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Digitising all trusts by 2025 ‘unachievable’ after £700m cut, government admits

NHS England’s target for all trusts to have a working electronic patient record (EPR) system by March 2025 is now ‘unachievable’’ and a new date has been set a year later, government has admitted.

A new report of the Infrastructure and Projects Authority – the government body which scrutinises and supports major projects – states: “Delivery confidence is [rated] red as a number of NHS trusts are reporting they are unlikely to be able to fully implement an electronic patient record by March 2025.”

The document, published quietly last week, downgrades the rating from “amber” to “red” – and also reveals £700m was cut from the programme’s budget last year. 

The “frontline digitisation” programme was launched by government and NHSE in 2021 with the aim of getting all trusts to a minimum level of capability, including 90% to have an EPR of an acceptable standard by the end of 2023, and 100 per cent by March 2025. 

But the IPA report states that a revised business case is now being prepared to reflect a new “end date” of March 2026.

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Source: HSJ, 24 July 2023

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‘A critical emergency’: America’s Black maternal mortality crisis

America is facing an intensified push to pass stalled federal legislation to address the US’s alarming maternal mortality rates and glaring racial disparities which have led to especially soaring death rates among Black women giving birth.

Maternal mortality rates in the US far outpace rates in other industrialised nations, with rates more than double those of countries such as France, Canada, the UK, Australia, Germany. Moms in the US are dying at the highest rates in the developed world.

Overall maternal mortality rates in the US spiked during the pandemic. Maternal deaths in the US rose 40% from 861 in 2020 to 1,205 in 2021, a rate of 32.9 deaths per 100,000 live births. For Black women, these maternal mortality rates were significantly higher, at 69.9 deaths per 100,000 live births in 2021.

These racial disparities in maternal health outcomes have persisted and worsened for years as the number of women who die giving birth in the US has more than doubled in the last two decades.

The CDC noted in a review of maternal mortalities in the US from 2017 to 2019, that 84% of the recorded maternal deaths were preventable.

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Source: The Guardian, 23 July 2023

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Nurse pioneers new device to reduce NG tube insertion errors

A nurse-led trial has found that a new electronic tool could reduce the number of preventable injuries and deaths caused by wrongly inserting nasogastric tubes.

The study, led by Tracy Earley, a consultant nutrition nurse at Royal Preston Hospital, tested a new fibre-optic device which can tell clinicians definitively if a nasogastric tube – which is inserted through the nose and delivers food, hydration and medicine into the stomach – has been placed correctly.

Currently, to check if nasogastric tubes – also referred to as NG tubes – are in the right place, nurses have to extract bodily fluid from the patient through the tube. Clinicians then test this fluid on a pH strip to judge whether the placement is correct.

Studies show that interpreting the pH level results in mistakes 12-30% of the time, and that in 46% of cases nurses are unable to draw aspirate at all. This means patients have to undergo x-rays, leaving them without nutrition or treatment for longer.

The study tested a device called NGPod, which uses a fibre-optic sensor to retrieve the pH reading from the tip of the NG tube leading to a definitive 'yes' or 'no' result in terms of whether it has been placed correctly – removing the need for aspirate or interpretation from the health professional.

It found that the device was as accurate as pH strip testing, and removed all of the risks associated with making subjective pH strip judgements.

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Source: Nursing Times, 18 July 2023

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NHS trust accused of cover-up is refusing to release report into deaths

An ambulance trust accused of hiding information from a coroner about patients that died is keeping a damning internal report about the deaths secret, the Guardian can reveal. A consultant paramedic implicated in the alleged cover-ups continues to be involved in decisions to keep the report from the public.

Earlier this month, North East Ambulance Service (NEAS) apologised to relatives after a review into claims it covered up errors by paramedics and withheld evidence from the local coroner about the deceased patients. But a bereaved family left in the dark about mistakes made before their daughter’s death have rejected the apology.

Now, it has emerged that a 2020 internal interim report on the alleged cover-up continues to be kept secret by the trust. The damning report by consultants AuditOne has been leaked to the Guardian after first being exposed by the Sunday Times. 

Paul Aitken-Fell, a consultant paramedic blamed in the report for amending information sent to the coroner and removing crucial passages about mistakes by the trust’s paramedics, remains in post. He also holds the gatekeeper role of FoI review officer, and as such has endorsed decisions to refuse to release the report to members of the public who ask for it.

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Source: The Guardian, 24 July 2023

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Government pledges better support for women who lose babies during pregnancy

Women who lose babies during pregnancy will be able to get a certificate as an official recognition of their loss as well as better collection and storage of remains under new government plans.

The government will make sure the certificate is available to anyone who requests one after experiencing any loss pre-24 weeks’ gestation.

The NHS will develop and deliver a sensitive receptacle to collect baby loss remains when a person miscarries. A&Es will also have to ensure that cold storage facilities are available to receive and store remains or pregnancy tissue 24/7 so that women don’t have to resort to storing them in their home refrigerators.

The new recommendations are part of the government’s response to the independent Pregnancy Loss Review.

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Source: The Independent, 23 July 2023

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Most NHS staff say they don’t have enough time to spend with patients

Most NHS staff think they have too little time to help patients and the quality of care the service provides is falling, a survey reveals.

Medical and nursing groups said the “very worrying” findings showed that hard-pressed staff cannot give patients as much attention as they would like because they are so busy.

In polling YouGov carried out for the Guardian, 71% of NHS staff who have direct contact with patients said they did not have the amount of time they would like to have to help them. A third (34%) felt they had “somewhat less than enough time” and 37% “far less than enough time” than they wanted. Almost a quarter (23%) felt they had the right amount of time while just 3% said they had “more time” than they wanted.

The survey presents a worrying picture of the intense pressures being felt at the NHS frontline. Those same personnel were asked if they thought the quality of care the service is able to offer has got better or worse over the last five years. Three-quarters (75%) said “worse”, including a third (34%) who answered “much worse”, while 17% said “about the same” and only 6% replied “better”.

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Source: The Guardian, 24 July 2023

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Managers wrongly dismissed doctor with PTSD, tribunal rules

A trust breached its own internal illness policy when managers sacked a doctor who had PTSD and had been drunk at work, an employment tribunal has ruled.

Judges criticised the move as a “complete failure” by East and North Hertfordshire Trust when Vladimir Filipovich was dismissed in July 2019.

Dr Filipovich was summoned to a hearing following allegations he had been drunk at work, did not disclose a diagnosis of post-traumatic stress disorder to his employer, and failed to take a recommended prescription of Citalopram.

In a decision published this month, the tribunal sharply criticised how the trust’s investigator handled the Citalopram claim, concluding he “did nothing to investigate the matter whatsoever”, and found ENHT had “appeared to simply take legal advice” on how to dismiss Dr Filipovich.

The tribunal also concluded ENHT “stopped following” its own illness policy, which aimed to get practitioners to return to work, and “abandoned” its requirement to obtain the latest occupational advice.

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Source: HSJ, 21 July 2023

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Ministers must fix ‘vicious cycle’ of short staffing in NHS mental health care, MPs warn

NHS mental health services are stuck in a “vicious cycle” of short staffing and overwhelming pressures, a government committee has warned.

Rising demand for mental health services has “outstripped” the number of staff working within NHS organisations, according to the public accounts committee.

A report from the committee warned that ministers must act to get services out of a “doom loop” in which staff shortages is hitting morale and leading people to quit the already-stretched services.

It found staffing across mental health services has increased by 22% between 2016 and 17 and 2021 and 22 while referrals for care have increased by 44% over the same period.

Healthcare leaders warned there are 1.8 million people on the waiting list for NHS mental health care with hospital bosses “deeply concerned”.

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Source: The Independent, 21 July 2023

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Trust chiefs sacked ‘only in extreme circumstances’, says government

The government has admitted that many ‘vulnerable’ hospitals ‘suffer with a lack of permanence of leadership’, but said that chiefs are only sacked by NHS England ‘in extreme and exceptional circumstances’.

The comments were included in the government’s response to the independent investigation into major maternity care failures at East Kent Hospitals University Foundation Trust, which highlighted how the practice of repeatedly hiring and firing leaders  had contributed to its problems.

The investigation said successive chairs and CEOs at the FT were “wrong” to believe it provided adequate care, and urged that they be held accountable. But it said senior management churn had been “wholly counterproductive”, and that it had “found at chief executive, chair and other levels a pattern of hiring and firing, initiated by NHS England” which would “never have been an explicit policy, but [had] become institutionalised”.

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Source: HSJ, 21 July 2023

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More than 250,000 dementia patients in England could miss new treatments

More than 250,000 dementia patients could miss out on new treatments for the disease because they do not have a formal diagnosis, according to government figures.

NHS data published for the first time shows the prevalence of different types of dementia with which people in England have been diagnosed.

Dementia is an umbrella term for many different conditions, affecting more than 55 million people worldwide.

This week, health regulators were urged to approve two new game-changing dementia drugs, after a landmark study confirmed that donanemab slowed cognitive decline in Alzheimer’s patients by 35%, while last year, a second drug, lecanemab, was found to reduce the rate by 27%.

The NHS primary care dementia figures estimate that there are about 708,000 people over 65 with dementia in England, but only about 450,000 have a recorded diagnosis. That means that more than 250,000 are missing out on these potential new treatments. 

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Source: The Guardian, 20 July 2023

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Only one in five staff at care scandal trust confident in execs

Just one-fifth of staff at a trust engulfed in an abuse scandal expressed confidence in the executive team, according to the Care Quality Commission (CQC), which has downgraded the trust and its leadership team to ‘inadequate’.

The CQC inspected Greater Manchester Mental Health Trust following NHS England launching a review into the trust in November 2022 after BBC Panorama exposed abuse and care failings at the medium-secure Edenfield Centre.

The two inspections, made between January and March 2023, which assessed inpatient services and whether the organisation was well-led, also saw the trust served with a warning notice due to continued concerns over safety and quality of care, including failure to manage ligature risks on inpatient wards.

Inspectors identified more than 1,000 ligature incidents on adult acute and psychiatric intensive care wards in a six-month period. In the year to January, four deaths had occurred by use of ligature on wards which the CQC said “demonstrated that actions to mitigate ligature risks and incidents by clinical and operational management had not been effective”.

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Source: HSJ, 21 July 2023

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Patients 'waiting for days' in Emergency Department

The Royal College of Nursing (RCN) has said patients are waiting for days in corridors at Belfast's Royal Victoria Hospital's Emergency Department.

Rita Devlin, NI director of the RCN, visited the unit on Thursday after getting calls from nursing staff.

She described the situation as "scandalous".

Speaking to Radio Ulster's Evening Extra programme, Ms Devlin said while it was the Royal Hospital on Thursday, the situation is "bad right across the EDs".

She said talking to nurses at the Royal, she was struck by "the absolute despair" some are feeling.

"I spoke to some young, newly qualified nurses who are leaving because they just can't take the stress and the pressure any more," she said.

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Source: BBC News, 20 July 2023

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ADHD and autism campaigners plan legal action against NHS over referral limits

Campaigners are planning to launch legal action after NHS chiefs in North Yorkshire placed limits on which adults can get referrals for autism and attention deficit hyperactivity disorder (ADHD) assessments.

North Yorkshire and York Health and Care Partnerships introduced a pilot programme in March in which adults seeking an NHS assessment for autism or ADHD are triaged via an online screening tool.

NHS chiefs say this screening process prioritises those with the most severe needs, rather than processing referrals in chronological order.

These priority needs reportedly include the patient being at risk of immediate self-harm or harming others, at risk of being unable to have lifesaving hospital treatment or care placement, or an imminent risk of family court decisions being determined on diagnosis.

Those who do not meet the criteria are given guidance and signposted to other support networks.

But campaigners say that in practise that means that most people cannot get a referral for an assessment – GPs can no longer make referrals themselves.

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Source: The Big Issue, 19 July 2023

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Modernisation Agency chief returns to lead improvement drive

The director of the Modernisation Agency in the early 2000s is returning to lead a new national service improvement drive, NHS England has announced, while asking systems and providers to “baseline” their improvement needs and capability.

NHSE is establishing a “national improvement board” to oversee a new improvement programme called NHS Impact, as recommended by a review last year of the current infrastructure.

NHSE announced the board will be chaired by David Fillingham, who was director of the NHS Modernisation Agency from 2001-2004 where, NHSE said, “he focused on developing new practices and fostering leadership development”. 

The national improvement board will choose a small number of improvement priorities to be followed across national bodies and the wider health service. It will “set the direction of system wide improvement” through “collaboration and co-design,” NHSE said.

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Source: HSJ, 19 July 2023

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System admits 10-year diagnostic waits

Adults across an integrated care system area are facing ‘unacceptable’ 10-year waits for an NHS assessment for attention deficit hyperactivity disorder, the longest known wait for such services in England.

Herefordshire and Worcestershire integrated care board has warned in board papers of “exceptionally high waiting times for ADHD assessment and treatment for Worcestershire patients (10 years+), with workforce challenges and service fragility compromising service delivery”.

HSJ understands the long waits for ADHD diagnosis, which is a national problem, is predominately affecting adults with approximately 2,000 people on Herefordshire and Worcestershire’s ADHD list alone.

Local provider Herefordshire and Worcestershire Health and Care Trust also warned on its website that its paediatric services were also “experiencing unprecedented demand”.

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Source: HSJ, 19 July 2023

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Adoption of AI in the NHS should be faster, experts say

The adoption of artificial intelligence (AI) by the NHS should be faster, and more frameworks should be in place to get emerging technologies to as many patients as possible, experts have told MPs.

A number of senior figures from medicine and biotechnology gave evidence to the Health and Social Care Committee as part of its inquiry into cancer technology.

Stephen Duffy, a professor of cancer screening at the Wolfson Institute of Population Health at Queen Mary University of London, told MPs there is “strong potential” for AI, particularly in areas such as reading mammograms for the breast screening programme.

However, he warned that there will be “staff issues in terms of the number of staff needed to double-read mammograms”.

He added: “Those issues aren’t going away. It seems to me that AI systems have already been shown to be very good in terms of detection of cancer on from mammograms, so they’re safe in that respect.

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Source: The Independent, 19 July 2023

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Service ‘collapses’ after department left with ‘no doctors’

A trust has been accused of presiding over the deterioration of a key service amid communication problems between senior leaders and a ‘worrying series of resignations’ which has left the department with ‘no doctors’.

The British Association of Dermatologists wrote to Worcestershire Acute Hospitals Trust on 13 July to request an urgent meeting with the provider’s management to discuss the matter.

The letter, seen by HSJ, outlines fundamental patient safety and staffing concerns about the trust’s dermatology service and accuses the trust of putting “continued communication barriers” between clinicians and management.

The letter, signed by BAD president Mabs Chowdhury, says there are now “no doctors in the department” after two consultants and a locum consultant resigned “due to apparent unhappiness with the running of services [and in] a continuation of a worrying series of resignations”.

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Source: HSJ, 19 July 2023

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Regulatory ‘burden’ has increased despite promises, say trust leaders

The majority of trust leaders have reported an increase in the ‘burden’ put on them by regulators, citing more demanding ‘ad hoc’ requests during heightened operational pressure.

In NHS Providers’ latest survey of NHS trust leaders’ experiences of regulation, a little over half of respondents – 52% – said the burden from NHS England and the Care Quality Commission had increased in the past year.

The percentage was higher among acute/community and community trusts, and all ambulance and specialist trust respondents said the burden had increased. 

An even higher overall share of trusts – 59% – said “ad hoc requests” from regulators had increased during the same time period. This includes requests for information or meetings at short notice, diverting staff from day-to-day operational duties.

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Source: HSJ, 20 July 2023

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Covid Inquiry: Bodies were treated like toxic waste, says daughter

The bodies of people who died with Covid were treated like "toxic waste" and families were left in shock, a bereaved woman has told the inquiry.

Anna-Louise Marsh-Rees said her father Ian died "gasping for breath" after catching the virus while in hospital.

Ms Marsh-Rees, who leads Covid-19 Bereaved Families for Justice Cymru, said he was "zipped away", and his belongings put in a Tesco carrier bag.

Ian Marsh-Rees died after catching the virus while in hospital, aged 85. His daughter said finding information regarding his care in hospital and how he became infected was "almost like an Agatha Christie mystery".

She said no GP ever suggested he might have Covid, although she now knows his discharge notes said he had been exposed to Covid.

"It wasn't until we saw his notes some months later that we saw the DNA CPR (do not attempt CPR) placed on him, and this was without consultation with us," she said.

"It kind of haunts us all that… people used to say 'well they're in the right place' when they go to hospital. I'm not sure they would say that any more," Ms Marsh-Rees said.

She now wants to change the way deaths are handled by health boards. She said it was important to prepare families before and support them after the death of a loved one, from palliative care to dignity in death.

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Source: BBC News, 18 July 2023

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Just one-fifth of staff speak up in trust’s internal inquiry

Just one in five staff who were approached in a trust’s internal inquiry – prompted by an undercover broadcast raising serious care concerns – engaged with the process, a report has revealed. 

Essex Partnership University Foundation Trust said it took “immediate action” to investigate issues highlighted in a Channel 4 Dispatches programme into two acute mental health wards last year. This included speaking to staff identified as a high priority in the investigation. 

However, a new Care Quality Commission report has revealed, of the 61 staff members the trust approached, only 12 engaged with the process. 

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Source: HSJ, 19 July 2023

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NHS is ‘tech averse healthcare system’, says ex-government adviser

A cut to the NHS tech budget, revealed by HSJ, has been described as “pretty outrageous” by a former government adviser and eminent medical leader.

Sir John Bell, an immunologist and geneticist and regius chair of medicine at Oxford University, made the comments in a talk at the Tony Blair Institute’s Future of Britain conference.

NHSE’s cut to its tech budget was attributed to having to divert the money to fund spending growth, and some other inflationary costs, without receiving extra from government. At the time, NHSE said the service “remains firmly committed to our digital strategy from supporting hospitals to adopt electronic patient record systems to transforming how patients access NHS services through the NHS App”.

But Sir John said: “The NHS is a technology averse healthcare system.”

He said NHS spending on medicines was “much lower than peers and if you look at our access to technology – like MRI and CR scanners – we’re right at the back. We just don’t do it.”

He added that rapid tech development and adoption was needed particularly to enable mass early diagnosis of diseases, and new treatment therapies.

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Source: HSJ, 18 July 2023

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Children waiting over a year in pain for NHS tooth removal

Children in some areas of England are waiting up to 18 months on average for dental general-anaesthetic treatment and teeth extractions, an investigation reveals.

Some have been left with prolonged dental pain, according to information shared with BBC News.

The parents of one girl who has waited three years for extractions say the pain keeps her up at night.

At the start of this year, more than 12,000 under-18s were on waiting lists for assessment or treatment at community dental service (CDS) providers, data obtained by the Liberal Democrats from the NHS Business Services Authority and shared with BBC News earlier this year reveals.

Children are referred to a CDS provider when they have tooth decay too severe to be treated in general practice.

They also treat those with physical or learning disabilities when general practice is not a practical option.

The longest average wait faced by children for general-anaesthetic treatment at a CDS provider is 80 weeks, at Harrogate and District NHS Foundation Trust.

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Source: BBC News, 19 July 2023

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Maternity unit refutes suggestion it breached safety standards

The trust at the centre of a maternity scandal insists it has been providing immediate anaesthetic cover for obstetric emergencies, contrary to an NHS England report suggesting it had not and had been potentially breaching safety standards.

Health Education England – now part of NHSE – visited William Harvey Hospital in March and was told senior doctors in training who were covering obstetrics could also be covering the cath lab – which deals with patients who have had a heart attack, and could receive trauma, paediatric emergency and cardiac arrest calls. This suggested the trust was in conflict with Royal College guidelines which state an anaesthetist should always be “immediately available” for obstetrics. 

East Kent Hospitals University Foundation Trust, which runs the hospital, originally told HSJ its rota had very recently been changed and that an anaesthetist with primary responsibility for maternity could leave any other work to attend to a maternity emergency immediately. However, it has since said it has been the case for a long time that an anaesthetist is available to return to maternity in case of an emergency. 

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Source: HSJ, 17 June 2023

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‘Culture battle’ over NHS England’s emergency recovery plans

Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements.

Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care.

The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention.

It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”.

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Source: HSJ, 18 July 2023

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Cough syrups could be made prescription-only over addiction fears

Concerns codeine-based cough syrup could be addictive and have serious health consequences have led the UK medicines safety regulator to consider stopping its sale over the counter.

The Medicines and Healthcare products Regulatory Agency (MHRA) is asking the public for their views on changing codeine linctus - which is a syrup with the active ingredient codeine phosphate and is used to treat a dry cough - to a prescription-only medicine.

This comes in the wake of multiple reports to the regulator that the medicine is instead being used recreationally for its opioid effects. Since 2018, the MHRA has received 116 reports of recreational drug abuse of, dependence on, and/or withdrawal from codeine medicines, including codeine linctus.

Dr Alison Cave, MHRA Chief Safety Officer, said this can have a severe impact on people’s health. She said: “Codeine linctus is an effective medicine, but as it is an opioid, its misuse and abuse can have major health consequences.”

Pharmacists are also “significantly” concerned, especially about the overdose risk.

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Source: The Independent, 18 July 2023

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