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Medicines blackout threatens ICS prevention target

The government’s target for England to become smoke-free by 2030 – which integrated care systems are expected to pursue – is being undermined by the unavailability of two smoking cessation medicines.

The objective, set by government in 2019, is being taken forward by many ICSs, as they seek to prevent premature illness and death, and narrow health inequalities, with smoking rates normally higher in more deprived populations.

However HSJ analysis of drug shortages revealed that the two cessation medicines are both currently unavailable for an extended period.

Champix (varenicline) has been unavailable since October 2021, a situation exacerbated by the absence of Zyban (bupropion), since December 2022.

Both drugs were withdrawn because of concerns about the presence of nitrosamines, which may increase risk of cancer if people are exposed to them above acceptable levels, and will be subject to further tests and regulatory checks if they are to return.

Matthew Evison, a lung cancer and tobacco dependency specialist at Manchester University Foundation Trust, said Champix was clinicians’ “most powerful weapon” against smoking. He said the treatment gap would make the target harder because “smoking prevalence declines will be slower without varenicline”.

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Source: HSJ, 30 January 2023

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A mysterious Adderall shortage reveals how America fails ADHD patients

Erik, a 26-year-old Seattle grocery clerk, who also has attention-deficit hyperactivity disorder (ADHD), has been unable to get his medications filled for months now – and he’s worried he’ll lose the first full-time job he’s ever had.

For people like Erik, ADHD medication is a prerequisite for basic functioning – and over the last year it’s become dramatically harder for patients like them to access care. Last October, the Food and Drug Administration (FDA) announced a shortage of Adderall, one of the most common stimulant medications for ADHD.

In recent months, patients have reported problems filling nearly every type of ADHD medication. What’s stranger is that no one seems to know why. Is it some kind of supply chain issue? A pandemic-era surge in demand? A government crackdown?

Official explanations have offered little clarity. The FDA’s announcement mentioned “intermittent manufacturing delays” at Teva, the producer of the branded version of Adderall, but few other details. The American Society of Health Pharmacists reports shortages of multiple ADHD drugs but says manufacturers have given no explanation.

The situation has left patients in turmoil.

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Source: The Guardian, 30 January 2023

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NHS faces ‘alarming’ exodus of doctors and dentists, health chiefs warn

The NHS faces an alarming mass exodus of doctors and dental professionals, health chiefs have said, as a report reveals 4 in 10 are likely to quit over “intolerable” pressures.

Intense workloads, rapidly soaring demand for urgent and emergency healthcare and the record high backlog of operations are causing burnout and exhaustion and straining relationships between medics and patients, according to the report by the Medical Defence Union (MDU), which provides legal support to about 200,000 doctors, dental professionals and other healthcare workers in the UK.

In an MDU survey of more than 800 doctors and dental professionals across the UK, conducted within the last month and seen by the Guardian, 40% agreed or strongly agreed they were likely to resign or retire within the next five years as a direct result of “workplace pressures”.

Medical leaders called the report “deeply concerning”. There are already 133,000 NHS vacancies in England alone.

NHS chiefs said it laid bare the impact of the crisis in the health service on staff, and MPs said it should serve as a “wake-up call” to ministers on the urgent need to take action to persuade thousands of NHS staff heading for the exit door to stay.

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Source: The Guardian, 29 January 2023

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Thousands of NHS staff with long Covid risk losing their pay

Thousands of NHS staff across the UK are facing pay cuts because of a change in Covid sickness policy.

Analysis by BBC Panorama suggests that between 5,000 and 10,000 NHS workers could be off sick with Long Covid.

Unions are accusing the government of failing to support health staff who worked during the coronavirus pandemic.

The government says the Covid-19 public inquiry will examine these issues when it begins taking evidence in May.

Changes to special sick pay rules introduced during the pandemic mean that some NHS staff unable to work due to Long Covid may soon no longer receive full pay.

Enhanced provision ended last year. Many had a six-month transition, so expect their wages to go down soon.

Some face losing their jobs.

Professor David Strain is the chair of the Board of Science at the British Medical Association (BMA) and says this makes him "genuinely angry".

He explains: "We've got a group of people that have put themselves forward to look after the population, they've been left with an illness and they're not being supported.

"They're just in a no man's land."

He believes that health workers with long Covid should be allowed to focus on their recovery without money worries.

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Source: BBC News, 30 January 2023

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Toxic slimming pill drug DNP to be declared poison

A highly toxic chemical compound sold illegally in diet pills is to be reclassified as a poison, a government minister has said.

Pills containing DNP, or 2,4-dinitrophenol, were responsible for the deaths of 32 young vulnerable adults, said campaigner Doug Shipsey.

His daughter Bethany, from Worcester, died in 2017 after taking tablets containing the chemical.

The deaths were down to a "collective failure of the UK government", he said.

DNP is highly toxic and not intended for human consumption. An industrial chemical, it is sold illegally in diet pills as a fat-burning substance.

Experts say buying drugs online is risky as medicines may be fake, out of date or extremely harmful.

Mr Shipsey said he had targeted the minister following the death of another young man who had taken the drug sold as a slimming aid.

Prior to this, following the inquests of dozens of young people who had suddenly and unexpectedly died from DNP toxicity, the government had "ignored numerous coroners reports" to prevent future deaths, he said.

"So, at last after 32 deaths and almost six years of campaigning, the Home Office (HO) finally accept responsibility to control DNP under the Poisons ACT 1972," he added.

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Source: BBC News, 28 January 2023

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NHSE launches new intervention regime for worst A&E performers

NHS England has revealed a new intervention regime, as it seeks to deliver on its new urgent and emergency care recovery plan.

Systems will be placed in three “tiers of intervention”, with those systems deemed “off-target on delivery” being given “tier three intensive support” from NHSE, which will include on-the-ground planning, analytical and delivery capacity, “buddying” with leading systems and “targeted executive leadership”.

The approach follows that which has been taken over the past year for elective and cancer care recovery. 

The urgent care plan, published by NHSE and the Department of Health and Social Care today, says: “NHS England will identify and share good practice so that all can learn from the best. For those systems that are struggling, we will offer support to ensure that they have the best opportunities to drive improvement locally.”

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Source: HSJ, 30 January 2023

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NHS plan: £1bn for hospital beds and ambulance fleet

Thousands of extra hospital beds and hundreds of ambulances will be rolled out in England this year in a bid to tackle the long emergency care delays.

The 5,000 new beds will boost capacity by 5%, while the ambulance fleet will increase by 10% with 800 new vehicles.

Details of the £1bn investment will be set out later in a joint government and NHS England two-year blueprint.

Questions have also been raised about how the extra resources will be staffed - 1 in 10 posts in the NHS is vacant.

The government believes the measures, which will be introduced from April, will help the NHS to start getting closer to its waiting time targets.

It has set goals that by March 2024:

  • 76% of A&E patients will be dealt with in four hours. Currently fewer than 70% are. The official target is 95%
  • An average response time of 30 minutes for emergency calls such as heart attacks and strokes. In December patients waited over 90. The official target is 18.

Prime Minister Rishi Sunak said cutting NHS waiting times was one of his five main priorities.

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Source: BBC News, 30 January 2023

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Nearly £15bn wasted on Covid PPE, says UK spending watchdog

The UK health department was forced to write down £14.9bn worth of personal protective equipment and other medical items, according to a report by the independent public spending watchdog, which also issued a scathing criticism of the UK Health Security Agency.

The National Audit Office said that the Department for Health and Social Care did not complete an “effective programme of year-end stock counts” to assess the quality and quantity of coronavirus-related items, such as lateral flow tests.

During the last two financial years, the DHSC reported nearly £15bn of write down costs associated with PPE and other health items. The department estimated that the continuing cost of storage and disposal of excess and unusable equipment stands at £319mn.

The watchdog found a “lack of adequate governance, oversight and control” at the UKHSA. It noted that due to a “lack of sufficient, appropriate audit evidence and significant shortcomings in financial control” the NAO was unable to provide an audit opinion on the 2021-22 accounts of the agency.

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Source: Financial Times, 27 January 2023

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Whistleblowers claim children ‘seriously harmed’ at scandal-hit mental health hospitals

Children came to “significant” harm due to chronically low staffing levels at scandal-hit mental health hospitals, whistleblowers have said.

In a third exposé into allegations of poor care at private hospitals run by The Huntercombe Group, former employees have claimed that staffing levels were so low “every day” that patients were neglected, resulting in:

  • Patients as young as 13 being force-fed while restrained.
  • Left alone to self-harm instead of being supervised.
  • Left to “wet themselves” because staff couldn’t supervise toilet visits.

One staff member, Rebecca Smith, said she was left in tears after having to restrain and force-feed a patient.

Following a series of investigations by The Independent and Sky News, 50 patients came forward with allegations of “systemic abuse” and poor care, spanning two decades at children’s mental health hospitals run by the organisation.

The government has since launched a “rapid review” into inpatient mental health units across the country following the newspaper’s reporting.

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Source: The Independent, 28 January 2023


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Trust receives record fine for maternity care failure

An acute trust has been fined a record sum by the Care Quality Commission for failing to provide safe maternity care, which resulted in the death of a baby after 23 minutes.

Nottingham University Hospitals must pay a fine of £800,000 within two years. It is only the second time the regulator has brought a case against a NHS maternity service, and the highest fine ever given for failings of this nature.

The trust pleaded guilty earlier this week to two charges of failing to provide safe care and treatment to Sarah Andrews and her baby daughter Wynter Andrews at Queen’s Medical Centre in 2019, a short time after her birth by Caesarean section. This guilty plea saw the fine reduced from £1.2m. 

An inquest in 2020 found the death was a “clear and obvious case of neglect”. It was also found there was “an unsafe culture prevailing within maternity services”, including a “failure to listen and respond to staff safety concerns”.

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Source: HSJ, 27 January 2023

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Political will to tackle health security ‘melting away’, warns Tony Blair

The impetus to tackle health security has started to “melt away”, despite the devastation wrought by the Covid pandemic, Tony Blair has warned.

In the foreword to a new book, ‘Disease X’, the former British prime minister said that while there are “concurrent crises jostling for the attention of governments”, leaders should not miss the opportunity to implement the “hard-won lessons” of the past three years.

“Covid-19 was an unprecedented global crisis and should mark a turning point in global health policy and preparedness,” Mr Blair wrote. 

“Our governments need to demonstrate the same level of political will, ambition and international cooperation that leaders demonstrated in the wake of World War II, when they coalesced around the objective of a sustainable peace. 

“This must be applied to the post pandemic order because, at its heart, health security is national security,” he added. “It is clear this will not be the last pandemic threat of our lifetimes … there is no excuse to be unprepared, again.” 

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Source: The Telegraph, 25 January 2023

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NHS in England will have one strategy for all major conditions, including cancer

The NHS in England is set to have a major conditions strategy to help determine policy for the care of increasing numbers of people in England with complex and often multiple long-term conditions.

Conditions covered by the strategy will include cardiovascular disease, chronic respiratory disease, dementia, mental health conditions, and musculoskeletal disorders. Cancer will also be included and will no longer have its own dedicated 10 year strategy.

England’s health and social care secretary, Steve Barclay, told the House of Commons on 24 January that the strategy would build on measures in the NHS long term plan.

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Source: BMJ, 25 January 2023

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High levels of microplastics found in operating theatres

High levels of microplastics have been found in operating theatres by researchers who highlighted the “astoundingly high” amounts of single-use plastic used in modern surgical procedures.

A team from the University of Hull found the amount of microplastics in a cardiothoracic operating theatre was almost three times that found in homes, and said this identifies another route through which the tiny particles can enter the human body, with unknown consequences.

The study, published in the journal Environment International, is the first to examine the prevalence of microplastics in surgical environments.

The team analysed levels in the operating theatre and the anaesthetic room in cardiothoracic surgeries and discovered an average of 5,000 microplastics per metre squared when the theatre was in use.

Jeanette Rotchell, professor of environmental toxicology at the university, said the types of microplastic particles identified relate to common plastic wrapping materials and could also come from blister packs, surgical gowns, hairnets and drapes for patients.

Prof Rotchell said: “Although we know microplastics are in the air in a variety of settings, we can’t yet say what the consequences are or whether microplastics are harmful to health. Researchers have yet to establish this.

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Source: The Independent, 27 January 2023

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Trust underplayed ‘catastrophic’ IT outage

A major London trust has been criticised for ‘underplaying’ the problems caused by a ‘catastrophic’ IT outage, a new report has revealed.

The Guy’s and St Thomas’ Foundation Trust report also noted one patient suffered “moderate harm” and several others “low” level harm after last July’s incident, which was caused by a combination of a heatwave and ageing infrastructure. 

However, the trust said there was no evidence the “underplaying” of issues was deliberate.

The report identified one incident of “moderate” patient harm, in which a patient was unable to receive a pancreas transplant due to staff being unable to safely monitor critical observations. The patient has since had a successful operation, the trust’s report stated.

Another 20 “low” harm incidents were reported, which included delays in patients receiving their test results and/or medicines, while the report added the trust could not rule out that “further harm events may be identified” amidst an ongoing harm review.

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Source: HSJ, 27 January 2023

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Medicine supply problems double in a year

Medicine supply issues have soared in the past year, with the number of unavailable medicines nearly doubling from 52 in January 2022 to 97 this month, figures seen by HSJ reveal.

Analysis of NHS supply alerts shared with HSJ shows a persistent monthly rise over the past year in the number of unavailable drugs. It also reveals that 12 “serious shortage protocols” – a more serious level of alert which allow pharmacists to dispense alternatives more easily – have been issued this month, compared to three in January last year.

This is based on an analysis by the British Generics Manufacturers Association of NHS Specialist Pharmacy Service (SPS) medicines supply tool data. SPS data, seen by HSJ, shows several “high impact” shortages, which means they have the potential to change clinical practice or have safety implications.

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Source: HSJ, 26 January 2023

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Immensa Covid test lab concerns ignored by Test and Trace

Concerns raised about dangerous discrepancies at a Covid testing lab which has since been blamed for causing an estimated 23 deaths were ignored by health officials for months.

Documents show Public Health Wales flagged "significant concerns" about results from Immensa, in Wolverhampton, in letters to colleagues in England.

They were told nothing was wrong and testing continued for six months.

Letters were released after a Freedom of Information request by the Times.

The UK Health Security Agency (UKHSA) has said as many as 39,000 positive results were wrongly reported as negative in September and October 2021, mostly originating from south-west England.

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Source: BBC News, 26 January 2023

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NHS ‘haemorrhaging’ senior emergency department nurses

Experienced emergency department nurses are “leaving in droves” because they feel unable to do their jobs properly under the current conditions, a doctor has warned.

Giving evidence to the Health and Social Care Select Committee yesterday, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, raised concern about nurse retention and morale in emergency departments.

“We are haemorrhaging experienced emergency nurses because they are finding it very frustrating"

He said: “What I'm also seeing is that a lot of nurses, particularly the experienced nurses, they're almost like the [non-commissioned officers] of the health service, the sergeants who know how to get things done, are leaving in droves.”

Dr Boyle added: “We are haemorrhaging experienced emergency nurses because they are finding it very frustrating.

“The problem is not because there's too much work but they're unable to do the work that they're trained to do."

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Source: Nursing Times, 25 January 2023

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NHS safety watchdog sends warning over charging for GP appointments

Charging for GP appointments will worsen patient safety and drive more people to A&E, the head of a national safety watchdog has warned.

Dr Rosie Benneyworth, the chief investigator for the Healthcare Safety Investigation Branch (HSIB), was responding to a suggestion by former health secretary Sajid Javid who said the present model of the NHS was “unsustainable”.

He said “extending the contributory principle” should be part of radical reforms to tackle growing waiting times.

But Dr Benneyworth said it would only drive more people to seek help from already overstretched services.

She said: “I don’t want to be drawn into the politics around this but I believe in free at the point of delivery NHS and my concern would be [if] we charge people that people would not come forward early for their care and that would leave people needing more urgent and emergency care, because of delayed presentations.”

Dr Benneyworth said there needed to be a bigger focus on patient safety in services outside of A&E, such as NHS 111 and out-of-hours services.

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Source: The Independent, 26 January 2023

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Surgeon admits botching surgeries that left patients with life-changing injuries

An NHS surgeon has admitted to botching patients’ surgeries which left them with life-changing injuries, a tribunal has heard.

Dr Camillo Valero, who works at Norfolk and Norwich NHS trust and is facing allegations over his conduct towards three patients, has been admitted to severing a patient’s gallbladder during an operation.

Dr Valero is facing a medical practitioner’s tribunal where he already admitted to failures during two patients’ procedures.

Allegations against him include a failure to obtain a “critical view of safety” for his patients during surgeries.

He is also accused of shouting at patients during an altercation in an allegedly “aggressive” manner.

According to a tribunal document he was accused of asking the patient “are you a doctor?” when discussing his medication.

During surgery, Dr Valero is alleged to have misinterpreted the patient’s anatomy or sought assistance from an experienced surgeon following mistakes.

In the case of the third patient, allegations which have not been admitted or proven, Dr Valero is reported to have inappropriately discharged a patient with learning disabilities and did not adequately assess their mental capacity.

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Source: The Independent, 25 January 2023

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Two thirds of GPs say ‘advice and guidance’ is blocking patients who really need a referral

Two-thirds of GPs feel ‘advice and guidance’ is preventing patients who really need a referral to secondary care from getting one, according to the findings of a snapshot survey of Pulse readers.

Advice and guidance (A&G) services, which involve GPs accessing specialist advice before making a referral, have become a major part of NHS England’s plans for clearing the pandemic backlog.

But of the 366 GP survey respondents in England who said they had used advice and guidance, 68% said they felt the pathway is blocking necessary referrals.

The survey also found that of those 366 GPs who had used A&G services:

  • Around half (49%) said A&G was reducing referrals;
  • More than three-quarters (78%) said it was increasing their workload;
  • Just over half (60%) said it was requiring them to work beyond their competence;
  • Two-thirds (68%) said A&G was resulting in patients complaining because their wish to see a consultant had been diverted.

One GP who wished to remain anonymous commented: "An increasing number of referrals are being rejected for secondary care service pressure reasons rather than clinical need. [This] often duplicates GP admin work as we need to re-refer, rewriting the referral and/or enclosing further information or tests results in order to get a referral accepted."

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Source: Pulse, 25 January 2023

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USA: 48% of physicians are happy at work, survey finds

Physicians' happiness fell amid the pandemic and is not rebounding easily, according to Medscape's 2023 Physician Lifestyle and Happiness Report.

The report is based on survey responses from 9,175 U.S.-based physicians in 29 specialties polled last year between 28 June and 3 October.

The report found:

1. 59% of physicians said they were "somewhat" or "very happy," down from 84% before the pandemic. These figures mirror percentages seen in Medscape's same report conducted last year. 

2. The percentage of physicians who are happy at work, specifically, fell from 75% before the pandemic to 48% today.

3. Four in 10 physicians said they regularly look after their own health and wellness, up from 33% who said the same in Medscape's 2022 report. 

4. 53% said they would take a pay decrease in return for better work-life balance. 

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Source: Becker's Hospital Review, 20 January 2023

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UK facing crisis point in abortion provision, experts say

The UK is facing a “crisis point” in abortion provision, experts say, with rising demand and restricted access to care in many areas putting unprecedented pressure on struggling NHS services.

Healthcare professionals described a “terrifying” state of affairs in which women are travelling hundreds of miles for appointments or waiting several weeks before they are seen.

Dr Jonathan Lord, the director of MSI Reproductive Choices UK, a major provider of abortion services, told the Guardian’s Today in Focus podcast: “There is no doubt we are seeing absolutely unprecedented levels of demand at the moment. All providers are reporting they are busier than they have ever been.”

Lord, who is also an NHS consultant gynaecologist, said the rise was being driven by “the economic downturn, the cost of living crisis and the ability to access good quality contraception” via GPs and sexual health services, which have been affected by the wider NHS crisis.

Clare Murphy, the chief executive at the British Pregnancy Advisory Service (BPAS), previously said: “The pandemic, and the policies adopted by the government, have had a clear impact on women’s pregnancy choices.” Faced with “economic uncertainty and job insecurity”, women had been forced to make tough decisions, she said.

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Source: The Guardian, 26 January 2023

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We need to tell the public that hospitals are ‘horrible places’, urges trust CEO

Hospitals are ‘horrible’ and unsafe places, which should be avoided ‘unless you really need to be there’, a longstanding trust chief executive has argued.

East Suffolk and North Essex Foundation Trust boss Nick Hulme also said the NHS had to be honest about the state of its acute services.

Speaking at a public meeting of the East Suffolk and North Essex Integrated Care Board, he described hospitals as “awful” and “horrible”, and said NHS leaders had “got to get that message out” to the public. 

He added: “The food’s rubbish, we don’t let you sleep, we don’t let you know what’s going on” and that although he had stayed in some “fairly dodgy” hotels, none had forced him to share a bathroom with six people.

The trust CEO told the meeting he wanted to emphasise to the public that “the worst place you can possibly be in the health system is a hospital, unless you need to be there”, according to a report in the East Anglian Daily Times.  He added that hospitals were “not safe places”.

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Source: HSJ, 26 January 2023

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Thousands exposed to severe harm due to ambulance wait times last month

Record numbers of patients suffered severe harm last month because they spent so long in the back of ambulances waiting to get into A&E, new NHS figures reveal.

An estimated 57,000 people in England “experienced potential harm”, of whom 6,000 were exposed to “severe harm”, in December – both the largest numbers on record – because they had to wait at least an hour to be handed over to hospital staff, according to NHS ambulance service bosses.

The health union Unison, which represents many ambulance staff, said the data showed that the ambulance service “is barely coping” with the huge number of calls it is receiving.

A senior ambulance service official said the high volume of patients being put at risk because they had to wait outside A&E so long before receiving medical attention, and paramedics being prevented from answering other 999 calls, was “horrific” and “astronomical”.

He added: “These figures also show that whatever NHS England say they are doing to try to resolve this huge problem, it clearly isn’t working.”

Martin Flaherty, Association of Ambulance Chief Executives (AACE) managing director, said: “Our December 2022 data for handover delays at hospital emergency departments shows some of the worst figures we have recorded to date and clearly underlines that not enough is being done to reduce and eradicate these dangerous, unsafe and harmful occurrences.”

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Source: The Guardian, 25 January 2023

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Women’s healthcare in Britain ‘worse than in China and Saudi Arabia’

Women’s healthcare in the UK is worse than that of China and Saudi Arabia, according to a global tracker

Poor efforts at prevention, diagnosis and treatment of health problems left the UK ranked lower than several countries with a troubling record on women’s rights.

The research, which compared a wealth of data, found Britain fared worse than most comparable Western countries, including the United States, Australia, New Zealand, France and Germany.

The UK was placed 30th out of 122 countries, in the 2021 Hologic Global Women’s Health Index published on Tuesday.

The score – three points lower than when a similar exercise was carried out last year – places it on a par with Kazakhstan, Slovenia, Kosovo and Poland for women’s healthcare provision.

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Source: The Telegraph, 24 January 2023

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