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Patients in England not collecting NHS prescriptions because of cost

Rising numbers of patients in England are failing to collect their medicines or asking pharmacists which ones they can “do without” because they cannot afford prescription charges, a survey shows.

NHS prescriptions are free in Scotland, Wales and Northern Ireland. In England there are exemptions for certain items, medical conditions and specific parts of the population, but most adults have to pay. The current prescription charge is £9.35 an item.

“We are deeply concerned that people are having to make choices about their health based on their ability to pay,” said Thorrun Govind, a pharmacist and chair of English pharmacy board of the Royal Pharmaceutical Society (RPS), which conducted the survey. “No one should have to make choices about rationing their medicines and no one should be faced with a financial barrier to getting the medicines they need.”

The findings, from a survey of 269 pharmacies, prompted the RPS to renew its call for patients with long-term conditions in England to get free prescriptions. Charges create a financial barrier to accessing medicines needed to stay well, it said.

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Source: The Guardian, 13 February 2023

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Some ambulance callers to be told go elsewhere

A new way of screening ambulance calls is to be introduced across England in an effort to improve response times.

NHS England is asking ambulance crews to review which emergency calls other than those classed as immediately life threatening can be treated elsewhere.

The calls - known as category two - include emergencies such as heart attacks and strokes. But the category also covers some that may not need such a fast response, such as burns and severe headaches.

About 40% of these lower priority calls classed as category two by call handlers will now receive callbacks from a doctor, nurse or paramedic to see whether there is an alternative to sending an ambulance.

In trials in London and across the West Midlands, nearly half of those receiving a callback were advised to go instead to an urgent treatment clinic, their GP or a pharmacist. NHS England is now asking the other eight ambulance services in England to adopt the approach. 

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Source: BBC News, 16 February 2023

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NHS signs nationwide £20m deal for ‘electronic infection control’ systems

The NHS has signed a £20m deal to enable health-service organisations to deploy technology to help better manage the spread of infections.

The contract – awarded to US-based healthcare giant Baxter – is intended to offer NHS trusts a means through which they can buy a comprehensive infection-control platform. According to newly published commercial information such a system would, in many cases, replace various specialist software programmes used by NHS trusts to collect and process data, alongside spreadsheets and paper documents.

“The system will support infection prevention and control activities to identify critical issues, proactively respond to improve the quality of care and streamline processes to reduce time spent on administrative and reporting tasks,” the contract notice said. 

“Most NHS Trusts tend to manage infection control surveillance through the use of various systems, collating laboratory, patient and surgery data and manually searching through the data to identify patients of interest or complex scenarios. Paper and excel spreadsheets are also used to record and manage surveillance. This process is time consuming and risk of error.  NHS trusts are finding that they do not have a robust infection control system to monitor and manage their patients.”

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Source: Public Technology, 15 February 2023

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NHS strikes force thousands to wait 18 months for surgery as flagship target to be missed

Thousands of patients are being forced to wait more than 18 months for treatments such as knee and brain surgery as the health service is set to miss its flagship target because of NHS strikes.

NHS England last week claimed it was “on track” to hit the mandated target, but senior sources have warned that the impact of prolonged walkouts combined with unprecedented demand for emergency care means that this is now unlikely.

The sources say it is probable that up to 10,000 patients will still be waiting for 18 months or more by the end of March, as a knock-on effect of the cancellation of 140,000 appointments because of strike action. More walkouts are planned over the coming weeks.

Patricia Marquis, RCN director for England, said the backlog was “yet even more evidence of what happens when you fail to invest in the workforce. If ministers are serious about preventing a further exodus and cutting the backlog, they need to hear the calls of NHS leaders and come to the table and talk about pay. Only then will patients receive the care they need and waiting lists start to come down.”

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Source: The Independent, 15 February 2023

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GPs now dealing with up to 3,000 patients each as staff shortages worsen

GPs are attempting to deal with up to 3,000 patients each, amid worsening staff shortages, according to new analysis commissioned by the Liberal Democrats.

The research shows that the number of patients per GP has risen sharply, as rising numbers of doctors reduce their hours, or opt for early retirement. The figures, which track the number of “full-time equivalent” fully qualified GPs, show the number has fallen from 29,320 in 2016 to 27,372 last year. The trend follows a rise in part-time work, with the average GP now working a three-day week. 

On average, there are now 2,273 patients per fully qualified doctor, up from 1,981 in 2016, the research commissioned by the Liberal Democrats shows. While the total number of GPs fell by almost 2,000, the number of registered patients grew from 58 million to 62.2 million, according to the House of Commons Library.

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said the research “shows yet again how GPs and our teams are working above and beyond to deliver care to an ever-growing patient population, with falling numbers of fully qualified, full-time equivalent GPs.”

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Source: The Telegraph, 14 February 2023

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NHS fined £180,000 after vulnerable patient’s death

A health board has been fined £180,000 for failing to protect a vulnerable pensioner who died after repeatedly falling in hospital. Colin Lloyd, 78, was assessed as posing a high risk of falling and required one-to-one care after being admitted to Raigmore Hospital in Inverness.

Despite repeated requests for more nursing staff none were made available and the pensioner suffered falls on the ward, which caused fatal injuries.

Fiona Hogg, NHS Highland’s director of people and culture, said: “We are deeply sorry for the failures identified in our care. Our internal review following the incident identified several areas of improvement and we have made a number of changes to our practice.”

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Source: The Times, 15 February 2023

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Exhausted doctors shun out-of-hours services

The number of GPs seeing patients outside standard surgery hours in Scotland has dropped by almost a quarter in three years.

Nurses and paramedics have had to fill in for doctors in the out-of-hours urgent care centres because GPs could not be found to cover the shifts. Some health boards have had to close their centres and send patients to overstretched A&Es instead because of the GP shortage.

Dr Andrew Buist, chairman of the British Medical Association’s Scottish GP committee, said, “Patient demand is outstripping GP capacity across the whole service, including out-of-hours. We simply do not have enough GPs in Scotland. Those who are working in out-of-hours may be doing more hours now than they perhaps did in 2019 which comes as no surprise if there are fewer GPs to go around but it is unsustainable and puts those working in the service at risk of exhaustion and burnout.”

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Source: The Times, 15 February 2023

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NHS private sector plan risks safety and ‘poaches’ staff, doctors warn

Healthcare leaders have been warned by nearly 200 doctors that plans to give more work to private hospitals will “drain” money and staff away from NHS services, leaving the most ill patients at risk.

In a letter seen by The Independent, almost 200 ophthalmologists urged NHS leaders to rethink plans to contract cataract services to private sector hospitals, as to do so “drains money away from patient care into private pockets as well as poaching staff trained in the NHS”. The doctors have called for “urgent action” to stop a new contract from being released, which would allow private sector hospitals to take over more cataract services.

Professor Ben Burton, consultant ophthalmologist and one of the lead signatories of the letter, said, “What is needed is a long-term sustainable solution rather than a knee-jerk reaction which risks the future of ophthalmology as an NHS service. The long-term solution will be achieved by investing in NHS providers to deliver modern, efficient care, and the private sector only used as a last resort.”

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Source: The Independent, 10 February 2023

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According to medical guidelines, your doctor needs a 27-hour workday

Some doctors say that however reasonable guidelines may seem, their cumulative burden causes “constant frustration” to medical practice.

A team of doctors wrote a study last year for the Journal of General Internal Medicine which suggested that if an American doctor followed all of the guidelines for preventive, chronic and acute disease care issued by well-known medical groups, it would require nearly 27 hours per day.

Guidelines have become “a constant frustration,” said Dr. Minna Johansson, a general practitioner in Uddevalla, Sweden, who also directs the Global Center for Sustainable Healthcare at the University of Gothenburg. “A lot of guidelines may seem reasonable when considered in isolation, but the cumulative burden of all guideline recommendations combined is absurd.”

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Source: New York Times, 14 February 2022

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Trusts abandon renewable electricity commitment

Around half of the largest trusts are not buying all their electricity from renewable sources despite a national requirement to do so, as prices of this type of energy rocket.

NHS England previously committed to the service purchasing only renewable energy from April 2021, as part of efforts to meet its target to be net zero for emissions it can control–including electricity–by 2040.

However, NHSE information seen by HSJ shows that nine of the largest 20 trusts have not been buying 100 per cent renewable electricity this financial year, amid soaring costs. Several trusts told HSJ they had abandoned previous decisions to only use electricity which was “guaranteed” to be renewable.

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Source: HSJ, 15 February 2023

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Service in ‘very distressing’ state after 19 deaths

The author of a Parliamentary report into ‘failing’ eating disorder services in 2017 says the number of concerning deaths still being reported five years on is ‘very distressing’.

In the five years since ombudsman Rob Behrens warned of major shortcomings around adult eating disorder services, HSJ has identified at least 19 women whose deaths sparked concerns from coroners about their care (see list below). At least 15 of these were deemed avoidable, and resulted in formal warnings being issued to mental health chiefs.

Source: HSJ, 14 February 2023

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Now for sale: Data on your mental health (Washington Post)

Capitalizing on the pandemic explosion in telehealth and therapy apps that collect details of your mental health needs, data brokers are packaging that information for resale, a new study finds. There’s no law stopping them.

In a study published Monday, a research team at Duke University’s Sanford School of Public Policy outlines how expansive the market for people’s health data has become.

After contacting data brokers to ask what kinds of mental health information she could buy, researcher Joanne Kim reported that she ultimately found 11 companies willing to sell bundles of data that included information on what antidepressants people were taking, whether they struggled with insomnia or attention issues, and details on other medical ailments, including Alzheimer’s disease or bladder-control difficulties.

Justin Sherman, a senior fellow at Duke who ran the research team, says that mental health data should be treated especially carefully, given that it could pertain to people in vulnerable situations — and that, if shared publicly or rendered inaccurately, could lead to devastating results.

Source: Washington Post, 13 February 2023

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One in three women with female health conditions forced to wait three years for diagnosis

A third of those with a women’s health condition have been made to wait three years or longer for a diagnosis, damning new research has revealed.

The same study found half of those women took a year or more to be given their diagnosis.

Srdjan Saso, a consultant gynaecologist and surgeon who works with King Edward VII’s Hospital, told The Independent: “A delayed diagnosis can mean a severe impact on quality of life both professionally and personally.

“It can have a significant impact on a woman’s day-to-day life and hence needs to be addressed properly and seriously. From a more sinister perspective, in certain cases, it can be cancer and we are picking it up late.”

Source: Independent, 14 February 2023

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Hospitals in England with worst A&E waits revealed

A&E waiting times have deteriorated so much this winter that at some hospitals in England more than half of patients have had to wait more than four hours.

BBC analysis of data for December and January shows Hull University Hospitals, Wye Valley and Shrewsbury and Telford were worst for A&E waits.

The best trust out of the 107 providing data, Northumbria Healthcare, had fewer than 10% waiting more than four hours.

NHS England said plans were being put in place to support struggling trusts.

Source: BBC, 13 February 2023

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Virtual wards set up ‘to save A&E’ only staffed 12 hours a day

Virtual wards, set up to relieve pressure on A&E departments, could create extra NHS demand as some are only staffed for 12 hours a day, the country’s top emergency doctor has warned.

The service allows patients to be monitored remotely from their own homes, freeing up hospital beds and capacity in emergency departments.

Patients are given devices to track their vital signs, such as blood pressure and oxygen levels, with readings sent back to doctors via smartphone apps.

Dr Boyle, President of the Royal College of Emergency Medicine, said that virtual wards “must not be seen as a silver bullet for all the problems in urgent and emergency care”.

“We’re very wary of virtual ward beds being used to say that there are increased beds within hospitals because that’s simply not true,” he said. “The plan for 7,000 or 5,000 extra beds need to be actual beds, with pillows, sheets and staff looking after them.”

Source: Telegraph, 11 February 2023

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GPs now dealing with up to 3,000 patients each as staff shortages worsen

GPs are attempting to deal with up to 3,000 patients each, amid worsening staff shortages, according to new analysis.

The research shows that the number of patients per GP has risen sharply, as rising numbers of doctors reduce their hours, or opt for early retirement.

Daisy Cooper, spokeswoman for Liberal Democrat Health and Social Care, said:

“This ever-worsening GP shortage is having a terrible human cost, as people face delayed or missed diagnoses and A&Es fill up with desperate patients looking for treatment."

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Source: Telegraph, 14 February 

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Colorectal A&G pathway has been ‘barrier’ to cancer diagnoses, GPs warn

GPs have raised concern about a new colorectal cancer pathway aimed at reducing referrals into one of England’s largest acute hospital trusts.

The pathway was implemented in December 2022 to tackle long waiting lists at United Lincolnshire Hospitals Trust (ULHT) by reducing the number of referrals from primary care. 

But the Lincolnshire LMC and Primary Care Network Association both raised concerns about the pathway and its impact on general practice in a letter to their ICB earlier this month.

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Source: Pulse, 13 February 

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Chronic UTI sufferers face mental health crises after being ‘dismissed and gaslighted’ for years

Women suffering from chronic urinary tract infections (UTIs) are facing mental health crises after being “dismissed and gaslighted” by health professionals for years, according to a leading specialist.

Daily debilitating pain has left patients feeling suicidal, with those in recovery describing lingering mental health problems “akin to post-traumatic stress disorder (PTSD)”, said Dr Rajvinder Khasriya, an NHS consultant urogynaecologist at the Whittington Hospital in London.

Patients have said they feel crippling anxiety over planning ahead to ensure there is always a toilet around, even after their condition has been controlled with treatment. 

Vicky Matthews, who searched for a diagnosis for three years after a recurrent UTI became chronic, said the condition caused a “gradual decline” in her mental health as medical professionals were unable to pinpoint what was causing her pain.

"I questioned my pain. I questioned what was going on. I questioned whether it was actually real and that was a pretty awful thing to be dealing with on top of having physical pain,” the 43-year-old said, describing what she felt was “mental torture”.

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Source: I News, 12 February 

Further reading on the hub

The clinical implications of bacterial pathogenesis and mucosal immunity in chronic urinary track infection

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Delayed discharges rise in 17 ICSs despite Barclay’s £250m fund

A high-profile £250m government intervention to free up hospital beds has so far failed to deliver any significant reduction in delayed discharges – with multiple systems instead reporting large increases.

Steve Barclay announced the fund, including £200m to buy step-down residential care beds to speed up discharges, on 9 January, following a “recovery forum” crisis summit at 10 Downing Street.

NHS England said in guidance on 13 January the funding must bring “immediate improvements”, and local leaders were again told to “maximise the impact of their areas’ allocation of the money in the run up to strikes on 6 February”. 

But according to official data, in the week the new money was announced, there was an average of 14,035 patients who did not meet the clinical “criteria to reside”, but were still waiting to leave hospital, equating to around one in seven occupied beds. The total numbers have barely changed since then, with an average of 13,975 cases reported in the week to 5 February, also representing one in seven occupied beds.

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Source: HSJ, 13 February 2023

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‘A growing threat to human health’: we are ill-equipped for the dangers of fungal infections

About 2 million people die a year as a result of a core group of fungi, and the WHO is concerned we are unprepared for the future.

In October, the World Health Organization released its fungal priority pathogens list, the first global effort to create a mycological “most wanted” list of the 19 fungi most dangerous to humans . “Despite posing a growing threat to human health, fungal infections receive very little attention and resources globally,” the report said. “This all makes it impossible to estimate the exact burden of fungal infections, and consequently difficult to galvanise policy and programmatic action.”

Fungi are the most populous life form on the planet, with an estimated 12 million species existing worldwide. Only a fraction of these species infect humans, but they are responsible for roughly a billion infections each year. “Most of those are superficial things like athlete’s foot, that no one’s particularly bothered about, but there is a core group that causes life-threatening infections, and particularly in susceptible populations such as the very old or young, and those with immune systems that don’t work properly,” says Mark Ramsdale, an associate professor of mycology at the MRC Centre for Medical Mycology in Exeter.

About 1.5 million people die a year as a result of these infections, says Ramsdale – although that may be an underestimation, because fungi predominantly infect people who already have major health problems. “The primary cause of death will probably be leukaemia or heart transplant, or whatever,” he says. “But the thing that actually kills the patient is a fungal infection, so there is a strong element of underreporting going on.”

Underestimating them would be a mistake.

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Source: The Guardian, 10 February 2023

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The moment I knew something was wrong at the Tavistock

A damning report last year from Dr Hilary Cass into the Tavistock Gender Identity Development Service (GIDS) found that it was putting children at “considerable risk”. Her full report is due to be published later this year.

Whistleblower Dr Anna Hutchinson, a senior clinical psychologist at GIDS, describes when she realised something was very wrong.

“I just couldn’t comfortably keep being part of a process that was, I felt, putting children — but also my colleagues — at risk,” Hutchinson explains. Faced with no discernible action from the executive, staff began to look for other ways to raise their concerns, to other people who might listen — and act. Hutchinson approached the Tavistock’s Freedom to Speak Up guardian. At least four other colleagues did the same in 2017. That same year, another four clinicians took their concerns outside GIDS to the children’s safeguarding lead for the Tavistock trust."

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Source: The Times, 13 February 2023

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First patient in UK fitted with sensor to give early heart failure alert

A heart failure patient has become the first in the UK to be fitted with an early warning sensor the size of a pen lid which gives off an alert if their condition deteriorates.

Consultant cardiologists Dr Andrew Flett and Dr Peter Cowburn have pioneered the procedure to fit the FIRE1 System during trials at University Hospital Southampton (UHS), Hampshire.

Dr Flett said: “This innovative new device has the potential to improve patient safety and outcomes in the management of patients with chronic heart failure and we are delighted to be the first site in the UK to implant as part of this ground-breaking study".

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Source: The Independent, 12 February 2023

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Failure to root out abusers in ambulance service leaves vulnerable patients at risk, watchdog warns

Emergency patients are being left open to abuse when they are at their most vulnerable because of a lack of vetting of ambulance workers, watchdog officials have warned.

One watchdog official warned that abusers would even seek out work as a paramedic because it provided an “attractive environment” for exploitation.

Figures show that dozens of ambulance workers have faced action over sexual assault in the past two years, while paramedics account for one in three cases of tribunal action against care professionals. But one survivors’ group warned the figures were just the “tip of the iceberg”.

Paramedics who have been struck off in the past two years include one who performed a sex act in front of a patient, while another was handed a suspended prison sentence for possessing thousands of images of child pornography.

Helen Vine, special adviser to the Care Quality Commission, told a recent webinar: “There is a small proportion of the population who are seeking to abuse our patients and the ambulance can be an attractive environment for that type of individual. One of the reasons for this is the ambulance sector is predominantly lone working … and ambulance services offer privileged often unsupervised access to patients who can be very vulnerable".

She said the lack of checks meant offenders were able to move between providers, adding: “They test the waters and their behaviours ... if they are challenged, they will move on, however, if they are not challenged then they can hide in plain sight, and they are wearing a trusted uniform and given responsible access to that patient group.

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Source: The Independent, 12 February 2023

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Striking ambulance staff must cover all ‘emergency’ calls, say ministers

Ambulance staff will need to respond to category 2 calls during strike action under new government proposals.

The Department of Health and Social Care has launched a consultation on minimum service levels in ambulance services. It comes as industrial action continues across the NHS and as legislation to ensure minimum services levels in key industries during strikes is making its way through Parliament. 

The consultation document read: “Our proposal is that calls classed as life-threatening and emergency incidents would always receive an appropriate clinical response when there is strike action.

“In England, currently, these calls are classified as category 1 (immediately life-threatening) and category 2 (emergency) calls…

“On strike action days, some workers would continue their work to ensure that these calls can be answered and responded to appropriately to protect the life and health of patients.”

The proposals added services must also have “adequate capacity and resourcing” in call control rooms, to ensure all emergency 999 calls to ambulance services were answered.

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Source: HSJ, 13 February 2023

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NHS consultants run private firms charging to cut waiting lists at their own hospitals

Some of the country’s most senior NHS clinicians are earning a lucrative sideline running private firms that offer to cut waiting lists at their own hospitals, the Observer can reveal.

Top consultants in Manchester, Sheffield and London are among directors of “insourcing” agencies that charge the health service to treat patients at weekends and evenings and have won millions of pounds of work.

Some hold leadership roles at NHS trusts that have awarded contracts to their own companies, raising concerns about potential conflicts of interest.

One deputy medical director jointly ran a firm that provided “insourcing” solutions to his own NHS trust before it was sold in a £13m deal last year. Other consultants have set up firms that they and their colleagues work shifts through themselves, often at rates above NHS price caps.

The Centre for Health and the Public Interest, an independent thinktank,  called for a ban on such arrangements. The General Medical Council said current conflict of interest policies did not always deliver “the transparency and assurance that patients rightly expect”.

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Source: The Guardian, 12 February 2023

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