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Clive Flashman

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  1. Clive Flashman
    The Public Accounts Committee (PAC) has warned there is a significant risk that digital solutions are being treated as a “cure-all” in the government’s plans to reduce NHS waiting times.
    In its latest report, the PAC said despite spending £2.2bn of capital funding on diagnostic transformation and a further £1.0bn on surgical transformation, NHS England (NHSE) has missed its recovery targets by significant margins and too many people are still waiting too long for tests and treatment.
    The PAC warned that this need for change comes at a time of major structural reform in the NHS, including NHSE being abolished and a 50% headcount cut across integrated care boards (ICBs). It says that these unfunded reforms, which will result in the loss of c. 18,000 administrative posts, could have a significant negative impact on patients and the NHS workforce and will lead to wasted effort.
    It says the integration and sharing of digital records across the NHS remains a key weakness in the system. It also raises concerns about access to and interoperability between digital resources, as well as issues of hardware availability and connectivity.
    The PAC calls on NHSE and the Department for Health and Social Care (DHSC) to set out:
    how the elective care transformation programmes are practically affected by the ‘analogue to digital’ shift in the 10 Year Plan; how it will solve the problem of legacy IT equipment and ensure that the IT systems used in different parts of the NHS are properly connected; and whether the 10 Year Plan itself has sufficient funding to deliver the digital transformation required by the plan. During an oral evidence session in September 2025, Sir Jim Mackey (CEO of NHSE) admitted that record sharing across the system remained a key issue. He said digital foundations have been laid through the electronic patient records (EPR) programme but warned that the landscape is evolving rapidly.
    Mackey said they needed to work out what role the centre (DHSC) should play in managing the proliferation of health technology being made available to and interacting with the NHS, such as consumer-led health devices. This includes developing a healthy market and moving away from big capital, central bidding processes and into more agile and rapid processes.
    The PAC also states that it is “sceptical that digital change can satisfactorily reach all patients as there is likely to always be a part of the population who find digital technology and tools too difficult to use”. As TechMarketView commented when the 10 Year Plan was published, with digital platforms like the NHS App becoming increasingly important routes to NHS services and information. Much stronger attention needs to be paid to accessibility and user capability, with a focus on digital inclusion and equity.
    Although the NHS backlog numbers are showing signs of improvement in some areas, they are still far too high. The structural reforms currently underway risk derailing this progress and disrupting digital transformation efforts. Too often digital solutions, particularly AI, are being seen as a panacea for an effective NHS – these technologies will be transformative, but their true potential will not be achieved without a balanced approach to securing the digital foundations. 
  2. Clive Flashman
    A 51-year-old woman has said she endured an “agonising” hysteroscopy at University Hospital of Hartlepool after not giving informed consent for the procedure.
    Dawn Lord attended the hospital in May 2023 expecting only routine blood tests and a discussion about future investigations. As she was leaving, her doctor abruptly suggested carrying out a biopsy. She said she was given no explanation of what this would involve and was “in shock” as she was asked to change for the procedure.
    During the biopsy, a cervical polyp was removed without warning. Mrs Lord said she repeatedly told staff she was in severe pain but was not offered any pain relief. When the biopsy failed, she was told a hysteroscopy — involving a small camera inserted through the cervix — would be “a better method”. She said she was not informed of what was happening and recalled hearing the doctor say “can’t get it” during the attempt.
    Despite being given a local anaesthetic, Mrs Lord described the pain as “beyond a scale of one to 10”. She continued to suffer heavy bleeding and intense pain over the following days, even fainting during the night. She complained to the hospital and received an apology five months later, along with £400 compensation.
    North Tees and Hartlepool NHS Foundation Trust admitted it had not met the “high standard of care” it strives for and said her complaint prompted a review leading to service improvements. The Parliamentary and Health Service Ombudsman said the trust had already apologised and committed to improving how it informs patients about procedures and obtains consent.
    A hysteroscopy is considered the gold-standard method for diagnosing gynaecological conditions, though the Royal College of Obstetricians and Gynaecologists says a third of patients report severe pain and should be offered appropriate anaesthesia.

    Full article here.
  3. Clive Flashman
    The article discusses concerns about proposed cuts to Integrated Care Boards (ICBs) in the UK and their potential impact on patient safety. ICBs are responsible for coordinating local healthcare services, but recent budget reductions could weaken their capacity to ensure effective oversight and patient safety.
    Healthcare leaders express alarm that these cuts may exacerbate existing gaps in service oversight and lead to inconsistent quality of care across different regions. The article highlights that, although some improvements have been made in patient safety and local care integration, financial limitations could hinder further progress.
    Experts warn that reduced resources may impair ICBs' ability to monitor performance, implement safety protocols, and respond to patient feedback, potentially putting vulnerable populations at greater risk. The article cites specific examples where local health entities have successfully tackled safety issues and improved patient outcomes, drawing attention to how vital ICBs are in facilitating such initiatives.
    The article calls for comprehensive dialogue about the sustainability of funding for ICBs and the significance of ensuring strong oversight mechanisms to protect patient safety. It emphasizes the risk of fragmented care if ICBs struggle to fulfill their responsibilities due to budget cuts and urges policymakers to consider the long-term repercussions on health services and patient welfare.
    In conclusion, the proposed ICB cuts pose a considerable threat to the current efforts in maintaining uniform patient safety standards and addressing the healthcare needs of diverse populations across the country, necessitating immediate attention from health authorities.
    Full article here.
  4. Clive Flashman
    A new poll found more than two-thirds of GPs are concerned about patient safety
    Patients have submitted requests about life-threatening conditions on non-urgent forms following changes to online access in GP surgeries, family doctors have said.
    Since October 1, GP surgeries in England have been required to keep their online consultation platform open during working hours for non-urgent appointment requests, medication queries and admin requests. However, family doctors told Pulse magazine they have received reports from patients about difficulty breathing, rectal bleeding and severe vomiting on the forms, which are designed for non-emergencies.
    A new poll of 431 GPs and practice managers by Pulse found more than two-thirds (67 per cent) are concerned about patient safety since the change.
    Read more here in the Independent.
     
  5. Clive Flashman
    Software developed in Cambridge is helping nine hospitals to prioritise care, saving lives and freeing beds sooner
    Hospitals are using artificial intelligence to select high-risk patients to go to the front of the 7.5 million-long NHS waiting list. Software trained on more than 200 million records in 46 countries considers blood pressure, age, respiratory rate and where a patient lives to give them a risk score. Its introduction is part of increasingly urgent efforts by the health service to manage record numbers of patients stuck on waiting lists for routine treatment. Many will be deteriorating while they wait.
     This month The Sunday Times revealed that thousands have died, gone blind or suffered serious injuries, including having limbs amputated, because of delays and failures in their care. The problem is costing almost £900 million a year in negligence payouts. 
     The NHS last hit its target to treat most patients within 18 weeks of being referred from their GP in February 2016. Now trusts are experimenting with new ways to balance the risks of such large waiting lists after the pandemic.
     AI software developed by the Cambridge-based company C2-Ai is being used in nine hospitals in Cheshire and Merseyside; similar tools are being piloted elsewhere.
     The technology helps identify patients who have a high risk of deteriorating while they wait, or who might struggle to recover after major surgery. These people are given help to improve their health while waiting and can be prioritised for surgery sooner.
     Almost 1,000 patients have benefited from interventions such as health coaching before and after surgery. The approach has almost eradicated post-op chest infections and halved the rate of other complications. It has also reduced the amount of time patients are staying in hospital by more than four days — meaning beds are free for those waiting in A&E or others needing routine surgery.
     One of those who is benefiting is Tim Ashcroft, a 74-year-old businessman who was diagnosed with oesophageal cancer in 2023. After six weeks of chemotherapy, Ashcroft, from Winsford, Cheshire, had surgery to remove his oesophagus and possible cancer of the colon. After the surgery he had a stoma — an opening in the abdomen — which led to a double hernia; he was put on a waiting list to have the procedure reversed.
     Ashcroft had lost five stone since the initial surgery. In October, the C2-Ai technology flagged him as a potential risk and he was given a referral to use a phone app, Surgery Hero, which provides tools for exercise, tracking food intake and mental health support. The app linked Ashcroft with a dietitian who helped manage his nutrition and maintain his weight. They also spoke to consultants to bring forward his surgery, which he is hoping to have in the coming weeks.
     “It gave me a sense that I can look after my health while I wait, and that’s important especially as waits are so long at the moment,” Ashcroft said. “If this is a process which can generally save time and save lives … I don’t think anyone would object to that.”
     Rowan Pritchard Jones, medical director of the Cheshire and Merseyside NHS region, said it was right for the NHS to prioritise higher-risk patients. “We really need to think more smartly about the risk that is sitting on our waiting lists,” he said. “Nobody gets better while waiting but there are certain groups of patients who disproportionately deteriorate while they wait — patients whose [mortality risk] might move from 15 per cent to 45 per cent.”
     According to Cheshire and Merseyside, 40 per cent of its highest risk patients — those living with a number of conditions or diseases at the same time — come from the 20 per cent most deprived members of the population. Pritchard Jones said: “We have patients to worry about here, patients who will do badly. Let’s think about stratifying patients by risk.”
     C2-Ai’s technology is not the only innovation being tried to spot patients at higher risk from waiting times.
     In Coventry, the cardiologist Kiran Patel developed an algorithm to identify patients who had higher clinical risks and underlying social and demographic factors that meant they should be prioritised for treatment. It took into account whether a person had made repeat visits to A&E and whether they lived in a deprived area or had other health conditions. Patel, now chief medical officer at University Hospitals Birmingham, believes similar approaches could be considered there. “We know from the evidence that people are dying more from non-pandemic related issues and deprivation of care,” he said. “So that evidence is out there, and the fact that we have long waiting lists, and the fact that there are millions of people on there, would suggest that it’s inevitable some may be dying.”
     The approach is likely to prove controversial, particularly if it is used to prioritise patients according to factors such as getting them back to work.
     Jo Andrews, a consultant anaesthetist and chief medical officer at the consultancy Carnall Farrar, said: “If we look at the national challenge around people who are off work sick, we need to go after the things where it’s going to make the greatest difference. “That requires a difficult conversation with people, because you would be saying to the 75-year-old waiting for their hip replacement who can’t play golf, ‘Sorry, you’re going to have to wait a bit longer’, because the 65-year-old who can’t work and is the sole breadwinner for their family needs to take priority.”
    From The Sunday Times
  6. Clive Flashman
    Nearly 5,000 nurses, over 100 physicians, and advanced practitioners at Providence Oregon began striking Friday, impacting all eight state hospitals and six women’s clinics. Striking workers cite systemic understaffing, safety concerns, and job security fears due to Providence’s operational changes and private equity involvement.
    The Oregon Nurses Association (ONA) has accused Providence of refusing to bargain effectively, leading to the strike after over a year of stalled negotiations. Providence countered, claiming it offered nurses a 20% pay increase and accused the union of stalling.
    Governor Tina Kotek urged all parties to return to the table, emphasizing the disruption to patient care. Providence has hired 2,000 temporary nurses but struggled to find replacement physicians, consolidating women’s clinic services and reducing capacity.
    Providence leadership acknowledged challenges but expressed commitment to resuming negotiations once operations stabilise.
    Full article here.
  7. Clive Flashman
    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.
  8. Clive Flashman
    Female health monitoring apps are putting women at risk by "coercing" them into disclosing - and then poorly handling - highly sensitive data, according to new research.
    The study examined the privacy policies and data safety labels of 20 of the most popular of these kind of apps, which are commonly used to help women conceive. It found a host of poor data-management practices, including some apps not having a delete function, even for highly personal information such as menstrual cycles and miscarriages. Its authors say it is the most extensive evaluation its kind completed to date. They say the apps are used by hundreds of millions of people.
    The BBC has contacted a number of app providers - none have responded to a request for comment.
    "While female health apps are vital to the management of women’s health worldwide, their benefits are currently being undermined by privacy and safety issues," the lead author of the study, Dr Ruba Abu-Salma, from King's College London, told the BBC.
    Other key findings from the study include:
    35% of apps claimed not to share personal data with third parties but contradicted this in their privacy policies 50% assured users that health data would not be shared with advertisers, but were ambiguous about other data collected 45% of privacy policies denied responsibility for third-party practices, despite claiming to vet them. Female-focused technology has boomed in recent years, with the market expected to exceed $75 billion by 2025. But Lisa Malki, another of the study's authors, said the industry needed to get better at protecting the women whose data it was using.
    Read full article on the BBC here.
  9. Clive Flashman
    One of the best doctors in the UK died on an understaffed Manchester hospital ward after falling sick with a condition he was an expert in treating, an inquest has heard.
    Professor Amit Patel was among the ‘best doctors in the UK’, the first person in the country to be qualified in stem cell transplantation and cellular therapy, and intensive care medicine. He was also a beloved husband and father-of-two.
    “He looked liked a corpse, 70 per cent of his blood was in his lungs, he was freezing cold and he looked like he was dead," his heartbroken wife told an inquest at Manchester Coroners Court. "I told my daughters, ‘daddy is dead’ – I didn’t have much hope he would be able to come out of that.”
    Professor Patel's condition was being investigated by doctors at Wythenshawe Hospital, Manchester Royal Infirmary, and across the country. But, he was in the unimaginable position of being a nationally recognised expert in the illness. During his career, he had formed ‘national guidance’ on the illness and sat on the national multi-disciplinary panel to which the most serious cases, including his own, were referred.
     The court heard how he was experiencing the symptoms of hemophagocytic lymph histiocytosis (HLH) – a rare and life-threatening immune disorder where the body reacts inappropriately to a 'trigger’, such as an infection or cancer, and leads to inflammation. Patients can be predisposed to HLH by Still’s disease, another rare autoimmune condition also causing inflammation, which Professor Patel was suspected to have had.
    Full article here.
  10. Clive Flashman
    Presymptom Health’s technology provides early and reliable information about infection status and severity in patients with non-specific symptoms, helping doctors make better treatment decisions. The company’s tests can be run on NHS PCR platforms, which were widely deployed during the COVID pandemic and are now often under-utilised. By detecting true infection and sepsis earlier, it’s possible to save lives and significantly reduce the incorrect use of antibiotics.
    When it comes to sepsis, Presymptom’s technology could revolutionise treatment. According to The UK Sepsis Trust, every 3 seconds, someone in the world dies of sepsis. In the UK alone, 245,000 people are affected by sepsis with at least 48,000 people losing their lives in sepsis-related illnesses every year.
    This is more than breast, bowel and prostate cancer combined. When diagnosed at a late stage, the likelihood of death increases by 10% for every hour left untreated. Yet, for many patients, with early diagnosis it is easily treatable.
    “We’re confident that our first product can play a big part in tackling Anti-Microbial Resistance (AMR), which has been identified by the World Health Organisation as  one of the top 10 global public health threats,” said Dr Iain Miller, CEO of Presymptom Health.
    “By understanding the presence, or absence, of infection as early as possible, doctors can be more confident in their diagnosis and avoid unnecessarily prescribing antibiotics – something that is a growing concern in the NHS and globally.
    “If we take Sepsis as an example. Sepsis diagnostics hasn’t moved on in more than a century, and currently doctors can only diagnose it when advanced symptoms and organ failure are present – which is often too late. Our technology enables doctors to diagnose both infection and sepsis up to three days before formal clinical diagnosis, radically transforming the process and preventing unnecessary deaths.
    The science behind Presymptom’s technology is based upon 10 years of work conducted at Defence Science and Technology Laboratory (Dstl) and originated from £16m of sustained Ministry of Defence investment in a programme of research designed to help service personnel survive infection from combat injuries.
    The technology is currently undergoing clinical trials at nine NHS hospitals in the UK, with results anticipated later in 2024. In addition, Presymptom is working on additional UK and EU trials.
  11. Clive Flashman
    The exodus of healthcare workers from Nigeria, Ghana and Zimbabwe continues, despite the WHO red list and a range of laws to keep them at home.
    It took nearly three hours of queueing in Ikorodu general hospital in Lagos state, Nigeria, before Hadijat Hassan, a retired civil servant, could see a nurse. The 66-year-old has attended the clinic for health checks since being diagnosed with diabetes nearly 10 years ago. But since May, she says, the delays, often while suffering from excruciating pain in her legs, are worse than ever.
    “You can get there [the hospital] and meet about 50 people waiting to be attended to,” Hassan says. “They said all of their nurses and doctors have been leaving for abroad. Just a few are left.”
    In Nigeria, there is one doctor for every 5,000 patients, whereas the average in developed countries is one doctor for about every 254 people.
    A hospital official said the Ikorodu management get resignation notices from nurses and doctors almost every month.
    “Many leave for the US, Canada, UK and, most recently, Australia,” says the official, who asked to remain anonymous.
    The National Association of Nigeria Nurses and Midwives has reported there is now a ratio of one nurse to 1,160 patients. Its president, Michael Nnachi, said that more than 75,000 nurses had left Nigeria since 2017.
    “If you look at the conditions of service of health workers generally, you’ll see the difficult challenges complicated by the current economic realities,” he said, adding that rising inflation has compounded the problems.
    The World Health Organization predicts a worldwide shortage of 10 million health and care workers by 2030 – mostly in low-income countries, where people are leaving for opportunities abroad.
    This is despite the WHO’s introduction of a safeguard list to stop rich countries poaching from poorer countries with staff shortages.
    The “red list”, launched in 2020 with plans to update it every three years, includes Nigeria, Ghana, Zimbabwe and 34 other African countries. Yet the UK’s nursing regulator, the Nursing and Midwifery Council, says more than 7,000 Nigerian nurses relocated to the UK between 2021 and 2022.
    Data from the Ghana Registered Nurses and Midwives Association shows that nearly 4,000 nurses left the country in 2022. In Zimbabwe, more than 4,000 health workers, including 2,600 nurses, left in 2021 and 2022, the government said.
    The WHO has no powers to prohibit recruitment of doctors from countries on the list, but recommends “government-to-government health worker migration agreements be informed by health labour market analysis and the adoption of measures to ensure adequate supply of health workers in the source countries”.
    Read the full article here
  12. Clive Flashman
    Making data on medical interventions easier to collect and collate would increase the odds of spotting patterns of harm, according to the panel of a recent HSJ webinar
    When Baroness Julia Cumberlege was asked to review the avoidable harm caused by two medicines and one medical device, she encountered no shortage of data.
    “We found that the NHS is awash with data, but it’s very fractured,” says Baroness Cumberlege, who chaired the Independent Medicines and Medical Devices Safety Review and now co-chairs the All-Party Parliamentary Group which raises awareness of and support for its findings.
    And it is that fracturing that can make patterns of harm difficult to spot. The report concluded that many women and children experienced avoidable harm through use of the hormone pregnancy test Primodos, the epilepsy drug sodium valproate, and the medical device pelvic mesh – simply because it hadn’t been possible to connect the dots.
    “It’s very hard to collect things together and to get an overall picture. And one of the things that we felt very strongly about was that data should be collected once, but used often,” said Baroness Cumberlege at a recent HSJ webinar. Run in association with GS1 UK, the event brought together a panel to consider how better data might help address patient safety challenges such as problems with implants.
    “But the big problem was they couldn’t identify who had which implants. No doubt somebody somewhere had written this down with a fountain pen and then someone spilt the tea over it and the unique information was lost,” recalled Sir Terence Stephenson , now Nuffield professor of child health at Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England.
    The review he chaired therefore suggested establishing a concept of person, product place – “for everybody who had something implanted in them, we should have their name, the identifier of what had been put in, and where it had been put in. And one of my panel members said: ‘Well, how are we going to record this? We don’t want the fountain pen and the teacup.’”
    Ultimately the answer suggested was barcode scanning. By scanning the wristband of a patient, that on the product being implanted, and one for the hospital theatre or department at which it was being implanted, the idea was to create an immediate and easy-to-create record.
    For those long convinced of the virtues of barcode scanning in health, it is a welcome development
    Two years later, the then Department of Health launched the Scan4Safety programme, in which six “demonstrator sites” implemented the use of scanning across the patient journey. At these organisations, barcodes produced to GS1 standards – meaning they are globally unique – are present on patient wristbands; on equipment used for care, including implantable medical devices; in locations; and sometimes on staff badges.
    Link to full article here (paywalled)
  13. Clive Flashman
    A group of potent synthetic opioids called nitazenes have been linked to a rise in overdoses and deaths in people who use drugs, primarily heroin, in England over the past two months, drug regulators have warned.
    The Office for Health Improvements and Disparities has issued a National Patient Safety Alert on potent synthetic opioids implicated in heroin overdoses and deaths.
    In the past 8 weeks there has been an elevated number of overdoses (with some deaths) in people who use drugs, primarily heroin, in many parts of the country (reports are geographically widespread, with most regions affected but only a few cities or towns in each region).
    Testing in some of these cases has found nitazenes, a group of potent synthetic opioids. Nitazenes have been identified previously in this country, but their use has been more common in the USA. Their potency and toxicity are uncertain but perhaps similar to, or more than fentanyl, which is about 100x morphine.
    The National Patient Safety Alert provides further background and clinical information and actions for providers.
  14. Clive Flashman
    As junior doctors begin a four-day strike today with a two-day strike by consultants a fortnight later, Sir Julian Hartley, chief executive of NHS Providers, said:

    "Trust leaders are very worried about six more days of severe disruption across the NHS this month.

    "We could be close to a tipping point. Trusts and staff are pulling out all the stops to reduce waiting times for patients but with no end to strikes in sight the sheer volume of planned treatment being put back due to industrial action will make it almost impossible for trusts to cut waiting lists as much as the government wants.

    "Waiting lists are now at a record high of 7.57 million, the pressure on urgent and emergency care services is relentless and an already stretched NHS is gearing up for another high-demand winter as pressure on tight budgets mounts.

    "A string of strikes – which have led to more than 835,000 routine treatments and appointments being put back since December – is estimated to have cost the NHS around £1bn already including lost income and hiring expensive staff cover.

    "The number of rescheduled appointments could be close to 1 million after this month's strikes and consultants have called another two-day strike in September. There will be a long-lasting effect on patients who have had treatment delayed and on already low staff morale.

    "Concerns are mounting too over how patient safety will be maintained during August's strikes as many NHS services will be even more stretched as many staff are on much-needed summer holidays and cover is harder to secure.

    "It's vital that the government and unions find a breakthrough urgently. Trust leaders understand the strength of feeling among striking staff and why they're taking action. Everyone in the NHS wants to concentrate on treating more patients more quickly rather than spend days making plans to cope with strikes.

    "People can still rely on the NHS during strikes, calling 999 in an emergency. For less urgent cases people should use 111 online for help and advice."
  15. Clive Flashman
    Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, May Ashford was not offered surgery until five years later.
    A woman died unnecessarily after doctors failed to operate soon enough on a growing brain tumour, according to the health complaints service.
    May Ashford, from Blackpool, was diagnosed with a brain tumour in 2010 after experiencing headaches and seizures.
    Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, she was not offered surgery until five years later.
    An investigation by the Parliamentary and Health Service Ombudsman (PHSO) said the treatment was too late as medical staff had failed to monitor the scan results properly.
    Medical experts said Mrs Ashford should have been operated on at least three years earlier, before the tumour had time to grow and affect the surrounding area of the brain.
    She tragically died aged 71 from a stroke following surgery.
    Link to full article here
  16. Clive Flashman
    The Care Quality Commission (CQC) has published a report on Stoke Mandeville Hospital, part of Buckinghamshire Healthcare NHS Trust following a recent inspection in June.
    CQC carried out a focused inspection of the trusts children’s emergency department in response to concerns raised about the safety and quality of the service. Inspectors found children and young people received safe care. However, the trust needs to review its systems to make sure potential serious incidents are managed in a way that allows any lessons learned to be shared, to reduce the risk of them happening again.
    Link to the full report  (opens in a new browser window)
  17. Clive Flashman
    After generations of inaction and very few novel ideas, researchers and activists are hopeful a new path is being charted in understanding and treating the crippling chronic condition
    “There’s an excitement at the moment,” says Andrew Horne. After decades of inaction, something is happening in endometriosis.
    Now, says the professor of gynaecology and reproductive sciences at the University of Edinburgh, “I do think things are changing. There are more people working on it, so it’s bringing in people from different disciplines with new ideas.”
    In the space of a few months, from gatherings in Edinburgh and Washington DC, labs in Sydney and Japan, there is a sense that new ideas are bubbling to the surface, including a fundamental rethinking of endometriosis not as a disease of the pelvis, but rather, says Horne, “a whole-body disease”. It’s hard to pinpoint the exact moment when despair turned to hope in the research and patient community. There was no single breakthrough. No one person responsible.
    In March, the largest ever study on the genetics of endometriosis was published in Nature Genetics, which found genetic links to 11 other pain conditions as well as other inflammatory conditions. The study, involving DNA from more than 760,000 women, found ovarian endometriosis is genetically distinct from other types and indicated there may be a genetic predisposition to excessive inflammation in people with the condition. One of the researchers, Dr Nilufer Rahmioglu from the University of Oxford, described the data as a “treasure trove of new information”.
    Weeks later on the other side of the world, researchers from Sydney’s Royal Hospital for Women attracted international attention after they grew tissue from different types of endometriosis and compared how each responded differently to treatments. Jason Abbott, professor of obstetrics and gynaecology at the hospital, likened the development to those made in the treatment of breast cancer three decades ago.
    Two weeks on from the Australian discovery, Japanese researchers found a common form of bacteria may be contributing to the growth of endometriosis via inflammation.
    The frisson was, by then, hard to miss.
    Read the full article here: https://www.theguardian.com/society/2023/aug/10/its-really-only-the-beginning-are-we-on-the-cusp-of-a-breakthrough-in-endometriosis 
  18. Clive Flashman
    Teens who have been bullied by their peers, or who have considered or attempted suicide, may be more likely to have more frequent headaches than teens who have not experienced any of these problems, according to a study published in the August 2, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that bullying or thoughts of suicide cause headaches; it only shows an association.
    “Headaches are a common problem for teenagers, but our study looked beyond the biological factors to also consider the psychological and social factors that are associated with headaches,” said study author Serena L. Orr, MD, MSc, of the University of Calgary in Canada. “Our findings suggest that bullying and attempting or considering suicide may be linked to frequent headaches in teenagers, independent of mood and anxiety disorders.”
    The study involved more than 2.2 million teens with an average age of 14 years. 
    Read the full article here: https://www.eurekalert.org/news-releases/997216
  19. Clive Flashman
    Videos circulating on the social media platform claim that castor oil can help to treat dryness, floaters, cataracts, poor vision and even glaucoma.
    Doctors have issued a warning not to use castor oil as a way to treat vision problems following claims on TikTok.
    Castor oil is a type of vegetable oil traditionally used to treat a range of issues like skin infections. It is even a common ingredient in some over-the-counter eye drops. But dozens of TikTok videos have gone one step further, claiming that by rubbing the oil over eyelids, eyelashes and under the eye, it helps to treat dryness, floaters, cataracts, poor vision and even glaucoma. One woman said that after two weeks of use, she doesn't need to wear reading glasses as often, while another said it prevented an eye infection from progressing.
    Now, doctors in the US have said the oil is "not going to seep in and dissolve or fix anything". They warned that some unsterilised bottles on shop shelves may even cause irritation or infection if put directly into the eye. "Castor oil is not a cure-all. If you have concerns about your eyes, you need to see an optician," Dr Ashley Brissette, a spokesperson for the American Academy of Ophthalmology. She said they cannot make recommendations as studies that look at the effects of eye drops which contain castor oil on dry eyes and blepharitis are of low quality, involving small sample sizes and no control groups.
    Dr Vicki Chan, a practising optician in Los Angeles added that castor oil has no effect on conditions that affect the inside of the eyeball. These include cataracts - an age-related condition that causes cloudy vision - floaters, and glaucoma, which occurs when fluid accumulates and damages the optic nerve. Dr Brissette added that ignoring early symptoms of glaucoma, or waiting to see it castor oil improves conditions such as cataract, can lead to permanent vision loss or complications with surgery. Instead, eating a healthy balanced diet; removing all make up before bed; wearing sunglasses outdoors and attending regular eye examinations are alternative ways to maintain eye health.
  20. Clive Flashman
    The Government has decided to cut the fee GPs are paid per Covid vaccination by a quarter, prompting BMA to issue a patient safety warning.
    NHS England has published the new enhanced service specification for Covid vaccines to be delivered between 1 September and 31 March next year, setting out that GPs will be paid £7.54 for each vaccine administered – down from £10.06 – and continue to be paid £10 for each housebound patient.
    The fee had already been reduced from £12.58 last year, when the BMA advised GPs to review whether they were still able to fulfil the ES commitments.
    The new specification said that practices with ‘sufficient workforce capacity so as not to impact the delivery of essential services and appropriately trained and experienced staff’ must indicate their willingness to participate in the programme before 5pm on 29 August.
    The Item of Service fee for flu remains £10.06 of each vaccine delivered, according to the new specification published last week.
    But the BMA said that that NHS England’s decision to reduce the Covid fee ‘undervalues general practice and threatens the safety of vulnerable patients’.
    Read the full article here: https://www.pulsetoday.co.uk/news/clinical-areas/respiratory/25-cut-to-covid-vaccine-ios-threat-to-patient-safety-bma-warns/ 
  21. Clive Flashman
    Steve Gulati, Associate Professor and Director of Healthcare Leadership at HSMC (University of Birmingham) discusses the concept of "time to care" within healthcare.
    A UK-wide poll of healthcare workers revealed that most NHS staff think they have too little time to help patients and the quality of care that services provide is falling. This reported reduction in the time to care is perhaps inevitable after almost a decade of health funding failing to keep up with increases in demand, and is a cause for concern for all of us – patients, carers or those working in the NHS. Where does this fit in to the wider picture – and can anything be done about it?
    It is not just NHS workers who are feeling the pinch – levels of public satisfaction with the NHS are at an all-time low. Interestingly, the two most cited reasons relate to access (difficulties or delays in getting appointments) and, tellingly, to staff shortages. Even against this gloomy backdrop, the collectivised funding model upon which the NHS is founded continues to find significant public support. All of this points towards a painful congruence – NHS staff feel that they do not have enough time to care, and the public is noticing.
    Is ‘time to care’ an outdated concept, harking back to an age of long patient stays, a paternalistic bedside manner and unrealistic expectations? Both staff and patient experience suggest not. Although technology plays an increasing role in healthcare diagnostics, treatment and recovery, delivering care remains a deeply human phenomenon and is essentially a relational and personal task. Recognising that frontline healthcare workers need time to care is not a new phenomenon. Influenced by service improvement methodologies, the ‘productive ward’ initiative in the mid-2000s placed an explicit emphasis on using efficiency techniques for the express purpose of releasing nursing staff to have “time to care”. It was acknowledged that productivity was more than metrics around bed occupancy and throughput, for example, and that the driving purpose of service improvement was to time to care. Whilst research indicated a nuanced impact, the principle is long recognised.
    If solutions to these problems were easy, they would have been implemented by now. There is no doubt that on one level, it really is a matter of resources – no system can carry a vacancy factor of around 10% for any length of time without there being an evident impact. However, even within an environment of constrained resources, choices are made every day by caregivers and leaders alike about what receives attention and what is allowed to move into the ‘important but not urgent’ category. That is in no way to blame the hard-pressed caregivers, but instead to indicate that even when it really does not feel like it, every individual has a level of agency.
    Feeling as though one does not have time to do one’s job is, put simply, unpleasant for all workers but should especially concern us in care environments. The impact on clinical safety and quality is an obvious starting point, but it is also important to recognise the impacts on care workers themselves with regard to emotional labour and the impact on the psychological contract that working in a caring profession, when people feel that they don’t have enough time to care, must have. As eloquently stated by the Vice-President of the Royal College of Physicians in Wales, it is “…very clear that good clinicians, be they nurses, doctors, therapists or pharmacists, need time to train, time to care and time to rest”. Even in challenging times, self-care and compassionate, values driven leadership can make a difference. Caring is everyone’s business.
    Link to original article: https://www.birmingham.ac.uk/news/2023/healthcare-workers-need-more-time-to-care
  22. Clive Flashman
    In the older European population, men, as well as those with lower socioeconomic status, weak social ties, and poor health, might experience more difficulties getting informal support and are considered to have a higher risk of worsening frailty state and lower quality of life. This reality is shown in a new doctoral thesis at Umeå university.
    Read the full article here
  23. Clive Flashman
    New study results in more precise language in the federally mandated warning about this possibility. (Article from the USA)
    Women who choose to use an intrauterine device, or IUD, for birth control should be aware of the very small possibility that the device could puncture their uterus. They should know how to recognize that circumstance if it occurs, according to a new study published in The Lancet.
    The U.S. Food and Drug Administration mandated the study to evaluate women's risks when an IUD is placed in the year after giving birth and when an IUD is placed during the period that a woman is breastfeeding a baby. These results were compared, respectively, with non-postpartum insertions and insertions in non-breastfeeding individuals, explained UW Medicine’s Dr. Susan Reed, the study’s lead author.
    Across the study cohort of 327,000 women, the percentage of perforation cases diagnosed within five years of IUD insertion was 0.6 %, the study concluded.
    The risk of perforation increased by nearly seven times if it was inserted between four days and six weeks postpartum, and increased by about one-third if inserted during the span of breastfeeding. The risk of an IUD-related perforation was relatively lower when inserted in women who were more than a year beyond delivery, in women who had never had a baby, and when the insertion occurred at delivery. Read full article here
  24. Clive Flashman
    Monitoring heart patients via a smartphone app prevented readmissions and sped up discharges in a pilot scheme that its developers hope will be introduced across the country.
    Patients sent data including their blood pressure, heart rate, oxygen levels and details of developing symptoms to their clinical team on an app.
    The figures were collated on a “dashboard”, which flagged any signs that a patient might need medical help, allowing doctors and nurses to bring them into hospital or alter their medication as required.
    The 12-week pilot by Huma, a healthcare technology company based in London, involved 40 patients at Cwm Taf Morgannwg University Health Board in south Wales and Betsi Cadwaladr University Health Board in north Wales.
    Click here to read full article (paywalled)
     
  25. Clive Flashman
    A hospice is using virtual reality (VR) to help patients relax and transport them away from their beds.
    St Giles Hospice, which has bases in Lichfield and Sutton Coldfield, said the headsets allowed patients "to escape the realities of their present situation".
    "I've never experienced anything quite like it in my life - I was totally lost in the moment," Janet, 71, said.
    The VR experiences include cities of the world, space, and wildlife.
    Beth Robinson, Occupational Therapist at St Giles Hospice, said the VR headsets helped patients "immerse themselves into a calming space".
    To read the full article, click here

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