CQC Raise Concerns Over the Safety of Independent Clinics and Doctors

A new report from the CQC analysing inspections of independent doctor services in England has raise concerns over safety.

The wide-ranging report looked at the quality of care being provided by:

  • private GP services
  • travel clinics
  • slimming clinics
  • circumcision clinics
  • allergy clinics
  • clinicians registered with the General Medical Council who provide consultations and/or treatments.

While some good practice was identified, analysis found that just under half of independent consulting doctor services and slimming clinics were not providing safe care, in accordance with the relevant regulations, on their first inspection.

Key Concerns

  • The safety and efficacy of prescribing.
  • Record keeping.
  • Clinicians not communicating their activity with the patient’s GP.
  • Limited functionality and interconnectivity of IT systems with NHS primary care services.
  • Almost a quarter of slimming clinics were not meeting the regulations for effective care, with some found to be treating people with medicines not recommended by the National Institute for Health and Care Excellence (NICE) or the Royal College of Physicians.
  • Inspectors found examples of appetite suppressants being prescribed to patients with a BMI lower than that recommended, or to patients with high blood pressure.
  • Concerns were also found around safeguarding in other types of providers, such as circumcision clinics. While these services had systems to obtain consent from both adults with parental responsibility in place, they had not always obtained written consent from both parents before a procedure, or only asked for consent from both parents when the provider suspected a possible dispute.

Encouragingly, re-inspections of slimming clinics showed evidence of improvement over the course of the inspection programme, with evidence that providers had addressed concerns and applied learning both from inspections of their own services and those of other providers.

Ursula Gallagher, Deputy Chief Inspector of General Practice and lead for Independent Providers said:

“In looking at this diverse group of services, we have found and highlighted some truly responsive care. We were also pleased to see that on re-inspection, providers showed improvement in a number of areas where we had found very real concerns such as safe prescribing.

“However, this was not always the case and too often we saw poor prescribing practice and providers with a limited awareness of their responsibilities – not just to their patients but to the wider healthcare system. I hope this report will help providers and others to identify what they need to do and where they might focus their efforts.

“Everyone providing these types of services has a legal responsibility to offer safe, high-quality care that not only meets the needs of the people using it, but also meets the legal requirements that exist to protect patients. Where this isn’t the case and we see risks to patient safety, we will not, and have not, hesitated to stop providers from operating.”

From the 1st April 2019 the CQC will start to introduce ratings for independent consulting doctors and clinics to align with their approach to regulating other services. This clear, at a glance indication of quality is designed to empower people to make informed choices about their care.

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An Author’s Guide to Copyright

Copyright has been around for almost as long as publishing!

In a recent blog post by the British Library it was reported that

“One of the first documented rulings with regards to copyright was made in the late 6th century in Ireland, when King Diarmait mac Cerbaill declared: To every cow belongs its calf; to every book its copy.”

In the early 1700s the first copyright law was passed, granting publishers legal protection against unauthorised copying and authors and artists have used copyright ever since.

Understanding Copyright

Copyright protects your work and stops others from using it without your permission.

You get copyright protection automatically – you don’t have to apply or pay a fee. There isn’t a register of copyright works in the UK.

You automatically get copyright protection when you create:

  • original literary, dramatic, musical and artistic work, including illustration and photography
  • original non-literary written work, such as software, web content and databases
  • sound and music recordings
  • film and television recordings
  • broadcasts
  • the layout of published editions of written, dramatic and musical works

You can mark your work with the copyright symbol (©), your name and the year of creation. Whether you mark the work or not doesn’t affect the level of protection you have.

Copyright prevents people from:

  • copying your work
  • distributing copies of it, whether free of charge or for sale
  • renting or lending copies of your work
  • performing, showing or playing your work in public
  • making an adaptation of your work
  • putting it on the internet

Your Rights

Your rights under copyright fall into two distinct categories, Economic Rights and Moral Rights.

Economic Rights

Economic rights give you the opportunity to make commercial gain from the exploitation of your works. This would usually be by licensing others to use the work, or by selling the rights.

The author of a copyright work has the exclusive right to authorise or prohibit the following acts:

  • Reproduction
  • Distribution (this right only applies the first time a copy of a work enters into commercial circulation and so would not prevent the re-sale of that copy, for example by a second hand shop).
  • Rental and lending
  • Public performance
  • Communication of a work to the public by electronic transmission. This would include broadcasting a work or putting it on the internet.
  • Adaptation

Moral Rights

Unlike economic rights, moral rights cannot be sold or otherwise transferred. However, the rights holder can choose to waive these rights.

There are four moral rights recognised in the UK:

  • The right to attribution – This is the right to be recognised as the author of a work. This right needs to be asserted before it applies. For example, in a contract with a publisher, an author may state that they assert their right to be identified as the author of their work.
  • The right to object to derogatory treatment of a work by adapting or distorting it.
  • The right to object to false attribution
  • The right to privacy of certain photographs and films – This right enables someone who has commissioned a photograph or film for private and domestic purposes to prevent it from being made available or exhibited to the public. For example, this would allow you to prevent a photographer from putting your wedding photographs on their website without your permission.

Find our more about copyright on the government’s Intellectual Property Office website.

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New Student Mental Health Services to Focus on First Year at University

A new taskforce has been set up by Education Secretary Damian Hinds to support students dealing with the challenges that starting university can bring.

The new taskforce will look at how students moving from sixth-form or college to university can be better supported in their crucial first year, building on the work already underway across the sector to improve support for student mental health.

Key Themes

  • Independent living – managing finances, having realistic expectations of student life, as well as alcohol and drugs misuse.
  • Independent learning – helping students to engage with their course, cope with their workload and develop their own learning style and skills.
  • Healthy relationships – supporting students with the skills to make positive friendships and engage with diverse groups of people. Other risks can include abusive partners, relationship breakdowns and conflict with others.
  • Wellbeing – including loneliness and vulnerability to isolation, social media pressures and ‘perfectionism’. Students may also not know how to access support for their wellbeing.

The group may look at other areas which can affect student mental health as part of future work, such as challenges students face when moving from education to the world of work.

Members of the new taskforce – which will be known as the Education Transitions Network – will include leading sector groups such as UCAS, the National Union of Students, Student Minds, Universities UK, the Association of Colleges and the Office for Students.

Rosie Tressler, CEO of Student Minds, said:

“We often hear from students and in our research that times of transition can significantly impact student wellbeing throughout their university experience. We therefore welcome the work of the Education Transitions Network, in enabling further collaborations in this space.

We need to ensure that student mental health is a strategic priority at our Universities and for health providers. Together, we can use our voices to improve the futures of millions of people.

The network will firstly look at ‘what works’ to help students handle the challenges of moving into higher education and spread good practice from examples of initiatives, such as the University of Huddersfield’s award-winning Flying Start inductions and the University of Portsmouth’s Welcome Ambassadors project, Student Minds’ Transitions and Know Before You Go, as well as measures developed through the Office for Students’ Challenge Competition projects.

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Female Authors Celebrated by Women’s Prize for Fiction

The long list of works shortlisted for Women’s Prize for Fiction has been announced, honouring both new and well-established writers with seven debuts making the list, writing in a diverse range of genres.

This year’s judging panel: Professor Kate Williams (Chair), author, historian and Professor of History at the University of Reading; Arifa Akbar, journalist and critic; Dolly Alderton, columnist, broadcaster and author; Leyla Hussein, campaigner and psychotherapist; Sarah Wood, digital entrepreneur

Now in its 24th year, the Prize celebrates excellence, originality and accessibility in writing in English from throughout the world.

The Long List:

The Silence of the Girls by Pat Barker

A brilliant retelling of Homer’s epic the Iiliad poem focuses on the cost of war to women through the story of Briseis, Achilles’ concubine.

Remembered by Yvonne Battle-Felton

Remembered is the debut historical fiction novel by Yvonne Battle-Felton, a story where Spring, an emancipated slave, is forced to relive a haunting past in order to lead her dying son home.

My Sister, the Serial Killer by Oyinkan Braithwaite

Sibling loyalty comes under pressure in a Lagos-set debut that mixes crime, love story and family saga

The Pisces by Melissa Broder

The Pisces is a story about falling in obsessive love with a merman: a figure of Sirenic fantasy whose very existence pushes Lucy to question everything she thought she knew about love, lust, and meaning in the one life we have.

Milkman by Anna Burns

Winner of the 2018 Man Booker Prize, Milkman is set during The Troubles in Northern Ireland, the story follows an 18-year-old girl who is harassed by an older married man known as the “milkman”

Freshwater by Akwaeke Emezi

A young Nigerian woman comes to terms with her many selves in this surreal novel rooted in Igbo cosmology

Ordinary People by Diana Evans

A very real portrayal of what couples experience when they hit that wall.

Swan Song by Kelleigh Greenberg-Jephcott

Based on real events, Swan Song is the tragic story of the beautiful, wealthy, vulnerable women whom Truman Capote called his Swans, and who deserted him after he betrayed them

An American Marriage by Tayari Jones

An American Marriage is a masterpiece of storytelling, an intimate look into the souls of people who must reckon with the past while moving forward- with hope and pain- into the future.

Number One Chinese Restaurant by Lilian Li

A behind-the-scenes look at various aspects of a restaurant, delicious food details, crime and drama—you’ll get all of this in Number One Chinese Restaurant.

Bottled Goods by Sophie van Llewyn

Set in 1970s communist Romania, Sophie van Llewyn’s novella-in-flash draws upon magic realism to weave a tale of everyday troubles, that can’t be put down.

Lost Children Archive by Valeria Luiselli

A squabbling US couple set out to document the Mexican migrant crisis in Luiselli’s cautious attempt at introducing autofiction to the real world

Praise Songs for the Butterflies by Bernice L. McFadden

Exploring ritual sacrifice in contemporary West Africa, Praise Song offers a fascinating, painful glimpse into a world beyond America’s shores, filled with tragedy and love and hope.

Circe by Madeline Miller

Madeline Miller’s gripping take on the Circe myth will summon you back for a feisty grapple with the Greek gods 

Ghost Wall by Sarah Moss

Ancient rituals and present-day abuse converge in a brief and brilliant novel with its roots in England’s deep past

Normal People by Sally Rooney

Rooney crafts a devastating story from a series of everyday sorrows by delicately traversing female and male anxieties over sex, class, and popularity. 

Professor Kate William, Chair of Judges, said of the list:

“The discussion amongst the judges was passionate and there were some really tough choices to make. I am thrilled to share this longlist – sixteen incredible books by a diverse group of women, from the UK and countries across the world, all brilliant stories that sweep you into another world. Each of them have been a privilege to read, and they have taken us into places a million miles from each other, exploring the lives of women and men in so many different but utterly compelling ways.”

The 2019 Women’s Prize for Fiction shortlist will be announced on April 29 2019 and the winner will be awarded on June 5 2019 at an awards ceremony in central London. The winner will receive an anonymously endowed cheque for £30,000 and a limited-edition bronze figurine known as a ‘Bessie’, created and donated by the artist Grizel Niven.

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CQC Guidance For Adult Social Care Service Providers on Client Relationships and Sexuality – Are You Compliant?

The CQC has published new guidance setting out how care providers should consider people’s relationship and sexuality needs.

The guidance builds on the quality framework, adding further detail on issues like relationships, diversity and protecting people from harm.

It covers a diverse range of often complex issues, including supporting people to form and maintain relationships, while also helping them to understand risks. It also highlights the importance of offering an environment that is welcoming to LGBT+ people, as well as looking at how to support those with physical disabilities.

When people receive personal care and support, they are likely to lose some privacy. People may feel restricted or judged by those providing their care. Some people may find that their health condition leads them to become vulnerable, as they behave in ways that they would not have done before.

Providers need to understand the importance of enabling people to manage their sexuality needs whilst ensuring that they do not risk discriminating against other people or breaching their human rights.

In response to the new guidance Debbie Westhead, Acting Chief Inspector of Adult Social Care, said:

“We know that the best care is person-centred and in supporting relationships and sexuality there can be no one approach that fits all.

“Supporting people to build and maintain relationships in the way they want to is incredibly important, regardless of who they are or what stage of life they are at. This guidance aims to ensure providers are supporting people to form and maintain sexual relationships that meet their needs, while also helping them to understand risks.”

Key Lines of Enquiry

Inspector’s key lines of enquiry, and the evidence they will be looking for to demonstrate compliance are detailed below.

Protecting people from abuse and discrimination. Supporting people to understand what keeping safe means.

  • Safeguarding policy
  • Safeguarding records
  • Staff training records
  • Staff knowledge
  • People’s care plans
  • Feedback from people and relatives

Involving people in assessing risks to them. Policies minimise restriction of people’s freedom.

  • People’s risk assessments
  • Safeguarding and Equality policies
  • Staff training
  • Staff knowledge
  • People’s care plans
  • Feedback from people and relatives

Processes are in place to ensure people with protected characteristics experience no discrimination.

  • Safeguarding and Equality policies
  • Staff training records
  • Staff knowledge
  • Feedback from people and relatives

Staff receive training which enables them to meet people’s needs.

  • Training and Equality policies
  • Staff training records
  • Staff knowledge

People are supported to meet their day-to-day health needs and access healthcare services when required. This may include access to family planning services or support with gender identity issues.

  • People’s care plans
  • People’s care records
  • Feedback from people and relatives

Arrangements are made so people and visitors have appropriate space to spend time together, or for people to be alone.

  • People’s care plans
  • Staff knowledge
  • Feedback from people and relatives
  • Observations around the service

People are supported to make decisions in line with legislation. Best interest decisions cannot be made for people around sexual relations.

  • People’s care plans
  • People’s capacity assessments
  • Staff knowledge
  • Feedback from people and relatives

Communication with people is accessible. Care and support is provided in accordance with people’s preferences and personal histories. Staff respect people’s wishes.

  • People’s care plans
  • Staff knowledge
  • Feedback from people and relatives

People receive support to express their views and can access advocacy services, if required.

  • Staff knowledge
  • People’s care plans
  • Feedback from people and relatives.

People can be as independent as they wish. Visitors are made to feel welcome. Young adults have choice and flexibility over their privacy and level of parental involvement.

  • People’s care plans
  • Staff knowledge
  • Feedback from people and relatives

People’s care plans reflect their holistic needs, including their interests and aspirations. Activities are socially relevant. People are encouraged and supported to make and maintain relationships within the service and the wider community

  • People’s care plans
  • Staff knowledge
  • Feedback from people and relatives
  • Observations around the service

Vision and values include inclusion and respect.

  • Statement of Purpose
  • Staff knowledge
  • Feedback from people and relatives

Accessible and open communication is promoted.

  • Statement of Purpose
  • Communication policy
  • People’s care plans
  • Staff knowledge
  • Feedback from people and relatives

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FSB Launches Fair Pay, Fair Play Campaign in Support of SMEs

Ahead of the Spring Statement next month, FSB’s Fair Pay, Fair Play campaign calls on Government to enlist the help of Non-Executive Directors, making them responsible for payment time targets, strengthen payment enforcement and adopt Project Bank Accounts in public procurement, as three key reforms that will help end the poor payment crisis in the UK.

FSB research shows that the vast majority (84%) of small firms report being paid late, with a third (33%) saying at least one in four payments they’re owed arrives later than agreed.

FSB National Chairman Mike Cherry, said: “For far too long some big businesses have been allowed to get away with poor behaviour that has seen them use their dominant position to bully and squeeze our small firms.

“This behaviour has forced many small businesses to take drastic steps like turning to personal credit cards and overdrafts, just to survive the wait for a payment. Sadly, some don’t survive this wait.

“Poor payment practices are not limited to the private sector and they stunt job growth and damage economic growth. At the heart of this scandal, however, lies a more important question about fairness and what is morally right.

“Why do we find ourselves in a situation where some think it is acceptable and fair to not pay our small businesses on time? The truth is that it isn’t fair – everyone deserves to be paid on time.

“In last year’s Spring Statement, the Chancellor listened to FSB and promised to act on the late payments crisis. As this year’s Spring Statement approaches, small businesses want him to follow up these words with tangible actions. Our reforms are not the silver bullet that will suddenly signal the end of poor payment practices but are certainly important and necessary steps towards this. I am calling on all politicians and big businesses to back these reforms and show that they believe in fair pay and fair play.”

The campaign calls on Government to:

  • Assign responsibility to prevent late payment to Non-Executive Directors: Large businesses should be required to assign a Non-Executive Director responsibility for payment practice and supplier relationships, by chairing a Supply Chain Committee or include supplier relationships in chairing the Audit Committee.
  • Strengthen payment enforcement:  Government should fine companies that fail to provide, or provide incomplete legally required data on payment practices.
  • Give the Small Business Commissioner the ability to undertake mystery shopper style investigations into the payment practices of large firms including verifying duty to report on payment practice data and investigating supply chain bullying.
  • Require that all FTSE 350 firms sign up to a strengthened Prompt Payment Code.
  • Project Bank Accounts should be adopted as the truly default choice for major procurement projects, with proper parliamentary oversight to ensure accountability. For any major construction project, a ministerial statement should be made to Parliament if project bank accounts are not used.

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Students Interested in AI Encouraged to Stay on at University

The government has launched a graduate artificial intelligence (AI) drive to boost productivity and create high skilled jobs.

Under the plans announced this week a new industry-funded AI Masters will be introduced and 16 dedicated centres will be opened at universities across the country to train the next generation of AIPhDs.

Up to 200 new AI Masters places will be made available at UK universities funded by companies such as DeepMind, QuantumBlack, Cisco and BAE Systems. The Masters programme marks the first nationwide effort to address the skills gap at this level, in collaboration with the Institute of Coding and British Computer Society and will include work-based placements.

1,000 students will have the opportunity to enhance their skills with new PhDs at 16 dedicated UK Research and Innovation AI Centres for Doctoral Training (CDTs), located across the country.

Up to 5 AI research Fellowships, have been created in collaboration with The Alan Turing Institute to both attract and retain the best research talent from around the world.

Adrian Smith, Institute Director, The Alan Turing Institute said:

Artificial intelligence represents an incredible opportunity to transform our economy and our lives for the better. The Turing AI Fellowships will be crucial in building UK leadership capability, driving forward ambitious research and ensuring that the UK can attract, retain, and develop world-leading research talent.

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Poor Governance and Risk Management Leads to CQC Awarding Cosmetic Surgery Centre an Inadequate Rating

A London cosmetic surgery centre has been rated Inadequate overall by the Care Quality Commission.

Wimpole Aesthetic Centre, in Marylebone, was rated Inadequate for being safe and well-led. It was rated Requires Improvement for being effective and responsive. There was insufficient evidence to rate caring, during the inspection which took place on dates in September and October 2018.

Key Findings

  • The centre was not ensuring staff were completing mandatory training.
  • They did not manage infection risk well. Patients were not screened for micro-organisms before procedures and did not monitor surgical site inspection rates.
  • Staff did keep records of patients’ care and treatment – however they were of variable quality.
  • The centre did not monitor the effectiveness of care and treatment.
  • Managers did not always have the right skills and abilities to run a service providing high-quality sustainable care.

The centre must now:

Areas the provider should improve include:

  • Ensuring that the sepsis policy outlined what staff should do if they identify a case.
  • Ensuring that all staff complete mandatory training.
  • Ensuring that theatres and corridors are not constricted or cluttered.
  • Ensuring that consent forms are completed in line with their own policies and national guidance.
  • Provide the training for managers to competently carry out their duties.

Dr Nigel Acheson, CQC’s Deputy Chief Inspector of Hospitals, said: 

“Good quality patient care is at the heart of everything we do at CQC and for that reason I want to see vast improvements in the standard of care provided at Wimpole Aesthetic Centre.

“Although we found some areas where the centre had improved in a limited way since our last inspection, we also found some new areas of concern.

“We have placed Wimpole Aesthetic Centre into special measures with the expectation there will be improvements in the next six months.”

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The Cut Out Girl Wins Costa Book of The Year Prize 2018

The Cut Out Girl – a powerful story about a young girl’s struggle to survive Nazi persecution, and a man’s attempt to unveil his family’s secrets – by Oxford University Professor of English Literature, Bart van Es, has been named the 2018 Costa Book of the Year.  

The Cut Out Girl is the extraordinary true story of a young Jewish girl in Holland during World War II who hides from the Nazis in the homes of an underground network of foster families, one of them the author’s grandparents.

Bart van Es beat bestselling Irish novelist Sally Rooney for her second novel, Normal People, debutauthor Stuart Turton for his first novel, The Seven Deaths of Evelyn Hardcastle, the Scottish poet J. O. Morgan for Assurances and children’s writer Hilary McKay for The Skylarks’ War to win the overall prize and a cheque for £30,000 at the awards ceremony.

The Costa Book Awards is the only major UK book prize open solely to authors resident in the UK and Ireland and also, uniquely, recognises the most enjoyable books across five categories – First Novel, Novel, Biography, Poetry and Children’s Book – published in the last year. 

The Cut Out Girl, published by Fig Tree, is the seventh biography to take the overall prize.  Since the introduction of the Book of the Year award in 1985, it has been won twelve times by a novel, five times by a first novel, seven times by a biography, eight times by a collection of poetry and twice by a children’s book.

Caroline Ward Vine wins 2018 Costa Short Story Award

Caroline Ward Vine, a former magazine publisher and now a strategic consultant to the creative industries and education, from Kent won the public vote and £3,500 for her story, Breathing Water.  Two runners-up, literacy and language specialist Sophie Wellstood from South-West London and engineer Amanda Huggins from West Yorkshire, received £1,000 and £500 respectively.

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Care Service Finding Creative Ways to Manage Risk Rated Outstanding by the CQC

The Care Quality Commission has rated the care being provided by Acute Need CIC to be Outstanding after an inspection in October and November 2018.

Acute Need CIC is a Domiciliary Care Agency located in St. Helens, Merseyside. The service provides care and support for up to five adults with complex needs due to an acquired brain injury. Support is provided to people in their own homes.

What Impressed the CQC

  • Inspectors found that people were supported to live enriched lives and did what they chose.
  • A proactive approach was taken to anticipating and managing risk to people to ensure they remained safe.
  • Staff encouraged them to be as independent as possible.
  • The level of detail within assessments was exceptional in comparison to other services they had worked at.
  • People and family members had been given the opportunity to share information about their life history, important relationships, likes, dislikes and preferences. Staff used this information as well as positive interaction, to get to know people and engage them in meaningful conversations.

Helena Dennett – CQC Head of Inspection, Adult Social Care North West said:

“This is an exceptionally good service. Leadership of the service demonstrated a high level of experience and capability to deliver excellent care; they were extremely knowledgeable and inspired confidence and passion in the staff team.

“The way in which assessments were compiled was outstanding in that they were completely individual and contained information and guidance specific to each person’s needs and personalities.

“Acute Need CIC has been rated as Outstanding in all five areas. They are delivering top class care and I congratulate all involved at the service, a fantastic effort and result. Well done.”

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