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Doctor suspended for sterilising woman without permission

A consultant gynaecologist who admitted sterilising a woman without her permission has been suspended from practising for 12 months.

The woman - known as Patient A - was sterilised by Dr David Sim following an emergency caesarean section.

Dr Sim previously admitted that the sterilisation was not necessary to save the woman's life or prevent harm to her health.

The procedure took place at Daisy Hill Hospital in Newry in September 2021.

On 1 December, the Medical Practitioners Tribunal Service (MPTS) found his fitness to practice was impaired.

The tribunal previously heard Dr Sim and the patient had discussed sterilisation twice over a period of years, but the patient had never consented or expressed any wish to undergo sterilisation.

When she required the emergency caesarean section, Dr Sim delivered the baby and blocked the patient's fallopian tubes to permanently impair their normal function.

Dr Sim previously admitted to the tribunal that this was in violation of the woman's reproductive rights.

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Source: BBC News, 5 December 2023

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"I'm begging for help for endometriosis"

Living with seizures and crippling pain, Zara Corbett says she's "begging for help" as she copes with endometriosis.

The 21-year-old told BBC News NI that if she had any other condition she would be receiving help.

"With gynae problems, particularly endometriosis, you are left waiting for years."

"Women should not be left suffering this pain, it's not good enough," the beautician said.

Zara has been put into early menopause - which is one potential treatment for endometriosis.

The County Down woman said Northern Ireland needed a dedicated centre to provide specialist support.

"I am begging for help from medical professionals including support from a multi-agency network because we are at our wits end - life cannot go on like this," she said.

Endometriosis UK, an organisation that helps women with the condition, said it was shocked and saddened that it does not see "good, prompt care" in Northern Ireland.

Its chief executive, Emma Cox, who visited Belfast in May, said services in Northern Ireland were "lagging behind" the rest of the UK.

"We hear of the very long waiting lists to access gynaecologists to get a diagnosis but also waiting lists to access surgeons, it's about the disease being taken seriously," Ms Cox said.

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Source: BBC News, 6 December 2023

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Experts call for fewer antidepressants to be prescribed in UK

Open letter to government from experts and politicians says rising usage ‘is a clear example of over-medicalisation’.

Medical experts and politicians have called for the amount of antidepressants being prescribed to people across the UK to be reduced in an open letter to the government.

The letter coincides with the launch of the all-party parliamentary group Beyond Pills, which aims to reduce what it calls the UK healthcare system’s over-reliance on prescription medication.

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Source: Guardian, 5 December 2023

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Huge delays to access maternal mental health care in England called a scandal

NHS figures obtained by Labour reveal 11,507 women sought care but did not get any last year.

Almost 20,000 women a year living with mental health problems triggered by being pregnant or giving birth are being denied support by the NHS, the Guardian can reveal.

Furthermore, those who do receive mental health help for their trauma are having to wait up to 19 months to start treatment in some parts of England because specialist services are so overstretched.

The situation has been described as “an absolute scandal” and sparked warnings that “rationing” of such vital care could leave women who do not get it in a very vulnerable state and risk their children facing lifelong health problems and stop mothers bonding with their baby.

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Source: Guardian, 5 December 2023

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Ministers lose infected blood vote after Tory MPs revolt

MPs have backed a move to speed up compensation for victims of the NHS infected blood scandal, delivering the prime minister his first Commons defeat.

Ministers will now have to set up a body to run the scheme within three months of a new bill becoming law.

The vote was passed by 246 votes to 242 after 22 Conservatives rebelled.

The Haemophilia Society said Rishi Sunak "should be ashamed" he had been forced "to do the right thing".

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Source: BBC News, 5 December 2023

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Humiliated Covid whistleblower says boss tried to 'break' her

A senior doctor who won a record £3.2m payout says her boss tried to "break" her after she raised concerns about how Covid was being handled.

Rosalind Ranson, medical director on the Isle of Man during the pandemic, experienced months of humiliation, an employment tribunal found.

Dr Ranson has given BBC News her first interview since the hearing.

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Source: BBC News, 5 December 2023

 

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GPs will not be nationally mandated to use advice and guidance, NHSE confirms

There will be no national mandate for GPs to use advice and guidance in a certain number of cases, NHS England has told Pulse. 

National medical directors for primary and secondary care said that formalised pathways should be developed ‘locally’, and decisions should be based on an area’s population.

In September, it was reported that NHS England’s upcoming outpatients strategy would further increase the use of advice and guidance (A&G) before GP referrals are accepted, with the RCGP then "voicing concerns" about this proposal. 

However, when asked about the reports that this would be mandated, Dr Stella Vig, national medical director for secondary care and clinical director for elective care, said she ‘doesn’t know’ where that came from, and ‘doesn’t recognise’ those comments.

NHS England also released guidance clarifying the medico-legal risks and clinical responsibility for clinicians using A&G or referral assessment services (RAS), which is now available on the NHS Futures website.

The guidance said that these forms of specialist advice are "expanding rapidly" as a result of improvements to digital services.

On legal issues, it said liability ‘will be determined on a case by case basis’ but that GPs could be liable if "all relevant clinical information is not provided" when sending an A&G request. 

But specialists at hospitals would be accountable if they send back advice to the GP which is ‘not clinically appropriate’ or if they ‘refuse to accept a patient’. 

On turnaround times, NHS England has said that ‘local variables will ultimately dictate the agreed response times’ for hospital teams dealing with A&G – but the guidance recommends that the response time "should not exceed 10 working days for routine requests". 

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Source: Pulse, 30 November 2023

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NHS trust under investigation accused of hypocritical email to staff

The boss of a hospital trust being investigated by police for alleged negligence over 40 patient deaths has been accused of sending a hypocritical email urging staff to have the courage to raise concerns despite the dismissal of whistleblowing doctors.

The investigation, Operation Bramber, was sparked by two consultants who lost their jobs after raising concerns about deaths and patient harm in the general surgery and neurosurgery departments of the Royal Sussex County hospital in Brighton.

In an email to staff on Friday, the chief executive, George Findlay, said the trust was committed to learning from its mistakes. He said: “When things do go wrong, we must be open, learn and improve together. That openness is how we give people courage to raise concerns and make a positive difference to patient care.”

James Akinwunmi, a consultant neurosurgeon who was unfairly dismissed by the trust in 2014 after he raised the alarm about patient safety, said Findlay’s email was “laughable”.

He told the Guardian: “Whistleblowers, including myself, have done exactly what he is encouraging in the email and they were sacked for it, so you can draw your own conclusions. I suspect what they are doing is damage limitation. Instead, they should be dealing with surgeons who have been a problem for years.”

Another more recent whistleblower, who did not want to be named, expressed incredulity at Findlay’s claim that he wanted to encourage staff to raise concerns.

They said: “The email is hypocritical. How can staff have the ‘courage to raise concerns’ after what has happened to those who have? Those brave enough to blow the whistle about patient safety have been sanctioned, lost their job and had their lives destroyed.”

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Source: The Guardian, 3 December 2023

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Minister: There’s systemic racism in the NHS

A health and social care minister privately said there was ‘systemic’ racism within the NHS and called for an investigation into it.

Helen Whately told Matt Hancock of her belief in a private message which was today shown to the covid public inquiry.

An inquiry hearing with Mr Hancock – who said he agreed with the point – was shown an exchange between Ms Whately, then care minister, and Mr Hancock in June 2020.

The Guardian had reported the previous day that an internal report had found systemic racism at NHS Blood and Transplant.

Ms Whately, who is now minister of state covering social care and urgent and emergency services, said: “I think the Bame next steps proposed are important but don’t go far enough. There’s systemic racism in some parts of the NHS, as seen in NHSBT.”

She added: “Now could be a good moment to kick off a proper piece of work to investigate and tackle it.”

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Source: HSJ, 1 December 2023

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Trust reports two ‘never events’ in area already under review for errors

A teaching trust has reported six ‘never events’ in less than two months, including incidents in a specialty already under review for errors.

The incidents occurred at University Hospitals Birmingham between 26 July and 10 September, including two wrong-side lesion biopsies in dermatology, two incorrect blood transfusions, one injection to the incorrect eye, and one misplaced nasogastric tube.

The two incorrect blood transfusions involved the same patient at Heartlands Hospital and were reported after a biomedical scientist carried out a retrospective investigation into the case. On both occasions, the patient was transfused with incorrect red blood cells.

It brings the total number of blood transfusion events reported at UHB to seven since 2020-21. The issue is already subject to a review by the Royal College of Physicians after Mike Bewick identified concerns in his review of patient safety at the trust.

It comes after clinicians working within the haematology specialty raised multiple concerns over patient safety in 2021 and intervention from the General Medical Council over concerns around junior doctors.

John Atherton, chair of UHB’s clinical quality and safety committee, told the board a preliminary review into never events had identified that “maybe we weren’t addressing these [incidents] seriously enough”.

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Source: HSJ, 1 December 2023

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Health secretary told to intervene over ‘systemic’ ambulance deaths

Ministers must intervene over systemic failures which are “too big for hospital or ambulance trusts to fix on their own” and have led to multiple preventable deaths, a senior coroner has warned.

In a move usually considered rare for such an official, Cornwall and Isles of Scilly coroner Andrew Cox has written to the Department of Health and Social Care a second time over ongoing delays to ambulance responses and long ambulance handovers in the area.

Last year he warned the NHS was “broken” after he ruled ambulance and emergency care delays contributed to the deaths of four people. Now, he has sent a similar report on the same types of failings in the deaths of John Seagrove, Pauline Humphris, and Patricia Steggles at Royal Cornwall Hospital to new health secretary Victoria Atkins.

Mr Cox wrote: “I set out in my [prevention of future death report] last year my understanding of the reasons for the difficulties that are continuing in the Cornwall & Isles of Scilly coroner area. I do not believe those reasons will have changed significantly.

”The challenges are systemic in nature. They are too big for a single doctor, nurse or paramedic to fix. They are too big for either the hospital trust or the ambulance trust to fix on their own.”

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Source: HSJ, 1 December 2023

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Infected blood: Tory rebellion expected on payouts amendment

The government faces a rebellion with at least 30 Tories backing an amendment to extend interim payouts to more victims of the infected blood scandal.

Up to 30,000 people were given contaminated blood products in the 1970s and 80s. Thousands have died.

A Labour amendment will be brought on Monday calling for a new body to be set up to administer compensation. More than 100 MPs, including Tories Sir Robert Buckland, Sir Edward Leigh and David Davis, are backing the move.

In a letter sent to Chancellor Jeremy Hunt, shadow chancellor Rachel Reeves called the scandal "one of the most appalling tragedies in our country's recent history."

She added: "Blood infected with hepatitis C and HIV has stolen life, denied opportunities and harmed livelihoods."

She praised Theresa May, who set up the Infected Blood Inquiry when she was prime minister in 2017. But she warned: "For the victims, time matters. It is estimated that every four days someone affected by infected blood dies."

The chancellor, himself a former health secretary, told the inquiry in July that the government accepted the moral case for compensation. But he said no final decisions could be made before the inquiry publishes its findings - now expected in March next year.

In August 2022, the government agreed to make the first interim compensation payments of £100,000 each to about 4,000 surviving victims and bereaved widows.

But inquiry chairman Sir Brian Langstaff, said in April this year that the parents and children of victims should also receive compensation and also called for a full compensation scheme to be set up immediately.

The Commons Speaker will decide on Monday which amendments to the bill MPs will vote on. But the government has said it will not be supporting the amendment.

A Department of Health spokesperson said: "We are deeply sympathetic to the strength of feeling on this and understand the need for action. However, it would not be right to pre-empt the findings of the final report into infected blood."

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Source: BBC News, 3 December 2023

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UK minority ethnic transplant patients face double inequity, MPs say

NHS “inaction” for more than a decade is causing unnecessary deaths of black, Asian and minority ethnic transplant patients, a report by MPs has concluded.

An inquiry into organ donation in the UK found that minority ethnic and mixed heritage people faced a “double whammy of inequity”: they are more likely to need donors, because they are disproportionately affected by conditions such as sickle cell and kidney disease, and they are less likely to find the right blood, stem cell or organ match on donor registers.

Matching tissue type is vital to the chances of successful treatment, and compatible donors who are not relations are more likely to be found among donors from a similar ethnic background.

While there are more donors than in previous years, theall-party parliamentary group (APPG) for ethnicity transplantation and transfusion’s inquiry report says just 0.1% of blood donors, 0.5% of stem cell donors and less than 5% of organ donors are of minority ethnic or mixed background. As a result, white people are nearly twice as likely to find a stem cell donor and 20% more likely to find a kidney donor.

The inquiry found a “staggering lack of consistent and detailed ethnicity data” within healthcare systems, which “undermines accountability and jeopardises the lives of those awaiting life-saving treatments”.

Responding to the findings, Habib Naqvi, the chief executive of the NHS Race and Health Observatory, said such stark ethnic disparities in organ donor participation were of “grave concern” and required “more investment from health providers and targeted campaigns to raise awareness” to build trust in the healthcare system.

Jabeer Butt, the chief executive of the Race Equality Foundation, said the inequalities were unacceptable. “Every person, regardless of ethnic background, deserves an equal chance at receiving life-saving transplants and donations when needed. This is a solvable problem, but it requires a shared commitment to action across government, health organisations and communities. Lives depend on it,” he said.

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Source: The Guardian, 4 December 2023

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Hospital staff failed man living with HIV by unnecessarily delaying surgery

A hospital that unnecessarily delayed a man’s surgery at the last minute because he had HIV failed in their care, according to England’s Health Ombudsman.

The 48-year-old from Walsall, who does not want to be named, had been due to have prostate surgery at Walsall Manor Hospital on 10 March 2020.

His surgery was scheduled to be the first of the morning. As he was about to enter the operating room, he was told that due to his HIV status his surgery would now be moved to last on the operating list that afternoon.

The hospital claimed that this was due to the level of cleaning and infection control that would need to take place following his surgery to reduce the risk to others.

However, the Parliamentary and Health Service Ombudsman (PHSO), found that Walsall Healthcare NHS Trust acted inappropriately and failed the man.

This is because the universal precautions that apply to all patients having surgery are enough to protect and prevent infections from spreading among patients and staff. Therefore, no additional cleaning should have been necessary.  

The policy of placing a patient at the end of an operating list usually relates to patients with a high-risk bacterial infection. It should not be applied to a person who has HIV and is receiving treatment.

The Ombudsman also found that although the Trust had made some changes since this happened, they had not done enough to make sure the same mistake did not reoccur.

PHSO recommended the Trust apologise to the man and create an action plan to stop this happening again. The Trust has complied with these recommendations.

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Source: Parliamentary and Health Service Ombudsman, 1 December 2023

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Deadly infection risk in newborns could be higher than previously thought, study warns

Newborn babies could be at a higher risk of a deadly bacterial infection carried by their mothers than previously thought.

Group B Strep or GBS is a common bacteria found in the vagina and rectum which is usually harmless. However, it can be passed on from mothers to their newborn babies leading to complications such as meningitis and sepsis.

NHS England says that GBS rarely causes problems and 1 in 1,750 babies fall ill after contracting the infection.

However, researchers at the University of Cambridge have found that the likelihood of newborn babies falling ill could be far greater.

They claim one in 200 newborns are admitted to neonatal units with sepsis caused by GBS. Pregnant women are not routinely screened for GBS in the UK and only usually discover they are carriers if they have other complications or risk factors.

Jane Plumb, co-founded charity Group B Strep Support with her husband Robert after losing their middle child to the infection in 1996.

She said: “This important study highlights the extent of the devastating impact group B Strep has on newborn babies, and how important it is to measure accurately the number of these infections.

“Inadequate data collected on group B Strep is why we recently urged the Government to make group B Strep a notifiable disease, ensuring cases would have to be reported.

“Without understanding the true number of infections, we may not implement appropriate prevention strategies and are unable to measure their true effectiveness.”

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Source: The Independent, 29 November 2023

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Rush to reduce elective backlog increasing ‘never events’, report finds

Moving less complex procedures out of operating theatres and into other care settings to free up capacity to support elective recovery has ‘inadvertently’ increased the risk of ‘never events’ at an acute trust, a report has warned. 

The warning was made in a report into four never events at North Bristol Trust’s Southmead Hospital between November 2022 and January 2023 – two of which involved the same patient. 

The review was commissioned by Bristol, North Somerset and South Gloucestershire integrated care board to examine common issues in never events involving invasive procedures. It found an increase in never events when procedures were moved away from operating theatres to other care settings. 

The review found moving procedures from theatres to outpatient or day case facilities to “support the reduction in the [elective] backlog and improve the waiting times for patients… may also inadvertently increase the risk of never events”. 

It added: “It is likely that a theatre environment has more established and embedded safety control mechanisms. Governance processes in moving such procedures should consider the impact on quality, for example, the gaps between safety processes and consideration of the minimum requirements for the new procedure location.”

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Source: HSJ, 29 November 2023

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NHS England faces lawsuit over patient privacy fears linked to new data platform

The NHS has been accused of “breaking the law” by creating a massive data platform that will share information about patients.

Four organisations are bringing a lawsuit against NHS England claiming that there is no legal basis for its setting up of the Federated Data Platform (FDP). They plan to seek a judicial review of its decision.

NHS England sparked controversy last week when it handed the £330m contract to establish and operate the FDP for seven years from next spring to Palantir, the US spytech company.

The platform involves software that will allow health service trusts and also integrated care systems, or regional groupings of trusts, to share information much more easily in order to improve care.

Rosa Curling, director of Foxglove, a campaign group that monitors big tech and which is co-ordinating the lawsuit, said: “The government has gambled £330m on overhauling how NHS data is handled but bizarrely seems to have left off the bit where they make sure their system is lawful.

NHS England says the platform will help hospitals tackle the 7.8m-strong backlog of care they are facing and enable them to discharge sooner patients who are medically fit to leave.

But this may be the first in a series of legal actions prompted by fears that the FDP could lead to breaches of sensitive patient health information, and to data ultimately being sold.

“You can’t just massively expand access to confidential patient data without making sure you also follow the law.”

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Source: The Guardian, 30 November 2023

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HIV blood tests to be rolled out to more hospitals

Opt-out blood tests for HIV, Hepatitis B and Hepatitis C will be rolled out to a further 46 hospitals across England, the government has announced.

Health Secretary Victoria Atkins said the new £20m programme would lead to earlier diagnoses and treatment.

Under the scheme, anyone having a blood test in selected hospital A&E units has also been tested for HIV, Hepatitis B and Hepatitis C, unless they opted out.

The trials have been taking place for the last 18 months in 33 hospitals in London, Greater Manchester, Sussex and Blackpool, where prevalence is classed by the NHS as "very high".

Figures released by the NHS earlier show those pilots have identified more than 3,500 cases of the three bloodborne infections since April 2022, including more than 580 HIV cases.

Ms Atkins said: "The more people we can diagnose, the more chance we have of ending new transmissions of the virus and the stigma wrongly attached to it."

She added that rolling out the tests to more hospitals would help ensure early diagnoses so people "can be given the support and the medical treatment they need to live not just longer lives but also higher quality lives".

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Source: BBC News, 29 November 2023

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People with Covid discharged to care homes over fears for NHS, inquiry told

People with Covid-19 were discharged to care homes over fears about the NHS getting “clogged up”, the pandemic inquiry has heard.

Professor Dame Jenny Harries, England’s deputy chief medical officer during the pandemic and now head of the UK Health Security Agency, told the inquiry of how an email she sent in mid-March 2020 described the “bleak picture” and “top line awful prospect” of what needed to happen if hospitals overflowed.

Discharging people to care homes – where thousands of people died of Covid – has been one of the central controversies when it comes to how the Government handled the pandemic.

On Wednesday, the Covid inquiry was read an email exchange between Rosamond Roughton, an official at the Department of Health, and Dame Jenny on March 16 2020.

Ms Roughton asked what the approach should be around discharging symptomatic people to care homes, adding: “My working assumption was that we would have to allow discharge to happen, and have very strict infection control? Otherwise the NHS presumably gets clogged up with people who aren’t acutely ill.”

Ms Roughton added that this was a “big ethical issue” for care home providers who were “understandably very concerned” and who were “already getting questions from family members”.

In response, Dame Jenny emailed: “Whilst the prospect is perhaps what none of us would wish to plan for, I believe the reality will be that we will need to discharge Covid-19 positive patients into residential care settings for the reason you have noted.

“This will be entirely clinically appropriate because the NHS will triage those to retain in acute settings who can benefit from that sector’s care.

“The numbers of people with disease will rise sharply within a fairly short timeframe and I suspect make this fairly normal practice and more acceptable, but I do recognise that families and care homes will not welcome this in the initial phase.”

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Source: The Independent, 29 November 2023

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Patient saw eight GPs before cancer spotted

Patients are at risk of having serious health conditions missed because of the lack of continuity of care provided by GPs, the NHS safety watchdog says.

Investigators highlighted the case of Brian who was seen by eight different GPs before his cancer was spotted as an example of what can go wrong.

Brian had a history of breast cancer and had been discharged from the breast cancer service. Two years later he began to have back pain. 

Over the following eight months, he saw two out-of-hours GPs and six GPs based at his local practices as well as a physio and GP nurse, before he was sent for a hospital check-up in late 2020.

A secondary cancer had developed on Brian's spine, but it was too late to offer him curative treatment and he was given end-of-life care. He has since died.

The watchdog said the lack of continuity of care resulted in the diagnosis of Brian's cancer being missed.

One of the key problems was that the different GPs he saw missed the fact he was attending repeatedly for the same issue.

Senior investigator Neil Alexander said Brian's case was a "stark example" of what can happen when there is a breakdown in continuity of care.

"He told our team 'when I am gone, no-one else should have to go through what I did'."

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Source: BBC News, 30 November 2023

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Trust leaders raise alarm over ‘mad’ approach to scrutiny of maternity services

The management of fragile maternity services is being hamstrung by a lack of clear standards and direction from government and regulators, trust chairs and chief executives have told HSJ.

Kathy Thomson, the retiring chief executive of Liverpool Women’s Foundation Trust, told HSJ that a major overhaul of regulation and oversight of maternity care was needed.

She warned that trust leaders were confused about what was expected of their stewardship of maternity services. Much of the increased scrutiny of the sector was coming from people with little knowledge and experience of maternity care, and maternity was beset by too many initiatives which “somebody thinks are a nice thing to do”.

Ms Thomson’s comments were echoed by a wide range of other NHS leaders (see ’damaging confidence’ below). 

Ms Thomson told HSJ: “How clear are we nationally about the real ask of maternity services? Are we going to say it’s the ten NHS Resolution (NHSR) safety standards, which are really tough to achieve and which we agonise over? Or is it the CQC standards, because they will often take a different view around very similar issues?

“We’ve had that this year after we’ve been assessed as compliant by NHSR, but then had to re-provide evidence after we’ve been criticised by the CQC for something… and then NHSR have written back to say we’re still fully compliant.

“So, should you put your time and energy into the NHSR standards, or do you spend the time on the more subjective drivers? Because we can’t keep doing all of it and having different parts of the NHS saying this is what you need to do or expecting something different.”

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Source: HSJ, 30 November 2023

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Number in hospital with norovirus in England 179% higher than last year

The number of people with norovirus in hospital in England is 179% higher than the average at this time of year, official data shows, as the NHS comes under mounting winter pressure.

Admissions caused by the vomiting and diarrhoea-causing norovirus have surged and cases of other seasonal viruses are also rising, according to NHS England figures. Health chiefs said the impact on hospitals from seasonal viruses was likely to be worsened by the current cold weather.

“We all know somebody who has had some kind of nasty winter virus in the last few weeks,” said Sir Stephen Powis, NHS England’s medical director.

“Today’s data shows this is starting to trickle through to hospital admissions, with a much higher volume of norovirus cases compared to last year, and the continued impact of infections like flu and RSV in children on hospital capacity – all likely to be exacerbated by this week’s cold weather.”

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Source: The Guardian, 30 November 2023

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NHS budgets must double to ensure buildings are fit for care

According to analysis from the NHS Confederation, capital budgets within the NHS must double to ensure that the delivery of faster and more productive patient care can be supported.

Published yesterday, the Investing to Save: The Capital Requirement for a More Sustainable NHS in England report has outlined that a further £6.4 billion of capital funding must be committed through all three years of the next Spending Review so that the NHS’ maintenance backlog can be addressed. This will also help with the refurbishment of dilapidated buildings, the upgrading of equipment, and the increasing of staff productivity.

Chief Executive of the NHS Confederation, Matthew Taylor, said:

“Some of our members have parts of their estate that are barely fit for the 19th century, let alone the 21st, so any future Secretary of State for Health and Social Care must make the physical and digital condition of the NHS a priority if the health service is to reduce backlogs and get productivity levels to where the government want them to be.

“Lack of capital across different care settings, covering digital and physical infrastructure and mental and physical health, is clearly not just leading to missed opportunities to improve productivity, but actively undermining it and causing patient safety issues. Health leaders across England have endless ideas about how capital funding could drive large productivity increases.

“Equipping staff with the right tools, and allowing them to operate in safe, modern, optimised environments will improve efficiency, meaning that an increase to the capital budget will help limit the need for growth in revenue spend, relieve pressure on wider NHS finances and services, and put the NHS on the path to longer-term financial sustainability.

“This will require a significant increase to the NHS capital budget to make up for years of under-resourcing and repeated raids on capital that has left much of the estate broken. Based on the assessment of health leaders, this will need to be an increase of £6.4 billion to take the capital budget to £14.1 billion for each year of the next spending review in order to fully address the repairs backlog and realise some of the innovative transformation projects which have previously fallen by the wayside. The next government must grasp the nettle.”

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Source: National Health Executive, 29 November 2023

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Stiffer stroke target introduced – despite failure to meet old standard

The failure of trusts to offer stroke patients the level of rehab required by standards introduced 10 years ago has not prevented the publication of new guidance which demands even higher performance.

New guidance has been issued by the National Institute for Health and Care Excellence (NICE) which says recovering stroke patients should receive therapy for at least three hours a day, five days each week.

Performance against this standard is not yet measured, but figures analysed by HSJ show nearly all units treating stroke patients are falling well short of the previous NICE standard issued in 2013. This required a much less ambitious 45 minutes per day.

The figures suggest it is inconceivable the NHS will meet the new NICE rehab requirements in the near future. When they were launched, NICE said: “It shouldn’t be underestimated how important it is for people who have been left with disabilities following a stroke to be given the opportunity to benefit from the intensity and duration of rehabilitation therapies outlined in this updated guideline.”

But Chartered Society of Physiotherapy chief executive Karen Middleton said there was no funding for physios to work on rehab, despite increases in staff supply. “Funding that we know is already limited is being prioritised to other things rather than into rehab,” she said.

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Source: HSJ, 29 November 2023

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BMA stance on physician associates impacting patient confidence, warns Health Education England

Health Education England (HEE) and NHS England have warned BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence.

HEE published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs – which includes physician associates (PAs) working in general practice – until regulation is in place.

The BMA Council passed a motion calling for a halt to recruitment of MAPs two weeks ago, on the grounds of patient safety. This followed a previous motion to that effect from its GP committee for England earlier this month.

Proposing to bring forward a planned meeting with the BMA to discuss the matter, HEE’s letter said: "This continuing public discourse around MAPs is impacting relations between your members and their MAP colleagues, the health and wellbeing of MAPs already working in the NHS, and potentially the confidence of patients."

HEE chief workforce, training and education officer Dr Navina Evans and NHS England medical director Sir Stephen Powis argued in the letter that evidence shows "MAPs are safe", and that they "increase the breadth of skill, capacity and flexibility of teams" and reduce workload pressure on other clinicians.

‘Any issues of patient safety identified resulting from MAPs ‘must be addressed in the same way we would any other profession’, the letter added.

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Source: Pulse, 27 November 2023

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