The Department of Health has launched a “vision and strategy” to support and develop the contribution of all nurses to the care of dementia patients.

The strategy, published as the Prime Minister’s Dementia Challenge reached its first anniversary, describes what is expected of general, “dementia skilled” and specialist nurses working across all care settings.

Significantly for industry, the strategy requires nurses to be “research aware and committed to delivering evidence-based care”.

Listing the values and behaviours necessary for nurses involved in dementia treatment and care, the strategy includes:

• recognising that dementia “brings cognitive, behavioural and physical changes”

• supporting advance care planning

• promoting patient choice and focusing on “strengths and unmet need”

• using “all available resources including networking, technology and social media to improve care and access to services”.

A pyramid of nursing care is outlined, with all nurses providing “usual care and support”, dementia skilled nurses providing “assisted care or care management”, and dementia specialist nurses providing “intensive or case management”.

Emphasis is placed on the need for “seamless” integrated care across a range of settings: home, community and hospital.

The strategy addresses the responsibilities of nurses not only in the NHS but also in social care, the prison service and the private and voluntary sectors.

Pauline Watts, DH Nurse Lead for Dementia Care, commented on the launch of the strategy: “Dementia is every nurse’s business – with a change in mindset, practice, commissioning and education, nurses can make a real difference to people living with dementia and their carers and families.”

Sir David Nicholson, Chief Executive of the NHS, could be charged with corporate manslaughter in a private prosecution over Stafford General Hospital.

A member of the public has applied to Camberwell Green Magistrates’ Court for permission to charge Nicholson with corporate manslaughter and misconduct in public office, as well as perverting the course of justice.

Alan Edwards of Greenwich, London, a former investment banker, seeks to convince the court that Nicholson has a prima facie case to answer – i.e. that his guilt is plausible on the known evidence.

Edwards hopes to call on witnesses including members of the Cure the NHS campaign; CQC board member Kay Sheldon and former CQC investigator Heather Wood; and patient groups representing families.

“The regulatory system is just not fit for purpose,” he said. “That is why I am doing this and because there are serious failings across the health system which means things like deaths are covered up.

“We will seek full disclosure of all correspondence with David Nicholson’s office to find out about all of the information he received, what information he had and what he did with that.”

Nicholson has already claimed that the Labour government’s infection control and waiting time targets were responsible for the deaths because they distracted healthcare professionals from care quality.

Legislation allowing prosecution for corporate manslaughter was passed in the UK in 2007.

Private prosecutions for serious crimes are rare in the UK, though precedents exist. It is not clear whether Edwards will be cleared to bring the prosecution.

The Department of Health commented: “We see no basis for this case.”

The Department of Health has agreed to withdraw and revise the current secondary legislation on competition in NHS commissioning.

New regulations, tabled in Parliament a month ago, appeared to give Monitor the power to enforce private sector tendering of virtually all NHS services.

Following protests from the Academy of Medical Royal Colleges (AMRC) and over 1,000 GPs, the DH has claimed any difference between this and the former regulations was purely “inadvertent”.

Allowing CCGs to decide which services would be put out to competitive tender was one of the modifications to NHS reform agreed following the ‘listening exercise’.

However, the new secondary legislation appeared to override the ‘discretionary’ powers of CCGs and enforce competition in all areas of care, potentially driving the contracting out of most NHS services to the private sector.

Monitor would be empowered to enforce competitive tendering except where only one qualified provider existed, which is rarely the case.

Last week, a letter signed by over 1,000 GPs was sent to the Daily Telegraph urging a full Parliamentary debate on the new regulations, which will become law by default unless actively opposed.

This weekend, the AMRC wrote to Health Minister Earl Howe expressing “considerable concern” that the regulations disregard assurances formerly given by the DH and would drive a “dangerous” fragmentation of the NHS.

The situation recalls former Health Secretary Andrew Lansley’s statement that the listening exercise had not significantly altered any aspect of the NHS reform.

However, following the protests, Health Minister Norman Lamb (pictured) said the DH had “inadvertently created confusion and generated significant concerns”, and would revise the secondary legislation to show that it was in line with existing rules.

The revised version will be “fully in line with the assurances given” to the medical professions, he said, and will confirm the power of CCGs to decide which services go out to tender.

Shadow Health Secretary Andy Burnham said the revision of the secondary legislation, less than a month before it comes into force, shows that “Coalition policy on competition in the NHS is in utter chaos.”

Dr Anna Dixon will leave her position as the Director of Policy at The King’s Fund and rejoin the Department of Health as Director of Quality and Strategy and Chief Analyst.

She will take up her new position in early May after spending more than six years with independent charitable organisation

Commenting on the appointment, Una O’Brien, Permanent Secretary at the DH, said the new recruit “brings expert insight in to a wide range of health and care policy.”

Before joining The King’s Fund, Dr Dixon worked in the Strategy Unit at the DH focussing on a range of issues including choice, global health and public health.

“I am delighted to be taking up this new role at the Department of Health at such a critical point when many organisations are taking on new responsibilities in the NHS and public health system,” said Dr Dixon.

“I look forward to working closely with colleagues in the Department as well as partners across the health and social care system to address the key strategic issues facing us, not least among which is the challenge of securing high quality care for patients and users.”

The Department of Health has published a ‘pledge’ to improve health outcomes for children and young people through co-ordinated activity across the NHS.

Stated aims include a reduction in the child mortality rate, improved care for children with long-term conditions, and better mental health care for the young.

A new Children and Young People’s Health Outcomes Board, led by the Chief Medical Officer, will focus on improving outcomes across paediatric care.

The DH is responding to a report from the Children and Young People’s Health Outcomes Forum, warning that child mortality rates in England are among the worst in Europe and that 26% of children’s deaths are linked to failures in direct care.

The Forum calls for attention to obesity, maintenance of long-term conditions, earlier diagnosis of mental health disorders, and better attention to the health needs of looked-after children.

GPs will be offered specialised training or support in paediatric health, and provided with new colour-coded health maps showing trends in conditions such as asthma and diabetes.

The CCGs will be asked to review their provision of services for children and investigate poor outcomes.

The DH also said it would investigate proposals by the Royal College of General Practitioners to extend GP training for a fourth year to include child health and mental health.

Health Minister Dan Poulter said: “It is a shocking fact that child mortality in Britain is the worst when compared to other similar European countries. There is unacceptable variation across the country in the quality of care for children – for example in the treatment of long-term conditions.

“Our pledge demonstrates how all parts of the system will play their part and work together to improve children’s health.”

Hilary Cass, President of the Royal College of Paediatrics and Child Health, commented: “It’s crucial that this momentum is maintained and that outcomes are regularly measured to drive improvements.

“We will be directly involved in a number of areas, which include enhancing the use of medicines in children and working with GPs to ensure paediatrics is part of their training.”

Signatories to the pledge include the DH, Healthwatch, the NHS Commissioning Board, NICE, MHRA and Public Health England.

A key principle of the pledge is that improving children’s health outcomes will not only reduce child mortality but lay the foundations for healthier adult lives.

The Department of Health blocked NHS Direct from telling the public that there is “no good quality clinical evidence” to show that homeopathy is more than a placebo.

It also removed a reference to a 2010 report from the House of Commons Science and Technology Committee that recommended the NHS stop prescribing homeopathic remedies.

This intervention followed lobbying by the Foundation for Integrated Health, an ‘alternative medicine’ charity set up by the Prince of Wales.

The NHS Choices website is commissioned by the DH from the private company Capita, and is meant to guide patient choices on health and treatment.

Communications obtained under the Freedom of Information Act show that the writer of the NHS Choices article on homeopathy was asked to meet with the Foundation for Integrated Health.

Following this, the draft guidance was edited by civil servants to take account of the views of a Foundation representative.

The statement that many independent experts would say “there is no good quality clinical evidence to show that homeopathy is more successful than placebo” was deleted.

So was the observation: “If the principles of homeopathy were true it would violate all the existing theories of science that we make use of today.” This is particularly significant for the pharmaceutical industry, as homeopathy denies the need for an active ingredient.

NHS Choices protested to the DH, calling the censored version “a serious gap in the information we provide for the public.”

David Mattin, the editor of the homeopathy article, commented: “The whole episode is an insight into the way special interest groups can influence the workings of government and the public sector, simply by making a lot of noise and having a few powerful friends.”

In the new Pf, Health Secretary Jeremy Hunt answers some questions from our readers. Maxine Vaccine delivers a brief audit report on his answers.

The most vital thing to remember about Jeremy Hunt is that he’s not Andrew Lansley. The older man spent nine years dreaming up a transformation of the NHS into a competitive healthcare market system, then claimed he’d had to invent it out of thin air when, as part of the new coalition government, he “saw the books” (which he’d had full access to for nine years) for the first time. Then he drove through legislation designed to break up the NHS and place its fragments on the bargain shelf of global corporate business, and mocked anyone who questioned it. Forced into a cosmetic display of ‘consultation’, he followed it up by declaring that the ‘listening period’ had been needed only to educate the ignorant doctors.

And suddenly, the Tories are faced with the prospect of losing power. Journalists are calling the Health and Social Care Act ‘Cameron’s poll tax’. Cue the new Department of Health. Exit the sneering headmaster and enter the elegantly half-smiling head boy. Who doesn’t half scrub up well, and – unlike Lansley – can say “the NHS is one of our greatest assets” without crossing his fingers behind his back. Jeremy Hunt was a contributor to Direct Democracy (2005), a Conservative Party activist guide that claimed the NHS was “no longer relevant” to modern society because it was a public sector health system. But he can say “the NHS is one of our greatest assets” because he can say anything. Lansley is a Thatcher type of politician, whereas Hunt is a Blair type.

His answers to the Pf questions are classic examples of why he has been drafted in to front NHS reform up to the next General Election, or at least part-way there. He never says the wrong thing. If he can’t say the right thing, he says nothing in a nice way. He makes you feel that anyone who disagrees with him must be insane. It’s only when you compare his words with what is actually going on that things get complicated – and you realise that, as a new lease-holder in the house that Lansley built, he has only unpacked the suitcases for two rooms: the front room and the bathroom. The rest of the house is unoccupied.

Regular Pf contributor Omar Ali asked Hunt a question about NHS rationing: how will making patients pay for services be integrated into the wider healthcare bill implementation? A good question, as this is already happening: patients in many areas are being told they cannot have cataract operations, varicose vein surgery or hip/knee replacements unless either (a) they wait until their need is greater (for example, they can have cataract surgery once they are blind) or (b) they go private. Referral management, which Sir David Nicholson is very keen on, is another form of rationing: if patients want to see a specialist in many situations, they have to go private. Hunt’s response is worth quoting in full:

Let me be absolutely clear on this – the NHS will always be free at the point of delivery and no one will be asked to pay for its services. Yes, in the future, services will be provided differently – public health services will be organised by local authorities, for example – but the founding principle of those NHS services being free, for those who need it, will never change.

Hunt is neatly splitting the hair of Omar Ali’s question. If people are paying for services they are not NHS services, they are private. But money will still be changing hands for services that used to be free. They just won’t be NHS services any more. And that “for those who need it” is significant. It has two aspects: severity of clinical need (already a moveable famine) and ability to pay (Direct Democracy suggests the NHS should become a means-tested state reimbursement of private healthcare fees). Who needs free healthcare, and what free healthcare they need, will be critical issues from now on – and legally, the Health Secretary now has no remit to influence those decisions, which will be made by autonomous CCGs and/or the autonomous Commissioning Board.

Pf reader Susan Ranch asked whether the Government’s recent announcement that it will cap individual payments for social care at twice the Dilnot-recommended level means that more NHS funding will be committed for elderly patients. Hunt replied: This is incorrect. The Government has not said this and no decision has been made. Strictly speaking, he is right. According to the BBC and three Tory-loyal newspapers (the Sunday Times, the Daily Mail and the Daily Express), journalists were briefed that setting the social care payment cap at £75k (whereas Dilnot had recommended £35k) would feature in the Government’s mid-term review. But it did not – and the critical backlash from social and healthcare experts was either unnecessary or effective, depending on your interpretation. Whatever its level, the cap appears unlikely to be implemented before the 2015 election.

Hunt went on to say: I want this country to become one of the best places in Europe to grow old and make sure people can live independent and healthier lives into old age. Which is the kind of gold-plated soundbite Lansley never delivered.

Another Pf reader, Leigh Saunders, asked how the pharmaceutical industry could work with the NHS to improve cancer survival rates. Hunt replied: The pharmaceutical industry already plays a vital role in improving the health of people with cancer. I want to improve mortality rates, where the targeting and development of medicines is becoming ever more important. I am sure the pharmaceutical industry will want to build on its work in this area and help improve cancer care.

Great stuff: that flatters the industry, expresses a decent medical aim, and then flatters the industry again. It doesn’t answer the question, but who cares?

Jeremy Hunt’s management of the Pf questions is a masterclass in accessible spin. It tells us almost nothing about Government policy, but it tells us why Hunt currently holds the lease on the house of NHS reform. He knows how to make it look good – and in politics, that’s not always easy. The pharma industry should recognise Hunt’s talents as those of marketing and sales. He’s one of us.

Maxine’s views and attitude are not necessarily those of Pf.

Health and wellbeing boards (HWBs) across the country will have to work closely with local providers of health and care services if they are to be successful, a new report warns.

The NHS Confederation’s report argues that the new responsibilities of the boards, such as creating joint strategic needs assessments and health and wellbeing strategies, can only be met effectively with the help of local assistance.

Jo Webber, Interim Director of Policy at the NHS Confederation, said HWBs would need to take a flexible approach to working with local providers if they are to successfully tackle regional priorities.

The report, Stronger together: how health and wellbeing boards can work effectively with local providers, outlines how local providers must be engaged with to build and establish strong links for service users.

“Over the past year (with funding from the Department of Health) we’ve produced a toolbox of resources to support newly-established health and wellbeing boards,” said Jo Webber. “With this latest publication, all the learning and advice from those with direct experience of engaging with health service providers – from big acute trusts, community service providers, and voluntary sector organisations – is being shared throughout the system, so the new boards can make use of the best tools for their local needs.”

The report was developed as part of the National Learning Network for health and wellbeing boards, which was funded by the DH and supported by the NHS Confed, the Local Government Association and the NHS Institute for Innovation and Improvement with the aim to share the learning and support of well-functioning HWBs.

A new House of Lords bill aims to restore the legal duty of the Health Secretary to “secure provision” of NHS services.

The National Health Service (Amended Duties and Powers) Bill, introduced by independent peer David Owen, would reverse the autonomy of the NHS – a key legal plank in its anticipated carve-up by the private sector.

According to Owen, the new bill would provide a Labour government with ready-made legislation to avoid “the worst ravages” of a healthcare market.

Since the establishment of the NHS in 1948, the Health Secretary has had a legal duty to ensure that health services are provided nationwide.

However, the Health and Social Care Act (2012) replaced this duty with a less specific “responsibility” for NHS management, with accountability for services passing into the remit of an “autonomous” NHS.

This transition, Owen claims, ensures that decisions about what services will be freely available to patients will be made by non-accountable bodies, including private companies.

Supporters of Owen’s bill include Clare Gerada, Chairwoman of the Royal College of General Practitioners, and Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London.

“This bill, if it becomes an act in 2015, will come just in time to save [the NHS] from the worst ravages of an external and full blooded market,” Owen said.

As legislation, he added, it would enable a new government “to reverse the marketisation of health, the treatment of health as just another utility, and to reinstate not just its democratic base but its values.”

The Department of Health commented that clauses clearly stating the Health Secretary’s “responsibility” and “accountability” for the NHS were included in the Health and Social Care Act “after constructive cross-party discussion”.

The Department of Health has outlined plans to make personal health budgets (PHBs) available to the 56,000 people receiving NHS continuing healthcare from April 2014.

It also anticipates that CCGs will offer PHBs to millions of people with long-term conditions.

However, it has admitted that no training or infrastructure exists to make this transformation of NHS care provision work.

A more fundamental change than the NHS reforms, the introduction of personal health budgets makes patients responsible for commissioning their own care.

Based on a three-year pilot study with 2,700 patients in 20 sites, the DH is confident that this system will reduce GP visits and hospital admissions, and so cut the cost of NHS care.

Patients will receive an agreed sum of money and will be responsible for designing a care package and choosing providers.

NHS continuing healthcare is provided outside hospital for people with ongoing healthcare needs – i.e. people with a complex medical condition that requires a lot of care, including specialised nursing support.

At a conference organised by the Westminster Health Forum, the DH’s PHB team leader Alison Austin said the new system offers “fantastic opportunities” for integrated care with better outcomes at less cost.

However, she said, healthcare providers currently lack the capacity to manage this “huge” change in the organisation of NHS care.

Other speakers at the conference discussed the challenge of taking responsibility for patient care out of the hands of clinicians.

Sarah Carr, a senior analyst at the Social Care Institute for Excellence charity, noted that patients choosing their own care package would represent “a really big challenge for clinicians schooled in evidence-based medicine”.

Jay Dobson, one of the organisers of the PHB pilot scheme, said the new approach would “revolutionise” NHS care – but at present, providers were unaware of it, and the healthcare market was not ready to provide that level of choice.

Further aspects discussed included the role of the voluntary sector (supported by CCG funding) in helping patients to manage their options; and the need for legal support to help commissioners draw up contracts.