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Maternity unit in Wales with 'significant patient safety concerns' improves but not by enough yet, say inspectors

Significant improvements have been made at the maternity unit at Swansea's Singleton Hospital but more are needed to ensure mothers consistently receive acceptable care, health inspectors have said.

Healthcare Inspectorate Wales (HIW) had strongly criticised Swansea Bay University Health Board following a visit to the unit last September. The regulator highlighted "significant patient safety concerns" and said the health board had failed to ensure safe staffing levels for four years. It added that fewer than half the staff surveyed said they would be happy if their own family members received the same care. In response, the health board developed an improvement plan and invested hundreds of thousands of pounds in new midwives and maternity care assistants.

HIW noted improvements to the leadership structure but said some positions were still on an interim basis. The health board, it said, must monitor and improve levels and the skills mix of staff throughout the maternity unit. However, it also said that at the time of the inspection staffing levels for midwifery and medical staff were appropriate.

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Source: Wales Online, 31 July 2024

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Over 1,000 more GPs to be recruited this year

The Department of Health and Social Care has announced that it will will recruit more than 1,000 newly qualified GPs thanks to action to remove red tape.

Currently, under a scheme known as the Additional Roles Reimbursement Scheme, primary care networks (PCNs) can claim reimbursement for the salaries (and some on costs) of 17 new roles within the multidisciplinary team – meaning more specialists are available to treat patients.

They are selected to meet the needs of the local population, but are currently prevented from using this to recruit additional GPs. The changes announced today means that newly qualified GPs  can quickly be recruited into the NHS through this scheme in 2024-2025.

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Source: Department of Health and Social Care, 1 August 2024

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Two new dementia risks identified by major report

Treating failing eyesight and high cholesterol are two new ways to lower the risk of dementia developing, a major report suggests.

Scientists have now identified 14 health issues which, if reduced or eliminated, could theoretically prevent nearly half of dementias in the world.

Middle-aged people and poorer countries have most to gain from targeting these risk factors, says the Lancet Commission's latest report on the topic.

It predicts that the number of people living with dementia could more than double to 153 million by 2050.

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Source: BBC News, 31 July 2024

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NHSE quizzing trust’s staff over serious culture and safety concerns

NHS England and commissioners are visiting a mental health trust’s services to ask its staff about concerns over safety, communication, and culture, HSJ has learned.

The unusual move for NHSE to speak directly to staff at Black Country Healthcare Foundation Trust, taking place today, comes during a long-running dispute between the provider and its medical consultant group.

NHSE’s Midlands team has been sent several letters in recent months, by anonymous groups of BCHFT staff, raising a range of serious issues.

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Source: HSJ, 31 July 2024

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CEO ‘exodus’ threatens NHS, ministers told

The NHS could face an “exodus” of chief executives within the next two years due to a retirement bulge and intense operational pressure, government pay advisers have warned.

The senior salaries review body’s latest report, published last night, said senior NHS leaders’ turnover was high, emphasising that one-third of executive directors had been appointed within the past 20 months (as of August last year).

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Source: HSJ, 30 July 2024

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Ditching of social care plan is a tragedy - Dilnot

Chancellor Rachel Reeves’s decision to scrap planned changes to the care system in England has been described as a "tragedy" by Sir Andrew Dilnot, the man who authored the proposals in 2011.

Speaking to the BBC's Today programme, Sir Andrew said: "We've failed another generation of families."

He said it was another example of social care "being given too little attention, being ignored, being tossed aside".

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Source: BBC News, 31 July 2024

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Slimming jabs: 'I thought my body was shutting down'

For those with severe weight issues, semaglutide – the active ingredient in slimming drugs – can be a life-changer. Celebrity success stories have massively increased demand, but brought with it a booming black market for illegal and often life-threatening products. BBC Investigations has discovered how easy these are to buy.

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Source: BBC News, 31 July 2024

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NHS payouts for medical negligence claims hit new annual high of £2.8bn

The NHS paid out record sums in damages and legal costs for alleged mistakes and negligence by medical professionals last year.

In 2023/24, the cost of settling clinical negligence claims increased to £2.8bn from £2.7bn the previous year.

Half the costs were associated with poor maternity care, an annual report from the health service’s legal authority revealed.

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Source: Independent, 29 July 2024

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How Labour can end the eye care crisis

Labour is rightly paying close attention to ophthalmology because challenges in the specialty — such as the long backlogs it faces and the potential to deliver more in primary and community care — align with its priorities for the NHS. The numbers are stark: more than 600,000 people are waiting for a first appointment with an ophthalmologist in England.

More worryingly, many more are waiting for follow-up appointments, and these people are often at greater risk of irreversible sight loss if they’re not treated promptly. In 2023, the think tank Reform found ophthalmology was the specialty with the most follow-up waits, at 10,000 per NHS trust.

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Source: HSJ, 30 July 2024

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Amber alert issued as NHS faces critical shortage of O type blood

A perfect storm of increased demand of O type blood from hospitals following the recent cyber attack which has impacted London hospitals and reduced collections due to high levels of unfilled appointments at donor centers in town and city centers, has caused stocks of blood to drop to unprecedentedly low levels.  

NHS Blood and Transplant has written to hospitals today to issue an “Amber Alert” asking them to restrict the use of O type blood to essential cases and use substitutions where clinically safe to do so. O negative and O positive donors are asked to urgently book and fill appointments at donor centers. 

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Source: Medical Life Sciences, 29 July 2024

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Stop discharging mentally ill, hospitals are ordered after killings

Hospitals have been ordered to carry out an urgent review of safety in NHS mental health services after a spate of deadly incidents.

NHS England wrote to trusts on Friday raising concerns that too many patients with severe conditions, who can pose a risk both to themselves and others, were struggling to access treatment.

Claire Murdoch, England’s mental health director, told services to stop discharging mentally unwell patients simply because they do not turn up to appointments.

Units have also been told to check for gaps in the care of people with severe mental illness, such as psychosis or paranoid schizophrenia.

According to the latest NHS guidance, issued alongside Murdoch’s letter, there have been repeated “service failures”. These include patients not getting consistent care, with staff chopping and changing, while in other cases workers have missed “red flags” such as criminal offending.

Families and carers have been ignored when they raised concerns, NHS England said.

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Source: The Times, 28 July 2024

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Junior doctors offered 22% rise in bid to settle dispute

The government has offered junior doctors a pay uplift worth around 20 per cent over two years to end their long-running industrial action.

The British Medical Association’s junior doctors committee is set to recommended the offer to members who will vote on whether to accept and end their dispute, several reports said.

HSJ understands the deal is worth a 22.3% cash terms pay increase over two years.

Reports said it included a backdated pay rise of 4.05% for 2023-24, on top of the existing deal of 8.8-10.3% depending on role or level. Then for 2024-25, the offer is for a 6% rise, and an additional one-off consolidated £1,000 payment—equating to a 7-9% rise.

If the deal is rejected by members, then industrial action could continue until at least September, when the junior doctors’ latest mandate is due to expire, days before the Labour party’s annual conference in Liverpool. The first strike was in March 2023.

The Government has not yet confirmed details of the offer, nor how it will be funded. NHS funding assumptions for 2024-25 only cover uplifts of 2%.

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Source: HSJ, 29 July 2024

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GPs capping patient numbers could have ‘catastrophic’ effect on A&E, says NHS chief

Industrial action by GPs could have a “catastrophic” impact on A&E units, the 111 telephone advice service and mental healthcare, a senior NHS leader has told the Guardian.

Family doctors who run GP surgeries across England are about to finish voting on whether to reduce the care they provide – including limiting the number of patients they see to 25 a day – in protest at the previous government increasing their budget by only 1.9% this year.

The ballot of GP partners being run by the British Medical Association (BMA) closes on Monday, with the result known soon afterwards. They are expected to vote in favour of taking industrial action – but not striking – that would start on Thursday.

The outcome of the ballot could pose another headache for Wes Streeting, the health secretary, who is holding talks with junior doctors aimed at resolving their long-running pay dispute during which they have gone on strike 11 times over the past 17 months in pursuit of a 35% rise.

In his first major policy announcement since replacing Victoria Atkins on 5 July, Streeting pledged to increase the share of the NHS budget that goes to general practice.

Referring to the prospect of industrial action by GPs, a source close to Streeting said: “This is just the latest example of the mess left by the Conservatives. We are determined to work with the profession to rebuild general practice, which is critical to making the NHS fit for the future. We will increase the proportion of resources going into primary care over time and help address the issues GPs face.”

There is huge concern across the NHS that GPs capping their patient contacts to 25 a day would cause significant disruption, with family doctors referring more patients than usual to already-overstretched hospitals as another tactic to force NHS England and ministers into a rethink. It could also extend waiting times for diagnostic tests and non-urgent hospital care, NHS chiefs fear.

“If all GPs implemented the patient cap, that could have a catastrophic effect on the entire healthcare system”, said Matthew Taylor, the chief executive of the NHS Confederation. “General practice is now supporting more patients than before the Covid pandemic, so any reduction in their activity will put more pressure on other services, including A&E.”

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Source: The Guardian, 28 July 2024

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NHS issues urgent plea after ‘perfect storm’ leaves blood supplies set to run out within hours

The NHS has issued an urgent plea for blood donors after warning national supplies are set to run out within hours.

Doctors urged people with O-type blood to donate, with national stocks of O-Negative projected to run out by Saturday. The health service said it has less than 5 days stock of all types of blood in what it described as an “unprecedented” shortage.

They called on people with the universal blood group O-negative, as well as O-positive donors, to urgently book into donor centres. 

Just 8 per cent of the population have type O-Negative but it makes up for around 16 per cent of hospital orders, according to NHS Blood and Transplant (NHSBT).

The health service said it was facing a “perfect storm” after a cyber attack impacted London hospitals in June.

Dr Gail Miflin NHSBT’s chief medical officer said: “Three blood donations are needed every minute in hospitals to deal with emergencies, childbirth and routine treatments. Blood only has a shelf life of 35 days so the NHS needs blood all year round. There are just under 800,000 regular blood donors, 108,000 of whom are O Negative. Ultimately, we need more people to be regular blood donors and come to one of our 25 donor centres.”

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Source: Independent, 27 July 2024

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Online portals deliver scary health news before doctors can weigh in

More Americans are learning of devastating health diagnoses through their phones and computers instead of personally from their doctors because of a federal requirement that people receive immediate access to medical test and scan results, from routine bloodwork to MRIs.

This shift has sparked a debate in the medical community about whether instant information empowers patients or harms them.

The new medical landscape resulting from a bipartisan law promoting transparency has exposed fault lines in a stressed health-care system where the promises of technological advancements are undercut by the heavy workloads foisted on medical professionals.

As more people receive troubling results online at the same time as their doctors—often waiting days or weeks for treatment plans—medical associations have been pushing to give doctors more time to release records revealing cancer and other grim diagnoses so patients don’t have to bear the news alone.

The idea of medical transparency undergirding provisions in the 2016 Cures Act is broadly supported. But implementation of the regulations expanding access to medical records, which took effect in 2021, has been more divisive.

Congress has taken little interest in this issue, and federal health officials have stood by the rules, arguing that concerns will be resolved as technology improves and as medical practices adjust how they prepare patients for results.

“There is just a moral imperative here, which is for patients, this is their information. They ought to be able to access it whenever they want,” said Micky Tripathi, the national coordinator for health information technology whose office crafted the requirement for the Department of Health and Human Services. “They also pay for it. They ought to be able to get things they pay for.”

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Source: Washington Post, 26 July 2024

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‘Huge emotional toll on managers’ from employment tribunal delays

Managers and staff are suffering a “huge emotional toll”—while trusts are facing extra costs—due to very long delays to hold employment tribunals.

A lack of judicial capacity following mass cancellations during covid means waiting times for a hearing are reaching as long as 18 months from initial claim, and more hearings are being cancelled at the last minute, meaning trusts are incurring significant financial costs, lawyers said.

Minutes from a Courts and Tribunals Judiciary meeting showed, as of this spring, some regions were listing three-five day employment tribunal hearings as far as two years away (early 2026), while others were being scheduled for the second half of 2025, despite recent signs of a falling caseload.

One senior employment law source, who did not want to be named, told HSJ both the staff making claims, and their organisations/managers, were being “hugely impacted” by the delays “because they are living in some of the worst moments of their lives”.

They said: “Equally, for those against whom claims are brought, some really serious allegations of discrimination, they’ve put a huge pressure on those people. They’re living with that hanging over them. That emotional toll is huge. We’ve had people who have retired and moved overseas. Who wants to come back from there for a tribunal claim relating to issues from six years ago? It has a really significant impact.”

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Source: HSJ, 29 July 2024

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Autumn date to fix blood transfusion services

Blood testing partnership Synnovis has warned that its hacked blood transfusion services may not be fully functioning again until the autumn.

Its systems fell victim to ransomware hackers and the pathology partnership says, external it has rebuilt many of the 60 which were affected.

The hackers made systems unusable unless a payment was received and caused significant disruption, with hundreds of operations and thousands of appointments cancelled.

Synnovis said the blood transfusion services would "continue to be stabilised over the summer".

The situation is also part of the reason the NHS made an urgent appeal for blood donors after warning stocks had dropped to "unprecedently low" levels.

Synnovis is a partnership between Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospitals NHS Trust and Synlab, a commercial testing firm.

It said more of its laboratories could now be reconnected to systems that enabled the service to receive test orders and return results electronically.

Core chemistry and haematology services have been restored at King’s College and Princess Royal University Hospitals, with Guy’s and St Thomas’, Royal Brompton and Harefield Hospitals to follow "in days". As a result it expected "to be able to increase the numbers and types of tests shortly".

Dr Chris Streather, medical director for NHS London, welcomed the news but said: “It will take further time for this to roll out, but we will soon start to see faster turnaround times for most routine blood tests." He said the delay in restoring blood transfusion services meant "that there will be a continued impact on planned operations and a need for hospitals to help each other by taking patients where needed".

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Source: BBC News, 26 July 2024

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Cancer treatment ‘biased against ethnic minorities’

A type of cancer treatment used in the NHS appears to be biased against non white European patients, research has found.

A review by the NHS Race and Health Observatory in partnership with Liverpool University – findings from which have been shared with HSJ –  looked into crucial genetic tests carried out before a type of drugs to treat cancer (fluoropyrimidines) is administered.

If a patient has certain gene variants, using the medicines can harm them, leading to severe side-effects that affect the bone marrow, bowel and skin, and in some cases can cause death. If the variants are present, other treatments have to be used.

However, the research by the RHO found that the NHS is testing for four variants, which are typically found in white Europeans. But the researchers found 53 additional relevant variants, which are not tested for, were present in patients from 12 countries and five ethnic groups – African American, East Asian, Latin American, Middle Eastern and South Asian.

Although their two-year research project is still ongoing, the RHO and Liverpool University team have decided to issue a call for an extension of this type of genetic testing (which seeks to identify a deficiency of the dihydropyrimidine dehydrogenase enzyme). A further recommendation for genetic testing for a variant found in those from African backgrounds is now under NHS review, which could be included in the National Genomic Test Directory, the RHO said.

RHO chief executive Professor Habib Naqvi said, “There is a duty to ensure every patient has access to the best available treatment when they are unwell."

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Source: HSJ, 26 July 2024

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Inga Rublite inquest: hospital missed two chances to treat woman dying in A&E

Staff at a hospital in Nottingham missed two opportunities to treat a woman found dying under a coat in a crowded emergency department, a coroner has concluded.

An inquest into the death of Inga Rublite, 39, found she died of natural causes but medical staff failed to recognise “persistent and escalating symptoms of brain haemorrhage” as she waited in A&E for more than eight hours.

Dr Elizabeth Didcock, an assistant coroner for Nottinghamshire, said Rublite should have been assessed by a senior doctor and sent for a head scan when she arrived at Queens medical centre (QMC) just after 10.30pm on 19 January this year.

When Rublite was next assessed by a nurse, at about 2am, and reported to be in severe pain, this should have been escalated to a doctor, she said.

“[Rublite] had persistent and escalating symptoms of brain haemorrhage that were not recognised,” said Didcock, adding that the department was “excessively busy” that night. “There were 76 patients waiting to be seen, and reduced medical staff generally across the department.”

Didock concluded Rublite suffered a second severe bleed on the brain shortly before she was found, which caused her death. “If she had been admitted for close monitoring, as she should have been, she would still have had [a] second rapid and devastating bleed.”

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Source: The Guardian, 25 July 2024

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Tourists heading to Greece warned of Covid variant as hospital rules return

Those going to Greece for their summer holidays have been warned of a spike in Covid cases related to the new FLiRT variant.

The increase has been reported by the Mediterranean country over the last 20 days.

In its latest report Greece’s National Public Health Organization, EODY, said it had seen an increase in hospital admissions, with 669 new Covid patients admitted from July 8 to 14, 2024. The report adds that this was a 44% increase in the average weekly number of new admissions over the previous four weeks. In total 26 Covid deaths were recorded.

Greece has recently struggled with heatwaves that has left many vulnerable people shielding from high temperatures inside. 

Last week the Metaxa Oncology Hospital in Piraeus, the port area of Athens, reintroduced masks and other protective measures within its wards. Visitors are limited to two per patient and there is a 48-hour rapid test requirement for those visiting.

The symptoms of the FLiRT and LB.1 variants are generally like those of earlier Covid-19 strains. Common symptoms include fever, cough, fatigue, loss of taste or smell, sore throat, muscle or body aches, shortness of breath, headache, and a runny nose.

Last week, the World Health Organization released a statement indicating Covid-19 is still responsible for around 1,700 deaths per week globally. WHO encouraged vulnerable populations to get vaccinated.

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Source: Independent, 25 July 2024

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NMC sets out next steps toward change

The Nursing and Midwifery Council (NMC) has set out the next steps towards change, having accepted all the recommendations of an independent review into its culture.

In the short-term , the NMC will take the following immediate actions, supported by external advice, to help it make the right decisions, address its cultural issues and follow through on change.

  • An external Empowered to Speak Up Guardian is now in place to support NMC staff to raise concerns and ensure they get independent support from a trained professional.
  • The NMC has invested in a partner to help improve psychological safety within the organisation, starting in Professional Regulation directorate.
  • It has started the process of appointing an equality, diversity and inclusion (EDI) advisor to its executive board, to support decision making.

It has also made some immediate commitments:

  • The NMC will co-opt one or more senior independent advisers to the Council to increase the challenge and support that the Council receives, to ensure the necessary cultural changes are delivered and to prevent a recurrence of the findings in the report.
  • It has committed to increasing the diversity of its executive board.
  • It will double the amount it spends on staff learning and development so that by October 2024, it can roll out improvements in leadership, line management, safeguarding, casework and tackling poor behaviours identified in the report.
  • It will develop a competency and behaviour framework, to launch in September, that will support recruitment, career progression and performance management.
  • It will offer extended decompression support to staff working on sensitive casework.

In the medium term, the NMC is reviewing its existing plans in light of the independent report’s recommendations. It is also working to enhance its approach to safeguarding, people and equality, diversity and inclusion (EDI). In the longer term, the organisation will focus on wider culture change, including the full implementation of Nazir Afzal and Rise Associates’ recommendations over a projected two-year period.

Helen Herniman, Acting Chief Executive and Registrar, said, “The independent report on our culture made difficult reading for everyone at the NMC and for many outside our organisation, including our stakeholders, the professionals on the register and members of the public who have engaged in our regulatory work. We are sincerely sorry to everyone we have let down. We are committed to delivering a change programme rooted in the report’s recommendations, and we are confident this will help us to make a step change in both culture and performance."

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Read The Nursing and Midwifery Council Independent Culture Review (9 July 2024)

Source: Nursing and Midwifery Council, 24 July 2024

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Health regulator not fit for purpose - Streeting

The body responsible for regulating NHS and care services in England is not fit for purpose, the health secretary has said.

Wes Streeting's intervention comes after an independent review found significant failings at the Care Quality Commission (CQC), according to headline findings released by the government.

The CQC inspects everything from hospitals and GP practices through to care homes and dental surgeries, covering 90,000 different services. Wes Streeting said he was “stunned” by the scale of the problems as he announced a set of emergency measures.

The CQC said it accepted the findings in full.

Among the failings identified were:

  • Inspectors lacking the necessary experience – including some being asked to inspect hospitals without ever having been into one before
  • Care home inspectors who had never met a person with dementia
  • A backlog of assessments with one in five services never having been given a rating – this is thought to include new care providers, GPs and private health clinics that have opened in the last five years
  • One NHS hospital having gone more than 10 years since its last inspection
  • A lack of consistency with assessments

The full interim report is due to be published on Friday.

Among the measures being taken is the appointment of Sir Mike Richards, a vastly experienced cancer doctor who has previously worked in government as national director of cancer care and spent four years as the chief inspector of hospitals from 2013, to work with senior leaders at the CQC and conduct a "rapid review" of the watchdog.

The regulator has just appointed an interim chief executive, Kate Terroni, who was deputy chief executive until last month when Ian Trenholm announced he was stepping down as head of the CQC.

Mr Streeting told BBC Breakfast he was also looking to appoint a new chief executive and chief inspector of hospitals who the government "can work with to turn the regulator around."

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Read the Independent review into the operational effectiveness of the Care Quality Commission: interim report

Source: BBC News, 26 July 2024

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Quarter of social care staff leave within three months, watchdog finds

A quarter of social care staff in Scotland leave their jobs within three months, while vacancies are at their height, a report has found.

The bodies responsible for delivering health and care services across the nation, known as Integration Joint Boards (IJBs), are grappling with a projected funding gap that is up by 187 per cent.

The Accounts Commission, a watchdog, has warned of “unprecedented pressures” on IJBs amid dwindling funds and surging demand for services.

IJBs play a crucial role in planning and commissioning essential community-based health and care services across Scotland. Their remit includes supporting disabled adults, social work with the elderly, GPs, pharmacists, mental health care and drug and alcohol services.

The report also underscored an “unsustainable” dependence on Scotland’s estimated 800,000 unpaid carers.

Colin Poolman, Scotland director of the Royal College of Nursing (RCN), said: “This damning report sets out the challenges facing community health and social care services. Too often, the focus is on the crisis in acute hospitals, but hospital overcrowding is a symptom of the lack of investment and prioritisation of community services. The whole system is at breaking point.”

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Source: The Times, 25 July 2024 (paywalled)

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Trust launches probe after cyber attack

One of the NHS’s least digitised teaching hospitals has been forced to carry out “a full forensic investigation” after a cyber attack last week, HSJ has learned.

Norfolk and Norwich University Hospitals Foundation Trust said the incident occurred last Wednesday. It was unrelated to the Microsoft outage, which disrupted some NHS IT systems, mostly in general practice, at the end of last week, the trust said.

A trust spokesman told HSJ: “No patient systems are compromised, and [at] this point in the investigation, we do not have any evidence of compromise of patient data. However, the investigation is ongoing and is extremely complex.”

NNUH chief digital information officer Ed Prosser-Snelling said the attack had been “detected and terminated [and] all emergency care, elective and outpatient services at our hospitals are continuing to run as normal.”

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Source: HSJ (paywalled), 24 July 2024

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Eight-year ADHD backlog at NHS clinics revealed

It would take more than eight years for the NHS to see all adult patients waiting for ADHD assessments in many parts of the UK, a BBC investigation has found.

Through Freedom of Information requests, the BBC has identified 24 services in that position, and nearly 200,000 people waiting.

The Royal College of Psychiatrists said no-one should be made to wait years for life-changing care. The new Labour government says delays to ADHD diagnosis are part of a “broken NHS” - which it is working to fix.

The long waits have been caused by rising demand - referrals have increased fourfold since 2019 - and three trusts have closed their waiting lists completely.

The BBC found one trust, Sheffield, has a waiting list of more than 6,000 people and assessed only three patients last year. Only two providers look able to work through their backlogs in less than a year. All four governments in the UK say they are working to improve matters.

There is no official list of adult ADHD service providers in the UK, but the BBC understands there are 70. Sixty-six responded to our request for information and 44 gave the BBC enough information to calculate their backlog.

“We’re seeing more people than ever seeking support from ADHD services which are struggling to meet this demand,” the Royal College of Psychiatrists told the BBC.

NHS England says it has “launched an independent expert taskforce which will investigate the challenges facing ADHD services and help them manage the rising numbers of referrals.”

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Source: BBC News, 25 July 2024

Further reading on the hub: Long waits for ADHD diagnosis and treatment are a patient safety issue

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