DSA02

Healthcare Regulatory Policy

and Healthcare Regulations

Defence Medical Services

Regulator

i

DSA02.DMSR Amendment Table

DSA02.DMSR will be reviewed on a regular basis for accuracy (at least annually). Amendments may be published at any time in response to changes in legislation, MOD policy and / or information.

VERSION RECORD

Version Number Version Date Changes to Previous Version

1.00 21 Dec 18 Initial Issue

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Foreword

Below is the Defence Medical Services Regulator’s (DMSR) safety message which states the Regulator’s commitment to improving Patient Safety and outlines the role of the Regulator in achieving this. Good regulations are key to appropriate and proportionate regulatory activity; DSA02.DMSR is the capstone document for the DMSR, setting the tone and context of how this will be achieved.

DMSR’s Safety Message

Director General of the Defence Safety Authority (DG DSA) is responsible for providing policy and regulatory regimes for Health Safety & Environmental Protection (HS&EP) across Defence. The MOD policy for HS&EP is set out in DSA01.1.

DG DSA has directly delegated to the Head Defence Medical Services Regulator (Hd DMSR), the authority to regulate the facilitation and delivery of medical activity by the UK Armed Forces in accordance with DSA01.1. The regulations set out in this document are the minimum standards to be adopted for Healthcare Safety; they are mandatory and full compliance is required. It is the responsibility of those planning, managing, supporting or undertaking activity within the scope of these regulations to ensure that personnel, including contractors, involved in the conduct of Defence activities are fully aware of their responsibilities.

The DMSR team is committed to enhancing the safe delivery of medical capability and the continuous improvement of the DMSR through a focus on improved safety and quality management. Key to this is the continued development of a widespread engaged safety culture.

To enable the DMSR’s vision of being a trusted and credible healthcare regulator that is effective, supportive and transparent, we must continue to engage with the Regulated Community and other regulatory bodies to ensure that our regulatory activity remains effective, relevant and proportional. Empowered by the Defence Safety Authority (DSA) Charter from the Secretary of State for Defence, the DMSR is required to regulate the delivery and facilitation of medical capability by the UK Armed Forces and enforce adherence to the regulations. The DMSR will also improve knowledge management across the community to enable increased transparency and a greater sharing of information.

Whether Regulator or Regulated, DMSR engagement through stakeholder liaison enables the identification and sharing of good practice across the Defence Medical Services (DMS). The DMSR need everyone involved in Defence healthcare to engage with and contribute to the evolution of the DMSR and continue the journey we are on together. This strategy document underpins the DMSR’s stated commitment to improving Patient Safety across the DMS and outlines the Regulator’s role in achieving it. This strategy will be used to align resources to accomplish the DMSR’s mission and deliver its vision in the best way possible.

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Contents

Foreword ............................................................................................................................................................... ii

CHAPTER 1 ...................................................................................................................................................... 1-1

Authority ............................................................................................................................................................ 1-1

Citation .............................................................................................................................................................. 1-1

Interpretation..................................................................................................................................................... 1-1

Enforcement Action ......................................................................................................................................... 1-2

Regulatory Waivers and Exemptions............................................................................................................ 1-2

Supporting Information .................................................................................................................................... 1-3

How to use this Defence Regulatory Publication ........................................................................................ 1-3

Coherence with other Defence Authority Policy and Guidance ................................................................ 1-3

Further Advice and Feedback - Contacts .................................................................................................... 1-3

Copyright ........................................................................................................................................................... 1-3

Status ................................................................................................................................................................. 1-4

Disclaimer ......................................................................................................................................................... 1-4

Medical Services Definition ............................................................................................................................ 1-4

Organisation and Arrangements ................................................................................................................... 1-5

Roles and Responsibilities ............................................................................................................................. 1-5

CHAPTER 2 ...................................................................................................................................................... 2-1

Regulatory Articles ........................................................................................................................................... 2-1

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CHAPTER 1

DMSR’s Regulation Policy Overview

Authority

1. The MOD has a duty to protect its employees, other personnel and the environment, from the effects of its activities. Effective Health, Safety and Environmental Protection is crucial to force protection and maximising operational capability.

2. Overall responsibility for safety within the MOD rests with the Secretary of State (SofS) for Defence. The overarching SofS Policy Statement is laid down in DSA01.1 – Defence Policy for Health, Safety and Environmental Protection.

3. Through the DSA01.1 Policy Statement and the DSA Charter, Head DMSR has been authorised to regulate healthcare activity across Defence where there are Disapplications, Exemptions or Derogations (DEDs) from statutory requirements, or where there is no statutory requirement or where assurance of specific hazardous activities is required.

4. The DMSR Regulatory Articles (RAs) provide a framework for ensuring that acceptable levels of healthcare safety are being achieved and maintained. The DMSR RA are intended for all those engaged in healthcare activities, including support, facilitation, assurance, management and leadership of healthcare.

5. These RAs apply to all Defence healthcare activities within the UK and overseas. Where there are interfaces with other regulatory domains these will be identified.

Citation

6. These regulations shall be referred to as DMSR RAs.

Interpretation

7. Definitions of phrases or words that are specific to DMSR RAs and the associated activity are contained in DSA03.DMSR - Glossary1 (Definitions and Acronyms). Note: any cross-cutting or generic MOD definitions can be found within the Defence Glossary.

8. The key definitions that apply to the implementation of the Defence Regulations:

a. Must or Shall. Describes an activity that is mandatory;

b. Should. Describes an activity that is considered to be good practice. If the activity is followed, then this will be considered sufficient to demonstrate compliance with a Regulation. However, alternative approaches may be utilised where this produces an outcome as good as that required by the Regulation.

c. As Low As Reasonably Practicable (ALARP). A risk is ALARP when it has been demonstrated that the cost of any further Risk Reduction, where the cost includes the loss of defence capability as well as financial or other resource costs, is grossly disproportionate to the benefit obtained from that Risk Reduction2.

1 Defence Intranet link only. 2 Adapted from Def Stan 00-056.

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Enforcement Action

9. Failure to comply with any regulation set out in this regulatory document may result in enforcement action which may be applied incrementally. The full DMSR Enforcement Policy can be found in DMSR SOP 8 - Enforcement Policy3. DMSR enforcement action is listed below:

a. Corrective Action Requirements (CARs).

b. DMSR Enforcement Notice.

(1) DMSR Improvement Notice (IN).

(2) DMSR Urgent Improvement Notice (UIN).

(3) DMSR Prohibit Notice (PN).

10. The Appeals process is detailed in DMSR SOP 84.

11. Operational Imperative. Where the Regulator has issued a PN, it may not be appropriate for the activity to cease due to the Defence imperative, in which case the following shall be considered:

a. Where it is judged that the operational benefits gained from a specific operational act outweigh the high residual risk that has been mitigated to As Low As Reasonably Practicable (ALARP), an operational commander5 may decide to continue with the activity. In arriving at such a decision, where time and security constraints permit, the assessment of the risk, its mitigation and justification of the benefits should be made in consultation with the appropriate Duty Holder (DH) and discussion with the Hd DMSR.

b. It might also be appropriate for a DH, when preparing force elements for a specific operation, to make such a judgement. This judgement should be made in discussion with the Hd DMSR and future operational commander to ascertain whether the output of the force preparation activity is essential to the operational capability required for that specific operation, and to consider alternative means of delivering that operational capability.

12. In both cases, the decision to continue the activity should be made at least one command level above that upon which the PN has been served. The person making the decision should personally assess, accept and document the risk being taken.

Regulatory Waivers and Exemptions

13. There may be occasions when the regulated community is unable to comply with DMSR regulations. In such circumstances, a regulatory waiver or exemption may be applied for to grant a temporary waiver or enduring exemption, from extant Regulations. When granting a waiver or exemption, the Regulator needs to be satisfied that any risk associated with non-compliance has been fully considered by the DH or Accountable Person (AP) as appropriate. When the need for a regulatory waiver or exemption is identified, the case is to be developed and submitted in accordance with the procedures detailed in DMSR SOP 26.

3 Defence Intranet link only.4 Defence Intranet link only.5 As authorised in a CDS Operational Directive.6 Defence Intranet link only.

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Supporting Information

How to use this Defence Regulatory Publication

14. The DSA02.DMSR sets out the Defence Medical Regulations, supporting Acceptable Means of Compliance (AMC) and links to policy. They are designed to be used by staff responsible for medical services.

15. If the AMC are followed, then this will be considered sufficient to demonstrate compliance. However, alternative approaches may be utilised where this produces an outcome as good as that required by the RAs. Justification may be required when alternative approaches are employed. Adherence to an AMC may be used as evidence during enforcement action. Other material may also be included within DSA02.DMSR which itself is not compulsory but is considered good practice and should be followed.

16. DMSR RAs are to be used by staff responsible for medical services worldwide, including all members of the Armed Forces, Civilian employees and others, including contractors. The DMSR RAs are organised into the following series:

Coherence with other Defence Authority Policy and Guidance

17. Where applicable, this publication contains links to relevant JSPs and regulatory documents, some of which may be published by different Defence Authorities. Where dependencies exist, these Defence Authorities have been consulted in regard to the formulation of the policy and guidance detailed in this publication.

Further Advice and Feedback - Contacts

18. The DMSR owns DSA02.DMSR Regulatory Policy and Regulations. For further information on any aspect of this document, or questions not answered within the subsequent sections, or to provide feedback (including proposed amendments on the content), contact:

Copyright

19. DSA02.DMSR Regulations are protected by Crown Copyright and the intellectual property rights of this publication belong exclusively to the MOD. Material or information contained in this publication can be reproduced, stored in a retrieval system or transmitted in any form, provided it is used for the purpose of furthering safety and environmental assurance.

Series Number Series Title

DMSR 1000 General

DMSR 2000 Safe People

DMSR 3000 Safe Practice

DMSR 4000 Safe Place and Equipment

Job Title / E-mail Project focus

DSA-DMSR-Gp@mod.gov.uk Policy & Legislation Pillar

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Status

20. All hard copies of DMSR RAs are to be regarded as uncontrolled copies. To check the latest amendment status, reference should be made to the online versions via the DSA Government Publications Library

Disclaimer

21. Nothing contained in the DMSR suite of publications removes the requirement for personnel to comply with all applicable legislation, other Defence Regulations, Defence Policy or the Secretary of State’s HS&EP Policy Statement.

22. This regulatory document is not intended to:

a. Address hazards associated with enemy or hostile action.

b. Address the requirements to put in place safe systems of work to manage residual risk in the workplace - that is managed in accordance with DSA01 Series and Top Level Budget (TLB) procedures.

c. Address Sustainable Development (SD). SD is important in protecting the environment, but it is not governed by the environmental protection elements of this regulatory document.

d. Be used for contracting purposes in its own right. Contracting for safety is in accordance with Defence Standard 00-0567; however, specific Defence Regulations can be included within contracts.

Medical Services Definition

23. Medical services can be defined as any part of the system designed to deliver MOD healthcare capability, where the output and the activity is not more appropriately regulated by another Defence Regulator. This includes:

a. Medical materiel, medical infrastructure, medicines and medical information systems.

b. People as an element of the healthcare system function.

c. Management and assurance of healthcare.

24. The determination of whether a medical system primarily impacts on another Regulator should be discussed and agreed with the relevant domain regulator.

7 Defence Standard 00-056, Safety Management Requirements for Defence Systems.

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Organisation and Arrangements

Roles and Responsibilities

25. Responsible Persons. All personnel have responsibilities for safety and environmental protection. Some personnel may have additional responsibilities within their Area of Responsibility (AoR). This includes a personal duty of care for all people, including contractors and members of the public, who come within their AoR. This personal duty of care extends to environmental protection not just within their AoR, but also for other areas affected by activities in their AoR. All responsible persons are accountable for ensuring that safety risks from activities are reduced to a level that is ALARP and that risks to the environment are appropriately managed by selection of the Best Practicable Environmental Option.

26. DSA01.1 - Defence Policy for Health, Safety and Environmental Protection defines the fundamental elements of DH management arrangements.

27. The DMSR RAs refer to Commanders of Medical Treatment Facilities (MTFs) as the Accountable Person for Healthcare delivery.

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CHAPTER 2

Regulatory Articles

DEFENCE MEDICAL SERVICES REGULATIONS

1000 SERIES - GENERAL

Regulation 1001 None Issued

2000 SERIES – SAFE PEOPLE

Regulation 2001 Person-Centred Care

Commanders of Medical Treatment Facilities must ensure that all treatment is appropriate, meets the needs of, and reflects the preferences of the patient.

Regulation 2002 Dignity and Respect

Commanders of Medical Treatment Facilities must ensure that all healthcare personnel treat all patients with dignity and respect.

Regulation 2003 Need for Consent

Commanders of Medical Treatment Facilities must ensure that all healthcare providers gain informed patient consent before giving care or treatment.

Regulation 2004 Safeguarding

Commanders of Medical Treatment Facilities must ensure that all patients are protected from abuse and improper treatment.

Regulation 2005 Meeting Nutrition and Hydration Needs

Commanders of Medical Treatment Facilities must ensure that the nutritional and hydration needs of all patients are met.

Regulation 2006 Receiving and Acting on Complaints

Commanders of Medical Treatment Facilities must ensure that any complaint received is investigated and necessary appropriate action is taken in response to any failure identified by the complaint or the investigation.

Regulation 2007 Competent Persons

Commanders of Medical Treatment Facilities must ensure that all persons involved in healthcare activities are competent and Suitably Qualified and Experienced Persons (SQEP).

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Regulation 2008 Duty of Candour

Commanders of Medical Treatment Facilities must ensure that all healthcare personnel act in an open and transparent way with patients.

3000 SERIES – SAFE PRACTICE

Regulation 3001 Safe Care and Treatment

Commanders of Medical Treatment Facilities must ensure that all persons involved in healthcare activities provide treatment that is safe and avoids patient harm.

Regulation 3002 Good Governance

Commanders of Medical Treatment Facilities must ensure that systems or processes are established, and operated effectively, to check the quality and safety of care. These systems must help to improve the quality of care and reduce patient safety risks.

Regulation 3003 Staffing

Commanders of Medical Treatment Facilities must ensure that they have sufficient numbers of competent and SQEP to meet the regulated healthcare requirements.

44000 SERIES – SAFE PLACE AND SAFE EQUIPMENT

Regulation 4001 Premises and Equipment

Commanders of Medical Treatment Facilities must ensure that their premises and equipment are clean, suitable, correctly maintained, used properly and secure.

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DMSR RA 2001

Rationale

Contents

Person Centred Care1

A successful healthcare system requires all patients to receive treatment that is appropriate to them, meets their needs and reflects their preferences.

2001: Person Centred Care

Regulation 2001

Person Centred Care

Commanders of Medical Treatment Facilities (MTFs) must ensure that all treatment is appropriate, meets the needs of, and reflects the preferences of the patient.

Acceptable Means of Compliance 2001

Person Centred Care

1. Commanders of MTFs should assure themselves that all healthcare providers:

a. Carry out an assessment of patient needs and discuss healthcare management options and preferences.

b. Design care or treatment with a view to achieving patient preferences and ensuring their needs are met.

c. Enable and support relevant persons2 to understand the care or treatment choices available to the patient, and to discuss the balance of risks and benefits involved in any particular course of treatment.

d. Work in partnership with relevant persons to make, or participate in making, decisions relating to patient care or treatment.

2. Evidence for this area is contained in the electronic Common Assurance Framework (eCAF) domains 4 and 5.

Policy and Guidance 2001

Person Centred Care

[This section will remain blank until Joint Medical Group (JMG) issue Person Centred Care policy in JSP 950].

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 Examples of relevant persons include, but are not limited to, the patient, spouse, parents, guardians, carers, Next of Kin, ‘Power of Attorney’ holders and healthcare providers.

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DMSR RA 2002

Rationale

Contents

Dignity and Respect1

A successful healthcare system requires all patients to be treated with dignity and respect at all times while receiving care and treatment.

2002: Dignity and Respect

Regulation 2002

Dignity and Respect

Commanders of Medical Treatment Facilities (MTFs) must ensure that all healthcare personnel treat all patients with dignity and respect.

Acceptable Means of Compliance 2002

Dignity and Respect

1. Commanders of MTFs should assure themselves that allhealthcare personnel:

a. Ensure the privacy of all patients.

b. Support the autonomy and independence of all patients.

c. Pay due regard to any protected characteristics2.

2. Evidence for this area is contained in the eCAF domain 4.

Policy and Guidance 2002

Dignity and Respect

3. The following JSP 950 Leaflet refers:

a. 1-2-11 – The Defence Health Record.

b. 1-2-15 – DMS Caldicott Policy.

4. The following JSPs refer:

a. JSP 441 – Managing Information in Defence.

b. JSP 887 Sect 3 – Diversity, Inclusion and Social Conduct.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 See Equality Act 2010.

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DMSR RA 2003

Rationale

Contents

Need for Consent1

A successful healthcare system requires all patients, or anybody legally acting on their behalf, to give informed consent before any care or treatment is given.

2003: Need for Consent

Regulation 2003

Need for Consent

Commanders of Medical Treatment Facilities (MTFs) must ensure that all healthcare providers gain informed patient consent before giving care or treatment.

Acceptable Means of Compliance 2003

Need for Consent

Consent

1. Commanders of MTFs should assure themselves that all healthcare providers obtain informed consent from the relevant person before care and treatment is provided.

Capacity

2. Where a patient is unable to give consent because they lack capacity to do so, then Medical Commanders should assure themselves that all healthcare providers act in the best interest of the patient.

3. Evidence for this area is contained in the eCAF domain 4.

Policy and Guidance 2003

Need for Consent

[This section will remain blank until JMG issue Need for Consent Policy in JSP 950].

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act.

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DMSR RA 2004

Rationale

Contents

Safeguarding1

A successful healthcare system requires all patients to receive care, free from abuse or improper treatment.

2004: Safeguarding

Regulation 2004

Safeguarding

Commanders of Medical Treatment Facilities (MTFs) must ensure that all patients are protected from abuse and improper treatment.

Acceptable Means of Compliance 2004

Safeguarding

1. Commanders of MTFs should assure themselves that:

a. Systems and processes are established and operated effectively to prevent abuse of patients.

b. Care or treatment is provided without unnecessary control or restraint2.

c. Patients must not be deprived of their liberty, for the purpose of receiving care, without lawful authority.

d. Care or treatment is provided without degrading the patient.

e. Care or treatment does not significantly disregard the needs of the patient.

2. Evidence for this area is contained in the eCAF domain 1.

Policy and Guidance 2004

Safeguarding

3. The following Publications refer:

a. JSP 834 - Safeguarding Service Children and Young People.

b. JSP 893 – Policy on Safeguarding Vulnerable Groups.

c. JSP 950 Leaflet 4-6-6 – Safeguarding Children and Young People – Competencies Required for MOD Healthcare Staff.

d. JDP 1-10 - Captured Persons (CPERS).

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 For care of CPERS see JDP 1-10 (Defence Intranet Link Only)

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DMSR RA 2005

Rationale

Contents

Meeting Nutrition and Hydration Needs1

A successful healthcare system ensures the nutritional and hydration needs of all patients are met.

2005: Meeting Nutrition and Hydration Needs

Regulation 2005

Meeting Nutrition and Hydration Needs

Commanders of Medical Treatment Facilities (MTFs) must ensure that the nutritional and hydration needs of all patients are met.

Acceptable Means of Compliance 2005

Meeting Nutrition and Hydration Needs

1. Commanders of MTFs should assure themselves that:

a. All patients are provided with suitable and nutritious food and hydration which is adequate to sustain life and is in the best interest of the patient.

b. If necessary, support is provided to enable patients to eat and drink.

c. Any reasonable preferences of a patient for food and hydration arising from religious or cultural background are met.

2. Evidence for this area is contained in the eCAF domain 4.

Policy and Guidance 2005

Meeting Nutrition and Hydration Needs

3. The following JSP 950 Leaflet refers:

a. 7-3-2 – Nutrition in the Military.

b. [This sub-para will remain blank until JMG issue Meeting Nutrition and Hydration Needs policy in JSP 950]

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act.

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DMSR RA 2006

Rationale

Contents

Receiving and Acting on Complaints1

A successful healthcare system requires all complaints received to be investigated and appropriate action taken in response.

2006: Receiving and Acting on Complaints

Regulation 2006

Receiving and Acting on Complaints

Commanders of Medical Treatment Facilities (MTFs) must ensure that any complaint received is investigated and necessary proportionate action is taken in response to any failure identified by the complaint or the investigation.

Acceptable Means of Compliance 2006

Receiving and Acting on Complaints

1. Commanders of MTFs should establish and operate an accessible system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to medical services.

2. Evidence for this area is contained in the eCAF domains 1 and 4.

Policy and Guidance 2006

Receiving and Acting on Complaints

3. The following JSP 950 Leaflet refers:

a. 1-2-10 – Complaints about Healthcare Services Provided by Defence.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act.

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DMSR RA 2007

Rationale

Contents

Competent Persons1

A successful healthcare system requires healthcare personnel who are assessed as competent and are Suitably Qualified and Experienced Persons (SQEP).

2007: Competent Persons

Regulation 2007

Competent Persons

Commanders of Medical Treatment Facilities (MTFs) must ensure that all persons involved in Healthcare activities are competent and Suitably Qualified and Experienced Persons (SQEP)2.

Acceptable Means of Compliance 2007

Competent Persons

1. Commanders of MTFs should assure themselves that:

a. All regulated healthcare professionals3 maintain registration to practice in line with the appropriate professional body’s4 requirements.

b. All healthcare personnel remain within their scope of practice and deliver healthcare for which they are suitably trained and competent.

c. All instances and allegations of poor performance of healthcare personnel are investigated and managed appropriately5.

2. Evidence for this area is contained in the eCAF domain 3.

Policy and Guidance 2007

Competent Persons

Professional Registration

3. The following JSP 950 Leaflets refer:

a. 4-1-4 – Returning to Clinical Practice and Maintaining Clinical Currency.

b. 5-1-5 – Statutory Registration of DMS Personnel.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 Practical workplace training is permitted under this regulation provided that suitable supervision by SQEP is in place. For example, Preceptorship, Foundation Training and Specialist Training. 3 Persons who must be registered with the relevant professional body where such registration is required in relation to the work that the person is to perform, or the title that the person takes or uses. 4 Relevant professional bodies include GMC, GDC, NMC, HcPC, GPhC and BPS. 5 JSP 950 5-2-4 refers.

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Policy and Guidance 2007

c. 5-2-2 – Armed Services Consultant Appointment Board Charter.

d. 10-2-1 – Appraisal of Doctors in the Defence Medical Services and Ministry of Defence.

e. 10-2-2 – Revalidation of Doctors in the Defence Medical Services and Ministry of Defence.

f. 10-2-3 –Revalidation of Nurses Working in the Defence Medical Services and Ministry of Defence.

Scope of Practice

4. The following JSP 950 Leaflets refer:

a. 2-22-2 – Standards of Proficiency for Exercise Rehabilitation Instructors.

b. 4-1-3 – Foundation Programme for Medical cadets.

c. 4-1-8 – Placement of DMS Primary and Secondary Care Specialists in UK Ambulance Service NHS Trusts and with Other Recognised Providers of Pre-Hospital care.

d. 4-2-1 – Placement of Newly Qualified, Newly Commissioned from the Ranks/Rates and Direct Entrant Military Registered Nurse (Adult) and Registered Nurse (Mental Health) within the Defence Medical Services.

e. 5-2-1 – Clinical Supervision for Nurses and Midwives.

f. 5-2-5 – Credentialing Policy for Coalition Healthcare Professionals Assigned to a UK-Led role 2/3 Multinational Medical Units.

g. 10-3-4 – Defence Operational Nurse Competencies.

Managing Poor Performance

5. The following JSP 950 Leaflets refer:

a. 1-2-13 – Raising Concerns, Including Whistleblowing, by DMS Personnel.

b. 5-2-4 – Managing Professional Concerns about healthcare personnel within the DMS and MOD.

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DMSR RA 2008

Rationale

Contents

Duty of Candour1

A successful healthcare system must be open and transparent with patients about their care and treatment.

2008: Duty of Candour

Regulation 2008

Duty of Candour

Commanders of Medical Treatment Facilities (MTFs) must ensure that all healthcare personnel act in an open and transparent way with patients.

Acceptable Means of Compliance 2008

Duty of Candour

1. As soon as reasonably practicable after becoming aware that a safety event has occurred, Commanders of MTFs should assure themselves that:

a. The patient has been notified of the event.

b. Reasonable support has been given to the patient in relation to the event.

c. The patient has been informed of any follow-up action related to the event2.

2. Evidence for this area is contained in the eCAF domain 4.

Policy and Guidance 2008

Duty of Candour

3. The following JSP 950 Leaflet refers:

a. 5-1-6 – Duty of Candour.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 This could include lessons identified, and feedback given across the organisation.

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DMSR RA 3001

Rationale

Contents

Safe Care and Treatment1

A successful healthcare system requires personnel to receive treatment that is safe and avoids patient harm.

3001: Safe Care and Treatment

Regulation 3001

Safe Care and Treatment

Commanders of Medical Treatment Facilities (MTF) must ensure that all persons involved in Healthcare activities provide treatment that is safe and avoids patient harm.

Acceptable Means of Compliance 3001

Safe Care and Treatment

1. Commanders of MTFs should assure themselves that all healthcare personnel:

a. Assess the risks to the health and safety of patients during care and treatment, and do all that is reasonably practicable to mitigate any such risks to As Low As Reasonably Practicable (ALARP).

b. Carry out proper and safe management of medicines.

c. Assess the risk of, and prevent, detect and control the spread of infections.

d. Carry out timely care planning with other healthcare providers where responsibility for patient care is shared or transferred.

2. Evidence for this area is contained in the eCAF domains 1 and 4.

Policy and Guidance 3001

Safe Care and Treatment

3. The following JSP 950 Leaflets refer:

a. Volume 2 Clinical Policy.

b. Volume 5 Quality of Care.

c. Volume 7 Public Health.

d. Volume 9 Medicines and Material Management.

e. Volume 11 Clinical Guidelines for Operations.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act.

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DMSR RA 3002

Rationale

Contents

Good Governance1

A successful healthcare system requires effective governance systems in place to check the quality and safety of care. These systems must help to improve the quality of care and reduce patient safety risks.

3002: Good Governance

Regulation 3002

Good Governance

Commanders of Medical Treatment Facilities (MTFs) must ensure that systems or processes are established, and operated effectively, to check the quality and safety of care. These systems must help to improve the quality of care and reduce patient safety risks.

Acceptable Means of Compliance 3002

Good Governance

1. Commanders of MTFs should assure themselves that systems and processes are in place that:

a. Assess, monitor and improve the quality and safety of the services provided, including gathering patient feedback.

b. Assess, monitor and mitigate the risks relating to the health, safety and welfare of patients.

c. Maintain securely an accurate, complete and contemporaneous record in respect of each patient, including a record of the care and treatment provided to the patient and of decisions taken in relation to the care and treatment provided.

d. Maintain securely other records in relation to:

(1) Healthcare personnel.

(2) The management of medical services.

e. Seek and act on patient and staff feedback, for the purpose of continually evaluating and improving medical services.

f. Evaluate and improve their MTF in respect of processing the information above.

2. Evidence for this area is contained in the eCAF domain 3.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act.

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Policy and Guidance 3002

Good Governance

3. The following JSP 950 Leaflets refer:

a. 5-1-4 – Healthcare Governance in the DMS.

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DMSR RA 3003

Rationale

Contents

Staffing1

A successful healthcare system requires enough suitably qualified, competent and experienced staff to make sure they can meet the regulated standards. Their staff must be given the support, training and supervision required to do their job.

3003: Staffing

Regulation 3003

Staffing

Commanders of Medical Treatment Facilities (MTFs) must ensure that they have sufficient numbers of competent and SQEP2 personnel to meet the regulated healthcare requirements.

Acceptable Means of Compliance 3003

Staffing

1. Commanders of MTFs should assure themselves that:

a. They have sufficient numbers of competent and SQEP personnel to meet the regulated healthcare requirements.

b. All healthcare personnel receive appropriate support, training, Continuous Professional Development, supervision and appraisal to enable them to carry out their duties.

c. All healthcare personnel are enabled, where appropriate, to obtain further training appropriate to their duties.

2. Evidence for this area is contained in the eCAF domain 3.

Policy and Guidance 3003

Staffing

[This section will remain blank until JMG issue Staffing policy in JSP 950].

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 See DMSR Regulation 2007.

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DMSR RA 4001

Rationale

Contents

Premises and Equipment1

A successful healthcare system uses premises and equipment that are clean, suitable, correctly maintained, used properly and secure.

4001: Premises and Equipment

Regulation 4001

Premises and Equipment

Commanders of Medical Treatment Facilities (MTFs) must ensure that their premises and equipment that are clean, suitable, correctly maintained, used properly and secure2.

Acceptable Means of Compliance 4001

Premises and Equipment

1. Commanders of MTFs should assure themselves that all MTF premises and equipment are:

a. Clean.

b. Secure.

c. Suitable for the intended purpose.

d. Properly used.

e. Properly maintained.

2. Evidence for this area is contained in the eCAF domain 6.

Policy and Guidance 4001

Premises and Equipment

3. The following JSP 950 Leaflets refer:

a. 2-10-2 – DMS Infection Prevention and Control Policy.

b. 3-3-2 – Policy for the Control of Feral Animals on Operations.

c. 3-3-3 – Pest Management Policy in the Armed Forces.

d. 7-2-2 – Communicable Disease Control, Surveillance and Advice in the Armed Forces.

1 Regulation required due to DMS exemption from The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. See Schedule 2 para 10 of Act. 2 When medical facilities are deployed to austere environments then deviations from firm based standards should be ALARP.

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Policy and Guidance 4001

e. 7-2-6 – Pandemic Influenza – Infection Control Guidance for Military Settings.

f. 7-2-10 – Healthcare Waste Management for Defence Medical Services’ Healthcare Facilities.

g. 7-2-11 – Environmental Cleaning for DMS Healthcare Facilities.