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Found 472 results
  1. News Article
    A website that tells patients how long they are likely to wait for NHS treatment will be made available in Scotland this summer. Humza Yousaf, the Scottish health secretary, said people queuing for tests and procedures and their doctors would be able to access information about any delays in their area using the software. Many patients living in pain are waiting years to have common operations such as hip and knee replacements. In theory, the SNP guarantee hospital treatment within 12 weeks of patients joining the waiting list, but this law was broken extensively before the pandemic and has now been breached hundreds of thousands of times. One orthopaedic surgeon, who did not wish to be named, said he was operating on patients whose joints had entirely collapsed after a two-year wait for a limb replacement made their case an emergency. Other patients who did not reach crisis faced even longer delays, he said. Dr Sandesh Gulhane, a GP and health spokesman for the Scottish Conservative Party, asked Yousaf, during a meeting of the Scottish Parliament’s health committee yesterday: “Why can’t we have in the future, in the [recovery] plan, indicative waiting times which are relatively live so we can all go on a website and see how long we need to wait.” Yousaf said it was fair for patients and NHS staff to expect to have information on waiting times, and that a website to provide this was being developed. “We are working closely with Public Health Scotland, we are working closely with boards to develop the infrastructure in order to collate and publish this data,” he said. “It’s an ambition of ours to have that available in a way that is easy to find, easy to understand, both for the patient but for the health professional too.” Read full story (paywalled) Source: The Times, 11 May 2022
  2. News Article
    A Scottish hospital has become the first in the UK and one of the first in the world to pilot using artificial intelligence (AI) in its cervical cancer screening programme. University Hospital Monklands has increased capacity by around 25% and improved analysis turn-around times with the measure, which experts said could “revolutionise” the screening process. The system, from medical technology company Hologic, creates digital images of cervical smear slides from samples that have tested positive for Human Papilloma Virus (HPV). These are then reviewed using an advanced algorithm, which quickly assesses the cells in the sample and highlights the most relevant to medical experts, saving them time in identifying and analysing abnormalities. “Preliminary results from the pilot are promising, as the team at University Hospital Monklands has increased capacity by around 25 per cent in the slide assessment and improved analysis turn-around times, as well as allowing screeners to dedicate more time to training on the latest technologies and dealing with difficult-to-diagnose cases,” says Allan Wilson, consultant biomedical scientist at NHS Lanarkshire who is leading the pilot. "Through AI and digital diagnostics, we have the potential to improve outcomes for women not only in Scotland, but around the world.” Samantha Dixon, chief executive of Jo’s Cervical Cancer Trust, welcomed the pilot. “Catching cervical cell changes means they can be treated to prevent them from developing into cervical cancer,” she said. Read full story Source: The Scotsman, 4 March 2022
  3. News Article
    Electronic patient record (EPR) systems must be implemented in at least 90% of NHS trusts by the end of next year, the health secretary has announced at HSJ’s Digital Transformation Summit. Speaking at the event with digital healthcare leaders in Birmingham, Mr Javid said an estimated one in five trusts are currently without EPR systems implemented. He said: “We have seen some brilliant progress {on digital transformation] but it’s not always been consistent across the board.” He said: “We must see these disparities as just as unjust as disparities in access to education and employment.” And added: “Electronic patient records are the essential prerequisite for a modern, digital NHS." Mr Javid said 40% of social care providers were grappling with entirely paper based records, and he also wanted them to all adopt electronic records. He also outlined the intended future of the NHS App, and the government’s ambition for this to be used by 75 per cent of adults in England by March 2024. Currently it is just over half of all adults. Mr Javid said he wanted the app to be the “future front door for interaction with the NHS”, and will be used by patients to directly communicate with their healthcare providers, to receive personalised health advice and to access test results. Read full story (paywalled) Source: HSJ, 24 February 2022
  4. News Article
    The NHS plans to treat up to 25,000 hospital patients at home in “virtual wards” to help clear the backlog caused by the pandemic, the “living with Covid” plan has revealed. Patients will be offered acute clinical care at home, including remote monitoring and treatment, as an alternative to hospital stays. Consultants or GPs will review patients daily via digital platforms and phone calls. In some cases, patients will be provided with a wearable device to continuously monitor and report their vital signs. The NHS has set a national target of 40 to 50 virtual beds per 100,000 population, which equates to about 25,000 beds across England, according to the “living with Covid” plan published this week. The document said: “The use of ‘virtual wards’ and ‘hospital at home’ models of care have ensured that patients can be safely cared for in their own homes and that additional bed capacity can be freed up in hospitals.” Commenting on the initial rollout of virtual wards, Dr Tim Cooksley, the president of the Society for Acute Medicine, warned a “hasty” rollout could risk patient safety. He said: “Virtual wards do have the potential to be a model of the future. However, it is essential they are appropriately planned, resourced and staffed so they simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic. Incorrect implementation could risk patient safety and significantly impact clinician and patient confidence.” Read full story (paywalled) Source: The Telegraph, 22 February 2022
  5. News Article
    The cost of living squeeze is a significant factor in some stillbirths, according to case reviews carried out in one of England’s most deprived areas. The review was undertaken in Bradford last year, and concluded: ”the current financial crisis is impacting on the ability of some women to attend essential antenatal appointments”. Missing these appointments was a factor in a range of maternity safety events, including stillbirths, it said. The researchers are now calling for new national funding to help ensure expectant parents do not miss important appointments because they cannot afford to attend. The research findings include: ‘Did not attend’ rates increased due to lack of funds for transport to antenatal appointments; “Lack of credit on phones prevented communication between women and maternity services, for example, making [them] unable to rearrange scans or appointments”; Wide spread incidence of “digital poverty, [for example] a lady with type 1 [diabetes] was unable to monitor her glycaemic control over night due to only having one phone charger in the house”; and “Families with babies on a neonatal unit going without food in order to finance transport to and from the unit.” Read full story (paywalled) Source: HSJ, 25 August 2023
  6. News Article
    Patients at all general practices across England will soon benefit from new digital phone lines designed to make booking GP appointments easier. Backed by a £240 million investment, more than 1,000 practices have signed up to make the switch from analogue systems - which can leave patients on hold and struggling to book an appointment - to modern, easy-to-use digital telephones designed to make sure people can receive the care they need when they need it. It is expected every practice in the country will have the new system in place by the end of this financial year, helping put an end to the 8am rush - a key pillar of the Prime Minister’s primary care recovery plan to improve patient access to care. Patients will be able to contact their general practice more easily and quickly - and find out exactly how their request will be handled on the day they call, rather than being told to call back later, as the government and NHS England deliver on the promises made in the primary care recovery plan announced in May. If their need is urgent, they will be assessed and given appointments on the same day. If it is not urgent, appointments should be offered within 2 weeks, or patients will be referred to NHS 111 or a local pharmacy. The upgraded system will bring an end to the engaged tone, see care navigators direct calls to the right professional, and the use of online systems will provide more options and help those who prefer to call to get through. Read press release Source: Department of Health and Social Care, 18 August 2023
  7. News Article
    NHS England’s target for all trusts to have a working electronic patient record (EPR) system by March 2025 is now ‘unachievable’’ and a new date has been set a year later, government has admitted. A new report of the Infrastructure and Projects Authority – the government body which scrutinises and supports major projects – states: “Delivery confidence is [rated] red as a number of NHS trusts are reporting they are unlikely to be able to fully implement an electronic patient record by March 2025.” The document, published quietly last week, downgrades the rating from “amber” to “red” – and also reveals £700m was cut from the programme’s budget last year. The “frontline digitisation” programme was launched by government and NHSE in 2021 with the aim of getting all trusts to a minimum level of capability, including 90% to have an EPR of an acceptable standard by the end of 2023, and 100 per cent by March 2025. But the IPA report states that a revised business case is now being prepared to reflect a new “end date” of March 2026. Read full story (paywalled) Source: HSJ, 24 July 2023
  8. News Article
    A cut to the NHS tech budget, revealed by HSJ, has been described as “pretty outrageous” by a former government adviser and eminent medical leader. Sir John Bell, an immunologist and geneticist and regius chair of medicine at Oxford University, made the comments in a talk at the Tony Blair Institute’s Future of Britain conference. NHSE’s cut to its tech budget was attributed to having to divert the money to fund spending growth, and some other inflationary costs, without receiving extra from government. At the time, NHSE said the service “remains firmly committed to our digital strategy from supporting hospitals to adopt electronic patient record systems to transforming how patients access NHS services through the NHS App”. But Sir John said: “The NHS is a technology averse healthcare system.” He said NHS spending on medicines was “much lower than peers and if you look at our access to technology – like MRI and CR scanners – we’re right at the back. We just don’t do it.” He added that rapid tech development and adoption was needed particularly to enable mass early diagnosis of diseases, and new treatment therapies. Read full story (paywalled) Source: HSJ, 18 July 2023
  9. News Article
    Cheshire and Merseyside won Gold in the ‘Supporting Elective Recovery Through Digital’ category, at the HSJ Digital Awards, alongside technology partner C2-Ai, after transforming how waiting lists are managed with the help of an AI-backed waiting list model. The tool helps surgical teams identify previously hidden high-risk patients, and to make informed decisions on how, when and where to treat patients to achieve the best outcomes. NHS England, who commissioned the project, reported that within six weeks patient waiting lists dropped by nearly 30%, as well as a 66% decrease in intensive care needs for high-risk patients, saved about 2,500 hospital bed-days across 20,000 patients, and cut emergency admissions to the waiting list by 8%. Read full story Source: NHS Cheshire and Merseyside, 3 July 2023
  10. News Article
    The NHS must undergo radical change or it will continue to decline and lose public support, Tony Blair has argued on the service’s 75th anniversary. It must embrace a revolution in technology to reshape its relationship with patients and make much more use of private healthcare providers to cut waiting times, the former Labour prime minister says. The prevalence of chronic health conditions, long waiting times, the NHS’s stretched workforce and tight public finances in the years ahead mean the service must transform how it operates, he said. “The NHS now requires fundamental reform or, eventually, support for it will diminish. As in the 1990s, the NHS must either change or decline,” he writes in the foreword to a new report from his Tony Blair Institute thinktank, which sets out ideas for safeguarding the NHS’s future. He adds: “Change is never easy and requires brave political leadership. If we do not act, the NHS will continue down a path of decline, to the detriment of our people and our economy.” Read full story Source: The Guardian, 5 July 2023
  11. News Article
    Smartwatches might help diagnose Parkinson's disease up to seven years ahead of symptoms, a study suggests. The UK Dementia Research Institute team at Cardiff University used artificial intelligence to analyse data from 103,712 smartwatch wearers. By tracking their speed of movement over a single week, between 2013 and 2016, they were able to predict which would go on to develop Parkinson's. It is hoped this could ultimately be used as a screening tool. But more studies, comparing these findings with other data gathered around the world, are needed to check how accurate it will be, the researchers say, in the journal Nature Medicine. Read full story Source: BBC News, 3 July 2023
  12. News Article
    A digital NHS Health Check is to be rolled out across England from next spring, the government has announced, in an attempt to alleviate the pressure on GP surgeries. The initiative will deliver 1m checks in the first four years, according to the Department for Health and Social Care (DHSC). Tens of thousands of cases of hypertension are expected to be identified and hundreds of strokes and heart attacks prevented. Patients will be able to access the check via a mobile phone, tablet or computer, the DHSC said. Participants will complete an online questionnaire, enter height, weight, and the results of a cholesterol test which they can carry out at home. They will also be asked to have their blood pressure checked at a pharmacy. The results, which will be available online, will direct people to personalised advice. Referrals to GPs will only be made if further tests and treatment are needed. Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “This initiative will help to reach more people and encourage them to get their blood pressure and cholesterol levels checked so that, where necessary, healthcare professionals can work with them to manage their condition. “This could play an important role in helping people live healthier for longer and saving lives in the coming years, while reducing pressure on the NHS.” Read full story Source: The Guardian, 28 June 2023
  13. News Article
    Artificial intelligence (AI) is set to be rolled out more widely across the NHS in a bid to diagnose diseases and treat patients faster. The Government has announced a £21 million funding pot that NHS trusts can apply for to implement AI tools for the likes of medical imaging and decision support. This includes tools that analyse chest X-rays in suspected cases of lung cancer. AI technology that can diagnose strokes will also be available to all stroke networks by the end of 2023 – up from 86% – and could help patients get treated faster and lead to better health outcomes. The Department of Health and Social Care (DHSC) said the technology could help cut NHS waiting lists ahead of winter. Read full story Source: The Independent, 23 June 2023
  14. News Article
    Criminals have issued ‘demands’ to an NHS IT supplier targeted by a cyber attack, leading health chiefs to fear they have accessed confidential patient data, HSJ has learned. IT firm Advanced was targeted last week. The company provides electronic patient records to several trusts and most NHS 111 providers. Multiple government agencies – including the National Crime Agency and GCHQ – are now working to identify the extent of the damage caused by the attackers, while leaders of affected mental health trusts have warned of a “pretty desperate” situation as staff are unable to access vital patient records. In a statement issued last night, Advanced said: “With respect to potentially impacted data, our investigation is under way, and when we have more information about potential data access or exfiltration, we will update customers as appropriate.” Read full story (paywalled) Source HSJ, 11 August 2022
  15. News Article
    Many NHS 111 services are without a crucial IT system for several days, after a cyber attack on a software supplier. Providers had to move to pen-and-paper yesterday, and have been unable to access patient records. Adastra – which is used by 85% of NHS 111 providers – went offline at 7am on Thursday. It was still affected as of Sunday, and staff were told it may not be online for several days. Advanced, which supplies Adastra, confirmed on Friday evening the incident was caused by a cyberattck, but says it managed to limit the damage to a small number of its servers. It was reported on Saturday that the attack is thought to have been by a criminal group trying to extort money — so-called ransomware — rather than an attack by a group linked to a state/government. As well as NHS 111, the system is used by some GP out-of-hours services and has also been marketed to urgent care providers. NHS 111 services have had to use lists of protocols when answering calls and write details down, rather than the software automatically implementing the protocols. One briefing note from commissioners in London, seen by HSJ, described the issue as a “total system outage” for NHS 111, and said “likely delays for patients… will continue throughout the weekend and potentially over next week”. Read full story (paywalled) Source: HSJ, 8 August 2022
  16. News Article
    Mobile apps to track patients' health are keeping them out of hospital and could cut waiting times, experts have said. It follows a trial of a new app which heart patients are using through their mobile phones. The trial allows clinicians to change treatments quickly and uses video consultations, avoiding unnecessary hospital visits. Rhodri Griffiths is the innovation adoption director at Life Sciences Hub Wales, and is looking for more ways to introduce similar technology. He believes the pandemic accelerated the use and acceptance of digital solutions in healthcare, by patients and clinicians. "We really are looking at a big digital revolution within healthcare and there are an amazing myriad of things coming through," he said. He explained data collected by smartphones and watches can help predict who is likely to have a heart attack. "We can avoid that happening. So prevention is key but it's also looking at how some of this can impact on waiting lists," he said. "So, looking at how theatres are used, which patients can be prioritised? "In social care it's looking at how pain is managed by face recognition." Mr Griffiths said he believed the data collected could also identify wider problems: "It's combining these digital solutions with our genetic information - bringing big data together on a population level we can start spotting trends". Read full story Source: BBC News, 4 August 2022
  17. News Article
    A stick-on patch that can take an ultrasound scan of a person’s insides as they go about their daily life has been hailed as a revolution in medical imaging. The wearable patch, which is the size of a postage stamp, can image blood vessels, the digestive system and internal organs for up to 48 hours, giving doctors a more detailed picture of a patient’s health than the snapshots provided by routine scans. In laboratory tests, researchers used the patches to watch people’s hearts change shape during exercise, their stomachs expand and shrink as they drank and passed drinks, and their muscles pick up microdamage when weightlifting. Prof Xuanhe Zhao at Massachusetts Institute of Technology, who led the research team, said the patches could “revolutionise” medical imaging because existing scans are very brief, sometimes lasting only seconds, and usually have to be performed in hospitals. Ultrasound scans are extremely common, with NHS England performing more than 8m last year. But the technique has major limitations, requiring highly trained sonographers to place and orient the probes on patients’ bodies to get high-quality images. For this reason, most ultrasound scans are brief and performed on patients who are required to keep still while the images are taken. Wireless patches could sidestep some of these problems, as they can be fixed in position and left to take images for hours, and even days, at a time, the researchers say. Beyond scanning organs for early signs of disease, the “set and forget” patches could monitor bladder function, tumours, and the development of foetuses in the womb. Read full story Source: The Guardian, 28 July 2022
  18. News Article
    County Durham and Darlington NHS Foundation Trust has created and implemented an artificial intelligence (AI) model to protect patients from acute kidney injury (AKI). The trust’s AI-driven model helps healthcare staff to identify patients who are at risk from AKI and to swiftly respond with treatment. The technology uses risk stratification digital tools that staff are able to access through an app. These are combined with care processes developed at the trust and which involve a new specialist nurse team, preventive specialist intervention, assessment and follow-up. Its implementation at County Durham and Darlington has led to a reduction in both hospital-acquired and community AKI. Overall, the incidence of AKI within the trust fell from 6.5% between March and May 2020, to 3.8% during the same period in 2021. The most significant reduction was seen in hospital-acquired AKI – which fell by more than 80%. Jeremy Cundall, medical director for County Durham and Darlington NHS Foundation Trust and executive lead for the project, said: “The partnership has resulted in patients being detected earlier – preventing AKI from occurring or mitigating the worsening of existing AKI. Accordingly, patients have been more effectively triaged to the right pathways of care including referral and transfer to tertiary renal units where appropriate.” Claire Stocks, early detection, resuscitation and mortality lead nurse for County Durham and Darlington NHS Foundation Trust, said: “This work has been a project very much about using collaborative partnerships to enhance patient safety and quality. An idea that was developed in a ‘cupboard conversation’ is now a fully operational specialist nurse service. Utilising digital innovations supports rapid triage, early detection and treatment to improve outcomes.” In addition to the improvements in patient safety, the technology has delivered cost savings for the trust too. County Durham and Darlington saved more than £2million in direct costs from reductions in AKI incidence. The improved transfer of patients has also released ICU capacity, vital at a time when the NHS is dealing with a growing national backlog for elective surgery. Read full story Source: Digital Health, 27 July 2022
  19. News Article
    Medical students are using hologram patients to hone their skills with life-like training scenarios. The project at Addenbrooke’s Hospital in Cambridge is the first in the world to use the mixed reality technology in this way. Students wear Microsoft HoloLens headsets that let them interact with the patient while still being able to see each other. Lecturers are able to alter the patient’s response, make observations and add complications to the scenario. It enables realistic and immersive safe-to-fail training which can be delivered remotely as well as in person. The first module, covering respiratory conditions and emergencies, has already been launched and more are planned around cardiology and neurology. The HoloScenarios system is being developed by Cambridge University Hospitals NHS Foundation Trust, in partnership with the University of Cambridge and US-based tech firm GigXR. Consultant anaesthetist Dr Arun Gupta, who is leading the project in Cambridge, said: “Mixed reality is increasingly recognised as a useful method of simulator training. As institutions scale procurement, the demand for platforms that offer utility and ease of mixed reality learning management is rapidly expanding" Read full story Source: CIEHF, 21 July 2022
  20. News Article
    Digital improvement will be added to the conditions which trusts and integrated care systems have to legally meet as part of their operating licence, the government has indicated. The move is part of a raft of actions unveiled by the Department of Health and Social Care which are intended to “modernise” the NHS. The Plan for Digital Health and Social Care states: “At present, there are limited formal mechanisms for overseeing delivery of NHS digital priorities. Digital does not yet feature in the provider licence, system oversight framework, or Care Quality Commission assessments.” It adds: “We are exploring options for filling this gap in discussions between NHS England and the CQC, and through a review and consultation with system leaders and frontline staff.” New “regulatory levers” will be used to: “signal that digitisation is a priority, identify the non-negotiable standards of digital capability, [and] explain how we will monitor and support compliance”. Read full story (paywalled) Source: HSJ, 30 June 2022
  21. News Article
    The NHS App will soon be updated with features to help offer people in England more personalised care. It is part of the government's plan for a digital revolution to speed up care and improve access while saving the health service time and money. By March 2023, more users will receive messages from their GP and be able to see their medical records and manage hospital elective-care appointments. By March 2024, the app should offer face-to-face video consultations. The government's ambition is for at least 75% of adults to be using it by March 2024. Currently, less than half - about 28 million - have it on their phone or tablet. The government also wants 90% of NHS trusts to have electronic patient records in place or be processing them by December 2023 and for all social-care providers to adopt a digital social-care record. And patients across the country should be able to complete their hospital pre-assessment checks from home by September 2024. Read full story Source: BBC News, 29 June 2022
  22. News Article
    A serious revelation may derail the Cerner Millenium rollout. A draft report by the Department of Veterans Affairs (VA) Office of Inspector General (OIG) states that a flaw in Cerner’s software caused the system to lose 11,000 orders for specialty care, lab work, and other services – without alerting healthcare providers the orders (also known as referrals) had been lost. This created ‘cases of harm’ to at least 150 veterans in care. The VA patient safety team classified dozens of cases of “moderate harm” and one case of “major harm.” The major harm cited affected a homeless veteran, aged in his 60s, who was identified as at risk for suicide and had seen a psychiatrist at Mann-Grandstaff in December 2020, after the implementation. After prescribing medication to treat depression, the psychiatrist ordered a follow-up appointment one month later. That order disappeared in the electronic health record and was not scheduled. The consequences were that the veteran, weeks after the unscheduled appointment date, called the Veterans Crisis Line. He was going to kill himself with a razor. Fortunately, he was found in time by local first responders, taken to a non-VA mental health unit, and hospitalized. The draft report implies that the ‘unknown queue’ problem has not been fixed and continues to put veterans at risk in the VA system. There may be as many as 60 other safety problems. Other incidents cited in the draft report include one of “catastrophic harm” and another case the VA told the OIG may be reclassified as catastrophic. Catastrophic harm is defined by the VA as “death or permanent loss of function.” Read full story Source: Telehealth and Telecare Aware, 21 June 2022
  23. News Article
    The Royal Surrey County Hospital is preparing to open its first virtual ward. From this summer 15 patients will receive treatment at home using apps and wearable technology, as an alternative to a stay in hospital. The ward will be overseen by a consultant, working with therapists, nursing staff and pharmacists. The hospital, in Guildford, plans to extend the ward to 52 patients by April 2024. Health providers across England have been asked to deliver virtual wards at a rate of 40 to 50 beds per 100,000 people by December 2023. It is hoped they will free up beds more quickly, speeding up admissions from A&E and for elective surgery. Read full story Source: BBC News, 7 June 2022
  24. News Article
    The NHS has signed a £20m deal to enable health-service organisations to deploy technology to help better manage the spread of infections. The contract – awarded to US-based healthcare giant Baxter – is intended to offer NHS trusts a means through which they can buy a comprehensive infection-control platform. According to newly published commercial information such a system would, in many cases, replace various specialist software programmes used by NHS trusts to collect and process data, alongside spreadsheets and paper documents. “The system will support infection prevention and control activities to identify critical issues, proactively respond to improve the quality of care and streamline processes to reduce time spent on administrative and reporting tasks,” the contract notice said. “Most NHS Trusts tend to manage infection control surveillance through the use of various systems, collating laboratory, patient and surgery data and manually searching through the data to identify patients of interest or complex scenarios. Paper and excel spreadsheets are also used to record and manage surveillance. This process is time consuming and risk of error. NHS trusts are finding that they do not have a robust infection control system to monitor and manage their patients.” Read full story Source: Public Technology, 15 February 2023
  25. News Article
    The National Institute for Health and Care Excellence (NICE) has recommended eight online therapies for anxiety and depression. NICE says the therapies have the potential to help more than 40,000 people in the UK. Each therapy must come with a formal assessment from an NHS therapist in order for it to be recommended. According to NHS Digital, there is a six-week waiting list for patients who need mental health support in England. There are hopes that introducing online digital therapies could ease pressure on the NHS. The treatments can help those with depression, anxiety, PTSD and body dysmorphia and are centred on the use of cognitive behavioural therapy (CBT) - a talking therapy which can help a patient manage their problems by suggesting alterations to their thought process and behaviour. The therapies have been conditionally recommended by NICE - meaning early assessments have taken place to identify promising medical technology but more evidence needs to be gathered. However, Professor Dame Til Wykes, of the School of Mental Health and Psychological Sciences at London's King's College, cautioned "we don't know enough" about the effectiveness of online therapies and whether the therapies will offer sufficient support for mental health patients. Her view was echoed by mental health charity Mind, with content manager Jessica D'Cruz asserting "the majority" of people needing support "will struggle to benefit from this". Read full story Source: BBC News, 1 March 2023
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