An exclusive interview with Mabon ap Gwynfor, Plaid Cymru’s spokesperson for health, social care and housing
Jason Foster on the promise of dramatically improved efficacy
THE DEEPSEEK BOMBSHELL
What does the new AI platform means for healthcare?
“In Wales, and indeed much of the UK, what we have is not a National Health Service but a National Illness Service...”
During a time of extraordinary pressure for the NHS, Mabon ap Gwynfor, Plaid Cymru’s spokesperson for health, social care and housing, believes that investment in preventative healthcare should be a priority for Wales and beyond.
In an exclusive interview with Healthcare Today, he talks about how technology could help with the healthcare disparity between rural and urban areas of Wales, the need to solve the personnel crisis in the NHS, and why he believes the possible closure of Cardiff University’s nursing programme is an issue of national concern.
Also in this issue, Jason Foster, chief executive of Ori Biotech, talks about the evolution of personalised therapies and precision medicine; global healthtech leader Konrad Dobschuetz argues that we can never eliminate bias in AI for healthcare; and much more!
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A new report from The National Audit Office outlines the extent of the government’s maintenance backlog, covering key public services including the NHS.
Building failures are now impacting the delivery of services within the NHS, with the report finding that there was an average of 5,400 clinical service incidents occurring within the health service every year between 2019-20 and 2023-24. Alongside clinical service incidents, the knock-on effects of these failures include poor staff retention and impacts on the ability to hit environmental targets. The report also identified that the maintenance backlogs have also been steadily increasing over the course of the past decade, with NHS England’s backlog increasing at an average of around £800 million per year.
“This report is further evidence of the enormous impact that starving services of vital capital funding is having. The cost to eradicate backlog maintenance in the NHS alone has risen to a staggering £13.8 billion –more than the £13.6 billion total cost of running the entire NHS estate,” said Matthew Taylor, chief executive of the NHS Confederation.
The National Audit Office makes four recommendations in the report.
First, there should be a standardised definition of the maintenance backlog so the true figure can be calculated. Second, that data on the backlog should be included in the State of the Estate report from next year.
It also calls for departments to produce long-term property plans, setting out capital needs and a plan for how to reduce the backlog. And finally – and urgently – that thought be given how the backlog can be tackled ahead of the next, and subsequent, spending review periods.
“Allowing large maintenance backlogs to build up at the buildings used to deliver essential public services is a false economy,” said Gareth Davies, head of the National Audit Office. “The government needs better data on the condition of its operational assets and should use it to plan efficient maintenance programmes to deliver better services and value for money,” he continued.
A report from the BBC has raised concerns around the standard of maternity services at two maternity units in in Leeds.
The freedom of information request obtained by the BBC revealed at least 56 cases from January 2019 to July 2024 where there had been a combination of stillbirths and neonatal deaths. In each case, the Trust’s review had identified care outcomes which might have made a difference to the outcome for babies.
Families are calling for an independent review into Leeds Teaching Hospitals NHS Trust, specifically for a judge-led enquiry to help improve maternity safety.
Medical negligence law firm Irwin Mitchell is representing a number of families who were all under the care of Leeds Teaching Hospitals NHS Trust when issues in their maternity care arose. “While we recognise maternity services in Leeds have been rated as a good by the Care Quality Commission, our clients remain concerned about the actual care families are receiving,” says Katie Warner, specialist maternity safety lawyer at Irwin Mitchell.
“They believe while paperwork is in place, these tick boxes for when inspectors visit and care on the ground is different. Our families’ concerns include staff communication with families and not listening to mums’ concerns,” she continues.
Leeds Teaching Hospitals NHS Trust had the highest neo-natal mortality rate in the UK of 4.46 per 1,000 live births in 2022. This is based on data from MBRRACE-UK – which reviews stillbirths and neonatal deaths.
Public expenditure for people in the last year of life across healthcare, social care and social security has reached £22 billion of which more than half (53%) is on healthcare. This equates to £18,020 per person.
This is the chief finding of research from the Nuffield Trust and the Health Economics Unit, commissioned by leading end-of-life charity Marie Curie.
Hospital care represents the largest share of healthcare spending, accounting for 81% of total healthcare spend (£9.6 billion). More than half of this healthcare spend (56%) goes on emergency hospital care (£6.6 billion).
In contrast, public spending on primary and community healthcare makes up only 11% (£1.3 billion) of health expenditure for people in the last year of life, with less than 4%
(£414 million) spent on hospice care. The remainder is taken up by GP practice costs and out-ofhospital care.
“The UK government has pledged to move more care out of hospitals as part of its 10-Year Health Plan for the NHS in England. But with £4 in every £5 of health care spend for those in their last year of life going on hospital care, our findings show the government has a serious challenge ahead to make this a reality for those in need at the end of life,” said report co-author and Nuffield Trust deputy director of research Sarah Scobie.
Marie Curie says there is a significant lack of access to end-of-life care in communities, leaving people dying alone, without the care they want at home and too often forced towards emergency services, such as ambulances and A&E, and admitted to hospital for their final moments.
The end-of-life charity is calling for a transformation fund to invest in innovative community-driven ways of caring for those at the end of their lives to help reduce hospital expenditure in line with targets and ultimately improve access to care and support for dying people.
“There is only one chance to get end-of-life care right, and alongside increased support for community services, we’re calling on the government to deliver a long-term funding plan, that includes ways to future-proof the workforce, so that wherever you live, whatever your illness, you’ll be able to rely on good care right to the end,” said Sam Royston, executive director of research and policy at Marie Curie. “All UK governments must prioritise palliative care to ease the strain on the overburdened and underfunded NHS and create a system that works for everyone,” he continued.
The long-awaited court case about the role of physician associates (PAs) and anaesthesia associates (AAs) that the British Medical Association (BMA) has brought against the General Medical Council (GMC) will start on 12 February in London.
In June last year, the BMA claimed that there is a dangerous blurring of lines for patients between highly skilled and experienced doctors, and assistant roles. The GMC has been using the term “medical professionals” in its materials to describe all of its future registrants – both doctors and associates. This includes in Good Medical Practice, the key GMC guidance document for doctors which defines the standards of care and behaviour that are expected, and which is used as a reference to determine fitness to practise.
“PAs are not doctors, and we have seen the tragic consequences when this is not made clear to patients. Everyone has the right to know who the healthcare professional they are seeing is and what they are qualified to do – and crucially, not to do,” said BMA chair of council Phil Banfield.
Alongside the BMA, Anaesthetists United, an independent group of grassroots anaesthetists, have planned a separate but complementary legal action, which relates to the lack of national regulation of scope of practice for PAs and AAs. It is expected this will be heard in May.
Those cautioning about how PAs and AAs are presented have rallied around the case of Emily Chesterton. The 30-year-old died in November 2022 after suffering a pulmonary embolism following two appointments with a PA who she believed was a GP. Questions were raised in Parliament by her then MP Barbara Keeley, who
pointed out that Chesterton was diagnosed with a sprained ankle and told to rest and take paracetamol.
“The physician associate who saw Emily did not introduce herself and her role to Emily during the appointment. The practice said that the physician associate had failed to explore the causes of Emily’s symptoms, failed to refer Emily for clinical investigations, and failed to consult a doctor after seeing a patient who had presented twice in one week with significant risk factors for pulmonary embolism. The practice also raised concerns about the physician associate’s overconfidence and lack of insight into the limitations of her clinical knowledge and practice,” the Labour MP said.
The case alleges that the GMC’s failure to distinguish properly between qualified medical staff and PAs by not enforcing a national scope of practice for the latter after they graduate represents an unlawful failure in its duty to properly regulate the clinical practice of these associate professions in the UK.
“The tragic case of Emily Chesterton, among others, should by now have made clear that blurring the lines between doctors and their assistants
can have fatal consequences. It is unconscionable that despite so many warnings from medical professionals the GMC has forged ahead with its attempt to regulate PAs and AAs in a manner that encourages that blurring,” said Banfield.
The GMC has consistently rejected BMA concerns and claims that the term “medical professionals” is not a protected title. In a statement in response to the BMA’s threat of legal action, a spokesperson said that they believed that the grounds for the threatened judicial review are “not even arguable”.
“We have made it very clear we will recognise and regulate doctors, PAs and AAs as three distinct professions. We have also been consistent in saying that, as their regulator, we will expect PAs and AAs to always work under some degree of supervision and to practise within their competence. They will have a responsibility to clearly communicate who they are and their role in the team,” they said.
In December, the GMC set and clarified regulations for PAs and AAs following a consultation between March and May last year. In midDecember, it began to write, inviting them to join the professional register.
ANEW report from the All Party Parliamentary Group (APPG) on eating disorders highlights what it calls the urgent need for a national strategy to address the growing eating disorder crisis in the UK.
“What was already a struggling support system for those affected by eating disorders has collapsed under pressure,” writes Liberal Democrat MP Wera Hobhouse in the introduction.
NHS admissions for eating disorders have almost doubled since the COVID-19 pandemic – from 19,000 to 30,000 last year.
The report is damning. People face significant barriers to accessing treatment, it says. Healthcare providers are insufficiently trained, care pathways are fragmented and
there is a lack of standardised data around eating disorders. More to the point, there is a postcode lottery in service provision which leads to patients at times being discharged from services with dangerously low BMIs.
Responding to the report, Kerrie Jones, chief executive and founder of specialist eating disorder clinic Orri, damned its findings.
“The report’s findings resonate deeply and sadly reflect what we see every day on the frontline of eating disorder care: sufferers and families struggling to access timely, effective treatment and left feeling unseen by the system, navigating a postcode lottery for treatment,” she said.
The report brings to light the stark reality of funding inequalities, she continued, emphasising that adult
services receive, on average, less than one-third per capita of the funding allocated to services for children and young people – despite the new onset of eating disorders occurring in adults in around half of cases.
The report calls for both a national strategy for eating disorders and additional funding for eating disorder services which should address the demand for both adult and children’s services. At the same time, research funding should be increased for eating disorders to enhance treatment outcomes and ultimately discover a cure for eating disorders.
“We fully support the report’s call for comprehensive reform and stand ready to continue working alongside policymakers, clinicians and charities to ensure that recovery is truly accessible to all,” said Jones.
Biotech incubator Flagship Pioneering has signed a deal with Britain’s Cambridge University Health Partners (CUHP) and the Milner Therapeutics Institute (MTI) to advance breakthrough scientific research and technologies.
The collaboration will focus on research and innovation and will enable Flagship Pioneering’s ecosystem of more than 40 companies to partner with CUHP and MTI to access breakthrough science and technologies, clinical translation and trial support, and data assets and biosamples.
It will also allow for career development opportunities with the group’s Flagship Fellowship programme.
“Our collaboration with CUHP and
MTI blends breakthrough research, clinical trial support, access to data assets, and accelerated talent development,” said Junaid Bajwa, senior partner and UK head of Flagship Pioneering.
Flagship intends to work with Cambridge University Health Partners and the Milner Therapeutics Institute to access opportunities in other organisations in the Cambridge life sciences ecosystem.
Flagship Pioneering invents and builds bioplatform companies that transform human health or sustainability.
Since its launch in 2000, the company said that it has originated and fostered more than 100 scientific ventures, resulting in more than £48 billion in aggregate value.
EYE CARE specialist
Optegra has launched a new service for NHS glaucoma patients in Greater Manchester.
The new, free service launched at Optegra Eye Hospital Manchester means that glaucoma patients whose condition has changed can be monitored and reviewed by expert surgeons and offered treatment as necessary.
These are patients who need a specialist, which cannot be provided by their local optician practice, and to date have had no option but to be put on waiting lists for their Trust hospital.
“The treatment pathway can vary for glaucoma patients, from those
whose condition is stable and lowrisk and who are regularly monitored at their community optometrist, to those with more complex, high-risk cases who need surgical intervention or treatment at a Trust hospital,” said Robert Petrarca, consultant ophthalmic surgeon and glaucoma lead at Optegra.
“However, there is a large cohort of patients in the middle who need to be monitored by glaucoma specialists…
“With the new monitoring, review and treatment service, we will only need to refer those who need complex trabeculectomy surgery on to Trusts – which means speedier access to treatment, as well as helping relieve Trust waiting lists for glaucoma,” he continued.
Optegra, based in Didsbury, can treat patients within weeks of referral from an optometrist. Specialist interventions include adjustments to medication (a drop regime to manage eye pressure), laser surgery or a stent procedure to drain fluid to relieve pressure.
Patients will then either continue to be monitored at Optegra, be referred back to their optometrist or on to a Trust hospital dependent on the severity of their condition.
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SMALL business research initiative SBRI Healthcare and the NHS’ Health Innovation Network have awarded £3 million to four companies that help improve the health and wellbeing of children and young people.
The competition was open to single companies and organisations from the private, public, and third sectors, including large corporates, small and medium enterprises, charities, universities and NHS providers.
It focused on the management of longterm conditions in the priority areas of asthma, the most common long-term condition among children and young people and one of the top ten reasons for emergency hospital admission of children in the UK; epilepsy, the most common significant neurological disorder affecting children and young people; and diabetes, which is becoming increasingly common among young people in the UK, the
majority due to Type 1 but there are growing numbers of Type 2.
“These innovations were selected because they have the potential to make a big difference to improving the health and wellbeing of children,” said Verena Stocker, director of innovation, research, life sciences and strategy at NHS England.
The first of the four companies is TidalSense which has patented a fast-response carbon dioxide sensor embedded within a connected, handheld and battery-operated handset.
The project will develop prototype AI-derived asthma diagnostic software to be combined with this hardware for children and determine how it could be used in clinical practice.
Neuronostics is looking at the way in which electroencephalograms (EEGs) contribute to epilepsy diagnosis, with an indication of epilepsy likelihood
even when the EEGs do not contain clinical signals.
Tiny Medical Apps is developing a digital health passport for epilepsy. Co-designed with Young Epilepsy, it will provide medication management, seizure tracking, and wellbeing support, with a special focus on those with learning disabilities. Features include voice control and NHS system integration.
Finally, Transdermal Diagnostics has introduced a non-invasive continuous glucose monitoring system. Its wearable device features disposable sensor patches and a rechargeable transmitter, offering continuous blood sugar monitoring via a mobile app.
The four projects have been awarded Phase 1 funding for six months to demonstrate technical and commercial viability. This phase enables 12 months of development and prototype evaluation before real-world implementation.
THE PRIVATE SECTOR treated more than 1.5 million patients from waiting lists last year, particularly in orthopaedics and ophthalmology care.
Over the past four years, the number of NHS patients who were served by the private sector has increased by 50%.
According to data from membership body the Independent Healthcare Providers Network (IHPN), the independent health sector delivered almost half a million (460,000) episodes of care a month last year for NHS patients, including appointments, scans, tests and surgical procedures.
All activity was paid at NHS prices.
It is now the case that independent providers are delivering 10% of all NHS elective care, and the sector carried out almost one in five NHS operations overall in the past 12 months – 18,000 every week.
“This latest data shows the independent sector’s increasingly pivotal role in delivering frontline NHS care – treating and removing more than 1.5 million patients from the waiting list in 2024 and helping the government to meet its key milestone to ensure 92% of patients are treated within 18 weeks by the end of this parliament,” said David Hare, chief executive of the IHPN.
The sector is playing a particular role in the delivery of NHS orthopaedics and ophthalmology care. In November last year, for example, over 22% of all NHS trauma and orthopaedics activity and over 21% of all NHS ophthalmology activity were delivered by independent providers.
As Healthcare Today reported, earlier this month the government published a new partnership agreement with the independent sector as part of plans to end the hospital waiting list backlog.
“This new agreement will help to cut waiting time faster in parts of the
country where the need is greatest,” said health and social care secretary Wes Streeting.
The NHS and Independent Sector Partnership Agreement will help expand capacity and widen patient choice by setting out how more treatments can be delivered through the independent sector, with care remaining free at the point of use.
The independent healthcare sector estimates that it can provide an additional 1 million appointments a year for NHS patients.
“Given NHS waiting lists are still at record levels, the sector is committed to building on this already impressive achievement and will be working with the government to ensure the principles contained in the recent NHS and independent sector partnership are fully embedded – enabling patients to have a greater choice over their care so they can get the treatment they need, when they need it,” said Hare.
A new report from the global think tank Milken Institute responds to the challenge posed by the need to invest in national health prevention infrastructure while also funding existing spending priorities within the NHS.
The report proposes two financing mechanisms to channel additional capital into community-level preventative services: a blended finance fund to attract Local Government Pension Scheme funding, using business relief to attract additional private capital, and a social impact bond to provide an initial proof of concept. The think tank calls its proposals “starting points” to inform policy conversations on how to ensure the longterm sustainability of the NHS.
“Investing in prevention improves individual health and makes economic sense,” said Simon Radford, director of policy and programming at the Milken Institute and one of the report authors.
The report argues that the establishment of a prevention fund, structured as a blended finance fund, would leverage government resources and philanthropic capital to attract additional investment from local government pension pools seeking both financial returns and positive social impact. By mobilising local government pension money, the government would solve multiple ambitions at the same time. First, it would meet the challenge outlined in the chancellor’s recent Mansion House speech for pension money to invest more both in the UK and into infrastructure. Second, it would help stem the flow of patients into the NHS. And third, it would temper the growing social care bill that is putting pressure on local council finances. It would do this while providing returns for local government pension fund beneficiaries.
“While this report focuses on the UK context, we hope that this pathbreaking work will hold lessons for health systems globally,” added Esther Krofah, executive vice president of Milken Institute Health.
“Health systems around the world are wrestling with how to fund both the treatment of a growing incidence of chronic disease while also finding ways to finance effective, long-term investment in prevention to reverse this trend,” she added.
The Royal College of Nursing (RCN) has approved a new member resolution and disciplinary policy.
This, it says, will enable the RCN to support members who have concerns about the behaviours of others by providing a fair and just process to seek resolution, while addressing poor conduct where needed.
Following the scheduled review of the existing RCN member resolution policy, the world’s largest nursing union and professional body commissioned external consultancy Unheard Voice to invite the views of members to inform an update on the policy.
All elected and appointed members, as well as those with experience in the process, were also asked to make submissions to the external review and provision was also made for anonymous submissions.
The review and experience of members looked at five areas of policy development.
First, the experience of members raising complaints or being named in a complaint at the start of the process. Then how can the RCN better support and encourage informal resolution of matters where that is appropriate.
Third the review looked at tightening timeframes and actions within the formal disciplinary investigation and hearing stages.
The review also looked at supporting members throughout the resolution process. And finally, clear lines of accountability for the delivery of the process have been drawn.
Rentschler Biopharma, a global contract development and manufacturing organisation for biopharmaceuticals, has said that it will close its operations in Stevenage as the firm increases its focus on biologics.
“Following a comprehensive strategic review, we are focusing our efforts on areas where we see the greatest demand and potential to create value sustainably,” said Benedikt von Braunmühl, chief executive of Rentschler Biopharma, in a statement.
“Biologics remain central to our operations, while we continue to evaluate other potential modalities.”
The Stevenage plant – the group’s only British outpost – has specialised
More than 17 million doses of illegally traded medicines were taken out of circulation last year by the Medicines and Healthcare products Regulatory Agency (MHRA) and its law enforcement partners. These included painkillers, sleeping tablets and erectile dysfunction treatments.
The MHRA’s Criminal Enforcement Unit (CEU) leads efforts to disrupt medicine crime. Using its legislative powers, it can freeze bank accounts, intercept digital currencies, seize luxury goods and confiscate the proceeds of crime following conviction. In 2024, the CEU’s financial investigators denied criminals access to a total of £7.5 million in assets.
“Criminals are in the illegal medicines trade for one reason only, to make
in cell and gene therapy. This is something, von Braunmühl said, which has “experienced slowerthan-expected growth, with demand across the industry not meeting our expectations”.
The firm said that it will support the affected employees by providing resources and assistance.
It has been clear that the company has seen biologics as the future. Last year the firm made its largest single investment to date at its headquarters in Laupheim, to enhance production efficiency and upgrade the site capabilities.
Earlier in the year, its new production line, in Milford, Massachusetts, became fully operational with four new 2,000 L single-use bioreactors.
money. By seizing their profits, we’re removing that single motivation,” said Andy Morling, who heads the MHRA’s Criminal Enforcement Unit (CEU).
Most of the seized medicines are not licensed for sale in the UK and they can contain too much or too little of the declared active ingredient and may also contain other ingredients not approved for use. The 17 million doses seized include 5.5 million doses of erectile dysfunction medicines, 5.5 million doses of pain treatments, 2.8 million doses of sedatives, 1.6 million doses of sleep disorder treatments, and 1.9 million doses of other medicines.
The CEU also continued to target those individuals and networks illegally trading in medicines online, disrupting more than 1,500 websites and posts on social media accounts selling medicinal products illegally.
“We work tirelessly to protect patients by preventing medicine crime, disrupting it, and bringing offenders to justice.,” added Morling.
“We do this by working with partners to remove illegally traded medicines from circulation, deny the criminal networks the proceeds of their crimes and disrupt online criminality.”
Children’s medical negligence claims have cost NHS Trusts in England more than £3.1 billion in compensation payouts alone in the past five years. Failure and delays in treatment and diagnosis were among the top causes of legal cases lodged against NHS Trusts.
Research conducted by Medical Negligence Assist has found that between them, the Trusts have settled 3,388 claims.
“The consequence of clinical negligence involving children’s care can be life-changing for those affected but equally devastating for the families,” said Medical Negligence Assist solicitor Sophie Cope.
The issue of medical negligence when it comes to children’s care has been in sharp focus with recent cases such as that of former Great Ormond Street orthopaedic surgeon, Yaser Jabbar who faces allegations
of leaving dozens of children with life-altering conditions and some requiring amputations due to botched surgery between 2019 and 2023.
A total of 127 NHS Trusts across England have had a combined 5,657 claims and incidents of medical negligence involving children aged between 0-17 reported to the NHS legal body since 2019.
Mid and South Essex NHS Trust alone has had to pay out £103.3 million settling 74 claims between 20192024. This is more than any other Trust in England.
The highest number of claims, however, have been settled by Manchester University Trust which has had to pay out £76.8 million to settle 104 legal claims of child medical negligence lodged against it in the past five years.
Since 2019, it has had 223 claims and
incidents of clinical neglect involving children’s care reported to the NHS legal body.
Death, brain damage, cerebral palsy and bowel damage are just some of the conditions and injuries children have sustained as a result of medical negligence across NHS Trusts in England.
The investigation from Medical Negligence Assist showed that 6,536 children’s clinical negligence claims and incidents have been reported to the NHS legal body in the last five years. Of those, 1,491 pertained to failure or delays in treatment and a further 1,079 were regarding failure or delays in diagnosis.
Death as a result of clinical negligence was the most prevalent type of claim, of which there have been 465 lodged against NHS Trusts in the last five years, with settlement payouts amounting to £34.3 million.
THE LATEST annual report from MBRRACE-UK, a national collaborative programme of work involving the surveillance and investigation of maternal deaths, found that 625 women died during or up to one year after the end of pregnancy between 2020 and 2022, including 38 recent migrant women.
“The maternal mortality rate for this period is significantly higher than that reported for 2017-19 and this remains significantly higher when deaths due to COVID-19 are excluded,” the report says.
Thrombosis and thromboembolism were the leading causes of maternal death during or up to six weeks after the end of pregnancy. The leading causes of late maternal deaths were mental-health related (34%) with deaths due to suicide or other psychiatric causes occurring in equal proportions.
“There simply aren’t enough staff to provide the safe, personalised and compassionate care that every woman deserves,” said said Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, responding to the report. “
“The tragic impact for women will continue until the government invests in improved staffing levels and training time, including for perinatal mental health services.”
There are distinct differences in the quality of care received. Inequalities in maternal mortality rates remain with a nearly three-fold difference in rates amongst women from Black ethnic backgrounds and an almost two-fold difference amongst women from Asian ethnic backgrounds compared to White women.
Nine percent of the women who died during or up to six weeks after pregnancy in the UK in 2020-22 had
difficulties such as a mental health diagnosis, substance use and domestic abuse.
Women living in the most deprived areas continue to have maternal mortality rates twice that of women living in the least deprived areas.
“We… strongly urge the UK government to develop strong, cross-government targets to end inequalities in maternity outcomes, supported by ring-fenced funding and wider investment in public health and NHS services,” added Thakar explaining that this should be co-produced with ethnic minority women and backed by evidence on expected impact.
“Improving maternity care safety is an absolute priority for the College, through our work as educators, in our quality improvement programmes and our clinical guidance,” she concluded.
Plaid Cymru’s spokesperson for health, social care and housing talks about how devolution has worked and what is needed to solve the NHS personnel crisis in Wales.
Written by Adrian Murdoch.
MABON AP GWYNFOR, member of the Senedd for Dwyfor Meirionnydd and Plaid Cymru’s spokesperson for health, social care and housing, talked to Healthcare Today about what the healthcare priorities for Wales should be, how technology could help with the healthcare disparity between rural and urban areas of Wales, and why he believes the possible closure of Cardiff University’s nursing programme is an issue of national concern.
There is clear pressure on the NHS. Where should the priorities in Wales be?
The NHS will always require substantial funding because medical advancements continually introduce new treatments, drugs and technologies.
These innovations come at a high cost. The current system primarily focuses on treating illness rather than promoting health. In Wales, and indeed much of the UK, what we have is not a National Health Service but a National Illness Service.
The emphasis has been on allocating funds to frontline care – hospitals and secondary care –rather than prioritising prevention.
This is not how it should be.
Instead, we need to redirect our focus and resources toward preventative healthcare. By investing in prevention, we can address health issues before they develop into more serious conditions, ultimately reducing the strain on frontline services.
Of course, I acknowledge that this shift will not be immediate or without challenges. But once this balance is achieved, we will see
I am deeply concerned that Cardiff University’s proposed announcement will have a detrimental impact on patient outcomes in Wales and, more broadly, on the health of our nation.
a more sustainable system – one where less funding is needed for reactive care because fewer people are becoming seriously ill in the first place.
The BMA’s Welsh GP committee voted to accept the revised 24/25 contract offer last week. Can the government afford to do this?
To fully appreciate the challenges
facing the NHS, we must recognise that its workforce is fundamental to the delivery of healthcare. If doctors, nurses, and allied health professionals are not valued and fairly compensated, they will leave.
This has serious consequences –not only for the healthcare system itself but, more importantly, for the patients who rely on it. The question, then, is not whether
we can afford to pay healthcare professionals what they deserve, but rather whether we can afford not to.
However, the issue extends beyond pay. While fair wages are crucial, many healthcare workers – particularly in nursing – are not leaving the profession entirely; they are simply moving to agency roles or the private sector, where they
receive better contracts, improved professional development opportunities, and more flexible working hours.
The NHS still operates under contractual and organisational frameworks rooted in the 1970s. This is evident not only in employment practices but also in outdated approaches to digitisation and service delivery.
If the NHS is to remain effective and sustainable, it must undergo modernisation across multiple fronts. This is not merely a managerial issue; it is a political one. Real change requires leadership and vision at the highest levels of government to ensure that the NHS is fit for the future.
How much does the announcement from Cardiff University about the possible closure of its nursing programme concern you?
I am deeply concerned that Cardiff University’s proposed announcement will have a detrimental impact on patient outcomes in Wales and, more broadly, on the health of our nation. While Cardiff University operates as an independent institution, the Welsh government relies on universities to support essential training programmes, including medical and nursing education. It is, therefore, the government’s responsibility to ensure that crucial courses – such as Cardiff’s nursing school –continue to operate.
Wales cannot afford to remain dependent on recruiting nurses from overseas for the next 25 years. We must focus on training and developing our own workforce. Cardiff University’s nursing school is one of the most respected in the UK – ranked among the top five –and its closure or downsising would significantly hinder our ability to train the number of nurses needed to sustain our healthcare system.
So far, the government has completely distanced itself from the issue, despite its significant financial role in higher education.
The government funds universities, contributes to student fees, and provides financial support to nursing students. Given this level
of involvement, it should have a say in ensuring that a programme as vital as Cardiff’s nursing school continues. It is not enough to stand by.
What concrete policies do you think are needed to solve the personnel crisis in the NHS in Wales?
When discussing the need for more healthcare staff, it is essential to consider both recruitment and retention.
The Welsh healthcare system is losing staff at an alarming rate, and before looking outward to bring in new workers, the priority should be to keep the skilled professionals already in place. To do this, policies must be developed that modernise employment contracts, ensuring they offer nurses the flexibility they need.
This issue is particularly pressing in nursing, where over 90% of the workforce is female.
Regardless of personal views on gender roles, the reality is that women still take on the majority of caregiving responsibilities in society and until there is a significant cultural shift where men share these responsibilities equally, healthcare contracts must reflect this reality by providing nurses with the flexibility necessary to achieve a work-life balance. At present, many nurses in Wales work far beyond their contracted hours, accumulating millions of unpaid hours annually. Due to the nature of their job, nurses cannot simply walk away at the end of their shift; they stay to complete their duties, often without pay. Their contracts must be updated to acknowledge these demands and provide the necessary structural support.
Beyond flexibility, nurses must also be given opportunities for continuous professional
development within their working hours.
This would allow them to maintain their licenses, enhance their skills, and see a clear path for career progression.
The government must ensure that contracts not only provide fair pay but also demonstrate genuine appreciation for the workforce.
In some hospices and private care homes, nurses sometimes accept lower wages in exchange for better contracts with improved working conditions.
This demonstrates that pay, while important, is not the sole factor in retaining staff – better working conditions and career development opportunities are just as crucial.
We cannot afford to leave people behind. Every household and community must have access to modern digital services.
Can technology help reduce the gap?
In the past year, there has been a great deal of discussion about artificial intelligence (AI), and while some concerns are understandable, I am genuinely excited about the potential AI holds for the healthcare sector.
In particular, AI could revolutionise
Mabon ap Gwynfor at First Minister’s Questions © Welsh Government (Crown Copyright), all rights reserved
diagnostics, especially in fields like cancer detection.
I recently attended the European Council summit in Brussels, where I was part of a panel discussing the rollout of a new European cancer app. The concept is simple but powerful. Patients would have an app where they can store and manage their own health information, deciding who has
access to it. For example, if a patient suffers from shortness of breath or joint pain, they could document these symptoms in real time.
With patient consent, this data could be shared with healthcare professionals, enabling them to track patterns and detect potential health concerns earlier.
We are now exploring the possibility of adopting this system in Wales, ensuring that patients here have access to the same technology.
Beyond individual patient care, AI could analyse data from thousands – or even millions – of users, identifying trends and correlations that might otherwise go unnoticed. This would not only streamline diagnosis and prognosis but also ease the burden on GPs and hospitals, freeing up valuable time and resources. Some countries are already leading the way in this digital transformation. Estonia, for instance, has successfully integrated digital healthcare into its national system, and Finland has been digitising medical records since the 1970s.
Meanwhile, in Wales, we are still relying on fax machines and paper records.
The potential benefits are immense – better efficiency, improved patient outcomes, and a more sustainable healthcare system. This is where we need to be heading, and we must act now to make it a reality.
Can technology help with the healthcare disparity between rural and urban areas of Wales?
Technology is undoubtedly one of the key solutions to improving healthcare, and we already have tools at our disposal that could be better utilised.
Telemedicine, for example, has proven to be highly effective in rural areas of France, the US, and other countries. However, in Wales, it has yet to be fully implemented and used to its maximum potential. To improve healthcare accessibility, we must make better use of the technology already available to us.
However, there is another pressing issue – digital connectivity. In many parts of Wales, particularly in my constituency, there are numerous black spots where fibre broadband has not yet reached households and mobile phone signals are unreliable or nonexistent. This digital divide presents a major barrier to implementing telemedicine and other modern healthcare solutions.
The situation is set to become even more urgent as BT prepares to switch off copper phone lines, meaning that broadband and phone services will soon rely entirely on fibre connections. Yet, many communities in Wales still lack the infrastructure, leaving them at risk of being further disconnected.
We cannot afford to leave people behind. Every household and community must have access to modern digital services.
Ensuring universal connectivity is not just a matter of technological progress – it is a fundamental issue of healthcare equity.
Can community involvement and local solutions pick up some of the slack?
Before devolution, when decisions were centralised at the UK level, policymaking was viewed almost exclusively through the lens of London, often failing to consider the unique dynamics and needs of communities across the country. Devolution has helped address this imbalance.
True progress, however, must come from the bottom up, driven by the voices of local communities rather than imposed from above.
A stark example of this failure occurred in 2013 when the health board in North Wales introduced a program called Healthcare in North Wales is Changing. The plan aimed to close several community hospitals and implement what was termed a “hub-and-spoke” model. While the concept may have sounded reasonable in theory, in practice, it was one designed by individuals familiar with healthcare
“Currently, primary particularly GP services, a significantly reduced the health budget decade ago, despite 90% of patient interactions.”
provision in urban areas, with little understanding of the realities of rural Wales.
Policies should be developed in collaboration with the people they affect, rather than imposed on them by decision-makers who do not fully grasp the challenges of delivering healthcare in rural areas.
What would be your healthcare priorities for the next two years?
While preventative measures are crucial for long-term health outcomes, addressing the immediate crisis of NHS waiting lists requires a more immediate focus. It is a symptom of deeper problems within the healthcare system.
Two critical areas that need immediate attention are primary care and social care. Currently, primary care, particularly GP services, receives a significantly reduced portion of the health budget compared to a decade ago, despite handling over 90% of patient interactions. This underfunding necessitates increased investment in GP services, including improved GP contracts that allow for more patient time and the recruitment of 500 additional GPs over the next two terms.
primary care, services, receives reduced portion of compared to a despite handling over interactions.”
This disconnect became glaringly obvious during a Q&A session with a senior member of the health board who admitted that “we haven’t figured out rural Wales yet”. And this was at the final stages of implementing the policy!
This is why we must listen to the voices of rural Wales. We need to understand what works and what does not, what local communities fear, and what they welcome.
Social care, often neglected and underfunded, is another crucial aspect. Social care workers are significantly undervalued, with limited career progression and inadequate compensation. This needs to be addressed to attract and retain qualified professionals. Furthermore, the immense contribution of unpaid carers, valued at approximately £8 billion annually in Wales, must be acknowledged and supported.
By addressing these two critical areas, we can effectively address the root causes of the waiting list crisis and improve the overall health and well-being of the Welsh population.
The chief executive of Ori Biotech explains why personalised medicines hold the promise of dramatically improved efficacy and safety.
Written by Adrian Murdoch.
ORI BIOTECH is a global leader in cell and gene therapy manufacturing technology and chief executive Jason Foster is a recognised thinker and speaker in the field.
Here, he talks to Healthcare Today about the evolution of personalised therapies and precision medicine, where to look for innovation in the field and, crucially, how to get it funded.
Healthcare Today: What role do you see personalised therapies and precision medicine playing in the future?
Jason Foster: The vast majority of medical interventions available today can be described as “generic” – not in the sense of generic medicines, but in their broad applicability. This generalised approach, however, often results in limited efficacy. Statistically, the proportion of patients who respond positively to these interventions is frequently below 50%.
One of the primary challenges is our limited ability to predict which patients will respond to which treatments. In the absence of more precise tools, healthcare providers rely on what is often referred to as a “shotgun approach,” administering treatments broadly across patient populations.
While this method has been the norm for the past 20 to 30 years and is certainly better than no intervention, it is far from optimal.
We are now witnessing a significant shift toward personalised medicine – an emerging approach that tailors medical treatments to the unique characteristics of each patient. This has profound implications for the pharmaceutical supply chain, medical practice, and healthcare
delivery. By focusing on the specific needs of individual patients, personalised medicine holds the promise of dramatically improved efficacy and safety.
A compelling example of this transformative potential can be seen in CAR T-cell therapies. These treatments, designed for oncology patients, already demonstrate success rates exceeding 90% in achieving complete responses. The patients who benefit from these therapies are often at advanced, refractory stages of illness, having failed traditional interventions such as chemotherapy and, in many cases, bone marrow or stem cell transplants. For these critically ill patients, CAR T-cell therapy often
represents their last hope, and the results are nothing short of extraordinary.
But this shift to personalised treatments brings its own set of challenges, particularly in making these highly specialised treatments widely accessible. The question then becomes: how do we ensure that personalised medicine is not only effective but also available to all patients who need it?
Healthcare Today: These solutions face huge challenges in scalability and cost. How do you bridge that gap?
Jason Foster: The cost of developing personalised medicines
Traditional pharmaceutical supply chains are designed for broadly applicable treatments. Personalised medicine
is indeed significant, with estimates suggesting it takes between $1 billion and $2 billion to bring a single pharmaceutical product to market. While personalised medicines are somewhat more expensive to develop than traditional treatments, the greater challenge lies not in their cost but in the complexity of their production and delivery. Traditional pharmaceutical supply chains are designed for broadly applicable treatments. Personalised medicine disrupts this model entirely. When a treatment is tailored to a single patient, the supply chain must be reimagined.
Addressing this challenge requires a fundamental shift in how we
think about pharmaceutical manufacturing and delivery. It often involves a “circular supply chain,” where the process starts with the patient. For example, a patient’s immune cells might be collected at a hospital and transported to a manufacturing facility. There, they undergo a complex series of processes before being returned to the patient as a finished therapeutic product. This cycle, from start to finish, typically takes six to twelve weeks or more.
These therapies are not only personalised but often living medicines. Unlike chemical or biological treatments, living cell therapies come with unique considerations. Cells must be
carefully preserved, unlike relatively stable chemical compounds. This adds layers of complexity to every stage of the process.
The cost of these therapies reflects their intricacy. Cell therapies, for instance, range from $400,000 to $500,000 per patient, while gene therapies can cost up to $5 million per patient. Despite these high prices, cost alone is not the primary barrier to wider adoption. Even if prices were reduced to zero, the physical capacity to manufacture these treatments would still be a limiting factor. The processes involved are difficult, resourceintensive, and constrained by the unpredictability of biology.
This lack of manufacturing capacity is particularly evident with CAR T-cell therapy, the first generation of cell therapies. In the US, only 20% of eligible patients have access to these treatments. Globally, this figure drops below 5%.
To address these issues and expand access to personalised medicine, we need to innovate on multiple fronts. Better systems, advanced technologies, and new approaches to manufacturing and distribution are essential to driving the next wave of innovation. With these advancements, we can strive to make personalised medicines as accessible as traditional small molecules and biologics, transforming healthcare for patients worldwide.
Healthcare Today: How significant is the regulatory issue?
Jason Foster: The phrase “regulatory innovation” is not one we often hear – it almost sounds like an oxymoron. However, during the Covid-19 pandemic and its aftermath, we witnessed an extraordinary level of regulatory innovation. In just a
year, five or six new therapies and vaccines reached the market – an unprecedented feat made possible by regulators addressing the acute global need with remarkable agility.
In the US, leaders like Peter Marks [director of the Center for Biologics Evaluation and Research] have been particularly open and innovative in facilitating patient access to these therapies.
The Food and Drug Administration (FDA) implemented measures like fast-track reviews and the integration of Phase One and Phase Two clinical trials. These unprecedented actions underscored the regulator’s commitment to bringing novel treatments to patients without compromising safety or efficacy.
A few years ago, we had the opportunity to meet with the FDA, including Peter Marks and his leadership team. Their interest in our work was clear, as they understood the ultimate goal: to ensure that approved products reach patients who need them. While patient safety and treatment efficacy remain paramount, regulators are increasingly embracing innovation to expedite access to advanced therapies.
Consider the traditional model of pharmaceutical manufacturing. For decades, it has been a centralised process: a large facility produces medications or biologics, which are then packaged and distributed through the supply chain. But this model is not wellsuited for personalised medicine. For example, if a patient’s cells are collected in the UK and need to be shipped to a manufacturing site in the US, only to be processed and flown back, the inefficiencies in cost, time, and logistics are glaring.
Regulators such as the FDA and the UK’s Medicines and
Automation, including robotics, is crucial to reduce costs, improve quality, and remove human error from the process.
Healthcare Products Regulatory Agency (MHRA) are exploring a decentralised approach to manufacturing. This involves smaller, localised manufacturing sites that can produce treatments closer to the patient, reducing what is called “vein-to-vein” time – the period from when a patient’s cells are collected to when the treatment is delivered back. Both agencies have issued guidance and sought public input on distributed manufacturing.
While regulators have shown strong support for advanced therapies, significant challenges remain. Chief among them is the need for new technologies to underpin these innovations. The current infrastructure is
insufficient to execute distributed manufacturing effectively. Cloud-based systems, advanced manufacturing technologies, and other innovations are essential to delivering safe and effective medicines in this way.
The potential is vast, but realising it requires sustained effort, investment, and technological breakthroughs.
Healthcare Today: You mentioned innovation during Covid. Have we taken on board those lessons or have we slipped back into our old ways?
Jason Foster: Encouragingly, a bit of the openness and flexibility fostered during the Covid-19
pandemic is still evident, but there are signs of bureaucracy creeping back in.
For example, I recently spoke with a hospital-based manufacturer in Europe with a long history of producing CAR T-cell therapies inhouse. Over the past seven years, they’ve successfully treated more than 500 patients with their own CAR T-cell product and they were exploring the possibility of licensing this treatment to countries where access to CAR T-cell therapies is currently limited or non-existent.
Unfortunately, the licensing process hasn’t been quick and straightforward. Despite their proven track record, the company is being required to navigate the
conventional regulatory process, which is time-consuming and costly. This process could take years and require tens of millions of euros, delaying access for patients in other countries who could benefit from this already validated treatment. It’s a frustrating situation, especially when lives are at stake.
Healthcare Today: What innovations are you most excited about looking into 2025?
Jason Foster: One significant trend in cell therapy is the shift from viral transduction to nonviral transfection techniques for genetic modification. While viruses are efficient at delivering DNA into cells, their manufacturing
and handling are complex and costly. Consequently, methods like electroporation are gaining traction as alternative delivery mechanisms. This trend is expected to continue due to the high cost and manufacturing complexity of viral vectors.
Another key area of development is automation. Current cell therapy manufacturing processes often rely on manual lab techniques, making scaling to GMP (Good Manufacturing Practice) grade extremely challenging. Automation, including robotics, is crucial to reduce costs, improve quality, and remove human error from the process. Platforms designed with this “second layer” of automation in mind – automating beyond initial bottlenecks – will be key to industry advancement.
Finally, the application of AI and machine learning is a major emerging trend. The cell therapy industry currently holds vast amounts of data, much of it unstructured and on paper, making analysis difficult. Digital, cloudnative platforms are essential to capture, structure, and aggregate this data. This allows for in-depth analysis and the development of predictive models.
For example, when a batch fails quality control, AI can help pinpoint the cause, moving beyond simple explanations like “patient variation”. These tools can also personalise treatment approaches based on patient characteristics and process variations, ultimately improving patient outcomes. 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.
This is just the beginning of what these digital tools can achieve.
After the uncertainty created in the tech market by the launch of DeepSeek, Alex Fairweather examines what this means for AI in healthcare.
AS ARTIFICIAL INTELLIGENCE gets more efficient and accessible, we will see its use skyrocket, turning it into a commodity we just can’t get enough of,” noted Satya Nadella. Microsoft’s chief executive was right. Just when we thought the hype cycle of Generative AI was peaking, the launch of DeepSeek R1 has pumped it back through the roof. Not only that, but this seems to be a legitimate inflexion point in its potential for adoption and commoditisation.
To cut a long and highly technical story short, DeepSeek R1 was developed using existing large language models (LLMs) to train a smaller, more agile model, that uses a more human-like way of thinking. To quote Google Gemini: “‘Inference’ refers to the act of drawing conclusions or making predictions based on available data, while ‘reasoning’ is the broader process of analysing information, identifying patterns, and applying logical rules to reach those conclusions.” What it is saying is that inference is the outcome of reasoning, while the AI system uses its derived knowledge to make decisions based on the new data it has.
DeepSeek R1 uses a reasoning model that produces a more conversational thought process. Its code is open source, and its performancerelative-to-cost claims to be higher than existing applications such as Chat GPT. The wow factor isn’t necessarily in the performance though, but more in what it means for the next stage of AI development.
A key takeaway is that DeepSeek has been created at a reduced cost (or so it is claimed!) which reduces barriers-to-entry to building new, bespoke LLMs, using existing larger models, requiring less compute, energy and cost. This
opens the possibility of application development using office-based hardware rather than a reliance on large data centres and IT hardware infrastructure comprising thousands of chips. This concept isn’t new, but the launch has shown that it could be achievable much sooner than expected. I’ve read some comments that compare this to the advent of modern PCs replacing mainframe computers in the 1980s and 1990s. If this is true, as happened back then, it won’t happen at once but it will eventually cause total disruption and transform the industry.
The devil is in the detail with any online LLM. By default, anything uploaded and produced is usually given to the company that operates it. In the case of DeepSeek, you are giving whatever data you input to a Chinese company and by extension
AI can help healthcare professionals connect information to provide
the Chinese government. Generally, it’s against most companies’ IT policies to use any LLM when connected to company hardware or networks because of the risk of IP theft. Similarly, no one in their right mind should upload company documents or patient notes to an LLM unless it’s strictly used offline. This goes for all applications –not just DeepSeek – so in short,
personal use only, and never on work devices! When I tested DeepSeek myself, I found the responses to be easier to read, subjectively more pleasant and it was generally a better user experience due to the more conversational nature of the model. The model seems to provide a deeper response to questions. When asked about exercise-induced asthma treatment, for example, both
DeepSeek and ChatGPT suggested broader holistic options, though both missed some information the other didn’t. The former created a holistic summary with a suggested approach whereas the latter suggested three best options.
As previously mentioned, the real upside is DeepSeek’s efficiency – it requires lower energy and computing demands. The fact the source code is freely available means that developers can create a local (offline) model as long as it meets your country’s data security requirements. This is a real bonus and the area of the biggest potential in healthcare Generative AI.
In summary, the hype isn’t about what it can do now, but what it will change in the future, across the ecosystem of Generative AI.
As I’ve written previously and has been much-discussed, we can’t be over-reliant on artificial intelligence. AI is a great enabler to augment human performance and productivity, but it is not a replacement.
Interpreting complex results and incorporating qualitative feedback may have taken a step forward over the past week, but primarily this is where humans shine compared to AI. None of the live testing of all LLMs comes close to a highly trained and intuitive expert in the field.
AI can help healthcare professionals connect siloed information to provide holistic care. Reasoning models such as DeepSeek appear to facilitate this better than inferencing models, combined with the improved economics this seems to show, and the potential for AI applications to become more bespoke, could empower faster adoption across the life sciences through greater accessibility and lower entry barriers.
Thomas Wolf, open-source advocate and co-founder and chief science officer of Hugging Face, has said: “In the internet revolution, we’re moving from building websites as the main business to actually building internet-native companies – so, the Airbnb of AI, the Stripe of AI, they are not about the model. They are about the system and how you make the model useful for tasks.”
This nicely summarises my take; DeepSeek has helped lower barriers to entry and opened a door for new AI applications to be produced. It is growing the ecosystem necessary for mass adoption.
It’s still early days, but the signs are promising that we can expect faster democratisation and adoption of bespoke AI applications sooner than we believed possible a week ago.
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Konrad Dobschuetz, the founder director of
Leap Advisory & Intelligence, argues that we can never eliminate bias in healthcare.
LET ME get one thing out of the way straight away. There is currently and will not be for the near future true artificial intelligence (AI) comparable to human reasoning in play anywhere on this planet. I might eat my own words but lucky they will not solely be mine but no others than Apple’s very own large language model (LLM) researchers.
In their paper published in October 2024, they concluded that they “found no evidence of formal reasoning in language models… Their behaviour is better explained by sophisticated pattern matching - so fragile, in fact, that changing names can alter results by ~10%!”
Thus, we look at this topic regardless of sector with a machine learning mindset, not “intelligence”.
For this article, we will consider this as Machine Learning (ML) or algorithms, not AI. Besides the hype, we have entered a new era indeed and will see more applications appearing, but true AI is some way off.
This clarity is required to start looking at our initial premise. Is there bias in algorithms in healthcare and if there is, how can we avoid it? Do we need some sort of MOT for this and are we running the risk of health inequalities on steroids?
Currently there are only very few, in the main static views on these healthtech interventions, such as the AI Act of the European Union in conjunction with its Medical Device Review mechanism. It is a look-onceand-never-look-again approach.
Furthermore, there is not too much detailed consideration towards bias in AI in the UK worth speaking of, nay a view exists at least within one of the key watchdogs for patient safety, the Medicines and Healthcare products Regulatory Agency (MHRA).
According to Laura Squire, medtech regulatory reform lead and chief
officer there, bias “is an issue which the agency is acutely aware of from many perspectives. AI has the potential to significantly transform health, but there are also significant risks of it exacerbating health inequalities or worse, if bias in data is not handled thoughtfully.”
There are some pieces in the works to look closer into this, albeit localised such as the agencies work with the University in Birmingham called Standing Together. The question remains, is this enough?
The Food and Drug Administration (FDA) in the US does look again but only if significant changes in datasets are at play. Surely that cannot be good enough. In the conversations for this piece, I spoke to several leaders in this field. All people that have been there and done it; Implemented ML in clinical settings or are researching it.
One of the first questions we need to answer is what is algorithmic bias and how can it affect healthcare outcomes.
According to an excellent article on Codecademy, it arises “when an algorithm produces systematic and repeatable errors that lead to unfair outcomes, such as privileging one group over another. Algorithmic bias can be initiated through selection bias and then reinforced and perpetuated by other bias types”.
We are working off the premise that any algorithm currently used in healthcare settings is being trained with data of at least 40 years.
This data is riddled with bias, human bias that is. Would it not be fair to assume that any risk stratification, bed occupancy forecast, or pathway automation software is full of it too?
Richard Stones, president of UK-based C2-AI (formerly known as Copeland Clinical AI), which has a long track record in developing AI systems that help hospitals and health systems worldwide, has a clear view is on this.
“We should measure outcomes first as Social Determinants of Health (SDOH) determine your health.
Rather than artificially trying to adjust based on postcodes, we need to measure outcomes precisely and then understand the way these differ across SDOH/EDI lines. That highlights issues of bias and inequity effectively. The second element is training algorithms with sufficiently large, representative datasets to eliminate bias,” he says.
There comes the question if we need more data to avoid bias or should it be less to ensure we do not introduce it in the first place. One answer here lies potentially in the black box issue that algorithms carry.
Andreas Haimboeck-Tichy, managing director healthcare at Accenture UK who has worked on many related projects over the years with the MHRA and the various UK NHS entities comments that it is important to be clear about “who trains it [the algorithm] and how can its decisions be explained”.
This is an interesting take on the topic. Can we avoid bias altogether if we open the lid and make it all open source? Andreas mentioned another interesting question. ‘What is the bias in the people using ML solutions in healthcare?’ Is there indeed a connection where a double whammy of distortion comes in?
Imagine a scenario where a well used but misaligned algorithm is providing suggestions in risk stratification and a user feels a manual adjustment is needed. Might we as well go back to pen and paper and the good old days of Multi Disciplinary Teams (MDTs) huddling together in a badly lit room for a decision?
James Teo, professor of neurology, director of data science and AI at Kings College NHS Foundation Trust as well as joint director for data science and artificial intelligence at King’s College Hospital and Guy’s &
St Thomas’ Hospital NHS Foundation Trust, opened another can of worms, and rightfully so.
One of my pet peeves has also made it into the world of clinical algorithms, so-called “pilotitis”. According to him, we currently have a “1,000 flowers blooming scenario in which you need to weed many of them”. It is a tantalising view on the subject as it wraps around the bias issue.
What do you do with 1,000s of solutions that have been trained with limited sets of data as alluded to previously and riddled with flaws? How do you control their spread and most importantly, their misuse? After all, we are talking about patient safety.
In this exact vein comes the comment from Helga Brogger who works as a senior researcher in AI at Oslo-based risk management firm DNV.
She has highlighted that bias in healthcare is a multi-stakeholder issue and that we “need acknowledgement that it [bias] is a great risk”.
A board member of the Norwegian Council for Digital Ethics, she has worked on machine learning and algorithms since 2017 across a variety of sectors, not just healthcare.
Let us close with an eye-opening admission from Teo which is backed up by his experience.
To the question of whether we can ever eliminate bias in healthcare, he is quite clear that we cannot as “not all bias is undesirable, and bias is inherent to reality” so there will always need to be “human monitoring’”.
May that be in how we collect patient data or how we interpret the suggestions and predictions of an algorithm. In the end, it still is us that decide and not a machine.
And would we not want it to be that way?
Konrad Dobscheutz is the founder director of Leap Advisory & Intelligence.
On 27 May 2024, NHS England announced that 143 hospital sites will be part of the first phase of implementing Martha’s Rule (an automatic right to obtain an urgent review when hospital care is of concern and a patient’s condition is deteriorating).
Martha’s Rule derives from the committed efforts of the parents of Martha Mills after an inquest determined that their daughter would likely have survived had doctors heeded the family’s concerns. The approach allows early intervention, providing patients, their families and carers to with 24/7 access to rapid review from a critical care outreach team. Under the first phase, the initiative is to be in place and tested in these locations by March 2025. In collaboration with Martha’s parents, NHS England is developing materials that will explain and raise awareness of the initiative in hospitals.
On 21 October, 2024, the Patient Safety Commissioner for England published a finalised set of Patient Safety Principles, following a public consultation that garnered more than 800 responses.
The Principles - which include creating a culture of safety, putting patients at the heart of everything and treating people equitablybuild on efforts to improve patient safety that have been made over the past 20 years. There has been a move away from a slow, siloed and disjointed approach. A greater emphasis has been placed on learning, and, in particular, a focus on the need to hear the patient voice has become paramount.
2024 saw the launch of new patient safety initiatives, placing further emphasis on the importance of learning, and the need to hear the patient voice. Kennedys Law’s Christopher Malla, Ed Glasgow and Roger Davis consider some of the major legal milestones for the year ahead.
The Principles will assist those in governance in healthcare. They will be a guide for those in leadership positions, not only at Board level, but also at all levels within healthcare providers. The Principles are about safe, effective and compassionate patient care, and reducing avoidable harm in a just and learning culture.
Avoiding Brain Injury in Childbirth is a national programme that has been in development in recent years to improve maternity outcomes, and was launched on 7 October, 2024. Central to the programme is supporting maternity services to bring improvements in two particular areas of clinical practice. Namely, monitoring and responding to changes in fetal heart rate and the management of impacted fetal head at caesarean section.
The initiative includes new training methods, and protocols, incorporating learnings from lived experiences. Listening to those receiving and providing maternity care, as well as birth partners, and their families has been key to shaping the programme. There are currently nine maternity units at NHS trusts participating in the pilot.
Looking ahead, the Department of Health and Social Care has indicated that if successful, a national roll-out of the programme could follow soon.
Aimed at reforming and modernising the existing Mental Health Act 1983 (the Act), the Bill was introduced in the House of Lords on 6 November, 2024. The Bill advances the majority of the recommendations for reform made in December 2018, following an independent review of the Act.
The government has indicated that implementation of the reforms will be phased and is anticipated to take several years due to the need for recruitment and training of both clinical and judicial staff.
Published in November, 2024, there is no official government position on the Bill, however, Health Secretary, Wes Streeting has expressed his opposition.
The Bill extends to England and Wales only. The proposals set out a model of assisted dying that would enable terminally ill adults who are mentally competent and meet other eligibility criteria to request and lawfully receive the provision of assistance to end their own life. Among key measures within the Bill are those relating to eligibility requirements (including for the purposes of the legislation when a person will be considered to be terminally ill).
Having undergone a second reading on 29 November, 2024, Members of Parliament will soon start debating principles of the Bill during the Committee Stage in the House of Commons.
TIMELY and accurate diagnosis is the foundation of effective patient care. However, diagnostic delays remain a persistent challenge, often leading to deteriorated patient outcomes, increased treatment costs, and heightened legal risks for healthcare providers.
By understanding the causes of delayed diagnosis and implementing proactive strategies, healthcare professionals can significantly improve patient safety and care quality.
A delayed diagnosis occurs when a medical condition is not identified within a reasonable timeframe, often resulting in missed opportunities for early intervention. The consequences can be severe. Patients may experience disease progression that limits treatment options and reduces survival rates, particularly in conditions such as cancer, sepsis, and stroke, where timely intervention is critical.
Late-stage diagnoses also increase healthcare costs, as they often require more aggressive and prolonged treatments. From a legal and reputational standpoint, delayed diagnoses contribute significantly to clinical negligence claims, leading to financial settlements, increased scrutiny from regulatory bodies, and damage to the trust patients place in their healthcare providers.
The causes of diagnostic delays are varied, often arising from a combination of systemic, cognitive, and technological challenges. Overcrowded hospitals, workforce shortages, and long waiting times for referrals can create significant bottlenecks in the diagnostic process.
TMLEP’s Lead Healthcare Investigator Nina Vagad reports on the persistent challenges of diagnostic delays.
Clinician fatigue and cognitive biases can also contribute, particularly when symptoms are subtle or resemble less serious conditions.
Communication failures, such as delays in test result reporting or a lack of follow-up on abnormal findings, further increase the risk of missed diagnoses. In some cases, outdated technology or a lack of interoperability between healthcare systems can prevent clinicians from accessing the full clinical picture, leading to incomplete or incorrect assessments.
Addressing these challenges requires a multi-faceted approach focused on improving diagnostic processes, strengthening communication, and leveraging technology to enhance decision-making.
Encouraging multidisciplinary case discussions and second opinions can help reduce the risk of individual oversight.
Implementing structured diagnostic checklists and clinical decision support tools can also assist in identifying potential red flags that may otherwise be missed.
Improving patient engagement through clearer communication of test results and follow-up plans ensures that concerns are addressed
in a timely manner, reducing the risk of conditions going undiagnosed. Investment in digital health solutions, such as artificial intelligence and predictive analytics, can further enhance diagnostic accuracy by identifying patterns and highlighting cases that require urgent attention.
TMLEP plays a crucial role in supporting healthcare providers in navigating the challenges of delayed diagnosis. Through independent clinical investigations, TMLEP helps identify the root causes of diagnostic failures and provides actionable recommendations to improve patient safety.
Additionally, TMLEP’s consultancy services assist healthcare organisations in reviewing and refining their diagnostic pathways, ensuring that systemic limitations are addressed.
By offering expert medical opinions and in-depth case analysis, TMLEP enables healthcare professionals to learn from past incidents and implement best practices that reduce the risk of future delays. As healthcare continues to evolve, the importance of timely and accurate diagnosis cannot be overstated.
By recognising the risks associated with delayed diagnosis and adopting proactive measures to mitigate them, healthcare providers can improve patient outcomes, reduce litigation risks, and enhance overall care quality.
With expert support from organisations like TMLEP, healthcare professionals can navigate these challenges more effectively, ensuring that patient safety remains at the heart of clinical practice.
WE PARTNERED with The University of Manchester and The Tyndall Centre for Climate Change Research to produce a report, Transforming Healthcare for a Greener Tomorrow, which encapsulates the critical role the healthcare sector must play in driving global environmental sustainability and provides a comprehensive roadmap for transitioning to low-carbon operations that uphold patient care standards.
In the first part of this feature, we explored how the urgency for the healthcare sector to adopting sustainable practices is highlighted by the fact that healthcare is also uniquely vulnerable to climate change as the adverse effects on human health further increase pressure on service delivery [1] Now I’m going to share the five vital interventions that healthcare providers can implement to accelerate carbon reductions now and in the next few years.
1. Greener buildings
Healthcare estates make up 18% of all healthcare provision emissions, so reducing emissions from buildings plays a central role in a provider’s net zero roadmap. Heating, cooling, ventilation systems, and energyintensive healthcare equipment comprise a large part of a building’s greenhouse gas (GHG) footprint. Monitoring and managing energy
It’s time to take action to make the healthcare sector more sustainable. In the second of two articles, Dr Robin Clark, medical director for Bupa Global, India and UK Insurance, shares five vital interventions that healthcare providers can implement to accelerate carbon reductions.
consumption so it can be reduced is vital for lowering emissions and can help reduce costs.
2. Sustainable clinical practice
To lower the carbon impact of demand for and delivery of services, we must reassess clinical pathways to provide care that’s best for patients and the planet.
This includes optimising:
• Patient site visits
• Duration of stays
• Use of testing
• Diagnostics and drugs
Achieving this needs time, input from specialist practitioners, and resource allocation. Combining clinical practice with sustainability knowledge may also require collaboration with academic institutions.
Digital services: Digital services have an important role in reducing carbon emissions. For example, once consent concerns about use of patient data are overcome, new approaches to healthcare data management and analytical capability, including AI and machine learning, have the potential to reduce hospitalisations, unnecessary diagnostic testing, post-operative complications, and re-admittance rates [2].
Changing interaction with patients to reduce trips to healthcare facilities cuts carbon and saves travel time and costs. For example, some admittance checklists and follow-up consultations could be completed online or by phone.
Anaesthetics: The fluorocarbons and nitrous oxide in anaesthetic gases are potent GHGs. Some private hospitals, such as the Cromwell Hospital, are already stopping or phasing out desflurane as an anaesthetic gas. Other efforts to reduce leakage of the gas across hospital estates and leakage of anaesthetic gases in theatres are increasing, for example using the SageTech Medical system to capture and reuse anaesthetic gases cutting emissions to near zero.
Streamlined care pathways: Sustainability hasn’t always been routinely embedded in care pathway decision-making, despite offering options to improve patient experience and outcomes, and lower costs. The Sustainable Healthcare Coalition provides resources to assess GHG, waste, and water
impact on care pathways, including a carbon calculator. The next step is bringing together professionals involved in the care pathway to determine alternative practices that could reduce the number of patient visits, hospital stays, and more. While not focused on carbon saving, programmes such as NHS Getting it Right First Time (GIRFT) will have climate benefits where new practices (e.g. rapid testing and diagnostics, timings of surgical interventions) reduce ward admissions and length of stays [3]. A recent study of inpatient transurethral resection of bladder tumour surgeries that were moved to day cases through GIRFT showed a cut in carbon emissions [4]
Transport produces the largest share of emissions in high-income countries. Fleet vehicles, such as ambulances, goods vehicles, and business travel, are within scope 1 and 2 emissions of organisations that report their carbon impacts. Tackling fleet vehicle emissions requires optimising the distance and number of journeys and switching from diesel and petrol to electric, hydrogen, and biofuel. Subsidising public transport and working with local transport providers to ensure bus route access to healthcare facilities can make greener commutes more viable. And on-site electric vehicle charging can contribute toward a low-carbon future.
Supply chain emissions account for the largest proportion of a healthcare organisation’s carbon impact [5], [6]. Making sustainability and carbon emissions part of procurement decision-making processes can often address healthcare’s scope 3 emissionsthe most challenging emissions scope to address. Individually, providers are unlikely to influence suppliers’ offers on packaging and low-carbon alternatives. However,
aligning product standards across healthcare providers can send a signal to suppliers about minimum sustainability performance.
Applying sustainability terms to tenders that include KPIs related to carbon emissions can further drive new low carbon offers from the supply chain. For example, the NHS requires 10% of tender evaluations to be based on a supplier’s sustainability score. Procurement that considers product lifetime and data on waste is an important first stage in minimising waste. Enhancing product lifetime by moving to reusable sharps and containers, drug trays, surgical gowns, and other items will reduce healthcare waste.
The importance of board, consultant, and staff buy-in to help drive down emissions is clear. Rapid buy-in requires high-quality governance, information, and engagement. It allows the relevant people to understand what is happening once changes are introduced, why change is necessary, and the role they can play. It also promotes effective collaboration between colleagues from different departments to achieve shared goals.
Decision-makers responsible for setting and delivering strategic priorities must be fully behind the need to decarbonise healthcare quickly, and this increasingly appears to be the case. Assigning employees as sustainability champions has been recognised as an effective way to link organisationwide goals with the daily activities that influence operational carbon emissions.
In a sector with diverse and complex activities, bottom-up and top-down strategies should be implemented, and champions should be recognised and supported.
We cannot have healthy people without a healthy planet. Unless we make a global effort to reduce emissions, the climate will become increasingly hostile to the life and ecosystems it has sustained for millions of years. Across our sector, there is an appetite for change and to reach net zero. It will require collaboration between healthcare organisations, involving every stakeholder, from management to patients, to turn this intent into positive action now. But, by taking the necessary steps to transform healthcare today, we can believe in the possibility of a greener tomorrow.
[1] Charlesworth, K.E., M. Jamieson, and M. Jamieson, Healthcare in a carbon-constrained world. Australian Health Review, 2018. 43(3): p. 241-245.
[2] Ioannou, I., S.X. Li, and G. Serafeim, The Effect of Target Difficulty on Target Completion: The Case of Reducing Carbon Emissions. The Accounting Review, 2016. 91(5): p. 1467-1492.
[3] Romanello, M., et al. (2023). “The 2023 report of the Lancet Countdown on health and climate change: the imperative for a healthcentred response in a world facing irreversible harms.” The Lancet 402(10419): 2346-2394.
[4] CIBSE, Energy Savings Opportunity Scheme. Chartered Institution of Building Services Engineers: https://www.cibse.org/ media/iawbw2tr/esos_cibseresponse.pdf
[5] Romanello, M., et al., The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. The Lancet, 2022. 400(10363): p. 1619-1654.
[6] Pinho-Gomes, A. C., et al. (2022). “Values, principles, strategies, and frameworks underlying patient and public involvement in health technology assessment and guideline development: a scoping review.” Int J Technol Assess Health Care 38(1): e46.
COSTS incurred in clinical negligence claims are significant and most (if not all) practitioners would agree that the costs incurred in low-value claims for damages are disproportionate. A small proportion of cases reach litigation, but for the vast majority of cases, there is no real control over costs in the pre-action stage or litigation phases up to that point. Reform is therefore needed.
The proposal to apply fixed recoverable costs (FRC) to lowvalue clinical disputes (LVCD), was intended to create a greater degree of predictability and proportionality, by reducing overall litigation costs, encouraging efficient working, creating a transparent costs structure, and promoting access to justice for some who may otherwise be unable to litigate.
Strangely a two-pronged approach developed rather than a single one. The Ministry of Justice (MOJ) has introduced a new, intermediate track comprising cases valued between £25,000 and £100,000, which applies to clinical negligence claims where liability has been admitted and only the amount of damages is to be determined. These changes were accepted by the MOJ back in September 2021 and subsequently implemented from the beginning of October 2023.
On the other hand, it has been three years since the Department
Neil Rowe, senior in-house counsel at THEMIS Clinical Defence, examines the current proposals and suggested improvements for costs in medical negligence claims.
of Health and Social Care (DHSC) first consulted on FRC for claims worth up to £25,000. Their proposed LVCD Protocol was expected to be launched in April and then (following the change of government) in October last year but at the time of writing there is no hint of when it may be implemented.
The LVCD Protocol plans to operate as follows:
• All clinical negligence claims with a value at settlement or following judgment between £1,501 and £25,000 (even if it was valued over £25,000 at the outset and didn’t follow the LVCD Protocol) will be subject to fixed costs unless they qualify for a specified exclusion.
• If a specified exclusion applies, the claim will not be limited to the fixed costs and the claim falls within the standard preaction protocol.
• Specified exclusions include where the claimant is a litigant in person; the claim involves a stillbirth or neonatal death; there are to be more than three medical experts addressing breach of duty and causation; the defendant raises limitation as an issue; or there are two or more defendants.
• A dual process will be implemented with two separate tracks, the standard track and the light track. Cases should progress on the standard track unless they meet certain conditions for the light track. It will be for claimants to determine which track is most appropriate for the claim.
• Light track cases are for situations where the parties do not anticipate a dispute over liability.
• Compared to the current preaction protocol the process is frontloaded so that the letter of claim served by the claimant is now accompanied by an indexed sorted paginated bundle of the claimant’s medical records, expert report(s), up to two witness statements and crucially an offer to settle the claim.
• Both track process provides for mandatory stock take and discussion. Failure to participate will lead to costs.
• Ultimately whether a claim will continue on the light track will be determined by whether the defendant admits breach of duty of care. If not, it reverts to the standard track.
For these low-value clinical disputes, fixed recoverable costs apply to pre-action cases. If the claim settles within the protocol the amount recoverable depends on the track and stage reached.
The following has been proposed:
be subject to FRC. Many claimants argue the introduction of FRC will mean that securing a specialist clinical negligence lawyer will be difficult as some will struggle to make a profit with the fees proposed and so turn cases away. Moreover, increasing the limit by a further £25,000 would make matters even more difficult.
There are clearly some contentious areas in the proposals. The main issues are the level of damages to which it applies, the fixed fee amounts, the claimant’s choice of track, exceptions, plus the number of experts and their fees.
Most defendants would no doubt argue that the damages limit should be increased to say £50,000 so that many more claims would
The fixed fees are challenged by many claimants as too low – a maximum of up to £14,500.
That said they have been carefully formulated by the DHSC and the figures are certainly proportionate. A sensible compromise approach would be to keep the limit to £25,000 and the fixed fees as proposed so DHSC can review the number of cases going through the scheme and better assess the access to justice argument.
There is scope for disagreement on the exceptions and conditions which will determine how many cases will fall within the scheme and on which track. Equally, claimants may try to argue that conditions do not apply so that the more lucrative standard track is appropriate rather than the light track. Rather than encourage satellite disputes over definitions of never events, the contents of investigation reports, or whether the facts speak for themselves, it would probably be more certain to rely on clear admissions of liability.
Clinical negligence claims are driven by expert evidence and often the bulk of costs claimed are made up of expert fees which are higher than the lawyers’ fees. It is therefore surprising that there is no proposal to limit expert fees in the same way as those of the lawyers. xConsidering the figures set out above, it should be possible for experts to produce suitable reports within capped or fixed fees between say £1,000 and £2,500 so that disbursements overall remain proportionate.
While many clinical negligence lawyers might have reservations about the current fixed recoverable costs proposals the need for reform remains. Rather than continuing to be overlooked, it is hoped that the scheme is piloted soon and then changes made where necessary to achieve balance between the parties and in the interests of costs proportionality and justice.
THE landscape for private healthcare in the UK continues to evolve. For medical consultants running private practices, achieving operational efficiency and financial sustainability has never been more crucial. Yet, amidst the demands of patient care, administrative tasks like medical billing can often feel like an overwhelming burden.
Medical billing experts understand the challenges consultants face and are here to help you achieve your practice goals by turning medical billing from a chore into an opportunity for growth. Outsourcing medical billing doesn’t just take the pressure off, it actively supports your practice’s growth and operational efficiency. Here’s how they help you address the common pain points associated with medical billing:
• Reduce the admin time spent on billing: By outsourcing your billing, you can eliminate timeconsuming administrative tasks. Their expert teams manage the entire billing process, allowing you and your staff to focus on what truly matters... patient care.
• Maximise practice revenue: Meticulous attention to detail ensures every service provided is billed accurately. Minimising errors and reducing the risk of rejected or denied claims all mean your practice will experience improved cash flow and maximised revenue.
• Enjoy more spare time: With billing off your plate, you can dedicate your time to priorities what matter most. Whether that’s advancing your career, growing your practice, or spending time outside of work. Outsourcing creates room for a healthier worklife balance.
As private healthcare practices in the UK face increasing administrative and financial pressures, achieving operational excellence in 2025 means embracing smarter solutions, says Medserv’s Derek Kelly
• Leverage technology: In 2025, technology is key to efficiency. Systems designed to give you the power to track your practice’s billing performance and designed to simplify how you interact with your billing data, can provide a detailed overview of your practice performance.
• Reduce billing administration overheads: Managing in-house billing teams can be costly and resource intensive. Outsourcing reduces overhead costs by replacing the need for dedicated billing staff, software investments, and ongoing training.
• Maximise reimbursements and reduce claim denials: Medical billing specialists are experts in navigating the complexities of UK private healthcare billing. Their expert knowledge ensures claims are submitted correctly the first time, reducing delays and increasing reimbursement rates. Should a claim be denied, our team proactively manages the appeals process.
• Access realtime information on claim status: Uncertainty around claim statuses can disrupt cash flow and create unnecessary stress. With systems designed to provide real-time information, you’ll have access to updates on each claim’s progress, so you’re always informed.
• Access to billing reports: These systems provide online access to detailed billing reports, available 24/7. This empowers you to monitor your practice’s financial performance, identify trends, and make informed decisions at your convenience.
As private practices face increasing demands, it’s clear that the traditional approach to managing medical billing inhouse is no longer sustainable. By outsourcing your billing to providers like Medserv, you gain a trusted partner that not only takes over the workload but actively improves your practice’s financial health.
Top reasons why outsourcing is a strategic move for 2025:
• Reduced stress: Letting go of billing-related worries improves your quality of life.
• Enhanced efficiency: Streamlined processes and advanced tools mean faster, error-free claims.
• Greater financial control: Detailed, real-time reporting gives you a clear understanding of your practice’s finances.
• Patient satisfaction: Transparent, error-free billing enhances the patient experience.
In 2025, your practice goals should be ambitious, but they don’t need to be overwhelming. By outsourcing medical billing to a company like Medserv, you gain a partner dedicated to reducing administrative burdens, maximising revenue, and streamlining processes. Are you ready to focus on what matters most... delivering exceptional patient care while achieving your practice goals?
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