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Crisis in NHS maternity units revealed as 21 rated ‘substandard’

Nearly half of all NHS hospital maternity services covered so far by a national inspection programme have been rated as substandard, the Observer can reveal.

The Care Quality Commission (CQC), which regulates health and care providers in England, began its maternity inspection programme last August after the Ockenden review into the Shropshire maternity scandal, which saw 300 babies left dead or brain damaged by inadequate NHS care.

Of the services inspected under the programme, which focuses on safety and leadership, about two-thirds have been found to have insufficient staffing, including some services that were rated as good overall. Eleven services saw their rating fall from their previous inspection.

Dr Suzanne Tyler of the Royal College of Midwives said: “Report after report has made a direct connection between staffing levels and safety, yet the midwife shortage is worsening. Midwives are desperately trying to plug the gaps – in England alone we estimate that midwives work around 100,000 extra unpaid hours a week to keep maternity services safe. This is clearly unsustainable and now is the time for the chancellor to put his hand in the Treasury pocket and give maternity services the funding that is so desperately needed.”

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Source: The Guardian, 9 July 2023

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Barclay: I’m fighting doctors’ pay demands for the sake of NHS staff

The government is resisting what it believes are inflationary pay demands from junior doctors for the sake of NHS staff, health and social care secretary Steve Barclay has told HSJ.

In a wide-ranging interview, Mr Barclay also:

  • Rejected the idea that it would be impossible to hit the prime minister’s waiting times pledge without settling the junior doctors strike;
  • Defined what he believed was the difference between good and bad management;
  • Refused to apologise to the 123 trusts whose bids for “new hospital programme” funding were rejected.

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Source: HSJ, 10 July 2023

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Weight-loss jabs investigated for suicide risk

Europe's drugs regulator has told BBC News it is conducting a review of some weight-loss jabs after being alerted to a possible link to thoughts of suicide and self-harm among users.

Member state Iceland notified the European Medicines Agency after seeing three cases.

The safety assessment will look at Wegovy, Saxenda and similar drugs, such as Ozempic, that help curb appetite.

Product leaflets already list suicidal thoughts as a possible side effect.

An EMA official said: "The review is being carried out in the context of a signal procedure raised by the Icelandic Medicines Agency, following three case reports.

"A signal is information on a new or known adverse event that is potentially caused by a medicine and that warrants further investigation.

"The case reports included two cases of suicidal thoughts - one following the use of Saxenda and one after Ozempic.

"One additional case reported thoughts of self-injury with Saxenda.

"The EMA will communicate further when more information becomes available."

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Source: BBC News, 10 July 2023

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Hospital threatened with loss of junior doctors over safety concerns

A struggling trust has been warned by regulators that it could see its junior doctors removed, after concerns about clinical supervision and safety at a hospital whose A&E closes at night.

NHS England inspectors who visited Cheltenham General Hospital found emergency patients – including potential surgical patients – became the responsibility of the overnight medical team when its accident and emergency closed in the evening.

One night, 26 patients had been handed across, the inspectors were told, and some patients were felt to be inappropriate for medical referral. A surgical registrar could be telephoned at Gloucester Royal Hospital about surgical patients.

They were told that although there were no incidents of serious harm, there had been many “near misses” and juniors felt “unsafe and unsupported in terms of consultant clinical supervision, overall clinical/nursing staffing support or logistically in managing patients in this setting or arranging transfers”.

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Source: HSJ, 7 July 2023

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Patient dies and three hospitalised in Sciensus chemotherapy incident

A cancer patient has died and three others have been hospitalised after they were administered unlicensed versions of chemotherapy by Sciensus, a private company paid millions by the NHS to provide essential medication.

Three health regulators have launched inquiries into the incident, according to people familiar with the matter. It was caused by an issue at the firm’s medicines manufacturing unit.

In a statement, Sciensus confirmed an “isolated incident” had “affected four patients” and that it was “deeply saddened” that one of them had died.

Sciensus offered its “sincere condolences” to the family and friends of the patient who died, and is conducting a thorough investigation, it added.

The four patients received unlicensed versions of cabazitaxel, a licensed chemotherapy used to treat prostate cancer. The versions administered to the patients differed from the licensed product and therefore were considered unlicensed medicines. 

Sciensus is required to comply with official standards to ensure the quality of the products it produces and the protection of public health. Breaches of these standards can result in the MHRA suspending or removing a company’s licence.

“Patient safety is our highest priority,” said Dr Alison Cave, the MHRA’s chief safety officer. “We are urgently investigating this issue and we will take any necessary regulatory measures to ensure patients are protected."

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Source: The Guardian, 7 July 2023

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Study finds rise in psychological distress in young adults

There has been a rise in the number of young adults in England who report feelings of severe distress, according to a new survey.

The study found one in five 18 to 24-year-olds said they experienced severe distress at the end of 2022, compared to around one in seven in 2021.

The research suggested reports of severe distress rose across all age groups, except for those over 65.

Experts have pointed to the pandemic, cost of living and healthcare crisis.

Researchers used a point-based score during telephone interviews to assess severe distress for the survey. People had not necessarily sought clinical help or a diagnosis at this point.

The research team, including academics from King's College London and University College London (UCL), say the rise in reports needs to be urgently addressed.

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Source: BBC News, 7 July 2023

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‘Beginnings of safety culture’ emerging at ‘cover-up’ trust

An ambulance trust at the centre of an inquiry into alleged cover-ups has shown signs of improvement, according to the Care Quality Commission (CQC).

North East Ambulance Service Foundation Trust has been accused of withholding information from coroners. An ongoing inquiry chaired by former acute trust chief executive Dame Marianne Griffiths is looking at how it deals with serious incidents, whistleblowers’ concerns and whether the trust complies with the “duty of candour” as well as its processes around inquests. 

The CQC report suggests it has made progress on many of these areas since inspections last year – which triggered a warning notice – and has raised the rating for its emergency and urgent care division from “inadequate” to “requires improvement”. 

The inspectors said it was a “mixed picture” but they had seen “the beginnings of a safety culture emerging within the trust”.

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Source: HSJ, 7 July 2023

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‘Insulting’ cut to staff support services confirmed by NHSE

NHS England has issued a ‘tokenistic’ and ‘insulting’ funding settlement for staff mental health and wellbeing hubs this year, which is not enough to provide proper support, HSJ has been told.

A letter sent by NHSE to its regional directors, and seen by HSJ, confirmed that the hubs have been allocated just £2.3m for 2023-24. NHSE says the funding, which is far below current running costs, must be spent within the financial year.

It appears to confirm fears that many of the 40 hubs will need to be shut, if they are not funded locally.

One hub lead said: “Day in, day out, we work with colleagues across the NHS who are struggling with a wide range of mental health issues, from anxiety and depression to burnout and dealing with the impacts of moral injury.

“Staff are exhausted, overwhelmed by their workload and struggling to give their patients the care they know they deserve.

“I urge ministers to speak directly to hub leads to find out exactly what the issues are on the ground, and how the hubs are helping staff who are working at their limits, while supporting staff retention.”

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Source: HSJ, 6 July 2023

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Sarms: Illegal muscle drugs sold in UK shops, BBC finds

"Dangerous" muscle-building drugs are being sold illegally in shops around the UK, a BBC investigation has found.

The substances, known as Sarms, can cause erectile dysfunction, mood swings and liver problems, doctors warn.

Secret filming by the BBC found they were widely available in shops that sell bodybuilding supplements as well as online.

Responding to the findings, the Royal Pharmaceutical Society (RPS) called for the law to be tightened.

Sarms - which stands for selective androgen receptor modulators - are body-enhancing drugs that mimic the effects of anabolic steroids, which increase muscle mass and strength.

Originally developed as an experimental drug to treat muscle-wasting conditions, they have become popular with gym-goers on social media who want to build muscle and lose fat.

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Source: BBC News, 7 July 2023

 
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Welsh Government criticised for failing to appoint a Patient Safety Commissioner

The Welsh Government is facing criticism after refusing to appoint an independent Patient Safety Commissioner – a role established in England last year and currently being legislated for in Scotland.

The moves in England and Scotland follow publication of the Independent Medicines and Medical Devices Safety Review in 2020, which investigated a series of scandals where patients suffered because of negligence and inaction.

The review recommended the establishment of a Patient Safety Commissioner in England, and last September Dr Henrietta Hughes became the first such commissioner.

The Scottish Parliament is currently legislating to introduce a Patient Safety Commissioner.

A Welsh Government spokesman said: “The situation here is different to the other devolved nations. We’ve recently introduced our own legislation and other measures to improve patient safety.

“We strengthened the powers of the Public Service Ombudsman for Wales to undertake their own investigations and introduced new duties of quality, including safety, and candour for NHS bodies. We have created [the body] Llais to give a stronger voice to people in all parts of Wales on their health and social care services. It has a specific remit to consider patient safety and has the power to make representations to NHS bodies and local authorities and undertake work on a nationwide basis.

“Our view is that introducing a Patient Safety Commissioner in Wales at this time would create considerable complexity and confusion. Also one of the main roles of the proposed commissioner is in relation to medicines and medical devices, which are not devolved to Wales.”

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Source: Nation Cymru, 6 July 2023

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Trust CEOs decry ‘undeliverable’ and damaging financial plans

NHS trusts have committed to financial plans without properly considering their consequences, with finance directors turning a blind eye to unrealistic forecasts under pressure from NHS England, some of the country’s top NHS chief executives have warned.

Many of the senior trust leaders speaking at HSJ’s Top CEOs roundtable admitted they had gone further than they wanted to in agreeing to higher levels of planned savings.

At the roundtable event, University College London Hospitals Foundation Trust CEO David Probert said there were “definite challenges to the professionalism of some of our fantastic finance leaders”, who were “being asked to put in place plans that [they] may not fully agree are deliverable or are highly risky.”

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Source: HSJ, 7 July 2023

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NICE advises GPs to offer home tests to all patients with bowel cancer symptoms to reduce waiting lists

GPs should offer all patients presenting with signs of colorectal cancer a faecal immunochemical test (FIT) to reduce the waiting times for a colonoscopy, the National Institute for Health and Care Excellence (NICE) has recommended in draft guidance.

The current NICE recommendation is to offer FIT to people presenting to primary care with low risk symptoms suggestive of colorectal cancer, while people with high risk symptoms should be immediately referred to the suspected cancer pathway. However, patients often have lengthy waiting times for colonoscopy because of limited capacity.

NICE estimates that the recommendation should lead to 50% fewer referrals for urgent colonoscopies being made by GPs each year.

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Source: BMJ, 5 July 2023

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Tens of thousands of children to be treated in ‘virtual wards’ at home

Tens of thousands of children will be treated in “virtual wards” to free hospital beds for more critically ill patients under new NHS plans.

The Hospital at Home service will be expanded to include paediatric care in every region of England this month, the health service announced.

As part of the service, clinical teams review patients daily and can provide treatments including blood tests, prescribe medicines or administer fluids through a drip. Ward rounds can include home visits or a video call, and many services use technology such as apps and wearable devices to monitor recovery.

Professor Simon Kenny, the NHS’s national clinical director for children and young people, said: “The introduction of paediatric virtual wards means children can receive clinical care from home, surrounded by family and an environment they and their parents would rather they be — with nurses and doctors just a call away.” 

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Source: The Times. 5 July 2023

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Vaping: BMA to review effects of “growing public health epidemic”

The BMA will review the dangers posed by e-cigarettes, after its annual representative meeting passed a motion warning that vaping was a “growing public health epidemic.”

The motion, which was passed by the meeting in Liverpool on 5 July, called on the BMA’s Board of Science to rereview the dangers of vaping, and discuss restrictions on marketing and cracking down on illegal sales to children. The BMA’s last position paper on vaping was published in 2017.1

The motion urged the board to consider whether doctors should include history of e-nicotine use as a “regular and essential” part of patient history and examination. 

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Source: BMJ, 5 July 2023

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NHS at 75: CPR call for ailing Northern Ireland health service

Northern Ireland's health system cannot expect its staff to "step up time and time again" to provide patient care and ensure their safety.

That is according to the head of Northern Ireland's Confederation for Health and Social Care, which is marking the NHS's 75th anniversary.

A long-term funding plan, political leadership and transformation are all overdue, Michael Bloomfield said.

"There is a clear vision for what needs to happen, the leaders across the health and social care system know what needs to happen - we just need political leadership to make sure it happens," he told BBC News NI.

Amid all the celebrations, there are mixed feelings about the current condition and future of health and social care.

The director of the Royal College of Nursing NI, Rita Devlin, described the idea of not having an NHS as "unthinkable".

"We need to make sure that the environment that we are asking our nurses to work in is one that values the work that they do and fairly pays and rewards them for what they do," she said.

Other issues that need addressing, she added, were career pathways, training and ensuring that "when a nurse wants to stay at the bedside, that that is valued equally as the nurses who want to go into management".

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Source: BBC News, 5 July 2023

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Lung cancer diagnoses of UK women to outnumber men’s for first time

The number of women diagnosed with lung cancer in the UK is expected to overtake men this year for the first time, according to projections that have prompted calls for women to be as vigilant about the disease as they are about breast cancer.

Lung cancer is the most common cause of cancer death in the UK, accounting for one in five of the total. It has one of the worst cancer survival rates, which is largely attributed to diagnoses at a late stage, when treatment is less likely to be effective.

Analysis by Cancer Research UK for the Guardian suggests women will overtake men for lung cancer diagnoses in 2022-24. The projections suggest that this year, female cases will eclipse male cases for the first time, with 27,332 and 27,172 cases respectively.

Cancer experts said the “very stark” figures reflected historical differences in smoking prevalence, specifically that smoking rates peaked much earlier in men than women. Women should now be as alert to potential lung cancer signs as they were about checking for lumps in their breasts, they said.

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Source: The Guardian, 5 July 2023

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Austerity has led to NHS quality of care declining in key areas

The quality of care that the NHS provides has got worse in many key areas and patients’ long waits to access treatment could become even more common, research has found.

The coalition government’s austerity programme in the early 2010s led to the heath service no longer being able to meet key waiting time targets, the Nuffield Trust and Health Foundation said.

Austerity ushered in “really concerning deterioration across the board” in the overall quality of NHS care, as judged by patients’ experience and prevention of ill-health, not just speed of access.

Analysis by the two thinktanks’ joint Quality Watch programme, which monitors more than 150 indicators of care quality over time, found that in England:

  • Fewer people with long-term heath conditions such as cancer, diabetes and depression, are getting enough help to manage their condition.
  • Breast cancer screening rates for women aged 53-74 have fallen.
  • It has become harder for patients to see a named GP.
  • Only 6% of midwives think their maternity unit has enough staff to do its job properly.

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Source: The Guardian, 5 July 2023

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Tony Blair urges expanded role for private sector as NHS turns 75

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.”

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Source: The Guardian, 5 July 2023

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MPs criticise ‘staggering’ failures at UK Health Security Agency

Britain’s lead public health body has a staggering lack of control over billions of pounds of spending, and there is no plan for stockpiling vaccines or personal protective equipment (PPE) for a future pandemic, a damning MPs’ report has found.

The public accounts committee was highly critical of the repeated governance and financial failings at the UK Health Security Agency (UKHSA), which was set up with great fanfare under Boris Johnson.

Meg Hillier, the committee chair, said it would be “utterly inexcusable” for the government to have failed to make serious preparations for future health emergencies and warned the lack of a plan for stockpiling could leave health workers once again exposed to danger as they were in 2020.

The committee lambasted the Department of Health and Social Care (DHSC), which oversees UKHSA, for lacking a strategy for reserves of PPE, vaccines and medicines despite its mandate to protect the country’s health security.

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Source: The Guardian, 5 July 2023

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NHS waiting list will ‘probably go up’ in England, says minister

A Conservative minister has acknowledged the NHS waiting list, which stands at a record high with more than 7.4 million people waiting for treatment in England, will “probably go up” before it goes down.

Speaking on the 75th anniversary of its creation, the health minister Maria Caulfield claimed the NHS would be “thriving” in 25 years’ time, saying a two-year waiting time had “virtually been eliminated”.

But experts have called for more investment in the NHS, with Prof Philip Banfield, the British Medical Council’s chair of council, saying the health service is so fragile that it may not survive until its 80th anniversary.

The shadow health secretary, Wes Streeting, said the NHS would die without “the necessary investment and reform” to change and modernise.

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Source: The Guardian, 5 July 2023

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NHSE and government reprimanded for ‘selective reporting’ of cancer performance

NHS England and the government have been criticised for “selective reporting” of statistics by an influential Westminster committee.

The chair of the Public Accounts Committee Meg Hillier wrote to NHS England CEO Amanda Pritchard requesting “greater realism about the scale of the challenge” on cancer services.

It follows the government and NHSE claiming in a government response to the committee that they had “implemented” one of its earlier recommendations, to “bring cancer treatment back to an acceptable standard”.

In their February report on backlogs and waiting times, MPs said cancer delays were “unacceptable” and services should be recovered “as a matter of urgency”. The report also criticised NHSE for “over-optimism” when drawing up cancer and elective recovery plans.

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Source: HSJ,  4 July 2023

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Organ harvesting: Trafficked for his kidney and now forced into hiding

Daniel was about to get the fright of his life.

He was sitting in a consulting room at the Royal Free hospital in London, speaking to doctors with his limited English.

The 21-year-old street trader from Lagos, Nigeria, had come to the UK days earlier for what he had been told was a "life-changing opportunity". He thought he was going to get a better job.

But now doctors were talking to him about the risks of the operation and the need for lifelong medical care.

It was at that moment, Daniel told investigators, that he realised there was no job opportunity and he had been brought to the UK to give a kidney to a stranger.

"He was going to literally be cut up like a piece of meat, take what they wanted out of him and then stitch him back up," according to Cristina Huddleston, from the anti modern slavery group Justice and Care.

Luckily for Daniel, the doctors had become suspicious that he didn't know what was going on and feared he was being coerced. So they halted the process.

 The BBC's File on 4 has learned that his ground-breaking case alerted UK authorities to other instances of organ trafficking. 

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Source: BBC News, 4 July 2023

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US maternal deaths doubled in last 20 years, study finds

Maternal mortality rates have doubled in the US over the last two decades - with deaths highest among black mothers, a new study suggests.

American Indian and Alaska Native women saw the greatest increase, the study in Journal of the American Medical Association (JAMA) said.

Southern states had the highest maternal death rates across all race and ethnicity groups, the study found.

In 1999, there were an estimated 12.7 deaths per 100,000 live births and in 2019 that figure rose to 32.2 deaths per 100,000 live births in 2019, according to the research, which did not study data from the pandemic years.

Unlike other studies, this one examined disparities within states instead of measuring rates at the national level, and it monitored five racial and ethnic groups.

Dr Allison Bryant, one of the study's authors, said the findings were a call to action "to understand that some of it is about health care and access to health care, but a lot of it is about structural racism".

She said some current policies and procedures "may keep people from being healthy".

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Source: BBC News, 4 July 2023

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Long Covid causing 'debilitating impact' on doctors

A "significant" number of doctors are still suffering with the "debilitating effects" of Long Covid, according to a new report.

Many are left in financial limbo as they have been forced to quit work or reduce their hours, the British Medical Association (BMA) report warns.

Some 600 doctors with long COVID were quizzed about the impact on their day-to-day lives.

One in five told the BMA and the Long COVID Doctors for Action group they had been forced to stop work or significantly cut back on their hours.

Carrying out essential daily activities such as getting dressed, household activities, and childcare have become difficult or not possible for 60% of the medics who took part in the survey.

Nearly half (49%) said they have experienced loss of earnings as a result of Long Covid symptoms of which include: fatigue, headaches, muscular pain, nerve damage, joint pain, ongoing respiratory problems.

The BMA has made a series of calls to support doctors with Long Covid, including:

  • Financial support for doctors and other health workers with Long Covid.
  • Long Covid to be recognised as an "occupational disease".
  • Better access to physical and mental health services for those affected after the report said that access to NHS long COVID clinics is "patchy".
  • Greater "workplace protection" for staff.
  • More support to help healthcare workers return to work "safely".

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Source: Medscape, 3 July 2023

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PTSD affects 300,000 young people in England and Wales, Channel 4 finds

Thousands of young people are living with post-traumatic stress disorder, with most cases going untreated, a Channel 4 documentary has revealed.

About 311,000 16- to 24-year-olds in England and Wales have PTSD, with most cases linked to personal assault and violence, according to figures estimated for the show.

Low awareness of the symptoms and the difficulty of diagnosing PTSD means that 70% of cases go untreated. If the NHS offered more early intervention therapy, it could save £2.4bn in taxpayer money, according to Channel 4’s analysis of research by King’s College London and Office for National Statistics data.

“When untreated, PTSD – it becomes a chronic condition. It becomes highly disabling. People’s lives can be fundamentally changed,” said Dr Michael Duffy, a psychological trauma specialist at Queen’s University Belfast, who features on the show. He added that it could be more common in areas of high socioeconomic deprivation.

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Source: The Guardian, 4 July 2023

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