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Patient Safety Learning

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  1. Event
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    This Westminster conference will assess priorities and next steps for addressing the impact of Long Covid in Ireland. Areas for discussion include developing and implementing research into Long Covid, the state of specialised services in Ireland, and the implementation and development of the Model of Care, which recommended the development of eight post-acute and six Long Covid clinics. It will be a timely opportunity to discuss Ireland’s strategy for tackling long COVID following analysis from Denis Naughten TD - who is part-chairing this conference - which suggests that almost 340,000 people in Ireland could have been affected by long COVID. It also follows a motion forwarded by a regional group of TDs calling for swifter action to support those with long COVID, which secured unanimous Dáil Éireann support. With the HSE now implementing the Model of Care for long COVID, and developing an epidemiological survey to gauge long COVID numbers in Ireland, delegates will assess the development of the model, workforce and recruitment priorities, and next steps for research and data. It will include keynote sessions from Dr Siobhán Ní Bhriain, Consultant Psychiatrist & National Clinical Director, Integrated Care, HSE; and Professor John Lambert, Consultant in Infectious Diseases and Genitourinary Medicine, Mater Misericordiae University Hospital and Associate Professor, UCD School of Medicine. Overall, sessions in the agenda will look at: the interim model of care: priorities for development and for creating a centralised care hub to provide support. long COVID clinics: next steps for implementation - providing effective staffing and funding - tackling long COVID backlogs and waiting lists - relieving pressures on GP waiting lists. patients: assessing and providing the support needed by those with long COVID and identifying those most at risk - options for workplace support and assisting those out of work to return quickly. research: building on data from current long COVID and post-acute COVID clinics to inform future strategies - implementing effective surveillance to understand, scale and respond to the issues. policy coordination: integrating responses with Sláintecare reforms and waiting list strategies. Register
  2. Event
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  3. News Article
    The NHS in England is facing a “perfect winter storm” with 10 times more people in hospital with flu than this time last year, and ambulances experiencing deadly delays when arriving at A&E with sick patients. There were an average of 344 patients a day in hospitals in England with flu last week, more than 10 times the number at the beginning of last December. And as many as 3 in 10 patients arriving at hospitals by ambulance are waiting at least 30 minutes to be handed over to A&E teams. Health chiefs say the crisis is leading to deaths. The figures on flu and ambulance delays were published by NHS England on Thursday and offered the first weekly snapshot of how hospitals are performing this season. Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, said: “These figures really hammer home just how stretched services already are as we head into a perfect winter storm. Significantly higher numbers of people are in hospital because of flu compared to this time last year, coupled with the fact that Covid-19 has not gone away.” He added: “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays, and patients are dying and coming to harm as a result on a daily basis.” Read full story Source: The Guardian, 24 November 2022
  4. News Article
    Hospital doctors failed to share with child protection services a list of "significant" injuries a five-year-old boy suffered 11 months before he was murdered, a case review has found. Logan Mwangi had a broken arm and multiple bruises across his body when he was taken to A&E in August 2020. But a paediatric consultant said these injuries were accidental and did not make a child protection referral. Logan, from Bridgend, was murdered by his mother, stepfather and a teenager. A Child Practice Review (CPR) has looked at how different agencies were involved with Logan's family in the 17 months before his death. Cwm Taf Morgannwg health board said it welcomed the commissioning of an independent review into how it identifies and investigates non-accidental injuries. The report said that if the injuries had been shared with social services, appropriate action could have been taken to safeguard Logan. Jan Pickles, the independent chair of the review panel, said it was a "a significant missed opportunity". She added: "Had further information from health been shared it most likely, though we cannot say for sure because of hindsight bias, would have triggered a child protection assessment in line with the joint agreed guidelines, as the nature of those injuries clearly met the threshold." Read full story Source: BBC News, 24 November 2022
  5. News Article
    The rate of people from black backgrounds being restrained in mental healthcare has more than doubled in the past six years, widening the gap with other racial groups, according to official NHS data. Standardised rates of black and black British people subject to restrictive interventions – including physical, chemical and mechanical restraints – have leapt from 52.1 per 100,000 people in 2016-17 to 106.2 in 2021-22. That is compared to a much smaller increase of 30% in the same period for people from white backgrounds, from 15.8 per 100,000 to 20.5. NHS race and health observatory director Habib Naqvi told HSJ he was “very concerned” at the rise. He said a “range of complex causes are likely to be presented to account for this pattern”, including disparities in care pathways, late presentation and lack of timely diagnosis, and general overuse of restrictive practice on people from minority ethnic backgrounds. He added: “It is critical we also focus on ‘causes of the causes’ of these disparities, including the impact of discrimination and bias on access, experience and therefore outcomes of mental health services.” Read full story (paywalled) Source: HSJ, 24 November 2022
  6. News Article
    Nurses across the UK will go on strike for the first time over two days in the fortnight before Christmas after ministers rejected their pleas for formal talks over NHS pay. The Royal College of Nursing (RCN) said its members would stage national strikes – the first in its 106-year history – on 15 and 20 December. Senior sources said the industrial action was expected to last for 12 hours on both days – most likely between 8am and 8pm. The unprecedented national industrial action will seriously disrupt care and is likely to be the first in a series of strikes over the winter and into the spring by other NHS staff, including junior doctors and ambulance workers. On Friday, RCN general secretary, Pat Cullen, said the UK government had chosen strikes over listening to nursing staff, adding: “If you turn your back on nurses, you turn your back on patients.” The RCN said that despite a pay rise of about £1,400 awarded in the summer, experienced nurses were worse off by 20% in real terms due to successive below-inflation awards since 2010. It said the economic argument for paying nursing staff fairly was clear when billions of pounds were being spent on agency staff to plug workforce gaps. It added that in the last year, 25,000 nursing staff around the UK had left the Nursing and Midwifery Council register, with poor pay contributing to staff shortages across the country, which it warned were affecting patient safety. There are 47,000 unfilled NHS registered nurse posts in England alone. Read full story Source: The Guardian, 25 November 2022
  7. News Article
    Nine acute trusts accounted for a third of all ‘hours lost’ to ambulance handover delays last week, according to new data. The first NHS England winter sitrep data showed wide variation between providers on ambulance handover performance, with a small number of providers accounting for a huge proportion of delays. There were nine trusts where, for each ambulance arrival in the week to 20 November, an average (mean) of more than an hour was lost to handover delays. The providers accounted for around 7,000 hours lost, 33% the national total, despite only accounting for 7% of ambulance arrivals. At University Hospitals Plymouth an average of 2.3 hours were lost. The other trusts were; Norfolk and Norwich University Hospitals; East and North Hertfordshire; The Queen Elizabeth Hospital King’s Lynn; Great Western Hospitals; University Hospitals of Leicester; Torbay and South Devon; University Hospitals of North Midlands; and Worcestershire Acute Hospitals. Many of the worst performing hospitals were in the South West and East of England regions, which have previously been identified as areas which struggle on handover delays. Read full story Source: HSJ, 24 November 2022
  8. News Article
    Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands. Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays. For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis. HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account. Read full story (paywalled) Source: HSJ, 23 November 2022
  9. News Article
    A report by the Scottish Public Services Ombudsman (SPSO) said the health board's own investigation into the patient's complaint was of "poor quality" and "failed to acknowledge the significant and unreasonable delays" suffered. The delays led 'Patient C' to develop a severe hernia which left them unable to work, reliant on welfare benefits, and requiring riskier and more complex surgery than originally planned. The watchdog criticised NHS bosses for blaming Covid for the delays when the patient had been ready for surgery since December 2018, and said there had been "no sense of urgency" despite "the gravity of C's situation". The report said: "It is of significant concern that the Board has failed to fully acknowledge the consequences of the delays and the adverse effects upon C's physical and mental health as a result. "The consequences for C of these delays cannot and should not be underestimated." Read full story Source: The Herald, 24 November 2022
  10. News Article
    For the first time, more than 2.5 million people in the UK are out of work because of a long-term health problem. The number has jumped by half a million since the start of the pandemic - but, BBC News analysis reveals, the impact is spread unevenly across the country, with some regions and types of job far more affected. For Mary Starling, there are good days and bad days. The 61-year-old is on strong painkillers, for arthritis. She needs a knee replacement - but that could mean another 18 months on an NHS waiting list. Mary is keen to return to that work - but needs her operation first. "I feel despair - but I'm resigned to it," she says. "I understand it isn't possible to magic up something, though it's wearing not being able to plan my life." The UK is in its fourth year of sharply rising chronic illness. The highest rates are among 50- to 64-year-olds, but there have also been significant increases in some younger groups. Although the link is not conclusive, the Bank of England has said record NHS waiting lists are likely to be playing a "significant role". Some of the largest increases are in people reporting mobility difficulties, such as leg and back problems, or heart and blood-pressure problems. More younger people, in particular, say they are not in work because of different forms of mental illness. But the largest increase in long-term sickness is in the catch-all "other health problems" category, likely to include some of those with "long Covid" symptoms. Read full story Source: BBC News, 23 November 2022
  11. Content Article
    A complaint from a patient was made to the Scottish Public Services Ombudsman (SPSO) about the care and treatment provided during the period January 2018 to September 2021. In January 2018 the patient underwent emergency surgery for a perforated sigmoid diverticulum (a complication of diverticulitis, an infection or inflammation of pouches that can form in the intestines). An emergency Hartmann's procedure (a surgical procedure for the removal of a section of the bowel and the formation of a stoma - an opening in the bowel) was performed. In April 2018, the patient was seen in an outpatient clinic and informed it would be possible to have a stoma reversal. The patient complained that the Board had continually delayed the stoma reversal surgery which they required, which as of September 2021 had not taken place. The patient also complained that Covid-19 could not account for the delays between the Board informing patient they were ready for surgery around December 2018 and the start of the pandemic in March 2020. The patient noted that as a consequence they had developed significant complications: a large hernia. The patient added that this had severely impacted their personal life and self-esteem, and left them unable to work and reliant on welfare benefits.
  12. News Article
    The NHS staffing crisis will be solved only if doctors and nurses get more flexible about their job descriptions and break down barriers between roles, according to Rishi Sunak’s health adviser. Bill Morgan argues that training times for doctors and nurses may have to be reduced, and suggests developing “sub-consultants” and entirely new medical professions, He wants ministers to create an Office for Budget Responsibility-style body to predict future workforce needs. The Treasury has held down the numbers of doctors and nurses Britain trains to prevent “supply-induced demand”, which encourages people to seek appointments that are not needed, Morgan argues. Chronic shortages of qualified staff are the biggest problem facing the health service, which has more than 130,000 vacancies. Morgan acknowledges that this means “some of the government’s key manifesto commitments will not be met”, citing the promise of 6,000 extra GPs. Sunak said this week that the government was “thinking creatively about what new roles and capabilities we need in the healthcare workforce of the future”. He urged the NHS to shed “conventional wisdom”. Read full story (paywalled) Source: The Times, 24 November 2022
  13. News Article
    Ministers are considering the use of body cameras within mental health units as part of the government’s response to NHS abuse scandals, The Independent has learned. Senior sources with knowledge of the conversation between the Department for Health and Social Care and the NHS have raised concerns about the plans. There are fears that using the technology in mental health units could have implications for human rights and patient confidentiality. One senior figure criticised the proposals and said: “The DHSC are all talking about body-worn cameras, closed circuit TV, etc... The whole thing is fraught with huge difficulties regarding human rights, about confidentiality. They are thinking about it [cameras] and it is ridiculous.” The DHSC’s mental health minister Maria Caulfield said in parliament earlier this month that she and health secretary Steve Barclay were due to meet with NHS officials to discuss what response was needed to recent exposes of abuse within mental health services. It comes after a string of reports from The Independent, BBC Panorama and Dispatches revealing abuse of inpatients. The Panorama and Dispatches reports included video evidence of abuse captured by hidden cameras. Following a scathing independent review into the deaths of three young women, Tees, Esk and Wear Valleys NHS Trust said it is piloting the use of body-worn cameras across 10 inpatient wards “to support post incident reviews for staff and patients.” Read full story Source: The Independent, 23 November 2022
  14. News Article
    Ambulance crews could not respond to almost one in four 999 calls last month – the most ever – because so many were tied up outside A&Es waiting to hand patients over, dramatic new NHS figures show. An estimated 5,000 patients in England – also the highest number on record – potentially suffered “severe harm” through waiting so long either to be admitted to A&E or just to get an ambulance to turn up to help them. Ambulance officers warned that patients were dying every day directly because of the delays since the service could no longer perform its role as a “safety net” for people needing urgent medical help. “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays and patients are dying and coming to harm as a result on a daily basis,” said Martin Flaherty, managing director of the Association of Ambulance Chief Executives (AACE), which represents the heads of England’s 10 regional NHS ambulance services. Flaherty added: “Our national data for hospital handover delays during October 2022 is extremely worrying and underlines the fact that in some parts of the country efforts to reduce or eradicate these devastating and unnecessary delays are simply not working.” Read full story Source: The Guardian, 23 November 2022
  15. News Article
    Greater Manchester’s mental health trust has been placed into the ‘equivalent of special measures’, the Manchester Evening News can reveal. The crisis measures enforced by the NHS come after allegations that patients were abused at a mental health unit run by the beleaguered trust. The Edenfield Centre is a mental health care facility in the grounds of the former Prestwich Hospital and was the subject of a BBC Panorama programme that claims patients were abused. Since the episode aired, 30 staff are facing disciplinary action and a dozen have already been sacked, the Manchester Evening News understands. The chair of the trust, Rupert Nichols, resigned last week after 'inexcusable behaviour and examples of unacceptable care' were 'exposed' at a mental health unit, he said. Now, NHS England is placing the Recovery Support Programme, the 'equivalent to the former special measures', multiple senior NHS sources say. Greater Manchester Mental Health NHS Foundation Trust (GMMH) is now under the highest level of NHS England intervention, the M.E.N. can confirm. Every trust is part of the NHS' Oversight Framework, those placed into its highest level are identified as experiencing the most significant and complex challenges in achieving financial sustainability and/or high-quality care receive intensive mandatory support. Read full story Source: 23 November 2022, Manchester Evening News
  16. News Article
    A maternity unit criticised for the preventable stillbirth of a baby is under investigation after the unexpected death of a second baby. The newborn baby died in December last year after her birth at the standalone midwifery-led unit (MLU) at Lagan Valley Hospital in Lisburn. Despite this, the unit continued to operate as normal for another three months when the South Eastern Trust temporarily paused births at the MLU. The second tragedy came four years after Jaxon McVey was stillborn when his delivery at the unit went catastrophically wrong. A post-mortem found he died as a result of shoulder dystocia – an obstetric emergency where the head is born but the shoulder becomes trapped behind the pubic bone. Jaxon’s mum, Christine McCleery, has hit out at the South Eastern Trust and raised concerns over the measures put in place following his stillbirth on Mother’s Day 2017. “I feel like they didn’t learn from Jaxon,” she said. “I don’t know if any other babies died before Jaxon, but I know one died afterwards. Read full story (paywalled) Source: The Independent, 23 November 2022
  17. News Article
    Attending physicians and advanced practice clinicians in US emergency departments are more concerned about medical errors resulting in patient harm than in malpractice litigation, according to a study published JAMA Network Open. The findings are based on an online survey of 1,222 ED clinicians across acute care hospitals in Massachusetts from January to September 2020. Respondents used a Likert scale of 1 (strongly disagree) to 6 (strongly agree) to indicate their degree of agreement with statements on how fearful they are of making a mistake that leads to a patient harm in their day-to-day practice, and how fearful they are of an error that results in being sued. The mean score was greater for fear of harm (4.40) than fear of being sued (3.40), the findings showed. Researchers said the mean scores for both fear of harm and fear of suit were similar regardless of whether the survey was completed before or after onset of the COVID-19 pandemic. Although previous studies have associated clinicians' fear of legal concerns with "excessive healthcare use through defensive medicine," the role fear of patient harm may play in clinical decision-making is less documented, researchers said. "Although the study did not delineate the association between this concern and potential overuse of testing, it suggested that fear of harm should be considered with, and may be more consequential, than fear of suit in medical decision-making," researchers said. Read full story Source: Becker's Hospital Review, 21 November 2022
  18. News Article
    A young mother lost both her feet and all 10 fingers to sepsis after a significant delay in treatment, an investigation has found. Sadie Kemp has been left permanently disabled from the “dangerous condition”, whilst an NHS hospital probe found a 3.5 hour delay in starting her care. Sadie is now calling for lessons to be learned after the internal report found numerous concerns in her treatment that ultimately led to her needing multiple amputations. The 35-year-old mother-of-two first attended A&E with agonising back pain caused by a kidney stone on Christmas night 2021. She was given pain relief at Hinchingbrooke Hospital, Cambridgeshire, and sent home to return the following morning for a kidney scan. She returned the same night at 4am as her pain endured. An assessment at 5.40am found she may have also been suffering from sepsis, but the step-by-step guide to chart and treat the illness was not found in her notes as being done at the time. The investigation found not only should the sepsis have been discovered and treated sooner, but the “lack of effective treatment” of the sepsis prior to the surgery meant she needed prolonged critical care. Read full story Source: The Independent, 22 November 2022
  19. News Article
    Performance failings at NHS Supply Chain are impacting patient care, staff wellbeing and retention, and local procurement teams are struggling to mitigate their impact, local procurement chiefs have claimed. The group of senior NHS buyers have raised their concerns in a highly critical letter to NHS Supply Chain chief executive Andrew New and NHS England’s chief commercial officer Jacqui Rock. The letter, seen by HSJ, was signed by 22 heads of procurement at trusts and integrated care systems. It raises concerns about the NHSSC’s core functions, like delivering products on time and in full, its governance, and highlights unanswered questions about how it interacts with NHSE’s new central commercial function. Read full story (paywalled) Source: HSJ, 22 November 2022
  20. News Article
    Ill patients are refusing sicknotes from their GP because they cannot afford time off work, while doctors suffer “moral distress” at their powerlessness to do more to help the most vulnerable, the new leader of Britain’s family doctors has revealed. More patients are experiencing asthma attacks or other serious breathing problems because they cannot afford to heat their homes, said Dr Kamila Hawthorne, the chair of the Royal College of GPs, while many have reported deteriorating mental health due to financial stress. Soaring food costs are also leading to a rise in fatigue, mouth ulcers and weak muscles, with people deficient in key vitamins because they cannot afford to eat anything other than a poor diet. So many patients are presenting with complex physical and psychological problems related to poverty, domestic violence, childhood abuse or poor housing that GPs are suffering psychologically from their inability to take the requisite action, she said. Hawthorne said: “Recently I’ve had patients refusing sicknotes because they can’t afford not to work. Quite often, when it’s clear that somebody needs some time off, they won’t take it. “These are people who ideally, medically, should not be at work [because] they have a chronic condition such as asthma or diabetes, but quite often mental health problems, quite severe mental health problems, I [see] some cases that really do require a bit of sicknote peace and quiet to try and help them get better. “I’ve been really surprised in the last year that when I’ve offered a sicknote they’ve said: ‘Oh no, no, I can’t take time off. I need the money from work.’ They’ve refused. They say: ‘I need to keep working to earn and to feed myself and my family.’ I don’t take it personally, of course, but I feel sad for people because for a few minutes you enter their lives and see that it’s really tough.” Read full story Source: The Guardian, 23 November 2022
  21. News Article
    An NHS England director says trusts should use ‘as robust triage as you can possibly do’ when deciding whether to accept referrals from GPs. Ian Eardley, NHSE’s joint national clinical director for elective recovery, was asked during an internal NHSE webinar how trusts can encourage GPs to work more closely with secondary care to make sure they only send appropriate referrals. He said: “There’s got to be as robust triage as you can possibly do, so if you’ve got referrals coming in which haven’t got the relevant or wrong information, then I think you need senior clinicians in a position to go back to the GP and say we need this bit of information or the other… Ultimately, it’s about robust front-end management.” However, he admitted it was a “difficult [issue and] really difficult to do anything centrally”. Read full story (paywalled) Source: HSJ, 23 November 2022
  22. News Article
    NHS therapy services won’t be able to manage increased demand driven by the cost of a living crisis as they are already thousands of therapists short, The Independent has been told. NHS counselling services in England are not meeting therapy access targets due to a shortfall of 2,000 workers, according to sources. The findings come as a poll by the UK Council for Psychotherapy (UKCP) and YouGov, shared with The Independent, found that almost one in two adults felt the cost of living crisis was affecting their mental health. According to the survey of more than 2,000 adults, 25 to 34 years old were most likely to say the cost of the living crisis was impacting their mental health. Adam Jones, policy and public affairs manager for the UKCP, said “I think what we’re concerned about is the fact that already, there is a record level of demand for mental health services. We also know there are record rates of prescription for antidepressant medication as well. We’re concerned the capacity currently is already falling short. “So with the rising demand going forward, we’re concerned that services are going to be stretched, waiting time is going to go up, average number of therapy sessions received is going to go down He warned that although the NHS is focussed on training new therapists, there was already an existing workforce of psychotherapists and counsellors who don’t work in the NHS. “We’d like to see more targeted recruitment of psychotherapists and counsellors who are already trained, and so that most would only require a short adaptive training to be able to work in an NHS context.” Read full story Source: The Independent, 23 November 2022
  23. News Article
    Menopausal women working in NHS England will be able to work flexibly should they need to under new guidance. Launching the first national NHS guidance on menopause, the NHS England chief executive, Amanda Pritchard, has called on other employers to follow suit to help “break the stigma”. She said many employees were “silently suffering” and were either too embarrassed to broach the subject or experience a “lack of support” when they did. No one should feel their only option is to “turn their back on their career” over menopausal symptoms, she added. “It’s our responsibility as leaders to ensure this doesn’t happen any longer.” The guidance aims to boost awareness as well as support the introduction of practical measures including flexible working patterns – including lighter duties, fans to make temperatures more comfortable, cooler uniforms and staff training. “Our guidance has been intentionally designed to be transferable to other workplaces too, so I hope organisations and women beyond the NHS can also benefit,” she said. Read full story Source: The Guardian, 23 November 2022
  24. News Article
    The Care Quality Commission (CQC) has hired two independent whistleblowing champions, Joy Warmington and Arpita Dutt, to oversee a major review of how it listens to concerns. The CQC previously announced it had appointed Zoe Leventhal KC, of Matrix Chambers, to lead the first phase of the review, which is considering how the CQC handled protected disclosures made by Shyam Kumar, an orthopaedic surgeon at University Hospitals of Morecambe Bay Foundation Trust, and whether ethnicity “played any part in the management of those disclosures”. On Friday it issued details of the second phase of the work, including that it had brought in two outside experts, and long-time champions of whistleblowers, to “help to ensure the independence and credibility of the review”. This was launched amid wider concerns about how it responds to whistleblowing concerns in the service and among its own staff, including potential discrimination and also comes as the CQC itself seeks to begin a major restructure. Read full story (paywalled) Source: HSJ, 22 November 2022
  25. News Article
    Contrary to current advice, getting pregnant within a few months of an abortion or a miscarriage does not appear to be extra risky for the mum and baby, say researchers who have looked at recent real-life data. The World Health Organization (WHO) recommends at least a six-month gap to give the woman time to recover. However, a study in PLoS Medicine, analysing 72,000 conceptions, suggests couples might safely try sooner for a baby. The baby loss support charity Tommy's says women who feel ready to try again immediately after a miscarriage should do so if there is no medical reason against it. The WHO says more research into pregnancy spacing is already under way and would inform any future updates to the advice. The research from Norway, spanning eight years from 2008 to 2016, found no major differences in outcomes when a new pregnancy happened sooner than a six-month delay. That is a different finding to earlier work in Latin America that - along with other studies - informed the WHO recommendations on pregnancy spacing. The authors of the latest Norwegian analysis say the advice needs reviewing so that couples can make an informed decision about when to try for a baby. Read full story Source: BBC News, 23 November 2022
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