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Child referrals for mental health care in England up 39% in a year

The number of children in England needing treatment for serious mental health problems has risen by 39% in a year, official data shows.

Experts say the pandemic, social inequality, austerity and online harm are all fuelling a crisis in which NHS mental health treatment referrals for under-18s have increased to more than 1.1m in 2021-22.

In 2020-21 – the first year of the pandemic – the figure was 839,570, while in 2019-20 there were 850,741 referrals, according to analysis of official figures by the PA Media.

The figures include children who are suicidal, self-harming, suffering serious depression or anxiety, and those with eating disorders.

Dr Elaine Lockhart, chair of the child and adolescent psychiatry faculty at the Royal College of Psychiatrists, said the rise in referrals reflected a “whole range” of illnesses.

She said “specialist services are needing to respond to the most urgent and the most unwell”, including young people suffering from psychosis, suicidal thoughts and severe anxiety disorder.

Lockhart said targets for seeing children urgently with eating disorders were sliding “completely” and that more staff were needed.

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Source: The Guardian, 3 January 2023

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Two in three UK doctors suffer ‘moral distress’ due to overstretched NHS, study finds

Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found.

Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill.

A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS.

Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said.

“There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association.

The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added.

“In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said.

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Source: The Guardian, 28 December 2023

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Overheating and flooding at hospitals in England ‘pose threat to patient safety’

Record levels of overheating and a sharp rise in flooding at England’s hospitals are putting vulnerable patients at risk, figures show.

Analysis of NHS data by the Liberal Democrats found that the number of health trusts reporting overheating in clinical areas had doubled compared with six years ago, and floods had increased by nearly 60% from last year.

An overheating incident is logged when an occupied ward or clinical area’s daily maximum temperature exceeds 26C, the temperature at which some patients become unable to cool themselves effectively.

The latest government figures show that in the summer of 2022 there were an estimated 2,985 excess deaths due to heatwaves, the highest number on record. Heatwaves also forced a fifth of UK hospitals to cancel operations.

The number of serious flooding incidents, where water caused disruption such as by breaching a building or flooding a road, rose from 176 to 279.

The climate crisis is expected to increase these risks to hospitals and patients. Helen Buckingham, the director of strategy at the Nuffield Trust, said: “These figures are a cause for real concern about the resilience of the NHS’s estate to the growing threat from extreme weather in the UK. As temperatures have climbed, so too have the number of overheating incidents in NHS hospitals.”

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Source: The Guardian, 27 November 2023

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Government should 'declare national NHS major incident' as service under same strain as first wave of Covid

The government should declare a national NHS major incident to rescue the healthcare system from the current crisis, a senior health official says.

Dr Tim Cooksley, president of the Society for Acute Medicine (SAM), says that the pressures on the NHS seen over the festive period are not new. He added that a number of recommendations had been outlined since the pandemic that offer the “best hope” of a short-term solution.

Declaring a national NHS major incident would mean all four UK nations would co-ordinate their response and allocate resources to help meet the overwhelming demand for care that is enveloping many hospitals around the country. Taking that step would help combat the current situation, Dr Cooksley says, which NHS chiefs believe is having a similar effect on the service to the first wave of the Covid-19 pandemic.

“The current situation in urgent and emergency care is shocking. It is in a critical state for patients and it is an extremely difficult for healthcare staff who are unable to deliver the care they want to," Dr Cooksley said. “Political leaders across the UK need to listen, meet urgently and accept the need to declare a national NHS major incident.

"The outcome must be a four-nation emergency strategy which results in short-term stabilisation, medium-term improvement and long-term growth – the grave situation we are in means it will be a long journey. Sustainable workforce and capacity plans are required urgently to boost morale among staff and patients – as we have long called for – and we now need to see action.”

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Source: Manchester Evening News, 1 January 2022

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Up to 500 people dying each week from emergency care delays, doctor says

Up to 500 people are dying every week because of delays in emergency care, Britain’s top accident and emergency doctor has said.

Dr Adrian Boyle, the president of the Royal College of Emergency Medicine (RCEM), said a bad flu season was compounding systemic problems, leading to hundreds of unnecessary deaths.

NHS leaders warned last week that the health service is in the grip of a “twindemic”, with soaring flu admissions and the impact of Covid “hitting staff hard”.

Dr Boyle told Times Radio: “If you look at the graphs they all are going the wrong way, and I think there needs to be a real reset. We need to be in a situation where we cannot just shrug our shoulders and say this winter was terrible, let’s do nothing until next winter.

“We need to increase our capacity within our hospitals, we need to make sure that there are alternative ways so that people aren’t all just funnelled into the ambulance service and emergency department. We cannot continue like this – it is unsafe and it is undignified.”

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Source: The Telegraph, 1 January 2023

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Dementia patients in England facing ‘national crisis’ in care safety

Families of people with dementia have said there is a national crisis in care safety as it emerged that more than half of residential homes reported on by inspectors this year were rated “inadequate” or requiring improvement – up from less than a third pre-pandemic.

Serious and often shocking failings uncovered in previously “good” homes in recent months include people left in bed “for months”, pain medicine not being administered, violence between residents and malnutrition – including one person who didn’t eat for a month.

In homes in England where standards have slumped from “good” to “inadequate”, residents’ dressings went unchanged for 20 days, there were “revolting” filthy carpets, “unexplained and unwitnessed wounds” and equipment was ”encrusted with dirt”, inspectors’ reports showed.

Nearly one in 10 care homes in England that offer dementia support reported on by Care Quality Commission inspectors in 2022 were given the very worst rating – more than three times the ratio in 2019, according to Guardian analysis.

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Source: 29 December 2022

 

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Surgery sends cancer text instead of festive message

A GP surgery accidentally told patients they had aggressive lung cancer instead of wishing them a merry Christmas.

Askern Medical Practice sent the text message to people registered with the surgery in Doncaster on 23 December.

Sarah Hargreaves, who was waiting for medical test results, said she "broke down" when she received the text, only to be later told it was sent in error.

The first text told recipients they had "aggressive lung cancer with metastases", a type of secondary malignant growth.

It directed patients to fill out a DS1500 form, which allows people with terminal diseases to claim certain benefits.

However, about an hour later people received a second text telling them it was an error and it was meant to wish them a merry Christmas instead.

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Source: BBC News, 29 December 2022

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AI cure for bed blocking can predict hospital stay

Technology that accurately predicts when patients will be ready to leave hospital upon their arrival in A&E is being introduced to solve the NHS bed-blocking crisis.

The artificial intelligence (AI) software analyses data including age, medical conditions and previous hospital stays to estimate how long a patient will need to remain.

Hospital managers can then alert social care services in advance about the date when patients are expected to be discharged, allowing care home beds or community care packages to be prepared.

Nurses said the technology had “revolutionised” their ability to discharge patients on time, meaning people who would otherwise have been stuck in hospital had got home for Christmas.

The new technology, developed by the British AI company Faculty, is being tested at four NHS hospitals in Wales belonging to the Hywel Dda health board. Analysis suggests that the tool will save NHS trusts 3,000 bed days and £1.4 million a year by speeding up discharges, which in turn frees beds for elective procedures such as hip replacements.

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Source: The Times, 26 December 2022

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Dementia village in Warwick is a pioneer in person-centred care

Woodside Care Village in Warwick is staged like a town centre in miniature, with benches and a fountain, cafe tables and front doors to homes styled as either “town”, “country” or “classical”. But none of the places are quite what they seem, because here everything has a greater purpose: to improve the wellbeing of people with dementia.

Modelled on a groundbreaking Dutch experiment in looking after people with Alzheimer’s disease, the purpose-built facility, which opened in 2019, is quietly breaking new ground for a better kind of dementia care.

“Everything is dressed and staged to look familiar,” said Jo Cheshire, the communications manager for the home’s operator, WCS. “We try to make sure people aren’t severing their links with the past. We have one lady who works in the launderette with a badge, because that’s what she did before. It feels like they are contributing to the community.”

“The idea is you have freedom,” said Cheshire. “If you come upon a locked door it can increase agitation, that’s unsettling for the other residents and it makes the carer’s job harder.”

Staff ratios are higher than normal, at two staff for every five or six people rather than the usual one. This means staff can spend more time interacting with the residents.

Staff are briefed with a “this is me” document, which details the likes and dislikes of each person with dementia and has photos through their lives, the time they like to get up, when they like to eat. 

A clinical trial of such “person-centred” dementia care in 69 care homes in London and Buckinghamshire published in 2020 showed that it improved quality of life for people with dementia and reduced agitation and the burden of depression or aggression. It also reduced hospital and GP visits.

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Source: The Guardian, 30 December 2022

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Some ICSs need ‘an awful lot of central control', says Hewitt

Some integrated care systems (ICSs) still require “an awful lot of control” from the centre, Patricia Hewitt has told HSJ, tempering any expectations that her government-commissioned review will bring about a wholesale roll-back of national performance management.

The former Labour health secretary, who is also an integrated care board chair, was commissioned in November by chancellor Jeremy Hunt and health secretary Steve Barclay to review ICS autonomy and accountability.

In her first interview since she started the work, Ms Hewitt also said: 

  • She had not ruled out “legislative tweaks” as a result of her review, but emphasised ICBs already had substantial ”soft power”;
  • Some ICBs were still indulging in ‘old school’ combative behaviour, and stressed they should not become ‘top down regulators’;
  • She wanted to “catalyse” the Care Quality Commission’s move to focus on systems and integration; and
  • It appeared there were probably too many non-clinical support staff in the NHS, but not too many managers, and she would look more closely at the issue.

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Source: HSJ, 30 December 2022

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Midlands hospital investigating forceps left inside patient after surgery

A hospital is investigating how a pair of metal surgical forceps were left inside a patient after they had been stitched up after abdominal surgery.

Worcestershire Acute Hospitals NHS trust has apologised unreservedly and said the incident at Redditch’s Alexandra hospital was “exceptionally rare”.

The medical blunder only became apparent after a seven-hour abdominal procedure last month, according to BBC Midlands, when the forceps were reported to be missing.

The worst fears of medics were confirmed when the missing 15cm arterial clamp was found by an X-ray while the patient was still under anaesthetic.

The surgical instrument could not be immediately removed and the patient was moved to intensive care overnight before another operation was performed the next day to retrieve the clamp.

It is understood the trust’s investigation will look at whether the required double-checking of all instruments was conducted before the patient was stitched up after surgery. It will also examine the end of operation signing-out process, which is supposed to ensure such errors do not happen.

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Source: The Guardian, 23 December 2022

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Generation of children held back as hundreds of thousands wait for key NHS care

Hundreds of thousands of children have been left waiting by the NHS for the developmental therapies they need, with some waiting more than two years, The Independent can reveal.

The long waiting lists for services such as speech and language therapy will see a generation of children held back in their development and will “impact Britain for the long haul”, according to the head of the Royal College of Paediatrics and Child Health (RCPCH).

More than 1,500 children have been left waiting for two years for NHS therapies, according to internal data obtained by The Independent, while a further 9,000 have been waiting for more than a year. The total waiting list for children’s care in the community is 209,000.

Dr Camilla Kingdon, president of the RCPCH, told The Independent: “The extent of the community waiting lists is extremely alarming. Community health services such as autism services, mental health support and speech and language therapy play a vital role in a child’s development into healthy adulthood, and in helping children from all backgrounds reach their full potential.

“A lack of access to community health services also has direct implications for children and families in socio-economic terms. Delays accessing these essential services can impact social development, school readiness and educational outcomes, and further drive health inequalities across the country.”

She said health and care staff are working immensely hard, but that without support they will struggle to address the long delays, which will “impact Britain for the long haul”.

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Source: The Independent, 26 December 2022 

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Majority of NHS targets ‘could be abolished in 2023 after review of health service’

The government could scrap a number of NHS targets after a review of the health service, it has been reported.

Chancellor Jeremy Hunt and health secretary Steve Barclay commissioned Patricia Hewitt, a former Labour health secretary, last month to review how the NHS’s new integrated care systems should work, as well as how the health service should work to “empower local leaders”, giving them more autonomy.

According to the i newspaper, the government could abolish a majority of health service targets as a result of the review, so it can be run along similar lines to schools. Ms Hewitt is set to publish her review next spring.

The newspaper said ministers believe the NHS has become “overly centralised”, with doctors and trusts having to meet many different targets - more than 70 for GPs - and forced to tailor their work to meet them.

Instead, the government would rather run the NHS “more like we do the schools system”, a senior government source told the i, giving local leaders increased responsibility on how to effectively meet NHS goals.

The idea of fewer targets was received positively by the Royal College of GPs, which described many of the targets as “tick box exercises”.

Professor Kamila Hawthorne, chair of the Royal College of GPs, told the newspaper that GPs are working under “intense workload” and pressure, with a “bureaucratic burden” adding to their workload.

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Source: The Independent, 26 December 2022

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UK Covid modelling data to stop being published

Coronavirus modelling data will stop being published in early January, the UK Health Security Agency (UKHSA) says.

Statistics covering the growth rate of the virus are currently released fortnightly, but the agency says this is no longer necessary.

Chief data scientist Dr Nick Watkins said this is due to the UK living with Covid-19 because of vaccines and therapeutics.

At the height of the pandemic both the R rate and growth rate for England were published weekly. Since April this year it has been published fortnightly.

Dr Watkins said it served as a useful and simple indicator to inform public health action and government decisions.

"Vaccines and therapeutics have allowed us to move to a phase where we are living with Covid-19," Dr Watkins said.

"We continue to monitor Covid-19 activity in a similar way to how we monitor a number of other common illnesses and diseases.

"All data publications are kept under constant review and this modelling data can be reintroduced promptly if needed, for example, if a new variant of concern was to be identified."

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Source: BBC News, 26 December 2022

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NHS on track to eliminate hepatitis C five years ahead of global targets

The NHS is set to eliminate hepatitis C in England by 2025 due to targeted screening campaigns for those at risk and effective drug treatments, according to health officials. NHS England said the measures are helping to dramatically cut deaths from the virus five years ahead of global targets.

Deaths from hepatitis C – including liver disease and cancer – have fallen by 35% since NHS England struck a five-year deal worth almost £1bn to buy antiviral drugs for thousands of patients in 2018.

The World Health Organization’s target of a 10% reduction in hepatitis C-related death by 2020 has been exceeded threefold in England.

An NHS screening programme launched in September is also enabling up to 80,000 people unknowingly living with the disease to get a diagnosis and treatment sooner by searching health records for key risk factors, such as historic blood transfusions or HIV.

Prof Sir Stephen Powis, NHS England’s national medical director, said the health service was “leading the world” in the drive to save lives and eliminate hepatitis C while also tackling health inequalities.

He said: “Thanks to targeted screening and because the NHS has a proven track record of striking medicine agreements that give patients access to the latest drugs, we are on track to beat global targets and become the first country to eliminate hepatitis C.”

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Source: The Guardian, 28 December 2022

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Four trusts added to NHSE ‘help list’

NHS England has revealed the latest list of trusts which it has identified as needing the most support to meet electives and cancer targets.

The national body identified 15 trusts which have been assessed as being at most risk of not meeting the key targets of either having no patients waiting 78 weeks or more for elective treatment by April 2023, or returning their 62-day cancer waiting list backlog to pre-pandemic levels by March 2023.

The 15 challenged trusts, which make up around 12% of acute trusts in England, are receiving “tier one” support which involves oversight from national teams, on-site expertise, extra funding and recruitment, and possible calls between their CEOs and government ministers.

NHS England said it has recently added four trusts to “tier one” for electives and cancer – York and Scarborough Teaching Hospitals Foundation Trust, Sheffield Teaching Hospitals FT, North West Anglia FT, and Royal Devon and Exeter FT. York and Scarborough FT, Sheffield FT, and North West Anglia FT has previously been in tier two for cancer services only, while Royal Devon and Exeter FT had previously been in tier one for electives only but is now in tier one support for cancer as well.  

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Source: HSJ, 23 December 2022

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Fresh nurse strike dates announced in England

Nurses will go on strike again on 18 and 19 January in England unless pay talks are opened, the Royal College of Nursing (RCN) has said.

Nurses at more hospital trusts than before will be involved in the strike action in the new year, the union said.

Meanwhile, the GMB union has called off a second day of ambulance strikes planned in England and Wales for 28 December.

But it announced a new co-ordinated walkout on 11 January.

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Source: BBC News, 23 December 2022

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‘Payment by results’ style system returns for electives

The health service in England is returning to a payment-by-results-style system for elective activity, new guidance confirms.

Providers struggled to hit elective targets in 2022-23, in large part due to ongoing covid, emergency care and staffing pressures, but some have argued that incentives to carry out more activity are too weak.

Proposals for the NHS payment system for 2023-24 issued state: “The large backlog in elective care is a significant issue for the NHS and the patients who rely on it. We want the NHSPS to include an elective funding mechanism which means that providers are paid based on the level of activity they deliver.”

The plans add: “The approach we are proposing gives providers maximum financial incentive to deliver the elective activity targets they are being set.”

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Source: HSJ, 23 December 2022

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Pharmacies say they’ll collapse without funding

England’s network of community pharmacies is “close to collapse”, with serious consequences for millions of patients, industry leaders have warned.

In a letter sent to Steve Barclay, the health secretary, they cautioned that “as a sector we are now at a fork in the road”, and urged him to “make a critical choice about the role you want pharmacies to play”.

The government has said it wants to make more use of community pharmacies in England to ease pressures on GP surgeries and accident and emergency departments. But the letter argues that funding cuts over the past seven years makes this goal unrealistic.

It warns: “Many pharmacies are now dispensing at a loss and facing a serious cashflow crisis which we fear if not addressed, will rapidly move towards many permanent closures. We fear that once they start, closures will be hard to stop, as the sector is now so fragile other pharmacies would struggle to pick up the slack.

“We are deeply concerned that this will put medicine supply at risk — with serious consequences for the millions of people who rely on dispensed prescriptions every year.” 

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Source: The Times, 23 December 2022

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Ambulance workers in England to strike again in January

Ambulance staff in five areas of England are to stage two further strikes in January, union leaders say.

The industrial action on 11 and 23 January is likely to heap more pressure on emergency care, which is already under serious strain.

Health Secretary Steve Barclay said further strike action was in no one's best interest.

Unison leaders say the action is a direct result of the government's refusal to negotiate over pay.

Life-threatening calls to 999, as well as the most serious emergency calls, will still be responded to, they say.

Services in London, Yorkshire, the North West, North East and South West will take action over pay and staffing.

The January strikes will each last for 24 hours from midnight, Unison says, and will involve all ambulance employees - not just 999 response crews.

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Source: BBC News, 22 December 2022

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Stay at home if you’re unwell, say experts, as flu and Covid cases rise in England

Flu and Covid are on the rise in England, with experts stressing the importance of vaccination and warning that people who feel unwell should stay at home rather than mingling with others during the festive season.

The figures come as cases of scarlet fever and strep A infections continue to rise.

The UK Health Security Agency (UKHSA) added that while invasive strep A infections remain rare there have now been a total of 94 deaths in England, including 21 children.

Dr Colin Brown, the deputy director at UKHSA, sought to reassure parents. “I understand how this large rise in scarlet fever and ‘strep throat’ may be concerning to parents, however the condition can be easily treated with antibiotics and it is very rare that a child will go on to become more seriously ill,” he said, adding that parents should visit NHS.UK, contact 111 online or their GP surgery if their child has symptoms so they can be assessed for treatment.

Dr Mary Ramsay, the director of public health programmes at UKHSA, noted a link between indoor mixing and the rise in cases and hospital admissions for flu and Covid.

“Both Covid and flu can cause severe illness or even death for those most vulnerable in our communities, and so it is also important to avoid contact with other people if you are unwell in order to help stop infections spreading over the Christmas and new year period,” she said.

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Source: The Guardian, 23 December 2022

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Antiviral does not cut Covid hospital admissions or deaths in vaccinated

The antiviral, molnupiravir, does not reduce coronavirus hospital admissions or deaths in vaccinated people at high risk, new research suggests.

But the treatment was associated with a shorter recovery time, by four days, and reduced viral load.

People who received molnupiravir reported feeling better compared to those who received usual care, the study found.

Researchers suggest that while the drug could have some benefits in terms of symptom reduction, the cost of the drug may mean it is not the best choice for the general population, given the study findings.

But it may be useful in reducing the pressure on UK health systems, they added.

Chris Butler, professor of primary care in the Nuffield Department of Primary Care Health Sciences and co-chief investigator of Panoramic, said: “Finding effective, safe and scalable early treatments for Covid-19 in the community is the next major frontier in our research response to the ongoing worldwide pandemic.

“It is in the community where treatments could have a massive reach and impact.

“But decisions about who to treat should always be based on evidence from rigorous clinical trials that involve people who would most likely be prescribed the drugs.”

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Source: The Independent, 23 December 2022

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Major German research funder launches audit of clinical trial portfolio

German public research funder Deutsche Forschungsgemeinschaft (DFG) is conducting an audit of the clinical trials it has supported in the past. The audit was announced in response to a request from TranspariMED asking DFG for a list of all its trials completed between 2009 and 2017, to which DFG replied that it currently has no such comprehensive dataset.

DFG stated that it is "currently preparing an evaluation of its clinical trials programme. In the framework of this evaluation the data you requested will be collected and analysed, as the outcomes of trials supported by DFG is of high interest including for DFG itself."

TranspariMED, an organisation which aims to end evidence distortion in medicine, sees this development as a good opportunity for DFG to check whether and when clinical trials were registered and their results made public.

Previous research has shown that nearly a third of German academic trials never make their results public.

This not only wastes public money, but also harms patients because it leaves gaps in the evidence base on the efficacy and safety of drugs, medical devices, and non-drug treatments.

Due to gaps in German law, there is still no legal obligation to make the results of many German clinical trials public.

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Source: TranspariMed, 20 December 2022

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Trust drops from ‘outstanding’ to ‘requires improvement’

A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission.

CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety.

The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt.

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Source: HSJ, 22 December 2022

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UK hospices warn of bed closures and staff cuts as energy bills soar

Hospice charities providing end-of-life services in partnership with the NHS have warned they will have to shut beds and sack staff because of the catastrophic impact of rising energy bills on their day-to-day running costs.

The UK’s network of independent, mainly voluntary-run palliative care providers said hospices were experiencing a perfect storm of soaring costs and rising demand just as revenues from traditional public fundraising methods are collapsing.

They have also warned that many patients who receive palliative care at home are struggling to maintain optimal care standards because they can’t afford to run central heating and the electrical medical equipment used in their everyday clinical care.

Hospices, which typically rely on charitable donations for 70%-80% of their running costs, and which are intensive users of gas and electricity, have reported facing energy bill rises of up to 350%.

Rachel McMillan, the chief executive of one of the UK’s biggest hospices, St Ann’s, in Greater Manchester, said: “We are at the point where we will have to take some very difficult decisions in terms of our business model and our service provision. Closing beds would be a last resort, but we are seriously going to have to think about this.

“The government needs to sit up and listen to hospices; we are an essential part of the care delivery system. We are not a luxury.”

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Source: 22 December 2022

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