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Invest in health workforce or risk collapse, WHO warns governments

Last year the World Health Organization (WHO) released a report warning of a “ticking time bomb” threatening health systems in Europe and Central Asia: a growing shortage of health workers.

With quickly ageing populations and an ageing health workforce—40% of doctors in Europe are close to retirement in a third of countries—along with a surge in chronic illnesses and the ongoing effects of the covid pandemic, WHO warned that many countries could soon see their healthcare systems collapse unless they take urgent action.

Six months on, the situation has worsened, as healthcare workers throughout Europe increasingly resort to industrial action over pay and conditions.

Hans Kluge, WHO regional director for Europe, said, “The health workforce crisis in Europe is no longer a looming threat—it is here and now. Health providers and workers across our region are clamouring for help and support...

“We cannot wait any longer to address the pressing challenges facing our health workforce. The health and wellbeing of our societies are at stake—there is simply no time to lose.”

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Source: BMJ, 24 March 2023

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Intervention at major trust as junior doctors flag patient safety risks

Trainee medics in a troubled maternity department have flagged concerns with national regulators over the safety of patients, it has emerged.

Last year the General Medical Council said it had concerns about the treatment of obstetric and gynaecology trainees at University Hospitals Birmingham and placed medics at Good Hope Hospital and Heartlands Hospital under intensive support known as “enhanced monitoring”.

The GMC’s review flagged serious concerns about emergency gynaecology cover arrangements and said there was a real risk trainees would become hesitant and reluctant to call on consultant support. In September it placed additional restrictions on training, due to “ongoing significant concerns about the learning environment and patient safety”.

Now it has emerged in board papers for Birmingham and Solihull integrated care board that Health Education England, now part of NHS England, and the GMC carried out a follow-up visit to UHB in late March to review progress. 

Board documents state that “several patient safety concerns [were] reported by postgraduate doctors in training to the visiting team”, with a subsequent feedback letter from HEE urging immediate changes to dedicated consultant time and job plans.

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Source: HSJ, 17 May 2023

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International trial aims to improve the quality of life for Long Covid patients

Researchers at the University of Derby and their regional, national and international partners are working collaboratively to develop bespoke support pathways for patients with Long Covid. 

Led by Dr Mark Faghy, they are currently running a series of projects to understand the determinants of recovery which captures the lived experience and informs a bigger piece of work to develop a holistic view of the key stakeholders that are required to develop pathways that can improve patient outcomes.

One part of this is the launch of a new Delphi Consensus statement which seeks to obtain input from patients, researchers and any healthcare professionals to inform the approaches to support people living with long COVID.  If you have an interest in this study, please click here.

For more information on the current work, please contact Dr Mark Faghy (@DrMark_Faghy and [email protected]) and also see:

https://www.derby.ac.uk/news/2022/international-trial-aims-to-improve-the-quality-of-life-for-long-covid-patients/ “

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International Day of the Midwife 2020

Today is International Day of the Midwife. Each year since 1992, the International Confederation of Midwives leads global recognition and celebration of the great work midwives do. 

Take a look at some of the resources and blogs we have recently published on the hub highlighting the work midwives are doing to support mothers and families during the coronavirus pandemic and the challenges services face.

Home births, fears and patient safety amid COVID-19

Midwifery during COVID-19: A personal account

Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic

Birthrights: COVID-19

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Internal memo warns of ‘increasingly common’ deaths in A&E

Senior doctors have raised concerns about the numbers of patients now dying in their A&E department due to extreme operational pressures.

HSJ has seen an internal memo sent to staff at Royal Albert Edward Infirmary in Wigan, which warns it is becoming “increasingly common” for patients to die in the accident and emergency department.

The memo suggests the department has reported five deaths in the latest weekly audit, when it would normally report one or two fatalities.

The memo said: “Of the 72 patients in A&E as I write this, 16 have been there over 24 hours and 34 over 12 hours. The longest stay is almost 48 hours…

“It’s becoming increasingly common to die in A&E. We have included A&E deaths [in weekly audits] for the last 4 years. They used to be 1 or 2. This week there were 5. They used to die at or just after arrival, but that’s changing too…

“There is every reason to think winter will be worse.”

The memo echoes warnings made by numerous NHS leaders in recent months around the intense service pressures and an increased risk of incidents and mistakes. 

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Source: HSJ, 17 August 2022

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Intensive care units for children not meeting standards, says NHSE report

Three intensive care units for children are not meeting standards for co-located services, a national report has found.

Royal Stoke University Hospital, Royal Brompton Hospital in London and Freeman Hospital in Newcastle, which all have “level three” paediatric intensive care beds for the most seriously ill patients, do not offer specialised paediatric surgery, according to a report from NHS England’s Getting it Right First Time (GIRFT) programme.

The report, released in April, said specialised paediatric surgery “should be co-located on the same site” as a paediatric intensive care unit with level three beds and be “immediately available” to meet quality standards set by the Paediatric Intensive Care Society.

The report also found the units do not offer services such as trauma, neurosurgery and bone marrow transplantation, which it says is a reflection of the variability and “the poor alignment” of specialised paediatric services at PICUs.

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Source: HSJ, 23 May 2022

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Intensive care units face ‘grim’ situation despite fall in Covid cases

The president of the Intensive Care Society has warned despite the fall in Covid cases, intensive care units in hospitals remain under substantial pressure, with Stephen Webb, a consultant in intensive care and deputy medical director at the Royal Papworth Hospital Trust, describing the situation as "grim".

“Cases of Covid infections are coming down but that’s not having much of an impact on hospitals and on intensive care units yet. The situation in ICUs is pretty grim at the moment and it’s grim for a completely different reasons from wave one and two of the pandemic.” Dr Webb told The Independent.

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Source: The Independent, 5 August 2021

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Intensive care staffing ratios dramatically diluted

The staff-to-patient ratios for intensive care are being dramatically reduced as the NHS seeks to rapidly expand its capacity to treat severely ill covid-19 patients, HSJ has learned.

Acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. 

Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”.

Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally.

She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough."

“It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.”

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Source: HSJ, 24 March 2020

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Intensive care doctors question 'overly aggressive' use of ventilators in coronavirus crisis

Doctors seeing patients with blood oxygen levels so low they are surprised they are conscious – yet they are sitting up and talking.

British and American intensive care doctors at the front line of the coronavirus crisis are starting to question the aggressive use of ventilators for the treatment of patients. 

In many cases, they say the machines – which are highly invasive and require the patient to be rendered unconscious – are being used too early and may cause more harm than good. Instead they are finding that less invasive forms of oxygen treatment through face masks or nasal cannulas work better for patients, even those with very low blood oxygen readings.

Dr Ron Daniels, a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust, on Thursday confirmed reports from US medics that he and other NHS doctors were revising their view of when ventilators should be used. 

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Source: The Telegraph, 9 April 2020

 

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Intensive care capacity must be permanently doubled, says Nightingale chief

Intensive care capacity in London must be doubled on a permanent basis following the coronavirus pandemic, according to the chief executive of the city’s temporary Nightingale hospital.

Speaking to an online webinar hosted by the Royal Society of Medicine, Professor Charles Knight said London had around 800 critical care beds under normal operations but “there’s a clear plan to double intensive care unit capacity on a permanent basis”.

He added: “We must have a system of healthcare in this country that means, if this ever happened again, that we wouldn’t have to do this, that we wouldn’t have to build an intensive care unit in a conference centre because we had enough capacity under usual operating so that we could cope with surge.”

It would also mean the NHS would no longer be in a position “where lots of patients, as we all know, get cancelled every year for lack of an ITU bed,” he said.

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Source: HSJ, 28 April 2020

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Integrated care systems to be CQC-rated, says Hancock

Health secretary Matt Hancock has said integrated care systems (ICS) will be rated by the Care Quality Commission (CQC).

The government’s recent white paper for a new NHS bill did not discuss any change in the CQC’s legal framework to allow it to rate ICSs, which sparked uncertainty around how ICSs would be regulated.

However, speaking in the House of Commons today of the “crucial” role the regulator plays in rating hospitals, Mr Hancock said: “I think that it is vital that the CQC has a similar role when it comes to ICSs.”

The CQC has not confirmed what, if any, legal changes it is seeking. Currently, if the regulator wants to inspect how well a system is working, it must ask permission from the secretary of state to do so.

It has carried out around 25 inspections of systems since 2017, but has not issued ratings.

Giving evidence at a Parliamentary committee meeting earlier today, Sir Robert Francis, Healthwatch England chair, said: “A rating [from the CQC] that summarises the performance of the organisation to the public is a form of accountability. It doesn’t affect patient choice in quite the same way as a provider rating does, but it may be a way of explaining to the public how their system is doing.”

He added that if inspectors are “continually being directed to go to the places the secretary of state chooses” then they may not carry the authority or credibility of an independent process.

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Source: HSJ, 2 March 2021

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Integrated care ICS told it’s ‘top down’ and ‘lacks effective leadership’

An under-pressure integrated care system has been told it lacks “effective leadership” and is “too centralised and top-down” in a survey of partner organisations.

Only 10% of senior leaders said Greater Manchester ICS had the necessary leadership and skills to deliver on its priorities. And only 7% agreed it had “clear roles, effective leadership and efficient processes”, in a survey carried out over the summer.

The work commissioned by the ICB received responses from 156 senior leaders in the ICB, its providers, local authorities, place teams, primary care, social care and voluntary and community services in the patch.

Several described the system’s leadership as “too centralised and top-down”, with “the tension between centralised control at the GM level and local autonomy” sparking “the most significant numbers of qualitative feedback” to the work, according to an ICB board paper this month.

Some also described “bullying by senior leaders and smaller organisations being treated inequitably”.

“Recent restructures and upheavals” have “weakened” a “history of great partnership working in Greater Manchester”, the survey feedback summary adds.

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Source: HSJ, 29 October 2024

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Insurers overrule consultants on best treatment for patients

Patients are being left in pain and having operations delayed or denied because insurers are overruling consultants’ decisions on treatment.

Policy holders with breast cancer, heart conditions, arthritis and knee problems are among those who have been unfairly denied procedures, The Times has found.

Analysis of Financial Ombudsman Service reports shows that complaints about private medical insurers have risen sharply.

Richard Packard, chairman of the Federation of Independent Practitioner Organisations, estimates that hundreds of patients a year are denied recommended treatments. “Consultants have reported that their expert decisions for the benefit of the patient are being overturned,” he said. “This is being done by insurance administrators at the end of a telephone. Some would seem to lack medical knowledge and [make] decisions based on computer algorithms, which can result in delayed treatment and patients suffering pain for longer than necessary.”

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Source: The Times, 18 November 2019

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Insulin shortages ‘causing stress and anxiety’ for UK diabetes patients

People with type 1 diabetes are being forced to endure the “stress and anxiety” of insulin shortages, patients, pharmacists and health campaigners have warned.

The “distressing” drug scarcity, the latest to affect the UK, is sowing uncertainty for the 400,000 people with the condition, with some products not available again until next year amid global manufacturing shortages.

Britain is already contending with record numbers of medicines becoming hard or impossible to obtain, including those for attention deficit hyperactivity disorder and epilepsy.

The Juvenile Diabetes Research Foundation (JDRF) said “a regular and reliable supply of insulin is essential for life” for people with type 1 diabetes. That is because their disease – an autoimmune condition unrelated to type 2 diabetes – means they cannot make insulin naturally and must inject it every day or receive it through a pump.

The Department of Health and Social Care (DHSC) confirmed there were “supply issues with a limited number of insulin products” that patients might find “distressing”.

One patient, an NHS doctor who puts vials of the drug into her insulin pump, said: “I spent the last two days trying to get hold of insulin to treat my type 1 diabetes. I was terrified when my usual, very reliable pharmacist told me he couldn’t get hold of my insulin. I had no idea that insulin could go out of stock. Type 1 diabetics fall ill and will die within a few days without insulin. I’m worried for fellow diabetics, not only to access the supply, to stay alive, but the stress and anxiety this causes.”

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Source: Guardian, 28 April 2024

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Insulin access still “severely limited” in low-income countries, report finds

Efforts by pharmaceutical companies to tackle global insulin inequity are “fragmented” and “falling short,” with many people with diabetes around the world still not having access to the drug.

A report by the Access to Medicine Foundation examined access schemes run by the three main insulin manufacturers—Eli Lilly, Novo Nordisk, and Sanofi. It found that despite the programmes they run, access to the treatment is still severely limited or lacking in many low and middle income countries (LMICs).

By 2030, the number of people with diabetes worldwide is expected to reach 643 million, with the numbers rising most rapidly in LMICs.

The analysis reported that over the past decade pharmaceutical companies have carried out a “patchwork of approaches” that were often focused on a small number of countries or based around particular types of products or specific patient populations.

It noted that most of the strategies had not guaranteed “sustained access for insulin dependent patients requiring ongoing, lifelong treatment” and most of the affordability schemes have been primarily focused on human insulins, with only a few for analogue products.

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Source: BMJ, 11 October 2022

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Inspectors were so concerned about what they saw at an Oldham GP practice, they immediately banned it from operating for four months

A GP practice serving one of Greater Manchester’s most deprived communities has been banned from operating for four months after regulators uncovered a catalogue of basic failures - including failing to follow up on a child reporting breathing difficulties for three days.

Jarvis Medical Practice in Glodwick has had its registration with the Care Quality Commission (CQC) suspended after ‘serious concerns’ passed to the body led to a snap inspection last month.

Inspectors found the practice, based at Glodwick Primary Care Centre, was failing 20 separate standards, many of them relating to patient safety.

It noted ‘poor quality’ and conflicting records that were sometimes impossible to properly understand and urgent home visits delayed or not carried out at all.

In one case a patient with a lump apparently received no physical examination and was not referred for tests or scans ‘due to Covid-19’.

Inspectors also found examples of patients with breathing difficulties, including a child, who were not dealt with for days after they got in touch. In one case no further contact was made for 11 working days, with no explanation provided in the patient's notes.

The practice, which serves more than 5,000 patients in the Oldham neighbourhood of Glodwick, has now been suspended by the CQC until October 11.

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Source: Manchester Evening News, 17 July 2020

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Inspectors moving between Covid-hit England care homes without tests

Health inspectors in England have been moving between care homes with high levels of COVID-19 infection without being tested, raising fears they have put more residents at risk of catching the virus, leaks to the Guardian have revealed.

In recent weeks all care home inspections carried out in the north of England have been of infected homes, including a facility where 38 of the 41 people receiving care and 30 staff – almost half of the workers – had tested positive, internal documents from the Care Quality Commission (CQC) show.

Over the last two months inspectors have been checking infection control procedures and care standards in up to 600 care homes, many of which were dealing with outbreaks of COVID-19, but the Department of Health and Social Care (DHSC) has yet to provide testing. The CQC said on Friday it was expecting to start testing inspectors “in the coming weeks”.

Weekly Covid deaths in care homes have been rising. In the week to 20 November, 398 people were notified to the CQC as having died from Covid, up from 138 a month earlier. The death toll remains lower than at the peak of the pandemic, when more than 2,500 people were dying a week in late April.

The situation has sparked “very real anxieties about contracting the disease” and spreading it between infected homes, the leaked memos reveal. One inspector described work to his managers as like “going into the eye of the storm”.

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Source: The Guardian, 27 November 2020

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Inspectors downgrade hospital A&E where patients left waiting ‘head to toe’

A hospital A&E department has been downgraded by regulators amid fears of “significant risk of harm” to patients after inspectors found some were crammed “head to toe” on trolleys during a surge in coronavirus cases.

The Care Quality Commission (CQC) has told bosses at the Royal Oldham Hospital to urgently improve its A&E service after the November inspection found staff were not following infection rules and patients were at risk of catching the virus.

The inspection confirms reports, revealed by The Independent last year, that patients in the A&E unit were being forced to wait close together for long periods. Whistleblowers from the trust said the practice was unsafe and the president of the Royal College of Emergency Medicine, Katherine Henderson, said it was a “potentially lethal” situation.

The CQC visited the emergency department on 30 November after it said concerns were raised over the safety of patients.

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Source: The Independent, 10 February 2021

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Inspectors discover poor standards at 28 mental health units

Inspectors have found 28 privately run mental health units to be “inadequate” in the past three years, prompting fears that vulnerable patients are receiving poor and unsafe care.

The disclosure of such widespread substandard care in mental health facilities run by non-NHS providers has prompted psychiatrists to call for a public inquiry to investigate.

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Source: The Guardian, 25 September 2019

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Inspectors criticise poor nursing and leadership in latest damning report

A damning new report has exposed numerous lapses in nursing care on wards at Shrewsbury and Telford Hospital Trust amid a culture which left patients at risk of “unsafe and uncaring” treatment, the care watchdog has said.

Inspectors from the Care Quality Commission (CQC) cited multiple examples of nurses at the scandal-hit trust lacking the knowledge to look after patients safely and failing to record key information needed to keep patients safe during an inspection of medical wards in June this year.

The inspectors found poorly completed nursing records, equipment unavailable and nurses not following procedures. This meant some patients developed pressure sores, fell from their beds and were injured or suffered pain at the end of their life. Other patients were at risk of suffering similar harm.

Inspectors ruled the trust, which was rated inadequate and put into special measures in 2018, was unsafe and criticised the hospital leadership for what it said was a “collective failure” that was perpetuating the problems at the hospital.

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Source: The Independent, 14 August 2020

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Inspection blitz on maternity units amid new system safety concerns

Almost 200 maternity units in England will be inspected by the Care Quality Commission amid fears for mothers and babies’ safety and concerns that improvements are not happening fast enough.

The commission is taking the unusual step as NHS England faces accusations of pressuring hospitals to reorganise the way midwives work when they lack the staff to do it safely.

The new model of care, which is designed to provide mothers with a dedicated midwife throughout pregnancy, has been introduced only partially across the NHS, leading to a two-tier service in which hospital wards are left short of staff and women face potentially dangerous delays.

Under “continuity of carer”, midwives work in teams and are on call for specific mothers when they go into labour. But this can leave hospital wards understaffed and women not included in the programme waiting for a midwife.

NHS England is pushing hospitals to make this the default model of care by March 2024 despite a warning by Donna Ockenden, who led the inquiry into baby deaths at the Shrewsbury and Telford Hospital Trust, and who said in her final report that introduction of the new model should be suspended if services lack enough staff.

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Source: The Times, 14 August 2022

Further reading - Midwifery continuity of carer resources on the hub.

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Inside the fight to improve outcomes for Black cancer sufferers

Getting tested for prostate cancer should’ve been easy for Paul Campbell. He wanted a check-up after seeing an advert on TV calling for men in their 40s to get thorough health checks.

He asked his GP but was immediately questioned about why he – a man who seemed otherwise healthy – would want a check-up.

“I had to fight my ground, I had to raise my voice. And eventually, I got the test,” Mr Campbell told The Independent. He was later diagnosed with aggressive prostate cancer.

“Had I not been assertive and pushy, by the time I found out, it would have been stage 4.”

Mr Campbell is far from being alone in his experience. New research from the NHS Race and Health Observatory found “alarming levels” of discrimination towards patients from ethnic minorities and huge levels of mistrust in the NHS system.

The survey of 2,680 people found only 55% trusted primary care to meet their health needs most or all of the time, while a third of south Asian participants said they either rarely or never trusted primary care to meet their health needs.

On Friday, the NHS Race and Health Observatory roundtable brought together 20 key partners from local communities, the volunteer sector, the government and broader NHS to discuss the findings.

Professor Habib Naqvi, chief executive, NHS Race and Health Observatory, said: “We cannot have a two-tier NHS based upon patient ethnicity, background or circumstances. This report reflects the clear need to bring speed and urgency to reform the NHS, so that patients do not face discrimination and systemic barriers when seeking healthcare.”

These issues have a real impact on health outcomes.

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Source: The Independent, 9 March 2025

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Inside the A&E crisis: ‘We were lined up so patients wouldn’t see the bodies’

An NHS whistleblower has sacrificed his career to capture on hidden camera the brutal reality of working in an ambulance service.

After watching yet another patient die needlessly in the back of his ambulance, Daniel Waterhouse became a whistleblower. That decision would end his career with the NHS at the age of only 30.

Waterhouse, from Finchley, north London, said his decision to go undercover for a Channel 4 Dispatches programme to be broadcast on Thursday was not easy.

“I thought about it for quite a while,” said Waterhouse, an emergency medical technician who wore hidden cameras and microphones while on shift for the East of England Ambulance Service. “It was a moral choice, and there’s a caveat to that as well, because going undercover in those situations could be considered immoral and will draw criticism I’m sure.

“But I think patient safety outweighs that, and those occasions were so strong in my head that I thought, ‘If only some change can happen, where some people don’t have to go through that and die or suffer permanent disability, then it would be worth it’.”

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Source: The Times, 3 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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Inside looming NHS winter crisis as hospitals face ‘armageddon’

As hospital beds fill up, seriously sick patients are sent to makeshift wards – cupboards, offices and corridors – to be treated by a doctor. Others are left languishing in waiting rooms, sometimes for days on end. In one particularly hard-hit hospital, a Costa Coffee cafe is turned into an emergency ward as medics struggle to cope with rising demand.

It’s only October, yet the picture across NHS wards up and down the country is one of concern, with medics telling The Independent they fear a winter crisis on a scale only seen at the height of the pandemic. One A&E consultant warns the health service is facing something akin to “armageddon”.

Every year, the NHS is under huge pressure at winter – a result of longstanding problems, including under-funding and an ageing population. But hospitals are already battling an “astonishing” number of flu and Covid patients this year, in part due to a “hugely concerning” early flu season, alongside a surge in A&E demand and staffing cuts.

On Tuesday, health secretary Wes Streeting admitted the NHS faces a “challenging” winter but insisted it was “already running hot” ahead of the season. But top medics have told The Independent that the government has failed to adequately plan for a potentially devastating few months.

Dr Vicky Price, president of the Society of Acute Medicine, told The Independent: “This winter, I’m more scared than I’ve ever been. We are in a state of dread going into these winter months.”

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Source: The Independent, 25 October 2025

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