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My personal view of the importance of high quality #research in dementia for the #G8summit



Dementia research

I have a foot in both research camps.

I believe in good quality research about the ‘medicine’ of dementia.

In the world of research, I am known to have contributed an original paper in the diagnosis of the frontal-variant of frontotemporal dementia.

This paper explained why people with a dementia could even end up having a diagnosis of this type of dementia, even though presenting in clinic with normal blood tests, psychological tests or brain scans.

Such patients did, however, have profound changes in behaviour and personality noticed by their closest ones, usually friends and family.

The paper itself has been quoted in the current Oxford Textbook of Medicine chapter reviewing the most common types of dementia, their diagnosis and management.

I do however have academic views on the importance of the ‘timely’ correct diagnosis of dementia, rather than early diagnosis.

I never give advice about anything on Twitter, as I am not a physician, but it is nice when what you say has an impact on general education of people about dementia.

I can be found on both @dementia_2014 and my other Twitter account (as I am trained in academic law as well as research in dementia) @legalaware.

Take for example how depression can be in the wrong hands misdiagnosed as dementia.
Shibley

This is an example, perhaps, of where a diagnosis is a label, and disabling not enabling.

But for very many a correct diagnosis of a type of dementia will be a key to the door for opening up the relevant care.

I feel that, whatever the ‘fiscal constraints’ the NHS finds itself in now and the future, despite the argued need for transformational change in NHS services, people with dementia should be at some stage diagnosed by somebody with specialist medical experience.

This is reflected here in a recent excellent article in the Telegraph.

The other camp is this, and oddly enough there is some overlap in my wish for people with dementia to be given the highest priority in society.

I also firmly believe in good quality research of allowing people to live as best a life they can.

This is intensely personal, as I am physically disabled, and I am all too aware about how people can make crash judgments of you.

I am about to publish a book on ‘Living well with dementia’ on January 13th 2014.

I am honoured to be well respected by academics in the field of dementia, including Prof Alistair Burns the current lead for dementia in England.

Burns tweet

I thrive from the research contributions daily all around the world in research into dementia.

I would like to see the UK play a part in leading the research community about all aspects, including the medicine of the condition itself, its possible cure one day, and current practical help in improving quality of life.

Finally, I think with the current academic community in the UK in dementia, the UK can and should achieve this.
Human brain

The legal issues in the statutory instrument (2013, No. 257) on NHS procurement in England



 

The key document in question is here.

In a nutshell, it has thrust private sector ‘competitive tendering’ in the procurement of NHS services into the limelight.

The legislature, as recommended by the executive, has an obligation to provide law that is clear and predictable, and the judiciary can only rely on the Acts on the statute books and any supporting discussions of what parliament might have intended. It is at the heart of parliamentary sovereignty that parliament can do what it wishes. There is, unfortunately, a large number of issues concerning this statutory instrument 2013 No. 257 concerning procurement in England. These embrace a plethora of commercial and legal, not just political, considerations, which do need to be discussed as a matter of some urgency in the public interest. Such discussion will be to the benefit of all involved parties.

The judiciary must have a clear understanding of how this law was arrived at, for it to interpret the ‘intention of parliament’ when any disputes arise as they indeed will. To help it, it has the Bill and Act itself, as well records in Hansard. The case and statute law, both domestic and EU law, have a recent history in effecting English NHS health policy, but only in as much the NHS has encroached upon ‘undertakings’ and ‘economic activity’ in EU law. The Health and Social Care Act (2012) has changed the legal climate substantially; indeed, the ambit of competition is thrown very wide indeed, as reflected in Regulation 10.

Section 75 of the Health and Social Care Act has firmly enmeshed the Act in competition legislation, parallel to but distinct from previous legislation such as the Public Contracts Regulations (2006). However, the adoption of key concepts and themes from the European law, voluntarily by the English legislature as proposed in the statutory instrument, makes it rather unclear as to the actual ‘direction of travel’. It is as if Parliament has wished to enmesh the NHS in European competition and procurement law, without any democratic scrutiny. The aforementioned statutory instrument is particularly vague on the precise functions of Monitor in the distinct phases of award and execution of procurement, does not map out how Monitor is to function on behalf of key stakeholders in the NHS along with other regulatory processes (such as judicial review or the health ombudsman), and how precisely this English legal framework will operate alongside other approaches (such as the UNCITRAL Model law, European regimens, and World Trade Organisation).

Critically, it seems quite mysterious how overall this particular method was chosen (formal tendering, as opposed to less structured methods of competitive tendering such as requests for proposals and quotations, or single-source procurement), when the discussions in the lower and upper Houses of Parliament did not heavily lean in this direction in the first place. (Such methods are extensively discussed in ‘Regulating Public Procurement: National and International Perspectives’ (2000) Sue Arrowsmith, John Linarelli and Don Wallace Jr. Kluwer Law International). This obligatory competitive tendering mechanism for the majority of tenders is a robust method of making sure as many contracts are awarded to the private sector as possible. There would be nothing to prevent parliament from legislating for a minimum of NHS services to stay in the NHS, as that would not offend any law in Europe; it does not distort the market, but for public policy reasons could easily be argued to have a legitimate reason. For example, if a key provider, e.g. of blood products, went bust, this could be the detriment of the entire service, and protection for such a service can easily be justified under statute.

Some specific points which are particularly noteworthy are raised in the Appendix.

 

APPENDIX

 

Regulation 3

3 (2)(b): “treat providers equally and in a non-discriminatory way, including by not treating aprovider, or type of provider, more favourably than any other provider, in particular onthe basis of ownership.”

It is quite unclear what this is driving at, and whether equality of providers is indeed a primary aim of the procurement process. For example, UNCITRAL model law on procurement of goods, construction and services lists this as an objective in the preamble to the law, but the Guide to Enactment suggests perhaps it is a subsidiary role.  Cases such as Fabricom case (Fabricom SA v Belgium (Judgment Joined Cases C-21/03, C-34/03, 3 March 2005) are particularly helpful here.

 3(b) What does “best value” in this sector indeed mean? Typical considerations such as  “value for money”, as well as social, technological, environmental and various other non-price considerations, need to be discussed at some point. Again, this is essential if the law and guidance for the NHS procurement is to have adequate clarity. The point is not so much playing party-politics about grinding this legislation to a halt with an intellectual ping-pong, but it is helpful, if this clause is to be included in this statutory instrument, to understand what is in parliament’s mind for later disputes to be resolved. Presumably Monitor have begun to think about this as they hope to issue specific guidance on this?

3(4)(c)  “allowing patients a choice of provider of the services” – as drafted it is unclear whether the true beneficiaries of the choice of providers are the patients themselves or CCGs (the relevant bodies); the relationship between actual patient choice and vicarious choices made by the CCGs is not addressed in this statutory instrument.

 

Regulation 4

Transparency for contract opportunities. This is indeed helpful to provide a rough check on how contracts are being awarded, but it has to be conceded that the public will be largely none-the-wiser as they will perform functions under the NHS logo (unless parliament requires the full identity of providers to be disclosed at the point-of-use for any particular patient.)

 

Regulation 6

This regulation, as drafted, is only confined to conflicts between purchasers and suppliers in the NHS, but a purpose of clauses such as this in other jurisdictions has been to address wider conflicts-of-interest, such as political donations. Although it may not be desirable to extend the ambit of discussion here too widely, some consideration should be made to how this might relate to other existant laws concerning bribery currently in force in England, for example?

 

Regulation 7

“Framework agreements”, which are not in fact ‘necessary’ will require in due course much greater detail  if they are to be included. They certainly require, pursuant to Stroud, some scrutiny. How many suppliers will be involved in such agreements, as this relates to a complex interplay between operational efficiency, security of supply and the scope of competition? The question has to be why they have been imported from EU procurement law voluntarily, when there is actually no obligation to. It would be helpful if parliament could provide some indication of the processes and purpose of any shortlisting in the operation of these framework agreements, particularly in relation to relevant national policy considerations and disclosure of relevant criteria?

 

Regulations 13-17: Monitor (Investigations, declarations, directions and undertakings)

Ideally the outcome should be clear rule-based decision-making systems that limits the discretion of procuring entities. Monitor will have to have to explain this in due course, but no mention even is made of the types of issues which Monitor might have to face (e.g. fraudulent information in the bidding or execution phases, mechanisms of correcting any errors, late tenders.)

Politicians should not undermine public perception of the English law



John Hirst, who took the UK to court over prisoners’ voting rights, once said, “MPs are not part of the Big Society themselves. More like Pig Society, with their noses in the trough.”

 

Politicians, as a group, with all their bickering over who was to blame over members of News International and Barclays Bank allegedly acting illegally, have been first to play down the existence of laws currently in force in the UK. The impression which David Cameron  and George Osborne would like to leave you with is that we have generally under-regulated thanks to Labour. Wrong. In 2006, Labour enacted the Fraud Act, after a report by the Law Commission reviewing relevant jurisprudence here on the matter. This is exactly the same trick where the Tories tried to leave the media and the public with the impression that phone hacking may be morally wrong, but not illegal. Since #Leveson, they have been unable to peddle this myth.

It is the case that LIBOR-rate fixing is not covered yet by the financial regulations, but the Financial Services Bill will be amended to reflect that. Lawyers should not tolerate the undermining of the existence of the Fraud Act.

MPs are not above the law either, as some of them will know all too well from the expenses scandal. The Home Secretary has been found to be incorrect over the nature of the human right (article 8), has been found guilty of contempt of court, and was unable to count time, all earlier this year. As a Home Secretary, this will further add to the undermining of the perception of law in the general public.

Some MPs have tried to advance the case that certain lawyers are “ambulance chasers”, and that they are only in it for the money. This argument has been disseminated in a wish to propose that our legal aid budget, protecting the employment, immigration, housing, welfare benefit (inter alia) rights of citizens in the England, toward the socially-deprived end of society’s spectrum, is luxurious rather than essential.

So I call for all politicians to be careful in not undermining the English legal system.

Annual Graham Turnbull essay competition on alternatives to imprisonment



Link: here

 

 

 

 

 

 

 

 

Law students, trainee solicitors, pupil barristers and junior lawyers are invited to enter the Law Society’s annual Graham Turnbull essay competition. This year’s essay title is: ‘In the light of the growing prison population should we look for alternatives to imprisonment?’ The deadline for entries is Friday 23 March 2012.

This is a very important, topical subject. I recently posted on a closely-related issue:

It is impossible to half-believe in rehabilitation

 

 

 

 

Law centres and legal aid funding



This is not a headline you will normally see.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Firstly, I should like to acknowledge Krish, who tweets at @TheTCHawk, for providing the inspiration for this blogpost. He has recently written on his experience with the Citizens Advice Bureau for which he works.

Instead, I have been working in a famous law centre in London for the last few months. This has been an incredibly rewarding for me, as I am looking forward to studying law further in my LPC in January 2012. I have already spent four years in legal training, but one of the many things that I have learnt of some importance is that lawyers do not get emotional.

Once I was aghast when a law student tweeted at a friend of mine, “Is there a difference between a law centre and a CAB?” However, it was a perfectly reasonable question.  As members of law centres, we must confront this issue of what we’re (=law centres) doing that’s different from CABs. Marketing professionals must have an understanding of the awareness of any particular brand, for example the CAB or the law centre, before proceeding to develop a marketing strategy. I feel that law centres will need to develop a professional marketing strategy to raise their awareness amongst the community and investors. In my belief, whilst the CABx brand is very strong indeed, perhaps for historical reasons, the ‘Law Centre brand’ is virtually non-existent in comparison. I would be interested to know whether this is borne out by any hard data.

I have been thinking about how my law centre, especially my area of welfare benefits advice for disabled citizens like me, can benefit from alternative sources of funding, like the Big Lottery Fund, but this fundamentally depends on what pitch I should make. Is it that we are any more central to the communiy than the CAB? Or is it that we have more specialist qualified legal advisors than the CAB who can act as advocates? Are any generalisations possible or warranted? Furthermore, legal aid funding affects private practice stakeholders, as well as legal centres and CABs, and market forces affect all three. For all stakeholders to benefit the public the most, which is their ultimate aim after all, they need to have a clear idea of their values and which services they’re providing, so that all stakeholders can achieve optimal market and strategic positioning in a crowded, funding-challenged, market, perhaps.

Whatever – I personally think all legal practitioners should be given support, acknowledging that funds are limited. but funding bodies will have to prioritise unfortunately. In fact, a focus on funding may have the beneficial effect of providing better precision to all stakeholders in their strategy and core competences of their legal services, whatever sector they are in. However, fundamentally, I most agree with the observation that, at this late stage, arguing over a sense of entitlement is totally unhelpful. It is desperately important that we fight until the end for our common purpose in protecting legal aid. I would find it very hard to support law centres if they wished to campaign at the expense of CABx or other stakeholders, but they should think about how they differ from other stakeholders when applying for London Borough grants for community investment or structural upkeep, I feel.

Immediately this throws you into the territory that, as a lawyer to-be one day hopefully, I am getting emotional. Worse than that, I am getting political. Of course, central to the whole debate, is access-to-law and the rule of law. The Law Society and Bar Council provide that the legal aid cuts offend this fundamental right, and indeed many blogposts and the Guardianistas have thus far pressed home this  vital point. However, an issue that my colleagues in the Law Centre I work at feel enormous frustration at the fact we are simply unable to get our message across.

We have, as citizens of society, to acknowledge that no political party will be in power forever, and it is not impossible that this Bill will become repealed in time or amended drastically. I feel that all employees in all legal institutions should not feel frightened in giving a voice to the opinions of citizens wishing to protect legal aid, and should be allowed to express such opinions in this organisational change.  As part of my MBA, I studied in enormous detail critical success factors for relatively-rapid organisational change like this in the public sector, and by far the most important issues are trust and openness in the followers (including legal professionals) in ensuring the change goes smoothly. This is in addition to the demanding structural changes which are necessitated in this reform.

An issue is that the Legal Aid and Sentencing Bill, as proposed, could have a selectively detrimental effect on certain groups of society, including the disabled. Many of us have been prone to defend our own patch, and there is somewhat an element of ‘divide-and-rule’ in the debate which has ensued. Yet again, whilst I find repugnant that welfare benefits legal advice is being cut at the expense of some other fields of law, I feel that we all should be pulling in the same direction of protecting all areas of law (but especially for the socially disadvantaged.)  In other words, lawyers and bloggers appear to the outside world to be not “in it together“,  talking at cross-purposes, and becoming constituted by tribalistic vocal subgroups which are easy to ‘defeat’ as a whole. Secondly, I believe, that there is an element of where looking forward to the holiday has become more exciting than the holiday itself. I had a feeling of this in our opposition to the Health and Social Care Bill, where Labour loved opposing, but were completely incompetent in articulating arguments about competition, quality, value and cost in the NHS. Indeed, further, like perhaps #OccupyLSX, the opposition for the left has become more exciting than the substantive points of the opposition itself; I do not deny the inspiring success of @SoundOffJustice, and others. In fact, I met them at the DODS meeting in September, and was overawed personally about how much passion they had put into their campaign.

Thirdly, some elements of the ‘progressive left’, for example the Liberal Democrats, perhaps could have been more articulate about the effects of the legal aid policy on children, families, and wellbeing, which are now central planks of Liberal Democrat policy. Fourthly, whatever the reasons for it, the Legal Services Commission has been criticised, and there is a huge amount which could be done to improve the legal aid funding mess which has developed for a number of decades, including the last Labour governments? Whilst I do not feel the need to be perjorative in quoting the “most expensive service in Europe” statistic, which is actually untrue, we do need to address how best to develop legal aid funding. Fifthly, and this is an economic and quasi-political argument, I am a Keynesian and I do not agree with the ‘maxing out the credit card analogy’, but likewise, albeit as an utilitarian, I do believe we have to prioritise given the deficit which has come around in a large part through recapitalising the banks in #gfc1 (a policy which I am still uncertain about).

Finally, we need to get people interested in this subject in the media. I don’t mean the Guardianistas necessarily, otherwise we’re preaching to the converted. Whilst Sepp Blatter and racism, superinjunctions, anonymised injunctions and Andy Marr, and the BBC’s Children in Need are very important issues, we could do with much more focused coverage and debate of the Legal Aid and Sentencing Bill. I think this is essential, as I bet my life that this will obtain Royal Assent without any difficulty in due course.

Scottish discomfort



Clearly, the most emphatic aspect of last night was the SNP’s decisive victory in Scotland. The Fabian Society has often recently emphasised Southern Discomfort as a source of votes. In other words, Labour latterly has been able to reach out to the Southern vote, such that you could travel from London to Grimsby without encountering a single Labour seat.

Ed Miliband needs to address carefully why the Scottish performance is so bad. Various aspects have come to light. Firstly, Ed had decided to use the elections as an offer to the Scots to deliver a message to the Coalition – the message that has been delivered is that the Scots want people to represent them positively north of the border, and they’re not sufficiently impressed with Labour to support them. Secondly, Ed badly judged the likely nature of victory of Scotland. Not only have the SNP been making good ground, but with promises that they may not be able to make, the overwhelming perception is that Iain Gray, despite being an undeniably nice person, is a flat uninspiring potential leader, and his campaign possibly peaked in a Subway shop.

The demographics are noteworthy. Labour’s Welsh performance was good, the Liberal Democrats undeniably had a terrible night, and Labour did make some gains in England. The scale of  these English gains is hard to assess given the ridiculous extent of expectation management from the Tory media concerning their ‘insignificance’.

However, it appears that Labour is relying more-and-more on a vote in Northern cities. It is not actually in Labour’s interest possibly for Scotland to ask for full independence (nor is it likely that the SNP would wish that), as that could lead to a redrawing of the England-Scotland border. The positive news is that if Labour regains its political compass in Scotland, it could make a recovery. The Liberal Democrats, making a recovery from Nick Clegg and their selective harpooning by the General Public in the whole of the UK, have their own problems. Reluctantly, it has to be said that the biggest victors of last night are Alex Salmond and David Cameron, even forgetting the result of the AV referendum for a second which looks like a resounding ‘No’.

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