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NHS England has found that one in five GP surgeries – and more than two-fifths in some regions – were built more than 75 years ago, and is concerned a lack of space will stop it meeting targets to train more GPs, HSJ has learned. An internal NHSE document seen by HSJ reveals a major audit it commissioned in 2019 – but has not made public – found 20 per cent of 8,900 buildings examined were built before 1948. The figure rises to more than 40 per cent of practices in London, HSJ understands. These practices are likely to be in converted houses, normally owned by GP partners, with very limited space and little scope for expansion. The NHSE slides which include the figure warn the “limited [GP] estate” means there is “strain on existing capacity and meeting current training needs is challenging”. HSJ understands officials are concerned poor estates and lack of space will restrict the big expansion of GP training planned under the NHS long-term workforce plan. Other fears relate to poor tech and the shortage of experienced staff to supervise trainees. NHSE said in a statement: “NHS England has asked every ICS to review their infrastructure to assess which buildings they need to expand and reconfigure to manage additional workforce over the next 10 years.” Read full story (paywalled) Source: HSJ, 9 May 2024

A piece of equipment known as a vein finder is being used for inpatients at Ysbyty Gwynedd in order to improve the experience for patients with hard-to-find veins. Anyone who has difficult veins will know the discomfort when there are failed attempts to locate a vein, such as when having bloods taken. Having noticed the need to improve the experience for patients with difficult veins, Junior Doctor Lois Williams secured a £3,000 grant from Health Education and Improvement Wales and around £600 from Menter Môn to purchase the equipment through the Trainees Transforming Training initiative. Dr Williams said: “We’ve been very lucky to obtain a grant to purchase a vein finder and we hope this will empower nurses, phlebotomists, medical students and junior doctors to take blood and cannulate from patients who are difficult to obtain access. It works by infrared, which can bounce back and show us visibility of the vein which you cannot do with the naked eye. It also helps to reduce the time we need to attempt cannulating patients and how often we might need to cannulate them because of failed attempts, which can be quite distressing for some patients. Our hope is that this will improve the quality of patient care in the future.” Read full story Source: NHS Wales, 30 April 2024

Bereaved families who lost loved ones in the contaminated blood scandal have claimed their relatives were being “used for research” after discovering historic notes in medical records. It is claimed that some patients being treated for the blood clotting disorder haemophilia in the 1970s and 1980s were given blood plasma treatment which doctors knew might be contaminated and infect them with hepatitis. They wanted to study the links between the haemophilia treatment Factor VIII and the risk of infection, but a number of families have claimed their loved ones were enrolled in these studies without their knowledge or consent. The Factor 8 campaign group alleges that instead of stopping treatment, clinicians lobbied to continue trials, even after identifying the association between hepatitis and the treatment. Jason Evans, director of the campaign group, found notes alluding to the research in his father’s medical records. He has since found other families who have discovered the same notes in the records of their loved ones. Mr Evans, whose father died in 1993 after being infected with both HIV and hepatitis C during the course of his treatment for haemophilia, said: “It is appalling that hundreds of people with haemophilia across the country were knowingly infected with lethal viruses under the guise of scientific research. These secret experiments, conducted without consent, show individuals were treated as mere test subjects, not human beings." Read full story Source: Independent, 9 May 2024

Drug shortages in England are now at such critical levels that patients are at risk of immediate harm and even death, pharmacists have warned. The situation is so serious that pharmacists increasingly have to issue “owings” to patients – telling someone that only part of their prescription can be dispensed and asking them to come back for the rest of it later, once the pharmacist has sourced the remainder. Hundreds of different drugs have become hard or impossible to obtain, according to Community Pharmacy England (CPE), which published the report. Widespread and often long-lasting shortages posed “immediate risks to patient health and wellbeing” and caused distress, it said. “The medicine supply challenges being faced by community pharmacies and their patients are beyond critical,” said Janet Morrison, CPE’s chief executive. “Patients with a wide range of clinical and therapeutic needs are being affected on a daily basis and this is going far beyond inconvenience, leading to frustration, anxiety and affecting their health. CPE, which represents England’s 10,500 community pharmacies, based its findings on a survey of the views of owners of 6,100 pharmacy premises and 2,000 of their staff. It found: 79% of pharmacy staff said that medicine shortages were putting patient health at risk. 91% of pharmacy owners had seen a “significant increase” in the problem since last year. 99% of pharmacy workers found a drug was unavailable at least weekly, and 72% encountered that several times a day. Pharmacists are finding themselves on the receiving end of abuse and hostility from patients who are frustrated and angered by not being able to get the drugs they have been prescribed. Read full story Source: Guardian, 9 May 2024

An agency providing last-minute freelance nurses to NHS hospitals is routinely charging up to £2,000 a shift, BBC News has discovered. Glen Burley, chief executive of an NHS trust, said that Thornbury Nursing Services is targeting areas in England where nurses are in short supply. He says it is "profiteering" from an overstretched NHS, but Thornbury says it offers a valuable, flexible service. The government says new measures will end the use of expensive agencies. However, Labour has said the high costs are a result of the "Conservatives' failure to train enough nurses over the past 14 years". Under NHS rules, hospital managers are obliged to use staffing agencies that work within an agreed framework, with a limit or cap on how much should be paid. But when last-minute essential cover is needed, trusts may use off-framework agencies, such as Thornbury. These are not legally obliged to abide by pre-agreed pay scales. Workload pressures in the NHS and a desire for more flexibility over shifts are thought to be driving more nurses to work for such agencies, which tend to pay the people on their books more while also taking a payment for themselves. BBC News has discovered Thornbury charges almost £2,000 for a 12-hour bank holiday shift by a specialist paediatric nurse - an area of expertise where there are known staff shortages. Of that, BBC News calculates the nurse receives about £1,050 - meaning nearly £800 goes to the agency.  Read full story Source: BBC News, 8 May 2024

NHS staff do not correctly monitor a baby’s heart rate during labour in almost half of cases where serious failings lead to tragedy, a review of maternity care has found. The Care Quality Commission identified that inadequate foetal monitoring occurred in 45 of 92 cases (49%) in which a baby died or suffered serious brain damage while being born in a midwife-led unit in England. The findings show that correct monitoring is “critically important” to ensure care is safe in all maternity units, said Sandy Lewis, the director of the CQC’s maternity and newborn safety investigations (MNSI) programme. It analysed four common failings in the 92 births in a report that is intended to help midwives and doctors improve the quality and safety of care. In one case the investigation team found that “there were likely to have been abnormalities in the baby’s heart rate which were ongoing for a prolonged period of time, which were not identified during intermittent auscultation [monitoring]”. In another, midwives were so busy dealing with a separate emergency on the unit that they failed to monitor the baby at the correct recommended intervals and the woman was left unattended. The 92 incidents involved 62 cases in which the newborn suffered a severe brain injury, 19 in which it was alive at the start of labour but was stillborn and 11 when it died within its first six days of life. Read full story Source: Guardian, 8 May 2024

Hospitals in the UK are facing shortages of almost 2,000 anaesthetists, leading the NHS to miss 1.4 million operations a year, doctors have warned. The government has been urged to increase funding for the number of newly qualified doctors who can train as anaesthetists as more than 2,000 miss out on places each year. The Royal College of Anaesthetists has said the NHS will not be able to tackle waiting lists without more of these specialist doctors. Their warning comes amid fears hospitals are substituting doctors for staff without sufficient training, called anaesthesia associates. This week the NHS will publish new waiting list figures. They stood at 7.6 million in March. Dr Fiona Donald, president of the Royal College of Anaesthetists warned: “The shortage of anaesthetists has reached crisis levels and is preventing patients from getting the operations they so desperately need. During the election campaign, I’m sure we’ll see all parties pledge to reduce NHS waiting lists but unless their policies include plans for more anaesthetists they will have limited impact.” According to the college, each year 2,600 doctors apply for anaesthetist training however only 550 places are funded. For more advanced training there are around 650 applicants a year yet only 400 are funded. Read full story Source: Independent, 8 May 2024

The government is launching a review of the Care Quality Commission and has appointed a senior NHS figure to lead it, HSJ understands. The Department of Health and Social Care has commissioned the work, along with other departments, and selected Penny Dash, current North West London Integrated Care Board chair and formerly a senior McKinsey & Company consultant, to lead it. HSJ understands the review will examine how the CQC’s recently updated assessment framework is working, and how it links to NHS England’s national oversight framework. It will also consider whether the CQC’s ratings were properly rewarding and incentivising the improvement of care, and how the regulator is taking into account service user and patient voices, sources told HSJ. One source involved said they hoped the work would also respond to providers’ complaints that CQC inspections are making it more difficult for them to redesign services, for example by enforcing minimum staffing requirements, and are skewing their priorities. Read full story (paywalled) Source: HSJ, 8 May 2024

Parts of ceilings have fallen in at two key units of a decrepit NHS hospital, forcing it to evacuate patients and cancel X-rays and scans, the Guardian can reveal. The problems at Stepping Hill hospital in Stockport, which is plagued by leaks and major structural defects, have prompted claims it is “dangerous for both patients and staff”. Read full story Source: Guardian, 3 May

A ransomware group has carried out its threat to NHS Dumfries and Galloway and released a "large volume" of patients' data on the dark web. A small amount of details were released in March as "proof" that the cyber criminals had accessed confidential information, with a warning that more would be published if a payment was not made to stop it. The new chief executive of NHS Dumfries and Galloway health board, Julie White, called the release an "utterly abhorrent criminal act". She said work was now beginning to with other national agencies including the Scottish government, police and National Cyber Security Centre to assess what has been published. Read full story Source: BBC News, 7 May 2024

Perinatal mental illness affects more than a quarter (27%) of new and expectant mothers across England and covers a range of conditions including postpartum depression and postpartum psychosis. A Guardian analysis of NHS figures has shown that for instances of perinatal mental illness that result in hospital admissions, black patients are more than twice as likely to be admitted than their white counterparts. Part of the reason why black mothers are more at risk of perinatal mental illness is because black people are more at risk of experiencing mental illness in general. Read full story Source: Guardian, 6 May 2024

Twenty one serious security failures at hospital mortuaries were discovered by the Human Tissues Authority between April 2022 and March 2024, HSJ can reveal. These included seven cases where unauthorised people gained entry to the facilities, 13 other breaches in “mortuary security processes” and one case in which there was unrestricted access to post-mortem images. Last month, the HTA issued new guidance for mortuaries that carry out post-mortems after what it described as “an increase in both the severity and frequency of reported incidents”. Read full story Source: HSJ, 7 May 2024

A coroner has issued a warning over a hospital’s new computer system after the death of a 31-year-old woman. Emily Harkleroad collapsed on 18 December 2022 and was taken to the University Hospital of North Durham, where she died the next morning from a pulmonary embolism – a clot on the lung. The assistant coroner for County Durham and Darlington concluded, on balance, that Ms Harkleroad’s death could have been prevented, external. She also noted computer system concerns had been raised by a number of clinicians. Read full story Source: BBC News, 24 February 2024

Ministers are preparing to announce a compensation package of at least £10 billion for contaminated blood victims after a Sunday Times campaign for justice was backed across the political divide. The announcement is expected to be made within hours of the public inquiry’s report into the scandal later this month and will establish a hierarchy of payments, with priority given to those with infectious diseases, including hepatitis C and HIV. The money, promised to be “northwards of £10 billion”, is yet to be signed off by Rishi Sunak but has the support of the Treasury and the Cabinet Office. It is expected to be funded through government borrowing. Read full story Source: The Times, 5 May 2024

Hospitals are being forced to cut medical staff, threatening their ability to care for patients, senior health leaders have warned. NHS trusts are reporting budget deficits after the chancellor Jeremy Hunt gave England’s health service £2.5bn extra funding, which only covers inflation and pay increases. The UK’s ageing population and the impact of having more than 6 million patients waiting for more than 7.5m treatments means that demand on the health service has increased substantially. Read full story Source: Guardian, 5 May 2024

A 999 call handler incorrectly categorised a call made by the wife of a man who died from a heart attack, an inquest has heard. The Welsh Ambulance Service Trust (WAST) handler should have escalated the call for Robert Weekley, 75, who died in his flat in Barry, to the most urgent level of 'red', which requires an ambulance to be sent within eight minutes. Instead they wrongly categorised it as the second-highest level, 'amber one', which has no set response time, an inquest into Mr Weekley's death at Pontypridd Coroners' Court was told. Read full story Source: Wales Online, 3 May 2024

Sajid Javid has revealed details of his young relative’s “brave battle” against myalgic encephalomyelitis, warning that patients with the condition are being “dismissed entirely” by doctors. During a debate held in Westminster Hall on Wednesday, the former health secretary spoke of the distressing experience of his cousin’s “amazing” daughter who developed the debilitating illness seven years ago, aged 13. ME is a complex neurological disorder that affects about 250,000 people in the UK and leads to symptoms including exhaustion and pain. Severe cases can be fatal, with patients bedridden and unable to eat or drink, and care held back by a lack of specialist NHS services. Read full story Source: The Times, 2 May 2024

A study cited at the infected blood inquiry as evidence that the devastating consequences of blood products contaminated with hepatitis could not have been foreseen, misrepresented the results of a trial in making its case, according to the Guardian. Up to 6,520 people are believed to have been infected with hepatitis C through imported factor VIII blood products in the 1970s and 80s, while a further 26,800 are estimated to have been infected with the virus though blood transfusions. About 2,000 people are estimated to have died as a result. The inquiry, which publishes its final report on 20 May, heard that the medical profession considered non-A and non-B hepatitis (later known as hepatitis C) as “relatively benign” at the time, with Pier Mannuccio Mannucci’s 2003 paper, 'Aids, hepatitis and haemophilia in the 1980s: memoirs from an insider', quoted in support of this proposition. Mannucci’s 2003 paper argued that the view held by “the great majority of haemophilia treaters was that the problem of hepatitis was a tolerable one, because the benefits of concentrates seemed to outweigh risks”. In making his argument, Mannucci cited his own work, writing: “A prospective biopsy study was undertaken by me … in 10 haemophiliacs with non-A, non-B chronic hepatitis followed up for more than six years. The study, published in 1982, demonstrated no case of progression towards cirrhosis or haepatocellular carcinoma.” However, the original 1982 report says that there were actually 11–not 10–people included in the study and “one patient with active cirrhosis died of liver failure during the follow-up period”. Who knew what about the risks and when is a key plank of the inquiry. Read full story Source: Guardian, 2 May 2024

In the first half of 2023, Covid-19 killed 42,670 people in the United States, while the flu killed about half that amount. Yet half as many people received the updated covid booster as those who got the flu shot — even though covid is twice as deadly as influenza. In all, around 22% of people have received the new covid booster, while 47% of people have had a flu vaccine. Experts said much of that covid-shot resistance is due to the continued polarizing nature of the pandemic and of the covid vaccine, which has been shown to reduce the risk for Long Covid as well as serious acute viral infections and deaths. "Public health messaging is also to blame for the lower-than-normal covid vaccine rates," said Dr Al-Aly, a global expert on Long Covid and chief of research and development at the VA Saint Louis Health Care System. "Patients need to better understand that the role of the vaccine isn't to completely prevent covid but to reduce the likelihood of hospitalisation and death, similar to that of a flu shot. By reducing the risk for severe disease, the vaccine also reduces the risk for Long Covid, a debilitating condition that's still poorly understood, has no cure, and has already caused thousands of American deaths," he said. Botched public health messaging also allowed for misinformation to run rampant. Rare adverse events associated with the COVID vaccine have been severely overplayed and spread like wildfire on social media. "Patients need to know that like any vaccine, vaccine injury does occur, but these vaccines have a better safety profile than almost any others," Al-Aly said. "The rewards of getting the vaccine far outweigh the risks, and patients need to understand that." Read full story Source: Medscape, 2 May 2024

Leading pharmacists have blasted the government over “shameful” increases in the cost of NHS prescriptions. From 1 May they will increase from £9.65 per item to £9.90. Pharmacists across the country have hit out at the increase, warning it will disadvantage working patients on lower incomes. And the National Pharmacy Association (NPA) said the move will create an “arbitrary barrier” to people’s ability to receive healthcare. According to an NPA survey, patients have already reported not getting regular medication due to the costs. Antibiotics, pain killers, asthma inhalers, blood pressure medication and antidepressants are examples of the most commonly reported medicines which patients have not taken due to cost. Hundreds of pharmacies reported seeing patients decline medicines due to the cost of prescriptions, one to five times a week. Nick Kaye, chair of the NPA, said: “To allow the prescription charge to rise to this level is a shameful neglect of working people on low fixed incomes, who are not exempt. Many people already choose not to collect some or all their prescription medicines because of cost, with potentially dire health consequences. As pharmacists, we understand the healing power of medicines. So naturally we oppose arbitrary barriers to people getting the medicines they need. This is a tax on the working poor that deepens the cost of living crisis for them." Read full story Source: Independent, 1 May 2024

The safety of a teaching hospital’s out-of-hours supervision has been questioned, including reports trainees were told not to ask for help “unless your patient is dying”. The General Medical Council put University Hospital Southampton Foundation Trust’s general surgery training under enhanced monitoring at the end of 2023 following a referral and quality management visit by NHS England South East, Workforce Training and Education – Wessex. The NHSE team’s visit and subsequent report said doctors in training had claimed senior staff were “not contactable” out of hours and there was “difficulty” in securing senior clinical advice, particularly on Sundays. The report added foundation year doctors were “discouraged” from contacting senior staff out of hours by “inappropriate” and “belittling” comments and behaviours, such as being told not to ask for help “unless your patient is dying”. Foundation doctors also reported starting rotation on call and conducting ward rounds without appropriate supervision. While the GMC open case is centred on patient safety concerns relating to supervising trainee doctors, the workforce and training directorate report also raised concerns about bullying, inappropriate sexual comments made by consultants, and a feeling that foundation doctors were unable to speak up. Read full story (paywalled) Source: HSJ, 1 May 2024

Increased reliance on imaging for diagnosis and efficient patient care mixed with higher volumes of patients has left US hospitals scrambling to meet demand with the few radiologists they have. There are over 1,400 vacant radiologist positions posted on the American College of Radiology's job board, according to a bulletin posted on its website. The total number of active radiology and diagnostic radiology physicians has dropped by 1% between 2007 and 2021, but the number of people in the U.S. per active physician in radiology grew nearly 10%, according to the Association of American Medical Colleges. An increase in the Medicare population and a declining number of people with health insurance adds to the problem. "Demand for imaging services is increasing across the country, creating longer worklists for radiology staff at the same time the healthcare system is experiencing a workforce shortage in radiology," Michigan Hospital Association CEO Brian Peters told The Detroit News in an April 28 report. "The combination of vacancies and increased demand can force imaging delays measured from days to upwards of two weeks." CMS also cut fees for both diagnostic (3%) and interventional radiology (4%) this year, according to an article published on healthcare technology company XiFin's website. This leaves many hospitals having to use external groups to stay on top of demand. Mr. Peters told Detroit News, "Hospitals and health systems are also competing with practices offering remote-only positions, which allows Michigan radiologists to work for out-of-state providers at higher rates." Read full story Source: Becker's Hospital Review, 29 April 2024

Medical devices should be judged more on the value they bring to a wider health economy than just the price of the items, according to draft Department of Health and Social Care procurement guidance seen by HSJ. The draft methodology, produced by Department of Health and Social Care’s MedTech directorate, outlines how “value” should be given a minimum weighting of 60 per cent while price should have a maximum weighting of 40 per cent when procurement teams are evaluating which products to buy. The “value” weighting will include a minimum of 10 per cent which must be applied to social value, which is already a requirement for all public procurements. This would reverse established practice across many procurements that sets the price of products or services as the most important factor, at times to the detriment of products that provide greater value to a health economy. It is intended to be used for all procurements of medical devices. It came from the 2023 MedTech strategy, which “identified that the value of medtech products should not be considered in isolation but across the whole patient pathway and that lowest price does not always translate to best value,” it said. The plan is for it to become one of a set of commercial ”playbooks” produced by NHS England as part of the implementation of its national commercial strategic framework, which it published in November 2023. The draft methodology should bring consistency to how the NHS judges value in a procurement and to the evidence suppliers produce to support their offering. This should mean effective products are adopted more widely and their system-wide benefits to patient pathways are realised at scale. Read full story (paywalled) Source: HSJ, 30 April 2024

A new trial to gather evidence on screening methods to detect prostate cancer is set to be led by researchers at Imperial College London, working alongside UCL, Queen Mary University of London and the Institute of Cancer Research. The £42million TRANSFORM screening trial, backed by charity Prostate Cancer UK, aims to find the best way to screen for prostate cancer and double the number of lives it could save. Previous trials using PSA blood tests and biopsies have shown that it is possible to prevent between 8% and 20% of prostate cancer deaths depending on how regularly patients are screened. But healthy people can potentially be harmed by this approach. Currently, there are more than 12,000 prostate cancer deaths in the UK alone, and this could mean thousands of lives saved each year in the UK. TRANSFORM will bring together leading prostate cancer researchers to test new approaches that have the potential to more than double the impact of screening, and ultimately reduce prostate cancer deaths by up to 40%. Read full story Source: Imperial College, 1 May 2024

Transgender women should not be put on single-sex female NHS wards, the government is proposing. The measure is part of a raft of changes to the NHS Constitution for England, the charter of rights for patients. The proposals stress the importance of biological sex for the first time when it comes to same-sex accommodation and intimate care. In both cases, the rights are available only where possible. For example, same-sex accommodation rights, which have existed for years, can and are breached where there is a clinically urgent need to admit and treat a patient and do not extend to areas such as critical care or accident and emergency. The guidance also means that trans men should not be housed on single-sex male wards. Under the proposals: transgender people, whose gender identity differs from their biological sex, may be provided single rooms, where appropriate patients will have the right to request a person of the same biological sex delivers any intimate care Health Secretary Victoria Atkins said it was about making it clear that "sex matters." She said, "We want to make it abundantly clear that if a patient wants same-sex care, they should have access to it wherever reasonably possible. By putting this in the NHS Constitution, we're highlighting the importance of balancing the rights and needs of all patients, to make a healthcare system that is faster, simpler and fairer to all." Labour's shadow health secretary Wes Streeting said: "Rights on paper are worthless unless they are delivered in practice. "The NHS constitution already pledges that no patient will have to share an overnight ward with patients of the opposite sex, but that is not the case for too many patients." Read full story Source: BBC News, 30 April 2024