An exclusive interview with Dame Lesley Regan
THE END OF LIFE BILL: TRANSPARENCY IS CRUCIAL
Professor Michael Dooley on what Britain can learn from Australia’s assisted dying programme THE FUTURE OF ROBOTIC SURGERY
Prokar Dasgupta explains how automated assistance has become democratised
“For the first time in history, women like me will live longer post-reproductive lives than we did reproductive ones.
“This shift brings with it very different healthcare needs.”
In an exclusive interview, Dame Lesley Regan talks about how the conversation around women’s health has evolved and why the creation of community-based hubs to treat women is such an effective tool and would save the NHS a “significant amount” of money.
Also this month, Professor Michael Dooley, director of the Voluntary Assisted Dying pharmacy service in Victoria explains what Britain can learn from the Australian experience of assisted dying; Prokar Dasgupta, professor of surgery at King’s College, London, and chair of the Centre for Robotics at The London Clinic, explains how robotic surgery has become democratised; and much more!
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20-23 24-27
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An external inquiry into issues with hip operations performed on children at Addenbrooke’s Hospital in Cambridge has been expanded to cover 800 patients.
As Healthcare Today reported in February, the Cambridge University Hospitals NHS Foundation Trust suspended the clinical practice of an orthopaedic surgeon after concerns were raised by colleagues in October last year.
The initial external review was carried out by an independent expert and considered a number of complex paediatric hip surgery cases performed by the Trust’s orthopaedic service over the past two and a half years. That review was completed in January and identified that the outcomes of treatment provided to nine children were below the standard expected. The Trust has now said that the review will be extended to a further 800 patients –both children and adults.
“The findings of the initial external review were extremely disturbing. Since then, not only have we been contacted by some of the families, but we’ve also heard heartbreaking stories from other families outside the scope of that initial review about their child’s treatment,” said Catherine Slattery, associate solicitor at Irwin Mitchell which is supporting a number of parents with concerns about orthopaedic operations. “That 800 cases will now be looked at is truly staggering,” she added.
The latest review will be led by barrister Andrew Kennedy. He will examine treatment provided to 700 patients who underwent planned operations. The review will
also scrutinise 100 adult and child patients who underwent emergency surgery.
“While the individual surgeon specialises in paediatric surgery, it is normal practice for all orthopaedic consultants to carry out emergency orthopaedic procedures on both adults and paediatric patients. Therefore, as part of this retrospective review, the expert clinical panel will also review an initial 100 adults and paediatric orthopaedic trauma cases to determine whether there are any concerns about the emergency treatment provided by this surgeon,” the Trust explained.
The Trust has confirmed that it will publish the findings from these external clinical reviews, along with the findings from the initial external review, once they are concluded.
“We will work tirelessly to examine all the cases within the scope of this review and to ensure that any shortcomings in care are identified as quickly as possible so that patients and families are fully informed and
further consultations and treatment can be offered as appropriate,” said Kennedy.
A separate investigation is to be carried out by specialist investigations company Verita into whether concerns about the surgeon should have been raised earlier.
“We know that concerns were raised as early as 2015 and were the subject of an external clinical review in 2016. The 2016 review indicated concerns about the care provided to a small number of patients and made recommendations for the Trust to implement. As part of their work, we have asked Verita to investigate whether that review was acted upon appropriately and, if not, why,” the Trust said.
“These issues are potentially more concerning due to the fact that concerns about this surgeon were raised ten years ago and the trust seems unsure whether 2016 recommendations to promote patient safety were implemented,” said Arran Macleod, senior associate at law firm Penningtons Manches Cooper.. “If they weren’t, then this would suggest an overall systemic failure by the hospital to ensure the safety of its patients,” he continued.
As a precautionary measure in 2024, the Trust said that it had restricted the individual surgeon’s clinical practice. Following the outcome of the initial review, it also said that although the surgeon had been suspended he is co-operating with the Trust’s process.
The Trust said that the individual surgeon had not been named for legal reasons.
AYOUNG woman in Manchester died as a result of what Manchester Coroner’s Court called “neglect” after doctors at Wythenshawe Hospital failed to give her appropriate antibiotics to treat sepsis for more than 25 hours.
Sharzia Bibi, 28, was admitted to the hospital’s emergency department at around 12:45 on 14 November 2023, complaining of severe stomach pain and bleeding.
Doctors there believed she may have a water or pelvic infection but did not consider she had sepsis – where the body attacks itself in response to an infection. This was despite her having a high heart rate and decreased functional ability.
A treatment plan for her to be given oral antibiotics was made. She did not receive these, however, for nine hours. More to the point, they were not suitable for her suspected and incorrect diagnosis and also contrary to hospital guidelines.
Following concerns about her condition the following morning, Bibi underwent emergency surgery at
12:30 on 15 November. It was only then that she was diagnosed with sepsis.
That evening she suffered a cardiac arrest and died in the early hours of the following morning. Following her death, her family and husband instructed expert medical negligence lawyers at Irwin Mitchell to investigate and secure answers.
“Understandably her loved ones have had a number of questions about Sharzia’s care and whether more should have been done to help her,” said Sarah Sharples, senior associate solicitor at Irwin Mitchell. “Our own legal investigations, which resulted in the Trust admitting liability in a civil claim, and the inquest which concluded Sharzia died of neglect, have sadly validated those concerns,” she continued.
Manchester University NHS Foundation Trust, which runs Wythenshawe Hospital, admitted liability for Bibi’s death in the civil claim. The Trust admitted that were it not for the failures in care, on the balance of probabilities, she would not have died when she did.
A separate inquest at Manchester Coroner’s Court concluded that
Sharzia died of “neglect” following “gross failures” in her care.
Coroner James Lester-Ashworth made a number of findings of gross failings in the case which amounted to neglect. These included a failure to consider sepsis when Sharzia was initially reviewed by a doctor and she was showing signs of the condition and a failure to provide the correct IV antibiotics for her possible diagnoses of a water or pelvic infection in line with the Trust’s anti-microbial policy. Instead, oral antibiotics were prescribed. Aside from the fact that the monitoring of Bibi’s fluid intake and urine output was inaccurate, there was also a nine-hour delay before antibiotics were prescribed and a delay of more than 25 hours in prescribing appropriate IV antibiotics. Given her emergency admission, the coroner said that the patient should have had observations every four hours, instead between 21:00 on 14 November and 06:14 the following day, no observations were undertaken.
“Nothing can ever make up for what’s happened, but we urge the Trust to reflect on this case and ensure patient safety is upheld at all times so other families don’t have to endure a similar trauma,” said Sharples.
PEOPLE with mental health needs are not getting the care they need thanks to a lack of staff, beds and training, accordings to findings from The Care Quality Commission (CQC).
The independent regulator of health and social care in England, interviewed more than 4,500 people who were detained under the Mental Health Act or sectioned, covering 870 wards, and spoke to relatives and people who were previously detained for its latest mental health report.
“We urgently need more community support and a better understanding of people’s needs to reduce the number of people being detained,” said interim director of mental health Jenny Wilkes.
“And we know the situation is even starker for people from deprived areas, people from ethnic minority groups, autistic people and people with a learning disability. While the
Mental Health Bill aims to address inappropriate detentions and improve mental health care, this can’t be addressed by legislation alone as there simply aren’t the resources to fix these issues,” she continued.
With demand far outstripping capacity, the report finds that there are not enough beds available, meaning people are placed far from home, their family, and their friends.
There are also not enough staff to support all patients, which is affecting people’s access to care and leading to people being restricted from going outside as there is nobody to supervise them, or in the most extreme cases, people being inappropriately confined.
While many respondents describe healthcare workers as “caring” and “wonderful”, there are ongoing concerns with staff numbers and training. In particular, not all staff have undertaken the mandatory training to understand the needs of autistic
people and people with a learning disability.
Despite a legal entitlement to aftercare, overstretched general practice and community mental health services are not always able to provide a supportive transition back into the community, meaning people do not have the best chance at recovery.
In nearly half of cases where a child or young person was detained, they had to be re-admitted within a year.
Young people, people from ethnic minority groups, and people from areas of deprivation face the biggest barriers to accessing care and are sectioned at higher rates than the general population.
Black people in particular are detained at 3.5 times the rate of white people. Meanwhile, people from the most deprived areas are attending A&E services for their mental health at 3.5 times the rate of people from the least deprived areas.
THERE is a lack of consistency in the way paramedics are educated and trained to carry out and interpret electrocardiograms (ECG) of patients who could be critically ill that could cause harm.
A report by the Health Services Safety Investigations Body (HSSIB) looks at the use of 12-lead ECGs in ambulance services. A 12-lead ECG usually involves using 10 electrodes to record 12 different views of the heart’s electrical activity, so it is more comprehensive than other ECGs that use fewer electrodes for monitoring purposes.
The way 12-lead ECGs are undertaken and interpreted was identified as a growing area of concern, with systemic safety risks that can have a significant impact on the outcome for patients.
“Carrying out and interpreting an ECG is an important skill for paramedics. It is crucial to the time critical care of patients, but is a complex task with many factors that impact its accuracy,” said Deinniol Owens, deputy director of investigations.
“From our conversations with higher education institutions, paramedics and national organisations, there was no indication that the importance of ECG skills are underestimated. However our investigation emphasised that there is still a concerning level of variation in the quality of paramedic ECG education and training across England,” he added.
The investigation found variation in the way 12-lead ECG skills are taught across different higher education institutions, including variation in the time spent teaching and the level of detail, assessment methods and the
subject matter expertise of lecturers involved in teaching about ECGs.
It also found there is confusion about the level of specialist knowledge paramedics may be expected to have about 12-lead ECGs. This has created challenges in understanding and implementing the required level of education, training, competence and professional expectations of paramedics in this area.
“Our report makes it clear that the paramedic role has evolved, and they are required to provide more urgent and unscheduled care, in even more pressured environments. As their role changes, so should the education and training system that supports them,” said Owens.
The report concluded that because paramedics are required to have a broad knowledge base to respond to many different emergency and non-emergency situations, any expectations for paramedics to have more specialist knowledge of 12-lead ECGs would need to be balanced with the need to support specialist knowledge in other areas.
Both paramedics and student paramedics were found often to lack
confidence in their ability accurately to interpret more complex 12-lead ECG and patient presentations. This was driven by the lack of formal national requirements setting out if, how and to what standard 12-lead ECG competency should be assessed.
It also found that because the ECG refresher training does not always form part of paramedic annual training, practice-based learning about undertaking 12-lead ECGs for student paramedics could be limited by the range of clinical scenarios they encountered and the 12-lead ECG skills of their placement supervisors.
The report’s safety recommendation to the Health and Care Professions Council and the College of Paramedics to improve the undergraduate teaching of 12-lead ECGs includes reviewing and updating any relevant standards, guidance and curricula to provide clarification on a number of areas.
This needs to be the level of education and expected level of competency and assessment required by student paramedics; the minimum standards expected for ECG education, including the time spent on learning, methods used, and subject matter expertise required of teaching staff; how patient-protected characteristics, health inequalities and other specific patient factors are taught; and how effective feedback mechanisms can be developed between education and ambulance services.
“Our recommendation and other learning in our report is aimed at improving paramedic education and training through consistency and clarity; paramedics should be able to feel confident when interpreting ECGs to ensure the best outcome for patients who may need life-saving treatment,” concluded Owens.
Swiss multinational holding healthcare company Roche has signed a multi-year collaboration with Oxford BioTherapeutics to discover novel antibody-based therapeutics to treat cancer. The biotechnology company will receive up to US$36 million in upfront payments from Roche.
Oxford BioTherapeutics has developed a discovery platform which enables greater sensitivity and thereby the selection of targets with improved attributes for drug development.
Under the terms of the agreement, targets are identified via Oxford BioTherapeutics’ platform and will be validated through the research collaboration. Any further research, development and commercialisation efforts against these targets will be driven by Roche. As well as the upfront payment, the firm said that it could receive milestone payments plus product royalties on net sale.
“By combining Roche’s expertise in developing transformative therapeutics with Oxford BioTherapeutics’ innovative target discovery platform, we aim to unlock new possibilities in cancer treatment,” said Boris Zaïtra, head
of corporate business development at Roche. The deal marks the third antibody-drug deal for Roche this year and follows similar pacts with China’s Innovent Biologics and Zurich-based Araris Biotech in January.
A survey from the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) has found that Gen Z surgeons are favouring working in the private aesthetics sector over reconstructive surgery. This has raised concerns about workforce shortages in public healthcare.
The survey, which covered both Europe and the US focused on the challenges, opportunities, and structural changes needed to address the influence of Gen Z.
Findings suggest that Gen Z is spearheading reduced working hours, enhanced work-life balance and a
decline in hierarchical mentorship. Instead those in that generation want to move towards a less formal relationship with superiors and peers.
“What Gen Z has shown us is that it’s time to overhaul the surgical landscape with a focus on balance and the wellbeing of our workforce,” said consultant plastic surgeon and ESPRAS president Mark Henley.
“These trends are actually pleas for an urgent review that considers the juxtaposition between providing a full service to patients and supporting colleagues in securing a well-balanced life. If we can address these growing
needs, we are more likely to avoid the devastating impact of losing our talented surgeons to the aesthetics sector, instead providing a workplace that offers good work-life balance, and enhanced mentorship opportunities. This has multiple benefits, including the delivery of highest quality patient care,” he continued.
In October 2024 eight leaders of national plastic surgery societies and associations were invited to complete a structured questionnaire with five open-ended questions. They provided detailed responses on challenges, opportunities, and structural changes needed to address Gen Z’s influence.
ASCOTTISH Government agreement with GPs to improve general practice has failed to deliver on several of its commitments which means that healthcare services may be cut.
The 2018 General Medical Service (GMS) contract aimed to address the financial pressures and growing workloads facing GPs, and to improve patients’ access to care.
Instead, says Audit Scotland, the effect seven years on is that the estimated number of whole-time equivalent GPs has fallen, the pressure on general practice has increased and proposals to support GP teams with more nurses, physiotherapists and other specialists have moved more slowly than planned.
This means, concludes the report General practice: Progress since
the 2018 General Medical Services contract is that people are finding it more difficult to access care.
“The pandemic pushed back plans for general practice. But the new delivery deadlines that were put in place were missed, and there’s not been enough transparency about progress since then,” said Stephen Boyle, auditor general for Scotland.
The Scottish government has not set out how it intends to invest in general practice over the medium-term, the report says.
It concludes that it is unlikely to hit its target of 800 more GPs by 2027 as spending on general practice as a proportion of overall NHS spending has fallen in recent years.
Any aims have not been helped that since 2021, spending has decreased by 6% in real terms, which has put
more pressure on GP practices. On top of a lack of funding, national data for primary care, the auditor general says, remains inadequate. There is a lack of robust information about general practice demand, workload, workforce, and quality of care.
“The Scottish government needs to clarify its plan for general practice and set out the actions, timescales and costs to deliver it,” said Boyle.
In response to the report, Iain Morrison, chair of BMA Scottish general practitioners committee, said: “This Audit Scotland report demonstrates in forensic detail exactly why so many practices across Scotland are struggling to meet demand and the enormous pressures so many GPs are having to work under which has left them angry and demoralised.”
The NHS in England is increasingly relying on workers from countries with significant healthcare staffing shortages since EU recruitment became more difficult post-Brexit.
By November last year, around one in eleven (9%) of all NHS doctors in England were from so-called red list countries – one of the countries listed by the World Health Organization (WHO) as having such a shortage of staff that other countries should not actively recruit from them.
Red list countries include Nigeria, Pakistan and Ghana. Between 2023 and 2024, the number of NHS staff in England from WHO red list countries continued to grow rapidly. More than 20,000 clinical staff from these countries were added to the workforce.
“The UK’s approach to health postBrexit is diverse and contradictory,”
said Tamara Hervey, Jean Monnet professor of EU law at the City Law School. “Our immigration policies don’t offer the consistency needed to build a health and social care workforce. In some areas, we are tracking the EU’s regulations. In others, we have adopted a different approach. The ‘reset’ of relations should prompt an honest and evidence-led public discussion about the pros and cons of divergence.”
A report from the Nuffield Trust think tank and a group of academics, funded by the Health Foundation tracks the impact leaving the EU is continuing to have on the NHS and its workforce.
It finds that following Brexit, all UK countries have relied heavily on very high migration of health care staff from outside the EU – rather than training and retaining enough domestic workers to fill staffing gaps.
In England, two-thirds of the increase
in registered nurses since exiting the single market in 2020 has come from staff trained outside the UK or EEA.
Since 2018, 46% of the increase in red list nurses was from Nigeria, 21% from Ghana and 16% from Zimbabwe – the main contributing red list countries for nurses. The number of Zimbabwean nurses in the UK is now more than one in ten of the number who are practising in Zimbabwe.
“This strategy for filling staffing gaps is also risky for the UK because changes to immigration policies can cause sudden and unpredictable changes to the flow of staff into the NHS,” said Nuffield Trust policy analyst and Brexit programme lead, Mark Dayan.
“Outsourcing the training of the most critical NHS staff leads to a boom and bust where staffing numbers swing back and forth based on migration policies and the global labour market, rather than based on any plans for the NHS.”
London North West University Healthcare NHS Trust has changed how it cares for patients with feeding tubes after a 41-year-old man died while he was awaiting cancer surgery in 2023.
In August 2023, Dilbuhr Pazir was diagnosed with T4 laryngeal cancer. Following consultations with medical professionals, his family felt positive about his prognosis and that with treatment he would have been highly likely to enter remission. But on 2 September 2023, while awaiting surgery at Northwick Park Hospital in northwest London, Pazir vomited while being fed by a nasogastric tube, running through his nose. The feed entered his lungs, and he suffered a cardiac arrest. After suffering from brain damage, he died at Slough’s Wexham Park Hospital on 19 October 2023.
Although Peter Anthony Murphy, the area coroner for North London, concluded that Pazir had died of natural causes, a Trust witness
said the patient should have been checked on more frequently.
“It was accepted in the incident report ordered by the Trust and in evidence that staff should have checked on Dilbuhr more frequently because he was a patient with a compromised airway meaning there was an increased risk of him choking,” said Frankie Rhodes, senior associate solicitor at Leigh Day.
“Since Dilbuhr’s death, London North West University Healthcare NHS Trust has changed its policy to ensure patients in similar circumstances
are no longer placed in side rooms. Feeding by nasogastric tube is also no longer carried out overnight, to minimise the risk to patients.”
A spokesperson for the Trust said: “We offer our heartfelt condolences to Mr Pazir’s family. Although the coroner concluded his death was due to natural causes and did not criticise the care provided by the Trust, we nonetheless have made some changes to further strengthen [sic] our clinical pathways for patients who have had cancer treatment that has affected their airway”.
SPIRE HEALTHCARE, the second-largest provider of private healthcare in Britain, is moving further into the occupational health space with the acquisition of Cheshirebased Acorn Occupational Health for £3.3 million.
Founded in 2005, Acorn provides occupational health services to a number of corporate clients in multiple industry sectors; as well as public-sector clients, including the NHS. Its services aim to support
the safety and overall well-being of employees, through mental and physical health assessments, and providing solutions designed to protect employees from work-related ill health and sickness absence.
In a statement to the stock exchange, Spire said that Acorn had generated earnings before tax of £0.63 million last year which is at a margin above that of the Spire Group.
It also said that a small further deferred performance consideration
payment may be payable to Acorn management in the 12-month period after the acquisition. The core management team will be staying with the business post-acquisition.
News of the group’s acquisition is a distraction from its recent poor stock market performance. In early March its shares dropped almost a quarter after it warned that higher costs could cut earnings by as much as 10% and Spire shares are down just over 18% since the start of the year.
THE British public remains unhappy with the NHS with only one in five respondents to a survey saying that they were satisfied with how it is run. This is the highest level of dissatisfaction with the health service since the survey began in 1983.
The latest British Social Attitudes (BSA) survey published by the Nuffield Trust and The King’s Fund shows that satisfaction has plummeted by 39 percentage points since the months before the pandemic.
The survey said that just 12% of people were satisfied with A&E waiting times and 23% with GP waiting times. People are unhappy about waiting times even if they are satisfied with the NHS overall, regardless of age, political affiliation or nation.
“Just five years after the British public was called on to ‘Protect the NHS’ at the start of the pandemic, these findings reveal just how dismayed they are about the state of the NHS
today. We found that every group in Britain is dissatisfied with access to vital services such as A&E and GP appointments,” said report author and fellow at The Nuffield Trust Bea Taylor.
NHS staffing and spending are also worrying the public with only 11% agreeing that “there are enough staff in the NHS these days”. A strong majority (69%) said the government spends too little or far too little on the NHS and only 14% thought that the NHS spends the money it has efficiently.
If forced to choose, the public would narrowly opt for increasing taxes and raising NHS spending (46%) over keeping them the same (41%). Only 8% said that they would prefer tax reductions and lower NHS spending.
Despite low satisfaction with services, there remains strong majority support for the founding principles of the NHS: that it should be free at the point of use (90%), available to everyone (77%), and funded by general taxation (80%).
The NHS Confederation, the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland, was nor surprised by the findings.
“While these findings will be a blow to those working in the NHS, unfortunately they are of little surprise given the survey was conducted at a time when the new government was communicating how broken the NHS was and when waiting lists were so high,” said Layla McCay, policy director at the NHS Confederation in response to the survey.
The most recent BSA survey was carried out between 16 September and 27 October 2024. It asked a nationally representative sample of 2,945 people across England, Scotland and Wales about their satisfaction with the NHS and adult social care services overall, and 933 people about their satisfaction with specific NHS services, as well as their views on NHS priorities, principles and funding.
FOUR new research projects backed by the government with £6.7 million funding will focus on developing technologies to help dementia patients manage memory loss, communication difficulties and cope better with everyday tasks.
The four projects are run by the University of Sheffield, which is developing technology to help dementia patients communicate as their disease progresses; HeriotWatt University, which is working on technology to anticipate and, where possible, slow the progression of dementia symptoms; Northumbria University, which is developing hubs in rural and remote areas, where dementia patients can access technology; and Imperial College London, which is developing tools to
support independent living.
The networks will also collaborate with a number of organisations including the NHS, Age UK, Alzheimer’s Society, Alzheimer’s Research UK as well as local authorities and councils.
“Backing these ground-breaking technologies won’t just help people with dementia - it’ll transform their lives, giving people the freedom to stay in their own homes, around the people they love,” said Karin Smyth, minister of state for health.
The funding comes from the UK Research and Innovation Engineering and Physical Sciences Research Council and the National Institute for Health and Care Research (NIHR), in partnership with Alzheimer’s Society. The teams will work alongside people living
with dementia and carers to ensure a lived experience.
According to an Alzheimer’s Society survey, 85% of people have said they would prefer to stay in their own home for as long as possible if diagnosed with dementia, but many are currently unable to do so.
“This is a really exciting opportunity that will bring together UK scientists and partners from health and social care, industry, third sector and lived experience, to develop new technologies that will help people affected by dementia to live independently for as long as possible,” said David Sharp at Imperial College London and director of the Care Research and Technology Centre at the UK Dementia Research Institute.
Ori Biotech, the London and Philadelphia-based developer of a platform that helps cell and gene therapy manufacturing, has launched a preferred partner network to accelerate the development and commercialisation of cell and gene therapies.
The founding members of the Ori Preferred Partner Network in the US include Charles River Laboratories, a joint venture between MD Anderson Cancer Center and Resilience called CTMC, ElevateBio, Kincell and a number of other currently undisclosed partners.
“By partnering with the top academic institutions and CDMOs globally, Ori is helping to deliver proven solutions that speed time to clinic, reduce comparability risk, and shorten development timelines,” said Ori Biotech chief executive Jason Foster.
For service providers, developing and manufacturing cell therapies, membership of the network have the opportunity to accelerate cell therapy product development via the new Ori Biotech platform.
This partnership approach, the company said, helps ensure that Ori and its partners remain at the cutting edge of cell therapy manufacturing innovation. Network members will get preferred access to Ori innovations, including its IRO platform, which can increase throughput, reduce costs of goods and accelerate development timelines. IRO was designed to integrate with other upstream and downstream technologies and provide a streamlined and closed workflow.
“Ori’s mission mirrors our own: expedite the delivery of life-saving therapies to patients,” said Matthew Hewitt, chief technology officer of the manufacturing business division at Charles River. “By joining Ori’s preferred partner network, we can support the advanced therapies industry by helping to drive the adoption of cutting-edge platforms, and address manufacturing bottlenecks.”
Foster talked to Healthcare Today in February about the application of AI and machine learning in drug discovery. “The potential of AI is significant, with the possibility of accelerating drug development timelines by approximately three years, speeding up both clinical development and the transition to commercial-scale manufacturing,” he said.
THE overwhelming reason for negative patient reviews on Doctify is that patients have felt that their doctors either rushed or gave them brief explanations.
The healthcare review platform has analysed hundreds of thousands of verified patient reviews over the past three years.
“It’s not just the care that matters – it’s the way it’s communicated. Over half of patients who left negative reviews felt the explanations they received were insufficient. When clarity is lacking, patients are left confused and frustrated, making it harder for them to feel confident in their care,” said Stephanie Eltz, chief executive and co-founder of Doctify.
Over half of the patients who left negative reviews felt the explanations they received were insufficient, including 55% who described explanations as rushed or brief; 37% who found the language unclear or vague; and 30% who felt there was a lack of detail, leaving them uninformed.
It wasn’t helped by the fact that almost 50% of patients who left negative reviews rated their healthcare provider’s bedside manner poorly, with the majority (60%) describing their provider as rushed and dismissive. Almost a third (29%) felt their care was cold or uncaring, 17% reported interactions that were insensitive or inappropriate, and one in ten (10%) said their provider did not engage.
“Understanding these patterns gives healthcare providers the insights they need to refine their practices, build trust, and improve the patient journey,” said Eltz.
THE UK Health Security Agency (UKHSA) has drawn up a watchlist of 24 pathogen families that could pose the greatest risk to public health, in a bid to focus and guide preparedness efforts against these threats.
It is the first specifically designed to consider both global public health threats as well as those most relevant to the UK population.
It provides information on pathogen families where UKHSA believes further research would be most beneficial to boost preparedness against future biosecurity risks, particularly around diagnostics, vaccines and therapeutics. Research and development across a range of other pathogen families not on this list also remains vital.
“This tool is a vital guide for industry and academia, highlighting where
scientific research can be targeted to boost UK preparedness against health threats,” said Isabel Oliver, chief scientific officer for UKHSA.
For each viral family included in the tool, an indicative rating of high, moderate, or low pandemic and epidemic potential is suggested.
These ratings are the opinions of scientific experts within UKHSA, who have considered routes of transmission and severity of disease arising from pathogens in each family to inform the ratings.
The UKHSA emphasises that this rating does not indicate which pathogen it considers most likely to cause the next pandemic, but rather those pathogens requiring increased scientific investment and study.
It also includes those pathogens where increased vaccine or diagnostics development is needed or those which
may be exacerbated by a changing climate or antimicrobial resistance. Among the pathogen families where UKHSA is keen to see greater scientific strides made are the coronaviridae family, which includes Covid-19; the paramyxoviridae family which includes Nipah virus; and the orthomyxoviridae family which includes avian influenza.
But, the agency is keen to underline, priorities and risks will change with updates in epidemiology and progress will be made with the development of diagnostics and countermeasures. Therefore, the tool, which is intended to be updated annually, must be used with other information as appropriate and represents a snapshot at one point in time.
“We are using the tool as part of our conversations with the scientific community, to help ensure that investment is focused to where it can have the biggest impact,” says Oliver.
mothers, wives or daughters understand what they need to do to maintain their health, they are not only more likely to take action themselves but also to share this knowledge with others. This ripple effect is immeasurable in its impact.
Do GPs and healthcare professionals have enough training in how to support women’s reproductive health in midlife and beyond?
I’m struck by how different things are now compared to my own clinical experience as a junior doctor. It would never have occurred to me to start an obstetric ward round with my consultant without first visiting the postnatal ward. Today, that kind of basic, essential care is often overlooked.
Back in 2011, I contributed to a report called High Quality Women’s Healthcare published by the Royal College of Obstetricians and
I don’t believe we need more money – we just need to reallocate the resources we already have.
Gynaecologists. It emphasised that despite the rise of highly technical interventions, the basics of women’s healthcare should not be forgotten. Yet, over the next 14-15 years, we completely ignored those recommendations.
This neglect is evident in my own experience. On Monday morning, I had an ST4 trainee with me –someone who is more than halfway through their specialist training in obstetrics and gynaecology. I was fitting a progesterone-coated coil into a woman’s uterus, not for contraception but as a mechanical barrier to address a specific condition.
I asked the trainee if she would like to load the coil for me, but to my surprise, she had never seen one before and didn’t know how to do it. This is a stark example of how the basics are being overlooked in modern training and practice.
You’ve spoken about the need for women’s health hubs to deliver wraparound care. What is stopping them being set up?
The problem is that everyone expects a lump sum of money to be dropped on the table to make it happen. But I don’t believe we need more money – we just need to reallocate the resources we already have.
The NHS budget currently exceeds £200 billion annually, and a significant portion of that is wasted on unnecessary secondary care appointments which is far more expensive to maintain than community-based services.
We need integrated care board leaders and healthcare leadership to think differently. Many consultations could be done virtually, saving time and resources.
Last autumn, I conducted a detailed analysis for ministers on the 600,000 women on the English waiting list for gynaecology services. Of those women, 85-87% do not require hospital admission or invasive procedures.
They are waiting to be seen in secondary care because they can’t access guidance, advice or minor procedures. GPs and practice nurses often say they can’t or won’t provide these services because they’re not properly reimbursed, lack training, or find it difficult to access certification. I’m working on alternative solutions, but the system keeps saying “no”.
General practice poses a particular challenge because GPs are not NHS employees – they’re contracted to provide services. If a GP needs to attend training to learn how to insert coils, they must backfill their role with a locum, which is costly and
creates disincentives. This is where the hub model comes in. By creating community-based hubs, we can see women closer to home, triage them effectively, and provide training opportunities.
How can we ensure that women from disadvantaged or minority backgrounds have equal access to the healthcare they need?
Because these hubs are communitybased, grassroots organisations, they act as advocates and help encourage women to access care. For example, if you have a group of women who wear hijabs, they are unlikely to feel comfortable having a cervical smear performed by a male clinician. Understanding these
cultural and social nuances is crucial to providing effective care.
There are also language and cultural barriers to consider. In some South Asian dialects, there is no word for “menopause”, making it nearly impossible to ask women about menopausal symptoms. Additionally, we’ve observed significant variations in the age of menopause onset across different ethnic groups, as well as stark disparities in health outcomes. To address these challenges, we need to communicate with women in ways they understand and provide access to healthcare professionals they can trust.
We’ve also piloted mobile hubs, which have shown great promise. In Manchester, for instance, we’ve
organised a couple of buses that travel around and provide services to sex workers, the homeless, and drug addicts.
This model ensures that even the most marginalised groups can receive the care they need in a way that respects their dignity and circumstances.
What policy changes are needed to make this happen?
The NHS is undergoing significant changes, and one clear indicator of this is the Department of Health’s public consultation in 2021, which asked women what was wrong with the health service from their perspective. The fact that it took
18 months to compile the resulting report was because the response was overwhelming. This engagement underscored the urgent need for action and ultimately led to the creation of the Women’s Health Strategy
The agreement I made with my co-authors was simple: for every problem we identified, we had to propose an alternative that was not only effective but also costefficient. I argued that improving women’s healthcare would benefit everyone – economically, socially, and educationally – and that it could be done for less money. In short, it’s a win-win for all.
Lead image of Dame Lesley Regan, courtesy of One Welbeck.
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Elizabeth Davies, a clinical negligence solicitor specialising in sepsis cases at JMW Solicitors, explains why delayed diagnosis may be grounds for legal action.
survival chances would have been significantly higher. This underscores the dangers of failing to escalate care, administer immediate antibiotics, and follow clear clinical guidelines. It also illustrates why families affected by negligent sepsis care pursue legal action - not only to secure compensation but to hold hospitals accountable and advocate for improved patient safety standards.
Individuals who believe treatment delays caused harm should request complete medical records to identify potential failings. Medical negligence solicitors can assess whether avoidable delays contributed to complications or death. Seeking legal advice early is crucial, as strict time limits apply for making a claim.
Families should maintain a timeline
of symptoms, hospital visits, and medical decisions. If a loved one has died due to sepsis-related complications, a claim may still be possible on their behalf.
Legal action can help secure financial support for ongoing medical care, rehabilitation, and necessary adaptations to living arrangements. More importantly, it holds healthcare providers accountable, prompting hospitals to improve sepsis protocols and prevent future failures.
Despite advances in sepsis awareness, hospitals continue to miss national sepsis care targets, leading to preventable deaths and life-altering complications. Sepsis screening remains inconsistent, with some NHS Trusts lacking
structured detection and escalation processes. While certain hospitals have improved, others persistently fall short of national guidelines, unnecessarily endangering patients.
Implementing mandatory sepsis training for all frontline staff could reduce treatment delays, particularly in A&E departments and GP surgeries, where early recognition is vital. A national sepsis strategy is essential to ensure uniform response times and treatment protocols across all hospitals.
Enhanced data collection and public reporting on sepsis treatment failures could spotlight hospitals that consistently fail to act within the critical one-hour window. Without transparency, patients and families are often forced to uncover medical failings through legal proceedings rather than proactive hospital accountability.
Delays in treating sepsis continue to claim lives, subjecting patients, and families to preventable suffering. The healthcare system must be held accountable for avoidable delays resulting in death, amputation, or permanent disability. Seeking legal advice is a vital step in ensuring patients receive justice and compelling hospitals to enhance their sepsis response times.
Many families do not realise that a delayed diagnosis or failure to follow NHS sepsis protocols may be grounds for legal action. Pursuing a claim not only helps individual families but also ensures that hospitals review their procedures and prevent further failures.
Those affected by sepsis negligence should act quickly to seek legal advice, request medical records, and gather evidence. Holding healthcare providers accountable is essential in driving change and preventing future tragedies.
Professor Michael Dooley, director of the Voluntary Assisted Dying pharmacy service in Victoria explains what Britain can learn from the Australian experience of assisted dying.
Written by Adrian Murdoch.
Britain is inching closer to a legal framework for assisted dying...
Sponsored by Kim Leadbetter, Labour MP for Spen Valley, the Terminally Ill Adults (End of Life) Bill was introduced to parliament in midOctober last year by way of the Private Members’ Bill ballot and was published a month later, in November. It is currently in committee stage.
As Healthcare Today reported in early March, there is growing acceptance among all types of clinicians towards assisted dying.
In June 2019, Victoria was the first state in Australia to pass Voluntary Assisted Dying laws. As the director of the Voluntary Assisted Dying pharmacy service in Victoria, Australia, Professor Michael Dooley is the expert people turn to when they want to understand how assisted dying can work in practice. He recently gave evidence to parliament about his experience and here, talks to Healthcare Today about how legislation should be implemented.
Based on your experience in Victoria, what key lessons should the UK learn when implementing an assisted dying framework?
Victoria was the first state in Australia to legalise assisted dying, and the legislation has now been in place for approximately five years. The practicalities of how the system operates, offer valuable insights for other jurisdictions. One of the most significant takeaways is the robustness of the Australian model, which has proven to be both safe and effective.
A notable aspect of the Australian approach is the use of specific medications for selfadministration, which differ from those employed. The medications used across Australia have
The legislation currently being considered in the UK follows a selfadministration model exclusively, without the option for practitioner administration.
been carefully selected and are demonstrably effective. In every case where patients have taken these medications, the outcome has been as intended: a peaceful death. Over the past five years, more than 2,000 patients have gone through the process, with the majority self-administering the medication in their own homes. This has been achieved safely, with families providing feedback that consistently describes the experience as peaceful.
For the UK, the key lesson is to examine the Australian model closely rather than looking to certain states in the US, where different medications and more complex processes have been used.
Are there any significant differences in approach in the British model?
The approach pioneered in Victoria is now being adopted and replicated across other Australian states, each of which has undergone an independent review process. Consistently, these reviews have reaffirmed the effectiveness and safety of the Victorian model. Based on conversations with several individuals involved in the UK’s efforts, the current legislation being progressed there focuses on self-administration of medication, but with the added requirement of supervision by a healthcare practitioner. This differs slightly from the Australian model, where such supervision is not mandated.
Why is there an emphasis that the drug is self-administered?
In Victoria, patients can request that a healthcare practitioner administer the medication, but only if they are unable to selfadminister. Under this framework, approximately 15% of patients have the medication administered intravenously by a practitioner, while the remaining 85% selfadminister it orally. However, in some other Australian states, the legislation has been designed to offer patients a choice between self-administration and practitioner administration. The legislation being considered in the UK follows a self-administration model, without the option for practitioner administration.
What legal safeguards in the Victorian system do you think are essential for the UK to replicate?
It is entirely appropriate to have a comprehensive set of safeguards in place, and the Victorian model incorporates these at every stage of the process. To begin with, there are stringent eligibility criteria. Two independent doctors must assess the patient to determine whether they meet the requirements for assisted dying. These assessments are spaced apart over time, ensuring that the patient has multiple opportunities to confirm their decision.
In addition to eligibility safeguards, there are measures in place to ensure patients are fully informed. They are provided with all the
necessary information to make a well-considered decision, supported by clear and accurate guidance. From a practical perspective, further safeguards are embedded in the prescribing process. Doctors are not permitted to choose from a range of medications; there is only one approved medication that can be prescribed, and its use follows a strict protocol. This eliminates variability and ensures consistency across all cases.
The medication itself is managed through a centralised, statewide pharmacy service. This service is responsible for dispensing the medication and conducting final assessments of the patient. These assessments include verifying
that the patient fully understands the process, is capable of selfadministering the medication, and has the necessary support to do so safely. Only after these checks are completed is the medication provided to the patient.
In the UK, the proposed legislation appears to include even more safeguards than those in place in Victoria. For example, the medication is provided to a health professional, such as the prescribing doctor, who then witnesses the patient selfadministering it.
In contrast, the Victorian model allows patients to take the medication when they choose, once it has been dispensed to them.
What role should palliative care play in an assisted dying framework, and how can the two coexist?
It’s a very good question and one that highlights an important aspect of the assisted dying process in Australia. Around 90% of patients who pursue voluntary assisted dying are also under the care of palliative services. Five or six years ago, there was considerable resistance from the palliative care community for a variety of reasons. Over the past five years, we have seen a marked change in this dynamic. Assisted dying is now increasingly viewed as a component of the broader end-of-life journey, rather than being seen as a separate or
conflicting pathway. There is now a much greater understanding and acceptance of how the two can coexist, with assisted dying being seen as one option within a spectrum of end-of-life care. The experience in Australia can serve as a valuable reference point for other countries that are considering similar legislation. This, in turn, will help facilitate a smoother and more cohesive approach to end-of-life care.
What training is needed? How can the UK ensure that healthcare professionals are adequately trained and supported to participate in assisted dying?
Each Australian state has approached the training of
THE UK’s social care sector is grappling with escalating financial pressures, now exacerbated by the recent increases in employer National Insurance (NI) contributions and the National Living Wage.
Analysis by the Nuffield Trust reveals that these changes are projected to cost adult social care providers an additional £2.8 billion in the upcoming financial year, placing many at risk of insolvency. Focusing solely on hourly wages, however, is not enough to address the sector’s deep-rooted issues.
Care is a sector that is steadfastly stuck in 1990s operational habits
and is reluctant to change. Staffing providers still operate on what is called a run or shift-filling basis – be it as little as 15-, 30-, 45- or 60-minute calls.
The domiciliary care market is split between small owner-managed businesses delivering very localised care – often no more than a five-mile radius – or huge franchise-driven providers who have grown via acquisition and swallowed swathes of smaller providers over the past 20 years. At every step, they have all championed paying the least they can get away with and this has had a long-lasting impact on the sector.
There’s a lot of talk about how the pay increases for carers have helped
Alex O’Neill, operations Fairway Healthcare, the problem with the old-fashioned methodologies, hourly wages.
an already poorly paid occupation and improved the carers’ lives, though each statement is always followed by a “but”. Regardless, there’s too much of a focus on hourly rates.
The focus needs to be on why there are such terrible retention and
operations director at Healthcare, explains why the care sector is methodologies, not
progression rates within the sector and why so many care workers feel undervalued.
Providers spend a fortune on things like marketing, recruitment and internal compliance procedures – all with a tick-box methodology. This is a sector that continually looks
in the wrong direction. All of this leads to a reliance on short-term strategies – using agency workers to fill shifts, which is effectively crisis management and last-minute action, resulting in poor standards.
The consequence is low staff morale, poor team spirit, more pressure on the incumbent workforce and eventually, ultimately, high staff turnover – a vicious cycle.
The facts are that too many care owners and managers pay as little as they can for care staff, and use a tick-box strategy to meet compliance requirements and deliver as many hours as possible, with as little fuss as they can. Overall, they spend a disproportionate amount of time
continually recruiting and never fixing the problem.
It’s important to get out of your comfort zone and look at how much your return on investment can improve if you prioritise your workforce. Recruit well, train well, offer development, encourage growth, and drive up retention. That way, you build a strong, skilful, motivated, and passionate workforce.
Stop looking at carer hourly wage costs – that isn’t the problem. The elephant in the room is shortsighted, out-of-touch, old-fashioned methodologies that waste time and money and never address the root of the problem.
Prokar Dasgupta, professor of surgery at King’s College, London, and chair of the Centre for Robotics at The London Clinic, explains how robotic surgery has become democratised.
TWENTY years ago, The London Clinic became the first independent hospital in the UK to launch a robotic surgery programme, initially using the original da Vinci system from Intuitive Surgical, California for urological conditions like prostate cancer.
Since then, we have adopted every version of this robot as it has evolved. The 3D-HD magnified vision and fine robotic wrists capable of operating without tremor (even if the surgeon has one) have transformed keyhole surgery forever.
Using this technology, patients experience less blood loss, reduced pain, shorter hospital stays and faster recovery. Despite initial concerns over cost, studies have since demonstrated that the minimally invasive technology is cost-effective for most cancers when compared to open surgery.
As a result, other specialties, including gynaecology, lung, bowel and throat surgery have also embraced this technology for
the benefit of their patients. Our robotics programme has continued to expand, incorporating robots for orthopaedics, spinal surgery and benign enlargement of the prostate.
Today, the remarkable da Vinci robot faces stiff competition from other international manufacturers, with about 50 new companies entering the market. To challenge the current gold standard, these systems must match or surpass da Vinci’s capabilities.
The alternative is that they market themselves as significantly cheaper options, thus attracting a wider variety of institutions who could not afford the da Vinci. Common features in these new systems include open consoles, enhanced 3D vision, lighter instruments and greater portability.
There is also renewed interest in automation, the origin of which can be traced back to John Wickham,
the world’s first robotic surgeon. One example is the Smart Tissue Autonomous Robot (STAR) which can suture bowel tissue more effectively than a human hand in animal models.
Another example, a water-jet robot from Procept Biorobotics, takes inspiration from Wickham’s original robot: the PROBOT, and creates a channel inside an enlarged prostate, much like coring an apple, to improve urine flow. The London Clinic now performs the highest volume of this procedure in the UK.
New robots entering the market hold the potential to reduce the cost of robotic surgery to levels comparable to traditional laparoscopy (keyhole surgery without robots), although the initial hardware investment may still be substantial.
Cambridge Medical Robotics, with its UK-designed Versius robot, and Medtronic, with its HUGO robot, have introduced competitive costper-procedure models as part of a comprehensive package.
THE best way to predict the future is to create it,” said Abraham Lincoln.
The comment from the US president rings true in healthcare today. Private healthcare operates amid rapid advances in digital health and generative AI, yet many leaders stick to familiar routines. In an era when healthcare has lagged behind other industries in adopting AI, the need for leaders proactively to scout emerging technologies has never been greater. Tech awareness is now a core leadership imperative and clinic leaders need to discover and adopt innovations – all while fostering the right culture.
How can busy practice leaders actually keep up with the whirlwind of healthtech developments? It starts with making tech scouting a routine part of leadership work. One strategy is to cultivate an open network
beyond your organisation. An open leadership mindset – reaching out to peers, industry groups, and even competitors – can pay dividends. Building this social capital keeps you informed of what others are doing. Leaders might join innovation forums, attend conferences or webinars, and subscribe to reputable health technology journals. These channels can alert you early to promising new solutions.
Internally, consider appointing innovation champions or small teams to research emerging tech. Some clinics rotate this role among staff to spread the learning. Encouraging employees to experiment with readily available tools is another tactic – for instance, allowing a doctor to try a voicerecognition AI for note-taking or letting reception staff test an online scheduling system. Such grassroots experimentation can uncover useful tech with minimal top-down effort. Leaders should also partner strategically: collaborating with
Alex Fairweather explains a healthcare leader now continuous learner and
a health tech startup, university or innovation hub can give your practice early access to innovation at low cost. Above all, maintain an open organisation – one where ideas from inside and outside flow freely. Furthermore, openness to collaboration with the wider community unlocks opportunities and benefits from new technologies.
Staying educated is important, fortunately there are many online sources to read about novel technologies in the context of healthcare. Training and consultancy can also be sought from specialists.
Real-world examples illustrate how proactive tech adoption can
explains why the role of now includes being a and innovator.
facilitate positive change both in healthcare and other industries.
According to a 2024 medical group survey, 43% of practices had added or expanded AI tools in the past year.
Their top use cases included automating documentation with AI scribes, triaging patient communications with chatbots, and streamlining. These adopters show that you don’t have to be a huge hospital to leverage emerging tech.
Consider the impact of seemingly small gains; Mayo Clinic piloted an AI assistant to draft responses to routine patient messages, giving nurses a first draft reply. The result was a time savings of about 30 seconds per message, adding up to an estimated 1,500 hours saved across the organisation in a month.
Such successes don’t happen by accident – they were enabled by leaders who were aware of new solutions and prepared their teams to use them. The good news is that once a few small wins are achieved (say, an automated reminder system that cuts no-show rates, or an AI that streamlines coding and billing), it builds momentum and confidence in further innovations.
The role of a healthcare leader now includes being a continuous learner and innovator. By creating a supportive culture, engaging stakeholders, and actively scouting for promising technologies, leaders can turn the buzz around emerging technologies into tangible benefits for their practice. The notion of change can be worrying, but if innovation scouting is done in alignment with the objectives of the organisation and facilitated by a strong culture of innovation, it
should be a positive experience for all stakeholders. The alternative is riskier: ignoring the rapid evolution of healthcare technology. As management thinker Peter Drucker cautioned, “the greatest danger in times of turbulence is to act with yesterday’s logic”. Forward-thinking clinic leaders will heed this advice, embracing new tools to solve real problems in their context and enhance patient care.
Ask yourself: Am I doing enough to explore what’s out there?
Building time for innovation into your leadership routine could transform your practice and the lives of your patients. In the end, the goal isn’t just to adopt tech, it’s to better fulfil the mission of improved patient outcomes. By scouting and harnessing the right emerging technologies in alignment with your organisation’s strategy, healthcare leaders can ensure their organisations are not just reacting to the future, but playing a part in creating it.
The High Court’s decision in Bartolomucci v Circle Health Group Ltd [2025] EWHC 529 (KB) reported on 7/3/25, provides clear judicial confirmation that a private hospital offering an all-in treatment package is not contractually liable for the acts of independent consultants operating under practising privileges.
This judgment will be of particular interest to healthcare providers, brokers, indemnity insurers, and legal professionals working in the private healthcare sector.
Mr. James Bartolomucci underwent a private hip resurfacing operation in 2015 at BMI The Edgbaston Hospital, which was owned and operated by BMI Healthcare Ltd (now Circle Health Group Ltd, hereafter “Circle”). As a result of complications during the procedure, Mr. Bartolomucci unfortunately suffered a catastrophic brain injury.
The case raised important legal questions about whether the hospital could be held contractually liable for the actions of the treating consultants involved.
The surgery was booked and paid for as part of a single all-in package costing £14,220.
The package was marketed as covering all elements of care related to the procedure, including preoperative, operative, and postoperative services.
The orthopaedic surgeon and anaesthetist who carried out the operation, however, were not
Neil Rowe, senior in-house counsel at THEMIS Clinical Defence, comments on what the High Court’s decision in Bartolomucci v Circle Health means for private hospitals, healthcare practitioners, insurers and those drafting consultant contracts.
employees or agents of the hospital. Instead, as is common in this setting, they were independent practitioners granted practising privileges, operating their own private medical practices from the hospital’s facilities.
Mr. Bartolomucci, represented by a litigation friend, brought Part 7 proceedings, alleging clinical negligence during the procedure, and seeking damages in tort for his brain injury.
This case was unusual in that the claim that came before the court focused exclusively on contractual liability. The consultant anaesthetist’s medical defence organisation (MDO) would not indemnify him.
Due to his brain injury Mr Bartolomucci has significant care needs and so the Claimant was concerned that any award of damages made could not be paid.
The Claimant therefore issued Part 8 proceedings and sought a declaration that Circle had contractually undertaken responsibility for the acts and
omissions of the consultants who treated him.
Part 8 proceedings are determined by the court interpreting the (limited) contractual documents available and the Claimant hoped that judgment in his favour could then be applied in the Part 7 proceedings for damages so that if liability was established against the consultants and damages awarded, Circle (or its indemnity insurers) would pay.
Circle rebutted the claim and argued that it was not responsible for the independent consultants who held practising privileges and only responsible for the nursing staff and other items specified.
Central to the case were the written terms and conditions provided as part of the treatment package.
The covering letter enclosing the terms and conditions referred to “details of our self-pay fixed price package for your surgery”.
The Claimant relied heavily on the words “your surgery”. Circle relied on the contract, where Clauses 18 to 20 were particularly relevant. These clauses:
• Stated that consultants were self-employed;
• Specified that consultants provided services direct to the patient;
• Indicated that while the hospital collected fees from the patient on behalf of the consultant, the consultants might separately invoice;
• These clauses were standard for many private healthcare settings and mirrored common industry practice.
The High Court found in favour of Circle.
The court held that the contractual documents did not support the claimant’s argument that Circle had undertaken to supply the surgical and anaesthetic services directly. Despite the use of all-in language in marketing and documentation, the contract made it clear that:
• The consultants were acting in their own capacity;
• The hospital’s role was limited to providing facilities, nursing support, and administrative services;
• The responsibility for the delivery of clinical treatment lay with the consultants themselves.
On this basis, the court refused to make the declaration sought by the claimant. Circle was not contractually responsible for the treatment provided by the consultants.
The claimant did not ask the court to consider issues in tort such as vicarious liability or non- delegable duty. It remains to be seen if a claimant in another case chooses to pursue this line of argument in a similar scenario. For now, fortunately there has been no expansion of the application of Woodland v Essex.
While the court’s judgment focussed on what a reasonable reader would understand from the documents it also commented that its view was consistent with commercial common sense. Documents created after the contract were not construed – in particular the practising privileges agreements between Circle and the consultants which had never been
seen by Mr Bartolomucci. Finally, while there was never any written contract between Mr Bartolomucci and the consultants the court inferred one through the consent process.
The sting in the tail for the Claimant was that Circle are entitled to recover their costs of the Part 8 claim as this was not a qualified one-way cost shifting (QOCS) personal injury case.
The judgment provides strong reassurance for private hospitals that operate using the practising privileges model. It confirms that:
• A private hospital is not contractually liable for the acts of consultants who are clearly identified as independent practitioners;
• The courts will give effect to express contractual provisions, even where a patient might assume they are receiving treatment “from the hospital” as a single entity;
• The prevailing model of consultant independence and separate indemnity arrangements remains legally robust.
Had the claim succeeded, it could have exposed private hospitals to significantly increased risk and liability exposure, with knock-on effects for indemnity markets and healthcare costs.
For those involved in drafting or reviewing consultant contracts and patient-facing documentation in private healthcare, the following best practices are recommended:
1. Be clear on consultant status
2. Ensure all contracts, marketing materials, and pre-treatment communications clearly state that consultants are independent practitioners, not employees or agents of the hospital.
3. Clarify what the package includes
4. Where all-in or bundled pricing is offered, define exactly what is included and who is responsible for each element of care.
5. Review standard terms regularly
6. Periodically review and update template contracts to ensure they reflect evolving legal standards and case law.
7. Avoid ambiguity in patient communications
8. Patient information leaflets and pre-admission documentation should reinforce the contractual distinction between the hospital and the treating consultants.
9. Ensure consultant indemnity cover
10. Require all consultants to maintain up-to-date professional indemnity insurance as a condition of practising privileges, and carry out regular compliance checks.
Bartolomucci v Circle Health Group Ltd confirms that private hospitals are not contractually responsible for the clinical treatment delivered by independent consultants operating under practising privileges – even where care is purchased as part of an all-in package. This decision will be welcomed across the healthcare sector as preserving the clarity and viability of long-established private practice models. At the same time, it will provide food for thought for those contemplating alternative indemnity structures for consultants operating within private providers.
IN THE ever-evolving landscape of clinical negligence claims, early resolution has become a key focus. The traditional litigation process is often lengthy, costly and emotionally taxing for all parties involved.
Pre-action clinical investigations, however, present a proactive and efficient alternative, offering a structured approach to resolving potential claims before formal legal proceedings commence.
At TMLEP, we understand the importance of early investigations in delivering clarity, reducing litigation costs, and ensuring fair outcomes.
Here, we explore the key benefits of early resolution through pre-action clinical investigations and how they particularly benefit claimants and partners seeking justice and fair compensation.
Litigation is an expensive process, and there can often be financial barriers when pursuing a clinical negligence claim. A well-conducted pre-action clinical investigation helps legal representatives determine the merits of a case early, allowing claimants to make informed decisions before investing in legal proceedings. If a claim is unlikely to succeed, claimants can avoid unnecessary expenses and emotional distress.
Reducing time spent on litigation for faster compensation
Clinical negligence cases can take years to resolve when they progress to court, delaying much-needed compensation for affected claimants. Early investigation reports provide a clear and objective assessment, facilitating fasting decision-making and settlements. This ensures that
TMLEP’s lead healthcare investigator Nina Vagad explains the benefits of early resolution through pre-action investigations from the perspective of a claimant.
claimants who have suffered receive compensation sooner, allowing them to focus on recovery and rehabilitation.
the claim for claimants seeking justice
For claimants, obtaining an expertled pre-action investigation ensures they have a solid foundation for their claim. Independent clinical insights can strengthen a case, increasing the likelihood of a fair settlement. Conversely, if a claim is unlikely to succeed, claimants can be advised accordingly, preventing them from pursuing a lengthy and emotionally draining legal battle with little chance of success.
Minimising emotional and psychological stress for claimants
Clinical negligence disputes can be deeply distressing for claimants and their families. The uncertainty of prolonged legal proceedings can add to their emotional burden. By resolving cases early through pre-action investigations, claimants can achieve closure faster, reducing stress and allowing them to focus on their health and well-being.
Encouraging open dialogue for fairer outcomes
One of the primary benefits of pre-action investigations is their role in fostering constructive communication between parties. By
obtaining an impartial expert opinion early, claimants and defendants can engage in informed discussions about potential resolutions. This process encourages transparency and promotes fair settlements, ensuring that patients receive appropriate compensation without unnecessary adversarial conflicts.
With changes coming into play with fixed recoverable costs (FRC) in clinical negligence cases, pre-action investigations have become ever more crucial. Given the potential cost restrictions, an early and thorough investigation ensures that claimants are aware of their case’s viability before proceeding with legal action. This reduces unnecessary legal costs for patients and ensures their resources are used effectively.
Pre-action clinical investigations are a vital tool in achieving early resolution, offering significant financial, procedural, and emotional benefits to claimants. By engaging in expert-led investigations at an early stage, claimants can make informed decisions, avoid unnecessary litigation, and achieve fairer outcomes. As the legal landscape continues to evolve, leveraging preaction investigations will be essential in navigating clinical negligence claims effectively.
At TMLEP, our pre-action clinical investigation service provides expert opinions, clear cases assessments and comprehensive reporting to support early resolution.
If you are a claimant or their legal representative, seeking clarity on your clinical negligence case, contact our team today to learn how we can help you achieve a fair and timely resolution.
WHILE traditionally more common in young children, in recent years there has been a significant increase in diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) in adults.
This has put pressure on the NHS patient pathway, with the volume of demand leading some trusts having to close waiting lists. This has, in turn, led many patients to seek diagnosis and treatment from private providers, who can offer assessments much faster. However, an issue has arisen in those privately diagnosed patients seeking to then revert back to the NHS for medication and treatment, due to the high costs of obtaining this from a private provider. GPs are then left with a choice; rely on the ADHD diagnosis from the private provider and prescribe medication under a ‘shared care’ arrangement, effectively allowing the patient to bypass the NHS waitlist, or refuse to do so and insist the patient receives an NHS diagnosis before receiving medication with NHS funding.
According to the National Institute for Clinical Excellence, an ADHD diagnosis should only be reached following a full clinical and psychosocial assessment, including obtaining a full developmental and psychiatric history, as well as observer reports and assessments of the patient’s mental state.
It is entirely up to an individual GP whether they enter into a shared
Kennedys’ Amber Anderson explains the potential difficulties when seeking a private ADHD dignosis and then turning to public health for ongoing care.
care arrangement and adopt a private provider’s ADHD diagnosis. Whilst the private healthcare sector should not be used by patients as a tool to bypass NHS waiting lists or expedite NHS treatment, patients have understandably become frustrated with the NHS system which is struggling to cope with the surge in demand.
Guidance from GPC England (England’s general practitioners committee) and published by the British Medical Association (BMA) – ‘General practice responsibility in responding to private healthcare’ – highlights that complying with a private healthcare provider’s request for tests or investigations “is outside the scope of NHS primary medical services”. However, if the GP deems the proposed investigations as “clinically appropriate”, the GP may proceed to arrange these if they feel that they are “competent to both interpret them and manage the care of the patient accordingly”.
The Guidance also refers to NHS guidance which states that private and NHS care should be kept as clearly separate as possible and NHS resources should never be used to subsidise the use of private care. The separation should be “as clear a separation as possible of
funding, legal status, liability and accountability between NHS care and any private care that a patient receives”.
Should a GP agree to a shared care arrangement, they must ensure the diagnosis was made by a healthcare professional with training and expertise in diagnosing ADHD. The GP is ultimately responsible for the prescriptions they write and must ensure that the medication is appropriate, necessary and safe for the individual patient. The GP could be subject to potential legal liability, should the diagnosis be incorrect or the medication inappropriate.
ADHD diagnoses reached by reliable private practitioners in compliance with NICE guidelines may well assist in alleviating pressure on NHS waiting lists, helping to reduce the backlog. GPs may wish to enter into shared care arrangements on this basis, should they feel comfortable doing so. However, GPs and other NHS bodies and practitioners should be mindful that not all diagnoses will be correct or reliable and that it is their prerogative to refuse to prescribe medication should they have any doubts over the ADHD diagnosis.
When the lines between private and NHS treatment are blurred, difficulties may arise. The GP is ultimately responsible for any injury or negative side effects a patient may experience from incorrect or inappropriate medication which they have prescribed.
Amber Anderson is a senior associate at Kennedys.
NAVIGATING the complexities of yearend reporting can be challenging, especially while managing dayto-day patient care. Partnering with a medical billing like Medserv can simplify this process, offering expertise and efficiency to help healthcare professionals close out their tax year successfully.
Year-end financial management is a crucial process for any healthcare practice. It involves reviewing revenue streams, reconciling accounts, ensuring tax compliance, and preparing reports that provide a clear financial picture. Accurate records not only support regulatory compliance but also help practices identify trends and set financial goals for the year ahead.
However, handling these responsibilities in-house can be overwhelming. The intricacies of medical billing, insurance reimbursements, and coding errors can lead to financial discrepancies and increased stress during tax season. This is where specialised support can make all the difference.
How a billing company supports a stress-free tax year end
Reducing errors and ensuring accuracy: Medical billing errors can complicate year-end financial reconciliation, leading to inaccurate reports and potential compliance issues. Trained professionals meticulously manage coding, claims processing, and payment reconciliation, ensuring that records are precise and ready for tax reporting.
Streamlined financial reporting: Leveraging technology to automate and streamline billing workflows
As the end of the tax year approaches, healthcare practices are faced with the critical task of ensuring their financial records are accurate, compliant, and ready for submission, says Medserv’s Derek Kelly
latest guidelines. This proactive approach reduces the risk of audits or penalties, providing peace of mind during tax season.
throughout the year ensures that every transaction is properly documented. This makes the transition to year-end reporting seamless, with comprehensive financial summaries available at your fingertips.
Real-time financial insights: Live reporting systems provide real-time access to financial data 24/7, 365 days a year. As tax deadlines loom, healthcare professionals can quickly retrieve up-to-date reports, track outstanding claims, and ensure that no revenue is left unaccounted for. Complete transparency ensures that practices remain in control of their finances at every step.
Proactive claim management for cleaner records: Unresolved claims can create inconsistencies in financial records, making yearend reconciliation more difficult. Proactive denial and rejection management ensures that claims are addressed promptly throughout the year, reducing the burden of chasing outstanding payments when closing out annual accounts.
Compliance and peace of mind: Tax laws and healthcare regulations are constantly evolving. Partnering with billing experts ensures that all claims are compliant with the
Comprehensive year-end tax reports: Perhaps most valuable of all, detailed monthly and year-end financial reports paint a clear picture of your practice’s financial health. These reports summarise income, expenses, outstanding claims, and overall performance, making tax filing straightforward and hasslefree. Practices can confidently submit their taxes, knowing their financial data is accurate and complete.
Boosting cash flow and financial predictability: With optimised billing processes, practices benefit from faster reimbursements and enhanced cash flow, which is especially important at the end of the tax year. Access to insightful reports empowers medical consultants to make informed financial decisions, set new goals, and plan for sustainable growth in the year ahead.
A trusted billing partner is dedicated to ensuring the financial success of healthcare practices. As the tax year draws to a close, expertise in revenue cycle management, combined with advanced technology, ensures that your practice operates smoothly while meeting all tax obligations. Closing out the tax year doesn’t have to be a daunting task. By working with a dedicated billing company, you can alleviate the administrative burden, minimise errors, and ensure your financial records are in top shape. Let the experts handle the complexities of medical billing, so you can focus on providing exceptional care to your patients.
Discover more about Medserv here.
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