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‘Alarming setbacks’ in mortality rates among pregnant women, research shows

Progress to cut the number of women dying in pregnancy or childbirth has stalled or even reversed in recent years, with a death recorded every two minutes, the United Nations has said.

Years of gains had begun to plateau even before the pandemic and there had been “alarming setbacks for women’s health,” according to a new report from several UN agencies, including the World Health Organization (WHO).

Maternal mortality rates had fallen widely in the first 15 years of the century, but since 2016, they had only dropped in two UN regions: Australia and New Zealand, and in Central and Southern Asia.

The rate went up in Europe and North America by 17% and in Latin America and the Caribbean by 15%. Elsewhere it stagnated.

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Source: The Telegraph, 23 February 2023

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Outstanding trust handed warning notice

An ‘outstanding’ rated acute trust has been served with a warning notice by the Care Quality Commission (CQC) and told to make ‘significant and immediate improvements’ to its mental health and learning disabilities services.

The CQC said staff at Newcastle upon Tyne Hospitals Foundation Trust had not always carried out mental capacity assessments when people presented with mental health needs. And this included when decisions were made to restrain patients in the emergency department.

A CQC warning notice, published alongside a report of an inspection between 30 November and 1 December last year, says the trust must make “significant and immediate improvements in the quality of care being provided” to people with mental health issues, learning disabilities or autism.

The warning notice also says the trust must ensure people with a learning disability and autistic people “receive care which meets the full range of their needs”. The trust’s records “did not show evidence that staff had considered patients’ additional needs,” the regulator said.

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Source: HSJ, 24 February 2023

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Draft of NHS workforce plan calls for doubling of medical school places

Britain could double the number of doctors and nurses it trains under NHS plans to tackle a deepening staffing crisis, according to reports.

The proposal to increase the number of places in UK medical schools from 7,500 to 15,000 is contained in a draft of NHS England’s long-awaited workforce plan, which is expected to be published next month.

Labour has already announced this policy as a key element of its plans to revive the NHS. However, it could face opposition from the Treasury because of how much it would cost, according to the Times, which reported on the plan.

The NHS in England alone is short of 133,000 staff – equating to about a tenth of its workforce – including 47,000 nurses and 9,000 doctors, according to the most recent official figures.

There are also shortages of midwives, paramedics and operating theatre staff. Staff groups say routine gaps in NHS care providers’ rotas are endangering patients’ safety, increasing workload and costing the service money.

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Source: The Guardian, 22 February 2023

 

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‘Institutionalised’ staff ‘perpetuating long hospital stays’

Nearly half of NHS patients with a learning disability or autism are still being kept inappropriately in hospitals, several years into a key programme to reduce inpatient care, a national review reveals.

The newly published review by NHS England suggests 41% of inpatients, assessed over an eight-month period to May 2022, should be receiving care in the community.

Reasons given for continued hospital care in the NHSE review included lack of suitable accommodation, with 19% having needs which could be delivered by community services; delays in moving individuals into the community with appropriate aftercare; legal barriers, with one region citing “ongoing concerns for public safety” as a barrier for discharge; and no clear care plans.

In some cases, individuals were placed in psychiatric intensive care units on a long-term basis, because “there was nowhere else to go”, while another instance cited a 20-year stay in hospital.

Other key themes included concerns about staff culture, particularly “institutionalisation” and suggestions that discharge delays were not being sufficiently addressed.

The report adds: “While the process around discharge can be time consuming, staff may perpetuate this by accepting such delays as necessary or inevitable.”

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Source: HSJ, 22 February 2023

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Wearable fitness trackers could interfere with cardiac devices, study finds

Wearable fitness and wellness trackers could interfere with some implanted cardiac devices such as pacemakers, according to a study.

Devices such as smartwatches, smart rings and smart scales used to monitor fitness-related activities could interfere with the functioning of cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter defibrillators (ICDs), and cardiac resynchronisation therapy (CRT) devices, the study published in the Heart Rhythm journal found.

Researchers found that the electrical current used in wearable smart gadgets during “bioimpedance sensing” interfered with proper functioning of some implanted cardiac devices from three leading manufacturers.

 Lead researcher, Dr Benjamin Sanchez Terrones, of the University of Utah. said the results did not convey any immediate or clear risks to patients who wear the trackers. However, the different levels of electrical current emitted by the wearable devices could result in pacing interruptions or unnecessary shocks to the heart. Further research was needed to determine the actual level of risk".

“Our research is the first to study devices that employ bioimpedance-sensing technology as well as discover potential interference problems with CIEDs such as CRT devices. We need to test across a broader cohort of devices and in patients with these devices. Collaborative investigation between researchers and industry would be helpful for keeping patients safe,” Sanchez said.

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Source: The Guardian, 22 February 2023

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Prostate cancer screening breakthrough as harms linked to testing reduced

Prostate cancer screening may be a step closer after a study suggested that harms linked to testing have reduced thanks to advances in medical technology.

Screening for prostate cancer has been heavily debated in medical circles due to potential harms including side effects from biopsies and unnecessary testing for those with no clinically significant cancer.

A new study set out to examine whether the “seesaw has been tipped” in favour of screening.

Researchers from Prostate Cancer UK combined the results of the latest clinical trials and real-world data on the “prostate cancer screening pathway” to examine the risk-to-harm benefit.

Prostate Cancer UK said that on average 67%t fewer men experienced harm during the diagnostic process with the newer techniques compared with older methods.

Prostate Cancer UK said the UK National Screening Committee, which makes recommendations to the Government, is to re-examine prostate cancer screening.

Dr Matthew Hobbs, lead researcher on the analysis and director of research at Prostate Cancer UK, said: “We’ve known for some time now that testing more men reduces prostate cancer deaths, but there have always been concerns about how many men would be harmed to achieve this.

“However, our evidence shows that screening may now be a lot safer than previously thought. That’s why we are so pleased that the committee is going to review the evidence once more.

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Source: The Independent, 23 February 2023

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Lack of private sector help putting elective target at risk, says trust

An acute trust and its integrated care system have said they risk missing the imminent waiting list target, after struggling to get as many patients treated in the independent sector as they hoped.

University Hospitals of North Midlands Trust and Staffordshire and Stoke-on-Trent ICS have found that some patients who had earlier been referred to independent providers, had then, while waiting for IS treatment, got sicker or became high risk to such an extent that they needed to be referred back to UHNM.

Other patients have declined being transferred to the independent sector, board meetings heard. 

Phil Smith, chief delivery officer at Staffordshire and Stoke-On-Trent Integrated Care Board, told its meeting last week he needed to “flag an escalated risk” to meeting the target, after deterioration in activity “linked to industrial action, linked to the willingness of patients to be treated in the independent sector and the independent sector’s ability to treat patients”.

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Source: HSJ, 22 March 2023

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Record levels of NHS staff seek mental health help in crisis deemed ‘worse than pandemic’

Record levels of NHS staff are seeking mental health help as clinicians warn the “crisis” facing workers is “worse than the pandemic”.

Hundreds of staff are being referred to the specialist mental health service, NHS Practitioner Health, with 842 workers referred in October 2022 – up from 534 in the same month the year before and 371 in 2020.

Around 40% of the staff seeking the service are GPs and 50% are hospital doctors.

The news comes as The Independent reported that the NHS and government are set to axe funding for 40 mental health hubs set up for health and social care workers following the pandemic.

Amandip Sidhu, of Doctors in Distress, which offers workers mental health support, said: “Health workers believe that the crisis they are currently dealing with is worse than during the pandemic and exacerbated by the fact there is no end in sight, with little evidence that decision-makers are taking steps to improve the situation.

“The fact that the public, their patients, lack sympathy or understanding is making many medics feel isolated and completely unappreciated.”

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Source: The Independent, 23 February 2023

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White candidates still 50% more likely to be recruited, says new NHSE data

White applicants remain 54% more likely to be appointed from NHS job shortlistings compared to ethnic minority candidates, a metric that has hardly budged since 2016, a NHS England report has revealed.

The 2022 NHS workforce race equality standard report, revealed a significant rise in the proportion of staff from ethnic minority backgrounds. And while there had been progress on some key targets since last year, others have stagnated.

NHSE’s report showed ethnic minority staff comprise 24.2% of the workforce in 2022, up from 22.4% last year and from 17.7% six years ago.

However, it also revealed the likelihood of white applicants being appointed from shortlists was 1.54 in 2022 than minority ethnic applicants – only a very small improvement on 1.57 in 2016, when WRES began

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Source: HSJ, 22 February 2023

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Trust ‘missed opportunities’ to prevent sex offender working as locum

A trust has admitted it ‘missed opportunities’ to identify that a locum doctor – who was arrested on hospital premises for two sexual offences — had already been cautioned for indecent exposure.

Salman Siddiqi admitted two offences – attempting to engage in sexual communication with a child and attempting to arrange or facilitate a meeting with a child for sexual offences – last month.

East Kent Hospitals University Foundation Trust, where he was working as a locum paediatric registrar at the time of the January offences, has now said there had been “missed opportunities” to identify his previous caution.

Chief medical officer Rebecca Martin told HSJ the trust had taken steps to ensure that these missed opportunities could not happen again. She said in a statement: “This includes standardising DBS checks for temporary workers booked through an agency and escalating all DBS and General Medical Council checks that feature conditions, cautions or warnings.”

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Source: HSJ, 23 February 2023

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Ethnic minority Covid death gap closes

People from ethnic minority backgrounds are no longer significantly more likely to die of Covid-19, new Office for National Statistics (ONS) data shows.

Early in the pandemic, deaths involving coronavirus were higher among black and Asian people than white people, with the highest risk among Bangladeshi, Black Caribbean and Pakistani groups.

Covid mortality rates for all ethnic minorities decreased last year. The latest data shows there is no significant statistical difference between the number of Covid deaths among ethnic minorities and the white population.

The ONS also said that "all cause" mortality rates - measuring how likely people are to die of any cause, including Covid-19 - have returned to pre-pandemic patterns.

The reasons for this change are complex, and experts say there are "various factors" to consider.

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Source: BBC News, 22 February 2023

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Laughing gas users risk spine damage, say doctors

Doctors at an east London hospital say they are seeing so many risky cases of laughing gas misuse that they have drawn up treatment guidelines for colleagues in the UK.

Nitrous oxide, sold in metal canisters, is one of the most commonly used drugs by 16 to 24-year-olds.

Heavy use can lead to a vitamin deficiency that damages nerves in the spinal cord.

The Royal London Hospital team say medics need to be on alert.

They have been seeing a new case almost every week.

The guidelines, endorsed by the Association of British Neurologists and written with experts from Manchester, Birmingham, Nottingham and the Queen Mary University of London, warn doctors what to look for and how to treat.

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Source: BBC News, 23 February 2023

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Messages and challenge to all participants of the 5th Global Ministerial Patient Safety Summit 2023

Ahead of the 5th Global Ministerial Patient Safety Summit 2023 in Switzerland, the World Patient Safety Epicentre shares three messages and one challenge to the participants attending. 

1. Please think about changing the term Patient Safety to Safety in Healthcare.

2. Please consider creating a World Patient Safety Epicentre Safety, People Solutions – Network and Center(s) of Safety in Healthcare Change,

3. Please invite two people to the discussion.

4. One challenge - Let’s save 155 patients by 17 September 2023 in each country.

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NHSE wrongly dismissed discrimination claim from black nurse, tribunal finds

NHS England has lost an employment tribunal case against a senior black nurse on grounds of race discrimination and whistleblowing, and has been criticised for serious flaws in its own investigations.

A judgement published today found Michelle Cox, a black woman who was an NHS continuing healthcare manager based in NHSE’s North West regional team, was excluded by her manager “at every opportunity”.

The case centres on problems between Ms Cox and her line manager, then regional head of continuing healthcare, which took place from around April 2019 to November 2020.

The tribunal ruled Ms Cox's line manager– who is now an associate director of nursing in the West Yorkshire integrated care system – had created an “intimidating and hostile and humiliating environment” for Ms Cox, which had the purpose and effect of unlawful harassment.

The tribunal also upheld Ms Cox’s complaint of detriment for whistleblowing, including for raising concerns that members of her team were sitting on continuing healthcare “independent review panels”, which she pointed out was a breach of independence and legal obligations.

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Source: HSJ, 22 February 2023

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USA: Investigation spotlights rise of for-profit ethics boards in research

A US government watchdog called for greater federal oversight of ethics boards that sign off on scientific studies, finding that for-profit companies have taken an outsize role in approving certain research and questioning whether financial motivations could put human subjects at risk.

Federal regulations require that certain research on human subjects — including those testing the safety of new drugs — first get approval from a registered institutional research board. These boards, which are made up of at least five members and can include researchers and academics, are designed to make sure that a study poses as little risk as possible and that participants have enough information to give consent.

While the majority of these boards are affiliated with universities, a small number have no affiliation with institutions conducting research. But according to a new report from the U.S. Government Accountability Office (GAO), these independent boards now account for the largest share of reviews of studies involving new drugs and biologics.

The GAO found that federal agencies overseeing the ethics panels inspect relatively few of them and lack ways to evaluate how well they protect people participating in research.

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Source: The Washington Post, 16 February 2023

 

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Derby maternity deaths may have been prevented

Three women who died under the care of a hospital's maternity unit may have survived if earlier recommendations had been implemented, a report has said.

The cases occurred at University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust over 16 months.

A review by the Healthcare Safety Investigation Branch (HSIB) also found a culture of intimidation and bullying.

The report found that although there was no common theme to the deaths - and four other life-threatening cases that occurred in the same period - processes and leadership had been inconsistent and fragmented.

HSIB said "robust action planning and prompt addressing of the learning" from previous recommendations from other investigations "may have had an impact on the outcome for the women who received care during the seven events included in this thematic review".

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Source: BBC News, 22 February 2023

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Suicidal NHS staff left in ‘dangerous limbo’ as mental health help ends

Suicidal NHS staff will be left in “dangerous” situations without support when national funding for mental health hubs ends next month, health leaders have warned.

The hubs, set up with £15 million of government funding for NHS workers following Covid, are being forced to close or reduce services as neither the Department for Health and Social Care nor the NHS has confirmed ongoing funding for 2023-24.

This will leave thousands of NHS staff, some of whom are described as “suicidal” in “complete limbo”, The Independent has been told.

The British Psychological Society (BPS) and the Association of Clinical Psychologists (ACP) said the failure to continue the funding was an “irresponsible” way to treat vulnerable health and care workers.

Professor Mike Wang, chair of ACP, said: “There is a clinical responsibility, not to remove a service from individuals who are vulnerable, and in difficulty … the problem with that is that the funding ceases at the end of March and that’s absolutely no time at all to make any [future] provision. So, it’s clinically irresponsible to simply halt a service. Some of these individuals are, you know, carrying suicide risk.”

He said it was “dangerous” and “astonishing” that funding for the hubs was ending “given the present circumstances of continuing effects of the pandemic, clear evidence of underfunding of health care in this country”.

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Source: The Independent, 22 February 2023

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London Ambulance lagging behind on diversity and must improve, bosses warned

The London Ambulance Service (LAS) failing on diversity and must implement specific targets for improvements, its leadership has been warned.

According to LAS data, just 20% of the workforce is from a Black, Asian or from a minority ethnic background despite almost half of the capital’s population (46.2%) being made up of non-white communities.

Of that 20%, 40.9% are in the lowest paid roles, compared to 15.9% who are in the highest wage bands, according to the LAS’ Integrated Performance report.

The LAS is in the process of developing a new strategy to help attract more diverse staff, which will be published early next year.

Research shows that ethnic minority groups suffer disproportionately higher levels of inadequate ambulance care due to a combination of issues such as a lack of cultural awareness among professionals, language and communication difficulties and a limited understanding of how the healthcare system operates for some minority groups.

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Source: The Independent, 21 February 2023

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Nurses set for 'intensive' talks with government after strike paused

Health Secretary Stephen Barclay is to meet Royal College of Nursing bosses for pay talks later, after the union suspended next week's planned strike.

In a joint statement, after months of bitter dispute, the two sides said they would begin "intensive talks" on "pay, terms and conditions" and "reforms to enhance productivity".

Next week's walkout in England, from 1 to 3 March, was set to be the biggest strike of this winter's pay dispute, with half of frontline services affected.

The action would have included nursing staff from intensive care units, cancer care and other services that were previously exempted.

RCN general secretary Pat Cullen said: "We will put our plans on the table, they can put their plans on the table - but I'm confident that we will come out with a fair pay settlement for our nursing staff."

She added they would make sure no stone was left unturned and a fair pay deal was reached as quickly as possible so they could end the strikes.

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Source: BBC News, 22 February 2023

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Patient safety put 'at risk' by crumbling NHS hospitals in desperate need of repair

Doctors have warned that patient safety is being put at risk by the state of crumbling NHS hospitals which have fallen into potentially dangerous disrepair, an ITV News investigation has found. 

Year-long leaks, collapsing floors, ageing roofs and potential for falling stone are among the issues exposed in the investigation - which have caused whole wards to be closed down. 

One doctor told ITV News conditions are so poor in hospitals she has worked in that “we are always just hoping that the next time something happens it does not cause something catastrophic.”Half of the 87 hospital trusts in England that responded to our Freedom of Information requests had at least one unresolved structural or maintenance issue, as of October 2022.

Footage shared with ITV News by staff working in NHS hospitals lays bare some of the appalling conditions doctors are forced to treat patients in every day.

Some leaks have been so severe they flood and close entire corridors, while some wards have become so unsafe they have been permanently shut.

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Source: ITV News, 22 February 2023

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NHSE set for £400m dentistry underspend despite ‘access crisis’

The national dentistry budget is set to be underspent by a record £400m this year, due to a shortage of dentists willing to take on NHS work, HSJ has learned.

The situation is understood to have prompted major concerns in the senior ranks of NHS England, and calls for a “fundamental rethink” of the much-maligned primary dental care contract.

The unspent funding is due to be used to plug budget deficits in other services and comes as patients in many areas struggle to access NHS dentistry. Healthwatch England described the estimated underspend as an “absolute scandal”.

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Source: HSJ, 21 February 2023

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‘One in five’ patient referrals bounced back to GPs, warns watchdog

A new report has condemned ‘serious issues’ with NHS referral processes, amid findings that one in five patient referrals made by GPs went into a ‘black hole’.

Healthwatch England said that 21% of people they spoke to with a GP referral to another NHS service were rejected, not followed up on or sent back to general practice.

The watchdog said that more support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to ‘communication failures’ following a referral.

According to the findings, the failures were due to GP teams not sending referrals, referrals going missing between services, or being either booked or rejected by hospitals without any communication.

Louise Ansari, Healthwatch England’s national director, said that thousands of people told the watchdog that the process is ‘far from straightforward.’

She said: "Falling into this “referrals black hole” is not just frustrating for patients but ultimately means people end up going back to their GP or visiting crowded A&E departments to get the help they need.

"This adds more burden to already stretched services, making things even harder for the doctors and nurses trying to provide care."

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Source: Pulse, 20 February 2023

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Donor organs should be allocated by need, not geography, report recommends

Donor organs should no longer go to the nearest in-need patient, an official report has recommended. 

Instead, specialised organ centres across the country will be responsible for preserving, repairing and matching an organ with the most needy individual on the transplant register, irrespective of location.

An official report commissioned by the Department for Health and Social Care and headed up by Prof Stephen Powis, the national medical director for England, has recommended 12 changes to further improve donation. 

Among the recommendations – which have been backed by the Government and are expected to be implemented in the coming weeks – is equal access to organ donation services “irrespective of personal circumstances, including ethnicity, geography, socio-economic status or sex”.

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Source: The Telegraph, 21 February 2023

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HRT: Around 400,000 women to receive cheaper menopause treatment

Hundreds of thousands of women could benefit from cheaper hormone replacement therapy (HRT) as part of a scheme to cut prescription costs.

The Department of Health said that from April, women prescribed HRT as part of menopause treatment will be able to access a new scheme to enable access to a year’s worth of treatment for just under £20.

The announcement follows the publication of the government’s women’s health strategy for England last summer.

Minister for Women Maria Caulfield said: “Around three-quarters of women will experience menopause symptoms, with one-quarter experiencing severe symptoms, which can seriously impact their quality of life.

“Reducing the cost of HRT is a huge moment for improving women’s health in this country, and I am proud to be announcing this momentous step forward.

“In our Women’s Health Strategy, we made menopause a top priority – by making HRT more accessible, we’re delivering on our commitment to women.”

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Source: The Independent, 21 February 2023

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Children’s surgery backlog grows as NHS prioritises adult waiting lists

Hundreds of thousands of children are waiting for surgery as new figures show the backlog has spiralled by almost 50 per cent in two years.

The latest NHS data for December lays bare the parlous state of paediatric medicine, with NHS leaders and doctors warning that adult care is being prioritised over children’s.

In December 2022, 364,000 children were waiting for treatment, from neurosurgery to ear, nose and throat operations, while a further 200,000 needed community services such as speech and language therapy.

The surgery figure is up by 48%t since April 2021 – a far bigger increase than was seen in the overall NHS waiting list, which grew by 36% over the same period.

Mike McKean, vice-president of policy at the Royal College of Paediatrics and Child Health, said “Lengthy waits are unacceptable for any patient, but for children and young people, waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage. It is not the same as for adults. If you miss the right window to treat a child, or wait too long, the consequences can be irrevocable.”

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Source: The Independent, 19 February 2023

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