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Babies born very premature can have brain development disrupted in intensive care unit, review finds

While most babies born more than two months prematurely now survive thanks to medical advances, little progress has been made in the past two decades in preventing associated developmental problems, an expert review has found.

The review also found that very preterm babies can have their brain development disrupted by environmental factors in the neonatal intensive care unit (NICU), including nutrition, pain, stress and parenting behaviours.

A review conducted by experts from the Children’s Hospital of Orange County in the US and the Turner Institute for Brain and Mental Health at Monash University in Australia found that while these neurodevelopmental problems can be related to brain injury during gestation or due to cardiac and respiratory issues in the first week of life, the environment of the NICU is also critical.

To improve outcomes for very preterm babies, the review recommended family based interventions that reduce parental stress during gestation, more research into rehabilitation in intensive care and in the early months of life, and greater understanding of the role of environment and parenting after birth.

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Source: The Guardian, 3 August 2023

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Trust given warning notice over rapid tranquillisation

A mental health trust has been served with a warning notice ordering improvements in its processes around rapid tranquillisation of patients.

The Care Quality Commission said the trust needed to ensure all staff at Kent and Medway NHS and Social Care Partnership Trust followed local and national recommendations to monitor and record a patient’s physical health when rapid tranquillisation was administered. Inspectors were concerned staff were not always aware of the potential impact of these medications.

Serena Coleman, CQC deputy director of operations in the south, said: “We found some staff weren’t always using the least restrictive options to make sure that people’s behaviour wasn’t controlled by an excessive use of medicines.

“As required medication, such as lorazepam and promethazine, was being used quite frequently but we couldn’t always find records to explain why these medications were necessary. There were examples where reviews hadn’t happened for long periods, meaning staff couldn’t be sure it was still appropriate to administer to people."

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Source: HSJ, 3 August 2023

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NHS to expand use of private sector to tackle waits

The use of the private sector to tackle the NHS backlog in England is to be expanded, the government says.

Ministers say they want to unlock spare capacity to get more people the treatment and operations they need.

This includes opening eight privately-run diagnostic centres and using new rules to make it easier for the NHS to purchase care in the private sector.

It comes as a record 7.5 million people are waiting for treatment - three million more than before the pandemic.

The private sector already carries out hundreds of thousands of treatments and appointments for the NHS every year. But it has said it has the capacity to carry out about 30% more than it is.

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Source: BBC News, 4 August 2023

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Trusts warned to check helipad safety after death

Trusts have been told to check the safety of their helipads after an accident in a hospital car park left a pensioner dead.

Jean Langan, 87, was blown over by the “downwash” of air from a helicopter at Derriford Hospital last year. She was walking through a car park at the hospital after an appointment when she fell and hit her head as an HM Coastguard helicopter landed on the hospital’s helipad. Another elderly woman broke her pelvis.

Now the Health and Safety Executive has written to trust chief executives reminding them of their duty to manage health and safety risks around helipads. These risks include downwash from helicopters, the moving parts of helicopters, and the design and location of helipads.

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Source: HSJ, 2 August 2023

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Negligence at Lancashire hospital caused boy permanent brain damage, court rules

An 11-year-old boy suffered permanent brain damage after birth because of negligence by hospital midwives who then fabricated notes, a high court judge has ruled.

Jayden Astley’s challenges in life include deafness, motor impairments, cognitive difficulties and behavioural difficulties, his lawyers said.

After a five-day trial at the high court in Liverpool, Mr Justice Spencer ruled that staff at the Royal Preston hospital in Lancashire were negligent in their treatment of Jayden in 2012.

The brain injury was caused by prolonged umbilical cord compression that resulted in acute profound hypoxia – lack of oxygen – sustained during the management of the birth, the court found.

Midwives failed to accurately monitor Jayden’s heart rate when he was born and failed to identify his bradycardic, or slow, heart rate during delivery. The judge also found that some entries in notes were fabricated.

In his judgment Spencer said it was agreed that all permanent damage to Jayden’s brain would have been avoided if he had been delivered three minutes earlier.

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Source: The Guardian, 2 August 2023

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GPs given freedom to order heart checks direct

GP practices in England will be able to order a host of checks directly to help speed up the diagnosis of a range of heart and respiratory conditions.

Traditionally GPs refer to specialists when conditions like heart failure and lung problems are suspected.

But the ability to direct refer, which was rolled out for cancer last year, is now being extended.

GPs welcomed the move, but questioned whether there was sufficient testing capacity to cope.

Royal College of GPs chair Prof Kamila Hawthorne said: "Any initiative to accelerate the process by which patients can be diagnosed and begin to receive any necessary treatment should be seen as positive."

She said GPs had "long been calling" for better access to diagnostic tests.

But she added: "For this initiative to be successful, it is vital that diagnostic capacity - both in terms of testing and people to conduct and interpret tests - is sufficient."

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Source: BBC News, 3 August 2023

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Directors to be judged on their ability to create ‘compassionate’ cultures

NHS England has announced the first details of its ‘Leadership Competency Framework’, and revealed it will be launched this September.

The LCF will underpin the annual appraisal of NHS board directors and, in turn, adherence to the revamped Fit and Proper Person Test.

NHSE also revealed that leaders, including senior clinicians, who hold “significant roles” but are not board members may be subject to the FPPT in the near future.

The new FPPT framework said the LCF would contain “six competency domains which should be incorporated into all senior leader job descriptions and recruitment processes”.

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Source: HSJ, 3 August 2023

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Warning over medical clinics using fake Google reviews

Medical clinics are using fake Google reviews to boost their profiles online, a BBC investigation has found.

Consumer groups say fake reviews are a "significant and persistent problem" and have called on internet firms to do more to remove them and fine companies.

Which? has warned it could be a serious issue if someone chooses a treatment clinic based on reading a fake review.

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Source: BBC 2 August 2023

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Should the acne drug that 'cost Annabel Wright and Jon Medland their lives' be banned for under-18s?

Jonathan Medland's voice crackles with anger and emotion when he talks about his beloved son Jon, who tragically took his own life aged just 22.

'He was the most exuberant, engaging, funny and amazing young man you could ever wish to meet — nobody had a bad word to say about him — he was really going places,' says Jonathan, 66, a retired driving instructor from Barnstaple in Devon. 'But that drug did something terrible to his brain.'

The drug he's referring to is isotretinoin — brand name Roaccutane — a pill first licensed in the UK for the treatment of severe acne in 1983 and since taken by hundreds of thousands of patients.

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Source: Mail Online 31 July 2023

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Should Ozempic come with a warning about a risk of suicidal thoughts?

In the U.S., the prescribing label of Ozempic's sister drug, Wegovy, already warns of possible suicidal ideation because of similar side effects linked to other weight loss drugs.

Following reports of self-injury and suicidal thoughts among a small number of people who’ve taken Ozempic or Wegovy in Europe and the United Kingdom, health regulators there are investigating whether the drugs carry a risk of these side effects.

The European Medicines Agency said last month that it was reviewing 150 such reports from people who took drugs in this class, called GLP-1 receptor agonists, which lower blood sugar and suppress appetite by mimicking a hormone in the gut.

Then last week, the U.K.'s Medicines and Healthcare products Regulatory Agency told Reuters that it was reviewing safety data about the drugs following similar reports.

Neither Ozempic nor Wegovy, which are both versions of a drug called semaglutide at different dosages, carry warnings about suicidal ideation in Europe or the U.K., since clinical trials have not shown evidence of an increased risk.

But in the United States, the Food and Drug Administration requires that medications for weight management that work on the central nervous system carry a warning about suicidal thoughts. Because the agency approved Wegovy as a weight loss treatment, its prescribing label asks medical professionals to monitor for these symptoms and to discontinue the medication if people develop them. Ozempic, which is only FDA-approved to treat diabetes, does not come with that warning.

But some patients think it should.

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Source: NBC 1 August 2023

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AI use in breast cancer screening as good as two radiologists, study finds

The use of artificial intelligence in breast cancer screening is safe and can almost halve the workload of radiologists, according to the world’s most comprehensive trial of its kind.

Breast cancer is the most prevalent cancer globally, according to the World Health Organization, with more than 2.3 million women developing the disease every year.

Screening can improve prognosis and reduce mortality by spotting breast cancer at an earlier, more treatable stage. Preliminary results from a large study suggest AI screening is as good as two radiologists working together, does not increase false positives and almost halves the workload.

The interim safety analysis results of the first randomised controlled trial of its kind involving more than 80,000 women were published in the Lancet Oncology journal.

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Source: Guardian 2 August 2023

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Trust apologises to dozens of families after harm to children

A hospital trust has apologised to families after dozens of children suffered hearing loss following failures in their care.

Croydon Health Services Trust had already revealed three children “may have been at risk of serious hearing loss or a delay to their speech development”, but it has now confirmed to HSJ that a further 49 “incurred mild to moderate hearing loss or impairment”.

The south London trust would not disclose the results of its internal review that begun after it declared a serious incident in March 2021, saying it was “ongoing”, but said it had acted on all the “immediate recommendations”.

The incident was declared after more than 1,400 children were found not to have been followed up by the trust. 

There was also an external review carried out by an audiologist from Guy’s and St Thomas’ Foundation Trust. It is unclear which review uncovered the incidents of harm. 

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Source: HSJ 1 August 2023

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Promising new Alzheimer’s drugs may be less effective for Black patients

Groundbreaking treatments for Alzheimer’s disease that work by removing a toxic protein called beta amyloid from the brain may benefit whites more than Black Americans, whose disease may be driven by other factors, leading Alzheimer’s experts told Reuters.

The two drugs - Leqembi, from partner biotech firms Eisai (4523.T) and Biogen (BIIB.O), and an experimental treatment developed by Eli Lilly (LLY.N), donanemab — are the first to offer real hope of slowing the fatal disease for the 6.5 million Americans living with Alzheimer’s.

Although older Black Americans have twice the rate of dementia as their white peers, they were screened out of clinical trials of these drugs at a higher rate, according to interviews with 10 researchers as well as four Eisai and Lilly executives.

Prospective Black volunteers with early disease symptoms did not have enough amyloid in their brain to qualify for the trials, the 10 researchers explained.

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Source: NBC 31 July 2023

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Patients ‘not thin enough’ for help as NHS battles eating disorder crisis

Desperately ill people with eating disorders are being refused NHS treatment for “not being thin enough”, as new figures reveal the health service is in the grips of a growing eating disorder crisis.

Shocking figures obtained by The Independent show at least 5,385 patients – the overwhelming majority, 3,896, of whom are children – were admitted to general wards for conditions such as anorexia and bulimia in 2021-22, more than double the number in 2017-18.

It comes as separate analysis of NHS figures suggests the number of children being treated for eating disorders more than doubled from 5,240 in 2016-17 to 11,800 in 2022-23.

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Source: Independent 1 August 2023

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Coroners issue 24 warnings over emergency care crisis

Coroners have warned of increasing numbers of deaths caused by problems in the emergency pathway, with some citing ‘severe’ staffing shortages.

HSJ has identified that at least 24 “prevention of future death” reports were sent to NHS organisations in England and Wales in the first half of 2023, which noted shortcomings within emergency services.

In six of the 24 cases, coroners found ambulance, emergency room and other delays caused or contributed to patient deaths.

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Source: HSJ 1 August 2023

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‘Serious failings’ contributed to baby’s death in 12-hour lone prison birth

Serious systemic failings contributed to the death of a newborn baby in a cell at Europe’s largest women’s prison, a coroner has concluded.

Rianna Cleary, who was 18 at the time, gave birth to her daughter Aisha alone in her prison cell at HMP Bronzefield, in Surrey, on the night of 26 September 2019. The care-leaver was on remand awaiting sentence after pleading guilty to a robbery charge.

The inquest into the baby’s death heard that Cleary’s calls for help when she was in labour were ignored, she was left alone in her cell for 12 hours and bit through the umbilical cord to cut it.

In a devastating witness statement read to the court, Cleary described going into labour alone as “the worst and most terrifying and degrading experience of my life”.

She said: “I didn’t know when I was due to give birth. I was in really serious pain. I went to the buzzer and asked for a nurse or an ambulance twice.” Cleary passed out and when she woke up she had given birth.

The senior coroner for Surrey, Richard Travers, said Aisha “arrived into the world in the most harrowing of circumstances”. He concluded it was “unascertained” whether she was born alive and died shortly after or was stillborn.

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Source: The Guardian, 28 July 2023

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NHS virtual wards available for 10,000 patients by September

The NHS has heralded a “new era” of healthcare that will see hundreds of thousands of patients avoid lengthy hospital stays and instead be treated in their own homes.

From September, 10,000 acutely ill patients will be cared for on “virtual wards”, using remote monitoring technology which automatically transmits data on their condition to teams of doctors and nurses several miles away.

Health chiefs believe the massive expansion of the scheme, which is already the largest in the world, is essential to free hospital capacity — preventing another winter A&E crisis and helping to bring down record waiting lists.

Every NHS region has set up virtual wards for frail over-65s, including dementia patients, as well as for respiratory conditions such as asthma or lung disease. From this month the scheme will be rolled out to cover under-18s, allowing terminally ill children to remain at home surrounded by family.

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Source: The Times, 28 July 2023

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NHS in acute condition: the crisis facing the UK’s hospitals

The prospect of waiting at least six weeks for a biopsy was too much for Neil Perkin. In February, the 56-year-old was told that he had suspected prostate cancer which needed to be confirmed by examining a sample of his tissue.

“After the initial appointment with the consultant, there were no letters, texts or anything,” Perkin said. Instead, he decided to pay for it himself: £5,000 – a substantial sum for the part-time ferry operator. The results from a private hospital in Guildford confirmed the cancer.

“I’d lost faith in the NHS by this point and I went private,” he said. “The cancer was spreading and my surgeon made it clear that if I’d waited for the NHS for my prognosis, [the] chances of cancer recurrence would be far worse.”

In May he paid another £22,500 for the prostate to be removed at a private hospital in London, with financial help from his family. “I feel let down. It turned out from the pathology that this was urgent and a delay would have made a huge difference to my outcome, my prognosis and quality of life. They got there in the nick of time.”

Portsmouth Hospitals University Trust said it was sorry to have been unable to meet Perkin’s expectations and strived to provide quality and timely care. “But we recognise that across the NHS there is an increased demand on services and this can impact patient waiting times.”

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Source: The Guardian, 30 July 2023

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Families caring for dementia patients in UK reaching crisis point, says charity

Soaring numbers of families struggling to care for someone with dementia have hit a “crisis point” with nowhere to turn for help when their loved one puts themselves or others at risk of harm, a charity has said.

More than 700,000 people in the UK look after a relative with dementia. Many feel they can no longer cope with alarming situations where they or their relative are at immediate risk of being harmed, according to Dementia UK.

Dementia can affect a person’s ability to manage their reactions to difficult thoughts and feelings. This can lead to them experiencing such intense states of distress that they become verbally or physically aggressive, putting themselves and those around them at risk of harm.

The charity says carers and their loved ones are being failed because health and social care support services are already stretched to their limit, which has led to a surge in calls to its helpline.

Sheridan Coker, the deputy clinical lead at Dementia UK, said: “We’re increasingly being contacted by families who are at risk of harm with no one to turn to. We receive calls where the person with dementia has become so distressed that they have physically assaulted the person caring for them, often a family member."

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Source: The Guardian, 31 July 2023

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Patients less pleased with GP phone access in all but one ICS

Patients in all but one integrated care system found it more difficult to contact their GP practice by phone this year compared to last year. 

GP patient survey data, published this month, showed the proportion of patients who found it “very” or “fairly easy” to get through by phone had fallen across almost every ICS by as much as seven percentage points. The measure fell nationally from 53 to 50%. 

The drop in performance comes as NHS England and the government ramp up focus on ease and speed of access to GPs as part of the primary care recovery plan, published in May.

An NHSE spokesperson said: ”Despite GP teams experiencing record demand for their services, with half a million more appointments delivered every week compared to before the pandemic, the GP survey found that the majority of patients have a good overall experience at their GP practice.

“However, the NHS recognises more action is needed to improve access for patients, which is why it published a recovery plan in May.”

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Source: HSJ, 31 July 2023

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Surgeon damaged dozens of patients by misplacing screws in their backs

Every day Sharon Smith has to take a strong morphine tablet to dull the excruciating pain she has lived with for more than a decade. 

“I am in chronic pain every day. It’s affected our whole family and I’ve lost all my independence,” said Smith, from Leigh, Greater Manchester.

Over four years from 2009, she endured three operations on her spine at Salford Royal Hospital, which as an NHS trust was once fêted as England’s safest.

But the hospital had a dark secret: an incompetent leading surgeon who, an independent review would later find, had already “contributed” to the death of a girl in 2007.

Now a wider investigation has confirmed that dozens of other patients who went under John Bradley Williamson’s knife were harmed or received poor care.

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Source: The Times, 30 July 2023

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‘We don’t have the bottle’ to hold line on bed numbers, says trust director

A director at a major acute trust said it needs to stop “caving in” to demand pressures by opening extra escalation beds.

Board members at Mid and South Essex were discussing a recent report from the Care Quality Commission (CQC), which rated medical services as “inadequate”.

The CQC flagged significant staffing shortages and repeated failures to maintain patient records, among other issues.

Deputy chair Alan Tobias told yesterday’s public board meeting: “We have just got to hold the line on these [escalation] beds. We never do. Every year we cave in…

“We have just got to hold the line with this… Do what some other hospitals do, they shut the doors then. We have never had the bottle to do that.”

Barbara Stuttle, another non-executive director, said: “Our staff are exhausted… We don’t have the staff to give the appropriate care to our patients when we have got extra beds. To have extra beds on wards, I know we have had to do it and I know why, [but] you are expecting an already stretched workforce to stretch even further.

“And when that happens, something gives. Record keeping, that’s usually the last thing that gets done because they’d much rather give the care to patients.”

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Source: HSJ, 28 July 2023

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Shropshire patient left to change in hospital corridor 'felt exposed'

A woman treated in a hospital corridor says the lack of privacy was "wholly inappropriate" after other patients saw her without a top.

Isabel Aston was taken to Princess Royal Hospital in Shropshire with pneumonia and sepsis and said she spent seven hours on a bed in a corridor.

She said she felt exposed when other patients saw her changing her clothes.

She explained: "People were walking in both directions [and] there aren't screens around your bed so people wanting the toilet who couldn't get out of bed were faced with the thought of using a bed pan in full view."

She added that on feeling hot at one point, she wanted to change her t-shirt, but the process proved lengthy due to cannulas in her arms.

"I did not have anything on underneath," she said. "I'm 64 years of age, I've probably reached an age where I'm not so self-conscious perhaps, but that could have been a much younger patient.

"That could have been a patient for whom perhaps culturally they couldn't have change their t-shirt... or somebody who had mastectomy scars [and] were very self conscious.

"It is wholly inappropriate for patients to be so exposed when they are so ill."

The hospital trust said it aimed to maintain patients' dignity despite being under operational pressures.

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Source: BBC News, 28 July 2023

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Allergy emergencies double in recent years in England

Dangerous allergic reactions are rising in England and now cause some 25,000 NHS hospital stays a year, according to data gathered by the NHS and analysed by the Medicines and Healthcare products Regulatory Agency.

Health officials say the rate has more than doubled over 20 years, prompting them to issue advice reminding people how to recognise allergies and respond.

For severe food-related allergic reactions, the rise in admissions is even greater.

The figures suggest anaphylaxis is on the increase, though some of the rise could be attributed to the growth in population.

Anaphylaxis can be fatal and develop suddenly at any age.

People who know they are at risk should always carry two adrenaline pens which they, or someone else, can administer in an emergency.

In addition, people at risk of an anaphylactic reaction should regularly check the contents of their adrenaline pens have not expired. They should see a pharmacist to get a new one if a pen is close to expiring.

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Source: BBC News, 28 July 2023

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Alarming decline in vaccine update must be tackled, say MPs

The UK’s status as a global leader on vaccination is at risk because of falling uptake rates among children and an “alarming” decline in clinical trial activity, MPs have warned.

The Health and Social Care Committee said in a report that it was concerned that England did not meet the 95% target for any routine childhood immunisations in 2021-22.1

Committee chair Steve Brine MP said that new spikes in measles cases in London and the West Midlands because of low uptake of MMR vaccines should be a “massive wake-up call” for the government to take action. “Vaccination is the one of the greatest success stories when it comes to preventing infection. Unless the government tackles challenges around declining rates of childhood immunisations and implements reform on clinical trials, however, the UK’s position as a global leader on vaccination risks being lost,” he said.

The Health and Social Care Committee said, “It is unacceptable that there are people who are unable to take advantage of the important protection that vaccination offers because of practical challenges of time and location that can and must be tackled.”

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Source: BMJ, 27 July 2023

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