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Sam

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  2. Sam
    The chairman of an inquiry that has confirmed a 20-year cover-up over the avoidable death of a baby has warned there are other families who may have suffered a similar ordeal.
    Publishing the findings of his investigation into the 2001 death of Elizabeth Dixon, Dr Bill Kirkup said he wanted to see action taken to prevent harmed families having to battle for years to get answers.
    Dr Kirkup, who has been involved in multiple high-profile investigations of NHS failures in recent years, said: “There has been considerable difficulty in establishing investigations, where events are regarded as historic. I don't like the term historic investigations. I think that these things remain current for the people who've suffered harm, until they're resolved, it’s not historic for them.  
    “There has been significant reluctance to look at a variety of cases. Mr and Mrs Dixon were courageous and very persistent and they were given help by others and were successful in securing the investigation and it worries me that other people haven't been.
    “I do think we should look at how we can establish a proper mechanism that will make sure that such cases are heard."
    “It's impossible to rule out there being other people who are in a similar position. In fact, I know of some who are. I think it's as important for them that they get heard, and that they get things that should have been looked at from the start looked at now, if that's the best that we can do.”
    Read full story
    Source: The Independent, 27 November 2020
  3. Sam
    GPs are failing to urgently refer patients with “red flag” signs of suspected cancer to a specialist, research suggests.
    Six out of 10 patients in England with key symptoms indicating possible cancer did not receive an urgent referral for specialist assessment within two weeks, as recommended in clinical guidelines, according to a new study.
    Nearly 4% of these patients were subsequently diagnosed with cancer within the next 12 months. The findings were published in the journal BMJ Quality & Safety.
    In the study, researchers analysed records from almost 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral under clinical guidelines. Of the 29,045 patients not referred, 1,047 developed cancer within a year (3.6%).
    Early diagnosis and prompt treatment is crucial to survival chances. Every four-week delay in cancer treatment increases the risk of death by 10%.
    Read full story
    Source: The Guardian, 5 October 2021
  4. Sam
    Campaigners have said that more lives would be lost unless mental health services were reformed. Figures show 120 people each year are killed by people with mental illnesses.
    Julian Hendy, whose father was killed by a psychotic man with a long history of mental ill health 17 years ago, said health professionals must be “more assertive” and work better with other agencies such as the police.
    Valdo Calocane, who was sentenced on Thursday to an indefinite hospital order after being convicted of manslaughter of three people in Nottingham, had fallen off the radar of mental health services, which allowed him to avoid taking his medicine.
    Hendy accused Nottinghamshire Healthcare NHS Foundation Trust, which was responsible for Calocane’s care, of “washing their hands” of him.
    He said: “It’s not responsible and it’s not safe. It doesn’t look after people properly … That hasn’t helped him at all, or protected his rights at all, because he has now committed this terrible offence.”
    Read full story (paywalled)
    Source: The Times, 26 January 2024
  5. Sam
    Most patients who want to see their own GP can no longer get an appointment with them, according to new figures suggesting the days of the family doctor are over. The statistics show record numbers of patients struggling to even get through on the telephone, and increasingly long waits for an appointment. For the first time, the majority of patients who wanted to see a particular doctor were unable to do so, the survey of more than 770,000 patients shows. The research comes amid mounting evidence of a wider NHS crisis, with waiting lists reaching an all-time high.  
    Read full story
    Source: The Telegraph, 11 July 2019
  6. Sam
    The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy.
    During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis.
    The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies.
    As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease.
    There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus.
    Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met.
    Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home.
    There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites.
    Read full story
    Source: The Independent, 27 0ctober 2020
  7. Sam
    Families of people with dementia have said there is a national crisis in care safety as it emerged that more than half of residential homes reported on by inspectors this year were rated “inadequate” or requiring improvement – up from less than a third pre-pandemic.
    Serious and often shocking failings uncovered in previously “good” homes in recent months include people left in bed “for months”, pain medicine not being administered, violence between residents and malnutrition – including one person who didn’t eat for a month.
    In homes in England where standards have slumped from “good” to “inadequate”, residents’ dressings went unchanged for 20 days, there were “revolting” filthy carpets, “unexplained and unwitnessed wounds” and equipment was ”encrusted with dirt”, inspectors’ reports showed.
    Nearly one in 10 care homes in England that offer dementia support reported on by Care Quality Commission inspectors in 2022 were given the very worst rating – more than three times the ratio in 2019, according to Guardian analysis.
    Read full story
    Source: 29 December 2022
     
  8. Sam
    Nurse Lucy Letby has been found guilty of murdering seven babies on a neonatal unit, making her the UK's most prolific child serial killer in modern times.
    The 33-year-old has also been convicted of trying to kill six other infants at the Countess of Chester Hospital between June 2015 and June 2016.
    Letby deliberately injected babies with air, force fed others milk and poisoned two of the infants with insulin.
    Commenting on the verdict, Parliamentary and Health Service Ombudsman Rob Behrens said:
    “We know that, in general, people work in the health service because they want to help and that when things go wrong it is not intentional. At the same time, and too often we see the commitment to public safety in the NHS undone by a defensive leadership culture across the NHS.
    “The Lucy Letby story is different and almost without parallel, because it reveals an intent to harm by one individual. As such, it is one of the darkest crimes ever committed in our health service. Our first thoughts are with the families of the children who died. 
    “However, we also heard throughout the trial, evidence from clinicians that they repeatedly raised concerns and called for action. It seems that nobody listened and nothing happened. More babies were harmed and more babies were killed. Those who lost their children deserve to know whether Letby could have been stopped and how it was that doctors were not listened to and their concerns not addressed for so long. Patients and staff alike deserve an NHS that values accountability, transparency, and a willingness to learn.  
    “Good leadership always listens, especially when it’s about patient safety. Poor leadership makes it difficult for people to raise concerns when things go wrong, even though complaints are vital for patient safety and to stop mistakes being repeated. We need to see significant improvements to culture and leadership across the NHS so that the voices of staff and patients can be heard, both with regard to everyday pressures and mistakes and, very exceptionally, when there are warnings of real evil.”
  9. Sam
    A trust is investigating after two junior doctors developed covid following an offsite event attended by 22 juniors where social distancing rules were allegedly ignored.
    The cases, involving doctors from the Royal Surrey Foundation Trust in Guildford, have been declared an outbreak by Public Health England and police have investigated the incident.
    But HSJ understands that contact tracing has concluded no patients needed to be tested because staff had worn appropriate PPE at all times and those involved had swiftly self-isolated once they realised they might have covid or had been at risk of exposure to it.
    It is not known whether any of the doctors had returned to work after the event before realising they might have been exposed to covid.
    Dr Mark Evans, deputy medical director, said: “Protecting our patients is our priority and we are committed to ensuring that all of our staff follow government guidance. This incident took place outside of work and has been reported appropriately, and there was no disruption to our services for patients.”
    Read full story
    Source: HSJ, 22 October 2020
  10. Sam
    Patients will be able to anonymously log concerns about their NHS treatment, via a phone app, as part of efforts to boost safety. The new strategy will see the creation of a centralised portal, allowing patients, their families and staff to record problems with medical devices, errors in medicines administration, or difficulties in spotting a patient’s condition deteriorating. Officials said that swift recording of such information would enable them to alert the rest of the NHS more quickly to risks of serious harm, and prevent tragedies being repeated.
    Full story
    Source: The Telegraph, 29 June 2019
  11. Sam
    Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of COVID-19 inpatients.
    The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of COVID-19 coming to the West Country.
    Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust (NDHT), said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.
    His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in COVID-19 inpatients. Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.
    Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon. My personal view — and of my colleagues around the country — is that there’s a tidal wave of COVID-19 coming to the West Country."
    “We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”
    Read full story (paywalled)
    Source: HSJ, 8 January 2021
  12. Sam
    The Care Quality Commission (CQC) has called for ‘ministerial ownership’ to end the ‘inhumane’ care of patients with learning difficulties and autism in hospital – after finding some cases where people had been held in long-term segregation for more than 10 years.
    Following its second review into the uses of restraint and segregation on people with a learning difficulty, autism and mental health problems, the CQC has warned it “cannot be confident that their human rights are upheld, let alone be confident that they are supported to live fulfilling lives”.
    The review was ordered by health and social care secretary Matt Hancock in late 2018 in response to mounting concerns about the quality of care in these areas.
    According to the report, published today, inspectors found examples people being in long-term segregation for at least 13 years, and in hospital for up to 25 years. It also found evidence showing the proportion of children from a black or black British background subjected to prolonged seclusion on child and adolescent mental health wards was almost four times that of other ethnicities.
    Looking at care received in hospital the CQC found many care plans were “generic” and “meaningless” and patients did not have access to any therapeutic care.
    Reviewers also found people’s physical healthcare needs were overlooked. One women was left in pain for several months due to her provider failing to get medical treatment.
    The regulator also reviewed the use of restrictive practices within community settings. While it found higher quality care, and the use of restrictive practices was less common, it said there was no national reporting system for this sector.
    Read full story (paywalled)
    Source: HSJ, 22 October 2020
  13. Sam
    A “very tense” behind-the-scenes row over how quickly hospitals in England can be expected to reduce the massive backlog of surgery has broken out between NHS bosses and ministers.
    The dispute has delayed publication of the government’s “elective recovery plan”, which Downing Street had indicated would be part of Boris Johnson’s “Operation Red Meat” political fightback this week.
    No 10, the Treasury and Department of Health and Social Care are pressing NHS England to ensure that hospitals do as many operations as they can, as quickly as possible, in order to tackle the backlog, which now stands at a record 6 million patients.
    They want to impose “stretching and demanding” targets on hospitals, sources with knowledge of the discussions said.
    However, NHS trust bosses say the ongoing impact of treating patients sick with Covid, due to the current Omicron surge, longstanding gaps in their workforce, exhaustion at the frontline and record levels of staff sickness, mean they need time to get back to doing as much surgery as they did before the pandemic.
    The Treasury is said to be frustrated with NHS England and privately believes it is “foot-dragging” over the targets. NHS bosses for their part fear the plan is being driven by “political expediency”, given the growing concern at the sheer number of people facing long delays for care.
    Read full story
    Source: The Guardian, 20 January 2022
  14. Sam
    NHS organisations have been told to prepare for redeploying or dismissing thousands of unvaccinated staff without an exit payment, and to raise the alarm about services which may be rendered unsafe.
    NHS England today issued guidance on ‘phase two’ of the government’s “vaccination as a condition of deployment”, which requires all patient-facing staff to have had two covid vaccinations by 1 April. 
    Tens of thousands of staff are believed to still be unvaccinated, and the cut off for having a first dose is 3 February.
    The guidance said efforts should be made to adjust roles or redeploy staff, but added: “From 4 February 2022, staff who remain unvaccinated (excluding those who are exempt) should be invited to a formal meeting chaired by an appropriate manager, in which they are notified that a potential outcome of the meeting may be dismissal.”
    It continued: “Whilst organisations are encouraged to explore deployment, the general principles which apply in a redundancy exercise are not applicable here, and it is important that managers are aware of this.”
    Employers will “not be concerned with finding ‘suitable alternative employment’ and there will be no redundancy entitlements, including payments, whether statutory or contractual, triggered by this process”.
    Trusts also do not have to “collectively consult” with staff being dismissed — as they would with a restructure — although this is “ultimately a decision for each organisation to take”.
    Read full story (paywalled)
    Source: HSJ, 14 January 2022
  15. Sam
    The number of Covid patients in hospitals in England and Scotland has continued to rise this week, as NHS England reached a deal with private hospitals to free up beds amid the outbreak of Omicron cases.
    Meanwhile, Covid staff absences in England rose to their highest level since the introduction of the vaccine. The number of NHS workers in England off sick because of Covid was up by 41% in the week to 2 January, according to the latest figures.
    Five health workers describe some of the challenges they are facing, including understaffing, waiting times and bed-blocking.
    Read full story
    Source: The Guardian, 14 January 2022
  16. Sam
    One in four doctors in the NHS are so tired that their ability to treat patients has become impaired, according to the first survey to reveal the impact of sleep deprivation on medics during the coronavirus pandemic.
    Growing workloads, longer hours and widespread staff shortages are causing extreme tiredness among medics, leading to memory problems and difficulty concentrating, according to the report by the Medical Defence Union (MDU), which provides legal support to about 200,000 doctors, nurses, dentists and other healthcare workers.
    The survey of more than 500 doctors across the UK, carried out within the past month and seen by the Guardian, uncovered almost 40 near misses as a direct result of exhaustion. In at least seven cases, patients actually sustained harm.
    Despite encouraging signs the Omicron wave may be fading, doctors admitted the constant pressure of the past 22 months spent fighting coronavirus on the frontline was taking a toll on their technical skills and even their ability to make what should be straightforward medical decisions. Medics admitted for the first time sleep deprivation was causing real harm to patients in the NHS.
    Almost six in 10 doctors (59%) reported their sleep patterns had worsened during the pandemic. More than a quarter (26%) of medics admitted being so tired that their ability to treat patients was “impaired”. Of these, one in six (18%) said a patient was harmed or a near miss occurred as a result.
    Read full story
    Source: The Guardian, 17 January 2022
    Read MDU press release
  17. Sam
    There are serious concerns over the standards of specialist care being provided to patients with the most complex mental health needs, a BBC investigation has found.
    Patients sent by the NHS to stay in mental health rehabilitation units say they have been placed in unsafe environments, often far from home, with untrained staff.
    Experts say not enough is being done to regulate the sector, which costs the NHS half a billion pounds a year.
    Lissa had spent years struggling with her mental health, having experienced traumatic life events. She was diagnosed with mixed personality disorder, depression and high-functioning Asperger's. So when the NHS sent her to a unit in Coventry run by Cygnet Health Care for a specialist talking therapy, she agreed.
    The hospital, however, was in special measures. There had been two deaths in the previous 20 months. In both cases there was found to be a failure to follow the patient's care plan and carry out observations correctly. Lissa says staff failed to treat her with dignity and respect.
    The system in England is regulated by the Care Quality Commission, (CQC). Some rehabilitation wards haven't been inspected for four or more years.
    John Chacksfield, who was a CQC inspector until late 2020, says greater scrutiny is needed.
    "Sometimes the private sector provides really excellent service, but there are certain units that really do need regular inspections just to make sure staff are being trained enough, or are having enough clinical supervision. It does worry me," he says.
    Read full story
    Source: BBC News, 18 January 2022
  18. Sam
    Swedish expert has praised Scotland for leading work in improving patient safety, with a decade-long programme which is now expanding into social care.
    Dr Pelle Gustafson (below), chief medical officer, of Swedish patient insurer Löf, said he was “particularly impressed” by the work in Scotland over the past 10 years during a meeting of the House of Commons Health and Social Care Committee.
    The Scottish Patient Safety Programme (SPSP), which has been in existence for around 13 years, was set up to make patient safety a priority in NHS Scotland, drawing on lessons from the airline industry such as introducing checklists.
    Gustafson was asked by Tory MP Dr Luke Evans which country he would hold at the “very top of the pillar” for preventative work during an evidence session on NHS litigation reform last week.
    He responded: “If you take all preventive work as regards patient safety, I would say that I am personally very impressed by Scotland.
    “In Scotland, you have a long-standing tradition of working. You have development in the right direction.
    “You have a system that is fairly equal all over the place and you also have improvement activities going on. I am very impressed by Scotland.”
    He added: “I am particularly impressed by the Scottish work over the last 10 years. There are a lot of things that we, in the Nordic countries, can learn from Scotland too.”
    Read full story
    Source: The National, 16 January 2022
     
     
     
     
  19. Sam
    Giving repeated booster doses of existing CovidD-19 vaccines in developed countries is not a sustainable global strategy for tackling the pandemic, the World Health Organization has said.
    Instead, WHO argues that the focus should shift towards producing new vaccines that work better against transmission of emerging variants.
    In a statement, published on 11 January, the WHO Technical Advisory Group on Covid-19 Vaccine Composition said, “A vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be appropriate or sustainable.”
    The expert group, which is assessing the performance of Covid-19 vaccines, said that to deal with emerging variants such as omicron, new vaccines needed to be developed that not only protect people against serious illness but against infection. “Covid-19 vaccines that have high impact on prevention of infection and transmission, in addition to the prevention of severe disease and death, are needed and should be developed,” the group said.
    Vaccines also need to be more effective at protection against infection, “thus lowering community transmission and the need for stringent and broad reaching public health and social measures,” the group said.
    Read full story
    Source: BMJ, 17 January 2022
  20. Sam
    A cervical cancer patient has been treated with the aid of artificial intelligence (AI) for the first time in the UK.
    Emma McCormick, 44, was treated at the St Luke's Cancer Centre in Guildford, Surrey.
    The Royal Surrey NHS Foundation Trust treated Ms McCormick, who is from West Sussex, using adaptive radiotherapy.
    The AI technology uses daily CT scans to target the specific areas that need radiotherapy.
    This helps to avoid damage to healthy tissue and limit side-effects, the hospital said.
    Patients are given treatments lasting between 20 and 25 minutes, although Ms McCormick's was slightly longer as she was the first patient, a hospital spokesman said.
    Ms McCormick received five AI-guided treatments per week for five weeks before having a further two weeks of brachytherapy.
    She said: "If it works for me, and they get information from me, it can help somebody else. It definitely worked and did what it was meant to do and so hopefully that helps others."
    Dr Alex Stewart, who treated Ms McCormick, said one of the benefits of the treatment was that it allowed for more precision, meaning there were fewer side-effects for the patients.
    Read full story
    Source: BBC News, 21 January 2022
  21. Sam
    Several drug companies have been fined £35 million for colluding to raise the cost of an anti-nausea drug used by cancer patients, taking the total fines stemming from a Times investigation to £400 million.
    The price paid by the NHS for prochlorperazine 3mg dissolvable tablets rose by 700%, from £6.49 a packet to more than £51, between December 2013 and December 2017, costing the NHS an extra £5 million a year.
    The Competition and Markets Authority (CMA) has ruled that several companies broke the law by fixing the market and agreeing not to produce a rival version of the drug, which is used to treat nausea and dizziness and can be prescribed to patients having chemotherapy.
    Andrea Coscelli, chief executive of the CMA, said: “The size of the fines reflects the seriousness of this breach. These firms conspired to stifle competition in the supply of this important medication, so that the NHS — the main buyer of the drugs — lost the opportunity for increased choice and lower prices.”
    He said the CMA would not “hesitate to take action like this against any businesses that collude at the expense of the NHS”.
    Read full story (paywalled)
    Source: The Times, 3 February 2022
  22. Sam
    Hormone replacement therapy (HRT) could be made available to buy over the counter.
    Health watchdogs are proposing a re-classification of the medication so women would be able to buy it in pharmacies without a prescription, it’s claimed.
    HRT is mainly used to treat menopause symptoms but it is not yet known which version of the medication will be a part of the proposal, the Daily Telegraph reports.
    Symptoms can include hot flushes, reduced sex drive and mood swings and usually pass after a few years.
    More than one million women a year are believed to suffer each year but treatment is currently only available after consultation with a GP or a specialist.
    A spokesperson for the Department of Health and Social Care said: "We understand that for some women menopause symptoms can have a significant impact on their quality of life, and we are committed to improving the care and support they receive.
    "That’s why we’re developing the first ever government-led Women’s Health Strategy, informed by women’s lived experience. Menopause, including improving access to Hormone Replacement Therapy, will be a priority under the Strategy."
    Read full story
    Source: The Independent, 2 February 2022
  23. Sam
    The NHS is "riddled with racism", the chair of the British Medical Association's council has told the BBC.
    Dr Chaand Nagpaul has spoken out in response to a survey by the BMA, shared exclusively with BBC News.
    At least 75% of ethnic minority doctors experienced racism more than once in the last two years, while 17.4% said they regularly faced racism at work, the survey said.
    NHS England said it takes a "zero-tolerance approach" to racism.
    Racism affects patients as well as doctors' wellbeing, by stopping talented people from progressing fairly and affecting doctors' mental health, Dr Nagpaul warned.
    "This is about a moral right for anyone who works for the NHS to be treated fairly," he said.
    Around 40% of the NHS's 123,000 doctors are from minority backgrounds, compared to about 13.8% of the general population. But despite this diversity, doctors told the BBC that there was a toxic "us versus them" culture in NHS trusts across the UK.
    They said they had faced bogus or disproportionate complaints from colleagues, racist comments from superiors, and even physical assault in the workplace. Some said they had tried to lodge complaints which were then ignored or dismissed without investigation.
    One consultant, from a black African background, told the BMA that after reporting previous incidents "no action was taken... I feel uncomfortable and anxious of reprisals".
    Read full story
    Source: BBC News, 2 February 2022
  24. Sam
    Children with mental health problems are dying because of failings in NHS treatment, coroners across England have said in what psychiatrists and campaigners have called “deeply concerning” findings.
    In the last five years coroners have issued reports to prevent future deaths in at least 14 cases in which under-18s have died while being treated by children’s and adolescent mental health services (CAMHS).
    The most common issues that arise are delays in treatment and a lack of support in helping patients transition to adult services when they turn 18.
    Coroners issue reports to prevent future deaths in extreme cases when it is decided that if changes are not made then another person could die.
    Dr Elaine Lockhart, the chair of the Royal College of Psychiatrists’ faculty of child and adolescent psychiatry, said the findings were “deeply concerning” and every death was a tragedy.
    She said there were too often lengthy delays and services were under strain as demand rises and the NHS faces workforce shortages.
    “In child and adolescent mental health services in England, 15% of consultant psychiatrist posts are vacant,” Lockhart said, calling for more support, investment and planning to grow staff levels.
    Read full story
    Source: The Guardian, 3 February 2022
  25. Sam
    Death has become “over medicalised” and the public should be encouraged to discuss dying and grief, experts have said.
    There's a call for shift in attitude towards palliative care, with more emphasis on compassion and less on giving medication that may prolong pain.
    According to a new Lancet commission, an overemphasis on aggressive treatments to prolong life, global inequities in palliative care access, and high end-of-life medical costs have led to millions of people suffering unnecessarily at the end of their life.
    The authors also note that the pandemic has made death and dying more prominent in daily life, while health systems have been “overwhelmed” when trying to care for those dying.
    People often died alone, with families unable to say goodbye to loved ones or grieve together, the commission said – the effects of which will “resonate for years to come”.
    The researchers argue that many people, mainly in low- and middle-income countries, have no access to end-of-life care, and particularly to opioids, while those in high-income countries may be overtreated.
    Attitudes towards death and dying should be “rebalanced”, the authors conclude, away from a medicalised approach towards a “compassionate community model”, where families work with health and social care services to care for those dying.
    Read full story (paywalled)
    Source: The Telegraph, 31 January 2022
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