the focus of a full specialist consultant workforce, with every major teaching hospital having a consultant-led service
Healthcare systems have been confronted by multiple, often conflicting, guidelines on the use of medical technologies. The National Institute for Clinical Excellence (NICE) was established in 1999 to address these problems in England. This work looks at what it does, how it works, changes made since its establishment, and the challenges it faces.
NHS Primary Care Trusts (PCTs) were created in 2002 to commission health services for their local populations, and are currently responsible for controlling about 80 per cent of the £76 billion NHS annual budget. In addition, PCTs have responsibility for public health, and many also provide community-based health services such as district nursing and community hospitals. The Committee's report examines the Government's proposals (set out in the Department of Health paper 'Commissioning a Patient-led NHS' published in July 2005, which can be downloaded at http://www.dh.gov.uk/assetRoot/04/11/67/17/04116717.pdf) to cut the number of PCTs and to contract out community health services by the end of 2008. The report raises a number of serious concerns about the proposals, including in relation to: failings in the consultation process; the impact of PCT restructuring and divestment of provider services; and the likelihood that the estimated financial savings of £250 million will be achieved.
The Government is committed to involving Parliament in the appointment of key public officials, and nominees for certain positions should be subject to a pre-appointment hearing with the relevant select committee. The hearing would be non-binding, but in the light of the report from the committee, Ministers would decide whether to proceed. On 30 April 2008, the Secretary of State invited the Health Committee to hold a pre-appointment hearing in respect of Baroness Young of Old Scone, the candidate for Chair of the Care Quality Commission (CQC). The Report looks first at the CQC and the role of the Chair, then at the appointment process, and finally considers the suitability of the candidate. The Committee finds that Baroness Young is a suitable candidate for the post, and has the requisite professional competence, independence and integrity.