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Use of private providers damaging NHS eye care, survey reveals

The independent sector should be commissioned to provide more NHS outpatient appointments, rather than just be focused on cutting cataract waiting lists, the president of the Royal College of Ophthalmologists has said.

A “workforce census” survey carried out by the college and shared with HSJ found almost 60% of respondents believed independent providers were having a “negative impact” on care and ophthalmology services in their area.

Speaking about its findings to HSJ, RCOphth president Bernie Chang said Covid had exacerbated problems caused by use of independent sector providers. These problems included cases being passed back to the NHS when IS care failed, and the NHS being left with a greater concentration of more serious, and costly, cases as the IS focussed on routine cataract operations.

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Source: HSJ, 3 April 2023

 

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‘Aggressive’ NHSE campaign insists trusts enable digital communications with patients

NHS England has launched a “very aggressive campaign” to ensure all acute trusts give patients the ability to make appointments and receive messages online. 

Details of the new “national requirement” which must be met by the end of 2023-24 were sent by NHS England to acute trust chief information officers on Friday.

NHSE wants all trust portals to integrate with the NHS App to enable patients to manage outpatient appointments and respond to messages through a single channel. 

Under NHSE’s requirements, the portals must:

  • Enable patients to view their outpatient appointments;
  • Enable the trust to send a waiting list validation questionnaire to patients;
  • Provide patients with a single point of access to contact the provider, for example to cancel appointments; and
  • Enable patients to access their correspondence from the trust.

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Source: HSJ, 31 March 2023

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NHS England warns against block cancellations during ‘unprecedented’ strikes

NHS England has told trust, system and regional leaders to avoid “block rescheduling” of elective cases during the four-day junior doctors’ strike next month.

In a letter sent by national medical director Sir Steve Powis and NHSE’s chief operating officer Sir David Sloman, NHS leaders are asked instead to use “rolling day-to-day cancellations” and reschedule cases “based on clinical risk”.

The letter also urges leaders to maintain “as much day case and outpatient capacity as possible” and to use digital or virtual consultations to support outpatient delivery. However, it acknowledges that because of the “unprecedented scale and timing of these strikes we accept that rescheduling activity is going to be essential to minimise risks to patients”.

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Source: HSJ, 31 March 2023

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Women's health: Body part names taboo a risk to health

Doctors are warning that embarrassment about naming parts of the female anatomy is putting women's health in jeopardy.

Dr Aziza Sesay said the hyper-sexualisation of women's bodies and anatomy "perpetuates the taboo, stigma and embarrassment".

She said it could lead to women not getting the medical help they need.

She said a lot of women's health conditions are often considered benign - meaning they're not life-threatening - but that she disliked the term as it minimised "how much it will affect someone's life".

Dr Sesay is one of a number of women's health specialists who are due to appear at Cardiff's Everywoman Festival on 24 June, where topics will range from periods to menopause.

The festival is the brainchild of colorectal surgeon, Julie Cornish, who works for Cardiff and Vale health board.

She said "embarrassing" symptoms are all too often never discussed.

"It's not uncommon to see patients who waited 10, 15 years with symptoms," she said. "It's got to the point where they've had to stop working, or their relationship has broken down.

"People retire early, they stop working or stop socialising. And that delay often means it's more severe. They might need surgery rather than simple physiotherapy, dietary tricks or modifications that could've worked so easily early on."

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Source: BBC News, 3 April 2023

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‘Free’ NHS makes people ‘lazy’ says pharmacy chief

The director of a leading pharmacy chain invited to advise the prime minister on healthcare reform has claimed the NHS makes people too “lazy” to take responsibility for their health.

Day Lewis director Sam Patel also said the fact the NHS was “free” meant there was little “jeopardy” discouraging people from becoming ill, and encouraged people to accept a lower level of care.

Mr Patel’s fellow Day Lewis director Jay Patel was one of the private healthcare leaders invited to Rishi Sunak’s Downing Street health summit this January. The company has more than 250 branches concentrated in London and the south of England.

Speaking at an event organised by strategy advisory firm Global Counsel last week, Mr Patel said: “Having an NHS fundamentally makes too many people lazy about taking care of their own health.

“Anything that’s free we just accept a lower level of care…. [We should be] making sure we’re taking good care of ourselves with vitamins, minerals, supplements, staying fit."

”... the jeopardy of feeling ill is not that bad because you get taken care of. In other countries, even in emerging markets like India where my parents originally come from, people spend vast amounts to make sure they don’t get ill because there is jeopardy in doing so. We need to change the population’s mindset to take care of themselves.”

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Source: HSJ, 3 April 2023

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'Dire' situation for adults waiting for ADHD diagnosis in NI

Adults in Northern Ireland seeking assessment for attention deficit hyperactivity disorder (ADHD) are being forced to go private because of a dire lack of referral services in some areas, a charity has said.

Some health trusts have not been able to accept new referrals for adult assessment and diagnosis.

ADHD charities said a lack of services or even waiting lists has forced many people to pay for a private diagnosis.

The charity's chief executive Sarah Salters added that some people who do get a private diagnosis cannot then get medication from their GP through the NHS.

The Department of Health said officials "are considering longer-term arrangements" for ADHD services, with future decisions "likely to be subject to ministerial approval and availability of funding".

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Source: BBC News, 2 April 2023

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Thousands of children in England facing ‘unacceptable’ NHS delays

Thousands of children experiencing “unacceptable” long waits for NHS treatment face a “lifelong” impact on their health, a senior doctor has warned, as shocking figures reveal that nearly 15,000 paediatric operations were cancelled over the last year.

Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, said the mounting treatment backlog in England risked “serious” and “devastating” physical and mental consequences for children and their families.

She sounded the alarm as data obtained under freedom of information laws by the Liberal Democrats showed that a record high 14,628 children’s operations were postponed in 2022, up from 11,870 the year before and the highest in five years of data examined. Some children have now waited several years for surgery, according to the data.

Delaying a child’s operation risks having a “lifelong impact” on their development, Kingdon said, and also “seriously impact” their mental health, with knock-on effects on their ability to socialise, go to school and reach their full potential.

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Source: The Guardian, 3 April 2023

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Trusts given five years to achieve safe midwife staffing

NHS trusts have been given until 2027-28 to employ enough midwives to meet safe staffing requirements, NHS England’s new maternity delivery plan has said.

The three-year delivery plan for maternity and neonatal services sets out to “make maternity and neonatal care safer, more personalised and more equitable for women, babies and families”.

It says: “Trusts will meet establishment [requirements] set by midwifery staffing tools and achieve fill rates by 2027-28, with new tools to guide safe staffing for other professions from 2023-24.”

The plan follows a series of high-profile maternity scandals in the NHS at Shrewsbury and Telford, East Kent, Morecambe Bay and an ongoing independent review by Donna Ockenden into Nottingham University Hospitals Trust. The Care Quality Commission has highlighted a string of other concerns across the NHS.

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Source: HSJ, 31 March 2023

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Watchdog investigates possible failures at mental health hospital after 24 alleged rapes

The care watchdog is investigating possible safeguarding failures at an NHS trust after a documentary uncovered figures showing there were 24 alleged rapes and 18 alleged sexual offences in just three years at one of its mental health hospitals.

The Care Quality Commission (CQC) told Disability News Service (DNS) that it had suspended the trust’s ratings for wards for people with learning difficulties and autistic people while it carried out checks.

The figures were secured by the team behind Locked Away: Our Autism Scandal, a film for Channel 4’s Dispatches, which revealed the poor and inappropriate treatment and abuse experienced by autistic people in mental health units.

None of the alleged rapes at Littlebrook Hospital in Dartford, Kent, led to a prosecution, with allegations of 12 rapes and 15 further sexual offences dropped because of “evidential difficulties” and investigations into 12 other alleged rapes and two sexual offences failing to identify a suspect.

A CQC spokesperson said: “Sexual offences are a matter for the police in the first instance.

“However, we take reports of sexual offences seriously and review them all, and raise these issues directly with the trust.

“We do this alongside involvement from police and local authority safeguarding teams’ own investigations and monitor any actions and outcomes taken by the trust to ensure people are kept safe."

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Source: 30 March 2023

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Covid testing scaled back further in England

Covid testing is being scaled back even further in England from April.

It is part of the "living with Covid" approach that relies on vaccines to keep people safe.

Most staff and patients in hospitals and care homes will no longer be given swab tests, even if they have symptoms.

Some will though, such as staff working with severely immunocompromised patients or if there is an outbreak on a ward or in a hospice or prison, for example.

The long-running Office for National Statistics Covid infection survey that estimated how many people in the community had the virus each week - based on nose and throat swabs from volunteers - has already come to an end.

The final one suggested 1.7 million people - about one out of every 35 (2.7%) - had Covid in the week ending 13 March, a14% rise on the previous week.

But the UK Health Security Agency says thanks to the continuing success of the vaccination programme, testing in England can now become more like the approach used for other common respiratory infections such as flu.

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Source: BBC News, 30 March 2023

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Cancer drug leaflets for patients in Europe omit important facts

Cancer drug information leaflets for patients in Europe frequently omit important facts, while some are “potentially misleading” when it comes to treatment benefits and related uncertainties, researchers have found.

Cancer is the biggest killer in Europe after heart conditions, with more than 3.7m new cases and 1.9m deaths every year, according to the World Health Organization.

Medicines are a vital weapon against the disease. But critical facts about them are often missing from official sources of information provided to patients, clinicians and the public, according to a study led by researchers from King’s College London, Harvard Medical School and the University of Sydney, among others.

“Regulated information sources for anticancer drugs in Europe fail to address the information needs of patients,” the study’s authors wrote in The BMJ journal. “If patients lack access to such information, clinical decisions may not align with their preferences and needs.”

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Source: The Guardian, 29 March 2023

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Bupa to cut 85 dental practices in staff shortage

Bupa is set to cut 85 dental practices amid a national shortage of dentists, in a move that will affect 1,200 staff across the UK.

The group said patients at some practices were unable to access the NHS dental service they need.

Bupa, which provides NHS and private care, said the 85 practices would be closed, sold or merged later this year.

The healthcare group's boss said the industry faced "systematic challenges" and the decision was a "last resort".

In August the BBC revealed 9 in 10 NHS dental practices across the UK were not accepting new adult patients for treatment under the health service.

Bupa has not been able to recruit enough dentists to deliver NHS care in many practices for months and in some cases years, it said.

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Source: BBC News, 30 March 2023

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NHS Highland reprimand for HIV patient email data breach

NHS Highland has been reprimanded for a data breach which revealed the personal email addresses of people invited to use HIV services.

The health board used CC (carbon copy) instead of BCC (blind carbon copy) to send an email to 37 people.

The Information Commissioner's Office (ICO) said the error amounted to a "serious breach of trust". It called for improvements to be made to data protection safeguards for HIV service providers.

The mistake meant all recipients of the email could see the personal addresses of the others receiving it.

One person said they recognised four other individuals, one of whom was a previous sexual partner.

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Source: BBC News, 30 March 2023

 

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Children must wait for ‘crisis’ before autism diagnosis, say overwhelmed systems

New restrictions are being introduced for autism assessments, with some areas now only accepting referrals for patients in crisis, HSJ has learned.

Commissioners in North Yorkshire and York have become the latest to introduce new criteria for autism and attention deficit hyperactivity disorder referrals.

Getting a diagnosis is key to unlocking care packages such as speech and language therapy, counselling, or special educational needs.

They said the changes are due to “unprecedented demand that has exceeded supply, resulting in unacceptable wait times and the need to prioritise resources towards children and most at-risk adults”.

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Source: HSJ, 30 March 2023

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Government reviews whistleblowing laws

A review of the whistleblowing framework – the laws that support workers who blow the whistle on wrongdoing in the workplace – has been launched by the Government.

The review will seek views and evidence from whistleblowers, key charities, employers and regulators.

Whistleblowing refers to when a worker makes a disclosure of information which they reasonably believe shows wrongdoing or someone covering up wrongdoing.  Workers who blow the whistle are entitled to protections, which were introduced through the Public Interest Disclosure Act 1998 (PIDA). Successive governments have taken steps to strengthen whistleblowing policy and practice.

It provides a route for employees to report unsafe working conditions and wrongdoing across all sectors.

This was keenly felt during the height of the Covid-19 Pandemic, when the Care Quality Commission and Health and Safety Executive recorded sharp increases in the number of whistleblowing disclosures they received.

The review will gather evidence on the effectiveness of the current regime in enabling workers to speak up about wrongdoing and protect those who do so. The evidence gathering stage of the review will conclude in Autumn 2023.

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Source: Gov.UK, 27 March 2023

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Slimming jabs could see rise in unsafe treatment for excess skin, surgeons warn

A rise in the use of slimming jabs could lead to an increase in unsafe treatment for tummy tucks and surgery to remove excess skin, UK surgeons have warned.

Drugs such as semaglutide and liraglutide are approved for use on the NHS for certain groups of people with obesity, and could help people reduce their weight by more than 10%.

Surgeons have warned that people using the jabs may not realise they could be left with excess skin.

“Whilst the newly introduced weight-loss drugs are not likely to produce comparable weight loss to bariatric surgery there is always the possibility that accompanying weight loss, a patient might be left with a degree of deflation and redundant skin,” said Marc Pacifico, the president of the British Association of Aesthetic Plastic Surgeons.

However, access to surgery on the NHS to remove excess skin is limited because the NHS do not fund post-weight loss plastic surgery any more, so it has to be undertaken in the private sector. That costs about £4,500 to £6,000 in the UK, so Mr Pacifico warned patients might seek cheaper procedures abroad..

“I would strongly warn against this as there might not be the safeguards and assurances that the drugs being used are of the same quality and provenance as those being prescribed in the UK,” he said.

He also warned that there are risks associated with having weight-loss plastic surgery abroad, such as the inability to undertake proper research on a surgeon, as well as the risks associated with flying straight after significant surgery – such as blood clots, as well as a lack of accessible follow-up with the surgeon and clinic to treat post-operative wound infections.

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Source: The Independent, 29 March 2023

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Whistleblowers ‘frustrated and disappointed’ by CQC, review finds

The Care Quality Commission’s follow-up of whistleblowing concerns from health and care staff has been poor and inconsistent, and there is a “widespread lack of competence and confidence” on dealing with race and racism at the organisation, two reviews have found.

A “Listening, learning, responding to concerns” review was published by the Care Quality Commission, alongside a linked independent review into how the regulator failed Shyam Kumar, a consultant orthopaedic surgeon in the North West, who was also a CQC specialist professional adviser.

The wider review looked at a range of issues including how the CQC deals with racism; how well it listens to whistleblowers in providers; and how it deals with its own staff, including as part of a recent restructure, and its internal “Freedom to Speak Up” process. It followed concerns bring raised, in addition to Mr Kumar’s case, about these issues.

Scott Durairaj, a CQC director who joined it last year and led the review work along with a panel of advisers, reported there was “clear evidence, during the scoping, design phase and throughout the review, of a widespread lack of competence and confidence within CQC in understanding, identifying and writing about race and racism”.

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Source: HSJ, 29 March 2023

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Trust leaders must admit ‘entrenched’ bullying culture or leave, says review author

The leaders of University Hospitals Birmingham (UHB) must acknowledge and seek to tackle the organisation’s pervasive bullying culture, and those who cannot may need to leave, the lead author of its patient safety review has warned.

In an interview with HSJ, Mike Bewick said humility is required to address major cultural issues identified through conversations he had with senior medics and former employees.

Professor Bewick’s overall view was that UHB was a “safe” place to receive care, but his team had been “disturbed” by consistent reporting of a bullying culture. Professor Bewick wrote in his report that even during his six-week review, initial goodwill from the trust had “dissipated”, adding his team has seen an organisation that is “culturally very reluctant to accept criticism”.

Speaking to HSJ, he acknowledged there were people within UHB who do not accept cultural problems, adding: “I would hope they see the right thing to do is to accept [they] didn’t get everything right, to do a bit of mea culpa, have some humility, and move on. Because I don’t think there’s necessarily a place for people who can’t move on.”

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Source: HSJ, 28 March 2023

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Febrile seizures: Health bodies called to take action to prevent child deaths

An inquest report into the death of a young boy who died at home in his sleep has called for health bodies to take action to prevent further deaths.

Louis Rogers' death was initially categorised as Sudden Unexplained Death in Childhood (SUDC) but the report recorded febrile seizures contributed.

The recommendations include:

  • A greater emphasis on medical education, research and public information for sudden unexpected deaths associated with febrile seizures
  • Referrals for assessment of febrile seizures should be undertaken earlier to exclude more severe underlying illnesses
  • The NHS website and pamphlet given to parents and guardians following a child's febrile seizure should be updated to help assist them in picking up potential early indicators of a more severe illness
  • "Robust national guidance" and education should be given to GPs so that timely referrals could be made
  • A checklist should be provided for health practitioners so that a child was not given a misdiagnosis of a febrile seizure
  • Records of all contact with health practitioners - including GPs and paramedics - should be available for all

The recommendations were made to six health authorities: Royal College of Paediatricians, Joint Royal Colleges Ambulance Liaison Committee, National Institute for Health and Care Excellence (NICE), Royal College of General Practice, Royal College of Emergency Medicine and NHS England.

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Source: BBC News, 29 March 2023

 

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Assisted dying inquiry hears people in UK face ‘unbearable suffering’

People dying in the UK face “uncontrollable” pain and “unbearable suffering”, which palliative care alone cannot fix, according to the first evidence to a major new parliamentary inquiry asking if assisted dying should finally be legalised.

In a shocking submission in favour of a law change, Molly Meacher told the Commons health and social care committee that the reality of end of life could include vomiting faeces, endless nausea and decaying tumours that smelled so bad they drove people out of hospital wards.

People “are existing, they’re not living”, the crossbench peer and chair of the charity Dignity in Dying told the committee inquiry, which comes eight years after the House of Commons last considered changing legislation in 2015.

Arguing strongly against any law change, Ilora Finlay, a crossbench peer and palliative care physician warned of the risk of “elder abuse” being worsened by a law change and said wider availability of palliative care, which remains patchy in the UK, must instead be a priority.

Charles Falconer, a Labour peer and former Lord Chancellor, described the current situation, where dying people sometimes withdraw their own treatment rather than taking drugs to end their life, as “a mess”. He proposed that assisted dying should be available only to terminally ill people and not those facing “unbearable suffering”, as others have suggested. A diagnosis would be needed from two doctors plus approval from high court judge.

“The bills that have been proposed [previously but defeated] say the person who decides to have an assisted death must have the capacity to make that decision,” he said.

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Source: The Guardian, 28 March 2023

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Mothers and babies being put at risk due to unsafe NHS maternity services, report says

Mothers and babies are being put at risk because maternity services are still providing unsafe care, despite a series of scandals that have cost lives, the NHS ombudsman has warned.

More tragedies will occur unless the health service takes decisive action to put an end to repeated and deeply ingrained problems which lead to “the same mistakes over and over again”, he said.

Rob Behrens, the NHS ombudsman for England, voiced his concerns when he launched a report on Tuesday which details the failings several women experienced while giving birth. It also sets out the lessons the NHS needs to learn, but Behrens claimed that too many trusts were not doing so.

Behrens voiced alarm that, although efforts have been made to improve the care mothers and their children receive, progress is too slow – and that means patients remain in danger.

His report says that: “We recognise that people working in maternity services want to provide high-quality care. Culture, systems and processes can get in the way of achieving that goal.

“But improvements are not happening quickly enough, and we have not seen sustainable change. We must do more to make services safer for everyone.”

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Source: The Guardian, 28 March 2023

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Bullying and toxic culture at one of England's largest NHS trusts

Repeated cases of bullying and a toxic environment at one of England's largest NHS trusts have been found in a review.

The Bewick report was ordered after a BBC Newsnight investigation heard from staff at University Hospitals Birmingham (UHB) saying a climate of fear had put patients at risk.

A first phase of the rapid review, headed by independent consultants IQ4U and led by Prof Mike Bewick, was published Tuesday.

It is one of three major reviews into the trust, commissioned following a series of reports by Newsnight and BBC West Midlands in which current and former staff raised concerns.

Summarising the findings, Prof Bewick, a former NHS England deputy medical director, said: "Our overall view is that the trust is a safe place to receive care.

"But any continuance of a culture that is corrosively affecting morale and in particular threatens long-term staff recruitment and retention will put at risk the care of patients across the organisation - particularly in the current nationwide NHS staffing crisis.

"Because these concerns cover such a wide range of issues, from management organisation through to leadership and confidence, we believe there is much more work to be done in the next phases of review to assist the trust on its journey to recovery."

The West Midlands trust said it fully accepted the report's recommendations.

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Source: BBC News, 28 March 2023

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Hospital at centre of rape and death inquiries to close after investigation by The Independent

A scandal-hit children’s mental health hospital will close months after an investigation by The Independent uncovered claims of poor care and systemic abuse.

Taplow Manor hospital, in Maidenhead, was threatened with closure by the NHS safety watchdog, the Care Quality Commission, only last week if it failed to make improvements following a damning report.

Active Care Group, which runs the hospital, confirmed it would close by the end of May, saying a decision by the NHS to stop admitting patients had rendered its “service untenable”.

The move comes after an investigation by The Independent and Sky News heard from more than 50 patients who alleged “systemic abuse” by the provider, while Taplow Manor is facing two police probes – one into a patient death and a second into the alleged rape of a child involving staff.

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Source: The Independent, 29 March 2023

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'Ticking time bomb' – here's how many NHS staff actually want to quit

More than three quarters of NHS workers are seriously considering leaving their jobs amid the ongoing strain on the health service.

According to research from the worker-led network Organise – which surveyed 2,546 NHS staff in March – 78.5% are thinking about packing it all in.

Only a fifth (21.5%) said they had no plan to give up their NHS job any time soon.

And the survey shows this sentiment is shared across a range of professions within the health service – with nurses, healthcare assistants, paramedics, doctors, health visitors and more all struggling with their jobs right now.

This comes after years of public concerns about the longevity of the health service, amid funding cuts, staff shortages and burnout – not to mention the additional strain from the Covid pandemic.

The findings also show that in the last three years:

  • 79% of respondents experienced stress
  • 62% reported anxiety
  • 55% reported burnout.

More than half (55%) of respondents said they needed to take time off from their jobs as a result, with a quarter saying this meant a month or more away from work.

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Source: Huffington Post, 29 March 2023

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Inside one hospice as struggling sector faces turning the dying away

Hospices will be forced to turn dying patients away because they are struggling with steeply rising costs at a time when the NHS is not increasing funding.

Hospices look after 300,000 patients and families every year across the UK. It costs about £1.5 billion a year for them to provide this care, with only a third of that coming from the NHS. The rest relies on charitable donations and fundraising in local communities as well as sales in charity shops.

As hospices battle to keep going, the Treasury has rejected pleas for a £30 million rescue package this year.

The money, those in the sector say, would prevent some from having to close inpatient units and beds or reduce their hospice-at-home teams, which care for patients in the community. Some are already making staff redundant and getting rid of beds.

Toby Porter, chief executive of Hospice UK, said the government was making “a huge avoidable mistake”, adding: “People will have a lesser experience at an incredibly important moment and it will lead to system pressures affecting the whole health system.”

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Source: The Times, 26 March 2023

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