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NHS cancer standards reform to speed up diagnosis for patients

Thousands of people referred for urgent cancer checks every month are set to be diagnosed and treated sooner, as the NHS reforms its cancer standards to reflect what matters most to patients and to align with modern clinical practice.

Developed by clinical experts and supported by leading cancer charities, there will be three cancer standards, which combine all of the previous standards and cover additional patients:

  • the 28-Day Faster Diagnosis Standard (FDS) which means patients with suspected cancer who are referred for urgent cancer checks from a GP, screening programme or other route should be diagnosed or have cancer ruled out within 28 days.
  • the 62-day referral to treatment standard which means patients who have been referred for suspected cancer from any source and go on to receive a diagnosis should start treatment within 62 days of their referral.
  • the 31-day decision to treat to treatment standard which means patients who have a cancer diagnosis, and who have had a decision made on their first or subsequent treatment, should then start that treatment within 31 days.

GPs will still refer people with suspected cancer in the same way, but the focus will rightly be on getting people diagnosed or cancer ruled out within 28 days, rather than simply getting a first appointment.

The three agreed standards will come into effect from October.

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Source: NHS England, 17 August 2023

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Staff ‘let down by leaders’ as ‘chaotic’ service gets double downgrade

A teaching trust has had its maternity services downgraded to ‘inadequate’ after inspectors found stillbirths and massive haemorrhages were not being treated as ‘serious incidents’.

Maternity services at St George’s University Hospitals Foundation Trust in south London were previously inspected in 2016, when they were assessed as “good”.

The Care Quality Commission (CQC) said serious incident declaration meetings at St George’s were regularly classing serious incidents as “adverse incidents”, meaning executives were not informed and there were missed opportunities for learning and development.

Inspectors also found incidents such as severe perineal tears, emergency hysterectomy, and birth injuries were rated as causing low or no harm when a higher level would have been appropriate, or and sometimes downgraded from a higher rating.

Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “We saw areas where significant and urgent improvements are needed to ensure safe care is provided to women, people using this service, and their babies.

“Both staff and people using the service were being let down by leaders who failed to respond quickly, resulting in care that was unsafe, and in the delivery suite, also chaotic.”

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Source: HSJ, 17 August 2023

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‘Warts and all’ references for NHS leaders ‘may be attacked’

NHS England could have gone further to insist that errors and failures by senior NHS leaders are disclosed to future employers, according to the leading barrister who reviewed the NHS’s fit and proper person test (FPPT).

Tom Kark KC’s review of the FPPT was delivered to government five years ago and made public the following year, and changes were finally proposed by NHSE earlier this month. 

In an interview with HSJ, Mr Kark said he broadly welcomed the plans, and that the revised framework should provide greater consistency across NHS boards “if applied correctly”; and could “strengthen the hand” of chairs and chief executives.

Part of the purpose of the regime is to prevent senior managers and other board members who make big errors in one role, from keeping this secret from a future employer.

Mr Kark told HSJ he had heard evidence that when “someone leaves under a cloud, they pop up somewhere else, and the information is lost.”

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Source: HSJ, 16 August 2023

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Government reports on 'overdue' major conditions strategy


The Government must provide the health service with more support to fulfil its ambition of extending healthy life expectancy and reducing premature death, an expert has warned.

It comes after the Department for Health and Social Care (DHSC) published an interim report on its Major Conditions Strategy, a 5-year blueprint to help manage six disease groups more effectively and tackle health inequality.

The groups are cancer, cardiovascular disease – including stroke and diabetes – musculoskeletal conditions, chronic respiratory diseases, mental health conditions and dementia. The Government said the illnesses "account for over 60% of ill health and early death in England", while patients with two or more conditions account for about 50% of hospital admissions, outpatient visits, and primary care consultations. By 2035, two-thirds of adults over 65 are expected to be living with two or more conditions, while 17% could have four or more.

Sally Gainsbury, Nuffield Trust senior policy analyst, said the Government is right to focus on the six conditions, but "will need to shift more of its focus towards primary prevention, early diagnosis, and symptom management". She added: "What's less clear is how Government will support health and care systems to do this in the context of severe pressures on staff and other resources, as well as a political culture that tends to place far more focus on what happens inside hospitals than what happens in community healthcare services, GP practices and pharmacies. This initiative is both long overdue and its emphasis has shifted over time. The Major Conditions Strategy is being developed in place of a White Paper on health inequalities originally promised over 18 months ago."

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Source: Medscape, 16 August 2023

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Addiction treatment eludes more than half of Americans in need

Roughly three in 10 adults have been addicted to opioids or have a family member who has been, and less than half of those with a substance use disorder have received treatment, according to a new survey conducted by KFF, a health policy research group.

The survey, which polled more than 1,300 adults in July, underscores the broad and often harmful influence of opioid addiction across the nation, which recorded around 110,000 fatal drug overdoses last year alone.

And the findings suggest that some proven medications for helping curb drug cravings, such as buprenorphine and methadone, are still not getting to those who need them. Only 25 percent of participants in the poll who said they or someone in their family had an opioid addiction reported receiving medication for themselves or family members.

Mollyann Brodie, the executive director of KFF’s polling program, said that the numbers might be an undercount, as some survey participants might have been hesitant to share histories of opioid addiction.

Addiction cuts across class, race and geography, the KFF researchers found. Rural and white Americans were the likeliest to report personal or family opioid addiction, but significant percentages of Black, Hispanic, urban and suburban families did, as well. White families were more likely than Black or Hispanic families to say that they had received treatment. Overdose fatality rates among Black Americans have climbed substantially in recent years, the Centers for Disease Control and Prevention found in a study last year.

Dr. David Fiellin, an addiction physician at the Yale School of Medicine, said the survey showed the need for a stronger federal response to substance use disorders, akin to the one for AIDS. He said, “There’s often a misunderstanding of what treatment actually looks like and what it is—people often look to a quick fix,” he said, referring to a detox strategy. “Effective treatment tends to be much more long term and requires addressing the denial that can be part of the condition.”

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Source: New York Times, 15 August 2023

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Study links lung conditions to young people who vape

Young people who vape are more at risk of bronchitis and shortness of breath, research has suggested, even if they also smoke cigarettes.

Researchers from the US tracked the respiratory health of young people in the Southern California Children’s Health Study between 2014 and 2018.

They conducted surveys which asked about people’s vape and cigarette use in the last 30 days. Researchers also included questions on bronchitic symptoms, such as a daily cough for three months in a row, as well as wheezing and shortness of breath.

The study found the odds of wheezing were 81 per cent more likely among past 30-day e-cigarette users than among “never users”. The odds of bronchitic symptoms were twice as likely, while those of shortness of breath were 78 per cent more likely after accounting for survey wave, age, sex, race and parental education.

The researchers said their findings contribute to “emerging evidence from human and toxicological studies that e-cigarettes cause respiratory symptoms that warrant consideration in regulation of e-cigarettes.”

Jon Foster, policy manager at Asthma + Lung UK, said it is “interesting” the study found a link between vaping and lung conditions in young people, but pointed out the regulation around the amount of nicotine and chemicals used in e-cigarettes is “much tighter” in the UK than the US. “More research would be needed to find out if the situation in the UK is the same,” he added. “However, given that we still know little about long-term effects, the growing popularity of vaping among children and young people is concerning.”

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Source: Independent, 16 August 2023

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Updated Covid vaccines are nearly ready as alarm grows over new variant’s rapid spread

Updated Covid vaccines are expected to become available in the US next month as alarm grows over a new variant dubbed Eris.

Healthcare providers are grappling with a rise in hospitalisations stemming from Covid infections. Eris or EG.5.1, a subvariant of Omicron that originally emerged in late 2021, now accounts for around 17per cent of current COVID cases, according to the CDC.

Symptoms of the new variant include a runny nose, headache, fatigue, sneezing and a sore throat. In the week of 30 July to 5 August, the latest period that data is available for, hospitalisations spiked by more than 14per cent, while deaths rose 10per cent compared to the previous week.

It comes as providers and pharmacies prepare to roll out an updated vaccine designed to combat Omicron — but experts are not very optimistic that the greater majority of Americans will opt to be vaccinated.

Fewer than 50 million people in the US got the shot last fall, compared to 250 million, or 73 per cent of the country’s population, when the vaccine was first made available in 2021, according to the agency.

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Source: Independent, 16 August 2023

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Heart attacks at record level after pandemic

Record numbers of people have been hospitalised with heart attacks in the wake of the pandemic, official figures show.

On Tuesday, health chiefs will launch a campaign urging those with symptoms to seek help, with fears that too many cases are being detected too late. The new figures for England show that more than 84,000 patients were admitted to hospital because of a heart attack in 2021/22 – a rise of more than 7,000 in a year. It follows warnings that heart deaths have risen by more than 500 a week since the first lockdown, with a fall in the numbers prescribed vital medication amid struggles to access GP care.

Health officials are afraid that people are still failing to come forward, adding to the collateral damage caused by the pandemic.

From this week, an NHS advert will encourage people to call 999 as soon as they experience symptoms of a heart attack, such as squeezing across the chest, sweating and a feeling of uneasiness, so people have the best chance of survival.

Prof Nick Linker, a cardiologist and NHS national clinical director for heart disease, said: “Cardiovascular disease causes one in four deaths across the country, so it is vital that people are aware of the early signs of a heart attack. Every moment that passes during a heart attack increases heart muscle damage, and nearly all of the damage takes place within the first few hours, so if you experience symptoms such as a sensation of squeezing or tightness across the chest alongside sweating, nausea, or a sense of unease, please call 999 so you have the best chance of a full recovery”.

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Source: The Telegraph, 15 August 2023

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Patients could get cancer scans without GP referral, says Steve Barclay

Patients with cancer symptoms could bypass their GP in the future and go straight for a scan, the health secretary has suggested, in the latest “radical” attempt by the government to cut huge NHS waiting lists.

The suggestion, which comes as the government is expected to reduce the number of NHS cancer waiting time targets, could form part of proposals to “design out bottlenecks” in the NHS system, Steve Barclay said in an interview.

Health department officials are reportedly working on proposals that would mean some patients experiencing cancer symptoms could go straight to an NHS diagnostic centre – or “one-stop shop” – without a GP referral.

“We are very much looking at those patient pathways,” Barclay told the Daily Telegraph. “Where there are bottlenecks in the system of referral from the GP, is there scope to go direct to the relevant diagnostic test or to the clinician? Breast cancer is a good example because almost always the GP refers on … and therefore there’s an opportunity to design out bottlenecks in the system.”

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Source: Guardian, 16 August 2023

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Women with poor mental health ‘have 50% higher risk of preterm birth’

Women who struggle with their mental health have an almost 50% higher risk of preterm births, according to the biggest study of its kind.

The research, published on Tuesday in the Lancet Psychiatry, examined data from more than 2m pregnancies in England and found about one in 10 women who had used mental health services had a preterm birth, compared with one in 15 who did not.

The study also found a clear link between the severity of previous mental health difficulties and adverse outcomes at birth. Women who had been admitted to psychiatric hospital were almost twice as likely to have a preterm birth compared with women who had no previous contact with mental health services. And women with history of mental health difficulties faced a higher risk of giving birth to a baby that was small for its gestational age (75 per 1,000 births compared with 56 per 1,000 births).

The study recommends that when pregnant women are first assessed by doctors and midwives they should be sensitively questioned in detail about their mental health. One of the reports authors, Louise Howard, professor emerita in women’s mental health at King’s College London, said such screening would help identify “clear red flags for a possible adverse outcome”.

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Source: Guardian, 14 August 2023

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Ministers name 30 trusts receiving share of £250m fund

Ministers have named the 30 trusts which will receive a share of a £250m fund to increase urgent and emergency care capacity.

The £250m pot is part of commitments made earlier this year in the NHS urgent and emergency care recovery plan, which pledged £1bn for 2023-24 to increase capacity (see full list of schemes in table below).

Trust leaders welcomed the funding but raised concerns about the announcement, stating that much of the extra capacity would not be in place until January and also raised questions about how extra beds would be staffed.

The funding will go towards creating 900 “new” hospital beds ahead of winter, which includes more than 60 intermediate care beds, improving assessment spaces and cubicles in accident and emergency departments, and developing or expanding urgent treatment centres and same day emergency care services.

NHS England expected the “majority” of these schemes will be completed by January, the announcement said.

This article contains a list of the schemes and how much funding each will receive.

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Source: HSJ, 15 August 2023

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Tennessee hospital faces civil rights investigation over release of transgender health records

Vanderbilt University Medical Center is facing a federal civil rights investigation after turning the medical records of transgender patients over to Tennessee’s attorney general, hospital officials have confirmed. The U.S. Department of Health and Human Services’ investigation comes just weeks after two patients sued VUMC for releasing their records to Attorney General Jonathan Skrmetti late last year.

“We have been contacted by and are working with the Office of Civil Rights,” spokesperson John Howser said in a statement late Thursday. “We have no further comment since this is an ongoing investigation.”

VUMC has come under fire for waiting months before telling patients in June that their medical information was shared late last year, acting only after the existence of the requests emerged as evidence in another court case. The news sparked alarm for many families living in the ruby red state where GOP lawmakers have sought to ban gender-affirming care for transgender youth and limit LGBTQ rights.

The patients suing over the release of their information say VUMC should have removed personally identifying information before turning over the records because the hospital was aware of Tennessee authorities’ hostile attitude toward the rights of transgender people. Many of the patients who had their private medical information shared with Skrmetti’s office are state workers, or their adult children or spouses; others are on TennCare, the state’s Medicaid plan. Some were not even patients at VUMC’s clinic that provides transgender care.

“The more we learn about the breadth of the deeply personal information that VUMC disclosed, the more horrified we are,” said attorney Tricia Herzfeld, who is representing the patients. “Our clients are encouraged that the federal government is looking into what happened here.”

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Source: NBC News, 10 August 2023

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Mysterious new long Covid symptom identified by scientists

A new symptom of long Covid has been revealed by scientists at the University of Leeds.

Though most people who contract Covid recover within a few days or weeks of experiencing initial symptoms, some people can experience longer, more persistent symptoms – termed Long Covid or post Covid-19 syndrome by the NHS.

Until now, the most commonly identified symptoms have included extreme tiredness, loss of smell, muscle aches and shortness of breath. Others include memory problems, chest pain, insomnia, heart palpitations, dizziness, joint pain, tinnitus and depression and anxiety. Now, a new study has revealed a previously unidentified symptom of long Covid.

Published in The Lancet medical journal, the research detailed a new symptom of the condition after a 33-year-old man was referred to the specialists’ clinic.

The patient had a six-month history of what the authors describe as a “rapid purple discolouration” on his legs. When standing, he remarked that they would feel progressively heavier and become “tingly, itchy and dusky” in colour. He added that a rash would occasionally appear on his feet, but that the mysterious symptoms would disappear when laying down. The disorder is known as acrocyanosis or persistent and extreme blue or cyanotic discolouration. It typically occurs in the hands and feet but can also appear across the nose and ears.

“This was a striking case of acrocyanosis in a patient who had not experienced it before his Covid-19 infection”, said co-author Dr Manoj Sivan, associate clinical professor and honorary consultant in rehabilitation medicine at the University of Leeds.

“Patients experiencing this may not be aware that it can be a symptom of Long Covid and dysautonomia, and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid. We need to ensure that there is more awareness of dysautonomia [malfunctioning of the nervous system] in Long Covid so that clinicians have the tools they need to manage patients appropriately.”

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Source: The Independent, 15 August 2023

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Mum fears NHS trust cover-up over Cambridgeshire suicides review

The mother of a woman who took her own life weeks after being discharged from a mental health ward fears a "culture of cover up" within the NHS trust.

Hannah Roberts, 22, died by suicide in 2018 and her mother Sally said there were "discrepancies" in the accounts of the talented musician's discharge. She feels an ongoing internal review into all Cambridgeshire & Peterborough NHS Foundation Trust (CPFT) suicides since 2017 should be independent.

CPFT did not respond to her comments.

The trust's chief executive Anna Hills previously said the internal review into 63 suicides would "be an important piece of work".

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Source: BBC News, 15 August 2023

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£250m funding for more hospital beds in England this winter

The government has announced £250m in funding to provide an extra 5,000 NHS hospital beds in England this winter. Ministers say 900 new beds should be ready by January, with the remainder to follow soon after, boosting capacity and helping lower record waiting lists.

The increase will mean nearly 100,000 permanent beds on wards and in A&E, available at the busiest time of the year - a 5% rise on current levels. NHS Providers said the extra capacity was needed "before winter begins".

Miriam Deakin, director of policy and strategy at NHS Providers, said trusts would welcome the support but cautioned any new beds would need to be staffed. She added that, since winter is the busiest time of the year for urgent and emergency care, trust leaders would be concerned that the promised extra capacity is only expected to be in place by January. "For the best results, trusts would need these new beds before winter begins," she said.

Pat Cullen, from the Royal College of Nursing, added: "The elephant in the room is who will staff these additional beds? Nursing staff are already spread too thinly over too many patients."

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Source: BBC News, 15 August 2023

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‘There won’t be enough people left’: Africa struggles to stop brain drain of doctors and nurses

The exodus of healthcare workers from Nigeria, Ghana and Zimbabwe continues, despite the WHO red list and a range of laws to keep them at home.

It took nearly three hours of queueing in Ikorodu general hospital in Lagos state, Nigeria, before Hadijat Hassan, a retired civil servant, could see a nurse. The 66-year-old has attended the clinic for health checks since being diagnosed with diabetes nearly 10 years ago. But since May, she says, the delays, often while suffering from excruciating pain in her legs, are worse than ever.

“You can get there [the hospital] and meet about 50 people waiting to be attended to,” Hassan says. “They said all of their nurses and doctors have been leaving for abroad. Just a few are left.”

In Nigeria, there is one doctor for every 5,000 patients, whereas the average in developed countries is one doctor for about every 254 people.

A hospital official said the Ikorodu management get resignation notices from nurses and doctors almost every month.

“Many leave for the US, Canada, UK and, most recently, Australia,” says the official, who asked to remain anonymous.

The National Association of Nigeria Nurses and Midwives has reported there is now a ratio of one nurse to 1,160 patients. Its president, Michael Nnachi, said that more than 75,000 nurses had left Nigeria since 2017.

“If you look at the conditions of service of health workers generally, you’ll see the difficult challenges complicated by the current economic realities,” he said, adding that rising inflation has compounded the problems.

The World Health Organization predicts a worldwide shortage of 10 million health and care workers by 2030 – mostly in low-income countries, where people are leaving for opportunities abroad.

This is despite the WHO’s introduction of a safeguard list to stop rich countries poaching from poorer countries with staff shortages.

The “red list”, launched in 2020 with plans to update it every three years, includes Nigeria, Ghana, Zimbabwe and 34 other African countries. Yet the UK’s nursing regulator, the Nursing and Midwifery Council, says more than 7,000 Nigerian nurses relocated to the UK between 2021 and 2022.

Data from the Ghana Registered Nurses and Midwives Association shows that nearly 4,000 nurses left the country in 2022. In Zimbabwe, more than 4,000 health workers, including 2,600 nurses, left in 2021 and 2022, the government said.

The WHO has no powers to prohibit recruitment of doctors from countries on the list, but recommends “government-to-government health worker migration agreements be informed by health labour market analysis and the adoption of measures to ensure adequate supply of health workers in the source countries”.

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New guidelines to help avoid injectable anaesthetic errors

Measures for avoiding medication errors with the injectable agents used routinely in anaesthesia care have been recommended in new guidelines from the Association of Anaesthetists.

The guidelines, published in Anaesthesia, the journal of the Association of Anaesthetists, were drawn up "in response to requests for guidance from members in view of continuing incidents of medication errors and patient harm."

The working party of UK anaesthesia experts that drew up the guidance emphasised the potential safety benefits of using prefilled and labelled syringes, as well as aids such as colour-coded medication trays. It highlighted that these were not yet in widespread use within the NHS.

The group noted that unlike many healthcare workers, anaesthetists usually undertook medication preparation (transfer from labelled ampoules into unlabelled syringes) in a solo capacity, and that there could be an average of 10 medication administrations per anaesthetic procedure. Labelling errors have been reported in around 1–1.25% of peri-operative administrations, and medication substitutions in 0.2% of administrations during anaesthesia.

The working party, chaired by Dr Mike Kinsella, honorary consultant in the Department of Anaesthesia at University Hospitals Bristol and Weston, said it aimed "to provide pragmatic safety steps" for use within operating theatres, as well as goals for the development of "a collaborative approach to reducing errors" as a basis for "instilling good practice."

"It is important to acknowledge that every practitioner is open to error," the authors said, noting that the risk could increase over time during a case, especially if an anaesthetist's performance was diminished by fatigue. 

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Source: Medscape, 10 August 2023

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Mapped: RTT waiting times

HSJ has published an interactive map of local NHS waits around England in June 2023, showing the pressures, with links to all the details by organisation and specialty.

It shows the local picture on 18-week referral to treatment taken from the latest Referral to Treatment (RTT) waiting times data released by NHS England.

View the map

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Source: HSJ, 14 August 2023

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Cervical cancer: Call for at-home smear tests in Wales

At-home smear tests should be introduced in Wales, campaigners say. Love Your Period campaigners said self-sampling at home would encourage more people to have the tests.

For women aged 25 to 64 a smear test is an effective way of detecting human papillomavirus (HPV) and preventing cervical cancer. According to Public Health Wales data, cervical cancer is the most common cancer in women under the age of 35, with regular screening helping to reduce the risk of getting cervical cancer by 70%.

The Welsh government said it followed advice from the UK National Screening Committee (UKNSC), which is yet to make a recommendation on self-sampling. However, it said Public Health Wales (PHW) was considering how the tests could be implemented in Wales. Currently, women in Wales are invited for a screening to check for the presence of high-risk HPV every five years.

Campaigner Jess Moultrie said tests should be made available to those who have experienced trauma and find the process of in-hospital smears triggering. "Being able to do it at home gives you that power, you can be a little bit more relaxed, it's not as intimidating."

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Source: BBC News, 14 August 2023

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Edinburgh firm develops blood test for early signs of Alzheimer’s

A Scottish research firm set up by a dementia expert who quit the NHS because of insufficient “infrastructure” has developed a blood test to allow doctors to identify Alzheimer’s disease earlier.

Scottish Brain Sciences, based in Edinburgh, announced it will collaborate with Roche Diagnostics on a series of projects, which the former’s founder, Craig Ritchie, said could have “big impacts”. Ritchie, who has led dozens of drug trials and pilots a European network on preventing Alzheimer’s, had been advocating the need to create new brain health centres across Scotland.

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Source: The Times, 14 August 2023

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Medics welcome NHS England clarification over delayed flu and Covid vaccine programme

Medics have welcomed clarification from health officials over when the upcoming flu and Covid-19 vaccination programme will begin.

NHS England had been criticised for pushing back the start date a month with pharmacists saying the change of plan would likely “catch patients off guard”. While school-aged children will be able to receive the flu shot from 1 September, adults were not expected to start getting flu and Covid jabs until October, a month later than recent years.

Officials briefed that the later start time was so sites can co-administer both vaccines wherever possible, to make it more convenient, and to ensure protection in later winter months – typically when viruses are more likely to spread. But NHS England was criticised for a lack of transparency and communication, as healthcare teams had been preparing to provide the service as usual from September.

NHS England said to maximise and extend protection during the winter and through the period of greatest risk in December and early January 2024, care home residents and care home staff must start receiving their jabs from 2 October, and other eligible flu and Covid cohorts from 7 October. However, in updated guidance officials said that as some firm commitments and appointments have already been made, any patient wishing to receive their vaccination in September will be allowed to do so. Most people are still likely to have their vaccines in October, officials believe.

Responding to news that NHS England will, if needed, now allow practices to deliver both vaccination programmes from September rather than October, Dr Katie Bramall-Stainer, chair of GPC England at the British Medical Association (BMA), said: “This news is very welcome, coming after the BMA made clear yesterday to NHS England that shifting the entire programme at the last minute to October would not only cause widespread confusion, but also serious disruption as flu clinics would have to be rearranged to fit the new timetable."

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Source: inews, 11 August 2023

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Many cancer waiting time targets set to be dropped in England

Two-thirds of NHS cancer waiting time targets are expected to be scrapped in England, in a move the health service says aims to catch cancers earlier.

NHS bosses want to reduce the number of targets, most of which have been routinely missed in recent years, from nine to three. They say the plan is backed by leading cancer experts and will simplify the "outdated" standards.

But some are concerned about the move. Pat Price, oncologist, visiting professor at Imperial College London and Head of the charity Radiology UK, said current performance was "shockingly bad", and while too many targets could be disruptive, "the clear and simple truth is that we are not investing enough in cancer treatment capacity".

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Source: BBC News, 14 August 2023

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What role might better data play in overcoming patient safety challenges? (With public poll on ID scanning)

Making data on medical interventions easier to collect and collate would increase the odds of spotting patterns of harm, according to the panel of a recent HSJ webinar

When Baroness Julia Cumberlege was asked to review the avoidable harm caused by two medicines and one medical device, she encountered no shortage of data.

“We found that the NHS is awash with data, but it’s very fractured,” says Baroness Cumberlege, who chaired the Independent Medicines and Medical Devices Safety Review and now co-chairs the All-Party Parliamentary Group which raises awareness of and support for its findings.

And it is that fracturing that can make patterns of harm difficult to spot. The report concluded that many women and children experienced avoidable harm through use of the hormone pregnancy test Primodos, the epilepsy drug sodium valproate, and the medical device pelvic mesh – simply because it hadn’t been possible to connect the dots.

“It’s very hard to collect things together and to get an overall picture. And one of the things that we felt very strongly about was that data should be collected once, but used often,” said Baroness Cumberlege at a recent HSJ webinar. Run in association with GS1 UK, the event brought together a panel to consider how better data might help address patient safety challenges such as problems with implants.

“But the big problem was they couldn’t identify who had which implants. No doubt somebody somewhere had written this down with a fountain pen and then someone spilt the tea over it and the unique information was lost,” recalled Sir Terence Stephenson , now Nuffield professor of child health at Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England.

The review he chaired therefore suggested establishing a concept of person, product place – “for everybody who had something implanted in them, we should have their name, the identifier of what had been put in, and where it had been put in. And one of my panel members said: ‘Well, how are we going to record this? We don’t want the fountain pen and the teacup.’”

Ultimately the answer suggested was barcode scanning. By scanning the wristband of a patient, that on the product being implanted, and one for the hospital theatre or department at which it was being implanted, the idea was to create an immediate and easy-to-create record.

For those long convinced of the virtues of barcode scanning in health, it is a welcome development

Two years later, the then Department of Health launched the Scan4Safety programme, in which six “demonstrator sites” implemented the use of scanning across the patient journey. At these organisations, barcodes produced to GS1 standards – meaning they are globally unique – are present on patient wristbands; on equipment used for care, including implantable medical devices; in locations; and sometimes on staff badges.

Link to full article here (paywalled)

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Potent synthetic opioids are linked to rise in heroin overdoses and deaths in England - new National Patient Safety Alert

A group of potent synthetic opioids called nitazenes have been linked to a rise in overdoses and deaths in people who use drugs, primarily heroin, in England over the past two months, drug regulators have warned.

The Office for Health Improvements and Disparities has issued a National Patient Safety Alert on potent synthetic opioids implicated in heroin overdoses and deaths.

In the past 8 weeks there has been an elevated number of overdoses (with some deaths) in people who use drugs, primarily heroin, in many parts of the country (reports are geographically widespread, with most regions affected but only a few cities or towns in each region).

Testing in some of these cases has found nitazenes, a group of potent synthetic opioids. Nitazenes have been identified previously in this country, but their use has been more common in the USA. Their potency and toxicity are uncertain but perhaps similar to, or more than fentanyl, which is about 100x morphine.

The National Patient Safety Alert provides further background and clinical information and actions for providers.

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'Tipping point' warning as strike-hit appointments near million mark

As junior doctors begin a four-day strike today with a two-day strike by consultants a fortnight later, Sir Julian Hartley, chief executive of NHS Providers, said:

"Trust leaders are very worried about six more days of severe disruption across the NHS this month.

"We could be close to a tipping point. Trusts and staff are pulling out all the stops to reduce waiting times for patients but with no end to strikes in sight the sheer volume of planned treatment being put back due to industrial action will make it almost impossible for trusts to cut waiting lists as much as the government wants.

"Waiting lists are now at a record high of 7.57 million, the pressure on urgent and emergency care services is relentless and an already stretched NHS is gearing up for another high-demand winter as pressure on tight budgets mounts.

"A string of strikes – which have led to more than 835,000 routine treatments and appointments being put back since December – is estimated to have cost the NHS around £1bn already including lost income and hiring expensive staff cover.

"The number of rescheduled appointments could be close to 1 million after this month's strikes and consultants have called another two-day strike in September. There will be a long-lasting effect on patients who have had treatment delayed and on already low staff morale.

"Concerns are mounting too over how patient safety will be maintained during August's strikes as many NHS services will be even more stretched as many staff are on much-needed summer holidays and cover is harder to secure.

"It's vital that the government and unions find a breakthrough urgently. Trust leaders understand the strength of feeling among striking staff and why they're taking action. Everyone in the NHS wants to concentrate on treating more patients more quickly rather than spend days making plans to cope with strikes.

"People can still rely on the NHS during strikes, calling 999 in an emergency. For less urgent cases people should use 111 online for help and advice."

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