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NHSE wrongly dismissed discrimination claim from black nurse, tribunal finds

NHS England has lost an employment tribunal case against a senior black nurse on grounds of race discrimination and whistleblowing, and has been criticised for serious flaws in its own investigations.

A judgement published today found Michelle Cox, a black woman who was an NHS continuing healthcare manager based in NHSE’s North West regional team, was excluded by her manager “at every opportunity”.

The case centres on problems between Ms Cox and her line manager, then regional head of continuing healthcare, which took place from around April 2019 to November 2020.

The tribunal ruled Ms Cox's line manager– who is now an associate director of nursing in the West Yorkshire integrated care system – had created an “intimidating and hostile and humiliating environment” for Ms Cox, which had the purpose and effect of unlawful harassment.

The tribunal also upheld Ms Cox’s complaint of detriment for whistleblowing, including for raising concerns that members of her team were sitting on continuing healthcare “independent review panels”, which she pointed out was a breach of independence and legal obligations.

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Source: HSJ, 22 February 2023

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USA: Investigation spotlights rise of for-profit ethics boards in research

A US government watchdog called for greater federal oversight of ethics boards that sign off on scientific studies, finding that for-profit companies have taken an outsize role in approving certain research and questioning whether financial motivations could put human subjects at risk.

Federal regulations require that certain research on human subjects — including those testing the safety of new drugs — first get approval from a registered institutional research board. These boards, which are made up of at least five members and can include researchers and academics, are designed to make sure that a study poses as little risk as possible and that participants have enough information to give consent.

While the majority of these boards are affiliated with universities, a small number have no affiliation with institutions conducting research. But according to a new report from the U.S. Government Accountability Office (GAO), these independent boards now account for the largest share of reviews of studies involving new drugs and biologics.

The GAO found that federal agencies overseeing the ethics panels inspect relatively few of them and lack ways to evaluate how well they protect people participating in research.

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Source: The Washington Post, 16 February 2023

 

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Derby maternity deaths may have been prevented

Three women who died under the care of a hospital's maternity unit may have survived if earlier recommendations had been implemented, a report has said.

The cases occurred at University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust over 16 months.

A review by the Healthcare Safety Investigation Branch (HSIB) also found a culture of intimidation and bullying.

The report found that although there was no common theme to the deaths - and four other life-threatening cases that occurred in the same period - processes and leadership had been inconsistent and fragmented.

HSIB said "robust action planning and prompt addressing of the learning" from previous recommendations from other investigations "may have had an impact on the outcome for the women who received care during the seven events included in this thematic review".

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Source: BBC News, 22 February 2023

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Suicidal NHS staff left in ‘dangerous limbo’ as mental health help ends

Suicidal NHS staff will be left in “dangerous” situations without support when national funding for mental health hubs ends next month, health leaders have warned.

The hubs, set up with £15 million of government funding for NHS workers following Covid, are being forced to close or reduce services as neither the Department for Health and Social Care nor the NHS has confirmed ongoing funding for 2023-24.

This will leave thousands of NHS staff, some of whom are described as “suicidal” in “complete limbo”, The Independent has been told.

The British Psychological Society (BPS) and the Association of Clinical Psychologists (ACP) said the failure to continue the funding was an “irresponsible” way to treat vulnerable health and care workers.

Professor Mike Wang, chair of ACP, said: “There is a clinical responsibility, not to remove a service from individuals who are vulnerable, and in difficulty … the problem with that is that the funding ceases at the end of March and that’s absolutely no time at all to make any [future] provision. So, it’s clinically irresponsible to simply halt a service. Some of these individuals are, you know, carrying suicide risk.”

He said it was “dangerous” and “astonishing” that funding for the hubs was ending “given the present circumstances of continuing effects of the pandemic, clear evidence of underfunding of health care in this country”.

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Source: The Independent, 22 February 2023

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London Ambulance lagging behind on diversity and must improve, bosses warned

The London Ambulance Service (LAS) failing on diversity and must implement specific targets for improvements, its leadership has been warned.

According to LAS data, just 20% of the workforce is from a Black, Asian or from a minority ethnic background despite almost half of the capital’s population (46.2%) being made up of non-white communities.

Of that 20%, 40.9% are in the lowest paid roles, compared to 15.9% who are in the highest wage bands, according to the LAS’ Integrated Performance report.

The LAS is in the process of developing a new strategy to help attract more diverse staff, which will be published early next year.

Research shows that ethnic minority groups suffer disproportionately higher levels of inadequate ambulance care due to a combination of issues such as a lack of cultural awareness among professionals, language and communication difficulties and a limited understanding of how the healthcare system operates for some minority groups.

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Source: The Independent, 21 February 2023

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Nurses set for 'intensive' talks with government after strike paused

Health Secretary Stephen Barclay is to meet Royal College of Nursing bosses for pay talks later, after the union suspended next week's planned strike.

In a joint statement, after months of bitter dispute, the two sides said they would begin "intensive talks" on "pay, terms and conditions" and "reforms to enhance productivity".

Next week's walkout in England, from 1 to 3 March, was set to be the biggest strike of this winter's pay dispute, with half of frontline services affected.

The action would have included nursing staff from intensive care units, cancer care and other services that were previously exempted.

RCN general secretary Pat Cullen said: "We will put our plans on the table, they can put their plans on the table - but I'm confident that we will come out with a fair pay settlement for our nursing staff."

She added they would make sure no stone was left unturned and a fair pay deal was reached as quickly as possible so they could end the strikes.

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Source: BBC News, 22 February 2023

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Patient safety put 'at risk' by crumbling NHS hospitals in desperate need of repair

Doctors have warned that patient safety is being put at risk by the state of crumbling NHS hospitals which have fallen into potentially dangerous disrepair, an ITV News investigation has found. 

Year-long leaks, collapsing floors, ageing roofs and potential for falling stone are among the issues exposed in the investigation - which have caused whole wards to be closed down. 

One doctor told ITV News conditions are so poor in hospitals she has worked in that “we are always just hoping that the next time something happens it does not cause something catastrophic.”Half of the 87 hospital trusts in England that responded to our Freedom of Information requests had at least one unresolved structural or maintenance issue, as of October 2022.

Footage shared with ITV News by staff working in NHS hospitals lays bare some of the appalling conditions doctors are forced to treat patients in every day.

Some leaks have been so severe they flood and close entire corridors, while some wards have become so unsafe they have been permanently shut.

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Source: ITV News, 22 February 2023

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NHSE set for £400m dentistry underspend despite ‘access crisis’

The national dentistry budget is set to be underspent by a record £400m this year, due to a shortage of dentists willing to take on NHS work, HSJ has learned.

The situation is understood to have prompted major concerns in the senior ranks of NHS England, and calls for a “fundamental rethink” of the much-maligned primary dental care contract.

The unspent funding is due to be used to plug budget deficits in other services and comes as patients in many areas struggle to access NHS dentistry. Healthwatch England described the estimated underspend as an “absolute scandal”.

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Source: HSJ, 21 February 2023

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‘One in five’ patient referrals bounced back to GPs, warns watchdog

A new report has condemned ‘serious issues’ with NHS referral processes, amid findings that one in five patient referrals made by GPs went into a ‘black hole’.

Healthwatch England said that 21% of people they spoke to with a GP referral to another NHS service were rejected, not followed up on or sent back to general practice.

The watchdog said that more support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to ‘communication failures’ following a referral.

According to the findings, the failures were due to GP teams not sending referrals, referrals going missing between services, or being either booked or rejected by hospitals without any communication.

Louise Ansari, Healthwatch England’s national director, said that thousands of people told the watchdog that the process is ‘far from straightforward.’

She said: "Falling into this “referrals black hole” is not just frustrating for patients but ultimately means people end up going back to their GP or visiting crowded A&E departments to get the help they need.

"This adds more burden to already stretched services, making things even harder for the doctors and nurses trying to provide care."

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Source: Pulse, 20 February 2023

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Donor organs should be allocated by need, not geography, report recommends

Donor organs should no longer go to the nearest in-need patient, an official report has recommended. 

Instead, specialised organ centres across the country will be responsible for preserving, repairing and matching an organ with the most needy individual on the transplant register, irrespective of location.

An official report commissioned by the Department for Health and Social Care and headed up by Prof Stephen Powis, the national medical director for England, has recommended 12 changes to further improve donation. 

Among the recommendations – which have been backed by the Government and are expected to be implemented in the coming weeks – is equal access to organ donation services “irrespective of personal circumstances, including ethnicity, geography, socio-economic status or sex”.

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Source: The Telegraph, 21 February 2023

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HRT: Around 400,000 women to receive cheaper menopause treatment

Hundreds of thousands of women could benefit from cheaper hormone replacement therapy (HRT) as part of a scheme to cut prescription costs.

The Department of Health said that from April, women prescribed HRT as part of menopause treatment will be able to access a new scheme to enable access to a year’s worth of treatment for just under £20.

The announcement follows the publication of the government’s women’s health strategy for England last summer.

Minister for Women Maria Caulfield said: “Around three-quarters of women will experience menopause symptoms, with one-quarter experiencing severe symptoms, which can seriously impact their quality of life.

“Reducing the cost of HRT is a huge moment for improving women’s health in this country, and I am proud to be announcing this momentous step forward.

“In our Women’s Health Strategy, we made menopause a top priority – by making HRT more accessible, we’re delivering on our commitment to women.”

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Source: The Independent, 21 February 2023

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Children’s surgery backlog grows as NHS prioritises adult waiting lists

Hundreds of thousands of children are waiting for surgery as new figures show the backlog has spiralled by almost 50 per cent in two years.

The latest NHS data for December lays bare the parlous state of paediatric medicine, with NHS leaders and doctors warning that adult care is being prioritised over children’s.

In December 2022, 364,000 children were waiting for treatment, from neurosurgery to ear, nose and throat operations, while a further 200,000 needed community services such as speech and language therapy.

The surgery figure is up by 48%t since April 2021 – a far bigger increase than was seen in the overall NHS waiting list, which grew by 36% over the same period.

Mike McKean, vice-president of policy at the Royal College of Paediatrics and Child Health, said “Lengthy waits are unacceptable for any patient, but for children and young people, waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage. It is not the same as for adults. If you miss the right window to treat a child, or wait too long, the consequences can be irrevocable.”

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Source: The Independent, 19 February 2023

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Big rise in long-term sick hitting UK workforce

The UK risks a shrinking workforce caused by long-term sickness, a new report warns.

Pensions and health consultants Lane, Clark and Peacock (LCP) says there has been a sharp increase in "economic inactivity" - working-age adults who are not in work or looking for jobs.

The figure has risen by 516,000 since Covid hit, and early retirement does not appear to explain it.

The total of long-term sick, meanwhile, has gone up by 353,000, says LCP. It means there are now nearly 2.5 million adults of working age who are long-term sick, official data from the Labour Force survey reveals.

The LCP says pressure on the NHS can account for some of the increase in long-term sickness. Delays getting non-urgent operations and mental health treatment are possible explanations. Others who would otherwise have had a chronic condition better managed may be in poorer health.

One of the report authors, Dr Jonathan Pearson-Stuttard, said: "The pandemic made clear the links between health and economic prosperity, yet policy does not yet invest in health, to keeping living in better health for longer. NHS pressures have led to disruption of patient care which is likely to be impacting on people's ability to work now and in the future."

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Source: BBC News, 20 February 2023

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Junior doctors in England to strike for 72 hours in March

Hundreds of thousands of operations and medical appointments will be cancelled in England next month and progress in tackling the huge care backlog will be derailed as the NHS prepares to face the most widespread industrial action in its history.

Junior doctors are poised to join nurses and ambulance workers in mass continuous walkouts in March after members of the British Medical Association (BMA) voted overwhelmingly to take industrial action.

In only the second such action in the 74-year-history of the NHS, junior doctors will walk out for 72 hours – continuously across three days, on dates yet to be confirmed – after 98% of those who voted favoured strike action.

Amid an increasingly bitter row between health unions and the government, NHS leaders expressed alarm at the enormous disruption now expected next month.

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Source: The Guardian, 20 February 2023

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Kettering Hospital ward accused of traumatising children may close

Children's services could be forced to close at a hospital that is accused of leaving young patients traumatised and sick through poor care.

The care regulator said it had taken action to "ensure people are safe" on Skylark ward at Kettering General Hospital (KGH) in Northamptonshire.

Thirteen parents with serious concerns after their children died or became seriously ill have spoken to the BBC.

A BBC Look East investigation has heard allegations spanning more than 20 years about the treatment of patients on Skylark ward, a 26-bed children's unit.

The BBC discovered:

  • An independent report found staff left a 12-year-old boy - who died at KGH in December 2019 - for four hours suffering seizures, and suggests little effort was made to obtain critical care support.
  • In April 2019, nurses allegedly dragged a "traumatised" four-year-old girl down a corridor in agony, insisting that she could walk. Medics are accused of refusing to carry out an MRI scan, which would have detected a dangerous cyst on her spine.
  • Mothers claim to have been threatened with safeguarding referrals, with one stating a referral was made against her after she complained her son was struggling to breathe, while another likened it to blackmail.

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Source: BBC News, 20 February 2023

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Striking staff drop cover for strokes and suspected heart attacks

Striking ambulance workers in two regions have said for the first time that they will only answer immediately life-threatening calls — abandoning previous agreements to cover some Category 2 incidents.

Agreed exemptions (derogations) from ambulance strike action so far this winter have varied regionally and across different unions; but all have so far included some Category 2 cover.

However, GMB told HSJ its members in the North East and North West today would cover only Category 1 calls – defined as “immediately life threatening” – during their action today.

Category 2 includes more than any other category, and covers a wide range of incidents including suspected heart attacks and strokes.

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Source: HSJ, 20 February 2023

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Black people have highest rate of STIs in Britain. Is enough being done to change that?

Black people have the highest rate of sexually transmitted infections in Britain and officials are not doing enough to address the issue, sexual health experts have warned.

Black Britons have “disproportionally high rates” of various STI diagnoses compared to white Britons, with those of Black Caribbean heritage specifically having the highest rates for chlamydia, gonorrhoea, herpes and trichomoniasis.

Experts have told The Independent that healthcare providers are failing to address these disparities in STIs. They have called for more research to fully understand the complicated reasons why STIs are higher among people of Black ethnicity.

Research conducted through the Health Protection Research Unit (HPRU) found that there were no clinical or behavioural factors explaining the disproportionately high rates of STI diagnoses among Black people.

But higher rates of poverty and poor health literacy among marginalised communities are all linked with higher STI rates, according to a 2016 study, which found that behavioural and contextual factors are likely to be contributing.

Moreover, experiences of racism among Black people can fuel a reluctance to engage with sexual health services and test frequently, according to HIV activist Susan Cole-Haley.

She told The Independent: “I very much believe that it is linked to socioeconomic disadvantage and racism, often in healthcare settings, which can be a significant barrier for people accessing testing, for instance, and feeling comfortable engaging with care.”

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Source: The Independent, 19 February 2023

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Health workers ‘shattered’, says Jeremy Farrar as more NHS strikes loom

Healthcare workers are “absolutely shattered” and unless something is done to address the crisis in morale, staffing and training then “they won’t be there when you need them”, one of the world’s leading scientists has warned.

Speaking to the Guardian, Prof Jeremy Farrar, the director of Wellcome and soon to be chief scientist of the World Health Organization, warned that healthcare workers would not be ready should another crisis hit.

“This is a global issue, which I think is hugely concerning. It’s certainly true in this country,” he said. “The resilience of healthcare workers, broadly defined from ambulance drivers to nurses to doctors, to care workers in social care, etc. They’re shattered. They are absolutely shattered."

Farrar said: “I think we have to address the morale, staffing, the training, everything from public health physicians to care workers, to doctors and nurses and physios and everybody in between because there’s very little spare capacity in any system globally. It’s particularly true in the UK. As you can see from the strikes, morale and resilience is very thin.”

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Source: The Guardian, 20 February 2023

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Urgent action ordered at maternity scandal trust

The trust at the centre of a maternity scandal has been ordered to report on urgent improvements in services for women and babies, amid ‘significant concerns’ about the risk of harm.

The Care Quality Commission (CQC) used its enforcement powers to issue the conditions on East Kent Hospitals University Foundation Trust, after it carried out an unannounced inspection last month.

However, the “section 31” warning letter has just been made public, and the first deadline for the trust to report back to the CQC is Monday (20 February).

The CQC said some of the problems it found were due to the labour ward environment – but others involved monitoring of women and babies whose conditions deteriorate and the risk of cross-infection due to poor cleanliness standards.

“We have significant concerns about the ongoing wider risk of harm to patients and a need for greater recognition by the trust of the steps that can be taken in the interim to ensure safety and an improved quality of care,” Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said in a statement today.

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Source: HSJ, 17 February 2023

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British Medical Association calls government reckless over pay talks

The British Medical Association has accused the government of "reckless" behaviour ahead of the results of a strike ballot by junior doctors.

The BMA's Professor Philip Banfield said the prime minister and health secretary were refusing to enter meaningful negotiations with unions.

The Department of Health and Social Care said it had met with the BMA and other unions to discuss pay.

Professor Banfield, the BMA's chair of council, said that Rishi Sunak and Health Secretary Steve Barclay were "standing on the precipice of an historic mistake".

He accused the government of "guaranteeing escalation", adding that officials were "reckless" for thinking they could stay silent and wait it out.

Professor Banfield also accused the government of "letting patients down", adding: "All NHS staff are standing up for our patients in a system that seems to have forgotten that valuing staff and their well-being is directly linked to patient safety and better outcomes of care."

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Source: BBC News, 19 February 2023

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High court judge ‘deeply frustrated’ by NHS delays in suicidal girl’s care

A high court judge has expressed her “deep frustration” at NHS delays and bureaucracy that mean a suicidal 12-year-old girl has been held on her own, in a locked, windowless room with no access to the outdoors for three weeks.

In a hearing on Thursday, Mrs Justice Lieven told North Staffordshire combined healthcare NHS trust “you are testing my patience”, after she heard that a proposal to move Becky (not her real name), could not progress until a planning meeting that would not be held until next week, and that a move was not anticipated until 2 March.

Three sets of doctors at the hospital trust have disagreed as to Becky’s diagnosis; at her most recent assessment doctors said she was not eligible to be sectioned, which would trigger the protections provided by the Mental Health Act, because her mental disorder was not of the “nature and degree” as to warrant her detention.

In a robust exchange, the judge demanded: “Where’s the urgency in this … I cannot believe that the life and health of a 12-year-old girl is hanging on an issue of NHS procurement, when you cannot tell me what it is you’re trying to procure.

“If the delay is procurement, I’m not having it,” Lieven continued. “I will use the inherent jurisdiction to make an order. We have a 12-year-old child in a completely inappropriate NHS unit for about three weeks, and it’s suddenly dawned on your client that ‘actually we’ll put her in a Tier 4 unit and we might have to do some [building] work.’”

Sometimes, the judge said, “public bodies have to move faster”.

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Source: The Guardian, 17 February 2023

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Higher bills are leading Americans to delay medical care

While some people avoided seeking medical care during the worst of the pandemic, worried about the risk of infection or unable to get an appointment because hospitals and doctors were overwhelmed, now many in the USA are finding that inflation and the uncertain economy have thrown up another barrier.

“We are starting to see some individuals who are putting off some care, especially preventive care, due to the costs,” said Dr. Tochi Iroku-Malize, the president of the American Academy of Family Physicians and the chair of family medicine for Northwell Health in New York. Choosing between going to the doctor or paying for rent and food, “the health issue is no longer the priority,” she said.

With the prices of prescription drugs, hospital stays and other treatments expected to increase significantly this year and next, some doctors expect families to have an even harder time affording medical care. 

When Margaret Bell, 71, found that her cancer had returned four years ago, she hesitated to resume her chemotherapy because she could not afford it, and higher prices have made it even harder. She would regularly skip appointments.

About one-fourth of respondents in a recent Gallup poll said they put off care last year for what they considered a “serious” condition.

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Source: New York Times, 16 February 2023

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Covid-19: Evusheld is unlikely to prevent infection with current or future variants, NICE concludes

The National Institute for Health and Care Excellence (NICE) has decided not to recommend Evusheld for adults who are unlikely to have an adequate immune response or cannot have the vaccine against Covid-19, citing a lack of evidence that it is effective against circulating variants.

However, it is still reviewing whether the antibody drug could be used to prevent covid-19 infection in adults at the highest risk of severe illness, including people with immunodeficiency, people who have had a solid organ transplant, and people with cancer.

NICE’s director of medicines evaluation, Helen Knight, acknowledged that the decision would be “disappointing for the many thousands” of vulnerable people who “continue to significantly modify their behaviour to avoid infection.

Commenting on NICE’s decision, Lennard Lee, senior clinical research fellow at the University of Birmingham, said, “While it’s right for NICE to ensure that treatment options are based on the best possible evidence for their safety, efficacy, and cost effectiveness, it must be recognised that those who remain extremely vulnerable to covid need to be prioritised in trials akin to those early days of the pandemic to find treatments fit for them.

“Otherwise, we run the risk of consigning half a million people to continue to live in 2020, stuck in their homes, not able to see their families and friends for fear of infection with no protection.”

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Source: The BMJ, 16 February 2023

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WHO reveals one-third of prisoners in Europe suffer mental health disorders

One in three prisoners in Europe suffer from mental health disorders, the World Health Organization (WHO) has said in a new report.

While European prisons managed adequate COVID-19 pandemic responses for inmates, concerns remain about poor mental health services, overcrowding and suicide rates, the report stated.

“Prisons are embedded in communities and investments made in the health of people in prison becomes a community dividend,” said Dr. Hans Henri P. Kluge, regional director of the WHO regional office for Europe. “Incarceration should never become a sentence to poorer health. All citizens are entitled to good-quality health care regardless of their legal status.”

The second status report on prison health in the WHO European region provides an overview of the performance of prisons in the region based on survey data from 36 countries, where more than 600,000 people are incarcerated. Findings showed that the most prevalent condition among people in prison was mental health disorders, affecting 32.8% of the prison population.

The report drew attention to several areas of concern, including overcrowding and a lack of services for mental health, which represents the greatest health need among people in prison across the region.

The most common cause of death in prisons was suicide, with a much higher rate than in the wider community, the report found.

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Source: United Nations, 14 February 2023

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Is Heatherwood Hospital a model for the future of the NHS?

Pradeep Gill can see very little of the intense activity around him. He is leaning back in a reclining chair inside one of Heatherwood Hospital's operating theatres.

Buzzing around him is the operating team, led by consultant orthopaedic surgeon Jeremy Granville-Chapman.

For the surgeon and his team, this procedure is the very definition of routine. They have carried out more than 1,000 joint operations in the past 10 months.

Heatherwood Hospital, part of the Frimley Health NHS Foundation Trust, is a specialist elective hub where patients can come in for routine but life-changing surgery at a super-charged pace with theatres working at full tilt, six days a week.

It is busy. But it is a good-busy, not the bad-busy we have come to associate with the NHS during this winter crisis.

The site opened in March last year and Frimley's hospital executives are keen to stress the impact it has made.

"As a specialist planned care facility, Heatherwood has been able to perform surgery six days a week with four out of its six state-of-the-art theatres dedicated to orthopaedic procedures," it said in a press release.

"The hospital has also successfully reduced the length of time patients stay in hospital, with 40% of patients safely discharged within 24 hours."

This is the practice the NHS wants to adopt as it battles a record seven-million-strong waiting list.

Heatherwood can do that because the hospital is ring-fenced from acute pressures that affect other hospitals, as one its most senior orthopaedic surgeons, Mr Rakesh Kucheira, explained.

"We have now realised that winter pressures are 12 months not just three months, which means the acute sites are not going to be able to do planned activity that they planned for, so we've got to create more space," he said.

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Source: Sky News, 9 March 2023

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