JEREMY HUNT:
KEEP THE
NHS SIMPLE
The former health secretary on why he thinks national targets should be scrapped ‘HOSPICE CARE OFFERS THE BEST VALUE FOR MONEY’ Why have government policies put such a strain on the services that hospices can offer?
DRIVING CANNABINOID INNOVATION
Clarissa Sowemimo-Coker
on reshaping medicine with precision and purpose
WELCOME
JANUARY 2025
Welcome to Healthcare Today, a dynamic new platform delivering essential news, features, expert analysis and interviews for a broad audience of healthcare professionals.
Here, you virtually hold in your hands, the first-ever Healthcare Today Digesta monthly roundup of deep-dive articles from prominent thought-leaders and policy-makers.
We’re starting as we mean to go on with an insightful conversation with former English health secretary Jeremy Hunt; an introduction to the myriad potential uses of cananabinoid innovations from Clarissa Sowemimo-Coker; an impassioned call to governmental action from children’s hospice CEO Martin Edwards and much more besides.
We hope you enjoy!
Glen Ferris Editor In Chief
Tell us your news: Contact: Adrian Murdoch, Editorial Lead adrian.murdoch@healthcaretoday.com +44 (0)7983 407607
Advertise with us: Contact: Glen Ferris, Editor In Chief glen.ferris@healthcaretoday.com +44 (0)7780 298825
ON THE RISE IN BRITAIN
PAS AND
PPS TO JOIN PROFESSIONAL REGISTER SELF-DIAGNOSIS
A new report finds that nearly half of people in Britain have self-diagnosed at least once in the last year while almost a fifth (18%) of 16-24-year-olds have self-diagnosed at least four times over the last 12 months.
The report from insurer Axa Health highlights the top two factors driving individuals to self-diagnose, which include difficulties in securing an NHS appointment (36%) and concerns about long waiting lists (22%).
A third of respondents, particularly younger individuals, turn to social media platforms which raises concerns about the accuracy of the information they encounter, due to the amount of user-generated content on these platforms. More than three-quarters of respondents (78%) believe there should be more regulation of health information available online.
“As digital tools in healthcare become increasingly integral – and for the most part, helpful - it’s crucial to ensure that the information people rely on is accurate and safe,” said Axa Health chief executive Heather Smith.
People are most commonly self-diagnosing minor ailments such as hay fever, sunburn and common colds (42%), but nearly a third (32%) have selfdiagnosed a mental health condition, including depression, anxiety, obsessive-compulsive disorder (OCD) and eating disorders.
The rates of mental-health self-diagnosis are most acute among young people. More than half (52%) of those aged 16-24 who have self-diagnosed did so for a mental health condition.
“The future of healthcare is evolving, and digital options are becoming an important part of this, but there needs to be a strategy in place to ensure we get the best out of digital tools and protect the public,” said Smith.
The report calls for a number of actions to enhance the safety and accuracy of online health information. First, the introduction of verified accounts for medical professionals on social media. Second, there should be stricter guidelines on health content online. There should be a health kite-mark certification to validate the accuracy of online health information. And finally, systems have to be established to “red flag misleading health content” and to educate users on how to identify unreliable sources.
Regulation of physician associates and anaesthesia associates has begun with the GMC sending invitations that they join the professional register.
The General Medical Council (GMC) has begun to write to physician associates (PAs) and anaesthesia associates (AAs) inviting them to join the professional register.
The government requested that the two professional groups be regulated in July 2019 and the GMC officially became the regulator for both professions on 11 December, 2024.
“As physician associates and anaesthesia associates join the register, and they become regulated professions, it will increase people’s confidence in the care they receive,” said GMC chief executive Charlie Massey.
All PAs and AAs on existing voluntary registers should have received invitations by the end of January. To join the register of PAs and AAs, individuals will need to complete an application and provide evidence, including their qualifications and, where relevant, work history and references, to show they meet the GMC’s standards. Once registered, members of the public will be able to search for PAs and AAs on the GMC’s registers. PAs and AAs will have a unique reference number, prefixed by the letter A.
“Employers have a responsibility to ensure individuals working in these roles can do so in safe environments, in which good patient care can continue to be delivered,” said Massey.
From December next year, it will be an offence to practise as a PA or AA in the UK without GMC registration.
TREASURY MOVE CUTS NHS CLINICAL NEGLIGENCE COSTS
THE impact of clinical negligence claims against the NHS are likely to improve after the Lord Chancellor, Shabana Mahmood, increased the personal injury discount rate (PIDR) from January, 2025.
In early December, she raised the rate from -0.25% to 0.5% putting England and Wales in line with the rate in Scotland and Northern Ireland. The rate was previously set in 2019 and must be reviewed every five years. It has been widely estimated that the changes, which become effective on 11 January, could save the NHS £454 million over the next decade. The PIDR is key to calculating compensation awards for claimants who suffer injuries as a result of negligence. It represents the assumed rate of return a claimant can earn by investing a lump sum compensation payment.
“It is my duty to set the rate at the level which I believe most reasonably reflects the rate of return that claimants could be expected to
receive from their investment of relevant lump sum damages,” explained Mahmood in a statement.
The issue of clinical negligence payments remains of concern to the NHS. The NHS Resolution’s Annual Report and Accounts for 2023-24 highlights that the cost of clinical negligence now stands at 1.7% of the NHS budget, or £2.8 billion a year, something it describes as “significant”.
The Medical Defence Union (MDU), which offers professional medical indemnity for clinical negligence claims, put this into context in a written statement to the House of Commons Public Accounts Committee into NHS financial sustainability in late November. It pointed out that the annual cost of clinical negligence claims has more than quadrupled since 2006/2007 and is now larger than the combined budget of every GP practice for the whole of the Midlands and is the same as the NHS spending on 1.2 billion pathology tests each year. The changes have been
welcomed. George Maughan, head of personal client insurance at THEMIS Clinical Defence, calls it a “welcome development”. With clinical negligence generally rising, he explains that the change helps mitigate future premium increases, and supports the retention of clinicians in the UK.
“In recent years, changes in the PIDR have led to a huge increase in the cost of clinical negligence claims. This has had serious implications for the NHS and for MDU members who have been shouldered with the increased costs.
“This change will provide some relief in the current difficult medico-legal climate,” says David Pranklin, MDU head of claims.
The knock-on effect of the change is positive for patients. “The increase from -0.25% to +0.5% and corresponding reduction in a claimant’s damages on settlement will enable public funds to be redirected to frontline services, including patient care,” says Christopher Malla, partner at Kennedys in London.
THE number of reported private hospital admissions in the second quarter of this year hit a record level for that period. It was the second highest level ever after the first quarter of this year, according to non-profit organisation the Private Healthcare Information Network (PHIN).
“Overall, the number of reported private hospital admissions is up on the equivalent quarter in 2023,” said PHIN director Richard Wells.
Admissions hit 232,000 in the quarter driven by a jump in the younger age groups. The biggest percentage increase came in the 10-19 year age group which was up 12% from 4,500 to 5,000. The 0-9 year age group also increased from 4,700 to 5,000 (9%).
Nonetheless, older patients continue to underpin hospital admissions. PHIN reports 46,900 admissions for 50-59-year-olds (up 5%).
PRIVATE HEALTHCARE ADMISSIONS REMAIN HIGH
Wells noted that the most popular procedures remained cataracts, chemotherapy and diagnostic upper GI endoscopy.
Northern Ireland had by far the largest increase in reported hospital admissions though this could be, PHIN said, partly due to improved reporting from the hospitals in that country.
England had the smallest level of growth but had the highest volumes of admissions. There was an increase in admissions in every English region except the South East (-0.3%), and Yorkshire and The Humber (-1.2%) which posted very small decreases.
While the overall picture is positive, the report shows a significant decrease in admissions for some procedures, specifically bypass operations and gastrectomy which were down 20% and 23% respectively.
“The reduction in weight-loss surgery admissions could be due to people choosing alternative types of weight-loss treatments, the growing
FARON PHARMA GETS REGULATORY NOD FOR BLOOD CANCER TRIALS
The Finnish clinical-stage biopharmaceutical company Faron Pharmaceuticals, focused on tackling cancers, has received approval from the British authorities to proceed with research into cancer immunotherapy.
Britain’s Medicines and Healthcare products Regulatory Agency (MHRA) has signed off a BEXMAB study – an open-label Phase I/II clinical trial – while its lead drug candidate Clevegen has received an Innovation Passport under the Innovative Licensing and Access Pathway (ILAP).
Faron’s drug candidate, also called bexmarilimab, is an investigational immunotherapy designed to overcome resistance to existing treatments for blood cancer and optimise clinical outcomes by
availability and popularity of weightloss drugs, or people opting to go abroad for treatment,” said Wells. Other procedures that are typically self-pay also showed a decline.
Demand for cosmetic surgery in general fell with breast lift operations down 18%, and breast augmentation down 7% while breast reduction procedures fell 9%.
“Often cosmetic procedures are not available on the NHS or through private medical insurance, so selfpay is the only option. The fall in the number of people having this sort of procedure may reflect people’s changing priorities or inability to afford to have procedures that aren’t for purely clinical purposes,” he explained.
There was an increased number of insured admissions and a reduction in self-paid admissions for both sexes compared to the same quarter in 2023. Admissions for females continue to be higher across both payment methods.
targeting myeloid cell function and igniting the immune system.
The ILAP was introduced by the MHRA in 2021 to give patients quicker access to treatments and therapies for life-threatening or seriously debilitating conditions, or conditions for which there is a significant patient or public health need. It includes enhanced regulatory support from the MHRA and provides collaborative opportunities with health technology assessment bodies and other stakeholders to accelerate the development of new medicines.
In late November, the company reported initial positive results from its ongoing BEXMAB study with a median survival rate more than double the standard rate at 13.4 months.
REDMOOR HEALTH
ACQUIRES THE WELL LED PRACTICE
The Palatine-backed digital healthcare services partner believes that the acquisition will help improve patient outcomes and empower primary care teams to drive change.
Palatine-backed digital healthcare services partner Redmoor Health has acquired Chichester-based The Well Led Practice, a leadership and team self-development platform for practices and primary care networks.
Financial terms have not been disclosed.
“By combining our digital transformation expertise with The Well Led Practice’s leadership and workforce development tools, we are
empowering primary care teams to drive meaningful, lasting change,” said Redmoor Health chief executive Matt Murphy.
Private equity firm Palatine made a “significant investment” in Redmoor Health in October 2022 as part of the final investment of its Impact Fund.
Impact Fund investment manager
Greg Holmes led the deal for Palatine alongside partner Beth Houghton, the head of Palatine’s Impact Fund. Both then joined Redmoor Health’s board. The investment added to the fund’s healthcare portfolio which includes
Healthcare; transcript – a specialist services provider to pharma and biotech companies; varicose veins treatment group Veincentre; and tech services group FourNet.
Murphy himself was appointed as chief executive in August last year as Marc Schmid, founder of Redmoor took a more strategic role to develop the firm as a strategic partner for the NHS and other public sector organisations. Clare Sieber, founder of The Well Led Practice has taken the role as Redmoor’s chief medical officer.
GYNAECOLOGY CARE CRISIS IS LAID BARE
ANEW REPORT from Medical Negligence Assist looks at the number of medical negligence claims relating to gynaecology that have been lodged against NHS Trusts in England in the past five years.
With stretched services, struggling staff and dwindling resources, a report published in late November by the Royal College of Obstetricians and Gynaecologists (RCOG) revealed the true scale and impact of the UK’s gynaecology care crisis. It estimates that more than 750,000 women are waiting for months and years with serious gynaecological conditions.
“UK governments must act now. The RCOG is calling on them to commit to long-term, sustained funding to address the systemic issues driving waiting lists, alongside delivering an urgent support package for those currently on waiting lists,” says Dr Ranee Thakar, president of the RCOG.
Medical Negligence Assist, a specialist service providing legal support to victims of medical errors, has looked into the issue and examined the number of medical negligence claims relating to gynaecology that have been lodged against NHS Trusts in England in the last five years between 2019 and 2024.
It found that across the NHS, 1,337 gynaecology medical negligence claims were lodged for “unnecessary pain” and a further 740 for additional or unnecessary operations.
Some 151 claims were lodged with the primary injury recorded as “cancer” and as well as 143 separate claims for “bowel damage and/or dysfunction”.
The most common cause of a claim was “Failure to warn – informed consent” regarding gynaecology treatment of which there were 1,324 claims and incidents across NHS Trust in the last five years. Of those, 292 claims were settled with damages payouts hitting £17.3 million.
Claims lodged against the NHS for “failure and delays in gynaecologyrelated diagnosis” however, resulted in the largest damages payouts.
Since 2019, there have been 384 claims and incidents on the issue of which 272 claims have been settled by the NHS with damages hitting £32.6 million.
In terms of the trusts themselves, although Liverpool’s Women Hospital NHS FT had the greatest number of complaints and incidents in the period (83), the greatest damages paid came from the Royal Wolverhampton NHS Trust which paid out £17.3 million from 33 claims.
“The state of gynaecology waiting lists in the UK is a crisis that demands immediate attention. Millions of people are waiting for non-cancer hospital gynaecological care, many are suffering with severe pain, the impact on their physical and mental health is devastating,” says Jane Plumb, RCOG women’s voices lead.
POCDOC
ASSOCIATE AND ANAESTHESIA
ASSOCIATE REGULATIONS
The General Medical Council has set and clarified regulations for PAs and AAs ahead of new regulations which come in, in mid-December.
The General Medical Council (GMC) has set and clarified regulations for physician associates (PAs) and anaesthesia associates (AAs) following a consultation between March and May this year.
This follows a request from the government in July 2019 to regulate the two professional groups.
The new regulations come into play on 17 December and are detailed in a new report.
Changes include the introduction of a second GMC case examiner when making decisions on fitness to practise cases involving PAs or AAs; and behaviours indicative of serious misconduct have been expanded to include cases where a PA or AA has deliberately misled patients or others about their registered status.
There is also clarification on rules for entry, re-entry and removal from the PA and AA registers.
The report acknowledges that a lot of the feedback received, particularly from those who disagreed with the proposals, covered issues that were either outside the scope of the consultation or already settled in law.
There were more than 3,000 responses to the consultation from 2,930 individuals and 81 organisations.
“This was, by its nature, a very technical consultation. But the feedback we have received has been extensive and helpful,” says GMC chief executive Charlie Massey.
Cambridge-based digital health diagnostics company PocDoc has raised £5 million in an oversubscribed new round of pre-Series A funding which takes the amount raised by the company to more than £10 million. It is the largest pre-Series A raise for a UK digital diagnostics business.
Launched in 2020, PocDoc is an app-based tech platform that uses microfluidic assay (MFA) technology and cloud-based AI diagnostics to assess, diagnose and treat major diseases. Using machine learning, data and process integration, dynamic workflows, clinical teams and realtime alerting, the system allows anyone with a smartphone or tablet to receive a full health assessment and follow-up services, including speaking to a clinician, notifying your GP, sending your results to your patient record and providing real-time treatment options.
“We have new tests for metabolic, kidney and whole body health in the pipeline, and we’ll be scaling into new international markets next year,” says chief executive Steve Roest.
Tim Irish, partner at investor KHP Ventures, the first NHS-anchored venture fund, said that he had come in on this round because PocDoc was showing “excellent traction”. Earlier this year, PocDoc was integrated into the NHS app, via its Healthy Heart Check – a diagnostic test for cardiovascular disease that lets patients see their results immediately in the app.
Funds raised will be used to support the company’s growth, specifically its growing list of pharmacy, retail, and corporate partnerships, as well as its deepening relationships with the NHS.
NHS CORRIDOR CARE GUIDANCE SLAMMED
THE Royal College of Emergency Medicine and Royal College of Nursing have hit out at the normalisation of medical care in corridors.
The Royal College of Emergency Medicine (RCEM) has hit out at guidance from NHS England which details how patients can be safely treated in corridors. Adrian Boyle, president of the independent professional association calls it the “normalisation of the unacceptable and dangerous”.
In mid-September, NHS England published a guidance paper on how to treat patients in what it euphemistically calls “temporary escalation spaces”.
Although it admits that this kind of treatment is “never acceptable when caring for children”, it says the current healthcare landscape means that “some providers are using temporary escalation spaces more regularly” and “this use is no longer in extremis”.
NHS England’s six-point plan was developed to provide what it calls “the safest, most effective and highest quality care possible” when treatment in corridors has been deemed necessary.
In an open letter Boyle and RCEM vice president Ian Higginson state simply that: “it is not possible to provide safe and good quality care in temporary escalation spaces, such as corridors”.
They refer to a study in the Emergency Medical Journal which shows that long waits in A&E departments before patients are admitted are linked to excess mortality.
They also accuse those who draw up such guidance as being “out of touch” with what is happening in Emergency Departments. This is backed up by a survey published in late November from the RCEM which found that almost nine out of 10 British A&E clinicians said that they aren’t confident that their departments will cope well this winter and 94% think that patients are being put at risk due to the pressures currently being experienced.
More to the point, 83% of respondents from 83 hospitals across the country, said that they had patients being cared for in corridors. At the time, Boyle called the findings “a stark warning” from those on the front line.
“Clinicians are worried, and patients are unsafe,” he said.
This is not a new concern. In a policy report published in June, the Royal College of Nursing (RCN) called corridor care “undignified” and “unacceptable”.
“There’s nothing about corridor care that resembles caring. Patients left on
trolleys or chairs for hours on end, often soiled, in pain and suffering – it’s tantamount to torture. There’s no part of our society that should consider this acceptable. So why are we accepting it?” wrote Nicola Ranger, the RCN’s general secretary and chief executive, in the introduction to the report. It is also an issue of which the government is aware.
In a speech on the NHS at the King’s Fund in September this year, prime minister Keir Starmer, railed against waiting times in A&E departments. “That phrase avoidable deaths should always be chilling,” he said.
But with what Stephen Powis, NHS national medical director calls the current “tidal wave” of flu infections and a 70% increase in hospital cases in the second week of December, the warning from RCEM is timely.
“Our patients need a firm commitment from our politicians, and NHS leaders not to accept the unacceptable,” says Boyle. “Rather than advising how to deal with overcrowding, all effort should be focused on preventing it.”
ANEW report by the Health Services Safety Investigations Body finds that female prisoners struggle with dignity, privacy and confidentiality in the way that healthcare is delivered.
Concerns have been raised by the Health Services Safety Investigations Body (HSSIB), a fully independent arm’s length body of the Department of Health and Social Care, about the continuity of care, both for internal and outpatient appointments, for female prisoners.
A report found that, due to staff shortages, female prisoners are often accompanied by male prison officers or a mix of male and female officers to appointments that are sensitive or require intimate examinations.
HSSIB reports a woman being handcuffed to a male prison officer during a mammogram.
In addition to their concerns about privacy and visual dignity, patients and healthcare staff told the investigation that personal hygiene was not taken into consideration. This was particularly the case for women who were going to obstetrics and gynaecology appointments. The women stated that they wanted to
FEMALE PRISONERS SUFFER CONTINUITY OF CARE
FEMALE PRISONERS SUFFER CONTINUITY OF CARE
shower before these appointments but were not given enough notice.
“We recognise that providing continuity of care to prisoners does create complexity,” says Dave Fassam, senior safety investigator at HSSIB, “However, our investigation highlighted that it can simply be the case that dignity and privacy of prisoners is not considered in the way it should be.”
The privacy and dignity concerns described by national organisations, healthcare staff and patients were also complicated by the issue of medical confidentiality. Patients often had their clinic appointments with prison officers in the clinic room, removing patient medical confidentiality. The investigation was told some patients were put on a long cuff which meant the officer could sit just outside the room while still attached to the patient; however, this was still within earshot of the conversation between the patient and the clinician.
Concerns over dignity, privacy and confidentiality are a key reason for patients, especially female prisoners, not attending appointments. Data in the report showed overall “did not attend rates” were high for outpatient appointments. These stood at 48% for women in 2024 versus 26% for the
general population. When it came to appointments within the prison, however, the investigation was told female prisoners are engaged and the attendance rate is good.
The report emphasises that using video and telephone calls could help to solve some of the issues seen with missed outpatient appointments. It could increase the number of outpatient appointments available and reduce the number of appointments that patients refuse to go to. It could also potentially reduce the cost related to prison officer escort duties which costs between £48 million and £50 million a year. Using remote technology could improve continuity of care for prisoners and reduce health inequalities. While many female patients may have to be examined in person, digital appointments could create opportunity to share sensitive concerns or symptoms in a comfortable environment. The safety recommendations in the report focus on ensuring dignity for prison patients, promoting the use of telemedicine within the prison system and ensuring continuity of care on prisoner transfer or release.
“As well as improving standards, we have recommended that the prison system be enabled to make better use of technology,” says Fassam.
Zoe, Mum of Ted
The Billing Partner Your Practice Deserves
JEREMY HUNT: KEEP THE NHS SIMPLE
The former health secretary explains why he thinks national targets should be scrapped, patients should have their own GPs and the importance of digital transformation.
Written by Adrian Murdoch.
SPEAKING just after a meeting of the new All-Party Parliamentary Group (APPG) on Patient Safety which was launched at the end of November and of which he is chair, Jeremy Hunt talked to Healthcare Today about patient safety, a “duty of candour” and the lessons learned from the COVID pandemic. The Health Secretary between 2012 and 2018 considers whether learning, candour and change can really happen in an environment with a generally hostile popular media and a parliament that seems more antagonistic than collaborative and what his priorities would be were he health secretary again.
Healthcare Today: Patient safety was the watchword when you were health secretary. Where do you still feel that work needs to be done?
Jeremy Hunt: Patient safety has become an increasingly important issue, partly due to a kind of circularity that has brought it back to the forefront of the agenda. When I became Health Secretary, what became immediately clear to me was that during the Blair and Brown years [Tony Blair and Gordon Brown were Labour British Prime Ministers between 1997 and 2010], the NHS had made significant progress, particularly in reducing waiting times for both elective and emergency care. However, one unintended consequence of the approach taken during that period was the emergence of a “targets culture”. This emphasis on meeting performance metrics sometimes led to corners being cut on safety and quality.
I was determined to preserve the achievements of that era – such as the reduced waiting times championed by figures like Alan Milburn [Health Secretary between
1999 and 2003] – but I also wanted to ensure that the NHS had a standard below which it should never fall. This led me to reform the Care Quality Commission (CQC), shaping it to function more like Ofsted in schools, with a focus on rigorous and consistent oversight.
During my tenure, I frequently spoke about patient safety, but I didn’t see it as separate from quality. Both rely on the same foundational principle: a learning culture. To improve safety and quality, there must be an environment where mistakes are acknowledged, lessons are learned, and practices are improved.
This is especially relevant now. The pandemic has effectively halted NHS reform, leaving us with alarming waiting times for both emergency and elective care. It’s reminiscent of the challenges faced by Labour when they first tackled NHS reforms in the past. The crucial lesson is that as we work to reduce waiting times again – and it’s encouraging to see [Prime Minister] Keir Starmer making this a priority.
While the new government has focused on reducing waiting times, they’ve yet to address emergency care comprehensively. As this winter is projected to be even more challenging than the last, that issue will inevitably demand attention.
Healthcare Today: You’ve often talked in the past about learning from healthcare systems like those in Sweden and the US in particular. What policies and practices do you think the NHS should adopt?
Jeremy Hunt: We’re not just living in a post-COVID world; we’re also in a political landscape shaped by a Labour government with a strong majority. The NHS is at the top of their agenda and there’s a broad
My advice to Wes Streeting is simple: scrap as many national targets as possible.
less adversarial, with lawyers playing a minimal role. This kind of cultural shift would be transformative for the NHS.
Beyond culture, there are structural challenges that need urgent attention. One of the core problems is the pervasive “targets culture”, which has led to the NHS becoming the most micromanaged healthcare system in the world. This over-regulation has left the system paralysed, stifling innovation and making it nearly impossible to establish a culture of continuous learning.
We’ve seen this dynamic overcome in other sectors. In education, we’ve granted headteachers significant autonomy, which has fostered innovation and driven standards in English state schools to world-class levels. Similarly, scrapping national police targets has allowed forces to focus on what works locally, contributing to falling crime rates. The lesson here is clear: excessive central control undermines progress.
So why do hospitals in the UK struggle compared to those in countries like the US, the Netherlands, France, or Germany? The answer lies in the heavy burden of managing upwards. The NHS is the only healthcare system in the world that actively prevents localised innovation by maintaining rigid national targets. My advice to Wes Streeting is simple: scrap as many national targets as possible.
that was recommended. Among these reforms, the one that likely had the most significant impact was empowering the CQC to conduct independent ratings of healthcare providers. Safety became one of their five core domains. That initiative created a level of focus on patient safety that had never existed before.
The introduction of the duty of candour was another important reform. This legal obligation requires hospitals to be transparent with patients and their families when mistakes occur, particularly in cases of serious harm or death. Because the hospital board is legally accountable, this reform has significantly reduced the egregious cover-ups that once happened. Today, hospitals are far more cautious about concealing errors, knowing the potential consequences.
However, the duty of candour stops at the institutional level. While it was extended to individual clinicians through changes in their professional codes of conduct, I was advised against making it a legal requirement for doctors and nurses. In hindsight, I’m still uncertain about whether this was the right approach. Cultural change may ultimately be more effective than legislative measures. The key is creating supportive environments in which clinicians feel safe to acknowledge mistakes and speak up without fear of reprisal.
consensus that the system requires bold reforms. This is a rare moment. When I was Health Secretary, the guidance I received from Number 10 was clear: keep things quiet, avoid rocking the boat, and ensure the NHS remained out of the headlines. In contrast, Wes Streeting appears to have a much stronger mandate
for radical change. There are long-standing issues I believe we must address. One critical area is fostering a low-blame culture, similar to what exists in Sweden. There, clinicians are encouraged to be open about mistakes, creating opportunities for learning and improvement without fear of legal repercussions. The process is far
Healthcare Today: That is an interesting point about linking patient safety to other elements. It is often connected with the “duty of candour” that you brought into the NHS. Do you think it is still being implemented properly?
Jeremy Hunt: During my tenure, I approached patient safety with an all-encompassing mindset, implementing nearly every reform
Healthcare Today: Do you really think that learning, candour and change can really happen in an environment with a generally hostile popular media and a parliament that seems more antagonistic than collaborative?
Jeremy Hunt: The role of the Health Secretary is to set the tone for the entire system. Every Health
The RT Hon Jeremy Hunt MP - © House of Commons
Secretary embarks on a learning journey. Early on, it’s tempting to believe that firing bad managers or bad doctors is the solution to systemic issues. As time went on, I came to realise that approach is counterproductive. It fosters a climate of fear, which is the opposite of what’s needed to create a culture of learning and continuous improvement.
What you really want is for people to feel safe enough to be honest about their mistakes. The most inspirational leaders I’ve encountered are those who openly admit when they’ve made an error. It takes a great deal of confidence to lead like that. For politicians, this kind of humility is almost impossible due to the way the media operates. That said, I did find moments as Health Secretary where I could challenge the punitive instinct without much backlash. For instance, I stood up for Dr. Hadiza Bawa-Garba in her case and didn’t face significant pushback.
The comparison to the airline industry might be overused, but it remains relevant. The safety culture they’ve developed – one that makes it easy for pilots to speak up about concerns – has been transformative. I firmly believe we can achieve a similar culture in the NHS, where openness and accountability drive real improvements in patient safety.
Healthcare Today: Language is part of it, and the rhetoric against what used to be called junior doctors, now resident doctors, very much started under the last government. You yourself referred to them as “militant”. Do you regret that type of rhetoric?
Jeremy Hunt: I don’t want to be overly defensive about my time in office, however, in the case of the junior doctors’ dispute, the situation was particularly
challenging. The British Medical Association’s (BMA) Junior Doctors Committee at the time was highly militant, driven by individuals who, in my view, had a strong political agenda. For instance, during the pay dispute leading up to the general election, the committee’s leader openly rejected a deal offered to junior doctors in England that was identical to the one accepted in Scotland. If that wasn’t politically motivated, I’m not sure what was.
To be clear, I wouldn’t describe junior doctors as a group as militant. But certain individuals within the leadership of the BMA’s Junior Doctors Committee were undeniably combative. This was not the case with the leadership of the BMA’s Consultants Committee, nor did I get the same impression from the national BMA leadership Unfortunately, the confrontational approach of some in the junior doctors’ leadership poisoned relations and made meaningful progress almost impossible.
This was deeply regrettable because junior doctors are among the most vital members of the NHS workforce. They work some of the most demanding hours and face immense pressure in their roles. The NHS depends on them, and it’s a shame that the adversarial dynamics during that period created significant challenges.
Healthcare Today: To cut through all of these questions – is the answer just money? Does the NHS just need more cash?
Jeremy Hunt: The issue facing the NHS isn’t about funding anymore. There’s a strong case to be made that, during my tenure as Health Secretary, the NHS needed additional resources, which is why I negotiated a £20 billion increase in its annual budget. However, when you compare the NHS to other
One of the reasons NHS productivity lags behind other sectors is its failure to fully embrace digital advancements
healthcare systems globally, it’s now one of the most wellfunded systems. Among the 38 OECD countries, the UK ranks fifth in healthcare spending as a proportion of GDP. Since the pandemic, NHS funding has risen significantly, and even before the upcoming election, Labour hasn’t framed the NHS’s problems as financial.
That said, I do believe social care requires more investment, as deficiencies there have a direct impact on the NHS. But beyond funding, the NHS faces significant structural challenges that must be addressed. One of the most critical reforms we need is to return to the system where GPs have their own patient lists. This approach, which is standard in most other countries, is supported by substantial evidence. International studies show that patients with a regular GP are 30% less likely to require
Healthcare Today: We can’t leave you without talking about COVID. Are there any lessons since the COVID pandemic, that you feel the system has failed to implement effectively?
undoubtedly important. However, we must not lose sight of the fact that another pandemic is not just possible – it’s likely.
hospital care, 25% less likely to die prematurely, and far less likely to be misdiagnosed.
When GPs have a personal connection with their patients and their families, they gain valuable knowledge that improves clinical decision-making. Unfortunately, since the 2004 contract changes, we’ve moved away from this model. Patients are now attached to surgeries rather than individual doctors, effectively transforming GP practices into call centres.
Doctors often see 40 patients a day, many of whom they’ve never met before. This is not only detrimental to the quality of care but also far more stressful for doctors, who are under pressure to make quick decisions without the benefit of prior knowledge or rapport. Reintroducing personal patient lists is an obvious and necessary reform.
Jeremy Hunt: There’s still so much more to be done. The NHS performed magnificently during COVID, and the dedication of its staff was truly extraordinary. However, this success came at a significant cost to non-COVID healthcare. To free up capacity for the pandemic, the NHS largely halted non-COVID care. This approach allowed us to ensure that everyone who needed an intensive care bed or ventilator received one, but it has left us with enormous waiting lists for cancer treatment and elective surgeries – issues that other countries have largely avoided. While our centralised system enabled rapid and decisive action, it also exposed vulnerabilities in our capacity planning for non-COVID care. This is a critical lesson we must address moving forward.
Beyond capacity issues, the most pressing reforms are needed in public health. During the pandemic, we were fortunate to have existing research on coronaviruses from severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which allowed us to develop a vaccine within a year. But many other viruses lack that kind of head start, and we could also face bacterial pandemics. The risks of global pandemics are increasing due to globalisation, and the idea of a “once-in-acentury” pandemic may now be more like once every decade or so.
I’m concerned that we’ve taken our eye off the ball when it comes to pandemic preparedness. The focus has shifted to other pressing issues like Ukraine and global political tensions, which are
Healthcare Today: If you were a health secretary again, what would your three priorities be? What would you focus on?
Jeremy Hunt: If I were to outline my priorities, I would start by scrapping national targets and empowering local leaders –specifically the 42 Integrated Care Board (ICB) chief executives and the 250 hospital trusts – to drive innovation in their own regions. While I would remove the rigid national targets, I would maintain a commitment to transparency by measuring and publishing key performance data. For instance, I firmly believe that everyone should receive treatment for elective conditions within 18 weeks and that no one should wait more than four hours in A&E. Publishing this information would ensure accountability and make it clear which hospitals are meeting these standards, and which are not.
Another critical reform would be returning to a system where patients have their own GPs. This change would be a cornerstone of primary care transformation, ensuring continuity of care and better outcomes for patients.
Finally, I would prioritise digital transformation. One of the reasons NHS productivity lags behind other sectors is its failure to fully embrace digital advancements. There is a tremendous opportunity here to enhance efficiency, such as increasing the number of daily surgeries performed by surgeons and redirecting patients to pharmacists for care that doesn’t require a GP’s attention. Additionally, the NHS app could be utilised far more effectively to streamline services and improve patient access.
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DRIVING CANNABINOID INNOVATION
Clarissa Sowemimo-Coker, CEO of Oxford Cannabinoid Technologies, discusses the company’s novel strategies, the role of artificial intelligence in drug development and the future of cannabinoids in mainstream healthcare.
Written by Glen Ferris.
OXFORD Cannabinoid Technologies (OCT) is leading the way in cannabinoidbased therapies, focusing on innovative, nonaddictive pain medications aimed at reducing opioid dependency. Their groundbreaking work is transforming how debilitating conditions are treated, offering hope to millions worldwide.
On the journey from early-stage discovery work to clinical trials, their mission to harness the therapeutic power of cannabinoids harnesses natural and cuttingedge methods to unlock potentially life-changing innovations.
Here, in an exclusive interview, Clarissa Sowemimo-Coker, chief executive officer of OCT, discusses the company’s novel strategies, the role of artificial intelligence in drug development and the future of cannabinoids in mainstream healthcare…
What makes Oxford Cannabinoid Technologies’ approach to cannabinoid-based medicine unique?
Our unique focus on the endocannabinoid system distinguishes OCT. This complex biological network regulates pain, mood, inflammation, and other critical functions.
By targeting this system, we can develop therapies with highly specific mechanisms of action, offering precision in addressing unmet medical needs like chronic pain.
Our diverse pipeline of smallmolecule assets reflects our patient-centred, science-driven approach. By offering a range of treatments, we aim to open new therapeutic frontiers and deliver transformative outcomes.
As our understanding of the endocannabinoid system deepens, targeted therapies can be developed to modulate specific receptors, opening doors to treatments that are more precise and have fewer side effects.
- Clarissa Sowemimo-Coker
How do you balance innovation with clinical and regulatory compliance?
Balancing innovation with compliance lies at the heart of everything we do. From the earliest stages of research, we embed global regulatory standards, such as those set by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA), into our processes.
For example, our preclinical and clinical trials are meticulously designed to meet stringent safety
and efficacy benchmarks, ensuring our therapies are both innovative and ready for widespread adoption. This approach allows us to innovate within a framework of responsibility and trust, ensuring that our therapies are not only cutting-edge but also ready for widespread adoption by prescription in mainstream healthcare. By integrating compliance into our culture, we can focus on delivering therapies that are both transformative and reliable.
What are the biggest misconceptions about cannabinoids in medicine?
One major misconception is equating cannabinoids with recreational cannabis, overshadowing their sophisticated therapeutic potential. Cannabinoids interact with endocannabinoid receptors like CB1 and CB2, enabling precise treatments for conditions such as chronic pain and inflammation. Additionally, there is often scepticism about the validity of cannabinoid-based treatments
science of endocannabinoid receptor modulation, we aim to reshape perceptions and build confidence in cannabinoids as a legitimate, evidence-based solution for treating complex medical conditions.
How is AI transforming cannabinoid research and drug development?
AI is revolutionising drug discovery. Through our exclusive collaboration with Hypatia AI, we’ve successfully developed an AI-enabled drug discovery asset that acts as a game-changer for early-stage research.
This cutting-edge tool enhances our ability to explore the therapeutic potential of cannabinoids by leveraging AIdriven insights across vast scientific literature and our proprietary library of more than 500 modified cannabinoid derivatives, which are classed as new chemical entities (NCEs). By integrating AI at the earliest stages of the research process, we can uncover connections, build knowledge graphs, and generate hypotheses that might otherwise go unnoticed. This approach enables us to streamline and accelerate the discovery of novel, non-addictive pain medications to address the global opioid crisis.
due to a historical lack of rigorous clinical data. However, this is rapidly changing with advances in research and the development of pharmaceutical-grade cannabinoid formulations designed for specific medical applications. We are addressing this gap by conducting robust, controlled clinical studies to demonstrate how targeting the endocannabinoid system can deliver safe, effective, and precise therapies.
By shifting the focus from stigmas surrounding cannabis to the
What sets this AI asset apart is its ability to process and analyse more than 30,000 scientific papers with unmatched speed and depth. Developed in collaboration with David Gordon’s team at Hypatia, the tool functions as an “AI librarian,” augmenting our researchers’ capabilities rather than replacing them. It allows our scientific team to focus on creativity and judgment while amplifying their capacity to discover hidden breakthroughs Emerging technologies like this will continue to reshape research,
enabling smarter, faster, and more targeted therapeutic discoveries that align with the needs of patients and the demands of a rapidly evolving healthcare landscape.
How do cannabinoids complement or replace existing treatments?
Cannabinoids can complement or replace treatments, especially in chronic pain management, where they offer an alternative to opioids.
Their ability to interact with the endocannabinoid system allows for targeted relief with fewer side effects. In conditions like neuropathic pain, cannabinoids may enhance the efficacy of existing drugs or serve as standalone therapies for patients who haven’t responded to conventional treatments.
What’s your outlook for the cannabinoid market over the next decade?
The market is poised for significant growth. Breakthroughs are likely in areas such as neuropathic pain, inflammation-driven diseases, and even neurodegenerative disorders like Parkinson’s and Alzheimer’s.
As our understanding of the endocannabinoid system deepens, targeted therapies can be developed to modulate specific receptors, opening doors to treatments that are more precise and have fewer side effects/ Additionally, the integration of AI in drug discovery will expedite the identification of novel cannabinoid applications.
The market’s expansion will likely be supported by evolving regulatory frameworks, broader physician acceptance, and increasing public awareness of the therapeutic potential of cannabinoids. While conventional
Cannabinoids are well on their way to becoming a cornerstone of mainstream healthcare rather than being viewed as alternative medicine.
- Clarissa Sowemimo-Coker
applications will remain important, particularly in pain and symptom management, the next decade will see cannabinoids tackling complex, systemic diseasesushering in a new era of precision medicine.
Do you think cannabinoids will eventually shift from being seen as alternative medicine to mainstream healthcare?
Yes, cannabinoids are well on their way to becoming a cornerstone of mainstream healthcare rather than being viewed as alternative medicine. However, achieving this transition will require several key developments.
First, robust clinical evidence is essential. Large-scale, welldesigned trials must continue to demonstrate the safety, efficacy, and cost-effectiveness of cannabinoid-based treatments.
This will build confidence among healthcare professionals and regulators. Second, education is critical. Misconceptions about cannabinoids persist, even among healthcare providers.
Widespread education awareness campaigns aimed at physicians, patients, and policymakers can help shift perceptions
by emphasising the science and therapeutic potential of cannabinoids rather than their association with recreational use.
Third, advancements in drug formulation and delivery methods will play a role. As we develop more precise and predictable cannabinoid therapies - such as those involving NCEs or personalised treatmentscannabinoids will increasingly align with the standards of modern pharmaceuticals.
Finally, regulatory evolution will be pivotal. Clearer guidelines and frameworks will enable faster approval of cannabinoid-based therapies, ensuring that they reach patients in need more efficiently.
As the evidence base grows and public demand increases, we anticipate cannabinoids becoming a trusted, mainstream option for a wide range of conditions.
Ultimately, the transition will depend on collaboration between innovators, healthcare systems, and regulators to ensure cannabinoids are not only scientifically validated but also accessible, affordable, and understood as a vital part of modern medicine.
“HOSPICE CARE OFFERS THE BEST VALUE”
Martin Edwards, chief executive of Julia’s
explains why government policies have put such a strain on the capacity and the range of services that hospices can offer.
Written
by Adrian Murdoch.
House,
HOSPICES have come under mounting financial pressure since the new Labour government’s first budget at the end of October. Thanks to rising costs and the recent increase in National Insurance contributions, coupled with inflation, deficits have risen. To put it into perspective, many hospices in England and Wales face an annual financial shortfall of around £1 million, typically 10% of the hospice’s budget.
Here, Martin Edwards, chief executive of Julia’s House, talks about the impact of rising costs on capacity and the range of services that the children’s hospice in Dorset and Wiltshire can provide, and why hospices need a sustainable funding model.
Could you talk us through your work at Julia’s House and your approach to patient safety?
The organisation is a children’s hospice that provides both in-house hospice care and home care. Delivering home care presents unique challenges due to the broader scope of control it requires. This means there must be an even greater emphasis on quality, training, and robust backup systems. Family support is a central part of the service. The hospice employs family support workers who conduct one-on-one visits with parents and siblings to help them cope with the trauma they are experiencing.
The hospice is recognised as one of the top-rated services in the country. It has twice been ranked as the number one charity employer by the Best Companies scheme. This achievement is based on independent staff surveys and benchmarking against other charity employers nationwide. Additionally, the Care Quality Commission (CQC) has awarded the hospice an outstanding rating. During its most recent inspection, the CQC found no
areas for improvement, a rare accomplishment in the sector. Despite these accolades, the hospice is vigilant about avoiding complacency. Maintaining a highquality service requires constant vigilance at all levels. This involves listening to service users, conducting anonymous, honest surveys with families about their experiences, and ensuring staff can provide feedback. Robust whistleblowing procedures and training programs are essential components of their approach.
Why have you been so vocal about the government’s first budget at the end of October?
There was a prevailing assumption that hospices would always be financially secure and that their services would be guaranteed for the future. Unfortunately, this is no longer
“Many hospices, including Julia’s House, face an annual shortfall of approximately £1 million between income and expenditure.”
the case. Over the past year, the collective financial deficit of hospices has exceeded the total deficits of the previous seven years combined, according to data from Hospice UK. The main driver of this alarming trend is inflation, which has significantly increased operational costs.
At Julia’s House, costs have risen by approximately 25% over the past four years. A major dilemma for the hospice is whether it can afford to match NHS pay awards, but inflationary pressures extend far beyond wages. Utilities and insurance have both surged at rates much higher than general inflation.
Even with growth in voluntary income, a funding gap has emerged. Compounding this issue, statutory income for hospices has not kept pace with inflation; in real terms, it has actually decreased.
At Julia’s House, statutory income accounts for just 8% of the total funding – one of the lowest proportions in the country – leaving the organisation to raise the remaining 92% through other means. Further financial strain has come from government policies, such as the recent increase in National Insurance contributions, which will cost Julia’s House an additional £250,000 annually.
This expense was not accounted for in the budget, which was already operating at a significant deficit. It is a challenge that is not unique to Julia’s House; hospices across the country are facing similar difficulties. For example, hospices in the UK have collectively closed 300 beds this year due to financial constraints. The ripple effects of these closures are deeply concerning. Patients who cannot be accommodated in hospices will inevitably spill over into the NHS, where bed availability is already a critical issue. A more realistic safety net of government funding is urgently needed, given the substantial savings hospices provide to the wider healthcare system.
Why has the Treasury said that hospices will not be exempted from this tax rise?
From a legal standpoint, it is challenging to create specific exemptions. Instead, the
government should focus on fully rebating the additional costs hospices face, such as those stemming from the recent National Insurance increase, through grant funding. There has been growing pressure for action on hospice funding. In response, Health
Secretary Wes Streeting has announced that he will address the matter and provide a statement by Christmas. Two questions remain unanswered, however.
First, will the government’s plans fully reimburse hospices for the financial impact of the National Insurance increase? Second, will the funding go further and tackle the structural deficits that have long plagued the hospice sector?
Relying on charitable donations –such as fundraising events, sponsored skydives, charity raffles, and sales in hospice-run shops –cannot continue to serve as a substitute for addressing the
underlying financial problems. Hospices are vital providers of palliative care in the UK, and their long-term sustainability requires a more stable and realistic funding model from the government.
Is there any indication of what the cost to the NHS will be if your funding is cut?
There is an underlying structural financial deficit in the hospice sector. Many hospices, including Julia’s House, face an annual shortfall of approximately £1 million between income and expenditure. To put this into perspective, with a turnover of £10 million, the deficit amounts to 10% of the hospice’s budget. This shortfall exists despite the support provided by existing rebates and the limited government funding received through local health boards, which remains insufficient to meet the sector’s needs. Adding to these challenges is the huge cash grab imposed by the recent
National Insurance tax hike, all of which are creating significant and growing challenges for the future of palliative care in the country. There hasn’t been an economic study of the cost to the NHS as a whole, but there has been research from York University, which looked at the health of 35,000 mothers comparing those with healthy children and mothers of children with a long-term palliative condition. It found that the mothers of the second group were twice as likely to develop cardiac disease or a serious mental health condition as mothers of healthy children and nearly 60% more likely to die young. Does anybody think that’s a good idea?
MPs from opposition parties do not seem to have been especially vocal about hospices. Is it simply a PR issue, or is there something fundamentally different at stake?
In my experience, backbench MPs across all parties are generally very supportive of representing their constituents. Julia’s House provides care for seriously ill children in the constituencies of 15 MPs across two counties, and they are consistently helpful. Challenges arise, however, when engaging with ministers who control government funding. The moment discussions turn to financial support, ministers often become defensive and resort to justifications such as pointing to the Gift Aid scheme as evidence of government support for charities. This is a decades-old mechanism designed to incentivise public donations to charitable causes. It should not be used as an excuse to mask what they described as a significant financial burden being placed on charitable employers like hospices.
Is the block to support at a cabinet level?
Wes Streeting’s Parliamentary Private Secretary (PPS) attended a meeting of the All-Party Parliamentary Group for Children
Who Need Palliative Care, where I was present as a guest. My impression was that the government is listening to the concerns raised, which is encouraging. However, we now have to wait to see how substantive the government’s response will be, noting that engagement is typical of a new administration.
Unexpectedly, the sector has also had to contend with a significant increase in taxation, which has intensified financial pressures. The government’s upcoming funding announcement might present what appears to be a substantial sum –such as £10 million or £20 million –but this would be insufficient to address the steep rise in costs currently facing hospices.
Inadequate support would leave the hospice sector in an even worse financial position, forcing cuts to vital services.
To what extent is the impact going to be on future services?
I don’t believe there will be a knockon effect on safety, but there will undoubtedly be an impact on capacity and the range of services we can provide. We may be forced to reduce the extent and variety of services we offer.For example, when you’re working with a physical hospice building, you’ll likely prioritise keeping that core service operational. Some of the seemingly easier cuts for hospices might involve respite services, community outreach, or family support programs. Ironically, these are often the services that make the most significant difference to families and are not available through the NHS.
Back in 2017, Julia’s House led a national research study in collaboration with Bournemouth University. It was approved by NHS ethics, so the methodology was rock-solid. We surveyed the service users of 18 children’s hospices across England and Scotland to
evaluate the impact of respite care on parental relationships. These parents face immense strain from providing 24/7 care, dealing with sleep deprivation, and having almost no time to spend as a couple. Our quantitative research demonstrated that parents in stable relationships received, on average, 43% more respite hours than those in relationships at risk of breaking down. While this finding aligns with what families have often told us anecdotally, having solid data to back it up was invaluable.
If respite services were to be cut across the country, what would the long-term impact be on the breakdown rates of parents caring for a seriously ill child? The effects wouldn’t be immediately visible, but over time, it would result in a kind of death by a thousand cuts. Hospices would be forced to reduce services that only they currently provide, services that are critical to
these families.While local authorities technically offer short breaks for eligible families, accessing those services is notoriously difficult. In many cases, the voluntary sector becomes the last line of support, filling in the gaps and enhancing the quality of life for families. For some, these services help keep parents together during unimaginably difficult times.
What are your hopes and expectations about the government’s announcement on the matter?
I hope the government recognises that hospice care offers the best value for money. This is because hospice care is heavily subsidised by public donations. In our case, 92% of our funding comes from donors. You simply can’t get better value than contributing to a service that is already predominantly funded by the public.
I hope the government recognises that hospice care offers the best value for money when it comes to providing bed nights and family support.
If the financial burden of hospice care were to fall back entirely on the state, it would ultimately cost the government far more. We’ve been raising this issue with successive governments for years. What we need is a long-term systemic solution – not a stop-start approach.
I recall a few years ago when Boris Johnson was prime minister, hospices lobbied the government for support. Johnson hosted a reception at 10 Downing Street, which our hospice was one of the few invited to attend. During that event, he announced £10 million in funding for hundreds of hospices. To put that into perspective, our turnover alone is £10 million a year, and we are just one of 250 hospices. That funding was little more than a drop in the ocean.
As the population grows, the demand for palliative care will only increase. The hospice sector is a crucial part of the solution to
meeting this need, but it cannot thrive – or even survive – without proper, consistent support.
Healthcare Today interviewed Martin Edwards before the government response to the hospice lobbying campaign. In late December, and partly thanks to lobbying efforts from Edwards and others, the government announced £100 million of capital funding, spread over two years, to help hospices provide the best end-of-life care to patients in a supportive and dignified environment. Hospices for children and young people will also receive a continuation of £26 million in revenue funding for 2025/26 through what until recently was known as the Children’s Hospice Grant. Following the announcement, Edwards told Healthcare Today: “We welcome the announcement of the fund and we look forward to working with the government on a long-term solution to hospice financing”.
CLINICAL RISK ASSOCIATED WITH INADEQUATE CONSENT
TMLEP’s Lead Healthcare Investigator Nina Vagad reports on the ramifications of failing to obtain proper informed consent...
UNDERSTANDING CLINICAL RISK
Inadequate consent remains a significant clinical risk in healthcare settings. Failure to obtain proper informed consent can lead to severe consequences, including litigation, reputational damage, and poor patient outcomes. When consent processes are mismanaged or overlooked, patients may undergo procedures without fully understanding the risks, benefits, or alternatives, leading to claims of medical negligence.
The risk is particularly heightened when complex medical decisions are involved. If a patient suffers harm due to a lack of proper consent, not only is there potential legal exposure, but it also undermines trust in healthcare institutions. This risk extends to include all healthcare providers, such as NHS hospitals, private healthcare organisations such as HCA and Nuffield Health and regulatory bodies.
THE IMPORTANCE OF PROACTIVE MANAGEMENT
Effective management of the consent process is not only a legal obligation but also a critical component in improving patient safety standards. By ensuring that consent procedures are transparent, well-documented, and appropriately communicated, healthcare providers can significantly reduce clinical risks. Doing so not only helps avoid costly litigation but also fosters better outcomes, thereby enhancing trust in the healthcare system.
Poor consent practices can lead to patients feeling confused or misled about their treatment. If these patients experience complications or poor outcomes, they are more likely to pursue legal action, creating a surge in litigation costs. Proactively managing the consent process with clarity, patient engagement, and thorough documentation protects healthcare providers from these outcomes, while simultaneously promoting patient-centred care.
HOW TMLEP CAN HELP MANAGE CLINICAL RISK
TMLEP offers comprehensive risk management consultancy services that are designed to help healthcare providers navigate complex clinical risk scenarios, such as inadequate consent. Our team of more than 2,600 clinical experts works closely with healthcare institutions to assess and mitigate risks associated with consent practices, ensuring compliance with best practices and legal standards. Our consultancy services begin with a thorough
risk assessment of your consent procedures.
We work alongside your clinical and administrative teams to identify areas of vulnerability and offer practical, evidencebased recommendations. This process is tailored to your specific organisational needs, whether you are managing a private hospital or a large NHS trust. We focus on creating systems that not only protect your organisation, but also enhance patient safety by fostering informed decision-making.
In the unfortunate event that an incident occurs, TMLEP also provides a robust incident response service. Our independent investigation team is equipped to quickly assess the situation, providing impartial, expert-driven reports that clarify what went wrong and how future incidents can be prevented. This process ensures that healthcare organisations can address issues proactively, offering transparency to patients and regulators alike.
TRANSFORMING HEALTHCARE FOR A GREENER TOMORROW
THE PROBLEM
In the healthcare sector, we account for an estimated five per cent of the global total of greenhouse gases (GHGs) responsible for climate change.
The urgency of 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]. This means the sector must intensify its pursuit of new approaches to obtaining energy, goods, and services sustainably [2] and providing safe, high-quality healthcare that does not negatively impact the planet.
Greater global demand for healthcare, driven by increasing and aging populations, could increase the sector’s impact on the climate and make decarbonisation initiatives even more challenging. If nothing changes, it’s predicted that the sector’s carbon emissions could increase by 50% by 2050 [3].
At Bupa we believe we can tackle climate change faster and have a far bigger impact if we collaborate across our sector.
We partnered with The University of Manchester and The Tyndall Centre for Climate Change Research on a report, Transforming Healthcare for a Greener Tomorrow, which encapsulates the critical role the healthcare sector must play in driving global environmental sustainability.
The healthcare sector has always aimed to do no harm. However, as the climate crisis escalates, we must consider how to extend this commitment to our environment, says Dr Robin Clark, medical director for Bupa Global and UK Insurance.
It also provides a comprehensive roadmap for transitioning to lowcarbon operations that uphold patient care standards.
We believe its findings are a call to action for everyone working in healthcare to act on the climate crisis and to make positive changes in how we work. We want to open up the conversation about building sustainability into healthcare, share best practice and work on common challenges together.
OUR METHODOLOGY
Our report is based on a progress review of the healthcare sector’s carbon-reducing actions.
We gathered additional insight through interviews with 16 organisations, including hospital and technology providers, NHS trusts, insurers, industry associations, and sustainability forums.
We also reviewed best practices in five non-healthcare sectors: retail (supermarkets), energy network operators, food and beverages, information and communications technology (ICT), and construction.
WHAT WE FOUND
The healthcare sector’s response to climate change has intensified in the last five years and, despite the impact of Covid-19, it’s catching up with others in its actions to reduce GHG emissions and build resilience to the effects of climate change.
However, the link between climate change and health outcomes means the healthcare sector should be a leading proponent of climate action.
The World Health Organisation (WHO) estimates that between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths every year from malnutrition, malaria, diarrhoea, and heat stress alone [1].
Since 2010, leading companies in sectors such as food and beverage, manufacturing, ICT, financial services, and agriculture have published climate change strategies and reported their carbon emissions.
In the retail sector, a significant number of shoppers prioritise sustainability, a trend that supermarkets have recognised and are addressing.
By comparison, healthcare has been a late adopter. Major providers in Europe, North America, and Australia only produced their first climate change targets or emissions reports in 2020.
This is partly because of how emerging regulatory frameworks, such as the Task Force on Climate-
Related Financial Disclosures (TCFD), affect different sectors. Healthcare has often been exempted from both mandatory and elective environmental standards due to the primary importance of medical care.
So far, the drivers for healthcare organisations working towards climate change targets are mainly driven by internal stakeholders.
WHAT OTHER SECTORS ARE DOING
While target setting and carbon reporting in healthcare is generally less advanced than other sectors, organisations within other sectors are not necessarily much further ahead on climate action.
Leading organisations cannot drive sector-wide climate impact reductions on their own. The retail, energy network, food and beverage, ICT, and construction sectors have organisations that set targets, share detailed carbon disclosures, and are making significant progress on emissions reduction. However, none of these practices are sector-wide. In the UK food and beverage sector, the UK supermarket retailers Sainsbury’s, Waitrose, Co-op, Tesco, and M&S are examples of leading companies that have been engaged in climate change action for more than a decade.
The link between climate change and health outcomes means the healthcare sector should be a leading proponent of climate action.
For energy procurement, strategies are in place to exceed 100% renewable energy tariffs to deliver greater carbon benefits through onsite energy generation and power purchase agreements for Scope 2 emissions. The sector has also long acknowledged the challenge of dealing with Scope 3 supply chain emissions (between 90% and 95% of emissions of the top supermarket retailers).
Carbon footprint labelling is an example of giving customers data to drive more sustainable shopping. Still, its effectiveness has been contested, with studies showing minimal effect on behaviour [4].
NEXT STEPS FOR HEALTHCARE
The healthcare sector could benefit from learning lessons from the supermarkets, and considering how to implement measures that drive similar outcomes to those
the supermarkets were aspiring to.
In our next article, we will explore the opportunities for healthcare providers and the five interventions they can implement to accelerate carbon reductions.
References
[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] 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.
[3] El-Sayed, A. and M. Kamel (2020). “Climatic changes and their role in emergence and re-emergence of diseases.” Environ Sci Pollut Res Int 27(18): 22336-22352.
[4] Lancet Countdown on Health and Climate Change Committee (2023). Healthy and Resilient Cities.
WHAT IS DRIVING THE NHS CLAIMS CULTURE?
Neil Rowe, senior in-house counsel at THEMIS Clinical Defence, examines why there is such a claims culture in the NHS and what is needed to reduce patient claims.
Is there an NHS claims culture or is it just a myth? Published statistics support the view that it is very real, indeed the number of complaints has doubled over a decade. The Parliamentary and Health Service Ombudsman, the highest level to which complaints about the NHS can be directed, received 14,615 formal complaints in 2011/12, which rose to 28,780 complaints by 2023/24.
Insofar as the number of claims is concerned, claims notified to the Clinical Negligence Scheme for Trusts (CNST) fluctuate but have fallen very slightly – from 11,382 in 2014/15 to 10,835 in 2023/24. Fewer claims were made during the Covid pandemic but last year the number of claims did increase by 3%. In any event, complaint and claims numbers are not steadily falling as hoped.
More shocking is that in terms of clinical negligence payments, according to the Health Select Committee, the NHS in England is an outlier paying double the share of total health spending as New Zealand, ten times the level of Australia, and 20 times as much as Canada. In 2023/24, clinical negligence payments increased to £2.9 billion or 1.7% of the entire NHS budget, the estimated “annual cost of harm” stood at £4.7 billion for CNST while its end-of-year provision was nearly £54 billion.
If there was any doubt about the seriousness of the problem, the liability is the largest on the government’s balance sheet save only or pensions and nuclear decommissioning.
will be made. Well-performed incident/complaint investigations and transparent patient communication should nip in the bud any potential for a claim.
THE STATE OF THE NHS
It is impossible to understand why there are so many complaints and claims against the NHS without an appreciation of what is causing adverse incidents. Lord Darzi’s report into the NHS in England in September 2024 opened with the concerning sentence: “the NHS is in serious trouble”.
The picture painted by Lord Darzi was stark and it is perhaps not surprising that while sources vary, there are estimated to be up to approximately two million adverse incidents in the NHS every year.
INCIDENTS AND COMPLAINTS
It is fortunate that nine out of ten patients who suffer an adverse incident don’t eventually claim, but the question remains why it is that the remainder do so.
How the NHS and its patients react to an adverse incident will directly inform whether ultimately a claim
matters. A decade on from inception, many commentators believe that duty of candour is not universally well understood. There is also concern that the introduction of the Patient Safety Incident Response Framework (PSIRF) with a greater degree of local flexibility will potentially lead either to a lack of investigation or to defensiveness.
ACCESS TO JUSTICE
Unfortunately, if a patient remains dissatisfied, they will want to take matters further. Another factor that will inform whether a patient will bring a claim is whether they can easily secure legal representation or are willing to act as a litigant in person. NHS Resolution initiatives such as gateways, website advice pages and litigant in person
A pre-pandemic NHS Resolution study concluded that patients bring claims depending on their basic capability to do so as well as whether they might be prompted to by external factors such as law firm advertising, family/friends, or even NHS staff.
The patient’s own motivation was especially important. While some would always want compensation from the outset they would be fuelled by emotional responses, the desire to avoid recurrence, the need for a (better) apology/explanation, or to ensure the responsible clinicians were held to account. It is the same today; patient representatives such as the charity Action against Medical Accidents (AvMA) reiterate the need above all for sufficient apology and explanation and to ensure lessons are learned for prevention.
There is no doubt that awareness of the complaints process is one factor for the increase in complaints, but if duty of candour is not implemented well then that can exacerbate
protocols make it easier for them to bring claims they otherwise may not do. Changes in funding a decade ago to introduce “no win, no fee” arrangements encouraged a huge spike in claims often brought by nonspecialist lawyers and accusations of “ambulance chasing” advertising. On the other hand, patient groups are now concerned that proposals to introduce fixed recoverable costs in claims worth up to £25,000 will significantly reduce the number of claims specialist solicitors are prepared to make.
REFORM IS REQUIRED
Lord Darzi set out a number of recommendations for the next tenyear plan to repair the NHS and make the most of the extraordinary depth of clinical talent within it.
By way of summary, they were to re-engage staff and re-empower patients, simplify and innovate care delivery for a neighbourhood NHS, drive productivity in hospitals, tilt towards technology, and reform to make the structure deliver. If these are delivered, then the patient experience should improve and adverse incidents reduce.
Significant long-term NHS reform is required to improve the NHS and therefore reduce both the number of adverse incidents and the proportion of claims that inevitably follow. It remains to be seen whether patient lawyers will bring fewer claims or if there will be more litigants in person, but further improvements in patient explanations and reassurances around prevention are key.
REMAIN FUTURE-PROOF WITH A DIVERSIFIED PORTFOLIO
2024 was truly the year of elections. It was forecasted that more voters than ever, across 64 countries, would head to the polls to cast their votes on the future leadership of their nations.
The US Presidential election, as a significant global power and a dominant exposure in investors’ portfolios, naturally gathered a lot of attention. Donald Trump’s victory saw him not only claim the White House but the coveted trifecta –the presidency, plus both chambers of Congress (the House and the Senate). The US president is often considered one of the world’s most powerful figures, wielding substantial influence over the world’s largest economy and one of its most formidable militaries, albeit limited by a system of checks and balances through Congress. Perhaps it is understandable that the media, politicians, celebrities and business owners alike make such a noise during the campaign.
For investors, it is natural at times of political uncertainty to wonder whether they ought to act, perhaps altering their portfolio to position for a specific outcome, or to move money into cash deposits until things ‘settle down’. Some choose to invest this way, mostly at their peril, as very few managers possess the ability to consistently predict such events. A better strategy, as is adopted in prudent portfolios, is to outsource this guesswork to the market itself, relying on the millions of daily participants to come up with their expectations and reflect them in prices. Thankfully, given both democrats and republicans support capitalism and believe in personal freedom and property rights, this strategy is a tried-andtested approach to investing.
Presidents may come and go, yet markets endure. Guy Beck explains why sticking to the investment philosophy is the route to success.
If we look at the global equity market return over the past century or so, we can see that both republican and democratic parties have resided over some fantastic periods, and some not so fantastic ones. However, the ability of capitalism to create wealth despite the ups and downs is evident, with $1 invested in 1926 becoming nearly $10,000 by 2024.
The challenge is that it is not enough to know what the outcome of an election will be, one also needs to know – without the benefit of hindsight – how the market will react once the event occurs. In reality, it is just guesswork. While guessing against randomness is impossible, taking on the known risk that equity returns are far less certain than holding cash rewards investors who ignore this short-term noise and focus on the long-term. The choice of the US President is important to some, but to the longterm investor it is largely irrelevant. An important tool at such times of market activity is diversification – that is, spreading eggs across baskets. Ensuring that diversification is not only achieved across countries but also within them is key.
Different areas of the market perform strongly at different
times – unfortunately there is no way of knowing which will be next, in advance. In the US, the past decade has been dominated by large tech-based stocks. The next decade may be entirely different. Or it may not.
The ‘lost decade’ of 2000-2009 highlights this point well, known as a time where the US stock market delivered little back to investors. It saw the S&P 500 (a stock market index which tracks the performance of the 500 biggest listed companies in the US) deliver a period of negative returns, the Dot-Com Crash of the early 00s, followed by the Global Financial Crisis.
But it was not all doom and gloom. Those driven to omit large US companies from their portfolio on the basis of this poor performance would have missed out on the strong performance that has come to pass. Nobody knows what the future holds. Keeping focused on the long-term, remaining diversified and having consistent exposure within each region continues to be the best line of defence – and provides the best opportunity – for what lies ahead.
The content of this article is for information only and must not be considered as financial advice. Cavendish Medical always recommends that you seek independent financial advice before making any financial decisions. Levels, bases of and reliefs from taxation may be subject to change and their value depends on the individual circumstances of the investor. The value of investments and the income from them can fluctuate and investors may get back less than the amount invested.
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