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Keep up to date with the latest news, research and activity in patient safety.

‘Falling to bits’: NHS faces £16 billion maintenance crisis

Patient safety is being put at risk by “decrepit” NHS buildings, experts have warned, as new figures show the maintenance bill has risen by more than 15% to almost £16 billion.
The sum outstrips the total cost of running the NHS estate, which was £14 billion in 2024-2025, according to NHS England data.
Health commentators warned that hospitals with “flooded corridors” and “roofs at risk of falling in” are impacting care and patient safety.
The latest Estates Return Information Collection (ERIC) shows that the cost to eradicate the backlog of NHS repairs in England increased to £15.9 billion in 2024-2025.
This is up by 15.7% on £13.8 billion reported a year earlier.
The backlog bill is a measure of how much funding is needed to restore buildings to a good state. It refers to maintenance work that should already have taken place rather than any that is planned.
Daniel Elkeles, chief executive of NHS Providers, said: “Critical parts of the NHS are falling to bits, literally, after years of underinvestment nationally. The safety of patients and staff is at risk.
“We can’t keep wasting money propping up ageing buildings not fit for purpose.”
He added: “Eye-watering sums are needed just to patch up buildings and equipment which are in a very bad way right across hospital, mental health, community, and ambulance services. We need to make the NHS as modern and winter-proof as possible, but the waiting list of essential repairs keeps getting longer and costs are soaring.”
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Source: Medscape, 17 October 2025
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Millions exploited by ‘menopause gold rush’ amid lack of reliable information, say UK experts

Millions of women are being exploited by a “menopause gold rush” as companies, celebrities and influencers take advantage of a “dearth” of reliable information on the issue, experts have said.
Healthcare companies and content creators saw menopause as a “lucrative market” and were trying to profit from gaps in public knowledge, women’s health academics at UCL said.
Researchers called for the rollout of a national education programme after finding a significant number of women do not feel well-informed about menopause.
Writing in medical journal Post Reproductive Health, they said: “There has been a rapid expansion in unregulated private companies and individuals providing menopause information and support for profit; this has been termed the ‘menopause gold rush’.
“This fragmented landscape of menopause support and education leaves people vulnerable to financial exploitation, may propagate misinformation and is likely to amplify existing menopause-related health inequities.”
One woman who took part in the UK study told researchers: “Everything I know about the menopause I learnt on Instagram from other women.” Only one in five – 22% – of 1,500 women surveyed by the UCL team felt well-informed about menopause.
Read full story
Source: The Guardian, 20 October 2025
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Low participation in medical trials puts millions of young people at risk

Millions of young people risk missing out on new treatments for health conditions and having to use medicines that are unsafe, ineffective or inappropriate because so few take part in medical research, experts have warned.
Data analysis by the Guardian reveals that members of gen Z – those born between the late 1990s and the early 2000s – are significantly underrepresented in clinical trials and health studies.
People aged 18 to 24 make up 8% of England’s population, but only 4.4% of those taking part in medical research.
Though less affected by life-threatening conditions such as cancer and heart disease, young adults still experience a significant burden of disease. Almost half – 45% – of those aged 24 or under have a long-term physical or mental health condition.
Experts said the lack of young people participating in research would have a serious impact on their physical and mental health for decades unless urgent action was taken to reverse the trend.
Kirsty Blenkins, the deputy chief executive of the Association for Young People’s Health, said adults aged 24 and under faced “a distinct set of health challenges” that were often “shaped by major life transitions, social pressures and inequalities” that impacted their physical and mental wellbeing.
Their absence from clinical and health research projects had serious implications, she added.
“Treatments and interventions may be designed and tested primarily on older adults, which means they may not always be safe, effective, or appropriate for younger populations. This can lead to poorer health outcomes, delayed diagnosis, and reduced trust or engagement with healthcare systems.”
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Source: The Guardian, 20 October 2025
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Scotland: Code-red patients waiting up to 18 hours for ambulances to arrive

Some code-red patients are waiting up to 18 hours for ambulances to arrive, it has been revealed, in delays that have been branded “scandalous”.
Freedom of Information requests from the Scottish Conservatives show that since January last year, one patient in that category waited over 17 hours for an ambulance in Lothian. Another waited 18 hours in the Highlands.
Code-red patients are those deemed to be at risk of cardiac arrest or at risk of needing resuscitation.
The figures also show one code-purple patient – those who are deemed the most critically ill and most at risk of cardiac arrest – was forced to wait over four hours for an ambulance in Glasgow in the past year.
The Scottish Ambulance Service’s (SAS) target median response time for code-purple cases is seven minutes.
Scottish Conservative shadow health secretary Dr Sandesh Gulhane described the waiting times as “scandalous” and accused the SNP of putting patients’ lives at risk due to their “chronic mismanagement” of the service.
He said: “These terrifying figures expose how patients’ lives are being jeopardised because our ambulance service is dangerously overstretched after years of chronic SNP mismanagement.
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Source: The Scotsman, 19 October 2025
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Women’s healthcare stuck in the Nineties, says health tsar

Women’s healthcare in the UK is stuck in the Nineties and red tape is blocking treatments on the NHS, the government’s women’s health ambassador has warned.
Dame Lesley Regan said women and girls had been “let down” by successive governments’ failure to take their health seriously. She announced plans for an “open door” policy to make it easier for treatments, tests and technology to become available on the NHS.
Speaking at the Women’s Health Week Europe conference in London this week, she said she was frequently asked if statistics about women’s health and access to care in the UK were from “1995 not 2025”.
“This is a really sad state of affairs,” said Regan, who is a professor of obstetrics and gynaecology at Imperial College London. “We’ve got so complacent about the importance of women’s health that we’ve really let girls and women down.”
She cited figures showing women suffered disproportionately from conditions such as osteoporosis, frailty and dementia in old age. More than 600,000 women are on the NHS waiting list for hospital gynaecology treatment and the gender health gap costs the UK economy £36 billion a year, mainly in lost productivity from women who are unable to work.
Regan said she was “really frustrated” that developers of treatments, tests and technology aimed at improving women’s healthcare often experienced pushback when they approached the government or were blocked by complex bureaucracy from making their products available via the NHS.
Read full story (paywalled)
Source: The Times, 20 October 2025
Related reading on the hub:
“It’s not menopause, you’re too young and don’t have the right symptoms"—the difficulties accessing menopause support and treatment Women’s heart health - a patient safety priority
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Hospital removed 1,000 patients from waiting list 'retrospectively'

A hospital trust has removed more than 1,000 patients from its waiting list by retrospectively applying referral criteria, which local GPs have said is disruptive and unsafe.
In June, University Hospitals of North Midlands Trust switched its criteria for non-obstetric ultrasound back to a method it had previously used until it was widened in September last year.
The trust, which runs Royal Stoke University Hospital and Stafford County Hospital, recently announced its ultrasound list had dropped from more than 15,500 in June to 10,563 in October, gaining local media coverage for a “significant” performance improvement.
North Staffordshire local medical committee (LMC) told HSJ the trust was “misleading” the public as a significant amount of the cut was due to the retrospective change to criteria, which it also said was disruptive for patients and compromised their safety. GPs say some of the patients had already been waiting six months.
One local GP who spoke to HSJ anonymously said some of those delisted would need to be re-referred for an ultrasound or alternative test. They cited a referral for abdominal pain with suspected gallstones which was made in January 2025, then rejected in August. For many people, suspected gallstones are not a serious problem. However, complications can be serious and sometimes life-threatening, if it leads to a blocked bile duct.
The GP said: “It’s all good for the trust to say that there is no risk, but if we don’t know [who has been removed], how would we mitigate that?” The GP also questioned: “If we miss something, who is actually responsible?”
Read full story (paywalled)
Source: HSJ, 17 October 2025
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Inquiry launched into 'repeated' maternity failings at Leeds NHS trust

After years of campaigning, bereaved families in Leeds have been told they will get a fully independent inquiry into local maternity services.
The inquiry was announced by Health Secretary Wes Streeting who said he was "shocked" that the families faced "repeated maternity failures... made worse by the unacceptable response of the trust".

Despite running one of the largest teaching hospitals in Europe, Leeds Teaching Hospitals NHS Trust "remains an outlier on perinatal mortality", according to official data.
In June, the Care Quality Commission downgraded maternity services at the trust to "inadequate", describing serious risks to women and babies and a deep-rooted "blame culture" that left staff afraid to speak up.
Grieving families have welcomed the launch of the inquiry.
In 2023, an inquest concluded Fiona Winser-Ramm and Daniel Ramm's first baby, Aliona, died in 2020 as a result of neglect from medical staff.
Mr Ramm said the inquiry had been "a long time coming".
"We have, as a group of families, spent years trying to essentially expose what the problems have been at least that we've known have existed all along," he said.
Read full story
Source: Sky News, 20 October 2025
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USA: Private equity takeover of hospitals led to rise in Medicare emergency patient deaths, says study

Private equity acquisition of hospitals have led to an increase in deaths among emergency department patients receiving Medicare, according to a recent study published in Annals of Internal Medicine.
It is the latest in a series of recent studies illustrating that private equity acquisition of health facilities leads to worsening patient outcomes, including death.
“Each of them sort of comes up with the same result,” said Martin Kenney, distinguished professor in the department of human ecology at the University of California, Davis and author of Private Equity and the Demise of the Local. “Private equity takes over things in the medical field, quality goes down, prices go up,” Kenney explained.
Researchers found that private equity acquisition leads to increased deaths in nursing homes, increased post-operative complications for common inpatient surgeries and even an increase in medical conditions acquired in the hospital, such as bloodstream infections and injuries from falls.
Read full story
Source: The Guardian, 14 October 2025
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Weight-loss jabs and autism checks fuel NHS waits

The demand for weight-loss jabs and autism and ADHD assessments is helping drive up NHS waiting lists for community treatment, according to a report.
The size of the NHS community care waiting list for children in England has increased by 58% since data began in 2022, compared with a 23% increase for adults, a study by the Nuffield Trust and the Health Foundation found.
Their study found that more than half (55%) of children and young people on the waiting list are waiting for community paediatric services. These services include neurodevelopmental assessments, which encompass diagnosing and managing conditions such as autism and ADHD.
The report said: “This may partly explain the overall growth in the waiting list for children and young people’s services, as we have previously reported a surge in demand for referrals and assessments for these conditions.”
Read full story
Source: Medscape, 16 October 2025
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‘Defining moment’ for nursing in the USA: Joint Commission recognises staffing as quality component

Starting in 2026, The Joint Commission will formally recognise nurse staffing as a national performance goal, meaning hospitals seeking accreditation must meet certain standards related to staffing and oversight. 
Under the new element of performance, known as Goal 12, healthcare organisations must have a nurse executive responsible for overseeing staffing policies and procedures. The goal stipulates that hospitals have a registered nurse on duty to either directly provide care or supervise nursing services provided by other staff 24/7. This marks the first time the organization has included nurse staffing as a core component of quality.

“There must be an adequate number of licensed registered nurses, licensed practical nurses and other staff to provide nursing care to all patients, as needed,” the rule states. 
The American Nurses Association celebrated the move, calling it a “defining moment” for the profession. The change also could influence how payers and policymakers approach reimbursement tied to care quality.
Read full story
Source: Becker's Clinical Leadership, 14 October 2025
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NHS medical negligence liabilities hit £60bn amid surge in maternity payouts

The NHS’s total liabilities for medical negligence have hit £60bn, driven by a jump in childbirth injury cases that cost more than £11m each on average to settle.
The total sum of money the health service in England may have to pay out to settle lawsuits for mistakes by staff has quadrupled from £14.4bn in 2006-07, amid more claims and rising legal costs.
The cost of settling clinical negligence legal actions has soared over the same period from £1.1bn to £3.6bn, with much of that jump related to babies suffering brain damage while being born.
The figures are contained in a report by the National Audit Office (NAO), which urged NHS chiefs to do more to prevent the harm.
The £60bn liability that the NAO has identified is an increase on the £58.2bn at which the Commons public accounts committee (PAC) put the figure in May.
Geoffrey Clifton-Brown MP, the PAC chair, said the £60bn bill was “astounding”.
“This is the second largest liability across government [after public sector pensions] and forecasts predict that these costs could continue to grow substantially,” he said.
Read full story
Source: The Guardian, 17 October 2025
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NHS is failing to deal with antisemitism

The government has announced a “short, sharp review” of antisemitism in the NHS, with the prime minister saying some cases are ”simply not being dealt with”.
Sir Keir Starmer announced the review in a meeting with the Community Safety Trust, which protects Jewish communities in the UK, today. He said: “There are just too many examples, clear examples, of antisemitism that have not been dealt with adequately or effectively.
“So we need to do that review. We’ve already put in place management training in relation to the NHS, but I think we need a wider review, because in some cases, clear cases are simply not being dealt with, and so we need to get to the root of that.” HSJ has asked what management training he is referring to.
Baron John Mann, who is the government’s adviser on antisemitism, has been appointed to carry out the review.
Health and social care secretary Wes Streeting today said there was “racism in our ranks” and he had been shocked by “NHS staff who seem to think that racism against Jewish people is acceptable – encouraged by a complacent and indifferent regulatory system.”
It follows widespread media coverage of cases where doctors who appeared to have made antisemitic remarks were allowed to continue working. Mr Streeting has previously said that in future they would be suspended before facing a tribunal.
Read full story (paywalled)
Source: HSJ, 16 October 2025
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Pregnant women in England at ‘growing risk’ of serious injury in childbirth

Pregnant women in England are at growing risk of suffering a serious injury while giving birth, NHS figures reveal.
The number of mothers sustaining a third- or fourth-degree perineal tear while delivering their baby has risen from 25 in 1,000 in June 2020 to 29 in 1,000 in June this year – a 16% increase.
Such injuries can have a “life-changing” impact on women’s physical and mental health, cause post-traumatic stress disorder and leave them afraid to have another child.
Childbirth experts linked the rise in the most serious forms of tear to poor NHS care, understaffing in NHS maternity units and mothers getting older and larger.
Women are also being put in danger because hospitals do not always properly establish the risk of suffering a tear using an assessment method recommended by obstetricians, midwives and MPs.
“Behind these figures are heartbreaking stories of women suffering unimaginable trauma at a moment that should be full of joy,” said Helen Morgan, the Liberal Democrat health spokesperson, who obtained the NHS England figures from the House of Commons library.
“The Conservatives’ neglect of maternity services was unforgivable, putting mothers and babies under threat. But Labour risks kicking action on this problem into the long grass.”
Read full story
Source: The Guardian, 17 October 2025
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‘Gamechanging’ HIV prevention jab to be approved for England and Wales

A “gamechanging” injection to prevent HIV is to be approved for use in England and Wales.
The long-acting jab, administered every two months, will offer an alternative to the daily pills used to protect against the virus.
This form of HIV prevention therapy, known as Prep (pre-exposure prophylaxis), is typically taken by HIV-negative people to reduce their risk of infection.
In draft guidance published on Friday, the National Institute for Health and Care Excellence (Nice) recommended cabotegravir (CAB-LA) for adults and young people at risk of HIV who are unable to take oral Prep.
The injection is already available on the NHS in Scotland.
The health secretary, Wes Streeting, said the approval of the injection was “gamechanging”.
“For vulnerable people who are unable to take other methods of HIV prevention, this represents hope,” he said.
“We’re making real progress on HIV, with Prep use up by 8% this year, and our ambition goes even further. England will be the first country to end HIV transmissions by 2030, and this breakthrough treatment is another powerful tool in our arsenal to reach that crucial goal.”
Read full story
Source: The Guardian, 17 October 2025
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Overall CQC ratings to be reintroduced

The Care Quality Commission (CQC) is proposing to reintroduce overall care quality ratings for trusts, and put more weight on “expert professional judgement”, in an overhaul of its assessments.
HSJ reported in June that the regulator had begun phasing out overall ratings for trusts and foundation trusts, which had previously been used as a key barometer of organisational success.
This was part of a major change to its assessment regime, decided last year under the CQC’s previous leadership, but given little publicity at the time. Instead, at organisational level, trusts receive only a “well led” rating.
But a consultation now issued proposes reversing this and states: “We are aware of the challenges of appropriately reflecting the quality and leadership of an NHS trust in a single well-led rating. We know that many of our stakeholders placed value on our previous overall quality rating for NHS trusts, and the previous structure of trust-level ratings.”
The approach decided last year has so far only been applied to a small number of trusts, but has led to situations where some sites or services are significantly upgraded or downgraded, with no impact on the overall “well led” rating.
Reviving overall trust quality ratings is one of several proposed reversals to changes introduced under the previous chief executive, Ian Trenholm. 
Read full story (paywalled)
Source: HSJ, 16 October 2025
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Baby died after “red flag” signs of bowel obstruction were missed in phone consultation, inquest hears

An inquest into the death of a baby after an advanced neonatal nurse practitioner missed “red flag” signs of a bowel obstruction during a phone consultation has again cast the issue of safe remote care into the spotlight.
Jax Miller died at 1 day old of volvulus, which occurs when a loop of intestine twists around itself and causes a bowel obstruction. It is known to be a critical medical emergency.
A number of doctors have expressed concern about the case on social media, particularly about the lack of a face-to-face consultation and the wider issue of non-medical professionals taking on roles traditionally held by doctors.
Jax was born on 7 June 2023 at the Princess Royal Hospital in Sussex and discharged home after a normal newborn and infant physical exam. Only one feed had been recorded before discharge, and Jax’s mother had been concerned about his reluctance to feed. She had also reported that Jax had vomited several times, which was not further investigated.
After discharge Jax remained reluctant to feed and continued to vomit. The mother was not advised to attend hospital immediately and was reassured that all was fine.
The next morning Jax’s mother took him to the Royal Alexandra Children’s Hospital in Brighton, where doctors carried out a laparotomy for suspected volvulus. The surgeon found a 360° malrotation with a completely dead small bowel and concluded that his condition was incompatible with life. Jax was redirected to a palliative pathway and died that evening.
At the inquest on 1 October the coroner concluded that Jax had died from natural causes, but he said, “There was a missed opportunity to provide the baby with urgent medical care due to an omission in communicating to his mother the appropriate actions to be taken should his condition become acute.” However, the coroner did not conclude that a prevention of future deaths report was necessary or appropriate.
Read full story
Source: BMJ, 14 October 2025
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