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News Article
NHS England faces lawsuit over patient privacy fears linked to new data platform
Patient Safety Learning posted a news article in News
The NHS has been accused of “breaking the law” by creating a massive data platform that will share information about patients. Four organisations are bringing a lawsuit against NHS England claiming that there is no legal basis for its setting up of the Federated Data Platform (FDP). They plan to seek a judicial review of its decision. NHS England sparked controversy last week when it handed the £330m contract to establish and operate the FDP for seven years from next spring to Palantir, the US spytech company. The platform involves software that will allow health service trusts and also integrated care systems, or regional groupings of trusts, to share information much more easily in order to improve care. Rosa Curling, director of Foxglove, a campaign group that monitors big tech and which is co-ordinating the lawsuit, said: “The government has gambled £330m on overhauling how NHS data is handled but bizarrely seems to have left off the bit where they make sure their system is lawful. NHS England says the platform will help hospitals tackle the 7.8m-strong backlog of care they are facing and enable them to discharge sooner patients who are medically fit to leave. But this may be the first in a series of legal actions prompted by fears that the FDP could lead to breaches of sensitive patient health information, and to data ultimately being sold. “You can’t just massively expand access to confidential patient data without making sure you also follow the law.” Read full story Source: The Guardian, 30 November 2023 -
News ArticleHealth Education England (HEE) and NHS England have warned BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence. HEE published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs – which includes physician associates (PAs) working in general practice – until regulation is in place. The BMA Council passed a motion calling for a halt to recruitment of MAPs two weeks ago, on the grounds of patient safety. This followed a previous motion to that effect from its GP committee for England earlier this month. Proposing to bring forward a planned meeting with the BMA to discuss the matter, HEE’s letter said: "This continuing public discourse around MAPs is impacting relations between your members and their MAP colleagues, the health and wellbeing of MAPs already working in the NHS, and potentially the confidence of patients." HEE chief workforce, training and education officer Dr Navina Evans and NHS England medical director Sir Stephen Powis argued in the letter that evidence shows "MAPs are safe", and that they "increase the breadth of skill, capacity and flexibility of teams" and reduce workload pressure on other clinicians. ‘Any issues of patient safety identified resulting from MAPs ‘must be addressed in the same way we would any other profession’, the letter added. Read full story Source: Pulse, 27 November 2023
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Content ArticleThe BMJ’s new “practical prescribing” series aims to improve decision making Prescribing is one of the most fundamental parts of medicine and one of the most common interventions in health care. In the UK, the British National Formulary lists more than 1600 drugs. The number of prescriptions dispensed in the community in England grew by 66% from 686 million prescriptions in 2004 to 1.14 billion prescriptions in 2021-22.34 Polypharmacy has also increased, with around 15% of people in England taking five or more medicines a day and 7% taking eight or more medicines a day. The BMJ in conjunction with the Drug and Therapeutics Bulletin has commissioned a series of articles on practical prescribing. These articles will highlight important issues for prescribers to consider and prompts for shared decision making between prescribers, patients, and their carers. The series—targeted at all medical and non-medical prescribers, particularly doctors in training—will cover medicines commonly prescribed in primary and secondary care. The format is designed to help readers recall their understanding of a medication through a series of questions, exploring up-to-date evidence, and reviewing accessible information not readily found in prescribing texts.
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News Article
Patients ‘neglected and confused’ after leaving hospital, says NHS watchdog
Patient Safety Learning posted a news article in News
Patients are being left feeling “confused and neglected” by not being told who to contact about their future care when they are discharged from hospital, an NHS watchdog has said. Research by Healthwatch England has found that 51% of people are not being given details when they leave of which services they can turn to for help and advice while they are recovering. The NHS was risking patients having to be readmitted as medical emergencies and hospital beds becoming even more scarce by failing to adhere to its own guidelines on discharge, it said. “While our findings show some positive examples, it’s alarming that guidance on safe discharge from the hospital is routinely not being followed,” said Louise Ansari, the patient champion’s chief executive. Healthwatch asked 583 people and their carers how their discharge had gone. Read full story Source: The Guardian, 19 November 2023 -
Content ArticleNew research from Healthwatch reveals worrying problems with hospital discharge arrangements. Many people told us they are not given the right support or information when being discharged from hospital. Read on about their experiences and Health Watch's calls to action.
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News Article
NHSE tells GPs they’re ‘breaching contract’ by denying record access
Patient Safety Learning posted a news article in News
NHS England has taken the unusual move of warning multiple GP practices they are breaching their contract by refusing to give people automatic access to future entries in their record. Under the current national GP contract, practices were ordered to give people on their list automatic access to prospective (future) medical records, via the NHS App, by 31 October. However, the British Medical Association GP committee has urged GPs to instead adopt an “opt in” model, saying it is concerned that giving automatic access could endanger some people. The BMA gave practices a template letter to use to tell their integrated care boards they cannot move ahead with automatic access “due to several risks that cannot be sufficiently mitigated”. NHS England’s own template letter for ICBs to use in response, seen by HSJ, states: “Based on your letter we interpret that the required changes were not implemented by 31 October 2023, thereby putting you in breach of your contractual obligations. We would therefore like to discuss with you your plan, including the timeline to become compliant.” It is an unusual warning from NHSE which could potentially apply to hundreds or thousands of practices. Read full story (paywalled) Source: HSJ, 16 November 2023 -
News Article
NHS failing to prioritise those in most need, says departing ICB chief
Patient Safety Learning posted a news article in News
The NHS should better track patients with the greatest clinical need so they can move to the front of the queue for treatment, a former government waiting list tsar has said. Anthony “Mac” McKeever told HSJ the health service could improve how it works through its elective backlog by using a system introduced during the covid pandemic to prioritise the most pressing cases. He said a “large chunk” of cases were still not given a code to say how long they are considered to be able to wait for surgery, which is at the heart of this process. Mr McKeever retired as Mid and South Essex Integrated Care Board chief executive this month following nearly five decades in the health service, including as a trust leader. Although Mr McKeever said he only knew the regional situation for the East of England, he would be “very surprised” if the national picture was any different. Waiting list expert Rob Findlay agreed this was a reasonable assumption. Read full story (paywalled) Source: HSJ, 17 November 2023 -
Content ArticleCommunity pharmacies in Sweden have changed during the COVID-19 pandemic, and new routines have been introduced to address the needs of customers and staff and to reduce the risk of spreading infection. Burnout has been described among staff possibly due to a changed working climate. However, little research has focused on the pandemic's effect on patient safety in community pharmacies. The aim of this study was to examine pharmacists' perceptions of the impact of the COVID-19 pandemic on workload, working environment, and patient safety in community pharmacies.
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Content ArticleA substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
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News ArticlePrivate healthcare companies are harming NHS patients in their own homes by failing to deliver vital medicines, and then escaping censure amid an alarming lack of oversight by ministers and regulators, members of the House of Lords have warned. More than 500,000 patients and their families rely on private companies paid by the NHS to deliver essential medical supplies, drugs and healthcare to their homes. The homecare medicines services sector is estimated to be worth billions of pounds. A report by the Lords public services committee says patients are being harmed due to “real and serious problems” with the services provided by for-profit companies. The absence of a single person or organisation with overall control or oversight of the sector means poor performance is going unchecked, it says. “There are serious problems with the way services are provided,” the Lords report says. “Some patients are experiencing delays, receiving the wrong medicine or not being taught how to administer their medicine. [This] can have serious impacts on patients’ health, sometimes requiring hospital care. This leaves NHS staff either firefighting the problems caused by problems in homecare medicines services, or working on the assumption that those services will fail.” Read full story Source: The Guardian, 16 November 2023
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Content Article“Crisis,” “collapse,” “catastrophe” — these are common descriptors from recent headlines about the NHS in the UK. In 2022, the NHS was supposed to begin its recovery from being perceived as a Covid-and-emergencies-only service during parts of 2020 and 2021. Throughout the year, however, doctors warned of a coming crisis in the winter of 2022 to 2023. The crisis duly arrived. In this New England Journal of Medicine article, David Hunter gives his perspective on the current state of the NHS.
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Content Article
NHS England: Medicines optimisation
Patient Safety Learning posted an article in Medicine management
Medicines optimisation looks at the value which medicines deliver, making sure they are clinically-effective and cost-effective. It is about ensuring people get the right choice of medicines, at the right time, and are engaged in the process by their clinical team. -
News Article
Four-plus pathway patients account for 700k of waiting list
Patient Safety Learning posted a news article in News
New data suggests around 700,000 cases on the elective waiting list relate to patients who are on at least four different pathways, and NHS England says personalised care plans must be developed to treat them more efficiently. NHSE has published new data that reveals the overall referral to treatment waiting list, of 7.8 million cases, is made up of 6.5 million individual patients. The difference is due to some patients waiting for more than one treatment. Stella Vig, NHSE’s clinical director for secondary care, told HSJ around 2-3% of the individual patients on the waiting list are on four to five pathways or more. Read full story (paywalled) Source: HSJ, 9 November 2023 -
News ArticleOne in 10 people attempting to contact their GP practice do not manage to get in contact, while a further 6% are only told to try again another day, according to new official survey findings commissioned by the government. The Office for National Statistics has been quietly carrying out the new regular GP access survey since the spring after ministers said they wanted to monitor the impact of their primary care recovery plan. After a sign of slight improvement in the summer, the latest survey results – for October – show no significant change since May. It also found, as did previous rounds, that of those who had tried to contact a GP practice in the past month, 10 per cent said they could not do so (see chart below, ‘Contact with GP practice’). Of those who did make contact, a further 6 per cent reported they were told to try again another day (see chart below, ‘Next step after contact’). The government and NHS England have made it a high priority in recovery plans that patients should no longer be asked to call back another day to book an appointment and should know “on the day” how their request will be managed, which may mean being advised to use a different service. Read full story (paywalled) Source: HSJ, 9 November 2023
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Content Article
Fundamental Care podcasts
Patient Safety Learning posted an article in Recommended video and audio resources
Throughout this series of Fundamental Care podcasts, a panel of key opinion leaders and passionate healthcare staff from the UK will discuss and debate evidence based best practices at the core of the day-to-day challenges faced in healthcare, not only for patients but also for healthcare workers themselves. -
News Article
NHS: Woman waited nine months for hospital discharge
Patient Safety Learning posted a news article in News
A woman who spent nine months in hospital waiting for a suitable care home placement became a "shadow of her former self", her mother has said. Jocelyn Ullmer, 60, from West Sussex, saw her health deteriorate after being admitted to hospital in June last year. Her mother, Sylvia Hubbard, 86, said: "We tried to get her out of hospital, but no-one wanted her." Across England, around 60% of patients classed as fit to leave remain in hospital at the end of an average day. Figures show the biggest obstacle is a lack of beds in other settings, such as care homes and community hospitals. The government said it was investing £1.6bn over the next two years to help improve the situation. Read full story Source: BBC News, 8 November 2023 -
News Article
Criminal acts of violence at UK GP surgeries almost double in five years
Patient Safety Learning posted a news article in News
Criminal acts of violence at GP surgeries across the UK have almost doubled in five years, new figures reveal, as doctors’ leaders warn of a perfect storm of soaring demand and staff shortages. Police are now recording an average of three violent incidents at general practices every day. Staff are facing unprecedented assaults, abuse and aggression by patients, with surgeries struggling to cope with “unmanageable levels of demand” after years of failure to recruit or retain sufficient numbers of family doctors. Security measures such as CCTV, panic buttons and screens at reception are now increasingly being rolled out across GP surgeries, the Guardian has learned, with senior medics claiming ministers perpetuate a myth that services are “closed”. Last night, Britain’s two most senior doctors condemned the wave of violence and called for urgent action to finally resolve the workforce crisis. “It is unacceptable that GPs and their staff are afraid and at risk of being verbally or physically abused, when they are working amid exceptional pressures and striving to do their best for patients,” said Dr Chaand Nagpaul, chair of the British Medical Association. “GP practices are facing unmanageable levels of demand with 2,000 fewer GPs than in 2015.” He added it was “no surprise” that patients were struggling to get appointments because of the national “lack of capacity” and “lack of historic investment in general practice”. Read full story Source: The Guardian, 31 May 2022 -
News Article
NHS will not hit virtual wards target, internal data suggests
Patient Safety Learning posted a news article in News
The NHS is on trajectory to fall short of a flagship pledge to have around 24,000 “virtual ward beds” in place by December 2023, internal data has revealed. NHS England’s figures from March, seen by HSJ, suggest the system is instead more likely to have created around 18,500 virtual beds by the 2023 deadline. Senior clinicians, including the Royal College of Physicians and the Society of Acute Medicine, have recently raised concerns about the speed and timing of the roll-out and staffing implications. And now fresh concerns are also being raised about the programme following publication of a new academic study which suggests virtual wards set up by the NHS during Covid made little impact on length of stay or readmissions rates. Alison Leary, professor of healthcare and workforce modelling, London South Bank University, was one of the first senior leaders to publicly voice concerns about the NHS’s virtual wards programme. Professor Leary told HSJ: “I am not surprised [systems are falling] short. Since Elaine [Elaine Maxwell, visiting professor, London South Bank University] and I published our piece in HSJ, I have been contacted by several clinicians who have serious concerns over virtual wards and staffing them.” Read full story (paywalled) Source: HSJ, 31 March 2022 -
News ArticleIn England, only a third of adults – and half of children – now have access to an NHS dentist. As those in pain turn to charity-run clinics for help, can anything stop the rot? It is over an hour before the emergency dental clinic is due to open, but Jodie Manning is taking no chances. She hasn’t been able to eat for four days – “I can’t physically bite down any more” – and is determined to get an appointment. Aged 19, she has been to hospital with severe toothache “three-and-a-half times” in the previous year. The half is when they sent her home without treatment; on the other occasions, she was kept in overnight after collapsing from pain and dehydration, when even drinking liquids hurt her swollen mouth. Morphine has become her crutch: she fell asleep in college recently after taking the powerful painkiller. Like many of those waiting grimly in line, she has been struck off by her NHS dentist after not attending for two years, even though surgeries were shut to all but emergency cases during Covid. The same desperation can be seen across England, particularly in the north and east. Only a third of adults – and less than half of English children – now have access to an NHS dentist, according to the Association of Dental Groups (ADG). At the same time, three million people suffer from oral pain and two million have undertaken a round trip of 40 miles for treatment, the ADG calculated recently, calling dentistry “the forgotten healthcare service”. Tooth extraction is now the most common reason for a child to be admitted to hospital, costing the NHS £50m a year. The decline of NHS dentistry has deep roots. Years of underfunding and the current government contract, blamed for problems with burnout, recruitment and retention. Dentists are paid a flat fee for services regardless of how long a treatment takes (they get the same amount if they extract one tooth or five, for example). Covid exacerbated existing challenges, with the airborne disease posing a health risk for dentists peering into strangers’ mouths all day. As the British Dental Association put it in its most recent briefing: “NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.” Read full story Source: The Guardian, 24 May 2022
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News Article
One in five patients leave some A&E departments in England without treatment
Patient Safety Learning posted a news article in News
More than one in five patients at some hospitals are leaving accident and emergency departments before completing treatment, and in some cases before being seen for assessment at all, with the rate across England trebling since before the pandemic. Experts told the Observer that the increase was probably driven by a combination of long A&E waiting times and by difficulties accessing NHS facilities such as GPs, community health services and NHS 111. The figures apply to patients who left A&E before an initial assessment; after an assessment but before treatment started; or before treatment was completed. They include patients who left to find treatment elsewhere. David Maguire, a senior analyst with the King’s Fund health thinktank, linked the rise to patients having difficulty accessing other parts of the NHS and going to A&E instead. “We’re probably talking about things that won’t require an admission, but it’s important that you get seen by someone,” he said. “So for example, somebody’s got a chest pain, somebody’s got some sort of adverse indication that you would want to seek attention for. It’s a perfectly rational thing to do. But it’s a struggle to access at other points [in the NHS], so you default towards A&E.” He added that staff shortages and social care capacity were also contributing factors. “I think it’s a lot of the NHS not functioning properly. Pre-pandemic, there was a certain amount of flex in the system – even with the problems that we were seeing around performance – that meant you could come to A&E with some of these issues. That flex in the system has gone – the capacity has been absorbed by other issues.” Read full story Source: The Observer, 21 May 2022 -
News Article
NHS prescription charges in England to be frozen
Patient Safety Learning posted a news article in News
NHS prescription charges in England are to be frozen for the first time in 12 years, the government has confirmed. Single prescription charges, which the Department of Health said would normally rise "in line with inflation", will remain at £9.35 until next year. Health Secretary Sajid Javid said freezing the costs would "put money back in people's pockets". Faith Angwet, a single mother of two, said she had to choose between paying for prescriptions to treat for her high blood pressure, or using that money to feed her children. She said the price freeze "won't go far" because "it's not necessarily the outgoings affecting me, everything is going up in price and I'm not able to afford everything I use to be, including my prescription". Claire Anderson, of the Royal Pharmaceutical Society, said people who do not qualify for free prescriptions because of their income, age, or medication type, often had to make decisions about which medicines they need. "Those medicines are prescribed for a reason because that patient needs that treatment," she told the BBC. And Laura Cockram, chairwoman of the Prescription Charges Coalition, who welcomed the freeze, said the government should review the list of those who qualified for free prescriptions. She said the prescription exemption charge list was put together more than 50 years ago, when conditions like HIV "didn't even exist" and at a time there "weren't life saving treatments for things like asthma, Parkinson's and MS". Read full story Source: BBC News, 16 May 2022 -
News Article
Website to show NHS delays
Patient Safety Learning posted a news article in News
A website that tells patients how long they are likely to wait for NHS treatment will be made available in Scotland this summer. Humza Yousaf, the Scottish health secretary, said people queuing for tests and procedures and their doctors would be able to access information about any delays in their area using the software. Many patients living in pain are waiting years to have common operations such as hip and knee replacements. In theory, the SNP guarantee hospital treatment within 12 weeks of patients joining the waiting list, but this law was broken extensively before the pandemic and has now been breached hundreds of thousands of times. One orthopaedic surgeon, who did not wish to be named, said he was operating on patients whose joints had entirely collapsed after a two-year wait for a limb replacement made their case an emergency. Other patients who did not reach crisis faced even longer delays, he said. Dr Sandesh Gulhane, a GP and health spokesman for the Scottish Conservative Party, asked Yousaf, during a meeting of the Scottish Parliament’s health committee yesterday: “Why can’t we have in the future, in the [recovery] plan, indicative waiting times which are relatively live so we can all go on a website and see how long we need to wait.” Yousaf said it was fair for patients and NHS staff to expect to have information on waiting times, and that a website to provide this was being developed. “We are working closely with Public Health Scotland, we are working closely with boards to develop the infrastructure in order to collate and publish this data,” he said. “It’s an ambition of ours to have that available in a way that is easy to find, easy to understand, both for the patient but for the health professional too.” Read full story (paywalled) Source: The Times, 11 May 2022 -
News ArticleThe latest batch of hospital patient safety ratings from America's Leapfrog Group shows a general decline among “several” hospital safety measures concurrent with the onset of the COVID-19 pandemic, according to the healthcare safety watchdog. Released Tuesday, the scores are accompanied by a report from Leapfrog that highlights a “significant” decline in the experiences of adult inpatients at acute care hospitals during the pandemic, with many areas “already in dire need” prior to the pandemic deteriorating even further. “The healthcare workforce has faced unprecedented levels of pressure during the pandemic, and as a result, patients' experience with their care appears to have suffered,” Leah Binder, president and CEO of the Leapfrog Group, said in a statement. Leapfrog’s twice-annual reports assess more than 30 patient safety measures and component measures compiled from the Centers for Medicare & Medicaid Services (CMS) and Leapfrog’s hospital surveys between July 2018 and March 2021. The most recent release assigns letter grades to nearly 3,000 US general hospitals and is the second collection of scores to incorporate safety and experience data from the COVID-19 pandemic. Read full story Source: Fierce Healthcare, 10 May 2022
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News Article
Nearly half of trust’s beds filled by patients fit to be discharged
Patient Safety Learning posted a news article in News
A chief executive has described her ‘considerable regret’ that growing difficulty in discharging patients has resulted in nearly half of her trust’s inpatients being clinically ready to leave. Debbie Richards, who leads Cornwall Partnership Foundation Trust, a community and mental health provider, highlighted the issue at the trust’s board meeting last month, amid a “dearth of adult social care provision” across the country. In her update to the board, Ms Richards said delays in finding onward care for patients awaiting discharge meant “almost 50 per cent of our community hospital beds are occupied by patients who have no medical need to be in hospital”. In her report to the board, Ms Richards said: “Despite having over 5,000 care home beds in Cornwall, the majority of these are full, or care home providers are unable to offer beds because of a lack of staffing. “Where there is capacity, this tends to be for lower-level residential beds where unfortunately there is much less demand.” Siobhan Melia, chair of the NHS Community Network and CEO of Sussex Community FT, said the “dearth of adult social care provision” was the biggest limiting factor in discharging delayed patients home, followed by high staff vacancies and sickness absence." She called for a national long-term funding settlement for social care and reform of the sector to address the key challenges. Read full story (paywalled) Source: HSJ, 10 May 2022 -
News Article
Hundreds of mentally ill prisoners denied urgent treatment in England
Patient Safety Learning posted a news article in News
Hundreds of severely mentally ill prisoners in urgent need of hospital treatment are being left in prison cells due to bed shortages in secure NHS psychiatric units, an investigation has discovered. Freedom of information (FoI) responses from 22 NHS trusts reveal for the first time that just over half of the 5,403 prisoners in England assessed by prison-based psychiatrists to require hospitalisation were not transferred between 2016 and 2021 – an 81% increase on the number of prisoners denied a transfer in the previous five years. In some areas, the majority of mentally ill prisoners were not admitted, which could be the result of long delays or a trust refusing to take certain patients. Norfolk and Suffolk NHS foundation trust, which was rated inadequate by the Care Quality Commission last month, only admitted 16 of 41 prisoners referred in 2021. Essex Partnership University NHS foundation trust only admitted 24 of 57 prisoners referred in 2021. Lancashire and South Cumbria NHS foundation trust only accepted 18 of the 38 prisoners referred in 2021. Peter Dawson, the director of the Prison Reform Trust, said the figures unearthed by the investigation suggested hundreds of very ill people were being denied the treatment they needed. “It is shocking that a growing number of people are not getting the transfer to hospital that clinicians say is essential for their mental health,” he said. “Instead they are languishing in often overcrowded and dilapidated prisons. It is cruel and guarantees people will leave prison in a worse state than when they came in, with every likelihood that the behaviour that originally led to their arrest and conviction will continue.” Read full story Source: The Guardian, 10 May 2022
