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System admits 10-year diagnostic waits

Adults across an integrated care system area are facing ‘unacceptable’ 10-year waits for an NHS assessment for attention deficit hyperactivity disorder, the longest known wait for such services in England.

Herefordshire and Worcestershire integrated care board has warned in board papers of “exceptionally high waiting times for ADHD assessment and treatment for Worcestershire patients (10 years+), with workforce challenges and service fragility compromising service delivery”.

HSJ understands the long waits for ADHD diagnosis, which is a national problem, is predominately affecting adults with approximately 2,000 people on Herefordshire and Worcestershire’s ADHD list alone.

Local provider Herefordshire and Worcestershire Health and Care Trust also warned on its website that its paediatric services were also “experiencing unprecedented demand”.

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Source: HSJ, 19 July 2023

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Adoption of AI in the NHS should be faster, experts say

The adoption of artificial intelligence (AI) by the NHS should be faster, and more frameworks should be in place to get emerging technologies to as many patients as possible, experts have told MPs.

A number of senior figures from medicine and biotechnology gave evidence to the Health and Social Care Committee as part of its inquiry into cancer technology.

Stephen Duffy, a professor of cancer screening at the Wolfson Institute of Population Health at Queen Mary University of London, told MPs there is “strong potential” for AI, particularly in areas such as reading mammograms for the breast screening programme.

However, he warned that there will be “staff issues in terms of the number of staff needed to double-read mammograms”.

He added: “Those issues aren’t going away. It seems to me that AI systems have already been shown to be very good in terms of detection of cancer on from mammograms, so they’re safe in that respect.

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Source: The Independent, 19 July 2023

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Service ‘collapses’ after department left with ‘no doctors’

A trust has been accused of presiding over the deterioration of a key service amid communication problems between senior leaders and a ‘worrying series of resignations’ which has left the department with ‘no doctors’.

The British Association of Dermatologists wrote to Worcestershire Acute Hospitals Trust on 13 July to request an urgent meeting with the provider’s management to discuss the matter.

The letter, seen by HSJ, outlines fundamental patient safety and staffing concerns about the trust’s dermatology service and accuses the trust of putting “continued communication barriers” between clinicians and management.

The letter, signed by BAD president Mabs Chowdhury, says there are now “no doctors in the department” after two consultants and a locum consultant resigned “due to apparent unhappiness with the running of services [and in] a continuation of a worrying series of resignations”.

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Source: HSJ, 19 July 2023

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Regulatory ‘burden’ has increased despite promises, say trust leaders

The majority of trust leaders have reported an increase in the ‘burden’ put on them by regulators, citing more demanding ‘ad hoc’ requests during heightened operational pressure.

In NHS Providers’ latest survey of NHS trust leaders’ experiences of regulation, a little over half of respondents – 52% – said the burden from NHS England and the Care Quality Commission had increased in the past year.

The percentage was higher among acute/community and community trusts, and all ambulance and specialist trust respondents said the burden had increased. 

An even higher overall share of trusts – 59% – said “ad hoc requests” from regulators had increased during the same time period. This includes requests for information or meetings at short notice, diverting staff from day-to-day operational duties.

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Source: HSJ, 20 July 2023

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Covid Inquiry: Bodies were treated like toxic waste, says daughter

The bodies of people who died with Covid were treated like "toxic waste" and families were left in shock, a bereaved woman has told the inquiry.

Anna-Louise Marsh-Rees said her father Ian died "gasping for breath" after catching the virus while in hospital.

Ms Marsh-Rees, who leads Covid-19 Bereaved Families for Justice Cymru, said he was "zipped away", and his belongings put in a Tesco carrier bag.

Ian Marsh-Rees died after catching the virus while in hospital, aged 85. His daughter said finding information regarding his care in hospital and how he became infected was "almost like an Agatha Christie mystery".

She said no GP ever suggested he might have Covid, although she now knows his discharge notes said he had been exposed to Covid.

"It wasn't until we saw his notes some months later that we saw the DNA CPR (do not attempt CPR) placed on him, and this was without consultation with us," she said.

"It kind of haunts us all that… people used to say 'well they're in the right place' when they go to hospital. I'm not sure they would say that any more," Ms Marsh-Rees said.

She now wants to change the way deaths are handled by health boards. She said it was important to prepare families before and support them after the death of a loved one, from palliative care to dignity in death.

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Source: BBC News, 18 July 2023

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Just one-fifth of staff speak up in trust’s internal inquiry

Just one in five staff who were approached in a trust’s internal inquiry – prompted by an undercover broadcast raising serious care concerns – engaged with the process, a report has revealed. 

Essex Partnership University Foundation Trust said it took “immediate action” to investigate issues highlighted in a Channel 4 Dispatches programme into two acute mental health wards last year. This included speaking to staff identified as a high priority in the investigation. 

However, a new Care Quality Commission report has revealed, of the 61 staff members the trust approached, only 12 engaged with the process. 

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Source: HSJ, 19 July 2023

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NHS is ‘tech averse healthcare system’, says ex-government adviser

A cut to the NHS tech budget, revealed by HSJ, has been described as “pretty outrageous” by a former government adviser and eminent medical leader.

Sir John Bell, an immunologist and geneticist and regius chair of medicine at Oxford University, made the comments in a talk at the Tony Blair Institute’s Future of Britain conference.

NHSE’s cut to its tech budget was attributed to having to divert the money to fund spending growth, and some other inflationary costs, without receiving extra from government. At the time, NHSE said the service “remains firmly committed to our digital strategy from supporting hospitals to adopt electronic patient record systems to transforming how patients access NHS services through the NHS App”.

But Sir John said: “The NHS is a technology averse healthcare system.”

He said NHS spending on medicines was “much lower than peers and if you look at our access to technology – like MRI and CR scanners – we’re right at the back. We just don’t do it.”

He added that rapid tech development and adoption was needed particularly to enable mass early diagnosis of diseases, and new treatment therapies.

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Source: HSJ, 18 July 2023

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Children waiting over a year in pain for NHS tooth removal

Children in some areas of England are waiting up to 18 months on average for dental general-anaesthetic treatment and teeth extractions, an investigation reveals.

Some have been left with prolonged dental pain, according to information shared with BBC News.

The parents of one girl who has waited three years for extractions say the pain keeps her up at night.

At the start of this year, more than 12,000 under-18s were on waiting lists for assessment or treatment at community dental service (CDS) providers, data obtained by the Liberal Democrats from the NHS Business Services Authority and shared with BBC News earlier this year reveals.

Children are referred to a CDS provider when they have tooth decay too severe to be treated in general practice.

They also treat those with physical or learning disabilities when general practice is not a practical option.

The longest average wait faced by children for general-anaesthetic treatment at a CDS provider is 80 weeks, at Harrogate and District NHS Foundation Trust.

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Source: BBC News, 19 July 2023

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Maternity unit refutes suggestion it breached safety standards

The trust at the centre of a maternity scandal insists it has been providing immediate anaesthetic cover for obstetric emergencies, contrary to an NHS England report suggesting it had not and had been potentially breaching safety standards.

Health Education England – now part of NHSE – visited William Harvey Hospital in March and was told senior doctors in training who were covering obstetrics could also be covering the cath lab – which deals with patients who have had a heart attack, and could receive trauma, paediatric emergency and cardiac arrest calls. This suggested the trust was in conflict with Royal College guidelines which state an anaesthetist should always be “immediately available” for obstetrics. 

East Kent Hospitals University Foundation Trust, which runs the hospital, originally told HSJ its rota had very recently been changed and that an anaesthetist with primary responsibility for maternity could leave any other work to attend to a maternity emergency immediately. However, it has since said it has been the case for a long time that an anaesthetist is available to return to maternity in case of an emergency. 

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Source: HSJ, 17 June 2023

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‘Culture battle’ over NHS England’s emergency recovery plans

Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements.

Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care.

The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention.

It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”.

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Source: HSJ, 18 July 2023

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Cough syrups could be made prescription-only over addiction fears

Concerns codeine-based cough syrup could be addictive and have serious health consequences have led the UK medicines safety regulator to consider stopping its sale over the counter.

The Medicines and Healthcare products Regulatory Agency (MHRA) is asking the public for their views on changing codeine linctus - which is a syrup with the active ingredient codeine phosphate and is used to treat a dry cough - to a prescription-only medicine.

This comes in the wake of multiple reports to the regulator that the medicine is instead being used recreationally for its opioid effects. Since 2018, the MHRA has received 116 reports of recreational drug abuse of, dependence on, and/or withdrawal from codeine medicines, including codeine linctus.

Dr Alison Cave, MHRA Chief Safety Officer, said this can have a severe impact on people’s health. She said: “Codeine linctus is an effective medicine, but as it is an opioid, its misuse and abuse can have major health consequences.”

Pharmacists are also “significantly” concerned, especially about the overdose risk.

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Source: The Independent, 18 July 2023

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‘Hips, knees and eyes’ funding focus ‘not fair’, says medical leader

Physical health and “hips, knees and eyes” still command the lion’s share of government money, despite persistent calls for fairer mental health funding, the Royal College of Psychiatrists’ departing president has told HSJ.

Adrian James also said future leaders must tackle bed and workforce shortages, while upcoming inquiries into poor care must allow people to speak openly without fear. 

NHS England CEO Amanda Pritchard has called the minimum investment standard for mental health “non-negotiable”. However, in an interview with HSJ, Dr James said mental health services are often missing out while “big chunks” of government money are allocated to reduce waiting lists. 

He said: “The [covid] recovery plan that was negotiated with the government really was about your hips, knees and eyes, in spite of big voices – one of them mine – saying, ‘what about the mental health backlog’. At that point, we didn’t get any extra money.”

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Source: HSJ, 18 July 2023

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NHS trust criticised over deaths of new mothers from herpes

A coroner has criticised an NHS trust over the deaths of two new mothers with herpes.

Kimberley Sampson, 29, and Samantha Mulcahy, 32, died in 2018 after having caesarean sections six weeks apart by the same surgeon at hospitals in Kent.

Their families have been waiting five years for answers on how they came to be infected with the virus, which can cause sores around the mouth or genitals.

Catherine Wood, Mid Kent and Medway coroner, said Sampson could have been given an anti-viral treatment sooner.

Wood added that in Mulcahy’s case “suspicion should have been raised” given the knowledge among staff from Sampson’s earlier death.

The coroner ruled out human culpability of any of the medical staff involved in the case and said it was “unlikely” for the surgeon to be the cause of the herpes infection found in both women.

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Source: The Guardian, 14 July 2023

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Girl, 14, could be left unable to walk after brain surgery cancelled three times

A14-year-old girl could lose the ability to walk after her brain surgery was cancelled three times as NHS children’s services are stretched to breaking point.

Piper Miller, who has severe autism, needs urgent surgery to remove fluid on her brain that if unaddressed could also leave her unable to control her bladder.

But her operation has been pushed back three times in the past month due to emergency operations taking priority and severe short staffing made worse by junior doctors’ strikes.

Her mum, Toni Milner said the delays had had a “heartbreaking and gut-wrenching” effect on her daughter whose anxiety is “sent through the roof” each time she is told she is not having her surgery.

Piper’s story comes as NHS data uncovered by The Independent reveals at least 340 life-saving children’s operations, such as transplant and lung surgery, were shelved from April to December 2022, while 763 emergency operations were refused due to a lack of intensive care beds.

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Source: The Independent, 16 July 2023

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‘He could have died’: family calls for better jaundice testing of black and Asian babies

Soon after her son Jaxson was born, Lauren Clarke spotted that his eyes were yellow and bloodshot. “We kept asking if he had jaundice, but each time we were told to keep feeding him and just put Jaxson in front of a window,” she says.

It was only when Clarke was readmitted six days later with an infection that Jaxson’s jaundice was detected by a midwife. By this time, his levels were becoming dangerously high.

“We spent a further five days in hospital for Jaxson to be treated with light therapy and antibiotics. If I hadn’t had to go back to hospital, he could have died or had serious long-term health conditions,” she says.

This week, the NHS race and health observatory will announce new funding for research into the efficacy of jaundice screening in black, Asian and minority ethnic newborns on the back of a recent report showing that tests to assess newborn babies’ health are not effective for non-white children.

The research cannot come too soon. Jaxson’s aunt, Gemma Poole, a midwife from Nottingham, created her company, the Essential Baby Company, to develop resources and training about the specific needs of women and babies with black and brown skins, after Jaxson’s jaundice was initially missed by clinicians.

Poole believes the trauma her nephew, brother and sister-in-law had to go through could have been avoided if health professionals had known better ways to spot jaundice in non-white babies.

“The colour of gums, the soles of the feet and hands, the whites of eyes, how many wet and dirty nappies and if the baby is waking for feeds and alert could be more reliable indicators if a black or brown baby has jaundice,” she says.

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Source: The Guardian, 16 July 2023

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Doctors call for return of face mask guidance

Doctors have warned the decision to remove face mask guidance in healthcare settings is "playing Russian roulette" with staff and patients' welfare.

It was withdrawn in May in hospitals, dentists and GP surgeries having been in place since June 2020.

Doctors from the British Medical Association (BMA) Scotland condemned the decision at the time.

Now, the Scottish Healthcare Workers Coalition has written to ministers to highlight the "very serious flaws" in changing the guidance.

The group is made up of Scottish healthcare workers who worked throughout the pandemic and are now living with long Covid or another chronic post-viral illness or disability.

In the letter, the coalition states the updated guidance is not based on the science of coronavirus transmission and "represents a flawed and dangerous decision which will result in more infection in health and social care settings".

Dr Shaun Peter Qureshi, of the Scottish Healthcare Workers Coalition, said: "At-risk patients have entirely legitimate concerns that they may endanger their health by visiting their GP or hospital.

"With at least 4% of NHS staff now living with chronic post-Covid complications, the Scottish government must follow the evidence and improve protections from the airborne spread (of the virus) in healthcare settings, not reduce them."

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Source: BBC News, 17 July 2023

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UK children waiting 16 months on average for ADHD and autism screening

Children with suspected ADHD and autism are waiting as long as seven years for treatment on the NHS, as the health service struggles to manage a surge in demand during a crisis in child mental health.

Experts said “inhumane” waits are putting a generation of neurodiverse children at risk of mental illness as they are “pushed to the back of a very long queue” for children and adolescent mental health services (Camhs).

UK children with suspected neurodevelopmental conditions faced an average waiting time of one year and four months for an initial screening in 2022, more than three times longer than the average wait for all Camhs services, according to research carried out by the House magazine and shared with the Guardian.

Half of all trusts responding to a freedom of information request had an average wait of at least a year, and at one-sixth of trusts it was more than two years. The NICE guidance for autism and mental health services stipulates that no one should wait longer than 13 weeks between being referred and first being seen.

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Source: The Guardian, 17 July 2023

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Government on track to break Boris Johnson’s ‘40 new hospitals’ promise

The government is on track to break a key election promise from Boris Johnson to build 40 new hospitals in England by the end of the decade, a damning report by the public spending watchdog has found.

Delays to projects mean the target is unlikely to be met, with work on buildings in the second cohort of the scheme yet to have started as of May, according to the National Audit Office.

The approach to achieving objectives at the lowest possible cost could also result in hospitals that are too small, the watchdog warned, as modelling assumptions may be unrealistic about the extent to which care in future will be provided outside hospitals.

The government failed to achieve good value for money, with the scheme having cost £1.1bn by March this year, and progress has been slower than expected, the report concluded.

The claim will ignite concerns that the new hospitals would struggle to cope in the event of another pandemic, given England already has one of the highest rates of hospital bed occupancy among countries in the Organisation for Economic Co-operation and Development.

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Source: The Guardian, 17 July 2023

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Maternity unit breached safety standards

A trust at the centre of a maternity scandal has been failing to meet Royal College standards in one of its maternity units, HSJ can reveal.

The duty anaesthetist for the maternity unit at the William Harvey Hospital in Ashford has also had to cover the hospital’s primary percutaneous coronary intervention suite. This could mean no anaesthetist is available to carry out an emergency Caesarean if they are needed to treat a heart attack patient. 

This goes against Royal College of Anaesthetists’ guidelines, which say a duty anaesthetist must be “immediately available for the obstetric unit 24/7”. The guidelines add that where the duty anaesthetist has other responsibilities – because, for example, they work at a smaller maternity unit where the workload does not justify them being there exclusively – then “these should be of a nature that would allow the activity to be immediately delayed or interrupted should obstetric work arise”. 

The William Harvey unit is East Kent Hospitals University Foundation Trust’s major birth centre. The trust has around 6,500 births a year – the majority at the WHH – and was heavily criticised for poor maternity care in a report by Bill Kirkup last year.

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Source: HSJ. 17 July 2023

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US regulators approve first over-the-counter contraceptive pill

The US Food and Drug Administration (FDA) has approved the first over-the-counter contraceptive pill, allowing millions of women and girls in the country to buy contraception without a prescription at a time when some states have sought to restrict access to birth control and abortion.

FDA officials said on Thursday it cleared Perrigo’s Opill – an every day, prescription-only hormonal contraception first approved in 1973 – to be sold over-the-counter. The pill will be available in stores and online in the first quarter of next year, and there will be no age restrictions on sales. The regulatory approval paves the way for people to purchase the pill without a prescription for the first time since oral contraceptives became widely available in the 1960s.

“Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” Patrizia Cavazzoni, the director of the FDA’s center for drug evaluation and research, said in a statement.

“When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.”

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Source: The Guardian, 13 July 2023

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‘Shocking’ A&E with ‘police everywhere you look’ must be solved, says director

A former national director has expressed her shock at visiting an accident and emergency department struggling with record numbers of mental health patients accompanied by police officers, and warned the issue needs an “absolute solution” from the area’s mental health trusts.

Kathy McLean, a non-executive director at Barking, Havering, and Redbridge University Hospitals Trust, and previously NHS Improvement’s medical director, told a board meeting last week there were “police officers everywhere you looked” at the accident and emergency at King George Hospital in Ilford, which had just experienced its third consecutive record month for mental health referrals.

While she recognised nearby mental health trusts North East London Foundation Trust and East London FT were “working hard”, she added: “This is not our problem, it is their problem that we’ve now got, and it’s not right for [patients], nor is it right for other people attending the emergency departments.

“I’ve been to more emergency departments than most people in the country and I was shocked, everywhere you looked there was a police officer… This now needs an absolute solution. If this was ambulances sitting outside our ED, people would be saying, you’ve got to sort it.”

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Source: HSJ, 14 July 2023

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Robots-led surgeries could boost efficiency and free up beds, say surgeons

Using robots to assist in operations could make surgery more efficient and free up NHS beds, a report has suggested.

The Royal College of Surgeons of England (RCS England) has published a guide: Robotic Assisted Surgery – a pathway to the future; exploring the potential benefits and challenges of the technology.

It said the document “provides a structured pathway” for surgeons who want to transition to robotic-assisted surgery, which allows doctors to operate with more precision using interactive, mechanical arms.

The report outlined “significant advantages” of using robots in surgery, including reduced post-op pain, fewer blood transfusions, more efficient use of anaesthetics and shorter hospital stays for patients.

There are also benefits when it comes to patient safety, the college said, with platforms eliminating tremors and providing a magnified image of the surgical site.

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Source: The Independent, 14 July 2023

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CQC inspection process may be ‘disproportionate’, finds Government review

The Care Quality Commission (CQC) inspection process may be ‘disproportionate’, a Government survey found, although the incredibly low response rate hampered conclusions.

All 51,000 providers registered with the CQC were given access to a survey as part of a post implementation review but only 86 responded and only 36 of those were NHS providers.

Most NHS responses to the survey came from organisations employing between 10 and 49 people, the review found.

The lack of engagement with the survey meant no conclusion could be reached about whether an alternative system would impose less regulation of the health and social care sector.

Criticisms among those who did respond included that the registration process is too inflexible, and the regulations too onerous and burdensome.

Some also felt the CQC regulations do not cover all health and social care activities where there is a possible risk to patient safety or service users.

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Source: Pulse, 13 July 2023

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Betsi Cadwaladr: More patient deaths may be linked to treatment

More families have been told by a health board that their relatives' deaths may have been linked to treatment by vascular services.

Betsi Cadwaladr University Health Board (BCUHB) has written to families who were part of a review after concerns were raised last year.

Four cases had already been reported to a coroner and the health board says it has been "very open" with relatives of other patients.

The service has recently been described by inspectors as making "satisfactory progress", but the health board admit it is still on a "long journey".

A report by the Royal College of Surgeons England (RCSE) in January 2022 found risks to patient safety due, in part, to poor record keeping.

It recommended to the health board that it investigate fully what happened to the 47 patients its report focused on.

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Source: BBC News, 13 July 2023

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New panel will oversee NHS competition regime, DHSC decides

The government will set up an independent panel to oversee disputes arising from decisions made under a new provider selection regime, it said today.

The new panel should “help ensure that… procurement processes are transparent, fair and propionate, enabling all providers to compete for contracts” and “are not unfairly excluded from offering services to patients and service users”, the Department of Health and Social Care said in a response to its consultation on the new rules governing the commissioning of healthcare services.

The intent is to move the NHS away from always putting new contracts out to competitive tender and “towards collaboration across the health and care system”, the document says. 

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Source: HSJ, 14 July 2023

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