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GPs won’t see us unless it’s ‘life or death’, complain pensioners

A 94-year-old man has said his GP refuses to see him “unless it’s life or death”.

Dennis Baker, from North Hampshire, said he felt “put off” by his doctor's surgery, which is a three-minute walk from his house.

The pensioner, who lives with his wife who has advanced dementia and is bed-bound, said he found it “quite difficult to carry on a conversation with a doctor” and cannot get one to visit him at home.

“The chances are [the receptionist] will say… ‘you're not dying, a doctor will phone you at some stage today’, that’s the usual response,” he told BBC Radio 4’s World at One.

It comes as the president of the Royal College of GPs (RCGP) said family doctors should start “saying no” to extra work to tackle the crisis in primary care.

Speaking at Pulse Live last week, Professor Dame Clare Gerada said the workload crisis was not the fault of GPs and they “cannot innovate [their] way out”.

“When you’re in debates and people are saying to you 'you’ve got to work harder and smarter' - no, the rest of the system has to adapt,” she told the conference.

“You have to start saying no.”

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Source: The Telegraph, 3 May 2022

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Hospital robots are helping combat a wave of nurse burnout in the US

Since February, the nurses at Mary Washington Hospital in Fredericksburg, Virginia, USA, have had an extra assistant on their shifts: Moxi, a 4-foot-tall robot that ferries medication, supplies, lab samples, and personal items through the halls, from floor to floor. After two years of battling Covid-19 and related burnout, nurses say it’s been a welcome relief.

“There's two levels of burnout: There's ‘we’re short this weekend’ burnout, and then there's pandemic burnout, which our care teams are experiencing right now,” says Abigail Hamilton, a former ICU and emergency room nurse that manages nursing staff support programmes at the hospital.

Moxi is one of several specialised delivery robots that has been developed in recent years to ease the strain on healthcare workers. Even before the pandemic, nearly half of US nurses felt that their workplace lacked adequate work–life balance. The emotional toll of seeing patients die and colleagues infected at such a large scale—and fear of bringing Covid-19 home to family—has made feelings of burnout worse. Studies also found that burnout can have long-term consequences for nurses, including cognitive impacts and insomnia years after the exhaustion of their early careers. The world already had a nurse shortage going into the pandemic; now, roughly two out of three nurses in the US say they have considered leaving the profession, according to a survey from the National Nurses United union.

Moxi has spent the pandemic rolling down the halls of some of the largest hospitals in the country, carrying objects like a smartphone or beloved teddy bear to patients in emergency rooms when Covid-19 protocol kept family members from bedsides.

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Source: Wired, 19 April 2022

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Empowering and investing in midwives could save millions of lives each year

Ms. Martinez is a midwifery student in Tulancingo, Mexico, working in an underserved community. “There is a health care house, but there are no permanent staff,” she explained. “In my community there are many youth pregnancies, and there are no dedicated health staff who could care for women or take care of teenagers.”

This shortage is partly due to a widely held misconception that midwifery is an antiquated profession, she indicated. “I met with doctors and nurses who questioned me: Why was I studying this midwife career? They didn't see room for that.”

Thursday is the International Day of the Midwife, a moment to recognise the enormous contributions of midwives to health care around the world. 

“Not only do their capable hands bring new life into the world, they are champions of sexual and reproductive health and rights, providing voluntary contraception and other essential services, while supporting childbearing women emotionally,” said Dr. Natalia Kanem, UNFPA’s Executive Director, in her statement marking the day.

Yet continued lack of recognition hinders not only the success of midwives but also the health and well-being of whole societies. “We will not achieve universal health coverage without them,” said Dr. Kanem, “or realize our aspirations to reduce maternal and newborn deaths, as agreed in the Sustainable Development Goals.”

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Source: United Nations Population Fund, 4 May 2022

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Patient watchdog chair quits and tells Javid funding cuts are endangering ‘its vital role’

Sir Robert Francis has announced he is to step down as chair of Healthwatch England 20 months early, claiming funding cuts mean the patient watchdog could soon struggle “to fulfil its vital role”.

The prominent QC has also announced he will quit his position as a non-executive director of the Care Quality Commission on November 15 2022.

In a letter to Mr Javid, Sir Robert said it had been an “honour and a privilege” to serve on the CQC’s board and a “great pleasure” to support Healthwatch England. He added: “I believe [Healthwatch England] has proved its worth to your department and the system more generally and is now in an ideal position to help you take forward your agenda for improving the patient’s voice.

“However, if I have one regret about my time as chair[man], it is that we have been unable as yet to find a way of reversing the alarming decline in the resources available to Healthwatch – I am afraid there is a growing risk the network will be unable to fulfil its vital role unless urgent attention is paid to this issue.”

Sir Robert has chaired a number of independent inquiries involving the NHS, most notably the inquiry into poor care and high mortality rates at Stafford Hospital – which was published in February 2013.

Last June, Sir Robert was appointed by the government to undertake an independent study into a framework for compensation for victims of the infected blood scandal.

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Source: HSJ, 3 May 2022

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Leaked NHS report warns GPs face ‘shocking levels’ of racism

GPs face “appalling and systemic” racism from patients and colleagues, a leaked NHS report has revealed.

The first Health Education England report for London of its kind says racism and discrimination are widespread within primary care across the capital, and GPs in other parts of the country have raised similar concerns.

Doctors speaking with The Independent have told stories of being called derogatory and racist names, of staff leaving due to the bigotry they’ve faced, and of patients asking to see a “white” or “English” GP.

Senior GPs have warned patients will ultimately suffer as a result, as experienced doctors leave practices to avoid such abuse.

Professor Simon Gregory, deputy medical director for Health Education England, said: “There is considerable evidence that the UK is systemically racist, and that the NHS is a systemically racist workplace.

“This report is shocking evidence of terrible, indeed appalling, levels of discrimination across protected characteristics and with much intersectionality, but especially shocking levels of racial discrimination.”

“The awful and painful narratives of so many colleagues over so many years cannot be ignored but thanks to London’s primary care educational leaders we now have firm evidence. Evidence that cannot be ignored.”

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Source: The Independent, 4 May 2022

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‘40,000 put at risk last month’ while waiting in ambulance

More than 38,000 patients were put at risk of harm during March – more than 4,000 of them seriously – while they waited in an ambulance outside hospital, according to estimates shared with HSJ.

The number of hour-plus delays to handing over patients from ambulances to emergency departments in March was the highest ever recorded, following steep increases since last summer.

Figures collected by the Association of Ambulance Chief Executives (AACE), and shared with HSJ, reveal that one trust recorded a delay of 23 hours during March. 

Based on its detailed information about the length of handover delays, AACE has produced an estimate of the likely number of patients harmed while waiting to he handed over, using a model initially developed in research published last year. This found 85 per cent of those who waited more than an hour could have suffered potential harm.

The AACE report said that patients who waited the longest were at greatest risk of some level of harm and the risk of severe harm tripled for those waiting for more than four hours compared with waiting for 60 to 90 minutes.

AACE managing director Martin Flaherty told HSJ: “We expect the situation to be no better when we collate our figures for April.

“The most significant problem remains hospital handover delays which continue to increase exponentially, with tens of thousands of ambulance hours being lost due to hospital handover delays, causing enormous knock-on effects out in the community, where delays in people receiving the ambulance resource they need are the obvious result.

“However, the human cost, in terms of direct harm that is being caused to patients through these combined delays at hospitals and in the community, as well as to the health and wellbeing of our ambulance crews, is substantial."

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Source: HSJ, 29 April 2022

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Trusts failing on waiting list ask told to ‘get act together’

Trusts have been told to ‘get their act together’ on health inequalities, after HSJ research suggested only a small minority have so far published data on disparities in waiting times between different patient groups.

Planning guidance issued by NHS England in September 2021 said trusts’ board performance reports should include a disaggregation of waiting lists by ethnicity and deprivation group.

Through freedom of information and media requests, HSJ attempted to obtain such data from the 20 trusts with the largest waiting lists, but only three currently appear to have met the requirement in full.

The remainder either said they were still undertaking the work, were thinking about how to publish it, or failed to respond.

Roger Kline, an academic researcher and former director of NHSE’s workforce race equality standard, said trusts should have been collecting and publishing the data for years.

He said: “We know there are issues around health and healthcare of some groups of people, most notably in poor working class communities and black and minority ethnic communities. It shouldn’t be seen as an optional extra, this should be part of good public health work and good equitable healthcare provision."

“This data should be on the trust website. It should be an active part of the conversations with local communities. Well done to the trusts that are pushing this forward. The ones that are not need to get their act together.”

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Source: HSJ, 3 May 2022

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When the NHS spends billions on personal injury cases, it’s the public that loses

Hunt’s radical plan to reform compensation for clinical negligence is “completely unacceptable” says the Association of Personal Injury Lawyers, which includes some of the kinds of firms that urge people to sue the NHS, soliciting online, in TV ads or posters in waiting rooms.

Damages paid by the NHS as a result of medical negligence claims have soared exponentially over the last decade, up from £900m to £2.2bn now. Yet despite horror stories of deaths and life-changing damage in badly run maternity wards, the National Audit Office (NAO) finds no evidence of more injuries, only that the number of claims and sums awarded by courts are shooting up. The NAO found that “the claimant’s legal costs exceeded the damages awarded in 61% of claims settled”. Though the lawyers in the clinical compensation business protest vigorously that they defend patients’ rights, the Hunt committee demolishes any justification for the present system.

The report quotes Sir Ian Kennedy QC, the chair of many inquiries and emeritus professor of health law and ethics at University College London, who wrote in 2021 that clinical negligence was an “outdated, arbitrary and scandalously expensive system” with a “stranglehold that lawyers exert over a system that should be putting the interests and needs of patients first”.

What injured patients need is an independent authority to conduct a speedy and transparent investigation of what went wrong, with everyone free to speak openly, ending in reasonable compensation and a pledge to prevent anyone else being put at risk by the same error. Peter Walsh, the chief executive of Action Against Medical Accidents, told the committee that litigation was often “a last-gasp attempt to get a sense of justice and to get to the bottom of what has actually happened after people have experienced denial after denial”.

Instead of a system of delays and denials that frustrates grieving families and terrorises doctors as lawyers seek to pin personal blame on someone, the committee proposes a system closer to those used in New Zealand and Scandinavia. An independent administrative body would investigate a patient’s case to see if the harm done was avoidable and if so, to fix fair compensation briskly within six months. The priority would be openness and learning from mistakes to protect future patients. Not needing to find a person to blame makes it easier for patients to get compensation – but the payout would be far lower. Some warn this lower burden of proof would encourage a flood of claims, but New Zealand found a similar system ended up halving the sums paid out. 

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Source: The Guardian, 3 May 2022

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US pediatricians’ group moves to ban race-based medical guidance

The American Academy of Pediatrics is attempting to ban race-based medical guidance which the organisation attributes to long-standing inequities in healthcare.

In a statement on Monday, the AAP said: “Race is a historically-derived social construct that has no place as a biologic proxy. Over the years, the medical field has inaccurately applied race correction or race adjustment factors in its work, resulting in differential approaches to disease management and disparate clinical outcomes.”

“Although it will continue to be important to collect clinical data disaggregated by race and ethnicity to help characterize the differential lived experiences of our patients, unwinding the roots of race-based medicine, debunking the fallacy of race as a biologic proxy, and replacing this flawed science with legitimate measures of the impact of racism and social determinants on health outcomes is necessary and long overdue,” the academy added.

A re-examination of AAP treatment recommendations that began before George Floyd’s 2020 murder by police in Minneapolis, and intensified after it and the resulting nationwide protests, has doctors concerned that Black youngsters have been under-treated and overlooked, said Joseph Wright, lead author of the new policy and chief health equity officer at the University of Maryland medical system, a network of hospitals.

According to Wright, the academy has begun to scrutinise its “entire catalog,” including guidelines, educational materials, textbooks and newsletter articles.

The academy went on to recommend a series of policies to medical societies, institutions and pediatricians. “All professional organizations and medical specialty societies should advocate for the elimination of race-based medicine in any form,” it said.

It urged institutions to collaborate with learner-facing organizations such as the Accreditation Council on Continuing Medical Education to expose more people to health equity content with a “specific focus on the elimination of race-based medicine”.

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Source: The Guardian, 2 May 2022

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Few staff using wellbeing hubs despite rise in sick days

Only 53,500 staff have used a flagship NHS staff wellbeing initiative in its first year of operation, HSJ can reveal, while separate analysis finds mental health sick days have soared in the last five years. 

Figures obtained via Freedom of Information requests reveal the NHS’s staff mental health and wellbeing hubs, set up in February 2021 in response to covid pressures, received 53,549 contacts from NHS and social care staff between then and January 2022.

It is the first time such data has been published and it comes as HSJ’s analysis of separate figures shows mental health sick days taken across acute and specialist NHS trusts have risen sharply in the past five years (see box below). 

The total number accessing the hubs, which is inclusive of social care staff, equates to less than 4 per cent of the NHS workforce as of January 2022. 

Sean Duggan, mental health chief executive at NHS Confederation, said: “Given what we know about the pandemic and the toll it has paid on NHS staff, I would have expected bigger numbers.

“We need to encourage more people to come forward. To me, this number says we certainly need to sustain the hubs with funding for years to come.”

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Source: HSJ, 3 May 2022

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US Supreme Court may overturn abortion law, leak suggests

The US Supreme Court could be about to overturn the nationwide legal right to abortion, according to an unprecedented leaked draft of a court document.

In a 98-page draft opinion, Justice Samuel Alito writes that the 1973 Roe v Wade decision legalising abortion across the US is "egregiously wrong".

If the top US court strikes down the ruling, "trigger laws" could instantly make abortion illegal in 22 US states.

The justices are not expected to issue a ruling until early July.

It sparked immediate outcry from Democrats, and protests - by both pro and anti-abortion supporters - outside the Supreme Court on Monday night.

Speaker of the House of Representatives Nancy Pelosi and Senate Majority Leader Chuck Schumer - both Democrats - issued a joint statement saying that if the report was accurate, the "Supreme Court is poised to inflict the greatest restriction of rights in the past 50 years".

News outlet Politico published the leaked document in full, quoting Justice Alito as saying: "Roe was egregiously wrong from the start. Its reasoning was exceptionally weak, and the decision has had damaging consequences.

"And far from bringing about a national settlement of the abortion issue, Roe and Casey have enflamed debate and deepened division."

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Source: BBC News, 3 May 2022

 

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Cancer checks: Record number of patients referred in England

A record 2.7 million people were referred for cancer checks in the last year, NHS England has said.

It comes after figures suggested the Covid pandemic saw numbers dramatically decline in 2020. But at least 30,000 people are still waiting to start treatment.

Charities have welcomed the increase in referrals but warned of the "devastating" impact the pandemic has had on cancer care.

Referrals for suspected cancer remain at about 16% higher than pre-pandemic levels and rose overall from 2.4 million to 2,65m in the past 12 months.

Dame Cally Palmer, national cancer director for NHS England, said there were still 30,000 people who had not started treatment due to the pandemic but that the new figures suggested some progress.

She said: "We are going further and faster than ever before in our ambitions to diagnose more cancers at an earlier stage so that we can save more lives."

It is "vital that we keep these referral rates high", she added.

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Source: BBC News, 2 May 2022

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'Utterly inhumane' hospitals still ban bedside visitors as Covid cases plunge

Hospitals are still banning patients from having bedside visitors in ‘immoral’ Covid restrictions. 

Last night, MPs, patient groups and campaigners criticised the postcode lottery that means some frail patients are still denied the support of loved ones. 

Nine trusts continue to impose total bans on any visitors for some patients, The Mail on Sunday has found. 

Almost half of trusts maintain policies so strict that they flaunt NHS England’s guidance that patients should be allowed at least two visitors a day. 

Shrewsbury and Telford Hospital NHS Trust, Sandwell and West Birmingham Hospitals NHS Trust and Royal Papworth Hospital NHS Foundation Trust are among those continuing total bans on visiting for some of their patients. 

University College London Hospitals NHS Foundation Trust (UCLH) has even been imposing its draconian restrictions on disabled patients who need special help for their care – only allowing visits on three days a week for a maximum of an hour each time. 

Tory MP Alicia Kearns said: ‘It is utterly unforgivable and immoral. There is no scientific evidence for any remaining inhumane restrictions on visiting. Trusts are breaching the rights of families. 

'Visitors save lives, they advocate and calm their loved ones. When will this madness end?’ 

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Source: MailOnline, 1 May 2022

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‘Lives at risk’ in Britain’s crumbling hospitals

Patients’ lives are at risk because NHS hospitals have been allowed to crumble into disrepair, with ceilings collapsing and power cuts disrupting surgery.

The number of clinical incidents linked to the failure to repair old buildings and faulty equipment has tripled in the past five years, an investigation by The Times found.

Hundreds of vital NHS operations and appointments are being cancelled as a result of outdated infrastructure, undermining attempts by doctors to tackle record waiting lists.

Recent incidents include an unconscious patient on a ventilator being trapped in a broken lift for 35 minutes and power running out as a patient lay in an operating theatre.

On Saturday, April 23, a five-hour power cut at the Royal London Hospital in east London led to the cancellation of operations including two lifesaving kidney transplants, and meant women giving birth had to be transferred to different maternity units in the backs of taxis.

Hospitals have also recorded hundreds of rat and pest infestations, and some rooms containing patients have been left “overflowing with raw sewage”.

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Source: The Times, 2 May 2022

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Republic of Ireland: Significant rise in ‘extreme’ incidents involving harm to patients

The number of notified “extreme” and “major” incidents involving serious harm to patients and others in hospital has risen significantly in the Republic of Ireland in recent years, new figures reveal.

Reported “extreme” incidents, which can involve death or permanent incapacity, rose from 373 in 2017 to 579 last year.

The number of cases classified as “major”, where there is long-term disability or incapacity, climbed from 46 to 82 in the same period.

“Moderate” incidents, when there is a patient injury involving medical treatment, also increased from 9,219 in 2017 to 13,563 last year.

Minor incidents, involving injury or illness needing first aid, also increased over the same time from 9,210 to 15,483.

The figures, involving patients, staff, visitors, contractors and the public, were released by the HSE in response to a parliamentary question from Aontú leader Peadar Tóibín.

A spokewoman for the HSE said: “It is HSE policy that all incidents are identified, reported and reviewed so that learning from events can be shared to improve the quality and safety of services.” 

“The number of reported incidents has increased year on year since 2004 with a significant increase noted since 2015, with the introduction of the National Incident Management System.”

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Source: Independent.ie, 3 May 2022

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Whistleblowing Bill launched in Parliament to widespread support

The Doctors’ Association UK (DAUK) has expressed its support for the Whistleblowing Bill launched in Parliament last week, with its first reading in the House of Commons by Mary Robinson MP, Chair of the All Party Parliamentary Group for Whistleblowing.

DAUK urged people to tweet their MP to show their support for the Bill.

DAUK Chair Dr Jenny Vaughan said: "Healthcare staff need to be able raise patient safety issues all of the time. We’re trained to do that, expect it, point this out as best we can. But sometimes poor safety arises because of the way we are told to work. Then, it can be just as hard for staff to speak up as it is for anyone else, because we can also be threatened, sanctioned, isolated, ignored and bullied.

"Blowing the whistle for us means saving lives, in the end. But we stand to lose as much as anyone. DAUK has supported many doctors who have been made to suffer because they spoke out, and there are many more who feel they should but are afraid to.  That is why this Bill is so important. For all staff within healthcare. And most of all, for patients  - the public. Stopping the greater harm for the greater good.”

The most important changes in the private members bill, led by Baroness Kramer would:

  • Require disclosures to be acted upon and whistleblowers protected.
  • Provide criminal and civil penalties for organisations and individuals failing to do so.
  • Establish a fully independent parliamentary body on whistleblowing, and provide easy access to redress.

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Source: Medscape UK, 26 April 2022

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Trust’s pension fix refusal risks wave of doctor resignations

A ‘significant flurry’ of senior doctors will look to retire after a trust rejected a scheme designed to avoid higher taxes on their pensions, according to internal emails.

Emails from senior doctors suggest Liverpool University Hospitals Foundation Trust has rejected proposals to introduce “pension recycling”, a scheme endorsed nationally to avoid the tax rules.

Government policy changes in 2016 reduced tax relief on higher earners’ pension contributions. This has discouraged clinical consultants from taking on extra shifts, and in some cases, prompted people to retire earlier than planned.

Last month, NHS England’s chief executive Amanda Pritchard suggested this was a continuing problem for hospitals as they seek to increase elective activity.

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Source: HSJ, 29 April 2022

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Lack of Covid testing leaves researchers blind to evolution patterns, WHO warns

A dramatic drop in testing for Covid-19 has left the world blind to the virus’s continuing rampage and its potentially dangerous mutations, the head of the World Health Organization has warned.

The UN health agency said that reported Covid cases and deaths had been dropping dramatically. “Last week, just over 15,000 deaths were reported to WHO – the lowest weekly total since March 2020,” WHO chief Tedros Adhanom Ghebreyesus told reporters.

While saying this was “a very welcome trend”, he warned that the declining numbers could also be a result of significant cuts in testing for the virus.

“As many countries reduce testing, WHO is receiving less and less information about transmission and sequencing,” he said. “This makes us increasingly blind to patterns of transmission and evolution."

“When it comes to a deadly virus, ignorance is not bliss.”

William Rodriguez, who heads the global diagnostics alliance FIND, also decried that many governments in recent months simply stopped looking for Covid cases.

Speaking at the press conference hosted by WHO, he pointed out that in the past four months, amid surging Covid cases from the Omicron variant, “testing rates have plummeted by 70% to 90% worldwide”.

The plunging testing rates came despite the fact that there is now more access to accurate testing than ever before.

“We have an unprecedented ability to know what is happening,” Rodriguez said. “And yet today, because testing has been the first casualty of a global decision to let down our guard, we’re becoming blind to what is happening with this virus.”

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Source: The Guardian, 26 April 2022

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Government to review the future of CQC and NHS England

NHS England, the Care Quality Commission and other arm’s length bodies will be subject to an efficiency and performance review led by the Cabinet Office.

The terms of a review into all government arm’s length bodies were set out this week, with minister Jacob Rees-Mogg insisting there is an “urgent need for public service reform”.

The ‘public bodies review’ programme will consider whether ALBs “should be abolished or retained”, should continue to deliver all their functions, and whether they have an “effective relationship” with their relevant departments.

Other ALBs include the National Institute for Health and Care Excellence, Health Education England, and the UK Health Security Agency.

A guidance document says: “The outcome of this work should see powers returned to accountable ministers, greater efficiency and where appropriate, the state stepping back both financially and from people’s lives…

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Source: HSJ, 29 April 2022

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Patients died after catalogue of errors by Priory mental health chain

NHS bosses have attacked the country’s leading private mental healthcare chain for failing to keep patients safe, The Times has learnt, as an investigation reveals the Priory Group has been criticised for failings in the care of 30 patients who have died.

An investigation by this newspaper reveals that the company, which earns at least £400 million a year from public sector contracts for looking after mentally ill patients, has been repeatedly criticised for the same failures of care over the past decade.

This week the Priory was criticised in the inquest of Eliana Hanton, 20, who died after hanging herself using a ligature point that had been highlighted as a risk in an internal audit four months earlier.

An inquest in Birmingham last week concluded that neglect by the Woodbourne Priory Hospital contributed to the death of Matthew Caseby, 23.

The company has repeatedly been criticised for the same failings in relation to patient deaths, leading to questions about whether it is learning from its mistakes, including inadequate or inaccurate risk assessments, staff's lack of training or expertise, a failure to address known ligature points or escape routes and materials which could be used to self-harm, and poor record keeping.

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Source: The Times, 29 April 2022

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Maternity scandal families slam NHS over no confidence vote ‘silence’

Families impacted by the Nottingham maternity scandal say they have been left in “limbo” following silence from NHS England in response to their concerns over a major review, as 50 more come forward.

The review into failures in maternity services at Nottingham University Hospitals Foundation Trust has now had 512 families come forward with concerns, up from 460 last month, and has spoken to 71 members of staff.

The update comes as families told The Independent they were yet to receive a direct acknowledgement or response to their warning on Monday that they had no confidence in newly appointed review chairwoman Julie Dent.

In response to a letter outlining her appointment, the families asked for Ms Dent to decline the offer and instead pushed for NHS England to ask Donna Ockenden, who is chairing a similar inquiry into Shrewsbury maternity care.

Former health secretary and health committee chairman, Jeremy Hunt, has now also challenged the NHS on Ms Dent’s appointment, and echoed the families’ call to ask Ms Ockenden.

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Source: The Independent, 29 April 2022

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People with arthritis told to exercise more and use painkillers less

People with arthritis are being urged to lose weight and exercise more rather than rely on painkillers as the main therapies for their condition.

NHS guidance from the National Institute for Health and Care Excellence (NICE) says people who are overweight should be told their pain can be reduced if they shed the pounds.

Aerobic exercise such as walking, as well as strength training, can ease symptoms and improve quality of life. Exercise programmes may initially make the pain worse, but this should settle down, the guidance suggests.

The guidelines also give recommendations on the use of medicines, such as offering non-steroidal anti-inflammatory drugs (NSAIDs) but not offering paracetamol, glucosamine or strong opioids.

NICE said there was a risk of addiction with strong opioids, while evidence suggests little or no benefit for some medicines when it comes to quality of life and pain levels.

The draft guidelines say people can be offered tailored exercise programmes, with the explanation “doing regular and consistent exercise, even though this may initially cause discomfort, will be beneficial for their joints”.

Tracey Loftis, head of policy and public affairs at the charity Versus Arthritis, said: “We’ve seen first-hand the benefits that people with osteoarthritis can get in being able to access appropriate physical activity, especially when in a group setting. Something like exercise can improve a person’s mobility, help manage their pain and reduce feelings of isolation.

“But our own research into the support given to people with osteoarthritis showed that far too many do not have their conditions regularly reviewed by healthcare professionals, and even fewer had the opportunity to access physical activity support.

“The lack of alternatives means that, in many cases, many people are stuck on painkillers that are not helping them to live a life free from pain.

“While we welcome the draft Nice guidelines, healthcare professionals need further resources and support to better understand their role in promoting treatment like physical activity for people with osteoarthritis.

“There is clearly a need for people with arthritis to be given a bigger voice so that their health needs are not ignored.”

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Source: The Guardian, 29 April 2022

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NHS boss feared waiting for ambulance after stroke

An NHS boss who had a stroke was taken to A&E by her husband rather than calling for an ambulance because of concerns over long waits.

In a series of tweets, Gloucestershire Hospitals NHS Trust chief executive Deborah Lee praised his swift actions.

She said he had "bundled her into his car", last week, after she had showed the signs of a stroke because he had heard her "lamenting ambulance delays".

She is recovering but says it may have been different if they had called 999.

Waits for an ambulance in England are the longest since new targets were introduced, in 2017.

And Ms Lee's regional service - the South West - has the longest waits in the country, with category-two calls, which include strokes, taking nearly two hours, on average, to reach patients in March.

The target is 18 minutes.

In the tweets, Ms Lee said: "Naturally, I am eternally grateful to my husband for his swift actions… but I can't get one thing out of my head.

"What if my husband hadn't been there and my daughter had called for an ambulance and I'd been put in the cat[egory]-two stack?"

She went on to say it was not the fault of the ambulance service and the whole system was "working unrelentingly to this but to no great avail".

Ms Lee said hospitals were struggling to discharge patients, because of a lack of social care, and so delays were building up in the rest of the system.

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Source: BBC News, 28 April 2022

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Experts who warned over Covid risk to care homes were told they were ‘too risk averse’

Ministers and public health officials were warned that stricter proposals were needed to protect care home patients from Covid-19, Wednesday’s high court ruling revealed.

Draft versions of guidance for hospitals and care homes during the first pandemic wave included measures that were challenged by NHS officials.

The government and Public Health England (PHE) were found to have acted unlawfully over a policy that allowed patients to be discharged from hospitals into care homes during the onset of the pandemic.

In their ruling on Wednesday, Lord Justice Bean and Mr Justice Garnham concluded that policies in March and early April 2020 failed to take into account the risk to elderly and vulnerable residents from non-symptomatic transmission of the virus.

It came after two women took Public Health England, the then health secretary Matt Hancock and NHS England to court over the deaths of their fathers in care homes during the first wave of the pandemic. During the last two years more than 20,000 care home residents have died from Covid-19.

However, court documents show early draft PHE guidance advised against transferring asymptomatic patients into care homes with outbreaks and against admitting Covid positive patients who had not completed their isolation period to care homes. Senior NHS leaders challenged the draft guidance, saying it would make care homes “too risk averse”.

According to documents revealed in the judgment, the then minister for social care Helen Whately raised several concerns about the discharge of Covid-positive patients into care homes.

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Source: The Independent, 28 April 2022

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'The thought of running out of HRT is terrifying'

A shortage of specific types of hormone-replacement therapy (HRT) has left women struggling with untreated symptoms of the menopause. Demand for prescriptions has more than doubled since 2017 - partly because of work by campaigners to extend access - but supply of some products has not kept up.

Yasmin Darling's experience of the menopause was sudden and profound. Two years ago, she had two operations to reduce her risk of inherited cancer which plunged her into an early menopause.

"It's really hard to navigate medical menopause 10 years early," the 45-year-old says.

"When you don't have the product you need, it makes it much more difficult to navigate."

Because of Covid, Yasmin has never been seen by a specialist at a menopause clinic, so she is managing as best she can on her own. 

Claire Lopez, 59, spent three weeks trying to obtain her usual HRT patches from different local chemists but they were out of stock. Without them, her body becomes "very stiff", leading to slipped discs and severe back pain.

"I have severe anxiety if I do not have these patches, so the total lack of coordination between GPs and pharmacists was extremely frustrating," Claire says.

In the end, she had to arrange a private prescription through a local clinic, in the Midlands, costing £50.

The government has said it is determined to ensure supplies of HRT can meet high demand.

Minister for Women's Health Maria Caulfield said: "There are over 70 HRT products available in the UK, most of which remain in good supply.

"However, we are aware of some issues with women being unable to access certain products.

"We will be appointing a new HRT-supply chairperson and convening an urgent meeting of suppliers to look at ways we can work together to improve supply."

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Source: BBC News, 27 April 2022

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