Dear Mr Louis Appleby

Would you expect to see the following as a recommendation following a Serious Untoward Incident?

"Clinical guidelines should be developed in relation to the management of patients diagnosed with rapid cycling conditions, giving clear advice about the need to actively engage patients who have a propensity to deteriorate quickly"

1. Is this a discovery about new symptoms of a "known" psychiatric illness?

2. Is this the first Trust to "discover" that rapid cycling patients can deteriorate quickly?

3. Is rapid cycling bipolar disorder not part of the core curriculum in the training for psychiatrists?

4. By not having clinical guidelines in place to treat this condition, not knowing what to do, were the Trust, in fact, in breach of their statutory duty of care by failing to provide the appropriate care and treatment for this condition?

By the way, the Trust were not following NICE guidelines or offering the NICE recommended therapies for this condition at the time.

Yours faithfully,

L Cowling

Department of Health and Social Care

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Our Ref: DE00000450370
Dear Mr/Ms Cowling,
Thank you for your recent email to Louis Appleby about rapid cycling
conditions. I have been asked to reply.
As you are aware, rapid-cycling bipolar disorder is a well recognised
psychiatric condition, the care and treatment of which is covered in the
National Institute for Health and Clinical Excellence (NICE) guideline on
bipolar disorder. The management of rapid-cycling bipolar disorder can be
very challenging.
The Core Curriculum for training in psychiatry includes an understanding
of the major psychiatric disorders, including bipolar disorder. NICE
guidance on bipolar disorder already includes guidelines on Rapid Cycling
Bipolar Disorder.
NICE's clinical guidelines are based on the best available evidence and
are developed through wide consultation with stakeholders. Clinical
guidelines represent best practice for NHS organisations.
NICE's clinical guidelines cover a whole pathway of care spanning all
stages of care from the diagnosis to treatment of a condition. NICE also
produces short clinical guidelines that address only part of a care
pathway.
Guidelines often include dozens of recommendations for the NHS and can
therefore be complex to implement for the NHS.
Because of local priorities, there are often different states of readiness
at different NHS organisations for the implementation of NICE clinical
guidelines: some organisations will already be meeting many of NICE's
recommendations, whereas others may be some way off.
In recognition of their complexity, NICE's clinical guidelines and public
health guidance are developmental standards for the NHS. NHS
organisations should progress towards their full implementation as and
when resources permit.
I would therefore recommend that you raise your concerns directly with the
Trust to which your email refers.
I hope that this reply is helpful.
Yours sincerely,
Rebecca Gonsalves
Department of Health

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Alix Cull left an annotation ()

What is Professor Appleby's answer to
a)schizophrenia
b)dementia?

? no suggstions.

D. Speers left an annotation ()

It may also be worth checking with local Strategic Health Authorities as there are new classifications known as "Never events" (not yet sure when this is due to be implemented or not!)and also:

You may be interested in looking at the responses to the Parliamenary Health Select Committee Report into Patient Safety, published recently on Hansard,there are serious failures in health regulation.
http://www.publications.parliament.uk/pa...

Dear Sir or Madam,

As I understand, recommended NICE treatments should be implemented within 3 months of published NICE guidelines.

Does the Department of Health have figures of how many Trusts fail to implement NICE recommended treatments? If not, then who would have this information?

Yours faithfully,

L Cowling

Department of Health and Social Care

Thank you for your email.

Where a reply is appropriate we aim to send one within 20 working days.

If your enquiry is about a medical matter, please contact NHS Direct on
0845 4647 or visit [1]NHS Choices, or contact your GP surgery.

For the latest on swine flu, please visit [2]the National Pandemic Flu
Service (NPFS) or call 0800 1 513 100.

For general health information you may also find it helpful to refer to
[3]Directgov, the UK Government's Official information website, or the
Department of Health website's [4]Frequently Asked Questions.

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Communications via the GSi may be automatically logged, monitored and/or
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2. http://www.direct.gov.uk/pandemicflu/
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4. http://www.dh.gov.uk/en/FAQ/index.htm

Department of Health and Social Care

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