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  1. Last week
  2. News Article
    A scandal-hit hospital trust has come under fire yet again after advertising for a maternity doctor with "a desire to promote normal birth". Hampshire Hospitals NHS Foundation Trust said it was seeking an obstetrics and gynaecology consultant in its high risk baby unit who would support "active" labour. Yet safe birth campaigners have reacted with fury online, claiming 'normal' has become a codeword for 'natural' birth — a fixation which has led to many midwives frowning on medical intervention and caesareans, even when needed. This 'obsession', they add, has been linked to failures at a number of maternity units in recent years where hundreds of babies died, major inquiries have found. The trust was embroiled in a similar controversy last year after Winchester's Royal Hampshire County Hospital faced a claim of unfair dismissal by a former consultant obstetrician and gynaecologist. Martyn Pitman, who had worked at the hospital for 20 years, was sacked last March after raising concerns about midwifery care and patient safety at the hospital. In a post on X, Catherine Roy linked to the advert, adding: "Where Martyn Pitman used to work. The takeover by normal birth is now complete I think. What a scandal." In response, consultant paediatrician Dr Ravi Jayaram, whose evidence helped catch convicted serial baby-killer Lucy Letby at Countess of Chester Hospital, said: "Anyone who applies for this should be immediately excluded from consideration for the post." He added: "[It] should read 'desire to support and promote safe birth' — if it needed to be said at all." Read full story Source: The MailOnline, 13 June 2024
  3. News Article
    C2.AI has formally launched its Maternity and Neonatal Observatory at the NHS ConfedExpo in Manchester (Government and Public Sector Journal). The observatory is intended to give hospitals and clinicians a detailed picture of the performance of maternity units and the health trajectories of individual women, so areas of concern can be identified and acted on. The system works by calculating and comparing observed outcomes for women and babies with expected outcomes for these individuals. To do this, it uses AI and machine learning to assess clinical factors, case-mix, and the social determinants of health. Early adopters within the NHS, where maternity services are under intense scrutiny, are expected soon.
  4. News Article
    The NHS supply chain contains “absolutely massive” cybersecurity risks which have not “really been talked about”, an integrated care board and trust chair has warned. Lena Samuels, who is chair of two London trusts and of Hampshire and Isle of Wight Integrated Care Board, said: “We’ve been talking internally about our own organisations but we haven’t really talked about the supply chain and the risks within that – and that is absolutely massive.” Ms Samuels, speaking at the NHS Confed Expo conference yesterday, said many NHS organisations still needed to question: “How do our risk registers capture what our supply chain resilience looks like in terms of cyber protection?” She said NHS organisations also needed to be considering “who on my board is going to ask that question” and “whether they’re going to even think of asking that question”, adding: “There’s so much that we’ve got to think about.” Read full story (paywalled) Source: HSJ, 14 June 2024
  5. News Article
    The owner of a group of privately-run children’s mental health hospitals is facing legal action by dozens of former patients, who claim they suffered inhuman and degrading treatement at the facilities. Hospitals formerly run by The Huntercombe Group face at least 54 individual clinical negligence claims, The Independent can reveal. Patients treated within several of the hospitals, now owned by Active Care Group, came forward to solicitors Hutchoen Law following several exposés by this publication, revealing allegations of “systemic abuse.” Documents submitted to Manchester Civil Court on Thursday before Judge Nigel Bird, who will decide if permission is be granted for claims to be brought, revealed allegations including: Assault and battery, relating to the inappropriate and unnecessary forced feedings and physical restraint. False imprisonment. Breaches of the Human Rights Act including prohibition of inhuman and degrading treatment. Read full story Source: The Independent, 13 June 2024
  6. News Article
    The mother of a 13-year-old girl who died of sepsis has said she hopes Martha’s rule, which gives patients and their families the right to a second medical opinion, will “upend” the “hierarchy” on hospital wards. Merope Mills, who campaigned with her husband, Paul Laity, to give families more say regarding care following the death of their daughter Martha, also called for a “mutual respect” between patients and doctors. More than 140 NHS sites in England have agreed to implement Martha’s rule, a patient safety initiative that will give patients and their families round-the-clock access to a rapid review by an independent critical care team from elsewhere in the hospital if they feel their health, or that of a family member, is deteriorating and they are not being listened to. Speaking at NHS ConfedExpo on Wednesday, Mills, an executive editor at the Guardian, said: “My big thing is, I think we need to be more equal. “It’s a very unequal place, a hospital ward, and there’s hierarchy and it’s very steep and it’s very strict. And, you know, when I first started talking about that, I sort of thought the nurses were at the bottom of the hierarchy. “And I refer to that because they didn’t feel that ability to speak up in Martha’s case. But I’ve actually come to realise that the people at the bottom of the hierarchy are the patients. “They are the ones with the least power and I just would like to upend that and just have a sense of mutual respect between doctor and patient.” Read full story Source: The Guardian, 14 June 2024
  7. News Article
    NHS England’s head of patient safety has suggested too much time and resource is being spent on “burdensome” inquiries to investigate failings in the system. Aidan Fowler said national chiefs want to see a shift away from “looking back 10 years and asking ‘what did we miss’”, and instead wants teams to be resolving problems in real time. At trusts where safety concerns have been highlighted, he said “people descend, and there are a lot of asks, and the pressure mounts, and they end up with an action list of hundreds of things, and it becomes very burdensome – we have to avoid that”. Speaking at a session at the NHS Confederation Expo event in Manchester this week, he encouraged organisations to report concerns early so NHSE can respond more quickly, supporting them and working through problems to prevent public inquiries from needing to happen in the first place. Mr Fowler added: “We have to get more proactive. We will spend less of our time in the future, is the plan, than we are now – doing what I call driving in the rear view mirror. “We don’t want to be looking back 10 years and asking, ‘what did we miss’, we want to be seeing things in real time… we don’t want to be spending our time in big inquiries into failings in the system.” Read full story (paywalled) Source: HSJ, 14 June 2024
  8. News Article
    Three staff have been put on “improvement plans” after a patient’s death which a coroner said nurses had been dishonest about, HSJ has learnt. North East London Foundation Trust was heavily criticised over the death of Winbourne Charles at an inquest last year. Coroner Graeme Irvine said staff “had not told the truth” about how Mr Charles came to take his own life in an inpatient unit at Goodmayes Hospital, in east London. Two witnesses refused to give evidence, citing a rule that they could not be compelled to incriminate themselves. Mr Irvine recorded a verdict of “suicide, contributed to by neglect, to which failures in medical intervention contributed and to which failures to respond to an obvious risk of self-harm contributed”. His prevention of future deaths report also noted “observation records appeared to have been created utilising a ‘cut and paste’ function” while there were “factually inaccurate entries” stating Mr Charles “was alive and well” up to two days after his death. In comments reported by the Barking and Dagenham Post last year, Mr Irvine said: “I think witnesses who have given evidence to me in this inquest have not told the truth. “It seems to me that this remarked upon a culture of impunity and that, unless someone sees there are consequences to their actions, nothing is going to change.” Read full story (paywalled) Source: HSJ, 14 June 2024
  9. News Article
    An £8m prize for a breakthrough in the fight against superbugs has been awarded, after a decade-long search for a winner, to a test that can identify how to treat a urinary tract infection in 45 minutes. The test could herald a “sea change” in antibiotic use, the judges said as they announced the winner of the Longitude prize on antimicrobial resistance (AMR). AMR, where the drugs used to treat infections no longer work, is a growing concern. It leads to the deaths of nearly 1.3 million people worldwide annually and is predicted to cause 10 million deaths a year by 2050. Between 50% and 60% of women will experience at least one urinary tract infection (UTI) in their lifetime, and up to half of the bacteria that cause the infections are resistant to at least one antibiotic. The infections can cause potentially fatal sepsis. However, a lack of good, quick tests means doctors often have to diagnose an infection based on symptoms and guess which antibiotic will work. The inappropriate use of antibiotics drives resistance by giving bacteria opportunities to adapt to evade them. The winning Sysmex Astrego’s PA-100 AST system is based on technology from Uppsala University in Sweden. A 400-microlitre sample of urine is placed on a phone-sized cartridge and then into a shoebox-sized analyser unit. It can spot bacterial infection within 15 minutes, and identify the antibiotic to treat it within 45 minutes. Read full story Source: The Guardian, 12 June 2024
  10. News Article
    Hundreds of thousands of people are being forced to wait months to start essential cancer treatment, with deadly delays now “routine” and even children struck by the disease denied vital support, according to a series of damning reports. Health chiefs, charities and doctors have sounded the alarm over the state of cancer care in the UK as three separate studies painted a shocking picture of long waits and NHS staff being severely hampered by a worsening workforce crisis and a chronic lack of equipment. The first report, by Cancer Research UK, found that 382,000 cancer patients in England were not treated on time since 2015. The charity investigated how many patients had begun treatment 62 days or longer after being urgently referred for suspected cancer. The national NHS target – under which at least 85% of people should start treatment within 62 days – was last met in December 2015. The second report, by the Royal College of Radiologists (RCR), said delays in cancer care had become routine, with nearly half of UK cancer centres experiencing weekly delays in starting treatment. The RCR also warned of a “staggering” 30% shortfall in clinical radiologists and a 15% shortfall in clinical oncologists – figures it projects will get worse in the next few years. The third paper, from four children’s cancer charities – Young Lives vs Cancer, Teenage Cancer Trust, Ellen MacArthur Cancer Trust, and Children’s Cancer and Leukaemia Group – said young patients were being failed by a lack of support after diagnosis. Naser Turabi, the charity’s director of evidence, said the crisis was causing widespread treatment delays that “negatively impact” patients. “One study has estimated that a four-week delay to cancer surgery led to a 6-8% increased risk of dying, and delays can also reduce the treatment options that are available. There are also the psychological effects – with waiting causing major stress and anxiety for cancer patients and their loved ones.” Read full story Source: The Guardian, 13 June 2024
  11. News Article
    An ambulance trust with a long history of cultural problems saw the proportion of staff reporting being bullied or harassed increase in 2023. The survey by East of England Ambulance Service Trust found 35 per cent of staff who responded said they had experienced bullying or harassment over the last 12 months—up from 32 per cent in 2022, and 25 per cent in 2020. The work commissioned by the trust also found that many staff who had experienced or seen bullying, or racial or sexual harassment, did not report it, with fear of retaliation being a key factor in their decision. Less than 40 per cent said they would speak to a Freedom to Speak Up Guardian about concerns. The trust—which has made high-profile efforts to address cultural issues in recent years—said it was normal to see a rise in complaints as staff became aware poor behaviour would not be tolerated, and felt safer to speak out. Hein Scheffer, the trust’s director of strategy, culture and education, said: “Bullying, harassment and poor behaviour have no place in our organisation and we regularly survey our people’s experience of workplace behaviours to help us root this out. We are working hard to improve our culture and we are among the most improved NHS organisations in England for staff feeling confident in speaking out – with 63% describing the trust as supportive." Read full story (paywalled) Source: HSJ, 12 June 2024
  12. News Article
    In the latest Office for National Statistics survey, published in April, 111,816 children (aged three to 17) in England and Scotland were estimated to be suffering from Long Covid during the four-week period ending 7 March. More than 20,000 of these children have found their ability to undertake day-to-day activities has been “limited a lot”. For Toby, it has meant pain, crushing fatigue and sadness – as well as months off school. Dr Binita Kane is a Manchester-based consultant respiratory physician with a special interest in Long Covid. Her experience comes from being a doctor treating patients with Long Covid and also being the mother of a girl with Long Covid. She says that the 2 million people struggling with Long Covid in England and Scotland have created a massive challenge for the health service. The model for post-Covid services was set up in 2020, and in terms of scale and pace the UK was ahead of the game then. But things have moved on and the NHS hasn’t kept up. “The NHS is a juggernaut,” Kane says. “It cannot change things in a rapid way unless you put the weight of everything behind it, like we did in acute Covid.” Read full story Source: The Guardian, 12 June 2024
  13. News Article
    HSJ understands that IT systems across the Cornwall and Isles of Scilly ICS went down around midday, prompting the declaration of a major incident. In a statement, a spokesperson for the ICS said the incident was a “local issue” and not a “cyber attack”. As a result of the issue, some planned outpatient appointments, including operations, have been cancelled. The outage is also thought to have contributed to a large ambulance handover backlog. Royal Cornwall Hospitals NHS Trust, Cornwall Partnership NHS Trust, and University Hospitals Plymouth NHS Trust, as well as GP surgeries and community providers, are understood to have been affected by the outage. Read full story (paywalled) Source: 11 June 2024
  14. News Article
    People aged 65 and over arriving at A&E in England who appear frail will soon receive a “health MOT at the front door”, the head of the NHS will pledge. A&E units must start giving everyone that age a battery of tests to see if they are frail or have any other underlying condition and then arrange whatever care they may need. NHS England hopes the initiative will reduce the number of older people being admitted to hospital, and cut overcrowding, “trolley waits” and “corridor care”. Amanda Pritchard, the organisation’s chief executive, will tell an audience of health service heads on Wednesday they must ensure by next April that all A&E units start offering detailed assessments of older people’s health. However, the service will only operate for 10 hours a day. “Health MOTs at the front door of A&Es for older people could be a lifeline for many. From blood pressure tests to a review of their falls history, these checks mean patients can be assessed quickly and directed to the right support for their needs,” Pritchard will say. “While some people do need to be admitted, it isn’t always the most suitable place for older patients’ needs, and they can also rapidly lose mobility while in hospital.” Read full story Source: The Guardian, 12 June 2024
  15. News Article
    “Outdated” guidance on prostate cancer could be putting men’s lives at risk, a charity has said. Prostate Cancer UK said that men at high risk of the disease can get a test, but only if they request one. It said that GPs are told not to raise the issue with men unless they have symptoms. But most men with early prostate cancer – when it is easiest to treat – do not have any signs or symptoms. Chiara De Biase, director of health services, equity and improvement at Prostate Cancer UK, said: “We simply can’t continue with a system where men at high risk of prostate cancer can get a test – but only if they know to request one. “This outdated guidance is failing both men and their clinicians, making health inequalities worse and putting lives at risk. It’s about time that changed. She added: “We know that a lot of men don’t come forward because they think they’ll be invited as part of routine tests – when this simply isn’t true". Read full story Source: The Independent, 12 June 2024
  16. News Article
    A new service in Somerset is being set up to support women who have had adverse outcomes during pregnancy. Maternity and neonatal independent senior advocates (MNISA) say they will act on behalf of women if they feel their experience when being cared for during pregnancy led to something going wrong. This can include death, babies being diagnosed with brain injuries or mothers needing critical care. MNISAs can attend meetings or support users through investigations and complaints. The service will be piloted until next year and while the role is independent from the maternity and neonatal trust provider (Somerset NHS Foundation Trust), it sits within NHS Somerset. Jane Innes, a qualified lawyer who has worked across the NHS for 30 years, will take up the new role in Somerset. She said: "There is an acknowledgement that people's voices need to be heard and listened to so systems can act and respond appropriately." Read full story Source: BBC News, 11 June 2024
  17. News Article
    A combined flu and coronavirus vaccine brings about a higher immune response to both diseases than when the vaccines are administered separately, a clinical trial has shown. Moderna, the biotech firm behind the Spikevax vaccine used in NHS booster programmes, is trialling a two-in-one jab that can also protect from the flu. Initial results have shown it may be better at protecting against them than what is now being used. The results showed that the antibody response in the participants brought about higher immune responses against flu and Covid-19 than when the vaccines were administered separately. Stéphane Bancel, the chief executive of Moderna, said: “Combination vaccines have the potential to reduce the burden of respiratory viruses on health systems and pharmacies, as well as offer people more convenient vaccination options that could improve compliance and provide stronger protection from seasonal illnesses. Read full story Source: The Guardian, 10 June 2024
  18. News Article
    Hundreds of patients are being harmed each year because NHS organisations have incorrectly identified who they are, an HSJ investigation has found. Responses to Freedom of Information requests from 166 trusts revealed 58,537 cases of patient misidentification logged in Datix or other patient safety systems between 2019 and 2023, including 4,713 causing some sort of harm. This is equivalent to 11,707 incidents a year, with 943 leading to harm. It includes a wide range of errors, but harm typically happens when patients are given the wrong treatment or medicine, or miss out on the right treatment, as a result of errors in recording and/or miscommunication. A typical example is patients being given a wristband with the wrong name – or ID information resulting in patients not being treated, or the wrong treatment being given. Some of the worst examples are where the wrong patient, or the wrong part of the body, is operated on. Patient Safety Learning's CEO Helen Hughes called on NHS England to review cases nationally to identify root causes. She added: “Where avoidable harm has occurred, it is vital these incidents are investigated, that causes and contributory factors are identified, and steps put in place to prevent their reoccurrence. In some cases, this may require standardisation of approaches to patient identification, while others may highlight contributory factors that are more difficult to address, such as staff fatigue.” Read full story (paywalled) Source: HSJ, 11 June 2024
  19. News Article
    A landmark study has compared the risk of complications of water births. The results could have implications for thousands of women each year who use birthing pools as a form of pain relief during labour, researchers said. It concluded having a water birth does not increase the risk of complications for mother or baby. The Pool study analysed 73,229 records from low-risk pregnant women who used a pool during labour across 26 NHS organisations in England and Wales between 2015 and 2022. The team explored the rate of severe tears suffered by women during childbirth, as well as the number of babies who needed antibiotics or help with breathing on a neonatal unit after birth. They also looked at the number of babies that died. According to researchers, risks “were no higher among waterbirths compared with births out of water”. Read full story Source: The Independent, 11 June 2024
  20. News Article
    The first NHS AI-run physiotherapy clinic is to be rolled out this year in an effort to cut waiting times amid growing demand and staff shortages. The new platform will provide same-day automated video appointments with a digital physiotherapist via an app that responds to information provided by a patient in real time. It is the first platform of its kind to be approved by the health regulator, the Care Quality Commission, as a registered healthcare provider. Patients seeking physiotherapy for issues such as back pain can be referred to the platform Flok Health through a community or primary care healthcare setting, such as their GP. They can also self-refer directly into the service. The service aims to provide faster care and reduce waiting times and pressure on clinicians, those behind it say. However, some in the industry say that AI cannot yet replicate the skill of a fully trained physiotherapist, and that treatment needs to be nuanced due to the complexity of cases. CSP health informatics lead, Euan McComiskie, said of the AI clinic: “There is no doubt that more needs to be done to tackle huge NHS waiting lists, particularly for musculoskeletal services and AI has huge potential to be an adjunct to the work of physiotherapists. However, AI cannot yet replicate the clinical judgment and skills of a physiotherapist, who is required to be registered with a statutory regulator, the Health and Care Professions Council (HCPC).” McComiskie added that physiotherapists manage “increasing complexity in patient presentation and their treatment needs to be individually tailored”. He said: “It is early days to know how much AI can eventually provide clinical decision making and more research is needed … but not at the cost of patient access, safety, experience nor trust.” Read full story Source: The Guardian, 9 June 2024
  21. News Article
    A 79-year-old woman bled to death following a hip operation after being rushed to a hospital which lacked a service to save her, a coroner has said. Christine Booker from Wareham died on 24 February 2023, the day after her hip replacement. Coroner Brendan Allen said she was initially transferred to Dorset County Hospital in Dorchester, which had no out-of-hours interventional radiology (an imaging procedure), before being sent to Royal Bournemouth Hospital. In a Prevention of Future Deaths report, he said patients in west Dorset faced a "potentially considerable and significant delay in the provision of urgent and life-saving treatment". Writing to Dorset County Hospital, external, the coroner said the lack of an out-of-hours service in Dorchester exposed patients to an "increased risk of death". Read full story Source: BBC News, 10 June 2024
  22. News Article
    Patients with cancer and those needing emergency operations were among those who had their treatment cancelled this week due to a major cyberattack on NHS hospitals in London. More than 200 emergency and life-saving operations, including those which should be done within 24 hours, had to be cancelled by Guy’s and St Thomas’ Foundation Trust (GSTT) and King’s College University Hospital NHS Foundation Trust. It is not yet clear how long the disruption will last, however hospitals are concerned they will struggle if it continues for more than a few days. According to a source, Synnovis carries out tens of thousands of tests a day but is unable to do so as it cannot access systems. The Independent revealed: More than a third of procedures and operations have been cancelled, which includes over 3,000 non-surgical appointments and hundreds of patients who have been referred for urgent cancer diagnosis. Mothers waiting to have c-sections have also had their procedures cancelled and hospitals are investigating potential harm. Transplant operations have been cancelled and hospitals have had to reduce the number of people they’re able to book in. Read full story Source: The Independent, 10 June 2024
  23. News Article
    An appeal has been launched for O blood-type donors to book appointments across England after the ransomware attack affecting major London hospitals. NHS Blood and Transplant is appealing for O blood-type donations as this is safe to use for all patients. The cyber-attack means the affected hospitals cannot match patients’ blood at the same frequency as usual. Several London hospitals last week declared a critical incident, cancelled operations and tests, and were unable to carry out blood transfusions after the attack on the pathology firm Synnovis, which Qilin, a Russian group of cybercriminals, is thought to have been behind. Memos to NHS staff at King’s College hospital, Guy’s and St Thomas’ (including the Royal Brompton and the Evelina London Children’s hospital) and primary care services in London said a critical incident had been declared. NHS Blood and Transplant is calling for O-positive and O-negative blood donors to book appointments in one of the 25 NHS blood donor centres in England to boost stocks. The hospitals affected by the cyber-attack cannot match patients’ blood at the same frequency as usual, NHS Blood and Transplant said. For surgeries and procedures requiring blood to take place, hospitals need to use O-type blood as this is safe to use for all patients. Blood has a shelf life of 35 days, so stocks need to be continually replenished, the NHS said. Read full story Source: The Guardian, 10 June 2024
  24. News Article
    A couple whose child died before birth due to failings in her care hope a new documentary can support their calls for a public inquiry into England's maternity services. Jack and Sarah Hawkins' daughter Harriet was stillborn at Nottingham City Hospital in April 2016. They hope an ITV programme - Maternity: Broken Trust - shown on Sunday evening can help their bid for a wider probe. An independent review into failings in maternity services in Nottingham is now the biggest maternity investigation in NHS history, but a report is not expected to be returned until 2025. Dr and Ms Hawkins - who received a £2.8m settlement over failings in their daughter's care - said a wider investigation was needed to highlight national issues. "I think maternity services across England are absolutely terrible," Ms Hawkins said. "We're in contact with people with dead babies from Leeds to Plymouth, and I think what really needs to happen is for there to be a public inquiry into England's maternity services. "It's not just Nottingham, it's everywhere, and hopefully this platform will give people the strength to come forward and speak up." Read full story Source: BBC News, 10 June 2024
  25. Earlier
  26. News Article
    Dan Harrison, who had schizophrenia and psychotic delusions about his parents, had been sectioned ten days before he attacked his father. He was detained at Neath Port Talbot Hospital, run by the Swansea Bay University Health Board. During those ten days he received no treatment or medication. He escaped through a door being held open by a member of staff who was talking to someone else and immediately headed for the family home where he killed his father. The attack came after Dan's mother, Jane, and her husband repeatedly asked for help from mental health services as their son’s state of mind and behaviour deteriorated. They were refused. Last month Kirsten Heaven, assistant coroner for Swansea, recorded in a narrative verdict that there had been repeated failings by the Swansea University Health Board and local council. She said multiple system failures had contributed to Kim’s death and warned of more deaths if they were not addressed. Jane is speaking out now, with her son’s permission, after a Sunday Times investigation highlighted the scale of mental health-related killings in Britain. There have been at least 233 reported since 2020 and there have been repeated warnings about NHS services failing to provide crisis care. Read full story (paywalled) Source: The Times, 1 June 2024
  27. News Article
    Three more babies have died from whooping cough this year as cases continue to rise across the country, according to the UK Health Security Agency. Since January, there have been 4,793 confirmed cases of whooping cough, with 181 babies under the age of three months diagnosed with the illness. A total of eight babies have now died from whooping cough this year. Pregnant women have been urged to get the whooping cough vaccine in order for their babies to be protected before they are old enough to receive the vaccine themselves. Babies can first be vaccinated against the disease when eight weeks old, while pregnant women are advised to get the vaccine at 16 and 32 weeks. Dr Gayatri Amirthalingam, a consultant epidemiologist at UKHSA, said: “Our thoughts and condolences are with those families who have so tragically lost their baby. “With whooping cough case numbers across the country continuing to rise and sadly the further infant deaths in April, we are again reminded how severe the illness can be for very young babies. “Pregnant women should have a whooping cough vaccine in every pregnancy, normally around the time of their mid-pregnancy scan (usually 20 weeks). This passes protection to their baby in the womb so that they are protected from birth in the first months of their life when they are most vulnerable and before they can receive their own vaccines. “The vaccine is crucial for pregnant women, to protect their babies from what can be a devastating illness.” Read full story Source: The Guardian, 6 June 2024
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